Objective To introduce the procedure of thoracic outlet tumors removal through posterior thoracotomy and its efficacy. Methods Ten patients with thoracic outlet tumors underwent surgical treatment via posterior approach from June 2004 to June 2007. Five patients suffered from neurogenic tumors, 4 patients apical lung carcinomas, and 1 patient apicoposterior lung tumor. The skin incision was started superiorly lateral to the transverse process of 6th cervical vertebrae, carried downward a way between the medial border of the scapula and the posterior midline and was extended in a gentle arc below the inferior angle of the scapula to the posterior axillary line. The chest was entered and the tumor is removed through resecting the rib(2nd or 3rd rib) located at the lower edge of the tumor after the scapula had been pushed forward. Results There was no death in this group. Tumors in 9 patients were resected completely. Thoracotomy only was done in another patients as a result of tumor invading neighboring major organs. Shoulder and back pain in 3 of 4 patients was remitted postoperatively. Two patients with “dumbell” neurogenic tumors improved strength of lower limbs. Pain and abdominal wall reflex resumed in one patient and muscle strength of lower limbs increased to 4th grade from 2nd grade in another one. Two patients required thoracentesis because of complicating with pleural effusion. The mean followup period was 18 months (range 336). Seven of 10 patients still lead a normal life. Conclusion Posterior thoracotomy can provide an excellent approach to remove the thoracic outlet tumors safely and completely.
Objective To summarize the experience of surgical treatment of congenital heart diseases through right axillary mini-thoracotomy and analyse related problems. Methods Two hundred and twenty-four patients of congenital heart diseases underwent open heart surgery under cardiopulmonary bypass （CPB） through a right axillary mini-thoracotomy（3rd or 4th intercostal）. Among them repair of ventricular septal defect （VSD） in 168, repair of atrial septal defect （ASD） in 48, total correction of tetralogy of Fallot （TOF） in 6, double-outlet right ventricular in 1 and Ebstein syndrome in 1. Results There was 1 postoperative death （0.45%）, the cause of death was acute pulmonary edema. Postoperative complication occurred in thirteen cases （5.8%）. There were no significant changes in CPB time, aortic cross clamping time, ventilating time and hospital stay days between right axillary minithoracotomy and median sternotomy at the same period （Pgt;0. 05）, but the bleeding volume both intraoperative and postoperative in the patients of right axillary mini-thoracotomy were significantly less than those in the patients of median sternotomy （Plt;0. 01）. Two hundred and fourteen patients were followed up （follow-up time from 2 months to 7 years）, 3 of them had early mild cardiac function insufficiency（ejection fractionlt;0. 50）, small residual shunt were found in 2 patients after VSD operation and the others recovered satisfactorily. Conclusion There were merits in right axillary mini-thoracotomy approach for treatment of properly selected congenital heart diseases; safe and reliable, low operative bleeding volume, and good results of aesthetics. But the use of this incision for repair of TOF and more complex congenital heart diseases should be careful.
Objective To find out the best time and investigate the indications for conversion to horacotomy in completely thoracoscopic lobectomy. Methods Between Sep. 2006 and Feb. 2009, 172 patients including 88 male and 84 female with the median age of 58.9 years, underwent completely thoracoscopic lobectomy. Postoperative pathology showed that there were 133 cases of primary lung cancer, 7 cases of lung cancer metastasis and other malignant tumors, and 32 cases of benign diseases. Among them, 46 patients had the tumor on the right upper lobe (RUL), 23 on the right middle lobe (RML), 31 on the right lower lobe (RLL), 36 on the left upper lobe (LUL) and 36 on the left lower lobe (LLL). Three incisions were made in all operations. The procedures of systematic lymphadenectomy and anatomic lobectomy were similar with routine thoracotomy. If there was mediastinal lymph node adhesion, metastasis or bleeding, the incision would be extended to 12-15 cm and the surgery would be converted to thoracotomy. According to whether the maximum tumor dimension was above 5 cm or under 3 cm, the patients were divided into two groups. At the same time, we also divided the patients into two groups based on whether thoracotomy was performed. The data of both two groups were compared respectively. Results All surgeries were carried out safely with no serious complications or perioperative deaths. The average surgical duration was 185 minutes, and the average blood loss was 213 ml. Thirteen operations were converted to thoracotomy with a conversion rate of 7.6%. Among them, 9 were interfered by lymph nodes and bleeding happened in 4 operations. Lobectomy was performed on 12 patients and pneumonectomy was performed on 1 patient after thoracotomy. For the 16 cases of tumor with its dimension larger than 5 cm, the average operation time was 187 minutes and the average blood loss was 203.8 ml, while for the 98 cases of tumor with its dimension smaller than 3 cm, the average operation time was 202 minutes and the average blood loss was 231.3 ml. The difference between these two groups was not statistically significant. Among the 13 cases of conversion to thoracotomy, the mean age of the patients was 68.7 years old and the average tumor dimension was 23.8 mm. For the 159 cases without thoracotomy, the average age was 59.3 years old and the tumor dimension averaged 27.8 mm. There was a significant difference between them (P=0.016). Conclusion Interference by lymph nodes and bleeding are the most important causes of conversion to thoracotomy in completely thoracoscopic lobectomy while size of tumor, fused fissure or plural adhesions can be always managed thoracoscopically.
