共查询到20条相似文献,搜索用时 15 毫秒
1.
M. R. P. Van Den Bossche G. Leman K. E. W. Ballaux J. Himpens 《Surgical endoscopy》1999,13(2):166-167
Pulmonary hernias are extremely rare. They are usually treated with open surgical procedures. We describe a case in which
a large, spontaneously acquired intercostal pulmonary hernia was successfully repaired by video-assisted thoracoscopic surgery
(VATS).
Received: 12 August 1996/Accepted: 26 November 1996 相似文献
2.
Indalecio Cano Juan L. Antn-Pacheco Araceli García Steve Rothenberg 《European journal of cardio-thoracic surgery》2006,29(6):997-1000
Objective: Congenital lung malformations are often discovered on routine prenatal sonography or postnatal imaging. Lesions such as congenital cystic adenomatoid malformation or pulmonary sequestration may be asymptomatic at birth, and their management is controversial. Thoracoscopy in children has been mainly used for lung biopsy and for the treatment of empyema and recurrent pneumothorax. Very few reports of more technically demanding procedures, such as lobectomy, are currently available. This report evaluates the safety and efficacy of video-assisted thoracoscopic (VATS) lobectomy in infants and small children with asymptomatic prenatally diagnosed lung lesions. Methods: During 2004, six patients underwent VATS lobectomy without a mini-thoracotomy. Mean age was 10 months (range, 6–19 months). Preoperative diagnosis included congenital cystic adenomatoid malformation (n = 5) and an extralobar pulmonary sequestration. All patients were asymptomatic and surgery was performed electively. Three or four 3–5 mm ports were used. Single lung ventilation and controlled low pressure pneumothorax were used in every case. A bipolar sealing device was the preferred mode of vessel ligation and bronchi were closed with interrupted sutures. A chest tube was left in all cases. Results: All the procedures were completed thoracoscopically. Operating times ranged from 70 to 215 min (mean, 130 min). There were five lower lobe and one middle lobe resections. There were no intraoperative complications and chest tubes were left in place 1–4 days. Two patients showed postoperative hemothorax that stopped spontaneously. Hospital stay ranged from 4 to 9 days (mean, 7 days). Conclusions: VATS lobectomy in small infants is a feasible and safe technique. Decreased postoperative pain, a shorter hospital stay, and a better cosmetic result are definite advantages of this minimally invasive procedure. Long-term morbidity due to a major thoracotomy incision is avoided. 相似文献
3.
Background: Indications for the use of video-assisted thoracic surgery (VATS) lobectomy are a controversial matter. This study aims to
provide a retrospective evaluation of VATS lobectomy in typical bronchopulmonary carcinoids.
Methods: Patient selection criteria for VATS lobectomy were as follows: (a) typical carcinoids with clear diagnosis; (b) centrally
located lung tumors not amenable to bronchial resection with bronchoplastic procedures, or tumors located in peripheral lung
tissues; (c) no hilar or mediastinal lymph node enlargement; and (d) normal respiratory function. Between January 1995 and
December 1999, 12 patients (eight men and four women with a mean age of 57 years) were treated, seven with a peripheral and
five with a centrally located tumor. Preoperative examination included chest roentgenograms, computed tomography (CT) of the
chest, bronchoscopy, and spirometry; diagnosis was established by direct bronchoscopy in five cases, transbronchial biopsy
in two cases, transthoracic biopsy in two cases, and videothorascopic wedge resection in three cases. Eleven VATS lobectomies
and one VATS bilobectomy were performed. All patients underwent hilar lymphadenectomy and mediastinal sampling.
Results: There were no intraoperative complications. The only postoperative complication, hematothorax (8.3%), required VATS reoperation.
Mean postoperative hospital stay was 5.33 days. Pathological examination of the resected specimens confirmed that the procedure
was radical in all 12 patients and revealed eight T1N0 and four T2N0. At a mean follow-up of 30 months, no signs of recurrence
were recorded.
Conclusion: VATS lobectomy in the treatment of selected typical carcinoids, both central and peripheral, seems to yield favorable results
and is therefore preferable to thoracotomy since it is less invasive.
Received: 21 January 2000/Accepted: 11 May 2000/Online publication: 5 October 2000 相似文献
4.
