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Objective:To compare the recovery effect of continuous infusion of dexmedetomidine combined with oxycodone or sufentanil in the anesthesia intensive care unit (AICU) in elderly patients after thoracoscopic radical surgery for lung cancer.Methods:Using the method of prospective study, 80 elderly lung cancer patients underwent selective thoracoscopic radical surgery under general anesthesia in Nanjing First Hospital from February 2021 to May 2022 were selected. The patients were divided into dexmedetomidine combined with sufentanil group (S group) and dexmedetomidine combined with oxycodone group (Q group) by random digits table method with 40 cases each group. On the basis of routine monitoring and treatment after operation, the patients in Q group were continuously injected with oxycodone 0.03 mg/(kg·h) and dexmedetomidine 0.4 μg/(kg·h) through analgesia pump, the patients in S group were continuously injected with sufentanil 0.03 mg/(kg·h) and dexmedetomidine 0.4 μg/(kg·h) through analgesia pump. The wake-up time, extubation time, awakening quality (Aldrete score and bucking score) and comfort level (Bruggrmann comfort scale score, BCS score) after entering the AICU were record; the sedation score (Ramsay score) and pain relief score (numerical rating scale score, NRS score) and hemodynamic changes (mean arterial pressure and heart rate) 3, 5, 7, 10 and 14 h after entering the AICU were record; the level of serum inflammatory factors, including tumor necrosis factor (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP) immediately, 5 h and 14 h after entering the AICU; press times of analgesia pump, adverse events, bleeding volume of drainage tube during AICU and overall satisfaction score when leaving the AICU were record.Results:The bucking score in Q group was significantly lower than that in S group: (1.02 ± 0.77) scores vs. (1.88 ± 0.34) scores, the Aldrete score and BCS score were significantly higher than those in S group: (8.93 ± 0.25) scores vs. (5.97 ± 0.32) scores and (3.03 ± 0.32) scores vs. (0.93 ± 0.52) scores, and there were statistical differences ( P<0.01); there were no statistical difference in wake-up time and extubation time between two groups ( P>0.05). There were no statistical difference Ramassy score, NRS score 3 and 5 h after entering the AICU, mean arterial pressure and heart rate between two groups ( P>0.05); the Ramassy score 7, 10 and 14 h after entering the AICU in Q group was significantly lower than that in S group, the NRS score, mean arterial pressure and heart rate were significantly lower than those in S group, and there were statistical differences ( P<0.01). There were no statistical differences in TNF-α, IL-6 and CRP immediately after entering the AICU between two groups ( P>0.05); the TNF-α, IL-6 and CRP 5 and 14 h after entering the AICU in Q group were significantly lower than those in S group, and there were statistical difference ( P<0.01). The press times of analgesia pump, bleeding volume of drainage tube and the incidences of nausea vomiting, respiratory depression, lethargy, restlessness, fever and lung infection in Q group were significantly lower than those in S group: (4.63 ± 1.10) times vs. (18.80 ± 1.54) times, (129.67 ± 4.14) ml vs. (164.00 ± 8.14) ml, 10.0% (4/40) vs. 52.5% (21/40), 2.5% (1/40) vs. 25.0% (10/40), 7.5% (3/40) vs. 47.5% (19/40), 0 vs. 20.0% (8/40), 2.5% (1/40) vs. 22.5% (9/40) and 2.5% (1/40) vs. 20.0% (8/40), and there were statistical differences ( P<0.01 or <0.05); there was no severe hypotension, severe bradycardia and delirium in both groups. The overall satisfaction score in Q group was significantly higher than that in S group: (3.53 ± 0.63) scores vs. (2.70 ± 0.65) scores, and there was statistical difference ( P<0.01). Conclusions:Continuous micro-pump infusion of dexmedetomidine combined with oxycodone in AICU elderly patients with lung cancer after thoracoscopic radical surgery can significantly improve the quality of recovery and comfort during extubation, without affecting the extubation time, and can effectively reduce the degree of pain, stress and inflammatory reaction in the early recovery period, and reduce the incidence of adverse events after surgery.