Objective To review the clinical experience of Heller myotomy for treatment of achalasia through a small thoracotomy. Methods Twenty-five patients with achalasia (9 moderate, 16 severe) underwent Heller myotomy without concomitant antireflux procedure through a small incision. A left thoracotomy was carried out through either the seventh or eighth intercostals space. The length of skin incision was 6 to 8 cm. Results There was no hospital death and severe postoperative complications. The mean operating time was 50 minutes. Mean hospital stay was 10 days. There was one intraoperative perforation and repaired successfully. All patients reported good to excellent relief of dysphagia and no symptom of gastroesophageal reflux after surgery. Eight patients were subsequently studied with a 24-hour esophageal pH monitoring and no evidence of pathologic reflux found. Conclusions Transthoracic Heller myotomy with a small incision is effective and safe method for treatment of achalasia with minimal invasion, quick recovery, less postoperative complication and shorter hospital stay. Proper extent of the myotomy may decrease the risk of subsequent gastroesophageal reflux in the postoperative period.
ObjectiveTo investigate the therapeutic effect, safety and effectiveness of multiple valvular surgery through right anterolateral intercostal thoracotomy, as well as the mid-term follow-up results and surgeon's learning curve.MethodsThe clinical data of 154 patients with multiple valvular disease were performed minimally invasive cardiac surgery in the Department of Cardiovascular Surgery, The First Affiliated Hospital of Air Force Medical University, from 2015 to 2019 were retrospectively analyzed. There were 103 males and 51 females, aged 23-68 years. Closed cardiopulmonary bypass was established through femoral artery and femoral vein, and the thoracic cavity was entered through a 6 cm transverse incision in the fourth intercostal space on the right side of sternum. Baseline and perioperative characteristics and postoperative outcomes were reviewed.ResultsThere was no perioperative death. The average cardiopulmonary bypass time was 159.3±39.4 min, and the aortic clamping time was 102.3±20.3 min. One patient underwent thoracotomy during the operation, and two patients underwent second thoracotomy for hemostasis. During the follow-up period of 10-55 months, 1 patient died, 2 patients developed mild perivalvular regurgitation, 6 patients developed moderate tricuspid regurgitation, and no serious cardiovascular events occurred in the rest of the patients.ConclusionOur findings demonstrate that multiple valvular surgery through right anterolateral intercostal thoracotomy is safe, and in an acceptable risk of complication. The early and middle follow-up results are satisfactory. The minimally invasive cardiac surgery can also meet the requirements of cosmetology, and is conducive to the recovery of patients' mental and physical health. This method is worthy of application in medical centers with rich experience in routine cardiac surgery.
