ObjectiveTo evaluate the efficacy of thoracoscopic complex segmentectomy for stageⅠnon-small cell lung cancer (NSCLC).MethodsWe retrospectively reviewed the perioperative clinical data of patients with stageⅠNSCLC who underwent thoracoscopic complex segmentectomy (n=58) or simple segmentectomy (n=33) between January 2017 and March 2020 in our hospital. There were 36 males and 55 females with a median age of 57 years (range: 50-66 years). The clinical data of the two groups were compared.ResultsThere were no significant differences between the two groups in characteristics including age, sex, weight, comorbidities, preoperative pulmonary function, dominant composition of tumor, tumor histology and size, overall complications, estimated blood loss, prolonged air leakage, length of hospital stay, length of drainage, surgical margin distance or number of dissected lymph nodes. Only the operation time and number of staples for making intersegmental plane were significantly different between the two groups (P<0.05). There was no perioperative death in both groups.ConclusionThoracoscopic complex segmentectomy is a feasible and safe technique for stageⅠNSCLC.
With the development and improved availability of low-dose computed tomography (LDCT), an increasing number of patients are clinically diagnosed with lung cancer manifesting as ground-glass nodules. Although radical surgery is currently the mainstay of treatment for patients with early-stage lung cancer, traditional anatomic lobectomy and mediastinal lymph node dissection (MLND) are not ideal for every patient. Clinically, it is critical to adopt an appropriate approach to pulmonary lobectomy, determine whether it is necessary to perform MLND, establish standard criteria to define the scope of lymph node dissection, and optimize the decision-making process. Thereby avoiding over- and under-treatment of lung cancer with surgical intervention and achieving optimal results from clinical diagnosis and treatment are important issues before us.
ObjectiveTo investigate the influence of different discontinuation time of clopidogrel and aspirin before off-pump coronary artery bypass grafting on postoperative volume of drainage and blood products imported.MethodsA total of 454 patients who underwent coronary artery bypass grafting in Beijing Anzhen Hospital from January 2017 through December 2019 were included. According to the preoperative discontinuation of clopidogrel and aspirin, all the 454 patients were divided into three groups including a guide group, a non-stop group and a stop group. There were 86 patients in the guide group including 59 males and 27 females with an average age of 64.12±6.15 years. They continued to take aspirin 100 mg/d before operation, but stopped clopidogrel for more than 5 days. In the non-stop group, there were 234 patients including 141 males and 93 females with an average age of 63.71±7.01 years. They continued to take aspirin 100 mg/d before operation, and stopped clopidogrel <5 days. In the stop group, there were 134 patients including 76 males and 58 females with an average age of 62.90±7.78 years. They stopped aspirin and clopidogrel for more than 5 days before operation. The clinical effectiveness was compared among the three groups.ResultsNo perioperative death occurred in all patients. There was no statistical difference in platelet count, coagulation function, liver function, renal function, or myocardial markers among the groups (P>0.05). The hemoglobin [97 (15) g/ L vs. 98 (21) g/L vs. 100 (20) g/ L, F=4.894, P=0.008] in the non-stop group was lower than that in the guide group and the non-stop group at 30 minutes postoperatively. The flow volume (399.87±127.19 mL vs. 367.05±125.89 mL vs. 349.63±130.68 mL, F=7.770, P=0.000) in the non-stop group at 3 hours postoperatively, the flow volume [600 (300) mL vs. 580 (245) mL vs. 550 (350) mL, Z=8.218, P=0.016] in the non-stop group at 6 hours postoperatively, the flow volume [750 (370) mL vs. 730 (350) mL vs. 730 (350) mL, Z=8.329, P=0.016] in the non-stop group at 12 hours postoperatively, the flow volume [890 (365) mL vs. 850 (340) mL vs. 850 (350) mL vs. Z=6.585, P=0.037] in the non-stop group at 24 hours postoperatively and the flow volume [950 (375) mL vs. 940 (360) mL vs. 940 (380) mL, Z=8.680, P=0.013] in the non-stop group at 48 hours postoperatively were more than those of the guide group and the stop group. The retention time of drainage tube was longer in the non-stop group [3 (1) d vs. 3 (1) d vs. 3 (1) d, Z=6.579, P=0.037] than in the guide group and the non-stop group. The amount of suspended erythrocytes input [0 (2) U vs. 0 (2) U vs. 0 (0) U, Z=6.150, P=0.046], and the amount of plasma input [200 (200) mL vs. 0 (200) mL vs. 0 (200) mL, F=4.144, P=0.016], the number of cases of plasma input (119 patients vs. 34 patients vs. 47 patients, Z=10.116, P=0.006) were more than those of the guide group and the stop group.ConclusionAspirin maintenance is recommended for patients before off-pump coronary artery bypass grafting. If not necessary, clopidogrel is discontinued for at least 5 days.
