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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。

电视胸腔镜下行儿童肋骨骨刺切除并膈肌破裂修补一例

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

Videoassisted Thoracoscopic Surgery Lobectomy: a Series of Consecutive 300 Patients and a 3year Follow-up

Abstract: Objective To summarize the clinical experiences of videoassisted thoracoscopic surgery (VATS) lobectomy performed on a series of 300 consecutive patients, and report the results of a 3year followup. Methods We retrospectively analyzed the clinical data of 300 consecutive patients who underwent VATS lobectomy from September 2006 to December 2009 in the Department of Thoracic Surgery, People’s Hospital of Peking University. Of the 300 patients, there were 159 males and 141 females with the age ranged from 18 to 86 years (58.30±13.90 years). Preoperative diagnosis showed that there were 266 patients of mass in the lung, 22 of bronchiectasis, 5 of cyst/abscess in the lung, 3 of pulmonary sequestration, 2 of fungus infection, and 2 of pneumothorax. We assessed the perioperative variables by standard descriptive statistics and estimated the 3year survival rate by KaplanMeier analyses. Results Sixtysix patients were diagnosed to have benign diseases and 234 patients were with malignancies. A percentage of 81.82% (54/66) of the benign patients had infectious diseases, and the majority of the malignancies was nonsmall cell lung cancer (213 patients), especially adenocarcinomas which comprised 73.08% (171/234) of all the malignancies. A total of 273 patients accomplished VATS lobectomy, of whom 27 patients required conversion to thoracotomy at a conversion rate of 9.00%(27/300). In the VATS lobectomy accomplished group, the mean operation time was 317±088 h, and the blood loss was 225.70±195.20 ml. Benign surgery took significantly less time (t=2.280, P=0.0032) and had shorter drainage time(t=1.392, P=0.0304) than those of malignancies. Dense adhesions between lymph nodes and blood vessels was the primary reason for conversion to thoracotomy in 17 patients at a percentage of 62.96%(17/27). Bleeding was the second reason for conversion in 5 patients at a percentage of 1852%. The patients in the upper lobe lobectomy group showed significantly higher risk of conversion compared with those in the nonupper lobe surgery group (χ2=6.131, P=0.013), while gender (χ2=1.182, P=0.277), pathology (χ2=0.210, P=0.647) and the tumor located in left or right side(χ2=2.933, P=0.087) didn’t influence the risk of conversion. The result of the 3year followup showed that there was no reoccurrence of symptoms in patients with benign diseases; Nonsmall cell lung cancer patients had a 3year survival rate of 0.87 with the 95% confidence interval (CI) from 0.77 to 0.96, and pathologic stage I patients at 0.91 with the 95%CI from 0.85 to 0.98. Conclusion VATS lobectomy is safe and effective. This research shows that domestic technologies of VATS lobectomy and its midterm results have reached the international standard.

电视胸腔镜下胸腺切除术治疗重症肌无力

目的探讨电视胸腔镜手术（VATS）下行胸腺切除治疗重症肌无力的可行性和治疗效果。方法19例重症肌无力患者，按照Osserman临床分型标准，Ⅰ型10例，Ⅱa型5例，Ⅱb型3例，Ⅲ型1例，均在VATS下行胸腺扩大切除术。结果19例患者均顺利完成手术，无手术死亡，平均手术时间120min，术中出血量均小于100ml，术后发生重症肌无力危象3例，经及时治疗治愈。术后对所有患者均进行了随访，随访时间〉6个月，重症肌无力病情完全缓解9例，好转6例，无变化4例，总有效率79％（15／19）。结论在VATS下行胸腺扩大切除术治疗重症肌无力是可行的，且创伤小、疼痛轻，以期望减少术后并发症。

Enucleation of Esophageal Leiomyoma by Videoassisted Thoracoscopic Surgery

Abstract: Objective To explore the outcomes of videoassistedthoracoscopic surgery (VATS) in the treatment of esophageal leiomyoma. Me thods [WTBZ] We reviewed and analyzed the clinical data of 87 patients with esophageal leiomyoma treated with VATS in Changhai Hospital of Second Military Medical University between June 2002 and January 2009. [WTHZ]Results [WTBZ]Videoassisted thoracoscopic leiomyoma enucleations was performed in 80 patients, whilea conversion to minithoracotomy was required in 7 others. All procedures werecompleted smoothly and the postoperative recovery was uneventful, without mortality or severe complications. The patients were drinking liquids from postoperative day 1 and were eating a normal diet from day 3. All patients were pathologically diagnosed with leiomyoma after operation. Followups of 6 months to 6.5 years (mean: 3.8 years) found no recurrence. [WTHZ] Conclusion [WTBZ]Videoassisted thoracoscopic enucleation can be the first choice for esophageal leiomyomas derived from lamina propria. Patients with esophageal leiomyomas of diameter gt;1.0 cm should be treated with VATS .

