Percutaneous transcatheter closure of atrial septal defect guided by transthoracic echocardiography in outpatients / 中国胸心血管外科临床杂志

@#Objective    To assess the feasibility and safety of percutaneous transcatheter closure of atrial septal defect (ASD) guided by transthoracic echocardiography (TTE) in outpatients. Methods    From December 2016 to June 2018, 50 simple ASD patients underwent TTE-guided transcatheter closure in the outpatient operating room of our hospital (a TTE group) including 22 males and 28 females at the age of 16-48 (27.40±6.95) years. Fifty patients with simple ASD treated with the guidance of conventional fluoroscopy during the same period were treated as a control group, including 22 males and 28 females at the age of 15-48 (28.58±6.96) years. Both groups were re-examined by TTE during follow-up at 1 month, 3 months, 6 months and 1 year. Results    The mean age, body weight, the size of ASD and occluder and success rate had no statistical difference between the two groups (P>0.05). Compared with the control group, the TTE group had significantly lower mean operation time (P<0.01) and less cost (P<0.01) since patients need not to be hospitalized. No related complications were found in the TTE group during follow-up. Conclusion    Percutaneous transcatheter closure of ASD guided by TTE appears safe and effective for outpatients, and can significantly reduce the cost.

Comparison of the effect of endoscopic surgery and routine cervical approach in the treatment of benign thyroid tumors / 中国现代普通外科进展

Objective:To compare the therapeutic effects of endoscopic surgery and routine neck surgery on benign thyroid tumors.Methods:From August 2014 to August 2016,240 patients with benign thyroid tumor were treated by operation in Zoucheng people's hospital,according to the random number method,they were divided into the observation group and the control group,120 cases in each group.According tothepatient's willingness to choose the choice of operation,the control group was performed the routine thyroid operation on the neck approach,and the observation group underwent endoscopic thyroidectomy through the breast approach.The two groups of surgical indexes,postoperative complications,and thyroid related hormone levels before and after the operation were compared.Results:The operation time of the observation group was significantly longer than that of the control group,but the amount of bleeding and the time of hospitalization in the operation were significantly shorter than those in the control group,the difference was statistically significant (P＜0.05).The incidence of cervical sensory decline,dysphagia and pain in the observation group was significantly lower than that in the control group,and the total incidence of complications was also lower than that in the control group(P＜0.05).The levels of FT3,T4 and TSH after the operation in the two groups were significantly lower than those before the operation,while the level of FT4 was significantly higher than that before the operation (P＜0.05).There was no significant difference in the levels of FT3,FT4,T4 and TSH after the operation between the two groups before and after the operation (P＜0.05).Conclusion:Endoscopic surgery for the treatment of thyroid benign tumors is better,less traumatic,and more beautiful.

Abordaje transtorácico para la hidatidosis pulmonar derecha y hepática concomitante / Transthoracic approach for concurrent right lung and liver hydatid cysts

Introduction: Pulmonary and hepatic hydatid disease occurs concomitantly in 4 to 33 percent of cases. When the condition is localized in the right lung and liver dome surgical resolution in one time is possible. Objective: To describe the transthoracic-transfrenic approach and review the available literature. Material and Methods: We report two cases operated at our institution through a right posterolateral thoracotomy and frenotomy in one stage, with uneventful postoperative evolution. A systematic review of the literature was conducted in the PubMed database period 1990-2011. Five studies met the inclusion criteria. Conclusions: Transthoracic-transfrenic approach is feasible and safe, allowing the surgical resolution in one time through a single incision, without another anesthetic procedure or subsequent laparotomy, with low morbidity and mortality.

Introducción: La hidatidosis pulmonar y hepática concomitante se presenta en el 4 a 33 porciento de los casos. Cuando la afección está localizada en el pulmón derecho y el domo hepático la resolución quirúrgica en un tiempo es posible. Objetivo: Describir el abordaje transtorácico-transfrénico y revisar la literatura disponible. Material y Métodos: Se presentan dos casos clínicos resueltos quirúrgicamente en nuestro centro a través de toracotomía posterolateral derecha y frenotomía en un tiempo, con evolución satisfactoria sin complicaciones. Se realizó una revisión sistemática de la literatura en la base de datos PubMed, período 1990-2011. Cinco estudios cumplieron los criterios de inclusión. Conclusiones: El abordaje transtorácico-transfrénico es factible y seguro, permitiendo la resolución en un tiempo quirúrgico a través de una sola incisión, sin necesidad de otro evento anestésico ni de una laparotomía posterior, con baja morbilidad y mortalidad.

