Objective To explore the clinicopathological features of bilateral primary breast cancer (BPBC) at different ages. Methods Clinical data of 105 BPBC patients admitted to the Department of Breast Surgery in The First Affiliated Hospital of Zhengzhou University from January 2017 to January 2020 were collected and divided into young group (≤40 years old) and middle-old group (>40 years old) according to age. The characteristics and differences of bilateral tumor lesions in pathological type, molecular type, tumor diameter, histological grade, clinical stage, lymph node metastasis, recurrence or distant metastasis, immunohistochemical indexes expression characteristics, consistency and difference, and overall prognosis between the two groups were retrospectively analyzed. Results There were statistically significant differences between the two groups in the size of the first primary cancer, lymph node metastasis, the high expression rate of Ki-67 in the second primary cancer, clinical stage of double primary cancer and recurrence or distant metastasis (P<0.05). In the young group, the proportion of the first primary cancer with T3–T4 stage was higher, the incidence of lymph node metastasis was higher, the proportion of high expression of Ki-67 in the second primary cancer was higher, and the proportion of patients with double primary cancer at first diagnosed as stage Ⅳ were higher than those in the middle-old group, and were prone to recurrence or distant metastasis. The expression of immunohistochemical indexes in bilateral cancer foci was consistent between the two groups (P<0.05). The expression consistency of ER and Ki-67 in the young group was better, and the expression consistency of PR and HER-2 in the middle-old group was better. The histological grade of the first primary cancer, TNM stage of bilateral primary cancer and recurrence or metastasis were independent factors affecting the prognosis of patients (P<0.05). Conclusions The BPBC patients of different ages have different clinicopathological features, and the expression of immunohistochemical indexes in bilateral cancer foci is consistent. Tumor histological grade of the first primary cancer may affect the prognosis of patients with BPBC, and the prognosis of patients with early bilateral TNM stage is better.
Multiple primary lung cancer is a special type of lung cancer. Its detection rate is increasing year by year, and there is no clear diagnosis and treatment strategy, which makes the diagnosis and treatment become a hotspot in clinical work. The molecular genetics is gradually changing the status quo of relying only on imaging and tumor-free interval to distinguish lung metastasis from multiple primary lung cancer, and it is an effective method for differential diagnosis and prediction of biological behavior of lung cancer. Based on our experience and other studies, it is recommended that surgical treatment should be preferred when there is no contraindication. The advantages and disadvantages of bilateral thoracoscopic surgery for bilateral multiple primary lung cancer during the same period are discussed, and its feasibility and safety are confirmed. For the lesions that cannot be completely resected, active surgical local treatment is recommended. The diagnosis and treatment of multiple primary lung cancer is still a clinical difficulty, and we hope that our research can provide theoretical and practical guidance for clinicians.
Objective To design the surgical strategy of percutaneous full-endoscopic bilateral decompression via unilateral posterior approach for bilateral lumbar spinal stenosis (LSS) and to evaluate the effectiveness. Methods The percutaneous full-endoscopic bilateral decompression via unilateral posterior approach for bilateral LSS was designed according to the pathological features of LSS. The technique was used to treat 42 patients with LSS between January 2016 and January 2018. There were 18 males and 24 females with an average age of 61.7 years (range, 46-81 years). The duration of symptoms was 1-20 years, with an average of 9.7 years. The surgical segment at L4, 5 were 27 cases, at L5, S1 were 15 cases. The operation time and perioperative complications were recorded. Lumbar X-ray, CT, and MRI examinations were performed at 1 week, 3 months, and 1 year after operation. Visual analogue scale (VAS) score was used to evaluate the low back pain and leg pain, Oswestry disability index (ODI) was used to evaluate the lumbar function, and single continuous walking distance (SCWD) was used to evaluate lower extremity nerve function. The clinical efficacy was evaluated by MacNab criteria at 1 year after operation. Results All patients underwent surgery successfully. The operation time was 68-141 minutes with an average of 98.2 minutes. All 42 patients were followed up 12-24 months with an average of 18.8 months. There were 2 cases of dural tears during operation, and 1 case of transient dysfunction of the lower limbs of the decompression channel after operation. All of them were cured after corresponding treatment. No serious complications such as death, major bleeding, or irreversible nerve injury occurred during follow-up. No segmental instability was found according to postoperative lumbar hyperextension and flexion X-ray films, and postoperative CT and MRI imaging showed that the stenotic lumbar spinal canal was significantly enlarged, and the compression of the nerve root was sufficient. The VAS score of low back pain and leg pain, ODI score, and SCWD at each time point after operation were significantly improved when compared with those before operation (P<0.05); the indexes were significantly improved over time after operation, and the differences were significantly (P<0.05). The clinical efficacy was evaluated by MacNab standard at 1 year after operation, and the results were excellent in 18 cases, good in 20 cases, fair in 3 cases, and poor in 1 case. The excellent and good rate was 90.5%. Conclusion The percutaneous full-endoscopic bilateral decompression via unilateral posterior approach for LSS is a safe and effective procedure. A well-designed surgical strategy and mastery of its technical points are important guarantees for successful operation and satisfactory results.