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Objective:To explore the preventive value of "integrated prevention strategy" for nipple and areola ischemia after single-port endoscopic subcutaneous mastectomy.Methods:The clinical data of 72 patients with breast cancer who received single-port endoscopic subcutaneous mastectomy in Beijing Friendship Hospital, Capital Medical University from July 2019 to July 2021 were retrospectively analyzed, they were all female. The follow-up period was up to July 2022. According to the perioperative treatment methods, the patients were divided into observation group ( n=40) and control group ( n=32). The patients in the observation group who adopted the "integrated prevention strategy" scheme, and patients in the control group who adopted the conventional treatment scheme. The incidence of postoperative nipple and areola ischemic was compared between the two groups, and the postoperative cosmetic effect, quality of life and satisfaction of patients were evaluated. Measurement data were expressed as mean ± standard deviation ( ± s), and t-test was used for comparison between groups; the Chi-square test was used to compare the data groups. Results:The postoperative drainage volume in the observation group was significantly lower than that in the control group [(632.40±226.37) mL vs (774.91±239.85) mL], and the difference was statistically significant ( P=0.013). Two weeks after operation, there was 1 case of nipple and areola ischemia in the observation group, and 7 cases in the control group, the difference was statistically significant between the two groups ( P=0.019). Twelve months after operation, the score of breast satisfaction (83.93±11.64 vs 67.28±11.52), chest satisfaction (89.63±8.06 vs 83.03±9.49) and psychosocial well-being (89.43±12.42 vs 78.88±10.40) in the observation group were better than those in the control group, the differences were statistically significant ( P<0.05). Conclusion:"Integrated prevention strategy" can effectively prevent the occurrence of nipple and areola ischemic after single-port endoscopic subcutaneous mastectomy and improve patient satisfaction, which has certain promotion value.
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Endoscopic breast surgery has become more and more popular, and prepectoral prosthetic breast reconstruction is also becoming more and more widely used. The combination of endoscopic surgery and prepectoral prosthetic breast reconstruction has produced a good complementary effect and promoted their respective development. This paper describes the characteristics of endoscopic breast surgery and prepectoral prosthetic breast reconstruction, analyzing the current status of the combination of these two technologies, and looks forward to the application of endoscopic prepectoral prosthetic breast reconstruction
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Objective:To explore the effect of perioperative aspirin administration on intraoperative and postoperative bleeding in patients undergoing video-assisted thoracoscopic (VATS) pulmonary wedge resection.Methods:Sixty-three patients scheduled for VATS pulmonary wedge resection in Shougang Hospital of Peking University from November 2020 to April 2022 were randomly assigned in 2 groups. All patients had a history of aspirin taking, patients in study group ( n=32) continued aspirin taking perioperatively, and patients in the control group ( n=31) stopped taking aspirin for 7 days before surgery and resumed taking 3 days after surgery. The volume of intraoperative blood lost, operation time, postoperative drainage volume, thoracic drainage tube placement time, postoperative hospital stay, postoperative thrombosis of lower extremity, perioperative cardiovascular and cerebrovascular events, and postoperative wound healing were documented and compared between the two groups. Results:There were no significant differences in age, gender, oral aspirin time, lesion location, lesion nature, localization, lesion size and underlying disease between the two groups (all P>0.05). All patients successfully completed the operation, and no patients switched to thoracotomy. The intraoperative blood loss in study group and control group was (27.72±12.86) ml and (31.35±13.81) ml ( t=1.08, P=0.283); the operation time was (61.16±10.24) minutes and (61.39±13.79) minutes, respectively ( t=0.08, P=0.940). There were no significant differences in postoperative thoracic drainage, drainage tube placement time, length of hospital stay, incidence of lower extremity thrombosis, incidence of cardiovascular and cerebrovascular events, and rate of poor wound healing between the two groups (all P>0.05). Conclusion:Perioperative administration of aspirin may not increase intraoperative and postoperative bleeding, and the incidence of operation-related complications in patients undergoing VATS pulmonary wedge resection.
