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电视胸腔镜辅助食管癌切除术

目的 探讨电视胸腔镜辅助食管癌切除术的方法。方法 2000年12月-2001年5月我科用胸腔镜辅助施行食管癌切除术5例，均为食管中段癌，0期1例。Ⅰ期2例，Ⅱa期1例，Ⅱb期1例。结果 手术经过均顺利，无1例中转开胸手术，手术时间平均180min，术中出血量平均210ml，无严重术后并发症发生，无手术死亡，均治愈出院。结论 随着胸腔手术设备和器械的改进，手术操作技术的熟练，选择适当的患者采用电视胸腔镜辅助食管癌切除术是可行的，且手术效果良好。

单孔与单向式胸腔镜肺癌切除术的结合—单孔单向式胸腔镜肺癌切除术 Combinating the concepts of single-port and single-direction in video-assisted thoracic surgery (VATS) lung cancer resection—Uniportal single-direction VATS lung cancer resection

Comparison of Surgical Trauma Between Videoassisted Thoracoscopic Surgery and Conventional Thoracotomy

Objective To compare the surgical trauma between videoassisted thoracoscopic surgery(VATS) and conventional thoracotomy, and to investigate the possible minimally invasive mechanism. Methods Seventyseven patients who had undergone consecutive operations from April 2005 to January 2006 were chosen from cardiothoracic surgery department of Fujian Provincial Hospital. Twentytwo cases had spontaneous pneumothorax diagnosed by chest X-ray examination, twentynine had patent ductus arteriosus diagnosed by color echocardiography, and twentysix had congenital atrial septal defect. According to lesions and operative methods, the patients were divided into two groups: conventional thoracotomy group(CTH group) and videoassisted thoracoscopic surgery group(VATS group). The concentrations of serum C-reactive protein（CRP），interleukin6 (IL-6)，interleukin-8（IL-8） and tumor necrosis factor-α(TNF-α) were selected as indexes to measure surgical trauma. ARRAY360 specific protein and pharmaceutical analysis system were used to determine CRP automaticly at the day before operation and on the 1st, 2nd and 3rd day after operation. Radioimmunoassay was used to measure the concentrations of IL-6，IL-8 and TNF-α. Clinical indexes such as operative time, cardiopulmonary bypass (CPB) time, intraoperative blood lost, postoperative analgesic time and hospitalization time were analyzed and compared. Results Under the condition that patients had the same diseases, there was no statistical significance in preoperative concentrations of serum CRP，IL-6，IL-8 and TNFα between VATS group and CTH group（P=0.067, 0.062, 0.053,0.064）. The concentrations of serum CRP(P=0.045,0.043,0.044), IL-6(P=0.042，0.032，0.039), IL-8(P=0.046，0.045，0.048) and TNF-α(P=0.041，0.043，0.043) on the 1st, 2nd and 3rd day after operation were significantly lower in VATS group than that in CTH group (Plt;0.05). Compared with CTH group, there were less blood lost（P=0.032）, shorter postoperative analgesic time and hospitalization time（P=0.041） in VATS group. There was no statistical significance in CPB time between two groups. However, hospitalization time varied with different diseases. Conclusion Compared with conventional thoracotomy，videoassisted thoracoscopic surgery has less surgical trauma, less intraoperative blood lost, shorter postoperative analgesic time, and can make patients recover rapidly. So it is worth spreading.

Analysis of risk factors for conversion to thoracotomy during video-assisted thoracic surgery lobectomy for lung cancer

Objective To explore the risk factors and short-term clinical effect of conversion to open thoracotomy during thoracoscopic lobectomy for lung cancer patients. Methods We retrospectively analyzed the clinical data of 423 lung cancer patients who were scheduled for thoracoscopic lobectomy between March 2011 and November 2015.There were 252 males and 171 females at median age of 60 (24-83) years. According to the patients who were and were not converted to thoracotomy, they were divided into a conversion group (378 patients) and a video-assisted thoracic surgery group (a VATS group, 45 patients). Then, clinical data of two groups were compared, and the risk factors and short-term clinical effect of unplanned conversions to thoracotomy were analyzed. Results Lymph nodes of hilar or/and interlobar fissure closely adhered to adjacent vessels and bronchi was the most common cause of unexpected conversions to thoracotomy in 15 patients (33.3%), followed by sleeve lobectomy in 11(24.4%) patients, uncontrolled hemorrhage caused by intraoperative vessel injury in 8 patients, tumor invasion or extension in 5 patients, difficulty of exposing bronchi in 3 patients, close adhesion of pleural in 2 patients, incomplete interlobar fissure in 1 patient. Conversion did translate into higher overall postoperative complication rate (P=0.030), longer operation time (P<0.001), more intraoperative blood loss (P<0.001). In the univariable analysis, the type of operation, the anatomical site of lung cancer, the lymph node enlargement of hilar in CT and the low diffusion capacity for carbon monoxide (DLCO) were related to conversion. Logistic regression analysis showed that the independent risk factors for conversion were sleeve lobectomy (OR=5.675, 95%CI 2.310–13.944, P<0.001), the lymph node enlargement of hilar in CT (OR=3.732, 95%CI 1.347–10.341, P=0.011) and DLCO≤5.16 mmol/(min·kPa)(OR=3.665, 95%CI 1.868–7.190, P<0.001). Conclusions Conversion to open thoracotomy during video-assisted thoracic surgery lobectomy for lung cancer does not increase mortality, and it is a measure of reducing the risk of surgery. Therefore, with high-risk patients who may conversion to thoracotomy, the surgeon should be careful selection for VATS candidate. And, if necessary, the decision to convert must be made promptly to reduce short-term adverse outcome.