Mini-Transthoracic Supradiaphragmatic Approach to the Thoracolumbar Junction

Anterior reconstruction with instrumentation of the thoracolumbar junction (TLJ) offers: 1) the biomechanical advantage of immediate restoration of the load-bearing anterior column and 2) the ideal biological milieu for an optimal arthrodesis. The authors describe the mini-transthoracic supradiaphragmatic (MTTS) approach to the TLJ. Its technical feasibility is compared with that of the traditional transdiaphragmatic and thoracoscopic supradiaphragmatic approaches to this area of the spine. This technique was performed in 21 patients from 2004 to 2006. There were no surgical mortalities. The MTTS approach without the use of a thoracoscope was successfully employed in this study to treat patients with various lesions located at the TLJ. The diaphragmatic opening, even at its smallest diameter, provides excellent views of the operative field and avoids the significant morbidities associated with the traditional transdiaphragmatic approach.

Treatment of Upper Thoracic Disc Herniation Using Transthoracic Approach without Division of Latissimus Dorsi: Technical Note / 대한척추외과학회지

Thoracic disc herniation is a rare condition in which a posterior approach, extrapleural approach, posterolateral approach, or transthoracic approach is currently used. The posterior approach is not recommended in thoracic disc herniation surgery because of the risk of spinal cord injury. The transthoracic approach makes it possible to remove the intervertebral disc and is considered a standard method. However, due to an extensive transverse skin incision, division of the latissimus dorsi muscles, and rib resection, the conventional open approaches involve a risk of complications, such as infection and post-thoracotomy pain syndrome; and a long period of rehabilitation and recovery is required. Excision of the intervertebral disc under thoracoscopic guidance can reduce the damage to the skin and muscles, but the equipment and surgical materials are expensive and a long learning curve is required. Therefore, we report a case and a new muscle splitting transthoracic approach that can be performed by incising 10 cm of skin longitudinally and preserving the serratus anterior and latissimus dorsi muscles.

Traumatic Intervertebral Disc Herniation Associated with Subluxation at the T1-T2 Level: Case Report

The authors report a case of traumatic first thoracic disc herniation associated with subluxation due to vehicle accidents in a 28-year-old woman. Magnetic resonance images revealed a fracture of the first thoracic vertebral body, posterior dislocation of T1 on T2 and a herniated intervertebral disc at T1-T2 disc space. The patient underwent excision of the protruded and migrated disc, partial corpectomy of T1 and T2 body and bone graft of the resected rib through transthoracic transpleural thoracotomy. The postoperative course was excellent. The paraparesis and paresthesia were fully recovered.

Comparison of Endoscopic-assisted, Transthoracic Endoscopic, and Conventional Techniques for Thyroidectomy / 中国微创外科杂志

Objective To compare the degree of trauma, postoperative pain, and cosmetic outcomes of endoscopic-assisted thyroidectomy (EAT), transthoracic endoscopic thyroidectomy (TET), and conventional thyroidectomy (CT), and to explore the characteristics of EAT and TET. Methods Forty-five patients with thyroid nodules were divided into three groups (n=15 in each) to underwent EAT, TET, or CT. The plasma levels of C-reactive protein(CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-?), and T-lymphocyte subgroups (CD3, CD4+, CD8+, and CD4+/CD8+) were determined before and 24 and 72 hours after the operations. The degree of operative trauma was compared after the operation. Postoperative pain and cosmetic outcomes were evaluated by visual analogue score (VAS) and 5-degree evaluation respectively. Results The VAS in the EAT group was 2.2?1.7 and 1.1?1.1 on the first and third day postoperation, which were significantly lower than those in the TET group (3.6?1.4 and 2.2?0.7, respectively; q=3.698, P0.05).Compared to preoperation, the level of CD4+/CD8+ lymphocyte in the CT group was decreased at 24 hours after the operation (q=4.076, P0.05). The levels of CRP determined at 24 and 72 hours postoperation were both significantly higher than that before the operation in the three groups (EAT group: m=21, P