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Clinical comparison of two thoracic drainage methods after thoracoscopic pneumonectomy

ObjectiveTo explore an effective and safe drainage method, by comparing open thoracic drainage and conventional thoracic drainage for lung cancer patients after thoracoscopic pneumonectomy.MethodsThe clinical data of 147 patients who underwent thoracoscopic pneumonectomy from January 2015 to March 2018 in our hospital were retrospectively analyzed, including 128 males and 19 females. Based on drainage methods, they were divided into an open drainage group (open group) and a conventional drainage group (regular group). The incidence of postoperative complications, chest tube duration, drainage volume at postoperative 3 days, postoperative hospital stay, hospitalization cost and quality of life were compared between the two groups.ResultsPostoperative complication rate was lower in the open group than that in the regular group (10.20% vs. 23.47%, P=0.04). The chest tube duration of the open group was longer compared with the regular group (5.57±2.36 d vs. 3.22±1.23 d, P<0.001). The drainage volume at postoperative 3 days was less in the regular group. In the open group, ambulation was earlier, thoracocentesis was less and re-intubation rate was lower (all P<0.001). The postoperative hospital stay in the regular group was significantly longer than that in the open group (8.37±2.56 d vs. 6.35±1.87 d, P<0.001) and hospitalization cost was significantly higher (66.2±5.4 thousand yuan vs. 59.6±7.3 thousand yuan, P<0.001). Besides, quality of life in 1 and 3 months after operation was significantly better than that in the open group (P<0.001).ConclusionCompared with the regular chest drainage, the effect of open thoracic drainage is better, which can help reduce postoperative complications, shorten the length of hospital stay, reduce the hospitalization cost and improve the quality of postoperative life. It is worthy of clinical promotion.

超声检测右心室功能对肺切除术患者预后的评估

目的　探讨用多普勒超声心动图检测术前静息和运动状态右心系统血流动力学变化及与患者术后恢复的关系。　方法　根据静息时右心射血分数 (RVEF)不同将 38例行肺切除术患者分为两组 ,A组 (n=17) :静息RVEFgt;0 .5 0 ,B组 (n=2 1) :RVEFlt;0 .5 0 ;又根据运动后 RVEF是否增加 ,将 38例患者分为两组 ,C组 (n=14 ) :RVEF增加 ,D组 (n=2 4 ) :RVEF降低。分别于术前和术后测定各组静息和运动状态的右心血流动力学等指标 ,观察这些指标的变化与患者术后恢复情况的关系。　结果　术后 D组与 C组比较 ,并发症发生例数增多 ,住院时间显著延长 ,心率增快 ,平均动脉压降低 ,RVEF较低 ,右心室收缩压较高 (Plt;0 .0 5 )。　结论　运动状态 RVEF值可作为肺切除手术患者术后恢复评估指标。

全肺切除治疗肺毛霉菌病合并肺脓肿一例并文献复习

目的 探讨侵袭性支气管肺毛霉菌病合并毛霉菌肺脓肿内科治疗无效时外科手术的可行性。方法 报告1例2022年在解放军总医院第八医学中心住院的支气管肺毛霉菌病合并毛霉菌肺脓肿患者内科治疗及外科手术过程，并对外科手术在肺毛霉菌病治疗中的有关文献进行复习。结果 患者男性，29岁，某药厂排污厂房工人，既往患有糖尿病。因咳嗽，咳痰，咯血40余天，高热5天入院。经支气管镜活检诊断为左主支气管毛霉菌病，积极内科治疗无效时，行左全肺切除术，术后治愈出院。术后病理示支气管肺毛霉菌病并左下肺毛霉菌肺脓肿。文献复习显示外科手术是支气管肺毛霉菌病治疗手段之一，但目前肺毛霉菌病手术治疗多限于单纯孤立病灶和肺叶切除术，全肺切除术罕见。未检索到类似本例全肺切除治愈支气管肺毛霉菌病，毛霉菌肺脓肿的报告。结论 侵袭性支气管肺毛霉菌病，合并毛霉菌肺脓肿在内科治疗无效时，外科手术治疗亦应值得考虑。

单剂头孢曲松预防肺手术后感染

目的 比较预防性使用单剂头孢曲松和四剂头孢曲松对肺手术后感染的效果，论证单剂头孢曲松预防方案的临床价值。方法 223例肺手术患者随机分成单剂头孢曲松组(单剂组，n=110）和四剂头孢曲松组（四剂组，n=113）进行临床对照研究。结果 单剂组的术后感染率（2%）明显低于四剂组（8%），差别具有显著性意义（Plt;0.05），而两组的平均住院时间和平均术后住院时间差别均无显著性意义(P＞0.05)。结论 单剂头孢曲松是一种较理想的肺手术预防性抗生素方案。

