ObjectiveTo investigate the occurrence of indwelling urinary catheter in patients receiving thoracoscopic lobectomy and relevant risk factors.MethodsWe retrospectively reviewed the clinical data of the 737 patients who received thoracoscopic lobectomy in our hospital and analyzed the risk factors of indwelling urinary catheter during postoperative hospitalization using univariate analysis and multiple-variate logistic regression analysis between December 2018 and May 2019. There were 253 males and 484 females at median age of 57 (50, 64) years.ResultsA percentage of 14.4% (106/737) of the patients adopted postoperative indwelling urinary catheter. Univariate regression analysis showed that gender and postoperative bedridden time were risk factors for indwelling urinary catheter in the patients after thoracoscopic lobectomy (P<0.05). Multiple-variate logistic regression analysis showed that male gender (OR=2.018, 95% CI 1.316-3.096, P<0.001) and postoperative bedridden time >18 hours (OR=2.298, 95%CI 1.502-3.516, P<0.001) were the independent risk factors for indwelling urinary catheter.ConclusionMale gender and those with longer postoperative bedridden time are high-risk population to indwell urinary catheter. Positive measures should be taken to reduce the chance of indwelling urinary catheter.
Cardiac surgery has a gradual change from traditional median sternotomy to minimally invasive surgery due to the appearance and application of peripheral extracorporeal circulation. There are great differences in the clinical practice of two different surgical methods in mitral valve operation. Minimally invasive thoracic surgery has the advantages of less trauma, less bleeding, faster recovery, beauty and so on. However, such surgery also has its weaknesses, such as longer learning curve, narrow operation space and high requirements of equipment. To compare the differences of early and long-term results in mitral valve operation between traditional median sternotomy and minimally invasive thoracic surgery is to better summarize and operate minimally invasive thoracic surgery for mitral valve surgery.
ObjectiveTo compare solitary pulmonary nodule resection via thoracoscopic 3D mode or 2D mode and to further evaluate the clinical application value of thoracoscopic 3D mode. MethodsWe retrospectively analyzed the clinical data of 120 patients with solitary pulmonary nodule between March 2013 and March 2014 in the First Hospital Affiliated to Xiamen University. The patients were allocated into two groups including a 3D-VATS group (50 patients) and a 2D-VATS group (70 patients). Pulmonary partial resection was performed firstly. Pulmonary lobectomy would be conducted or not on the basis of intra operative rapid pathological results. ResultsTwenty three patients were performed 3D-VATS in the 3D-VATS group. Twenty-nine patients were diagnosed as pathological malignancy underwent lobectomy plus partial dissection. There were statistical differences between the 3D-VATS group and the 2D-VATS group in operative time (t=1.967, P<0.05), intra operative blood loss (t=7.85, P<0.05), drainage volume 24 h after operation (t=6.18, P<0.05), postoperative chest tube retention time (t=7.1, P<0.05), and postoperative hospital stay (t=2.35, P<0.05). Following-up time in the 3D-VATS group was 6.3 (2-12) months. Complications occurred in 3 patients, including 2 patients with postoperative pneumonia and 1 patient with paroxysmal atrial fibrillation in the 3D-VATS group. The following-up time in the 2D-VATS group was 8.2 (2-15) months. Complications occurred in 4 patients, including 1 patient with chylous hydrothorax, 2 patients with pneumothorax, 1 patient with delayed pulling up the chest closed drainage in the 2D-VATS group. The patients in both groups with complications were cured by appropriate treatment. Conclusion3D-VAST for SPN is a new operation mode choice. It is safe and feasible with low incidence of postoperative complications. Surgery vision, stereo feeling, the operation of adaptation, and postoperative recovery have certain advantages. It is worthy popularizing.
ObjectiveTo summarize the experience of totally thoracoscopic cardiac surgery for ventricular septal defect.MethodsClinical data of 449 patients undergoing totally thoracoscopic cardiac surgery for ventricular septal defect from May 2008 to December 2018 in Shanghai Yodak Cardiothoracic Hospital were analyzed retrospectively. There were 232 male and 217 female patients, aged from 3 to 55 years with a mean age of 17.3±11.2 years.ResultsAll the operations were completed successfully. Mean operative time was 2.4±0.3 h. The mean extracorporeal circulation time and aortic cross-clamp time was 64.2±11.6 min and 28.4±10.7 min, respectively. Mechanical ventilation time and intensive care unit stay was 6.9±3.8 h and 20.5±5.6 h, respectively. Postoperation drainage quantity was 213.1±117.2 mL. The hospital stay was 6.9±1.3 d. Intraoperative and postoperative complications occurred in 11 patients (2.4%), including 1 patient of intraoperative reoperation, 3 patients of reoperation for bleeding, 3 patients of the incision infection, 2 patients of small residual shunt, 1 patient of right femoral artery incision stenosis complicated by thromboembolism and 1 patient of right pleural cavity pneumothorax. The mean follow-up time was 72.2±33.9 months. During the period, there was no reoperation, but 2 patients of ventricular septal defect small residual shunt, 1 patient of mild-moderate mitral valve and 1 patient of mild-moderate aortic valve incompetence, respectively. During the period, heart function of the patients was NYHAⅠ-Ⅱ.ConclusionTotally thoracoscopic cardiac surgery for ventricular septal defect is a safe and effective treatment, with few serious complications, fast recovery for patients and good short to medium-term outcomes.
