Video-assisted thoracoscopy versus open thoracotomy for spontaneous pneumothorax.

This retrospective study was designed to compare the contribution of the video-assisted thoracoscopic surgery (VATS) and open thoracotomy in the management of spontaneous pneumothorax (SP). The medical records of 100 patients with recurring or persisting (SP) treated were reviewed. The patients were divided into two groups: group I treated by thoracotomy while in group II (VATS) was used. There were 96 men and 6 women aged from 16 to 75 years. Indications for operation and sex distribution were comparable. The mean age for group I was 35 years and for group II was 45 years. Hospital stay was identical in both groups. The amount of narcotic requirements was lesser in group II than in group I as well as the postoperative respiratory dysfunction. There have been no recurrence to date (mean follow-up 6 years for the group I and 3 years for the group II). VATS have been shown to produce results comparable to those obtained following open thoracotomy with reduction of postoperative pain, respiratory dysfunction, catabolic response to trauma and decrease in wound related complications. VATS is a valid alternative to open thoracotomy for primary (SP) but it should be used with caution for the management of secondary pneumothorax.     

A single institution experience using the LigaSure vessel sealing system in video-assisted thoracoscopic surgery for primary spontaneous pneumothorax

This study sought to report our 6-year experience with the LigaSure vessel sealing system（LVSS） in videoassisted thoracoscopic surgery（VATS） for primary spontaneous pneumothorax.A series of 180 consecutive patients with primary spontaneous pneumothorax were operated on in our institution from May 2005 to December 2010.Intraoperatively,large lesions（bullae or blebs） with a diameter more than 2 cm were resected by staplers,and the residual lesions were treated by LVSS.LVSS was also used to ablate the apical area when no lesions were found.Conventional apical pleural abrasion was done in all cases.All patients were successfully treated using VATS with minimal perioperative bleeding.The mean operating time was 76 minutes（range,43-160 minutes） for single-side procedures and 169 minutes（range,135-195 minutes） for bilateral procedures,the mean number of applied staples was 1.93 per patient（range,0-8 days）,the duration of drainage was 3.8 days（range,2-15 days）,and the duration of hospital stay was 5.8 days（range,3-16 days）.Postoperative complications included persistent air leak（〉 5 days） in 11 cases（6.1%） and residual pneumothorax in 6（3.3%）.None required reoperation.The mean duration of follow-up was 57 months（range,24-105 months）.Recurrence was seen in three cases（1.7%）,and all underwent another operation thereafter.None of the lesions in the relapse cases received ablation with LVSS in the first operation.LVSS can optimize VATS for primary spontaneous pneumothorax and reduces the use of single-use staples.The method is safe,easy to use,and cost-effective and produces satisfactory results.     

Effects of additional pleurodesis with dextrose and talc-dextrose solution after video assisted thoracoscopic procedures for primary spontaneous pneumothorax

Recurrence after thoracoscopic surgery for primary spontaneous pneumothorax is a lingering problem, and many intraoperative methods to induce pleural symphysis have been introduced. We analyzed the effects of chemical pleurodesis during thoracoscopic procedures. Between August 2003 and July 2005, 141 patients among indicated surgical treatment for primary spontaneous pneumothorax in two hospitals of our institution allowed this prospective study. The patients were randomly assigned to 3 groups: thoracoscopic procedure only (group A, n=50), thoracoscopic procedure and pleurodesis with dextrose solution (group B, n=49), and thoracoscopic procedure and pleurodesis with talc-dextrose mixed solution (group C, n=42). There was no significant difference in demographic data among the three groups. The two groups that underwent intraoperative pleurodesis had significantly longer postoperative hospital stays (A/B/C: 2.50+/-1.85/4.49+/-2.10/6.00+/-2.58 days; p=0.001) and a higher incidence of postoperative fever (A/B/C: 10.0/22.45/52.38%; chi(2)= 21.598, p=0.00). No significant differences were found for recurrence rates or the number of postoperative days until chest tube removal. Therefore, the results of our study indicate that intraoperative chemical pleurodesis gives no additional advantage to surgery alone in deterring recurrence for patients with primary spontaneous pneumothorax. Thus, the use of such scarifying agents in the operating room must be reconsidered.     

