ObjectiveTo systematically review the postoperative recovery of lung function in patients with early stage non-small cell lung cancer (NSCLC) after different operation, such as lobectomy versus segmentectomy and video-assisted thoracoscopic surgery (VATS) versus traditional open chest surgery.MethodsClinical studies about effect of different surgical methods on lung function in patients with early NSCLC were searched from PubMed, EMbase, The Cochrane Library, CBM and CNKI databases from inception to October 1st, 2016. Two researchers independently screened literature, extracted data and evaluated the risk of bias of included studies, and then meta-analysis was conducted by RevMan 5.3 and MetaAnalyst software.ResultsA total of 25 studies involving 2 924 patients were included. The results of meta-analysis showed that: compared with lobectomy group, one-second rate difference (ΔFEV1%) (MD=–0.03, 95%CI –0.03 to –0.03, P<0.001) and predictive value of forced vital capacity difference (ΔFVC%) (MD=–0.09, 95%CI –0.11 to –0.06, P<0.001) of preoperative to postoperative in segmentectomy group were higher. However, there was no significant difference between two groups in first second forced expiratory volume difference (ΔFEV1) (MD=0.01, 95%CI –0.10 to 0.11, P=0.92). Compared with thoracotomy group, VATS group had lower ΔFEV1 (MD=–0.19, 95%CI –0.27 to –0.10, P<0.0001), ΔFVC (MD=–0.20, 95%CI –0.37 to –0.03, P=0.02), ΔFEV1% (MD=–0.03, 95%CI –0.06 to –0.01, P<0.001) of preoperative to postoperative (≤3 months), and maximum minute ventilation (ΔMVV) (MD=–5.59, 95%CI –10.38 to –1.52, P=0.008) of preoperative to postoperative (≥6 months). However, there were no statistically significant differences in difference of carbon monoxide diffusion rate (ΔDLCO%) (MD=–0.04, 95%CI –0.09 to 0.02, P=0.16), ΔFEV1% (MD=–0.02, 95%CI –0.06 to 0.02, P=0.32) and ΔFEV1 (MD=1.13, 95%CI –0.92 to 3.18, P=0.28).ConclusionThe protective effect of segmentectomy on postoperative pulmonary function is better than that of lobectomy. VATS has a protective effect on the ventilation function within 3 months and 6 months after surgery. Due to limited quantity and quality of included studies, the above conclusions are needed to be validated by more high quality studies.
ObjectiveBy establishing a set of evaluation system for thoracoscopic clinical function and applicability, to evaluate and compare the advantages and disadvantages of different brands of thoracoscopes, and to provide some suggestions for the innovation and upgrade of thoracoscopes, especially for the domestic thoracoscopes.MethodsThe project coordination team initially formulated the evaluation index system for the clinical function and applicability of thoracoscope by querying literature and brainstorming. The Delphi expert consultation method was used to distribute questionnaires to the selected experts. Experts provided scores which were based on the importance of each indicator, and clarified the basis of their judgment and the familiarity with the evaluation indicators. After two rounds of screening by Delphi method, a thoracoscopic clinical function and applicability satisfactory questionnaire was formed. The appropriate sample for pre-investigation was selected, and the reliability and validity were tested. The index composition was adjusted based on the results of the test to form a final evaluation scale.ResultsThe project coordination team initially formulated 24 thoracoscope-related evaluation indicators. After two rounds of experts consultation, the item "brightness adjustment" was deleted without any additional entries. The positive coefficients of the experts in the first round and the second round were 100.0% and 80.0%, respectively. The two rounds of authoritative coefficients were 0.86 and 0.90, and the coordination coefficients were 0.272 (P<0.001) and 0.523 (P<0.001), respectively. A total of 140 questionnaires were issued in this pre-investigation. The recovery rate was 100.0% and the effective rate was 90.0%. The Cronbach's α value of the scale was 0.936, and the Spearman-Brown split-half reliability coefficient was 0.972. The factor analysis finally extracted 3 common factors. The total variance of the cumulative interpretation was 70.9%. The three common factors were named "operation related", "image related" and "device related".ConclusionThe evaluation index system developed in this study has good reliability and validity, and can be used as a tool to evaluate the clinical function and applicability of thoracoscopes.
ObjectiveTo evaluate the impact of video-assisted thoracoscopic surgery (VATS) esophagectomy and routine operation on the short-term quality of life in patients with esophageal cancer. MethodsFrom January 2012 through January 2014, 157 esophageal cancer patients were classified into a VATS group (n=42) and a routine operation group (n=115) in our hospital. All patients in the two groups completed the Chinese versions of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ)-C30 and QLQ-OES18 at one, six and 12 months after operation separately. ResultsAt the end of 6, 12 months after operation, the evaluation on global health status was higher in the VATS group(68.8±12.3 vs. 62.7±13.7, P<0.05; 76.2±10.4 vs. 68.6±8.8, P<0.05). At the end of 1, 6, 12 months after operation, the scores of symptom pain were less significantly in the VATS group than those in the routine operation group (P<0.05). One month after operation, the score of active ability in the VATS group was higher (P<0.05). At the end of 6, 12 months after operation, the score of emotional function and social role in the VATS group was higher (P<0.05). At the end of 12 months after operation, the score of role function and cognitive function in the VATS group was also higher (P<0.05). ConclusionVATS is of better effect on improving short-term quality of life of esophageal cancer patients compared with routine operation.