Objective To analyze the clinical efficacy of totally thoracoscopic surgery and conventional thoracotomy in repair of ventricular septal defect (VSD). Methods We retrospectively reviewed the clinical data of 50 VSD patients admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2015 to January 2017. According to the surgical pattern, they were divided into two groups: a totally thoracoscopic surgery group (21 patients, 13 males, 8 females, aged 38.36±10.02 years), and a thoracotomy group (29 patients, 18 males, 11 females, aged 42.36±13.02 years). The operation time, hospital stay, ventilator-assisted time and thoracic drainage were compared between the two groups. Results There was no death in two groups. In the thoracoscopic group the duration of cardiopulmonary bypass (CPB) time and the aortic clamping time were longer than those of the thoracotomy group (P<0.05), but postoperative drainage, patients with postoperative use of blood products and postoperative hospital stay were less (P<0.05). There was no statistically significant difference between the two groups in operation time, postoperative ventilator-assisted time or duration of ICU stay. Conclusion Compared with the conventional thoracotomy, totally thoracoscopic VSD repair with less trauma, quicker recovery and less blood use, is safe and reliable and can be used as a preferred surgical intervention.
ObjectiveTo investigate the feasibility and clinical outcomes of bilateral endoscopic thoracic sympathectomy (ETS) through single hole for palmar hyperhidrosis (PHH). MethodsFrom August 2012 to April 2013, 19 PHH patients were admitted in the Department of Thoracic Surgery, The Third People's Hospital of Chengdu. There were 7 male and 12 female patients with their age of 24.7(15-33) years. All the patients underwent bilateral ETS through single hole under general anesthesia. ResultsAll the operations were successfully performed. Average operation time was 28.4 minutes, and postoperative hospital stay was 1.6 days. Seventeen patients were followed up for 2 to 10 months. PHH symptoms all disappeared without Horner's syndrome or hemopneumothorax. ConclusionBilateral ETS through single hole is a minimally invasive, reliable and safe procedure for PHH with low morbidity.
ObjectiveTo compare postoperative efficacy of thoracoscopic partial pneumonectomy with or without thoracic drainage tube postoperatively.MethodsThe PubMed, Wanfang database, CNKI and Web of Science from January 2000 to August 2020 were searched by computer to collect randomized controlled studies (RCT), cohort studies and case-control studies on the efficacy of chest drainage tube placement versus no placement after thoracoscopic partial pneumonectomy. Two reviewers independently screened articles and extracted data to evaluate the risk of literature bias. Meta-analysis was performed with RevMan software.ResultsA total of 15 articles were included, including 1 RCT and 14 cohort studies. A total of 1 524 patients were enrolled, including 819 patients in the test group (no postoperative chest drainage tube group) and 705 patients in the control group (postoperative chest drainage tube group). Compared with the control group, the length of hospital stay in the test group was shorter (MD=–1.3, 95%CI –1.23 to –0.17, P<0.000 01) and the incidence of postoperative pneumothorax was higher (RD=0.06, 95%CI 0.01 to 0.10, P=0.01). There was no significant difference between the two groups in operation time (MD=–2.37, 95%CI –7.04 to 2.30, P=0.32), the incidence of postoperative complications (RR=2.43, 95%CI 0.79 to 1.80, P=0.39), the reintervention rate of postoperative complications (RD=0.02, 95%CI=–0.00 to 0.04, P=0.05), postoperative subcutaneous emphysema (RD=0.02, 95%CI –0.01 to 0.06, P=0.20) and the incidence of postoperative pleural effusion (RD=0.04, 95%CI –0.00 to 0.09, P=0.10) .ConclusionCompared with the patients with chest drainage tube placement after thoracoscopic partial pneumonectomy (the control group), the test group can shorten the hospital stay. Although the incidence of postoperative pneumothorax is higher than that of the control group, the operation time, incidence of postoperative subcutaneous emphysema and in-hospital complications, and reintervention rate of in-hospital complications are not statistically significant between the two groups. Therefore no chest drainage tube may be placed after partial pneumonectomy.