Objective To observe the short-term efficacy and the incidence of adverse cardiovascular events in patients aged over 80 years with multivessel coronary artery disease following two-stage Hybrid surgery. Methods We retrospectively analysed the clinical data of 67 patients aged over 80 years with multivessel coronary artery disease undergoing surgery in our hospital. The were 44 males and 23 females with an anverage age of 82.4±2.1 years. According to the operation pattern, the patients were divided into two groups: a two-stage Hybrid surgery group (n=29, 19 males, 10 females, aged 83.2±3.1 years) and a traditional thoracotomy group (n=38, 25 males, 13 females, aged 83.3±3.4 years). We compared the clinical results of perioperation between the two groups. Results Conpared with the traditional thoracotomy group, the two-stage Hybrid surgery group had shorter postoperative duration of mechanical ventilation (6.7±2.2 hvs. 18.2±3.4 h) and hospitalization stay (15.7±3.0 dvs. 20.7±5.6 d) and had less volume of chest drainage during the first 24 h after surgery (176.5±32.3 mlvs. 443.8±51.5 ml). The incidence of adverse cardiovascular events in the two-stage Hybrid surgery group was significantly lower than that in the traditional thoracotomy group (6.9%vs. 23.1%, P<0.05). Conclusion The two-stage Hybrid surgery in patients aged over 80 years with multivessel coronary artery disease can significantly decrease the postoperative incidence of adverse cardiovascular events, shorten the postoperative duration of mechanical ventilation and hospitalization stay, reduce the volume of chest drainage during the first 24 h after surgery and improve prognosis of surgery for the elderly patients.
Objective To compare right anterolateral minithoracotomy and traditional median sternotomy in the treatment of left atrial myxoma. Methods Forty-one patients with left atrial myxoma treated in our hospital from January 2009 to January 2018 were divided into two groups according to the operation method: a right anterolateral minithoracotomy group including 15 patients, with 7 males and 8 females, aged 45.1±15.4 years; a median sternotomy group including 26 patients, with 10 males and 16 females, aged 49.4±11.9 years. The clinical data of the two groups were compared. Results There was no significant difference in preoperative clinical data between the two groups. All patients completed the operation without perioperative death. There was no significant difference in the operation time, cardiopulmonary bypass time, aortic clamp time or the incidence of postoperative complications between the two groups. However, compared with the median sternotomy group, the right anterolateral minithoracotomy group had shorter duration of mechanical ventilation, ICU stay and postoperative hospital stay, and less volume of drainage and blood transfusion 24 hours after surgery (all P<0.05). After 3–106 months follow-up, no recurrence was observed in both groups. Conclusion Compared with traditional median sternotomy for left atrial myxoma resection, right anterolateral minithoracotomy is safe, effective and less traumatic. It can be used as a routine treatment for left atrial myxoma.
Objective To investigate the impact of complete video-assisted thoracoscopic lobectomy and open lobectomy on perioperative heart rate （HR） and blood oxygen saturation （SO2） of lung cancer patients，and explore whether minimally invasive surgery can enhance postoperative recovery of lung cancer patients. Methods A total of 138 lung cancer patients were chosen from 161 consecutive patients with pulmonary diseases who were admitted to West China Hospital of Sichuan University between September 2010 and December 2011. According to different surgical approach，all the 138 lung cancer patients were divided into routine thoracotomy group （thoracotomy group，70 patients including 53 males and 17 females with their average age of 56.1±9.7 years） and complete video-assisted thoracoscopic lobectomy group （VATS group，68 patients including 46 males and 22 females with their average age of 53.4±6.5 years）. There was no statistical difference in preoperative clinical characteristics between the 2 groups. Preoperative and postoperative （1st，3rd，7th and 30th day） numeric pain rating scale （NPRS），HR and SO2 were compared between the 2 groups. Results （1） There was no statistical difference in NPRS on the 1st and 3rd postoperative day between the 2 groups （3.83±0.79 vs. 3.93±0.67， 2.88±0.59 vs. 3.03±0.71，P＞0.05），but on the 7th and 30th postoperative day，NPRS of the thoracotomy group was signi- ficantly higher than that of VAST group （1.61±0.33 vs. 1.22±0.12，1.58±0.26 vs. 1.19±0.31，P＜0.05）. （2） Postop- erative sedentary HR of both VATS group and thoracotomy group were significantly higher than preoperative levels ［（84.13±17.21） / minute vs. （73.67±10.32）/minute， （86.13 ±19.67） / minute vs. （72.24±14.21） / minute， P＜0.05］. Postoperative HR of VATS group decreased to preoperative level on the 3rd postoperative day，while postoperative HR of the thoracotomy group decreased to preoperative level on the 7th postoperative day. （3） There was no statistical difference between preoperative and postoperative （all the time points） sedentary SO2 of both VATS group and thoracotomy group （96.34 %±2.11% vs. 97.12%±2.31%，95.33%±4.13% vs. 94.93% ±4.31%，P＞0.05）.（4） The changes of HR and SO2 before and after exercise of VATS group were significantly smaller than those of the thoracotomy group on the 3rd postoperative day ［（11.11±4.81）/minute vs. （18.23±6.17）/minute，3.1%±1.2% vs. 7.4 %±2.7%，P＜0.05］ . Conclusion The impact of complete video-assisted thoracoscopic lobectomy on cardiopulmonary function is comparatively smaller，which is helpful for postoperative fast-track recovery of lung cancer patients.