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Objective:To explore the practical value of general anesthesia with non-intubated spontaneous breathing in uniportal thoracoscopic surgery in elderly patients.Methods:Clinical data of 86 elderly patients undergone uniportal thoracoscopy surgery during hospitalization at our hospital between March 2020 and December 2021 were retrospectively reviewed and analyzed.Based on the anesthesia intubation method, they were divided into a non-intubated spontaneous breathing video-assisted thoracic surgery group(NI-VATS group)and a one-lung ventilation video-assisted thoracic surgery group(OLV-VATS group), with 43 cases in each group.Data were compared on the inflammatory indexes, preparation time for anesthesia, time to awakening after anesthesia, intraoperative lung collapse score, mediastinal flutter score, time to postoperative feeding, digestive tract complications, sore throat, postoperative pulmonary atelectasis, and hospitalization time.Results:Compared with the OLV-VATS group, the NI-VATS group had a shorter anesthesia preparation time [(19.8±2.6)min vs.(32.3±4.5)min, t=-15.77, P<0.001]and a shorter time to awakening [(6.8±2.1)min vs.(11.9±2.9)min, t=-9.485, P<0.001], slightly poorer operating field during surgery, an unfavorable lung collapse score [(2.5±0.7) vs.(1.8±0.7) t=4.704, P<0.001], worse mediastinal flutter [(2.1±0.6) vs.(1.3±0.5), t=6.514, P<0.001]. Lower procalcitonin(PCT)[(0.189±0.130)μg/L vs.(0.264±0.123)μg/L, t=-2.744, P=0.007), a shorter time to postoperative feeding [(3.4±1.0)h vs.(5.5±1.0)h, t=-9.55, P<0.001], and lower rates of digestive tract reactions(4.7% vs.20.9%, χ2=5.108, P=0.024)and throat pain(4.7% vs.23.3%, χ2=6.198, P=0.013), and a shorter length of hospital stay [(3.8±0.3)d vs.(4.9±0.8)d, t=-7.266, P<0.001]. Conclusions:For the elderly patients undergoing uniportal thoracoscopic surgery, non-intubated spontaneous breathing may somewhat obstruct the operating field, but it can shorten the time of anesthesia and the time to awakening, does not increase complications from anesthesia and surgery, favors rapid postoperative recovery for patients and therefore should be promoted.
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Objective:To investigate the effects of one-lung ventilation with a laryngeal mask airway combined with a bronchial blocker on respiratory function in older adult patients undergoing thoracoscopic surgery.Methods:Sixty older adult patients who underwent thoracoscopic surgery in Zhejiang Veteran Hospital from January 2019 to December 2020 were included in this study. They were randomly divided into a single group (a simple bronchial blocker) and a combined group (a bronchial blocker combined with a laryngeal mask airway), with 30 patients in each group. Awakening (time to extubation, spontaneous respiration and eye opening), respiratory function [peripheral oxygen saturation, vital capacity, maximum voluntary ventilation measured before and 3 days after surgery], hemodynamics [heart rate and mean arterial pressure were recorded before (T 1) and immediately after placement of a bronchial blocker or a laryngeal mask (T 2) and at the time of removal of a bronchial block or a laryngeal mask (T 3)], and adverse events (hoarseness, throat pain, dysphagia and choking) were recorded. Results:Time to extubation, time to spontaneous respiration, and time to eye opening in the combined group were (5.62 ± 1.23) minutes, (6.85 ± 1.34) minutes, and (7.34 ± 1.52) minutes, respectively, which were significantly shorter than (8.62 ± 1.55) minutes, (10.25 ± 1.78) minutes, (11.38 ± 1.85) minutes in the single group ( t = 9.94, 10.00, 11.06, all P < 0.05). At 3 days after surgery, peripheral oxygen saturation, vital capacity, and maximum voluntary ventilation in the combined group were (98.23 ± 1.05)%, (2.18 ± 0.60) L, (54.23 ± 5.36) L, respectively, which were significantly higher than (96.23 ± 1.01)%, (1.82 ± 0.50) L, (48.12 ± 4.23) L in the single group ( t = 7.51, 2.52, 4.90, all P < 0.05). Mean arterial pressure measured at T 3 was significantly lower in the combined group than that in the single group [(98.25 ± 2.32) mmHg vs. (93.35 ± 2.48) mmHg, t = 7.90, P < 0.05]. The incidences of hoarseness, throat pain and choking in the combined group were 6.66% (2/30), 10.00% (3/30), 6.66% (2/30), respectively , which were significantly lower than 33.33% (10/30), 43.33% (13/30), 43.33% (13/30) in the single group (χ 2 = 6.66, 8.52, 10.75, all P < 0.05). There was no significant difference in the incidence of dysphagia between the two groups ( P > 0.05). Conclusion:Use of a laryngeal mask airway combined with a bronchial blocker during thoracoscopic surgery in older adult patients facilitates postoperative recovery, has little impact on hemodynamics, and is highly safe.