ObjectiveTo introduce the method and preliminary experience of robot-assisted bilateral internal mammary arteries (BIMA) harvesting for off-pump coronary artery bypass grafting (OPCAB) with 5 grafts via left anterolateral minithoracotomy.MethodsBIMA were harvested using the da Vinci robotic surgical system, and the right internal mammary artery (RIMA) was pulled out of the thoracic cavity through right second intercostal space. Intercepting the distal part of the RIMA for the BIMA composite Lima-Rima Y graft and anastomosing the great saphenous vein with remaining RIMA end to end. The Y graft anastomosed with left anterior descending (LAD) branch and diagonal branches (DIAG), artery-vein graft sequentially anastomosed with blunt round branch, left ventricular posterior branch and posterior descending branch.ResultsThe operation succeeded without hemodynamic instability and intra aortic balloon pump (IABP) implantation or cardiopulmonary bypass. The blood flow of Y graft was 24 mL/min, and the blood flow of artery-vein graft was 30 mL/min. Ventilator assistance time was 35 hours, ICU staying time was 62 hours, and postoperative myocardial enzymes increased temporarily. Postoperative coronary CTA showed that all the grafts were patency, and cardiac ultrasound indicated that the heart function was normal. The patient cured and discharged from hospital 7 days after operation.ConclusionRobot-assisted bilateral internal mammary artery harvesting for OPCAB with 5 grafts via left anterolateral minithoracotomy is feasible, which can achieve complete revascularization.
ObjectiveTo explore the effect of tranexamic acid (TXA) on the transfusion rate, dominant blood loss, and postoperative complications in simultaneous bilateral total hip arthroplasty (SBTHA).MethodsA clinical data of 72 patients who underwent the primary SBTHA between January 2010 and December 2018 was retrospectively analyzed. A single dose of 15 mg/kg TXA was administered intravenously before 5-10 minutes of operation in 48 patients of trial group and 24 patients were not treated with TXA in the control group. There was no significant difference between the two groups (P>0.05) in the gender, age, body mass index, the type of disease, American Society of Anesthesiologists (ASA) grading, comorbidity, and preoperative hospital stay, hemoglobin, hematocrit, platelet count, coagulation function tests. The operation time, intraoperative blood loss, and postoperative transfusion rate, dominant blood loss, complication, and hospital stay were recorded and compared between the two groups.ResultsThe median operation time of the trial group was 208.0 minutes, and that of the control group was 202.5 minutes, with no significant difference (Z=−1.046, P=0.295). Postoperative transfusion was performed in 26 patients (54.2%) in the trial group and 21 patients (87.5%) in the control group, and the difference of transfusion rate between the two groups was significant (χ2=7.843, P=0.005). However, there was no significant difference in the amount of transfused suspended red blood cells and plasma between the two groups (P>0.05). The median intraoperative blood loss was 550 mL in the trial group and 600 mL in the control group, with no significant difference (Z=−1.378, P=0.168). The postoperative drainage volume and median dominant blood loss in the trial group were (542±269) and 1 050 mL, respectively, which were significantly lower than those in the control group [(710±316) and 1 270 mL] (P<0.05). There was 1 case of skin tension blisters around the incision, 1 case of lower limb numbness and muscle strength loss, and 1 case of lacunar cerebral infarction in the trial group, while in the control group, there was 1 case of skin ecchymosis around the incision and 1 case of bilateral lower limb numbness and muscle strength loss, which showed no significant difference in the incidences of complications (P>0.05). No pulmonary embolism or deep venous thrombosis was found in the two groups. The median postoperative hospital stay and median total hospital stay were 9.0 and 13.0 days in the trial group, while 9.0 and 13.0 days in the control group, respectively, with no significant difference (P>0.05).ConclusionFor patients who are treated with the primary SBTHA, TXA can reduce transfusion rate and perioperative dominant blood loss, and has a good hemostatic effect without increasing complications of incision, pulmonary embolism, deep venous thrombosis, and hospital stay. Therefore, TXA is relative safe.