电视胸腔镜下治疗肺叶切除术后支气管胸膜瘘 总被引:2,自引:0,他引:2
本文报道 2例肺癌患者行肺叶切除分别于术后第 4、7天出现支气管胸膜瘘。再次手术经VATS直接以无损伤编织线缝合封闭瘘口 ,外用医用合成胶或生物蛋白胶。 2例支气管膜瘘均治愈出院。 相似文献
5.
Background Video-assisted thoracoscopic surgery (VATS) lobectomy does not represent a unified approach, but rather a spectrum of operative techniques ranging from a complete endoscopic thoracotomy to a minithoracotomy. A prospective randomized trial was conducted to compare the differences in these techniques and their results to determine the best of VATS lobectomy for lung cancer.Methods This study randomized 39 consecutive patients with clinical stage I lung cancer to undergo either a complete (C-VATS, n = 20) or an assisted (A-VATS, n = 19) VATS approach for pulmonary lobectomy.Results The operating time was longer (p = 0.002) and blood loss was less (p = 0.004) with C-VATS than with A-VATS. Although there was no significant difference in analgesic use or duration of thoracic drainage between the groups, a shorter hospitalization was observed after C-VATS. Serum peak levels of postoperative inflammatory markers (white blood cell count, C-reactive protein, creatine phosphokinase) were lower with C-VATS and an earlier return to normalization than with A-VATS.Conclusion Various differences exist among the VATS lobectomy techniques, and complete VATS lobectomy as a purely endoscopic surgery may be technically feasible and a satisfactory alternative to the conventional procedure for stage I lung cancer. 相似文献
6.
Analysis of thoracoscopy in trauma 总被引:4,自引:2,他引:2
7.
We describe herein the operative steps used to perform a transmyocardial laser revascularization by thoracoscopy. A special
technique and specific equipment are required for the efficacy and safety of the procedure. Our preliminary results with this
novel approach suggest that it could be a valid alternative to the thoracotomic procedure. 相似文献
8.
Background: Recent data suggest that children have a higher incidence of recurrence than adults after nonoperative treatment of primary
spontaneous pneumothorax (PSP). Video-assisted thoracoscopic surgery (VATS) allows efficacious therapy with significantly
less morbidity. We attempt to define the most cost-effective clinically efficacious strategy using VATS to manage pediatric
PSP.
Methods: We retrospectively reviewed all admissions to a tertiary care children's hospital for PSP between January 1, 1991 and June
30, 1996.
Results: Fifteen children had 29 primary or recurrent PSPs. Mean patient age was 14.8 ± 1.1 years, boy–girl ratio 4:1, median body
mass index 18 (normal, 20–25), and 67% of pneumothoraces left sided. All patients were managed initially nonoperatively: 14
with tube thoracostomy drainage and 1 with oxygen alone. Of the children initially managed nonoperatively, 57% had a recurrent
pneumothorax, and 50% of these patients eventually developed contralateral pneumothoraces. Nonoperative treatment for recurrence
resulted in a 75% second recurrence rate. In contrast, eight children who underwent operative management had a 9% incidence
of recurrence. The total for charges accrued in treating 29 pneumothoraces in these 15 patients was approximately $315,000.
In the same population, the estimated charges for initial nonoperative therapy followed by bilateral thoracoscopy after a
single recurrence would be $230,000.
Conclusions: A cost-effective treatment strategy for pediatric primary spontaneous pneumothorax is tube thoracostomy at first presentation,
followed by VATS with thoracoscopic bleb resection and pleurodesis for patients who experience recurrent pneumothorax.
Received: 15 May 1998/Accepted: 15 January 1999 相似文献
9.
Background: Fibropurulent empyema (stage II of Light) does not respond to antibiotic therapy and simple drainage. If the condition is
inadequately treated, restrictive pulmonary deficit develops, necessitating thoracotomy and decortication. We report our experience
with the videoscopic management of stage II and limited stage III disease.
Methods: Ten consecutive patients underwent videoscopic debridement of fibropurulent empyema; three of them required removal of limited
visceral and parietal rind.
Results: The mean operating time was 42 ± 8.1 min. Postoperative pyrexia and leucocytosis settled within 4.2 ± 2.1 days and 13.1 ±
3.2 days, respectively. Intercostal chest tubes were removed by 4.5 ± 1.0 days. The mean fall in hematocrit following surgery
was 4.9%. Parenteral analgesics were required for 1.0 ± 0.5 days and oral analgesics for 3 ± 1.6 days. The mean postoperative
stay was 11 ± 8.1 days. No patient required any further intervention.