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Objective:To investigate the predictive value of 18F-FDG PET-CT in the conversion from thoracoscopic lobectomy to thoracotomy for non-small cell lung cancer (NSCLC). Methods:The clinical data, CT and PET-CT images of 193 patients with primary NSCLC undergoing thoracoscopic surgery from January 2014 to June 2021 at China-Japan Friendship Hospital were retrospectively analyzed. All patients were divided into 45 cases who were converted to thoracotomy (the conversional group) and 148 cases who were not converted to thoracotomy (the non-conversional group). Univariate analysis was performed on clinicopathological characteristics and image parameters. Multivariate logistic regression was used to analyze the factors affecting the conversion to thoracotomy. Taking the final conversion to thoracotomy or not as the gold standard, the predictive effect of variables in the conversion to thoracotomy was analyzed through the receiver operating characteristic (ROC) curve. Delong test was used to compare the area under the curve (AUC) predicted by all variables.Results:In the conversional group, the proportion of peribronchial lymph node (PLN), peribronchial cuffs of soft (PCS), pleural calcification, pulmonary nodule calcification, PLN or PCS calcification or increased density on chest CT was higher than that in the non-conversional group (all P<0.05); and the maximum standardized uptake value (SUV max) of PET in the conversional group was higher compared with that in the non-conversional group ( P<0.001). Univariate logistic regression analysis suggested age ( OR = 4.663,95% CI 2.191- 9.923, P < 0.001) and PLN or PCS density of chest CT scan ( OR = 2.824, 95% CI 1.791-7.303, P < 0.001) were independent influencing factors of the conversion from thoracoscopic lobectomy to thoracotomy. ROC analysis showed that the effect of the conversion to thoracotomy predicted by the combination of 18F-FDG PET and chest CT [AUC = 0.891 (95% CI 0.831-0.951); the optimal cut-off value of SUV max and CT was 3.45, 70 Hu: the sensitivity was 84.4%, the specificity was 83.8%] was better than that by chest CT alone [AUC = 0.678 (95% CI 0.591-0.766); the optimal cut-off value of CT was 70 Hu: the sensitivity was 62.2%, the specificity was 62.8%; P < 0.001] and by age [AUC = 0.625 (95% CI 0.532-0.719); the optimal cut-off value was 65.5 years: the sensitivity was 75.6%, the specificity was 60.1%; P < 0.001]. Conclusions:PLN or PCS density on chest scan and age are valuable in predicting the conversion from thoracoscopic lobectomy to thoracotomy for NSCLC patients. The combination of PET and CT has an additional role in predicting the conversion to thoracotomy during thoracoscopic lobectomy.
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Objective:To evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on emergence agitation in the patients undergoing thoracoscopic surgery.Methods:Eighty patients of both sexes, aged 25-64 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, undergoing elective thoracoscopic surgery under general anesthesia, were divided into 2 groups ( n=40 each) by a random number table method: TEAS group (group T) and control group (group C). In group T, the Hegu (L14), Zusanli (ST36) and Sanyinjiao (SP6) were stimulated starting from 30 min before induction of anesthesia until the end of operation, with a frequency of 2/100 Hz and disperse-dense waves.The intensity of stimulation was the maximum current that patients could tolerate.In group C, stimulating electrodes were placed at the same acupoints before induction, but no electrical stimulation was applied.Ramsay sedation score and VAS score were recorded.and emergence agitation was assessed using RSS agitation score.Blood samples from the median cubital vein or internal jugular vein were collected before anesthesia induction (T 1), at the end of surgery (T 2), immediately after removal of tracheal tube (T 3) and at 15 min after removal of tracheal tube (T 4) for determination of serum interleukin-6 (IL-6) and IL-10 concentrations by enzyme-linked immunosorbent assay.The intraoperative consumption of propofol, remifentanil and sufentanil was recorded.Adverse reactions such as tachycardia, bradycardia, hypertension, hypotension, respiratory depression, delay of awakening and nausea and vomiting were recorded after operation. Results:Compared with group C, the amount of intraoperative remifentanil consumed was significantly decreased, serum IL-6 concentrations were decreased, and the serum IL-10 concentration was increased T 2-4, Ramsay sedate score was increased, and the incidence of agitation was decreased in group T ( P<0.05). There was no significant difference in VAS score and incidence of postoperative adverse reactions between the two groups ( P>0.05). Conclusions:TEAS can reduce the development of emergence agitation in the patients undergoing thoracoscopic surgery, which is related to inhibition of inflammatory responses.
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Objective:To analyze the preliminary effects of subxiphoid video-assisted thoracoscopic extended thymectomy.Methods:We retrospectively analyzed the clinical data of six patients who underwent subxiphoid video-assisted thoracoscopic extended thymectomy in Peking University International Hospital from August 2018 to June 2020.Results:All six patients underwent successful subxiphoid video-assisted thoracoscopic extended thymectomy without conversion to thoracotomy. The rate of R0 resection was 100%. Operative time was (175.50 ± 67.78) minutes, intraoperative blood loss was (40.83 ± 31.37) mL, and postoperative drainage time was (7.17 ± 3.55) days. The total amount of postoperative drainage was (1781.67 ± 1293.53) mL. Postoperative hospital stay was (10.67 ± 6.35) days. The length of hospital stay was (19.67 ± 5.65) days. The Visual Analog Scale score measured after surgery was (2.12 ± 0.48) points. Three patients had grade 1 complications, with an incidence of complications of 50.00%. Grade 3-5 compilations did not occur in any patient. No patient died during the perioperative period.Conclusion:Subxiphoid video-assisted thoracoscopic extended thymectomy is safe and effective and provides a good visual field. The surgical method allows bilateral thoracic surgery, reduces surgical trauma, and has a broad application prospect.