ObjectiveTo review our experience of reoperations for pulmonary venous stenosis (PVS) after total anomalous pulmonary venous connection (TAPVC) repair for the past decade in Fuwai Hospital.MethodsNine patients underwent reoperation for PVS between 2009 and 2019 in Fuwai Hospital, including 4 males and 5 females with an average age of 5.10±5.00 years. The patients were divided into a sutureless group (n=3) and a non-sutureless group (n=6). Clinical data were reviewed and analyzed.ResultsFor primary TAPVC type, 4 patients were supracardiac, 2 patients were cardiac, 1 patient was infracardiac, and 2 patients were mixed-type anomaly. The median cardiopulmonary bypass time was 95 (63, 208) min, aortic clamping time was 58 (30, 110) min, ICU stay was 24 (24, 2 136) h. Early hospital death occured in 1 (11.1%) patient. One (11.1%) patient with single ventricle physiology had hospital comorbidity, who underwent hemofitration therapy. The follow-up time was 11.9 (2.2, 18.0) months, during which 1 patient died of restenosis of pulmonary vein and another patient died of stroke. No statistically significant difference was found between the sutureless group and non-sutureless group in postoperative or follow-up results (P>0.05). ConclusionSurgery is effective for treatment of PVS after repair of TAPVC, yet with a realatively high morbidity and mortality. The advantage of sutureless repair over conventional repair for this particular group of patients is yet to be verified.
ObjectiveTo review and summarize the research progress of adenocarcinoma of esophagogastric junction (AEG) in staging, surgical treatment, endoscopic treatment and adjuvant therapy in recent years, so as to provide reference and help for the follow-up research and treatment of this disease.MethodLiterature review was used to review the literatures on AEG treatment in various databases.ResultsThe incidence of AEG had increased rapidly in recent years, with high malignancy and poor prognosis. Siewert typing had allowed researchers to gain insight into the disease, and treatments were increasingly diversified. At present, the main treatment was still radical surgery. Because AEG was adjacent to the esophagus and stomach, there were many controversies about its staging, surgical approach, resection range, digestive tract reconstruction, adjuvant treatment and so on, especially Siewert type Ⅱ.ConclusionsThe surgical approach, resection range, and laparoscopic surgery of Siewert typeⅡcan choose according to esophageal involvement distance judgment, pathological staging is uncertain, still need several studies to reach a consensus. With the application of laparoscopy and adjuvant therapy, how to select individualized treatment options that require multidisciplinary collaboration for further study.
Objective To evaluate the effectiveness of arthroscopic treatment and nonsurgical treatment on ankle degenerative osteoarthropathy. Methods Between July 2009 and June 2011, 58 patients (58 ankles) suffering from ankle degenerative osteoarthropathy underwent arthroscopic treatment (arthroscopic group, n=28) and routine treatment (control group, n=30). There was no significant difference in gender, age, body mass index, disease duration, and degree of ankle degenerative osteoarthropathy between 2 groups (P gt; 0.05). Mazur score, visual analogue scale (VAS), and Tegner activity scale were used to evaluate the effectiveness. Results Incision healed primarily in arthroscopic group. The patients of 2 groups were followed up 1-2 years, averaged 1.5 years in arthroscopic group and 1.6 years in control group. At last follow-up, Mazur, VAS, and Tegner scores were significantly improved when compared with the preoperative scores in 2 groups (P lt; 0.05), but no significant difference was found at last follow-up between 2 groups (P gt; 0.05). According to Mazur scoring, the results were excellent in 8 cases, good in 14 cases, fair in 5 cases, and poor in 1 case, with an excellent and good rate of 79% in arthroscopic group; the results were excellent in 6 cases, good in 15 cases, fair in 6 cases, and poor in 3 cases, with an excellent and good rate of 70% in control group; and no significant difference was observed between 2 groups (u=0.98, P=0.77). Moreover, there was no correlation between Outerbridge classification and Mazur score in patients undergoing arthroscopic treatment (r=0.18, P=0.34). Conclusion Arthroscopic and nonsurgical treatments of ankle degenerative osteoarthropathy can both achieve good effectiveness.
ObjectiveTo understand the current situation of surgical treatment of hilar cholangiocarcinoma. MethodThe literature relevant to surgical treatment of hilar cholangiocarcinoma at home and abroad in recent years was reviewed. ResultsThe various surgical treatment schemes of hilar cholangiocarcinoma had advantages and disadvantages. At present, there were still disputes and no unified consensus on preoperative preparation, selection of intraoperative surgical resection range, and applications of laparoscopy and robot, etc. The individualized surgical treatment plan should still be formulated based on the specific condition of the patient and the professional experience of the surgeon. The individualized surgical treatment plan should still be formulated based on the specific condition of the patient and the professional experience of the surgeon. ConclusionIt is believed that accurate preoperative condition evaluation should be carried out for each patient with hilar cholangiocarcinoma, so as to formulate the best surgical treatment plan, achieve individualized accurate treatment and benefit patients.
