Thoracoscopic resection of a solitary pulmonary lymphangioma: Report of a case

We present herein the rare case of a young man who was found to have a solitary tumor in the right upper lobe of his lung by a routine chest X-ray. The tumor was removed by thoracoscopic surgery, and pathological examinations confirmed the diagnosis of a primary lymphangioma of the lung. A brief review of the available literature on this extremely rare type of benign tumor follows the case report.     

Intrapulmonary cystic lymphangioma: Report of a case

(Received for publication on Aug. 25, 1997; accepted on Mar. 10, 1998)     

电视胸腔镜手术207例报告

目的总结电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)治疗胸部疾病的体会. 方法 1997年10月～2004年3月,开展VATS 207例,包括自发性气胸肺大疱结扎或切除155例,自发性或创伤性血气胸紧急探查止血30例,肺部良性疾病行肺楔形切除、活检14例,纵隔肿瘤摘除8例. 结果 190例经胸腔镜完成手术,12例附加胸部小切口,5例中转开胸手术.胸部手术时间20～180 min,平均56 min.术后住院5～52 d,平均9 d.术后并发症17例,占8.2%(17/207),其中肺泡漏9例,复张性肺水肿6例,胸腔感染2例.2例术后3～4个月自发性气胸复发. 结论 VATS治疗自发性气胸肺大疱、创伤性血气胸和某些胸部良性疾病较传统开胸手术具有更多优点,适时附加胸部小切口,积极防治并发症,可使VATS更安全.     

An acute presentation of pediatric mesenteric lymphangioma: a case report and literature overview

Introduction: Lymphangioma accounts for 5% of benign pediatric tumors and less than 1% is located in the abdomen. While mesenteric lymphatic malformation or mesenteric lymphangioma (ML), mostly appears asymptomatic in adults, an acute clinical presentation is seen more often in children. Symptoms can mimic obstruction or peritonitis and diagnosis can therefore be challenging. Imaging studies are performed to exclude other causes of obstruction or peritonitis. Diagnosis of ML is always made by histology. Surgery is the treatment of choice and recurrence after complete resection is rare.

Case report: We describe an acute abdomen in a four-year-old boy caused by a mesenteric lymphatic malformation. Imaging studies at the emergency department were inconclusive and final diagnosis was made by histological examination. Surgical intervention with resection of an ischemic ileal segment was necessary. Complete resection of the ML was not possible without compromising the functional digestive outcome due to diffusely spread lesions in the mesentery of the small bowel. Follow-up with ultrasound was performed.

Conclusion: Mesenteric lymphangioma can cause an acute abdomen in children. Complete resection is recommended but might not be feasible without compromising the functional digestive outcome. Alternative treatments should be studied further to treat diffuse and complicated ML.     

The use of the carbon dioxide laser in head and neck lymphangioma

The carbon dioxide laser has been used to treat various lesions of the head and neck, ranging from carcinomas to hemangiomas, and even including tatoos. A search of the literature does not reveal any reports of the carbon dioxide laser being used to treat lymphangioma. This report discusses the efficacy of treating lymphangioma of the air and food passages with the carbon dioxide laser, and presents three patients who have been treated in this fashion-two for palliation and one for cure.     

电视胸腔镜技术在快速康复外科中的作用

目的探讨电视胸腔镜手术在快速康复外科中的作用。方法对308例患者行电视胸腔镜手术,选取手术时间、拔管时间、住院时间、手术切口长度、出血量等与280例开胸手术临床资料比较研究。结果308例患者中34例胸腔镜辅助小切口,4例中转开胸,共10例出现围手术期并发症,无死亡病例。结论胸腔镜手术与传统开胸手术相比,具有切口微创美观、出血量明显减少、痛苦轻、恢复快、手术时间短、手术并发症少、平均住院日短等优点,为胸内疾病开辟了新的诊疗方法。此项技术微创安全,同时符合快速康复外科的最新理念。     