Comparison between Video-assisted Thoracoscopic Surgery and Conventional Surgery for Multiple Rib Fractures

ObjectiveTo compare clinical outcomes between video-assisted thoracoscopic surgery (VATS) and conventional surgery for the treatment of multiple rib fractures. MethodsA total of 173 consecutive patients with multiple rib fractures were admitted to Dujiangyan People's Hospital from January 2010 to December 2012. There were 122 males and 51 females with their age of 19-71 (41.3±7.1) years. According to different treatment strategies, all the patients were divided into 3 groups:conservative treatment group (83 patients with a mean of 4.9±1.3 fractured ribs, including 20 patients with flail chest), conventional surgery group (41 patients with a mean of 5.2±1.1 fractured ribs, including 11 patients with flail chest) and VATS group (49 patients with a mean of 5.3±1.5 fractured ribs, including 14 patients with flail chest). Length of hospital stay, duration of postoperative pain, incision length, operation time, chest drainage duration and morbidity were compared among the 3 groups. ResultsThe incision length (5.2±1.5 cm vs. 8.5±2.3 cm, P=0.031), operation time (1.1±0.3 hours vs. 1.8±0.2 hours, P=0.003), chest drainage duration (0.3±0.0 day vs. 3.2±1.1 days, P=0.007) and length of hospital stay (13.7±1.5 days vs. 17.3±2.3 days, P=0.017) of VATS group were significantly shorter than those of the conventional surgery group. A total of 159 patients were followed up, and chest x-ray was examined at 1, 3 and 6 months after discharge. After 3 months, bone callus formation was evident around the rib fractures in chest x-ray in patients undergoing surgery, while bone union with deformity was shown in some patients of the conservative group. ConclusionWith the development of various internal fixation materials, surgical internal fixation has become a trend for patients with multiple rib fractures, and VATS internal fixation is minimally invasive with satisfactory clinical outcomes.

Comparison of efficacy between robot-assisted and uniportal video-assisted thoracoscopic lobectomy

ObjectiveTo compare the perioperative efficacy and safety of robot-assisted thoracoscopic surgery (RATS) and uniportal video-assisted thoracoscopic surgery (UVATS) in the lobectomy for early lung adenocarcinoma.MethodsClinical data of 70 early lung adenocarcinoma patients, receiving RATS or UVATS lobectomy by the same surgical team in our hospital from November 2018 to May 2020 were retrospectively analyzed. There were 24 males and 46 females with an average age of 59.3±8.9 years. According to different surgical methods, the patients were divided into a RATS group (31 patients) and a UVATS group (39 patients). The operation time, intraoperative blood loss, postoperative hospital stay, indwelling time, drainage volume, number of lymph node dissected, stations of lymph node dissected and perioperative complications were compared between the two groups.ResultsThere was no conversion to thoracotomy or perioperative death in both groups. There was no significant difference in intraoperative blood loss, postoperative hospital stay, indwelling time of thoracic drainage tube, thoracic drainage volume or stations of lymph node dissected between the two groups (P>0.05). There was no significant difference in the incidence of pulmonary infection, persistent lung leakage, chylothorax, arrhythmia or overall complications between the two groups (P>0.05). The operation time of the RATS group was longer than that of the UVATS group (195.8±52.8 min vs. 154.0±43.1 min, P=0.001). The number of lymph node dissected in the RATS group was more than that of the UVATS group (P=0.016).ConclusionBoth RATS and UVATS are safe and feasible in the treatment of lung cancer. The number of lymph nodes removed by RATS is significantly more than that of UVATS.