Objective To investigate the effects of different puncture levels on bone cement distribution and effectiveness in bilateral percutaneous vertebroplasty for osteoporotic thoracolumbar compression fractures. Methods A clinical data of 274 patients with osteoporotic thoracolumbar compression fractures who met the selection criteria between December 2017 and December 2020 was retrospectively analyzed. All patients underwent bilateral percutaneous vertebroplasty. During operation, the final position of the puncture needle tip reached was observed by C-arm X-ray machine. And 118 cases of bilateral puncture needle tips were at the same level (group A); 156 cases of bilateral puncture needle tips were at different levels (group B), of which 87 cases were at the upper 1/3 layer and the lower 1/3 layer respectively (group B1), and 69 cases were at the adjacent levels (group B2). There was no significant difference in gender, age, fracture segment, degree of osteoporosis, disease duration, and preoperative visual analogue scale (VAS) score, and Oswestry disability index (ODI) between groups A and B and among groups A, B1, and B2 (P>0.05). The operation time, bone cement injection volume, postoperative VAS score, ODI, and bone cement distribution were compared among the groups. Results All operations were successfully completed without pulmonary embolism, needle tract infection, or nerve compression caused by bone cement leakage. There was no significant difference in operation time and bone cement injection volume between groups A and B or among groups A, B1, and B2 (P>0.05). All patients were followed up 3-32 months, with an average of 7.8 months. There was no significant difference in follow-up time between groups A and B and among groups A, B1, and B2 (P>0.05). At 3 days after operation and last follow-up, VAS score and ODI were significantly lower in group B than in group A (P<0.05), in groups B1 and B2 than in group A (P<0.05), and in group B1 than in group B2 (P<0.05). Imaging review showed that the distribution of bone cement in the coronal midline of injured vertebrae was significantly better in group B than in group A (P<0.05), in groups B1 and B2 than in group A (P<0.05), and in group B1 than in group B2 (P<0.05). In group A, 7 cases had postoperative vertebral collapse and 8 cases had other vertebral fractures. In group B, only 1 case had postoperative vertebral collapse during follow-up. ConclusionBilateral percutaneous vertebroplasty in the treatment of osteoporotic thoracolumbar compression fractures can obtain good bone cement distribution and effectiveness when the puncture needle tips locate at different levels during operation. When the puncture needle tips locate at the upper 1/3 layer and the lower 1/3 layer of the vertebral body, respectively, the puncture sites are closer to the upper and lower endplates, and the injected bone cement is easier to connect with the upper and lower endplates.
Objective To share the experience of single-stage bilateral pulmonary resections by video-assisted thoracic surgery (VATS) for multiple nodules. Methods Clinical records of patients undergoing one-stage bilateral resections of multiple pulmonary nodules between January 2015 and December 2016 in our institution were retrospectively reviewed and analyzed. There were 9 males and 15 females, aged from 33 to 69 (55.0±8.0) years. Two patients underwent bilateral lobectomy. Lobar-sublobar (L/SL) resection and bilateral sublobar resection (SL-SL) were conducted in 9 patients and 13 patients respectively. Results All operations completed successfully. Operation time was 135–330 (231.4±59.1) min, duration of use of chest drains was 2–17 (5.4±3.1) days. Overall duration of hospitalization after surgery was 5–37 (8.6±6.3) days. There was no perioperative death. Postoperative course was uneventful in 17 (70.8%) patients. The postoperative complications included one patient of incision infection and one patient of pulmonary infection. Persistent air leak for >3 days duration and unilateral pleural drainage for more than 200 ml/d were observed in 3 patients and 2 patients respectively. Conclusion Single-stage bilateral surgery in selected patients with synchronous bilateral multiple nodules is feasible and associated with satisfactory outcomes.