Artificial chord is a mature mitral valve repair technique, especially in adult mitral valve repair. It is still challenging to repair mitral valve in children with artificial chords because the quality of mitral valve is soft and immature. There are some differences in the methods of suture, the choice of suture size and the number of artificial chords. Although the artificial chords could not grow naturally, we found through the long-term research that most children did not have mitral valve restriction or even chords rupture due to itself can compensate through the growth of the flap and papillary muscle. This article summarizes the recent research progress on the treatment of mitral valve insufficiency in children with artificial chords, providing reference for clinical treatment.
Objective To evaluate the safety and mid- to long-term efficacy of surgical correction of isolated partial anomalous pulmonary venous connection (IPAPVC). Methods We retrospectively collected consecutive patients who were diagnosed with IPAPVC and underwent surgical correction at Fuwai Hospital of Chinese Academy of Medical Sciences and Fuwai Yunnan Cardiovascular Hospital from June 2009 to May 2019, summarized the basic preoperative and intraoperative data of patients, analyzed the postoperative and mid- to long-term follow-up results. Results A total of 54 patients were enrolled, including 29 males and 25 females, with an average age of 16.20±2.40 years, ranging from 1 month to 62 years. There were 28 (51.9%) patients with varying degrees of arrhythmia, 22 (40.7%) patients with cardiac insufficiency, and 39 (72.2%) patients with pulmonary hypertension. According to Bordy's typing, 14 (25.9%) patients were classified as type A, 23 (42.6%) type B, 4 (7.4%) type C, 5 (9.3%) type D and 8 (14.8%) mixed type. Transthoracic echocardiography was performed in the whole group of patients and the accuracy of staging diagnosis was 66.7% (36/54), and cardiac CT angiography (CTA) was performed in 37 patients and the accuracy of staging diagnosis was 94.6% (35/37). All surgical procedures were assisted with cardiopulmonary bypass, aortic cross-clamping time was 0-219 (67.02±5.23) min, cardiopulmonary bypass time was 40-261 (105.09±5.23) min, and there was no serious intraoperative complication. Postoperative tracheal intubation time was 0-230 (13.33±4.20) h, intensive care unit stay was 0-13 (1.89±0.28) days, postoperative hospital stay was 5-18 (7.20±0.38) days, and follow-up time was 16-140 (62.58±5.12) months. There were 2 (3.7%) all-cause postoperative deaths, including 1 in-hospital death and 1 death during the follow-up, and there was no intraoperative death. Among the survivors, there were 3 patients with surgery-related complications: 1 patient had atrial septal defect with the second surgical treatment, 1 early obstruction of the superior vena cava and 1 arrhythmia. Two patients had complications of IPAPVC (atrial fibrillation, collateral circulation) prior to surgery and underwent the second surgery with a poor prognosis, and 1 patient had preoperative cardiac insufficiency and atrial fibrillation, whose symptoms persisted for a long time during the follow-up. Conclusion IPAPVC accounts for a lower percentage of partial anomalous pulmonary venous connection, transthoracic echocardiography combined with CTA improves diagnostic accuracy, and IPAPVC should be treated with elective surgery after diagnosis. The surgical approach should be individualized with imaging features such as disease staging, number of drains and drainage location. Surgical treatment of IPAPVC is safe and effective, and regular follow-up is warranted.
ObjectiveTo compare the outcomes following emergency surgery or conservative treatment for patients with acute type A aortic intramural hematoma (IMH).MethodsClinical data of consecutive patients diagnosed with acute type A aortic IMH in our hospital from September 2014 to December 2018 were retrospectively analyzed. The patients who met our surgical indications received surgery (an operation group) and other patients received strict conservative treatment (a conservative treatment group).ResultsFinally 127 patients were enrolled, including 112 males and 15 females with an average age of 53.6±13.0 years. Of 127 patients, 85 (66.9%) patients accepted emergency surgery and 42 (33.1%) patients accepted strict conservative treatment. There was no difference between the two groups in early mortality or complications (P＞0.05). The 5-year survival rate was 90.4% in the operation group and 74.3% in the conservative treatment group (P=0.010). A maximum aortic diameter in the ascending aorta and aortic arch≥45 mm and maximum thickness of IMH in the same section≥8 mm were risk factors for IMH-related death in patients undergoing conservative treatment (P＜0.001).ConclusionThe mortality associated with emergency surgery for patients with acute type A aortic IMH is satisfactory. In clinical centers with well-established surgical techniques and postoperative management, emergency surgical treatment may provide a better outcome than conservative treatment for patients with acute type A aortic IMH.