Analysis on minimally invasive diagnosis and treatment of 49 cases with solitary nodular ground-glass opacity.

OBJECTIVE: This study is designed to investigate the treatment approach and prognosis of pulmonary ground-glass-like shadow, especially solitary nodular ground-glass opacity (SNGGO). METHODS: Forty-nine cases of SNGGO that persisted after anti-inflammatory treatment in our hospital were retrospectively studied. These patients received thoracoscopic surgery due to indefinitive diagnosis and a tendency of canceration (some cases were followed up for 1-24 months before surgery). Intraoperative rapid frozen section was performed for pathological diagnosis, and surgery method was chosen according to pathological results and the health status of the patients. RESULTS: Forty-three cases showed malignancy, among which 36 cases received thoracoscopic total resection of the lung cancer and seven received simple wedge resection or pulmonary segment resection due to poor lung function; two cases were atypical adenomatous hyperplasia (AAH) and received wedge resection; and four cases were benign and received lesion resection only. Intraoperative frozen section results were in line with postoperative pathological analysis. No lymph node metastasis was detected in any malignant cases as indicated by lymph node dissection or sampling. All malignant cases were staged Ia by postoperative pathological analysis. Neither recurrence nor metastasis occurred during the 1-30 months' follow-up. CONCLUSIONS: SNGGO that persists after anti-inflammatory treatment tend to be adenocarcinoma, which can hardly be diagnosed in the early stage through non-invasive examination. If there's no contraindication for surgery, video-assisted thoracoscopy (VATS)-guided resection of the lesion plus intraoperative rapid frozen section should be performed to synchronize diagnosis and treatment, which could achieve satisfactory prognosis.

[Muscle-sparing thoracotomy in chest surgery].

OBJECTIVE: To review the clinical experience of muscle-sparing thoracotomy in intrathoracic surgery. METHODS: Thoracotomy was performed in 386 patients from 1998 to 2002, during the procedure lateral-transverse incision, free dissection of muscular flap and entering to the thoracic cavity through certain intercostal space were applied. Two sets of rib retractors were used to ensure the excellent field exposure. RESULTS: Intrathoracic surgery was carried out by this method with the advantage of excellent surgical field exposure, less pain and relative quick recovery. CONCLUSION: Muscle-sparing thoracotomy has the merits of less injury and the same good exposure as routine thoracotomy and it can be carried out in majority of chest surgery.

Application of mechanical dilatation of the pyloric sphincter in esophagectomy for esophageal carcinoma.

The objective of this study was to investigate the effectiveness of additional intraoperative mechanical dilatation of the pyloric sphincter in order to prevent early postoperative gastric retention after esophagectomy using the stomach as substitute for esophageal carcinoma patients. Between October 2001 and May 2002, 32 consecutive esophageal carcinoma patients were treated with esophagectomy combined with additional intraoperative mechanical dilatation of pyloric sphincter (trial group). Another 30 patients underwent esophagectomy without additional intraoperative mechanical dilatation of the pyloric sphincter (control group). Both groups were compared in the following aspects: amount of postoperative GI drainage, time of flatus, intrathoracic gastric fluid retention and other surgical related complications. The amount of GI drainage in the trial group was significantly less than that in the control group (p < 0.05), and time of anal exsufflation was 1 to 2 days. X-ray demonstrated only 0 to 25% of intrathoracic gastric fluid retention and no related complications such as anastomotic leakage, so the patients in the trial group suffered less gastric reflux. Additional intraoperative mechanical dilatation of the pyloric sphincter in radical esophagectomy can accelerate gastric emptying, the recovery of gastric-intestinal function and obviously decrease the occurrence of early postoperative gastric retention and related complications. This method does have the advantages of ease of performance, confirmed effectiveness and safety. It can be utilized in radical esophagectomy through any approach of thoracotomy.