Clinical Outcome of Complete Video-assisted Thoracoscopic Surgery Lobectomy for Patients with Early-stage Non-small Cell Lung Cancer

Abstract： Objective To evaluate the safety, feasibility, and clinical outcome of complete video-assisted thoracoscopic surgery （VATS） lobectomy for patients with early-stage non-small cell lung cancer （NSCLC）. Methods We retrospectively analyzed the clinical data of 160 consecutive patients（the VATS group, 83 males and 77 females with average age at 60.8 years）with early-stage NSCLC who underwent complete VATS lobectomy between January 2005 andDecember 2008 in Zhongshan Hospital of Fudan University，and compared them with 357 patients（the thoracotomy group, 222 males and 135 females with average age at 59.5 years）who underwent open thoracotomy in the same period. Results The conversion rate of the VATS group was 5.0%（8/160）. The operation time of the VATS group was significantly shorter than that of the thoracotomy group（113.0 min vs.125.0 min, P=0.039）. Length of postoperative hospital stay was not statistically different between the two groups（10.3±4.3 d vs.9.1±4.6 d，P=0.425）. The postoperative morbidity of the VATS lobectomy group and the thoracotomy group was 9.4%（15/160）and 10.1% （36/357） respectively，and the postoperative mortality of the two groups was 0.6%（1/160）and 2.0%（7/357）respectively. There was no statistical difference in the mean group of lymph node dissection （2.4±1.5 groups vs.2.4±1.7 groups，P=0.743） and the mean number of lymph node dissection （9.8±6.3 vs.10.1±6.4，P=0.626） between the two groups. The overall 5-year survival rate of the VATS group was significantly higher than that of the thoracotomy group （81.5% vs.67.8%, P=0.001）. Subgroup analysis showed that the 5-year survival rate of pⅠa stage, pⅠb stage, and pⅢa stage was 86.0%, 84.5%, and 58.8% respectively in the VATS group, and 92.9%, 76.4%, and 25.3% respectively in the thoracotomy group. Conclusion Complete VATS lobectomy is technically safe and feasible for patients with early-stage NSCLC. The lymph node dissection extension of complete VATS lobectomy is similar to that of open thoracotomy, and long-term outcome of complete VATS lobectomy is superior to that of open thoracotomy. Randomized controlled trials of large sample size are further needed to demonstrate superiority.

电视胸腔镜下食管癌根治并胸内吻合术60例

Uniportal complete video-assisted thoracoscopic surgery of 133 patients

Objective To explore the learning curve and evaluate the safety of uniportal complete video-assisted thoracoscopic surgery (VATS) lobectomy. Methods We reviewed retrospectively the clinical data of 133 patients, who underwent uniportal VATS between March 2015 and October 2016 in Sichuan Provincial Cancer Hospital. There were 79 males and 54 females at age of 52.21±10.77 years. Results All the 127 patients completed uniportal VATS, 4.51% (6/133) converted to open surgery. There were 78 patients with lobectomy, 6 patients with segmentectomy, 37 patients with wedge resection, 6 patients with pleural, mediastinal lymph node biopsy or mediastinal tumor resection. In the lobectomy group, mean surgical time was 148.75±34.12 min, mean blood loss was 118.87±59.96 ml, mean number of lymph nodes was 11.25±6.15, the mean duration of chest-tube placement was 2.17±1.35 days, and mean length of stay was 7.58±2.59 days. Conclusion Based on skillful performance of the conventional thoracoscopic lobectomy, the learning curve for single port thoracoscopic lobectomy comprises at least 20 patients. The uniportal VATS lobectomy is a safe and operable method of minimally invasive technique, and it is worthy to be applied in thoracic surgery.

Videoassisted Thoracoscopic Lobectomy and Conventional Thoracotomy to Primary Nonsmall Cell Lung Cancer

Objective To investigate the clinical value of using videoassisted thoracoscopic lobectomy（VATS lobectomy） to treat primary nonsmall cell lung cancer(NSCLC) so that the videoassisted thoracoscopic surgery(VATS) can be better used in clinic. Methods From September 2007 to December 2008, seventysix NSCLC patients were collected. Thirtyseven patients underwent VATS lobectomy(VATS group), 21 male and 16 female with an average age of 60.4 years. Among them 20 underwent videoassisted minithoracotomy lobectomy, and 17 underwent total thoracoscopic lobectomy. Thirtynine patients underwent conventional thoractomy(conventional thoracotomy group), 32 male and 7 female with an average age of 58.7 years. Perioperative clinical and laboratory parameters of the two groups were compared. Results There was no severe complication and perioperative mortality in both groups. There were statistical significances between VATS group and conventional thoracotomy group in incision length (7.6±1.9 cm vs. 28.5±3.6 cm, t=-31.390,P=0.000), postoperative dosage of dolantin(160±125 mg vs.232±101 mg，t=-2.789,P=0.007), postoperative chest tube time(chest tube output＞100ml,4.8±2.5 d vs. 8.1±3.2 d，t=-4.944,P=0.000） and postoperative hospitalization time(12.1±3.0 d vs. 15.7±4.7 d，t=-3.945,P=0.000). There was no statistical significance between two groups in operation time（t=1.732，P=0.087）, intraoperative blood loss（t=-1.645，P=0.105） and the number of lymph node dissection（t=-0.088，P=0.930）. The total hospitalization expenses in VATS group were higher than that in conventional thoracotomy group, but there was no statistical significance（t=1.303，P=0.197）. The serum levels of glucose at 1st day after operation（7.2±1.2 mmol/L vs. 8.4±2.2 mmol/L, t=5.603,P=0.000）and the total count of white blood cell (12.7±3.8×10.9/L vs. 15.1±5.9×10.9/L,t=5.082,P=0.004) in VATS group were significantly lower than that in conventional thoracotomy group. The prealbumin(PA) level in VATS group was significantly higher than that in conventional thoracotomy group（215.0±45.5 mg/L vs.147.3+50.8 mg/L,t=-7.931,P=0.000). Conclusion VATS lobectomy could clean lymph node completely. Its advantages include less postoperative trauma, lower acute phase response, mild pain, rapid recovery, shorter hospitalization time and less economic burden. It could be an operation approach for early NSCLC patients who have been strictly selected.