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Objective:To analyze the effect of dexmedetomidine combined with thoracic paravertebral block (TPVB) on sleep quality, serum interleukin-6 (IL-6) and high mobility group protein (HMGB-1) levels in patients undergoing thoracoscopic pulmonary surgery.Methods:The clinical data of 90 patients who received thoracoscopic pulmonary surgery from January 2020 to January 2021 in Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed. Among them, 45 patients were given dexmedetomidine combined with TPVB before operation (experiment group), and 45 patients were given TPVB before operation (control group). The indexes of sleep quality were recorded, including Pittsburgh sleep quality index (PSQI) and total sleep time 24 and 48 h after operation. The visual analogue score (VAS) during quiet and cough 1, 6, 12, 24 and 48 h after operation were recorded. The serum substance P (SP), 5-hydroxytryptamine (5-HT), C-reactive protein (CRP), IL-6 and HMGB-1 before operation and 1 d after operation were detected. The adverse reactions were compared between 2 groups.Results:The PSQI 24 and 48 h after operation in experiment group was significantly lower than that in control group: (11.38±4.61) scores vs. (13.65±2.72) scores and (8.78±3.79) scores vs. (10.95±2.81) scores, the total sleep time was significantly longer than that in control group: (7.71±2.64) h vs. (5.49±2.10) h and (9.75±3.14) h vs. (7.82±2.67) h, and there were statistical differences ( P<0.01). The VAS during quiet and cough 1, 6 and 12 h after operation in experiment group was significantly lower than that in control group, and there was statistical difference ( P<0.01); there was no statistical difference in the VAS during quiet and cough 24 and 48 h after operation between 2 groups ( P>0.05). There were no statistical differences in serum SP, 5-HT, CRP, IL-6 and HMGB-1 before operation between 2 groups ( P>0.05); the SP, 5-HT, CRP, IL-6 and HMGB-1 1 d after operation in experiment group were significantly lower than those in control group: (132.59±10.34) ng/L vs. (141.57±12.26) ng/L, (0.73±0.11) μmol/L vs. (0.95±0.09) μmol/L, (32.46±3.54) mg/L vs. (38.53±4.12) mg/L, (145.67±24.68) ng/L vs. (162.79±23.51) ng/L and (70.35±6.81) ng/L vs. (92.36±7.08) ng/L, and there were statistical differences ( P<0.01). The incidence of adverse reactions in experiment group was significantly lower than that in control group: 20.00% (9/45) vs. 48.89% (22/45), and there was statistical difference ( χ2 = 8.32, P = 0.004). Conclusions:Dexmedetomidine combined with TPVB can effectively improve postoperative sleep quality of patients undergoing thoracoscopic pulmonary surgery, relieve pain, and reduce postoperative serum pain mediators and inflammatory factors, with fewer adverse reactions.
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Objective:To proceed a comparative study of characteristics and safety of video-assisted thoracoscopic thymectomy between artificial pneumothorax combining subxiphoid-costal margin approach versus right thoracic cavity approach.Methods:From January 2018 to December 2021, 251 patients(including myasthenia gravis with thymic hyperplasia or thymoma, thymic cysts and anterior mediastinal occupying lesions)undergoing thoracoscopic extended thymectomy in our department were retrospectively studied, and their clinical data were collected.The surgical methods were divided into artificial pneumothorax combining xiphoid costal margin approach(artificial pneumothorax group, n=165)and via right thoracic approach(right thoracic group, n=86). Clinical data such as preoperative information, operative duration, blood loss, postoperative drainage, drainage duration, and surgical complication were compared between two groups.Results:There were no statistical differences in age, gender and pathology between two groups(all P>0.05). Compared with the right thoracic group, operative duration[(108.6±45.2)min vs.(127.6±42.1)min, t=-3.628, P=0.000], intraoperative blood loss[(37.9±131.7)ml vs.(107.4±284.8)ml, t=-8.215, P=0.000], postoperative drainage volume[(379.0±285.5)ml vs.(646.6±373.3 ml), t=-6.277, P=0.000]and drainage duration[(2.2±1.0)d vs.(3.1±1.0)d, t=-7.275, P=0.000]were statistically significantly decreased in the artificial pneumothorax group.No significant difference was found(all P>0.05)in phrenic nerve injury(1/165 vs.0/86, P=1.000), myasthenia crisis(3/89 vs.2/66, χ2=0.014, P=0.906), and the conversion to thoracotomy(3/165 vs.2/86, P=1.000). Conclusions:VATS thymectomy by artificial pneumothorax combining subxiphoid-costal margin approach is a safer method, having a less trauma, less bleeding and less incidence rate of complication.Especially, it is more suitable for elderly female patients who cannot be intubated in double lumen, cannot tolerate one-lung ventilation, and have pulmonary insufficiency.
