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@#Objective To analyze risk factors for chronic cough after minimally invasive resection of non-small cell lung cancer (NSCLC) and explore the possible prevention measures. Methods A total of 128 NSCLC patients who received minimally invasive resection in 2018 in our hospital were enrolled, including 63 males and 65 females with an average age of 60.82±9.89 years. The patients were allocated into two groups: a robot-assisted thoracic surgery (RATS) group (56 patients) and a video-assisted thoracic surgery (VATS) group (72 patients). Chronic cough was assessed by visual analogue scale (VAS), meanwhile, other perioperative indicators were compared between the two groups. Univariate and multivariate logistic regression analyses were performed to identify risk factors for postoperative chronic cough and explore the prevention strategies. Results Overall, 61 (47.7%) patients were diagnosed with chronic cough after surgery, including 25 (44.6%) patients in the RATS group and 36 (50.0%) patients in the VATS group, and the difference was not statistically significant (P>0.05). Compared with the VATS group, the RATS group got shorter endotracheal intubation time (P=0.009) and less blood loss (P<0.001). The univariate analysis showed that age (P=0.014), range of surgery (P=0.021), number of dissected lymph nodes (P=0.015), preoperative cough (P=0.006), endotracheal intubation time (P=0.004) were the influencing factors for postoperative chronic cough. The multivariate analysis showed that age <57 years (OR=3.006, 95%CI 1.294-6.986, P=0.011), preoperative cough (OR=3.944, 95%CI 4.548-10.048, P=0.004), endotracheal intubation time ≥172 min (OR=2.316, 95%CI 1.027-5.219, P=0.043), lobectomy (OR=2.651, 95%CI 1.052-6.681, P=0.039) were the independent risk factors for chronic cough. Conclusion There is no statistical difference in postoperative chronic cough between the RATS and VATS groups. The RATS group gets less blood loss and shorter endotracheal intubation time. Patients with younger age (<57 years), preoperative cough, lobectomy, and longer duration of endotracheal intubation (≥172 min) are more likely to have chronic cough after surgery.
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@#Objective To analyze the feasibility of totally no tube (TNT) in da Vinci robotic mediastinal mass surgery and its significance for fast track surgery. Methods A total of 79 patients receiving robotic mediastinal TNT surgery in the General Hospital of Shenyang Military Command from January 2016 to December 2017 were enrolled as a TNT group; 35 patients receiving robotic mediastinal surgery in General Hospital of Shenyang Military Command from January 2014 to December 2017 and 54 patients receiving thoracoscopic mediastinal surgery during the same period were enrolled as a non-TNT group and a video-assisted thoracoscopic surgery (VATS) group. The muscle relaxation and tracheal intubation/laryngeal masking time, operation time, intraoperative blood loss, postoperative ICU stay, postoperative hospital stay, postoperative visual analogue scale (VAS), hospitalization costs and postoperative complications and other related indicators were retrospectively analyzed among the three groups. Results Surgeries were successfully completed in 168 patients with no transfer to thoracotomy, serious complications (postoperative complications in 9 patients) or death during the perioperative period. All patients were discharged. Compared with the non-TNT group, the TNT group had significantly less muscle relaxation-tracheal intubation/laryngeal masking time, operation time, intraoperative blood loss, VAS pain score, ICU stay, postoperative hospital stay (P<0.01); there was no significant difference in the total cost of hospitalization between the two groups (P>0.05). Between the non-TNT group and the VATS group, there was no significant difference in time of muscle relaxation and tracheal intubation, operation time and ICU stay (P>0.05). The non-TNT group was superior to the VATS group in terms of intraoperative blood loss, VAS pain scores on the following day after operation, chest drainage volume 1-3 days postoperatively, postoperative catheterization time and postoperative hospital stay (P<0.05); but the cost of hospitalization in the non-TNT group was significantly higher (P=0.000). Conclusion The da Vinci robot is safe and feasible for the treatment of mediastinal masses. At the same time, TNT is also safe and reliable on the basis of robotic surgery which has many advantages such as better comfort, less pain, ICU stay and hospital stay as well as faster recovery.
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Objective:To compare the surgery indicators of early lung cancer patients between video-assisted thoracoscopic surgery and thoracotomy in order to provide suggestion for surgery scheme.Methods: 126 early lung cancer patients, from March 2014 to January 2016 stayed in our hospital, were chosen as observation object. They were divided in control group (63 cases, thoracotomy) and observation group (63 cases, video-assisted thoracoscopic surgery), and to compare series of surgery indicators, IL-6 and TNF-α between the two groups.Results: The operating time and blood loss of observation group were lower, and the dissected lymph node number of observation group was higher than control group, respectively, and both of the differences were statistical significant (t=6.568,t=3.096, P<0.05;t=3.659,P<0.05); the hospital stay, catheter-retaining time and pain score of observation group were lower than control group, and the differences also were statistical significant (t=15.850,t=12.379,t=10.272;P<0.05); the differences of IL-6 and TNF-α between two groups were no statistical significant before treatment, and both of them reduced after treatment; both of the IL-6 and TNF-αof observation group were lower than control group (t=13.073, t=1.629;P<0.05); on the other hand, the total rate of complications of observation group, such as pneumonia, pulmonary atelectasis and arrhythmia, were higher than control group (x2=0.208, x2=2.800,x2=0.341;P<0.05). Conclusion: Early lung cancer patients are more suitable for video assisted thoracoscopic surgery, and its effect is better and is more conducive to the rehabilitation of patients after surgery.
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Objective To discuss the value of video -assisted thoracoscope technology in diagnosis and treatment of thoracic trauma .Methods Form January 2009 to December 2013, a retrospective analysis was carried out on 43 patients with thoracic trauma .All the patients were treated with video -assisted thoracoscope technology . Results The procedure were successful and all the patients were cured out of hospital .Conclusion It is wide oper-ation indication, little harm, definite treapeutic effect, little complication and fast recovered to treat the patient with thoracic trauma using video -assisted thoracoscope technology , and it is a good choice for diagnosis and treatment in thoracic trauma.
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Objective To explore the application effect and nursing measure of the video- assisted minithoracotomy in thoracic surgery. Methods 249 cases undergoing thoracic surgery were randomly di-vided into the small incision thoracotomy group (146 cases) and the conventional thoracotomy group(103 eases). The small incision thnracotomy group completed thoracic surgery with video-assisted minithoracoto-my. The conventional thoracotomy group used conventional thoracotomy incision. The operation time,blood loss during operation,indwelling time of thoracic duct and hospitalization time were recorded and compared by t test. Results Ssignificant difference existed in operation time, blood loss during operation, in-dwelling time of thoracic duct and hospitalization time between the two groups. Conclusions Video- as-sisted minithoracotomy in thoracic surgery has the advantages of simple operation, wide indications, few complications and short hospitalization time, which is worthy of clinical application.