Conclusions: Videoscopic debridement of empyema produces excellent results, with minimal patient morbidity and a short hospital stay.
We recommend it as the preferred method for first-line management of fibropurulent (stage II) empyema.
Received: 10 December 1998/Accepted: 13 May 1999 相似文献
10.
K. Nakajima M. Fukuzawa M. Minami Y. Fujii Y. Fukui N. Usui Y. Komoto M. Takashina A. Okada 《Surgical endoscopy》1998,12(1):54-56
This report describes a case of anterior mediastinal teratoma in a 10-year-old girl, which was successfully resected thoracoscopically.
Received: 4 October 1996/Accepted: 23 January 1997 相似文献
11.
Operative technique for thoracoscopic thymectomy 总被引:2,自引:1,他引:1
In most cases, myasthenia gravis (MG) and thymoma require complete removal of the thymus gland and resection of the pericardial
fatty tissue. There is some debate however, over which surgical approach is best for thymectomy. We have developed a new technique
for complete thoracoscopic thymectomy. Between October 1994 and February 1998, we performed a prospective observational study
of thoracoscopic thymectomy in 19 patients. The results were analyzed with special reference to perioperative morbidity, short-
and intermediate-term improvement of MG, and quality of life. This study showed the feasibility of complete thoracoscopic
thymectomy. The procedure was successfully applied in 19 of 20 cases. Thoracoscopic thymectomy was accomplished with zero
mortality and a very low perioperative morbidity. While the short-term improvement of MG after this procedure was comparable
to that seen with conventional surgery, the short- and intermediate-term quality of life was much better. The preliminary
results of thoracoscopic thymectomy appear to be excellent for both patients and neurologists. A prospective randomized trial
has been designed to compare thoracoscopic thymectomy with the gold standard of median sternotomy for thymectomy.
Received: 9 March 1998/Accepted: 22 June 1998 相似文献
12.
Min Jeng Cho Dae Yeon Kim Seong Chul Kim Ki-Soo Kim Ellen Ai-Rhan Kim Byong-Sop Lee 《Journal of pediatric surgery》2012
Purpose
The goal of this study was to compare the safety and efficacy of treatment for pulmonary sequestration (PS) by transcatheter arterial embolization (TAE) versus surgical resection and to consider the role of a thoracoscopic approach.Methods
A retrospective review involving 73 children (≤ 15 years of age) with PS between 2002 and 2011 was performed.Results
Forty-two patients were managed with TAE, and 31 underwent surgery alone. Their presenting symptoms were pneumonia (n = 11), pneumothorax (n = 2), pneumomediastinum (n = 1) and respiratory distress (n = 6).Fifty-three (72.6%) were asymptomatic. The average age at treatment was 17.0 ± 44.4 and 31.3 ± 41.7 months for the TAE and surgery groups, respectively. In the TAE group, complete regression was observed in only 3 patients, 4 showed no regression, and 35 (83.3%) had residual lesions. Four patients developed sepsis or other blood vessel complications after TAE. The results of resection via thoracotomy versus a thoracoscopic approach were evaluated in 34 patients, including 3 who underwent the operation after TAE. Twenty-seven patients underwent thoracotomy, and 7 underwent thoracoscopic resection. There were no significant differences between the groups except time to chest tube removal, which was shorter in the thoracoscopic group (p = 0.046). Complications included a wound infection in 1 patient after thoracotomy.Conclusions
We believe that even in asymptomatic patients, all PSs should be resected because of the risk of infection, the low rate of natural regression, complications after TAE, and to exclude other pathology. Our experience also shows that thoracoscopic resection of PS is feasible, efficacious, and safe in newborns and infants. 相似文献13.
Background: Minimally invasive surgery (MIS) is an ideal way to obtain biopsy specimens in children with cancer. We examined the safety,
reliability and outcome of decisions made based on tissue obtained using MIS.
Methods: Fifty-nine oncology patients underwent 62 MIS procedures between January 1994 and July 1998. Complications, biopsy results,
and outcomes were reviewed.
