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@#Objective To investigate the optimal treatment scheme for the first primary spontaneous pneumothorax (PSP) in young patients. Methods The clinical data of 171 patients with the first PSP were retrospectively analyzed who were treated in Huaihe Hospital of Henan University between November 2011 and October 2017. There were 157 males and 14 females with a median age of 18 years at onset and a median body mass index of 18.51 kg/m2. According to the treatment methods, they were classified into two groups, a conservative treatment group (a non-surgical group, n=86) and a surgical group (n=85). The characteristics including clinical data, efficacy evaluation criteria, complications and recurrence of the two groups were analyzed. Results As a result, 73.68% of the patients suffered PSP in their daily routine. The drainage duration in the non-surgical group was longer than that in the surgical group (4 d vs. 3 d, P=0.008). There was no statistical difference in the success rate of lung re-expansion between the two groups (98.85% vs. 100.00%, P=1.000). The proportion of the surgical group using postoperative analgesic drugs was higher than that in the non-surgical group (48.23% vs. 10.46%, P=0.000). The recurrence rate of the surgical group was lower than that of the non-surgical group (3.53% vs. 46.51%, P=0.000). No relationship between smoking and recurrence of pneumothorax was found in both groups (P=0.301, P=1.000). The success rate of lung re-expansion in the non-surgical group was not statistically different between the 24F subgroup and the 12F subgroup (39/39 vs. 33/34, P=0.458). No advantage of intraoperative pleural fixation was found in the surgical group (P=0.693). Conclusion Thoracoscopic surgery is the first choice for the treatment of the first PSP in young patients.
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Objective To investigate the two kinds if thoracic cavity closed drainage contrast analysis and evaluate the pigtail catheter for treatment of spontaneous pneumothorax in adolescents.Methods This study included 53 adolescent patients with the first spontaneous pneumothorax in Huaihe Hospital of Henan University between January 2013 and December 2015.According to the different operation ways,they were divided into two groups:silicone tube and pigtail catheter group.The following post-operative data was evaluated:pain,subcutaneous emphysema,drainage time,hospital stay,new drain insertion,and wound healing at the site of insertion.Results There were 32 patients in the silicone tube group and 21 ones in the other group.The data revealed a significantly reduced the operation time and pain in the pigtail catheter group compared to the chest tube group(P ＜ 0.05).However,no statistical differences in success rate,postoperative hospital stay and complications incidence were found between the 2 groups.Conclusion Compared to common chest tube,the employment of pigtail catheter in the adolescent patients with pneumothorax significantly reduces the operation time and pain.Nevertheless,no statistically significant differences were discovered in success rate,postoperative hospital stay and the incidence of complications between the two corresponding groups.Thus pigtail catheter is competent in terms of closed thoracic drainage in adolescents who are the first diagnosed as spontaneous pneumothorax.
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Objective To compare short-term clinical effect according to the extent of lymphadenectomy.To identify the rational lymph node dissection in patients with esophageal squamous cell carcinoma(ESCC).Methods Between January 2010 and December 2013,160 patients with ESCC received video-assisted laparothoracoscopy esophagectomy plus three-field lymphadenectomy(3FL) (86 cases)or two-field lymphadenectomy(2FL) (74 cases).Retrospectively analyzed the lymph node metastasis, postoperative complications and short-term survival rates between 3FL and 2FL.Results There was significantly differences in the number of lymph node between 3 FL(28.60 ± 3.30) and 2 FL(14.54 ± 5.59) (P ＜ 0.05) , but no significantly differences in postoperative complications between 3FL(22.09％) and 2FL(14.86％) (P ＞ 0.05).There was significantly differences in half-year survival rates between 3FL(93.02％) and 2FL(83.78％) (P ＜ 0.05).Conclusion Three field lymph oode dissection can reduce local recurrence, improve survival rate of some patients with ESCC.We suggest that esophagectomy plus three-field lymphadenectomy should be conventional.
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BACKGROUND:Some scholars believe that for primary spontaneous pneumothorax thoracoscopic surgery and intraoperative pleurodesis can effectively reduce the recurrence rate. ＜br> OBJECTIVE:To study the reliability and validity of video-assisted thoracoscopic entoiodine pleurodesis for treatment of primary spontaneous pneumothorax. ＜br> METHODS:Videothoracoscopy procedures were performed on 64 patients with primary spontaneous pneumothorax, including 46 males and 18 females, with an age ranging from 15 to 30 years. According to the use of pleurodesis, the patients were randomly divided into two groups:experimental group and control group. In the control group, no entoiodine was used;while in the experimental group, entoiodine dipped gauze was used on the visceral pleura. The operation time, intraoperative bleeding, postoperative drainage, postoperative leakage time, postoperative extubation time, postoperative complications and the recurrence rate of pneumothorax within 1 year after operation were compared between two groups. ＜br> RESULTS AND CONCLUSION:No significance was found in the operation time, intraoperative bleeding, postoperative leakage time, postoperative extubation time and postoperative complications between the two groups (P>0.05). Although the experimental group had significantly more postoperative drainage volume than the control group (P＜0.05), there were no consequences of medical intervention. Video-assisted thoracoscopic entoiodine pleurodesis could significantly reduce the recurrence rate of pneumothorax in 1 year after operation (P＜0.05). The results show that video-assisted thoracoscopic operation with entoiodine is a reliable and effective method to reduce the recurrence of pneumothorax after operation in patients with primary spontaneous pneumothorax.