82例电视胸腔镜的临床应用

目的　总结电视胸腔镜手术 (VATS)在胸外科疾病治疗中的临床应用经验。方法　回顾分析 1999年 6月至 2 0 0 1年 2月采用VATS治疗 82例病人的临床资料。结果　全组病人无院内死亡和并发症发生 ,全部痊愈出院。结论　VATS具有创伤小、痛苦轻、恢复快和对美容影响小的优点。自发性气胸、肺大疱切除可作为VATS的首选术式。VATS为胸内疾病的诊断和治疗提供了一种重要手段 ,但目前临床应用有局限性     

电视胸腔镜辅助小切口肺叶切除35例临床分析

目的探讨胸腔镜辅助小切口肺叶切除在早期肺癌及肺良性病变治疗中的应用价值。方法回顾分析我院2002年2月～2006年6月行胸腔镜辅助小切口肺叶切除35例的临床资料。其中周围型肺癌(T1N0～1M0)31例,支气管扩张症3例,右肺中叶不张并脓肿1例。解剖性肺叶切除30例,非解剖性肺叶切除5例。结果本组无中转开胸,手术时间85～210min,(115±35)min。术中出血150～450ml,(210±55)ml。2例术后并发急性呼吸衰竭,使用呼吸机辅助机械通气分别治疗3、5d后顺利脱机;1例术后急性心肌梗死,经早期溶栓治疗痊愈。其余32例无术后并发症。全组拔除胸腔闭式引流管时间2～10d,平均5.4d。3例肺良性病变,随访41、33、13个月,无明显远期并发症;25例肺癌平均随访时间15.2月(3～53个月),其中随访3～12个月6例、12～24个月9例、24～36个月7例、36～53个月3例,因肺癌复发或转移死亡4例(16%),肿瘤复发带瘤生存2例(8%),无瘤生存19例(76%)。结论胸腔镜肺叶切除对周围型肺癌(T1N0～1M0)及肺部局限性良性病变是一种完全可行并且安全的手术方法。     

电视胸腔镜手术在胸外科的应用

目的探讨电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)在胸外科的应用. 方法回顾分析1998年7月～2002年12月78例胸腔镜手术的临床资料.其中:自发性气胸肺大疱切除40例,胸外伤探查12例,肺包块楔形切除9例,胸膜活检 胸膜固定6例,纵隔肿瘤切除4例,肺叶切除4例,肺叶切除术后支气管胸膜瘘2例,食管平滑肌瘤切除1例. 结果无一例中转开胸,5例因胸膜顶粘连辅助小切口.3例中老年自发性气胸术后持续漏气,分别于第7,8,13天拔除胸管,其余均在48h内拔除胸管.5例引流管口延期愈合.手术并发症发生率10.3%(8/78). 结论 VATS在胸外科有广阔的发展空间,一次性耗材价格昂贵限制其临床应用,腔镜下缝合技术或打结技术的应用比较适合目前的国情,节省医疗费用.     

电视胸腔镜食管癌切除术

目的探讨胸腔镜食管癌切除术适应证. 方法 1997年7月～2003年7月,对75例食管癌胸腔镜下经右胸游离食管、肿瘤,清扫淋巴结,经上腹切口游离胃,并经胸骨后上提,行左颈食管胃吻合. 结果中转开胸3例,2例因肿瘤侵及肺门及心血后壁无法分离而中转开胸,1例因奇静脉出血而中转开胸.手术时间160～220 min,胸部操作时间60～90 min ,术后出血300～400 ml,无手术死亡.术后出现胃扭转1例,吻合口漏2例,吻合口狭窄1例,乳糜胸1例.60例随访3个月～7年,平均4年,2例锁骨上淋巴结转移,1例腹腔淋巴结转移,1年生存率85.0%(51/60),3年生存率40.0%(31/60),5年生存率40.0%(24/60). 结论胸腔镜食管癌切除可行,适用于Ⅰ、Ⅱ期非外侵患者.     

Intra-abdominal cystic lymphangioma

Cystic lymphangioma is an uncommon intra-abdominal lesion that is an occasional incidental finding. We report herein the case of a 27-year-old woman with a 3-year history of abdominal pain due to a large intra-abdominal cystic lymphangioma. The lesion was removed surgically with a complete resection that is the optimal treatment with excellent prognosis.     