ObjectiveTo summarize the clinical experience of thoracoscopic and laparoscopic esophagectomy for esophageal carcinoma. MethodWe retrospectively analyzed the clinical data of 38 patients with esophageal carcinoma undergoing thoracoscopic and laparoscopic esophagectomy in Central Hospital of Chongqing Three Gorges between March 2011 and March 2013. There were 25 males and 13 females aged 64.25±7.68 years (ranged 45-79 years). The esophagus was freed and the lymph nodes were cleaned under the thoracoscope in the left lateral position. Then the stomach was freed under laparoscope and lifted up to anastomose with the esophagus through the passageway behind the sternal bone. ResultsAll surgical process progressed successfully without intraoperative death or major hemorrhage. The total operating time ranged from 250 to 340 minutes. The intraoperative hemorrhage ranged from 80 to 350 ml. The number of lymph nodes cleaned ranged from 7 to 15 (10.24±2.04) and a total of 8 patients were found of tumor metastasis. Postoperative stage grading indicated 8 patients of T1N0M0, 16 patients of T2N0M0, 5 patients of T2N1M0, 6 patients of T3N0M0 and 3 patients of T3N1M0. Postoperative complications included chylothorax in 1 patient, pulmonary infection in 4 patients, and cervical anastomotic leakage in 4 patients. All 38 patients were followed up for 3 to 12 (6.31±2.18) months, and 1 patient was lost. Two patients died from cervical anastomotic leakage resulting in chest infection. The other all achieved recoveries without metastatic or recurrence of tumor. ConclusionThe intraoperative and postoperative complications of thoracoscopic and laparoscopic esophagectomy for esophageal carcinoma are less frequently than traditional surgery, so it's worthy of promotion in large regional general hospitals.
ObjectiveTo introduce a new type thoracic vest designed according to the incision characteristics of female patients undergoing totally thoracoscopic cardiac surgery.MethodsSixty-one female patients undergoing totally thoracoscopic cardiac surgery from February 2019 to May 2020 in our department were enrolled. All female patients had hypermastia and (or) mastoptosis which covered the incision. They were randomly divided into a research group (group A, n=32) and a control group (group B, n=29). The group A used the new type thoracic vest, while the group B used the traditional single shoulder belt. The degree of satisfaction, visual analogue scale (VAS) score 24 hours after the thoracic drainage tube removed, the average time-consuming of dressing change, dressing frequency and the incision infection rate were compared between two groups.ResultsThe degree of satisfaction in the group A was higher than that of the group B (P<0.001). The VAS scores of pain, average time-consuming of dressing change and dressing frequency in the group A were less or lower than those of the group B (P<0.001). There was no statistical difference in the incision infection rate between the two groups (P=0.214), but incision infection rate of the group A was lower than that of the group B.ConclusionThe new type thoracic vest seems to be more beneficial for patients than traditional single shoulder belt. It is easy to use, increases the psychological satisfaction of patients, reduces the pain and the incision infection and improves work efficiency, which is worthy of clinical application.
ObjectiveTo discuss the possibility and safety of video-assisted thoracoscope surgery for pulmonary aspergilloma. MethodsWe retrospectively analyzed the clinical data of 39 patients with pulmonary aspergilloma in Beijing Chaoyang Hospital between June 2009 and May 2014. The patients were divided into two groups according to their operation method including a conventional thoracotomy surgery group (open group, n=11) and a video-assisted thoracoscope pneumonectomy group (VATS group, n=28). There were 8 male patients and 3 female patients with age of 29-64 (50.7±9.7) years in the open group. There were 13 male patients and 15 female patients with age of 20-75 (55.4±15.3) years in the VATS group. We compared clinical effectiveness between the two groups. ResultsThe operations of all patients were performed successfully. There were statistical differences between the two groups in the average length of operative time (P=0.001), the loss of intraoperative blood (P=0.005), and the score of pain (P=0.001). There was no statistical difference in lead flow of postoperative chest (P>0.05) and the time of hospitalization (P>0.05). ConclusionVideo-assisted thoracoscope surgery in the treatment of pulmonary aspergilloma could be feasible, safe, and effective based on our study. It is worth of clinical application and popularization．
Objective To explore the clinical value of pleura biopsy and partial pleura cryobiopsy via electronic bronchoscope in diagnosis of unknown exudative pleural effusion. Methods Diagnostic results of 563 patients with unknown exudative pleural effusion were analyzed retrospectively. Bronchoscope and routine pleura biopsy were performed in 187 patients. Bronchoscope and routine pleura biopsy plus partial pleura cryobiopsy were performed in 376 patients. Pathological positive rates of the two groups were compared. Results In the 187 patients examined by bronchoscope and routine pleura biopsy from 2006 to 2008, 161 patients obtained pathological positive results ( 86.1% ) . In the 376 patients examined by bronchoscope and routine pleura biopsy plus partial pleura cryobiopsy from 2009 to 2012, 354 patients acquired pathological diagnosis ( 94.1% ) . There was significant difference between the two groups ( P lt; 0.05) . The main complications were bleeding and local chest pain, and they can be controlled easily. Conclusions Electronic bronchoscope and pleura biopsy can obtain high detection rate of nearly 90% in diagnosis of unknown exudative pleural effusion especially when combined with cryobiopsy of partial pleura. Electronic bronchoscope combined with pleura biopsy or cryobiopsy is an alternative in clinical settings when thoracoscope is unavailable.