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BACKGROUND:Although thoracoscopy with pleurodesis is regarded as a positive and effective way for the treatment of malignant pleural effusion, the merit and demerit of sclerosants are directly related to postoperative recovery and the success of pleurodesis. OBJECTIVE:To evaluate the therapeutic effect of talc pleurodesisvia thoracoscopy in the treatment of refractory malignant pleural effusions METHODS:There were 14 male and 15 female patients in this study, age ranging from 38 to 79 years. Al patients with refractory malignant pleural effusion underwent talc pleurodesis under thoracoscopy. The postoperative adverse reactions, chest CT scan 1 month after operation and the fluid drainage were observed. RESULTS AND CONCLUSION:Twenty-nine patients with chest pain were observed in this study. Eighteen patients could relieve the pain itself without medications, eight patients required oral Tramadol and three patients took Demerol or morphine oraly to ease the pain. Fever occurred in three cases at 3 days after operation. Neither pneumonedema, acute respiratory failure, nor death ocurred postoperatively. One month later, complete successful pleurodesis was achieved in 24 cases, and partial successful in 3 cases, and unsuccessful in 2 cases. The results indicate that thoracoscopy with talc pleurodesis can be regarded as a positive and effective way for the treatment of malignant pleural effusion.
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ObjectiveTo investigate the efficacy of transurethral resection and ball pouch dilatation for treatment of ureterostenosis.MethodsThe clinical data of 49 cases of ureteral stricture were analyzed retrospective analysis from June 2008 to June 2011 with 20 cases of male patients and 29 cases of female patients.The age was 15 to 56 years,with a mean age of 40 years.Ipsilateral renal function were mild impairment in 4 cases,moderate impairment in 35 cases,and severe damage in 10 cases.There were ureteropelvic junction etenosis in 11 cases,upper ureteral stricture in 13 cases,and lower segment stenosis in 25 cases.The ureteral stricture length was 0.3 to 2.0 cm,with a mean of 1.2 cm.Seventeen patients were treated with transurethral resection and ball pouch dilatation by minimally invasive percutaneous nephrostomy,and 31 cases were completed by ureteroscopy.The ureteral stents were removed by ureteroscope after 3 - 6 months.45 cases were followed up for 12 -43 months,with a mean of 24 months. ResultsForty-eight cases were completed smoothly with 1 case converted to open surgery.The surgical time was 25 to 95 min with a mean of 42 min.The postoperative hospital stay was 2 to 6 d with a mean of 4 d.In the follow-up of 45 cases,B ultrasound and CT scan showed hydronephrosis reduced significantly in 39 patients,IVU showed unobstructed ureter without significant stenosis.And 6 cases showed no significant changes in hydronephrosis. Conc(t)usionThe method of transurethral resection and ball pouch dilatation has good clinical effect,less pain and shorter hospital stays,which provides a new and effective treatment for patients with ureteral stricture.
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Objective To investigate the efficacy of retroperitoneal laparoscopic heminephroureterectomy for duplex kidney anomalies.Methods Retroperitoneoscopic heminephroureterectomy was performed on nine patients, six males and three females.The average age of the study group was 37 years ( range 13 to 58).Seven cases had anomalies on the upper kidney pole, two cases had anomalies on the lower kidney pole.Five anomalies were on the left side, two were on the right side and two were in bilateral sides (one special case had three ureters on the left side and two ureters on the right side ).Three cases complained of flank pain; two cases were found hydronephrosis by physical routine examination;Three cases complained of flank pain and fever; one cases complained of hematuria and kidney atones.All the cases were preoperatively diagnosed by color doppler ultrasound, MRU, IVP or CTU.Retroperitoneal laparoscopic heminephroureterectomy was performed on all patients.The operation time, blood loss, hospital stay, intraoperative and postoperative complications and efficacy were observed.Results All the retroperitoneal laparoscopic procedures were successfully completed.No intraoperative complications were found.The average operation time was 87 min (range, 65 to 125).The average blood loss was 112 ml (range, 30 to 600).The recovery times of intestinal function was 1.6 days ( range, 1 to 3 ).The average postoperative hospital stay was 7 days (range, 5 to 12).The syndrome disappeared and kidney function was normal at a mean followup of 18 monthes.Conclusions Retroperitoneal laparoscopic surgeries for duplex kidney has the benefits of being minimally invasive, fewer complications, quick recovery and certainty of efficacy.Retroperitoneal laparoscopic surgeries can be considered as a first operation method to treat duplex kidney anomalies.
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Objective To explore the clinical utility of fluorescence in situ hybridization (FISH) urine test as a non-invasive method for diagnosing the upper urinary tract urothelial carcinoma (UUTUC).Methods Urine specimens from 30 consecutive patients with UUTUC were analyzed by means of FISH and cytology.Ultrasonic and CT were also used to analyze urine specimens from the study group.Urine specimens from 30 patients with other diseases were also analyzed by means of FISH and cytology in order to compare the specificity.Results The sensitivities of FISH,cytology,CT and ultrasonic were 87％,37％,90％ and 43％.The specificity of FISH and cytology were 97％ and 93％.The sensitivity between FISH and MMCT were compared and they were not statistically significantly superior to ultrasonic and cytology.FISH and cytology were compared and no specific statistical significance was found.The positive and negative predictive value for FISH was 96％ and 88％.For cytology it was 85％ and 60％.Conclusions FISH analysis is a useful ancillary test in the detection of UT-TCC with excellent sensitivity and specificity.It provides a more reliable and less invasive approach to diagnosis and postoperative follow-up for UT-TCC.