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Objective:To investigate the surgical method and clinical application value of single-port inflatable endoscopic prepectoralis prosthesis implantation for breast reconstruction (external prosthesis wrapping Off-Label).Methods:From September 2021 to February 2022, 7 breast cancer patients who underwent single-port inflatable endoscopic prepectoralis prosthesis implantation breast reconstruction (Off-Label) in Beijing Friendship Hospital, Capital Medical University were retrospectively analyzed. Statistical analysis of surgical complications, postoperative movement deformities, postoperative chest wall pain, postoperative quality of life and satisfaction scores of patients were conducted.Results:All 7 patients successfully completed the operation. There were no complications such as postoperative bleeding, infection, ischemic necrosis of nipple-areola complex or skin flap, postoperative movement deformity, postoperative chest wall pain, capsular contracture, prosthesis exposure or removal. The BREAST-Q scale was used to evaluate the quality of life and satisfaction after breast reconstruction. Postoperative breast satisfaction (55-100 points), chest wall status (52-89 points), and social psychological status (62-100 points) can be compared High rating.Conclusion:The single-port inflatable endoscopic prepectoral prosthesis implantation breast reconstruction (Off-Label) can achieve better radical effect and cosmetic effect through a shorter operation time, and the postoperative quality of life and satisfaction of patients are higher.
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Objective:To retrospectively analyze the efficacy of video-assisted thoracoscopic surgery (VATS) in the treatment of solitary pulmonary nodule (SPN) and related factors affecting the diagnosis of benign and malignant SPN.Methods:The clinical data and surgical conditions of 317 patients with SPN who were resected by VATS and diagnosed by pathology in Chaoyang Central Hospital from January 2017 to December 2019 were retrospectively analyzed.The patient′s surgical efficacy and corresponding imaging features were explored.Results:Of the 317 patients, 124 (39.1%) cases underwent uniportal VATS and 193(60.9%) cases underwent multi-portal-portal VATS, 195(61.5%) cases had lobectomy, 16(5.1%) cases had anatomical segmentectomy, and 106(33.4%) cases had wedge resection. The operation time of the whole group was 50 - 210 (146.5 ± 34.7) min, intraoperative blood loss was 10 - 180 (69.3 ± 31.5) ml, thoracic drainage tube retention time was 2 - 7 (3.7 ± 1.4) d, postoperative hospital stay was 3 - 21 (6.4 ± 1.8) d, and the complication rate was 1.0%(3/317). No perioperative death occurred. Among all the nodules, 98(31.0%) cases were benign nodules and 219(69.1%) cases were malignant. Multivariate analysis showed that maximum nodule diameter, lobulated sign, burr sign, vascular bundle sign and pleural sag sign were independent related factors for the diagnosis of benign and malignant nodules ( P<0.05). Conclusions:VATS has less trauma and fewer complications, which has important clinical value for the diagnosis and treatment of benign and malignant SPN. Nodule maximum diameter, lobulated sign, burr sign, vascular bundle sign, pleural pit sign are independent related factors that affect the diagnosis of benign and malignant SPN.
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Objective To investigate the effect of the amputation order of pulmonary artery and pulmonary artery on pulmonary residual blood volume in total thoracoscopic lobectomy.Methods Sixtyeight patients who were scheduled to underwent total thoracoscopic lobectomy from June 2015 to April 2019 in Beijing Aerospace General Hospital were selected.The patients were divided into first amputation pulmonary artery group and first amputation pulmonary vein group by random envelope method with 34 cases in each group.Five cases in first amputation pulmonary artery group and 4 cases in first amputation pulmonary vein group were excluded because of the procedure modification or the fragmentation of the specimen during the course of operation.In the end,29 cases were enrolled in first amputation pulmonary artery group and 30 cases in first amputation pulmonary vein group.In first amputation pulmonary vein group,all arteries were ligated before interruption of the veins;and in first amputation pulmonary artery group had a reverse sequence.The perioperative period status were recorded,and the crude pulmonary quality,dry pulmonary quality,pulmonary residual blood volume and adjusted pulmonary residual blood ratio were measured or calculated.Results All 59 patients were operated successfully.No serious complications occurred,no perioperative death occurred,and no patients needed blood transfusion.There was no statistical difference in the incidence of minor complications between first amputation pulmonary artery group and first amputation pulmonary vein group:27.6％ (8/29) vs.33.3％ (10/30),P＞0.05.There were no statistical differences in operative time,transoperative bleeding volume,pulmonary residual blood volume,crude pulmonary quality,dry pulmonary quality,adjusted pulmonary residual blood ratio,hemoglobin difference before and after surgery,postoperative drainage time and postoperative hospitalization time between 2 groups (P＞0.05).Conclusions The amputation order of pulmonary artery and pulmonary vein sequence of vessel interruption during total thoracoscopic lobectomy has no effect on the pulmonary residual blood volume,can be reasonably selected according to the intraoperative situation.