ObjectiveTo compare the differences of clinical effects between the bilateral endoscopic breast reconstruction and the open breast reconstruction. MethodsThe clinical data of 28 female patients who underwent bilateral breast graft reconstruction in the Department of Breast Surgery of West China Hospital from January 2017 to January 2021 were analyzed retrospectively. The patients were divided into two groups: an endoscopic group (n=12, aged 41.3±8.9 years) and an open group (n=16, aged 41.6±8.8 years). The clinical data of the two groups of patients were compared. Results There was no significant difference in demographic and oncological data between the two groups (P>0.05). There was a significant difference in the implants between the two groups (P=0.008). The operation time (298.2±108.6 min vs. 326.5±95.8 min, P=0.480) and anesthesia time (373.4±91.2 min vs. 400.3±97.1 min, P=0.463) were not significantly different. The total complications (P=0.035) and major complications (P=0.024) in the open group were more than those in the endoscopic group. For the comparison of breast satisfaction, psychosocial well-being and sexual well-being, the scores at six months and one year after surgery were higher in the endoscopic group than those in the open group (P<0.05). ConclusionThe endoscopic reconstruction is safe and effective, with high satisfaction rates regarding breast reconstruction and quality of life, and is superior to conventional open surgery.
Objective To summarize clinical outcomes of subxiphoid uniportal video-assisted thoracoscopic surgery for bilateral chest diseases simultaneously. Methods The clinical data of 60 patients with bilateral chest diseases treated by uniportal thoracoscopic surgery via subxiphoid approach in the Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical College from August 2016 to December 2017 were retrospectively analyzed. There were 35 males and 25 females, aged 25.5±8.8 years ranging from 13 to 51 years. There were 40 patients wtih palmar hyperhidrosis, and 20 patients with bilateral pulmonary bullae and onset of one-side pneumothorax. All patients adopted subxiphoid uniportal video-assisted thoracoscopic surgery. Among them 36 patients with palmar hyperhidrosis underwent resection of R3 bilateral sympathetic nerves, 1 resection of R4 bilateral sympathetic nerves, 3 resection of R3+R4 bilateral sympathetic nerves, and 20 patients with pulmonary bullae underwent bilateral bullectomy and pleurodesis. Results Fifty-five patients cured within 1 to 4 days and discharged after surgery. One patient with incision infection and pulmonary infection after bullectomy, cured and discharged after 3 weeks anti-inflammation and incision dressing change. Four patients with Grade B healing recovered after 1 to 2 weeks dressing change. During the follow-up, no pneumothorax or hand perspiration relapsed. Conclusion Subxiphoid uniportal video-assisted thoracoscopic surgery for simple bilateral chest disease simultaneously is safe and feasible, which not only avoids simultaneous trauma of bilateral punch, but also alleviates the pain of patients.
Objective To evaluate the influence of diabetes on coronary artery bypass graft (CABG) surgery using bilateral internal mammary artery (BIMA). Methods From December 2015 to August 2017, 182 patients (153 males, 29 females, age of 56.5±6.8 years) underwent CABG using BIMA. The propensity score was used to create matched diabetes (n=66) and non-diabetes (n=66) cohorts. The operative data, post-operative outcomes and coronary computed tomographic angiography (CTA) of the diabetes group (53 males, 13 females, age of 57.8±7.2 years) and the non-diabetes group (56 males, 10 females, age of 56.3±6.0 years) were analyzed retrospectively. Results There was no peri-operative mortality. There was no difference in operative sternal wound complication (P=0.466), or graft patency (P=0.730 for internal mammary arteries and 0.684 for saphenous vein grafts) between the matched diabetes and the non-diabetes groups. However, patients with elevated glycated hemoglobin (HbA1c) (n=54) had more sternal wound complications (P=0.006). The level of Hb1Ac of the patients with sternal wound complication was significantly higher than that of the patients without sternal wound complication. Conclusion BIMA grafting may be performed routinely even in diabetic patients, without increased complications. However, elevated HbA1c level should be avoided to reduce sternal wound complication.