Objective To explore the safety, effectiveness, and mid-term efficacy of total thoracoscopic mitral valvuloplasty (MVP) with chordal replacement (CR) and quadrangular resection (QR) for the treatment of mitral regurgitation (MR), and to provide reference for guiding the development and selection of clinical diagnosis and treatment methods for MR patients. Methods A prospective randomized controlled study was performed to collect patients with MR who underwent MVP at the Department of Cardiovascular Surgery, Leshan People's Hospital from January 2021 to March 2022. They were randomly divided into a CR group and a QR group by using a random number table, and were followed up for 12 months after the operation. The medical history, perioperative data and adverse cardiac endpoint events during the follow-up period were collected. The differences in surgical efficacy between the two groups were evaluated and compared, and the Kaplan-Meier method was used to compare the differences in survival rates between the two groups of patients. Results A total of 100 patients were enrolled. There were 46 patients in the CR group, including 27 males and 19 females with an average age of 49.50±9.23 years; there were 46 patients in the QR group, including 24 males and 22 females with an average age of 49.91±11.48 years. The aortic occlusion time in the CR group was longer than that in the QR group (P<0.05). Other surgical indicators, including total surgical time, extracorporeal circulation time, ventilator-assisted time, ICU hospitalization time, size of the valve ring, concomitant surgery during the same period, and the incidence of perioperative complications were not statistically different between the two groups (P>0.05). The left atrium diameter, left ventricular end-diastolic diameter, left ventricular end-diastolic volume, left ventricular end-systolic volume, and left ventricular ejection fraction (LVEF) of the two groups before discharge after the surgery were significantly improved compared to those before surgery (P<0.05). There was a statistical difference in LVEF between the two groups before discharge after the surgery (P<0.05). There was no statistical difference in clinical efficacy between the two groups (P>0.05). Kaplan-Meier analysis showed that the overall incidence of exemption from mild and above mitral regurgitation 12 months after the surgery in the CR group and QR group was 84.8% and 89.1%, respectively. According to the log-rank test, there was no statistical difference in the overall survival curve between the two groups (χ2=0.356, P=0.551). Conclusion CR and QR are both safe and effective methods for the treatment of simple posterior MR.
ObjectiveTo summarize the clinical experience of thoracoscopic combined subsegmentectomy (CSS). MethodsThe clinical data of 76 patients who underwent thoracoscopic CSS in Anqing Municipal Hospital from May 2018 to July 2022 were retrospectively analyzed, including 22 males and 54 females, aged 27.0-76.0 (54.3±10.5) years. All patients underwent preoperative three-dimensional computed tomography bronchography and angiography using dual source CT. The modified inflation-deflation technique or indocyanine green was used to identify the intersubsegmental border. ResultsA total of 86 pulmonary nodules were resected in 76 patients. One patient of left upper lobe S1+2c+S4a, 1 patient of right upper lobe S2b+S3a and 1 patient of right upper lobe S1b+S3b were further performed lobectomy due to insufficient margin. One patient of left upper lobe S1+2+S3a was further performed left upper division segmentectomy due to residual atelectasis. One patient of left upper lobe S1+2c+S3a was further performed left upper division segmentectomy due to B3b+c injury, and the rest completed planned surgeries successfully. The operative time was 90.0-350.0 (174.9±53.2) min. The operative hemorrhage volume was 50.0 (20.0, 50.0) mL. The postoperative hospital stay time was 6.0 (5.0, 7.0) d. Postoperative complications included pulmonary infection in 9 patients, hemoptysis in 3 patients, persistent pulmonary leakage>3 d in 4 patients, pneumothorax in 1 patient, pleural effusion in 1 patient, and myocardial infarction in 1 patient. All of the patients were cured and discharged without perioperative death. ConclusionThoracoscopic CSS is relatively complex. Preoperative planning under three-dimensional reconstruction and intraoperative fine operation are helpful for safe completion.
Objective To explore clinical application values of thoracoscopic and laparoscopic-assisted minimally invasive McKeown procedure for esophageal cancer. Methods Clinical data of 196 patients with esophageal cancer （EC） who underwent thoracoscopic and laparoscopic-assisted minimally invasive McKeown procedure in West China Hospital of Sichuan University from February 2008 to August 2012 were analyzed retrospectively. There were 145 male and 51 female patients with their age of 40-76 （58.8±6.6） years. There were 43 patients with EC in the upper segment of the esophagus, 115 patients with EC in the middle segment of the esophagus and 38 patients with EC in the lower segment of the esophagus.Results Total operation time was 215-780 （305.0±40.7） minutes，including thoracoscopic operation time of 50-580 （105.0±38.4） minutes and laparoscopic operation time of 28-105 （54.0±8.6） minutes. Intraoperative blood loss was 20-440 （285.4±38.5） ml. The number of dissected lymph nodes was 6-39 （20.4±1.6） for each patient. Postoperative hospital stay was 7-93 （12.8±5.2） days. Sixty patients （30.6%） had postoperative complications，including 28 patients （14.3%） with pulmonary comp-lications，5 patients （2.5%） with chylothorax，5 patients （2.5%） with arrhythmias，15 patients （7.6%） with anastomotic fistula，10 patients （5.0%） with recurrent laryngeal nerve injury，and other complications in 2 patients. Conclusion Thoracoscopic and laparoscopic-assisted minimally invasive McKeown procedure is a safe and feasible operation for esophageal cancer.