胸腺切除术中达芬奇机器人与传统手术对比分析

目的 研究分析采用达芬奇机器人手术、胸腔镜手术和开胸手术三种不同手术方式进行胸腺切除术的临床资料,探讨机器人手术对治疗胸腺病变的临床应用价值.方法 回顾性分析2009年1月至2013年8月我院进行手术切除的136例胸腺病变的临床资料,其中采用达芬奇机器人手术43例,胸腔镜手术49例,正中胸骨切开手术44例.收集记录三种不同手术方式病例的临床一般性资料,术中以及术后恢复情况资料进行比较分析.结果 全组患者均手术成功,三组患者的术前临床资料无统计学差异,达芬奇机器人手术和胸腔镜手术组,在手术时间、术中出血量、术后24 h胸引量、术后ICU及住院天数方面明显优于开胸手术组（P＜0.05）.达芬奇机器人手术同胸腔镜手术比较,平均术中出血量（78±21mlvs 126±29 ml）、术后胸引天数（1.9±0.7vs2.5± 1.1）d以及术中中转开胸率（0/43 vs 3/49）方面,前者明显优于后者,P＜ 0.05.两组手术时间、术后住院时间无明显差异.结论应用机器人及胸腔镜的微创手术较开胸手术创伤小,术后恢复快.达芬奇机器人手术系统在胸腺切除手术中可取得和胸腔镜手术相似的治疗效果,但在术中操作和安全性上更有的优势.     

电视胸腔镜治疗气胸血气胸30例

目的 探讨电视腔镜在气胸、血气胸治疗中的应用价值。方法 回顾分析采用电视胸腔镜治疗气胸、血气胸30例临床资料。结果 30例电视胸腔镜手术均获成功。仅有l例术中并发复张性肺水肿,抢救转危为安,无手术死亡。平均手术时间89分钟,平均住院时间为5．8天,全部痊愈出院。结论采用电视腔镜手术治疗气胸、血气胸安全、有效、微创。术中采用钛夹间断夹闭法操作方便、经济;高度警惕术中出现复张性肺水肿并发症。     

电视胸腔镜胸腺切除治疗重症肌无力症

目的探讨电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)胸腺切除治疗重症肌无力症(myasthenia gravis,MG)的可行性. 方法 18例MG采用VATS经右胸前侧径路行胸腺切除联合纵隔脂肪清扫. 结果 17例顺利完成手术,1例因电凝钩伤及左头臂静脉干而中转开胸止血.平均手术时间105 min,术中失血量平均80 ml.全组无术后死亡及危象发生.18例随访1～20个月,平均11.3个月.按Osserman疗效评价,缓解5例(27.8%),明显改善6例(33.3%),部分改善4例(22.2%),无变化3例(16.7%),有效率83.3%(15/18). 结论 VATS经右胸前侧径路行完全胸腺切除可行,且具有创伤小、恢复快等优点.     

Single-incision versus multiport video-assisted thoracoscopic surgery in the treatment of lung cancer: a systematic review and meta-analysis

Objectives: Recent studies compared single-incision thoracoscopic surgery (SITS) with more widely used conventional multiport video-assisted thoracoscopic surgery in the treatment of lung cancer. To establish the safety and feasible of SITS in the treatment of lung cancer, we conducted this systematic review and meta-analysis.

Methods: Eleven studies were identified from the databases of PubMed, Cochrane Library, SpringerLink, and ScienceDirect. The randomized controlled trials (RCTs) and non-randomized studies evaluated the outcomes of SITS compared with multiport video-assisted thoracoscopic surgery in the treatment of lung cancer were included for analysis. Odds ratio (OR, used to compare dichotomous variables) and weight mean difference (WMD, used to compare continuous variables) were calculated with 95% confidence intervals (CIs) based on intention-to-treat analysis.

Results: Eleven studies including 1314 patients were included for analysis. Our analysis showed that the operative time, blood loss amount, mean duration of chest tube, lymph nodes retrieved were similar between two approaches, the SITS pulmonary resection might be associated with shorter hospital stay (p?=?.008) and lower complication rate (p?=?.009) when compared with conventional multiport video-assisted thoracoscopic surgery approaches.

