Abstract：Pulmonary metastasectomy is an important curative option for patients with osteogenic and softtissue sarcoma spread to the lungs. Complete surgical removal of pulmonary metastases can improve survival and is recommended under certain criteria. Specific issues that require consideration when planning pulmonary metastasectomy include: preoperative assessment of the operation index and contraindications, choice of surgical strategies, pulmonary parenchymal preservation, and the role of lymphadenectomy. With the development of iconography and chemotherapy, the emergence of targeted drugs, and the innovation of radiotherapy, the concept of the diagnosis and treatment for pulmonary metastases from osteogenic and softtissue sarcoma is also undergoing great changes.
Desmoid tumor is a rare, locally-invasive fibromatosis with a high recurrence rate and non-metastatic features. Here, we reported a 62-year male patient with desmoid tumor in the superior sulcus of left lung, complaining of cough, chest pain, limited-movement, and pain on the left upper arm. We performed extended resection of the tumor, including wedge resection of the left upper lobe, resection and anastomosis of partial left subclavian artery, resection of T1 nerve root, cauterization of adhesive pleura, and resection of the left first and second ribs. After surgery, the patient's symptoms were relived. The duration of hospital stay was 8 d. This is the first reported case of surgical treatment for the superior sulcus desmoid tumor.
Abstract: Objective To investigate the value of videoassisted thoracoscopic surgery (VATS) in the treatment of myasthenia gravis (MG) by comparing the early clinical outcomes of extensive thymectomy of VATS and median sternotomy. Methods 195 patients who received extended thymectomy for MG from July 1998 to May 2007 in our department were divided into two groups by operative approach, 83 patients in the VATS group (from April 2002 to May 2007) and 112 patients in the full median sternotomy group(from July 1998 to May 2007). The clinical features, such as operative time, operative blood loss, postoperative drainage, the incidence of crisis, duration of crisis (time of mechanical ventilation), were retrospectively analysed by independent samples t test or chisquare test to evaluate the early outcomes.Results The postoperative drainage in the VATS group was more than that in the median sternotomy group (164.65±38.19ml vs. 98.26±26.84ml, P=0.023), and the operative blood loss in the VATS group was less than that in the median sternotomy group（53.24±11.69ml vs. 97.37±24.61ml,P=0.036）. The incidence of crisis in the VATS group was 4.82%（4/83），which was less than that in the median sternotymy group ［13.39%(15/112), P=0.046,OR=3.054］. And the persistence time of mechanical ventilation for post-operative crisis in the VATS group was much shorter than that in median sternotomy group （75.33±39.31h vs. 189.20±89.74h, P=0.012）. Conclusion VATS extended thymectomy for myasthenia gravis is safe and less invasive. It can decrease the incidence of crisis and the time of mechanical ventilation of crisis, as well as decreasing operative blood loss.
目的 总结纤维瘤病的治疗经验。方法 回顾性分析1998年6月至2007年6月峰峰集团孙庄矿医院收治的39例纤维瘤病患者的临床资料。结果 首次手术治疗31例，其中治愈27例，复发4例； 保守治疗的8例，与手术后复发的4例再次接受手术治疗，其中10例治愈，2例复发（均为再手术病例）。结论 纤维瘤病若手术切除不彻底，易复发； 扩大切除术效果较好。
Objective To compare three surgical treatments for mediastinal mass with myasthenia gravis. Methods Retrospective analysis was performed on the clinical data of 53 patients who underwent extended thymectomy between January 2010 and December 2017 in our hospital. There were 29 males and 24 females, aged 17-73 years. Patients were divided into three groups according to the surgical methods: a group A (video-assisted thoracoscopic surgery with the da Vinci robotic system, n=22), a group B (video-assisted thoracoscopic surgery, n=12) and a group C (median sternotomy, n=19). The gender distribution, age, intraoperative blood loss, operation time, postoperative extubation time, postoperative hospital stay, Osserman classification of myasthenia gravis, postoperative myasthenic remission rate, etc were compared in three groups. Results No perioperative death was observed in 53 patients. One patient in the group C suffered from postoperative myasthenic crisis and improved after active treatment. One patient with video-assisted thoracoscopic surgery was converted to median sternotomy due to the intraoperative injury of the left brachiocephalic vein. Compared with the group B and group C, the group A had shorter operation time, less intraoperative blood loss and drainage on the first postoperative day and fewer days of extubation. Postoperative hospital stay was less in the group A than that in the group C (P<0.05). The postoperative myasthenic remission rate was higher in the group A than that in the other two groups, but there was no statistical difference. Conclusion Because of the robot’s unique minimally invasive advantage, in this study, the outcome of patients with myasthenia gravis treated with Da Vinci robots and thymectomy is better than that of the remaining two groups in terms of perioperative outcomes and myasthenic remission rate. But long-term results and a large of number matching experiments are needed to confirm. However, it is undeniable that robotic surgery must be the future of the minimally invasive surgery.
