Risk factors for postoperative chylothorax after robot-assisted versus video-assisted thoracic surgery in radical lung cancer resection: A propensity score matching study / 中国胸心血管外科临床杂志

@#Objective    To compare the postoperative chylothorax outcomes of robot-assisted thoracic surgery (RATS) and video-assisted thoracoscopic surgery (VATS), analyze the risk factors for postoperative chylothorax after minimally invasive radical lung cancer resection and explore possible prevention and control measures. Methods    Between June 2012 and September 2020, 1 083 patients underwent minimally invasive pulmonary lobectomy and systematic lymph node dissection in our hospital, including 578 males and 505 females with an average age of 60.6±9.4 years. Patients were divided into two groups according to the operation methods: a RATS group (499 patients) and a VATS group (584 patients). After propensity score matching, 434 patients were included in each group (868 patients in total). Chylothorax and other perioperative indicators were compared between the two groups. Univariate and multivariate logistic regression analyses were performed to identify risk factors for postoperative chylothorax. Results    Overall, 24 patients were diagnosed with chylothorax after surgery. Compared with the VATS group, the rate of chylothorax was higher (3.9% vs. 1.6%, P=0.038), the groups and numbers of dissected lymph nodes were more (both P<0.001), and the intraoperative blood loss was significantly less (P<0.001) in the RATS group. There was no statistical difference in the postoperative hospital stay (P=0.256) or chest tube drainage time (P=0.504) between the two groups. Univariate analysis showed that gender (P=0.021), operation approach (P=0.045), smoking (P=0.001) and the groups of dissected lymph nodes (P<0.001) were significantly associated with the development of chylothorax. Multivariate analysis showed that smoking [OR=4.344, 95%CI (1.149, 16.417), P=0.030] and the groups of dissected lymph nodes [OR=1.680, 95%CI (1.221, 2.311), P=0.001] were the independent risk factors for postoperative chylothorax. Conclusion    Compared with the VATS, the rate of chylothorax after RATS is higher with more dissected lymph nodes and less blood loss. The incidence of chylothorax after minimally invasive radical lung cancer resection is higher in the patients with increased dissected lymph node groups and smoking history.

Effect of complete lung cancer resection on the balance of Th17/Treg in the peripheral blood of patients / 实用肿瘤学杂志

Objective The aim of this study was to investigate the effect of complete lung cancer resection on the balance of Th17/Treg cells in the peripheral blood of lung cancer patients. Methods Flow cytometry was used to detect the percentage of Th17 and Treg cells in the peripheral blood of 21 patients with lung cancer before and after operation and 21 healthy controls. RT-PCR was used to detect the expression of fork-head/winged helix transcription factor( Foxp3) and retinoic acid-related orphan receptor γt ( RORγt)in PBMC. The plasma levels of interleukin(IL) -17 and transforming growth factor(TGF) -β1 were detected by enzyme-linked immunosorbent assay(ELISA). Results After surgery,the percentage of Th17 cells in the peripheral blood decreased and the percentage of Treg cells increased in patients when compared to the pre -operation ( P <0. 01). After surgery,the expression of RORγt was decreased and the expression of Foxp3 was increased in the CD4 +T cells of patients in comparison with the pre-opera-tion(P<0. 01). After surgery,the expression of IL-17 was decreased and the expression of TGF-β1 was increased in the plasma of patients in comparison with the pre -operation( P <0. 01). In addition,the percentage of Th17 and Treg cells,the expression of RORγt and Foxp3,and the expression of IL-17 and TGF-β in the peripheral blood were increased in preoperative lung cancer pa-tients when compared to healthy controls. Conclusion There is a Th17/Treg imbalance in the peripheral blood of lung cancer pa-tients after complete resection of lung cancer.

Research of rapid rehabilitation group in the perioperative nursing of thoracoscopic lung cancer resection / 中国实用护理杂志

Objective@#To analyze retrospectively the effect of rapid rehabilitation group in the perioperative nursing of patients undergoing thoracoscopic lung cancer resection.@*Methods@#Patients receiving the operations of thoracoscopic lung cancer resection from January to December 2017 were enrolled as the rapid recovery group. Patients receiving the same operations from January to December 2016 were chosen as the routine nursing group. The perioperative care of the rapid recovery group was undertaken by the rapid rehabilitation group. The perioperative care of the routine nursing group was performed according to the routine nursing procedure. As the rapid recovery group, more emphasis was placed on the ensuring of physical comfort, active functional exercise, personalized pain relief and psychological care on the basis of the routine nursing measures. The hospitalization days, Visual Analogue Scale (VAS) scores, and the scales of the satisfaction were compared between the two groups.@*Results@#The hospitalization day and VAS score of the rapid recovery group was (8.7 ± 2.3) days, (3.3 ± 1.2) points, and the routine nursing group was (10.3 ± 2.5) days, (4.5 ± 3.1) points. There were significant differences between the two groups (t =3.38, 2.67, all P <0.01). The patients′ scales of the satisfaction in the rapid recovery group was (99.5 ± 1.4) points, and the routine nursing group was (99.1 ± 1.6) points. There was no significant difference between the two groups (P>0.05).@*Conclusions@#The perioperative nursing involved by the rapid rehabilitation group of the thoracoscopic lung cancer resection can shorten the hospitalization day and receive ideal pain control, which are conducive to faster recovery.

Research of PQRS in evaluating the quality of postoperative recovery in the patients with lung cancer / 中国康复医学杂志

Objective:To research the quality of postoperative recovery of patients with lung cancer through the(PQRS),and compare the recovery quality after video-assisted thoracoscopic surgery (VATS) or traditional open lobectomy.Method:PQRS scale was used to evaluate the recovery of 140 patients with lung lesions preoperatively and postoperative 1 day,3 days,7 days,14 days and 1 month.95 patients who met the set standard and complete the PQRS scales were enrolled and divided into video-assisted thoracoscope group or traditional thoracotomy group.This article mainly compared and analysied the quality of postoperative recovery of patients in both groups.Result:Except the anesthesia time,other general datum showed no statistical difference.In total recovery rate,the video-assisted thoracoscope group has significant difference when compared with the traditional thoracotomy group(P ＜ 0.05).The recovery rates of VATS group in feeling of the harmful factors,emotional factors and the daily life are higher than that of the traditional thoracotomy group,with statistically significant differences(P ＜0.05).However,the recovery rates in the physiological factors and cognitive factors had no statistical difference between two groups(P＞ 0.05).Conclusion:PQRS can effectively evaluate the quality of postoperative recovery in patients with lung cancer,and VATS is helpful to quick recovery postoperatively.