Results: The study population comprised 32 boys and 27 girls, with an average age of 8.8 years. There were 47 thoracoscopic and 15
laparoscopic operations. Laparoscopic procedures included initial biopsy, determination of resectability, and second-look
exam. Thoracoscopic procedures included 40 lung biopsies and seven biopsies/resections of mediastinal masses. Diagnostic accuracy
was 100% in all cases. No patient was found retrospectively to have been inadequately treated based on decisions made from
tissue obtained by MIS.
Conclusion: MIS is a safe and accurate means of obtaining tissue in pediatric oncology patients. Treatment decisions can be made accurately
and with confidence using these techniques.
Received: 19 March 1999/Accepted: 27 August 1999 相似文献
14.
A. P. C. Yim 《Surgical endoscopy》1996,10(12):1198-1200
Background: Video-assisted thoracoscopic surgery (VATS) is now an established approach in the management of many thoracic conditions.
However, the high cost of this new technology has deterred many Asian hospitals from widely applying this technique.
Methods: This article describes our strategies to reduce cost in our practice of VATS over the last few years.
Results: VATS involves (1) careful patient selection, (2) use of conventional thoracic instruments as much as possible, (3) modification
of conventional instruments, (4) limited use of expensive consumables, and (5) development and application of endoscopic suturing
technique.
Conclusions: VATS is still in evolution. Cost containment, while desirable in the West, is a high priority in Asia if this new surgical
approach is to be applicable even in developing countries. More research is greatly needed in this area.
Received: 13 February 1996/Accepted: 10 June 1996 相似文献
15.
Complications in thoracoscopic spinal surgery 总被引:7,自引:0,他引:7
Background: The literature contains few reports on negative outcomes after thoracoscopic spinal surgery.
Methods: From November 1995 to February 1998, 90 patients underwent minimally invasive spinal surgery by thoracoscopic assistance
as treatment for their anterior spinal lesions. The diagnoses included 41 spinal metastases, 13 cases of scoliosis, 12 burst
fractures, 10 cases of tuberculous spondylitis, 8 cases of pyogenic spondylitis, 2 thoracic disc herniations, 2 cases of ankylosing
spondylitis with discitis, 1 osteoporotic compression fracture, and 1 case of thoracolumbar kyphosis. The procedures included
biopsy only (3 patients); thoracic discectomy (3 patients); multilevel anterior releases, discectomy, and fusion (14 patients);
corpectomy for decompression (6 patients); corpectomy and interbody fusion (32) patients; and internal instrumentation (28
patients).
Results: A total of 30 complications were noted in 22 patients (24.4%). Two fatal complications occurred, resulting from massive blood
transfusion in one case and postoperative pneumonia in another. Other nonfatal complications included four cases of transient
intercostal neuralgia, three superficial wound infections, three cases of pharyngeal pain, two cases of lung atelectasis,
two cases of residual pneumothorax, two cases of subcutaneous emphysema, one inadvertent pericardial penetration due to adhesion,
one chylothorax that resolved after conservative management, one vertebral screw malposition, and one graft dislodgement that
needed late revision surgery. Three patients required ventilatory support for longer than 72 hours. Five patients with spinal
metastases had an estimated intraoperative blood loss of more than 2,000 ml. No injury to the internal organs or spinal cord
was observed. There were four conversions to open procedures due to two cases of severe pleural adhesions and two poorly tolerated
one-lung ventilation. At the latest follow-up, nine patients had died as a result of cancer dissemination.
Conclusions: (a) Well-selected patients and attention to details are essential to optimizing surgical results. (b) A refined technique
for less invasive tumor surgery has been developed. (c) Surgeons had better experience with the standard anterior spinal approach
and showed no hesitation in converting to an open procedure when necessary. A procedure failure does not mean a treatment
failure.
Received: 14 May 1998/Accepted: 25 August 1998 相似文献
16.
Anastomosis level and specimen length in surgery for uncomplicated diverticulitis of the sigmoid 总被引:1,自引:0,他引:1
Background: Extent of bowel resection and level of anastomosis are unsettled issues of surgery for diverticulitis of the sigmoid. The
aim of this study was to compare the adequacy of open colon resection (OCR) with that of laparoscopic colon resection (LCR)
for uncomplicated diverticulitis of the sigmoid (UDS), specifically addressing level of anastomosis and length of specimen.
Methods: Comparisons were made between 40 selected patients undergoing LCR for UDS between 1992 and 1994 and 35 diagnosis-matched
controls who previously underwent OCR by the same surgeons at the same institution.