Conclusions: In selected patients SITS is safe, feasible and may be considered an alternative to multiport VATS.     

胸腔镜手术治疗创伤性血胸

目的探讨电视胸腔镜在创伤性血胸中的应用. 方法 2000年3月～2004年3月,电视胸腔镜手术治疗创伤性中等量以上血胸60例,其中伴休克征象12例,合并肝脾损伤6例.单侧胸腔镜手术48例,除3例心脏损伤辅助小切口行心脏修补术外,均在镜下手术;双侧胸腔镜手术6例;胸腔镜和腹腔镜联合手术6例. 结果手术时间45～175 min,平均105 min.术后住院7～13 d,平均11 d,无并发症发生. 结论电视胸腔镜手术治疗创伤性血胸手术时间短,恢复快,是一种安全、有效、微创的方法.     

Robot assisted thoracoscopic resection of giant esophageal leiomyoma

INTRODUCTION

Esophageal leiomyoma represents the most common benign esophageal tumor. Robot-assisted thoracoscopic surgery has provided ability to remove it successfully using a minimally invasive approach.

PRESENTATION OF CASE

A 63-year old female with history of chronic chest pain presented with an esophageal mass on chest CT and endoscopic ultrasound. Robot-assisted surgery was performed using three robot arms, a camera and an assistant port. A 10 cm leiomyoma was enucleated and removed through a 2 cm myotomy. Completion endoscopy confirmed integrity of the esophagus. Patient''s chest pain resolved postoperatively, and she was discharged on postoperative day 3.

DISCUSSION

Our case describes successful removal of the giant esophageal leiomyoma (10 cm) by robot assisted minimally invasive resection through a 2 cm myotomy.

CONCLUSION

Use of robot allows for removal of large esophageal leiomyoma. The improved dexterity and patient outcome offered by robot suggests its potential as the mainstay technique for giant esophageal leiomyoma removal.Abbreviations: CT, computed tomography; Endo-GIA, endoscopic gastrointestinal automatic stapler     

电视胸腔镜手术在肺癌治疗中的应用

电视胸腔镜手术（video-assisted thoracoscopic surgery，VATS）是一种微创、安全、可行的技术。随着手术器械和技巧的日趋改进，电视胸腔镜在临床的应用越来越广泛。本文就电视胸腔镜手术在肺癌治疗中的应用作一综述。     

Video-assisted thoracoscopic management of mediastinal tumors.

BACKGROUND: Many successful attempts at removing benign mediastinal tumors with the video-assisted thoracoscopic technique have been reported, but no formal report has been published regarding malignant mediastinal tumors treated with this technique. We report our preliminary experience with video-assisted thoracoscopic removal of mediastinal tumors, benign or malignant. METHODS: Seven patients with mediastinal tumors treated with video-assisted thoracoscopic surgery were reviewed from January 1999 to April 2000. Their tumor pathologies included benign or malignant thymoma, neurilemmoma, and teratoma. RESULTS: The mean operation time was 240 minutes. The mean blood loss was 173 mL. The mean insertion time of chest tubes was 3 days. The mean admission time was 6 days. No deaths occurred during the study. Morbidity occurred in 2 patients. No tumor recurrence has been seen during the mean follow-up of 7 months. CONCLUSIONS: The short-term results support the feasibility of VATS in managing technically resectable mediastinal tumors. Yet the long-term prognosis for the malignant lesions is deferred and needs further study.     

Video-assisted thoracoscopic lobectomy with bronchoplasty for lung cancer: tip regarding bronchial anastomosis

No study has discussed the application of video-assisted thoracoscopic surgery (VATS) to bronchoplasty or the handling of a needle and forceps in a bronchial anastomosis. We use the following steps for bronchial anastomosis: Insert the needle and forceps vertical to the bronchial wall, move them in such way as to scoop something up, rotate and turn around, repeat the second step, and pull from the bronchial wall along the curvature of the needle. Handling the needle forceps along the curvature of the needle is critically important.