ObjectiveTo analyze the risk factors for post-thymectomy myasthenic crisis (PTMC) and prolonged mechanical ventilation, in myasthenia gravis patients who underwent extended thymectomy. MethodsWe retrospectively analyzed the clinical data of 79 patients including 38 males and 41 females who experienced PTMC and required mechanical ventilation in Daping Hospital between June 2008 and November 2014. Single factor analysis and multivariate analysis were conducted. ResultsMorbidity of PTMC was 20.6% (79/384). Result of single-factor analysis showed that postoperative pneumonia was one of the main reasons of prolonged mechanical ventilation (P < 0.05). Result of multiple-factor analysis showed that the operation time was positively correlated with mechanical ventilation time (P < 0.05). The risk factor of prolonged mechanical ventilation time in PTMC was not associated with sex, age, disease history, myasthenic crisis history, Osserman classification, dosage of pyridostigmine before and after the operation, surgical approach, bleeding volume, other therapies besides mechanical ventilation (P > 0.05). ConclusionMechanical ventilation is one the main therapy of PTMC, operation time, and postoperative pneumonia are the main factors to prolong mechanical ventilation time. In order to decrease morbidity of PTMC and shorten mechanical ventilation time, the operation time should be controlled and pulmonary infection should be avoided.
Myasthenia gravis (MG) is an autoimmune disease with indefinite pathogenesis. MG is closely related to thymic diseases, and thymectomy is an important way for MG treatment. However, there are some controversies regarding thymectomy, including indications, operation opportunities, operative procedures, surgical approaches, perioperative managements, and efficacy evaluations, etc. Therefore, based on the literature and the experience of Chinese experts, this consensus has been written after careful discussion and inquiry and 29 recommendations have been made, aiming to guide surgical treatment of MG and improve the clinical outcomes.
Objective To evaluate the effectiveness and advantages of the wide local excision for Paget’s disease involing the penis and scrotum by comparing with the radical excision. Methods A retrospective analysis was made on the clinical data of 41 patients with Paget’s disease involving penis and scrotum who met the inclusion criteria between November 2010 and August 2015. Among them, 14 patients received wide local excision (group A), and 27 patients received radical excision (group B). No significant difference was found in age, course of disease, and lesion site between two groups (P>0.05). The recurrence rate, operative time, times of intraoperative frozen section pathology, hospitalization time, grade of wound healing, appearance and functions satisfaction were recorded and compared between two groups. Results The operative time and hospitalization time in group A were significantly shorter than those in group B (P<0.05); the times of intraoperative frozen section pathology in group A were significantly less than that in group B (P<0.05). All patients were followed up 13 to 67 months (mean, 35.5 months) in group A and 11 to 70 months (mean, 38.8 months) in group B. Grades A, B, and C wound healing was obtained in 11 cases, 2 cases, and 1 case of group A and in 12 cases, 7 cases, and 8 cases of group B respectively, showing significant difference between two groups (Z=–2.102, P=0.036). The 5-year recurrence rate was 28.6% (4/14) in group A and 22.2% (6/27) in group B, showing no significant difference (χ2=0.202, P=0.654). The score of satisfaction in appearance and functions in group A was significantly higher than that in group B (t=–2.810, P=0.008). Conclusion Paget’s disease involving penis and scrotum has a slow disease progression and good prognosis. Wide local excision can relieve symptoms effectively and obviously decrease perioperative risk in elderly patients, with no significant increase of the recurrence rate.
ObjectiveTo investigate the clinical characteristics of uniportal and three-port subxiphoid video-assisted thoracoscopic surgery (XVATS) extended thymectomy.MethodsThe clinical data of 60 consecutive patients of XVATS thymectomy in Xuzhou Central Hospital from January 2017 to May 2019 were retrospectively analyzed. There were 29 males and 31 females, with an average age of 53.1 (27.0-76.0) years. The patients were divided into an uniportal XVATS group (30 patients) and a three-port XVATS group (30 patients). The clinical effectiveness was compared between the two groups.ResultsThere was no significant difference in age, sex, body mass index, tumor size, intraoperative blood loss, postoperative time of thoracic tube indwelling and thoracic drainage, or postoperative hospitalization time between the two groups (P>0.05). There was no perioperative mortality, conversion to thoracotomy, thrombosis or mediastinal infection. The operation time of the uniportal XVATS group was significantly longer than that of the three-port group (87.5±19.0 min vs. 75.8±15.7 min, P=0.012). Besides, patients in the uniportal group had significantly lower pain score during 3-14 postoperative days than that of the three-port group (P=0.001).ConclusionUniportal XVATS extended thymectomy is feasible with less pain as compared with the patients using three-port XVATS, but it needs longer operation time at initial stage.