Results: The OCR and LCR patients were well-matched for age, gender, weight, ASA grade, duration of symptoms, and number of previous
admissions. There were no significant differences, respectively, between OCR and LCR patients in morbidity rates (2 vs. 5,
p= 0.33) and rates of mobilization of the splenic flexure (17:18 vs. 29:11, p < 0.1). Specimen length (18 cm vs. 11 cm, p≪ 0.01), colosigmoid vs. colorectal anastomosis (24:11 vs. 1:39, p≪ 0.01), and presence of inflammatory cells at the proximal resection margin (2 vs. 11, p= 0.02) were significantly different. The OCR patients had statistically longer follow-up than LCR patients (63 months vs.
46 months, p≪ 0.01). Recurrent diverticulitis rates were 9.6% and 2.7% after OCR and LCR, respectively (3 vs. 1, p= 0.73).
Conclusions: Inadequate sigmoid resection should prompt diligence to take down the splenic flexure placing the distal anastomotic margin
on the rectum to ensure adequate surgery.
Received: 12 August 1997/Accepted: 16 November 1997 相似文献
17.
Background: We compared our results with bullous vs diffuse emphysema by performing a bilateral thoracoscopic stapled volume reduction
technique in 15 patients (age 45–80, 10 males, five females).
Methods: Eight patients demonstrated bullous emphysema and seven patients diffuse emphysema. Lung reduction was performed with a bilateral
thoracoscopic stapled technique utilizing bovine pericardium in the supine position.
Results: Comparison of the bullous versus diffuse groups revealed no significant differences in means for the following variables:
length of air leak (7.5 vs 3.3 days); length of stay (8.1 vs 6.5 days); pre-op FEV1 (23% vs 22%); pre-op dyspnea index (3.4 vs 3.6). At 3 months the bullous subset had a highly significant improvement (p < 0.007) in FEV1 (88%) compared with the diffuse subset FEV1 (59%).
Conclusions: These early results suggest that patients with bullous emphysema are at no greater risk and demonstrate a significantly greater
improvement in FEV1 than patients with diffuse emphysema.
Received: 14 May 1997/Accepted: 6 August 1997 相似文献
18.
目的 探讨肺部小结节胸腔镜术前CT引导下注射硬化剂定位的临床应用价值.方法 2010年12月至2012年1月,27例患者,检出29枚孤立性肺结节,胸腔镜术前在CT引导下注射硬化剂(医用胶)定位后成功行胸胸腔镜下肺楔形切除术.结果 CT引导下注射医用胶定位成功率100%.定位时间(6.87±6.75)min,定位后无严重并发症,29枚小结节均成功定位后行胸腔镜下肺楔形切除术,无中转开胸于术,手术后均经病理确诊.结论 CT引导下注射硬化剂(医用胶)定位方法安全、可行,效果可靠. 相似文献
19.
Port-access first-rib resection 总被引:5,自引:0,他引:5
We have developed a thoracoscopic first rib resection technique for treatment of thoracic outlet syndrome (TOS), employing
new instruments designed for endoscopic surgery. A 49-year-old man with Paget-Schroetter syndrome was treated bilaterally,
and a 25-year-old woman with neurologic symptoms was treated on the right side by thoracoscopic approach via three ports.
Harmonic scalpel, endoscopic elevators, rongeurs, and an endoscopic drill were used. In two patients, approximately 80% of
the first rib overlying the subclavian vessels and brachial plexus was successfully removed by this technique. We conclude
that port-access first-rib resection is feasible and reproducible using the new instruments described.
Received: 9 March 1998/Accepted: 12 November 1998 相似文献
20.
A Annicchiarico G Dalmonte A Morini F Marchesi 《Annals of the Royal College of Surgeons of England》2021,103(1):e4
In the past few years, minimally invasive oesophagectomy has become an increasingly popular approach for oesophagectomy showing advantages in terms of fewer postoperative complications, shorter hospital stay and faster recovery. We present the case of a 60-year-old man with a lesion of the distal third of the oesophagus and solid pulmonary nodule who underwent McKeown subtotal oesophagectomy by laparoscopic and thoracoscopic approach in prone position with concomitant thoracoscopic pulmonary wedge resection. The postoperative course was smooth, and the patient was discharged on postoperative day 10. The procedure is feasible and safe, and combines better respiratory postoperative outcomes even when associated with other diagnostic or therapeutic lung procedures. 相似文献