Application of Completely Videoassisted Thoracoscopic Lobectomy in Pulmonary Diseases Treatment

Abstract: Objective To summarize the clinical experiences of applying completely videoassisted thoracoscopic lobectomy in pulmonary diseases treatment, and evaluate its safety, indication and efficacy. Methods We retrospectively analyzed the clinical data of 47 patients with pulmonary diseases undergoing completely videoassisted thoracoscopic lobectomy at the First People’s Hospital of Yunnan Province between October 2008 and November 2010. Among the patients, there were 35 males and 12 females with their age ranged from 30 to 72 years averaging at 61.5 years. Adenocarcinoma was present in 27 patients, squamous carcinoma in 9 patients, small cell carcinoma in 1 patient, tuberculosis in 3 patients, bronchiectasis in 3 patients, pulmonary inflammatory pseudotumor in 2 patients, hamartoma in 1 patient, and giant bulla in 1 patient. All patients underwent completely videoassisted thoracoscopic lobectomy which was carried out through three miniinvasive incisions without the use of rib spreader. Systemic lymph node dissection was performed for patients with malignancies. Blood loss, operation time, the rate of conversion to thoracotomy, postoperative hospital stay, and complications were observed. Results Completely videoassisted thoracoscopic lobectomy was successfully performed in 44 patients, and the other 3 patients were changed to open thoracotomy due to bleeding in one patient, T3 tumor in one patient and accidentally injured bronchus in one patient. The overall conversion rate was 6.4% (3/47). The mean operation time, blood loss and postoperative hospital stay were respectively 120±45 minutes, 150±80 ml, and 7±2 days. No perioperative death occurred. There were 9 patients of complications including lymphatic fistula, air leak, atrial fibrillation and atelectasis, and they all recovered after conservative treatment. Fortyfour- patients were followed up for -1 to 23 months with 3 patients missing. One-patient had bloody sputum during the followup, but recovered spontaneously later. Brain metastasis occurred to a stage Ⅲa patient with primary lung cancer 9 months after operation, and the patient survived after treatment with gamma knife. No recurrence happened to the other patients and their quality of life was good. Conclusion Completely videoassisted thoracoscopic lobectomy is a safe and feasible surgical procedure for patients with earlystage lung cancer and benign pulmonary lesions which need lobectomy. However, it is necessary to select the patients carefully in the early period of practising.

The Interruption of Patent Ductus Arteriosus with Video Assisted Thoracic Operation——A Comparison with the Conventional Trans thoracic Approach

Objective\ To investigate the surgical technique and clinical results of interruption of patent ductus arteriosus (PDA) with video assisted thoracic operation (VATO).\ Methods\ Fifty PDA cases were divided into two groups, 25 cases treated with VATO(VATO group) as compared to other 25 cases with conventional surgical interruption(conventional surgical interruption group). In the VATO group, the PDA was interrupted by 2 3 hemoclips under VATO technique, and PDA interrupted by suture ligation with the techni...

Clinical Research on the Combined Video-assisted Thoracic Surgery with Two Trocars and Endoscopic Ultrasonography in the Treatment of Esophageal Leiomyoma

Objective To explore the minimal invasiveness and practability of combined video-assisted thoracic surgery (VATS) with two trocars and endoscopic ultrasonography (EUS) in the treatment of esophageal leiomyoma. Methods Between February 2007 and February 2012, we retrospectively analysed the clinical data of 166 patients who underwent various surgeries for the treatment of esophageal leiomyoma. Among them, 62 received routine thoracotomy (group A), 49 accepted conventional VATS surgery with three trocars (group B), and 55 underwent combined VATS surgery with two trocars and EUS (group C). Then, we summarized the clinical indexes of patients in all the three groups for further comparative analysis. Results There was no significant difference among the three groups in age, gender, and lesion location, origin level and size (P > 0.05). There were significant differences between group A and C in blood loss, surgery time, intraoperative localization, postoperative incision pain, hospitalization expenses, length of hospital stay, fasting time, pulmonary infection, and the complications during the follow-up (P < 0.05). There were significant differences between group C and B in blood loss, surgery time, intraoperative localization, fasting time and pulmonary infection (P < 0.05). Conclusion Combined VATS surgery with two trocars and EUS is safe, minimally invasive, thorough with few complications, which is worthy of clinical promotion.

电视胸腔镜手术治疗双侧肺大泡：同期手术优于分期手术

目的　探讨电视胸腔镜手术（video-assisted thoracscopic surgery，VATS）在双侧肺大泡切除中的可行性、手术时机及治疗效果。 方法 回顾性分析2001年4月至2011年6月中山大学附属佛山医院佛山市第一人民医院应用电视胸腔镜施行同期或分期手术切除双侧肺大泡患者168例的临床资料，男135例，女 33例；年龄15～68（41.5±10.6）岁。依据手术方式不同分为同期手术组（92例）和分期手术组（76例）。分析两组患者围手术期及远期并发症发生情况，比较行双侧同期肺大泡手术的效果。 结果　168例患者均顺利完成手术，住院时间为7～16（6.6±2.4） d，无术中及术后死亡患者，2例因严重肺粘连中转开胸。术后随访6个月～10年，围手术期并发症同期手术组显著低于分期手术组，差异有统计学意义（P＜0.05）；远期并发症两组间差异无统计学意义（P＞0.05）；术后总体并发症同期手术组低于分期手术组，差异有统计学意义（P＜0.05）。 结论　VATS同期或分期治疗双侧肺大泡疗效确切，行双侧同期手术效果更佳。