Objective To explore clinical efficacy and independent risk factors related to the recurrence of primary spontaneous pneumothorax (PSP) after video-assisted thoracoscopic surgery (VATS). Method We retrospectively anal- yzed the clinical data of 566 PSP patients by VATS in our hospital between December 2011 and June 2014 year. The patients were divided into a triple-port group(110 patients with 88 males and 22 females, aged 31.34±15.62 years) and a double-port group (456 patients with 383 males and 73 females, aged 31.46±15.65 years) by operation methods. We tried to find out the independent risk factors related to the recurrence. Results There was no statistical difference in intraoperative blood loss, postoperative drainage, drain removal, postoperative complications, postoperative length of hospital stay and rate of postoperative recurrence between the two groups (P>0.05) . However, the operation time (P<0.001) and the drainage of postoperative 48 hours (P<0.05) in the double-port group was shorter or less than that in the triple-port group. The overall recurrence rate was 1.41% (8/566) . The minors (OR=14.75, P=0.045) , no bulla type (OR=32.76, P=0.019) , and multiple bulla type (OR=15.48, P=0.013) were the independent risk factors for postoperative recurrence. Conclusions The double- port VATS technique has similar effect with triple-port VATS technique on spontaneous pneumothorax patients under- gone pulmonary bullae ligation and pleurodesis. Bulla ligation and whole mechanical pleurodesis can get better clinical efficacy and lower rate of recurrence. The minor, no bulla type, and multiple bulla type are the independent recurrence risk factors of PSP after surgery.
Objective To investigate the gastrointestinal(GI) protective effect of Omeprazole on children undergoing thoracoscopic heart surgery with cardiopulmonary bypass (CPB). Methods One hundred and twenty seven patients who were scheduled for cardiac surgery with CPB were randomly equally divided into three groups. Group A and B underwent thoracoscopic heart surgery, while the control group underwent conventional heart surgery by sternotomy. Before CPB, group A was treated with Omeprazole 10mg added to the priming solution.? Group B and the control group were treated by adding the same amount of normal saline (to the priming solution). pH and red blood cell count of gastric secretion and serum gastric level (Assay Designs ELISA) were measured at the following intervals: before CPB, 30 minutes into CPB, at termination of CPB,4 and 24 hours after termination of CPB. Results Compare to prior to CBP, the value of the gastric pH in group A was significantly higher (Plt;0.01), and that of group B was significantly lower (Plt;0.05)at the end of CPB. The same value in the control group was significantly lower (Plt;0.05)4h, after the end of CPB. Compared to prior CPB, the mean red blood cell count of gastric secretion and serum gastric level were significantly descent (Plt;0.01) in all there group post CBP. Compare to the control group, the mean gastric pH level in group A was significantly elevated at all time intervals post CBP; while the mean gastric secretin red blood cell count was significantly decreased. The mean serum level in group A 30 min post CBP was significantly lower than that in group B and the control group. Compared to the control group, the mean gastric pH level was significantly lower in group B but returned to the pre-CPB level in 24 h. The mean gastric secretin red blood cell amount and serums gastric level in group B at all time intervals were significantly decreased compare to those of the control group. Conclusion Thoracoscopic heart surgery of children with CPB
ObjectiveTo analyze the operation outcomes and learning curve of uniportal video-assisted thoracoscopic surgery (VATS).MethodsAll consecutive patients who underwent uniportal VATS between November 2018 and December 2020 in Shangjin Branch of West China Hospital of Sichuan University were retrospectively enrolled, including 62 males and 86 females with a mean age of 50.1±13.4 years. Operations included lobectomy, segmentectomy, wedge resection, mediastinal mass resection and hemopneumothorax. Accordingly, patients' clinical features in different phases were collected and compared to determine the outcome difference and learning curve for uniportal VATS.ResultsMedian postoperative hospital stay was 5 days, and the overall complication rate was 8.1% (12/148). There was no 30-day death after surgery or readmissions. Median postoperative pain score was 3. Over time, the operation time, incision length and blood loss were optimized in the uniportal VATS lobectomy, the incision length and blood loss increased in the uniportal VATS segmentectomy, and the postoperative hospital stay decreased in the uniportal VATS wedge resection.ConclusionUniportal VATS is safe and feasible for both standard and complex pulmonary resections. While, no remarkable learning curve for uniportal VATS lobectomy is observed for experienced surgeon.