ObjectiveTo summarize clinical advantages and outcomes of minimally invasive mitral valve replacement (MVR) combined with atrial fibrillation (AF) radiofrequency ablation via right minithoracotomy. MethodsEight patients with mitral valve disease and AF who received surgical therapy in the First Hospital of China Medical University between October 2009 and October 2012 were included in the study. There were 4 males and 4 females with their age of 34-67 (52.4±17.5) years. All the patients underwent minimally invasive MVR combined with AF radiofrequency ablation via right minithoracotomy. Clinical outcomes were summarized. ResultsThere was no in-hospital death or conversion to conventional sternotomy in this group. Two patients received biological valve replacement and 6 patients received mechanical prosthesis. Operation time was 207.9±18.1 minutes, cardiopulmonary bypass time was 81.7±23.9 minutes, and chest drainage amount was 126.7±34.5 ml. AF recurred in 1 patient on the 3rd postoperative day. All the patients were in sinus rhythm at discharge. These patients were followed up for 18.3±7.4 months. During follow-up, 1 patient had AF recurrence. Seven patients were in NYHA class Ⅰ, and 1 patients was in NYHA class Ⅱ. ConclusionMinimally invasive MVR combined with AF radiofrequency ablation via right minithoracotomy can achieve satisfactory clinical results and esthetic appearance, and is a good choice for patients with mitral valve disease and AF.
ObjectiveTo investigate therapeutic effect and influence on survival of complete laparoscopic transesophageal hiatus approach approach and transabdominal combined thoracotomy approach in treatment of Siewert type Ⅱesophageal gastric junction adenocarcinoma (AEG).MethodsFrom January 2012 to December 2014, the patients with Siewert type Ⅱ AEG were collected in the Department of General Surgery (Gastrointestinal Surgery) of Weifang People’s Hospital, then who were designed into a transabdominal group and transabdominal combined thoracotomy group according to the operative approach method. The intraoperative and postoperative statuses were compared between these two groups.ResultsIn this study, 142 patients with Siewert type Ⅱ AEG were included, 83 in the transabdominal group and 59 in the transabdominal combined thoracotomy group. There were no significant differences in the baseline data such as the gender, age, preoperative histological differentiation, TNM stage, etc. between the two groups (P>0.05). Compared with the transabdominal combined thoracotomy group, in terms of the operation time, the volumes of intraoperative blood loss and blood transfusion, and the proportion of patients with blood transfusion were better (P<0.05); the postoperative hospitalization time, time to use analgesics, time of the first activity out of bed, and time of removed electrocardiographic monitoring were also earlier (P<0.05); the numbers of lymphadenectomy and metastatic lymph nodes were less (P<0.05) in the transabdominal group. But there was no significant difference in the rate of lymph node metastasis between the two groups (P>0.05). The total incidence of complications in the transabdominal group was lower than that in the transabdominal combined thoracotomy group (χ2=9.871, P=0.002). The median survival time was 39 months in the transabdominal group and 34 months in the transabdominal combined thoracotomy group. The survival had no significant difference between the two groups by the Kaplan-Meier analysis (χ2=0.281, P=0.596). The result of multivariate analysis showed that the TNM stage and lymph node positive rate were the independent factors influencing the survival of the patients with Siewert type Ⅱ AEG.ConclusionsAccording to results of this study, it is safe and effective for patients with Siewert type Ⅱ AEG to adopt a complete laparoscopic transabdominal approach. For elderly patients with poor cardiopulmonary function who can not tolerate transthoracic surgery, it could reduce postoperative complications and improve safety.