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Analysis of the safety and feasibility of two closed thoracic drainage methods after video-assisted thoracoscopic lung volume reduction surgery

ObjectiveTo investigate the effects of closed thoracic drainage with single tube or double tubes after video-assisted thoracoscopic lung volume reduction surgery.MethodsRetrospective analysis was performed on 50 patients (39 males, 11 females) who underwent three-port thoracoscopic lung volume reduction surgery in our hospital from January 2013 to March 2019. Twenty-five patients with single indwelling tube after surgery were divided into the observation group and 25 patients with double indwelling tubes were divided into the control group.ResultsThere was no significant difference in pulmonary retension on day 3 after surgery, postoperative complications, the patency rate of drainage tube before extubation, retention time or postoperative hospital stay (P>0.05). Postoperative pain and total amount of nonsteroidal analgesics use in the observation group was less than those in the control group (P<0.05). ConclusionIt is safe and effective to perform closed thoracic drainage with single indwelling tube after video-assisted thoracoscopic lung volume reduction surgery, which can significantly reduce the incidence of related adverse drug reactions and facilitate rapid postoperative rehabilitation with a reduction of postoperative pain and the use of analgesic drugs.

Perioperative outcomes of uniportal versus three-port video-assisted thoracoscopic lobectomy for 2 112 lung cancer patients: A propensity score matching study

Objective To analyze the perioperative outcomes of uniportal thoracoscopic lobectomy compared with three-port thoracoscopic lobectomy. Methods Data were extracted from the Western China Lung Cancer Database, a prospectively maintained database at the Department of Thoracic Surgery, West China Hospital, Sichuan University. Perioperative outcomes of the patients who underwent uniportal or three-port thoracoscopic lobectomy for lung cancer during January 2014 through April 2021 were analyzed by using propensity score matching. Altogether 5 817 lung cancer patients were enrolled who underwent thoracoscopic lobectomy (uniportal: 530 patients; three-port: 5 287 patients). After matching, 529 patients of uniportal and 1 583 patients of three-port were included. There were 529 patients with 320 males and 209 females at median age of 58 (51, 65) years in the uniportal group and 1 583 patients with 915 males and 668 females at median age of 58 (51, 65) years in the three-port group. Results Uniportal thoracoscopic lobectomy was associated with less intraoperative blood loss (20 mL vs. 30 mL, P<0.001), longer operative time (115 min vs. 105 min, P<0.001) than three-port thoracoscopic lobectomy. No significant difference was found between the two groups regarding the number of lymph node dissected, rate of conversion to thoracotomy, incidence of postoperative complication, postoperative pain score within 3 postoperative days, length of hospital stay, or hospitalization expenses. Conclusion Uniportal video-assisted thoracoscopic lobectomy is safe and effective, and the overall perioperative outcomes are comparable between uniportal and three-port strategies, although the two groups show differences in intraoperative blood loss.

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。

胸腔镜下袖式肺叶切除术治疗支气管肺癌视频要点

胸腔镜下左肺下叶S8+9 段切除术视频要点

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

Progress in diagnosis and treatment strategies for multiple primary lung cancer

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.

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.

Surgical Treatment for Primary Spontaneous Pneumothorax without Bullae: A Comparative Study of Three Procedures

ObjectiveTo explore the surgical procedures for primary spontaneous pneumothorax without bullae. MethodsWe retrospectively analyzed the clinical data of 52 patients with primary spontaneous pneumothorax without bullae, who underwent surgical treatment in Second Affiliated Hospital of Kunming Medical University between January 2008 and January 2013. There were 46 males and 6 females, with mean average age of 23.2±4.3 years (ranged from 16 to 34 years). According to the different methods of intraoperative surgery, all patients were divided into three groups. The patients in a group Ⅰ (n=20) underwent video-assisted thoracoscope (VATS) selective apex of low energy electric coagulation treatment. The patients in a group Ⅱ (n=21) underwent VATS lung tip part of lung resection. The patients in a group Ⅲ (n=11) received VATS resection of the pleura. The clinical effectiveness among the three groups was compared. ResultsCompared with other two kinds of operation schemes,the leak duration(2.61±1.89 d vs. 4.90±3.20 d vs. 5.36±2.57 d, P=0.012), postoperative chest tube drainage time (3.67±2.13 d vs. 6.00±3.73 d vs. 7.03±2.58 d, P=0.003), postoperative length of hospital stay (4.95±2.16 d vs. 7.35±3.03 d vs. 8.61±2.67 d, P=0.002) and the recurrence rate (0.0% vs. 23.1% vs. 12.5%, P=0.021) of the patients with lung tip part resection of lung tissue by VATS were significantly lower. There were no statistically significant differences in the indicators of the patients with selective apex of low energy electric coagulation by VATS and those with pleural resection by VATS (P>0.05). ConclusionLung tip part of the lung tissue resection by VATS for primary spontaneous pneumothorax without bullae is better than VATS selective apical low energy coagulation treatment and VATS resection of the pleura both in the short and long-term efficacy.

Thoracoscope Surgery in 14 Children by Retaining Spontaneous Breathing under Intravenous Anesthesia

目的探讨单腔气管内插管保留自主呼吸的静脉全身麻醉下小儿胸腔镜手术的可行性及安全性。 方法选取郑州大学第一附属医院胸外科2012年2～12月采用单腔气管内插管保留自主呼吸行静脉全身麻醉下胸腔镜手术治疗的14例患儿作为试验组，男9例、女5例，年龄4～9岁；选取2010年5月至2011年10月采用常规双腔气管内插管全身麻醉下胸腔镜手术治疗的20例小儿患者作为对照组，男13例、女7例，年龄3～10岁。比较两组手术时间、术中失血量、术毕至拔管时间、住院费用、住院时间及术后并发症发生率等指标。 结果两组患儿手术均顺利，无术中术后死亡。试验组和对照组患儿平均手术时间[（85.7±16.9）min vs.（83.5±16.5）]及术中失血量[（90.0±55.0）ml vs.（85.0±50.0）ml]差异无统计学意义（P>0.05）。试验组的术毕至拔管时间[（0.5±0.1）min vs.（8.3±1.4）min]、住院费用[（24.3±4.7）千元vs.（27.8±5.3）千元]、住院时间[（6.6±0.9）d vs.（12.7±3.2）d]、术后并发症发生率（7.1%vs.25.0%）都显著短或少于对照组（P < 0.05）。 结论单腔气管内插管保留自主呼吸静脉全身麻醉下小儿胸腔镜手术治疗小儿胸部疾病具有一定的安全性及可行性。