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Objective: To observe the value of CT-guided accurate localization of small pulmonary nodule with memory alloy coils before video-assisted thoracoscopic surgery (VATS). Methods: Totally 92 patients (102 small pulmonary nodules) underwent localization of small pulmonary nodules with memory alloy coils before VATS were enrolled. VATS was performed within 24 h after localization. The localization effect and complications were observed. Results: The success rate of localization of 102 small pulmonary nodules was 98.04% (100/102), and the operation time of localization for each lesion ranged 8 min to 45 min, with the average time of (17.26±5.92)min. The memory alloy coils of 2 patients took off from lung tissue and remained in the chest wall in VATS. After localization, the incidence of small amount of pneumothorax was 10.78% (11/102), of small amount alveolar hemorrhage was 12.75% (13/102), whereas the patients had no symptom and untreated. VATS was successfully performed for 102 small pulmonary nodules without conversion to thoracotomy. Conclusion: CT-guided accurate localization of small pulmonary nodule with memory alloy coils before VATS is effective and safe.
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Objective: To observe the value of CT-guided localization of small pulmonary nodule with new pulmonary nodule locating needle before thoracoscopic surgery. Methods: Totally 50 patients with 53 small pulmonary nodules (diameter 5.0-15.0 mm) were retrospectively analyzed. All patients underwent video-assisted thoracoscopic surgery (VATS) after CT-guided localization. The positioning effect and complications were observed. Results: The anchor positioning needle was successfully implanted in 53 lesions of 50 patients, and the positioning success rate was 100% (53/53). During the puncture process, minor bleeding occurred near puncture needle passage in 9 cases (9/50, 18.00%), while mild pneumothorax and pleural reaction were noticed during the localization operation in 14 cases (14/50, 28.00%) and 1 case (1/50, 2.00%), respectively. VATS was performed on the day of positioning in 8 cases and on the next day of positioning in 42 cases. All 53 nodules were successfully found and removed according to the guidance of positioning needle. Conclusion: CT-guided localization of small pulmonary nodule with new pulmonary nodule locating needle before VATS was effective and safe.
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Objective: To observe the complications and impact factors of microcoil locating of pulmonary nodules before video-assisted thoracoscopic resection (VATS). Methods: A retrospective analysis was performed on 160 patients with pulmonary nodules (160 nodules) who underwent CT guided microcoil location of pulmonary nodules before VATS. Postoperative complications were counted, and the impact factors of relative complications of microcoil location were analyzed. Results: Nodules were successfully located in all 160 cases. Pneumothorax and pulmonary hemorrhage were found in 26 and 37 cases, respectively, while no air embolism occurred. All patients underwent VATS on the next day, and no microcoil displacement was found during operation. Univariate analysis showed that the patient's position (P=0.04), the distance from nodule to pleura (P=0.03) and the times of puncture (P<0.01) were related to pneumothorax, while the distance from nodule to pleura (P=0.03) was related to pulmonary hemorrhage. Multivariate analysis showed that the patient's position, the distance from nodule to pleura and the times of puncture were all independent risk factors for pneumothorax (all P<0.05), and the distance from nodule to pleura was the independent risk factor for pulmonary hemorrhage after locating of microcoil (P=0.01). Conclusion: Pneumothorax and pulmonary hemorrhage might occur after microcoil location of lung nodules before VATS. Pneumothorax related to the distance from nodule to pleura, patient's position and the times of puncture, while pulmonary hemorrhage only related to the distance from nodule to pleura.