兔一侧全肺切除术后血浆心钠素变化及意义

目的　探讨心钠素(ANP)与肺切除术后心肺并发症的相关关系。　方法　将30只兔随机分为3组。组Ⅰ：12只，行左全肺切除术；组Ⅱ：12只，行右全肺切除术；对照组：6只，不行肺切除。3组术前、术后测血气分析，ANP，心肌酶和心电图监测，均不吸氧。　结果　组Ⅰ和组Ⅱ术后30分钟pH下降，动脉血氧分压(PaO2)下降，动脉血二氧化碳分压(PaCO2)升高；术后60分钟ANP升高，术后180分钟心肌酶升高，与术前比较差异均有显著性(P＜0.05或P＜0.01)。组Ⅰ和组Ⅱ有心律失常者的ANP与无心律失常者比较差异有显著性(P＜0.01)。ANP与PaO2，肌酸激酶呈相关关系(r=-0.737，0.779，P＜0.01)。　结论　兔一侧全肺切除术后ANP显著升高，可作为肺外科术后监测心肺并发症的无创指标之一。

电视胸腔镜肺切除的手术方法

目的 为了评价电视胸腔镜肺切除术在肺部肿瘤治疗中的可行性,而对其手术方法和治疗原则进行探讨. 方法 回顾性分析1992年10月至2000年3月,127例胸腔镜肺切除术患者的临床资料,其中肺楔形切除术71例,肺叶切除术50例,全肺切除术6例. 结果 全组无手术死亡及严重并发症, 手术时间、引流时间、住院时间均明显缩短.全组平均胸腔引流时间2.4天,平均住院天数10.6天. 结论 胸腔镜肺切除术是安全可行的,只要严格掌握手术适应证,运用合理的手术方法和技巧,一般可以达到与常规开胸手术同样的效果.

肺切除术后心脏疝一例

Influence of Perioperative Nursing Intervention on Pulmonary Tuberculosis Patients Undergoing Lung Resection

ObjectiveTo observe the impact of perioperative nursing intervention on pulmonary tuberculosis patients undergoing lung resection. MethodThirty-six pulmonary tuberculosis patients going to undergo lung resection hospitalized between January and December 2013 were randomly divided into intervention group and control group with 18 in each. Patients in the intervention group received routine perioperative care plus nursing intervention including preoperative, environmental, dieting and pain intervention. Then, complications, hospitalization time and costs, as well as patients' satisfaction with the nursing work were compared between the two groups. ResultsAfter nursing intervention, complications, hospitalization time, hospital costs of patients in the intervention group were significantly less than the control group (P<0.05), and patients' satisfaction was significantly higher (P<0.05). ConclusionsPerioperative nursing intervention on lung resection treatment and rehabilitation of patients play an active and effective role, which can reduce complications, shorten hospitalization time, reduce hospital costs and improve patients' satisfaction.

Progress of Thoracoscopic Pulmonary Segmentectomy for Early-Stage Non-small Cell Lung Cancer

Abstract： The principles of 2010 National Comprehensive Cancer Network（NCCN） clinical practice guidelines in non-small cell lung cancer address that anatomic pulmonary resection is preferred for the majority of patients with non-small cell lung cancer and video-assisted thoracic surgery (VATS) is a reasonable and acceptable approach for patients with no anatomic or surgical contraindications. By reviewing the literatures on general treatment, pulmonary segmentectomy, pulmonary function reserve, and the anatomic issue of early stage non-small cell lung cancer surgery, the feasibility and reliability of thoracoscopic pulmonary segmentectomy are showed.

Coopdech支气管封堵器用于全肺切除术后对侧胸腔内手术三例

目的探讨Coopdech支气管封堵器用于全肺切除术后对侧胸腔内手术麻醉的可行性及疗效。 方法回顾性分析上海市肺科医院2012年1～12月3例全肺切除术后患者需要进行对侧胸腔内手术时，在纤维支气管镜引导下置入Coopdech支气管封堵器隔离目标肺叶，进行选择性肺叶通气麻醉。比较3例患者封堵前后生命体征和血气分析。 结果3例患者均顺利完成手术，术中调整呼吸参数（封堵后，减少潮气量、增加呼吸频率）维持脉搏血氧饱和度（SpO2）大于96%、动脉血氧分压（PaO2）大于75 mm Hg、动脉血二氧化碳分压（PaCO2）35～45 mm Hg、pH值7.32～7.40，术中目标肺叶萎陷良好，给外科医生提供了良好的手术视野，术毕患者清醒拔管回ICU。 结论Coopdech支气管封堵器可以用于全肺切除术后对侧胸腔内手术的麻醉。