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Objective@#To explore the efficacy of thoracoscopic bronchial sleeve lobectomy for central non-small cell lung cancer (NSCLC), and to evaluate the safety of this operation.@*Methods@#The clinical data of 29 patients who underwent thoracoscopic bronchial sleeve lobectomy at Shanxi Provincial Cancer Hospital from May 2015 to September 2018 were retrospectively analyzed, and the surgical effect and safety were analyzed.@*Results@#Twenty-nine cases underwent thoracoscopic bronchial sleeve lobectomy. The types of resection included 13 cases of right upper, 10 cases of left upper, and 6 cases of left lower sleeve lobectomy. The operation time was 180-400 min, and the median time was 240 min. The bronchial anastomosis time was 35-60 min, and the median time was 48 min. The intraoperative blood loss was 150-460 ml, and the median blood loss was 220 ml. The number of lymph node dissection was 12-39 lymph nodes per patient, with a median of 19.6 lymph nodes per patient. The thoracic drainage tube was placed for 4-16 days after operation, with a median of 6 days; the postoperative hospital stay was 6-16 days, with a median of 9 days. The postoperative complication rate was 24.1% (7/29), including 1 case with pulmonary air leakage (> 7 days), 2 cases with pulmonary infections, 3 cases with arrhythmia, and 1 patient discharged from the hospital on the 7th day after surgery, but died of anastomotic fistula bleeding on the 40th day. The rest of the patients recovered smoothly after surgery. The median follow-up time was 6 months (3-12 months). No tumor recurrence or anastomotic stenosis was observed.@*Conclusion@#Thoracoscopic bronchial sleeve lobectomy is a safe and feasible surgical treatment for central NSCLC.
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Objective:To explore the clinical application value of CT-guided methylene blue staining and/or Hookwire localization of pulmonary ground-glass nodule (GGN) before video-assisted thoracoscopic surgery (VATS). Methods: Totally 141 patients with 160 GGN underwent VATS after CT-guided methylene blue staining and/or Hookwire implantation for localization of nodules. The success rate of localization, puncture complications and success rate of surgery were calculated. Results: All GGN were successfully located and resected. Among 160 nodules, 18 were located with stained with methylene blue, 12 with Hookwire implantation, while 130 nodules were located with combination of two methods, and the success rates of methylene blue staining, Hookwire implantation and combination of these two methods were all 100%. Small amount of pulmonary hemorrhage and pneumothorax were observed in 25 and 38 cases respectively during puncture, including 13 cases with both pulmonary hemorrhage and pneumothorax. Postoperative pathology showed that 117 nodules were malignant and 43 were benign nodules. Conclusion: CT-guided methylene blue staining and/or Hookwire implantation before VATS can accurately locate GGN, reduce puncture complications and improve the success rate of resection.
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Objective To evaluate the effect of thoracic paravertebral nerve block (TPVB) at different time points on postoperative long-term quality of life in the patients undergoing thoracoscopic radical resection of lung cancer.Methods One hundred and fifty patients of both sexes,aged 25-64 yr,with body mass index of 18-24 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective radical resection of lung cancer,were divided into 3 groups (n =50 each) by a random number table method:preoperative TPVB group (P1 group),TPVB at the end of operation group (P2group) and preoperative TPVB combined with TPVB at the end of operation group (P3 group).In group P1,TPVB was performed at T4,6 points on the affected side under ultrasound guidance before anesthesia induction,and 0.5％ ropivacaine 10 ml was injected in total.In group P2,TPVB was performed at T4,6 points on the affected side under ultrasound guidance at the end of operation,and 0.5％ ropivacaine 10 ml was injected in total.In group P3,TPVB was performed at T4,6 points on the affected side under ultrasound guidance before anesthesia induction and at the end of operation,and 0.5％ ropivacaine 10 ml was injected each time.The analgesia pump was connected at the end of operation in three groups.The patients were followed up after operation,and 5 ml solution extracted from the analgesic pump was intravenously injected when VAS score was greater than or equal to 4.The occurrence of postoperative chronic pain in the 3 groups was recorded though telephone follow-up at 6 and 12 months after surgery,and the effect of pain on daily life and treatment measures were scored.A concise health-related quality of life scale was used to evaluate patients' quality of life,and the physical and mental health scores were calculated.Results There was no significant difference in the incidence of chronic pain at 6 and 12 months after surgery among the three groups (P＞0.05).The physical and mental health scores were significantly decreased at 12 months after surgery than at 6 months after surgery in the three groups (P＜0.05).Compared with P1 and P2 groups,the scores of effect of pain on daily life and treatment measures were significantly decreased,and the physical and mental health scores were increased at 12 months after surgery in group P3 (P＜0.05).Conclusion The combination of preoperative TPVB and TPVB at the end of operation can effectively improve postoperative long-term quality of life in the patients undergoing thoracoscopic radical resection of lung cancer.