全胸腔镜与开胸手术治疗创伤性血气胸的对比分析

目的 探讨全胸腔镜与开胸手术治疗创伤性血气胸的疗效。方法 回顾性分析我院2015年1月~2017年5月手术治疗的创伤性血气胸患者115例,按照手术方式分为开胸组60例和VATS组55例。开胸组采用传统开胸手术治疗创伤性血气胸,VATS组采用全胸腔镜手术治疗创伤性血气胸。比较两组患者手术时间、术后当日引流量、术后拔引流管时间、镇痛时间、术后住院时间、住院费用、术后并发症以及随访情况。结果 开胸组手术时间、术后当日引流量、术后拔引流管时间、镇痛时间及术后住院时间均高于VATS组,差异具有统计学意义（P＜0.05）。两组患者住院费用比较,差异无统计学意义（P＞0.05）。两组患者术后并发症率相比,差异无统计学意义（P＞0.05）。术后随访1~3个月,均无复发及死亡。结论 全胸腔镜手术治疗创伤性血气胸,较传统开胸手术创伤小、手术时间短、疼痛轻、并发症少、恢复快,对患者的影响轻、患者容易接受,适合在临床推广应用。     

同期经剑突下单孔胸腔镜双侧肺大疱手术疗效分析

目的：研究分析采用经剑突下入路的单孔胸腔镜手术对双侧肺大疱行同期切除的临床疗效及预后。方法：将2014年1月至2015年12月收治的双侧肺大疱患者70例随机分为观察组和对照组,每组各35例,观察组和对照组分别采用经剑突下、经肋间入路行单孔胸腔镜双侧肺大疱切除术。比较两组患者的手术相关指标、术后并发症发生情况、切口疼痛程度等。结果：70例患者均顺利完成手术,观察组手术时间较短,术后48 h、72 h、第5天疼痛较轻,差异具有统计学意义(P<0.05),出院后随访6个月观察组切口疼痛及麻木的发生率明显低于对照组(P<0.05);而两组术中出血量、胸腔引流管置管时间、胸腔引流量、术后并发症发生率比较均无显著统计学差异(P>0.05)。结论：同期经剑突下单孔胸腔镜双侧肺大疱切除术安全可行,可缩短手术时间,可有效减轻术后疼痛,预后良好。     

Surgical treatment for intra-thoracic migration of acupuncture needles

The aim of this study was to introduce the experience of diagnosis and treatment for patients with migrated acupuncture needle to pleural cavity and or lung parenchyma. We had treated 5 patients who had acupuncture needles in their thoracic cavity from January 2000 to September 2009. The mean age was 55.8 yr old. All patients suffered from the sequelae of the cerebrovascular accident and had been treated with acupuncture. They had drowsiness and hemiplegic or quadriplegic motor activity. Fever and dyspnea were main symptoms when referred to us. Diagnosis was made by the chest radiography and chest computed tomography which revealed straight metallic materials in their thoracic cavity. The needles were removed via thoracotomy or thoracoscopic procedures. Pleural decortications were also needed in four patients. Thoracoscopic surgery was successfully performed in two patients. After the removal all patients became symptomless. Although we experienced only five patients who have migrated acupuncture needles in thoracic cavity, we suggest that thoracoscopic removal of the needle with or without pleural decortication is the most optimal modality of treatment in those patients.     

自发性气胸胸腔镜术后复发情况和影响因素分析

目的分析自发性气胸患者胸腔镜术后复发现状和影响因素。方法选取我院胸外科2009年3月至2011年3月收治的218例自发性气胸胸腔镜术后患者为研究对象,采用自编问卷对自发性气胸患者胸腔镜术后情况进行调查,应用SPSS 19.0统计软件进行描述性统计和二分类Logistic回归分析并找出其复发的影响因素。结果自发性气胸患者胸腔镜术后复发率为5.05%(11/218),多因素Logistic回归分析结果示复发性气胸(OR=2.432,P=0.000)和多发肺大疱(OR=1.918,P=0.000)是自发性气胸电视胸腔镜手术后复发的危险因素。结论自发性气胸胸腔镜术后患者复发率较高,应加强复发性气胸和多发肺大疱患者管理,减少其复发,改善患者的预后。     

Thoracoscopic apical pleurectomy for persisting or recurring pneumothorax.

Regardless of its origin, the treatment of persisting or recurring spontaneous pneumothorax (SP) is classically surgical. To assess the contribution of thoracoscopy in the management of SP 100 consecutive patients with persistent or recurrent pneumothorax were treated at our unit by endoscopic procedure between 1992 and 1997 to obtain permanent pleurodesis and to treat the lung lesion responsible for the leak. There were 90 men and 10 women ranging in age from 16 to 60 years (mean age 28+/-12 years). The technique includes electrocoagulation of pleural blebs and thoracoscopic apical pleurectomy. All patients were subjected to physical examination and plain x-ray at 1 and 3 months and 1 year postoperatively. After completion of the procedure, air leaks disappeared in 90 cases, while 5 cases air leak ceased 5 to 7 days postoperatively. The remaining 5 cases were converted to an open procedure. The mean length of follow-up was 3 years. No patient required transfusion and there were no operative deaths. No recurrence of pneumothorax occurred and no major complications encountered. Video-assisted thoracoscopic pleurectomy for the treatment of pneumothorax is concluded to be that safe and efficacious. It shortens the hospital stay, requires less amount of postoperative narcotic analgesia.     

电视胸腔镜手术在胸部疾病诊断和治疗中应用的体会

目的　探讨电视胸腔镜手术 (VATS )在胸部疾病诊断和治疗中的作用。方法　 1996年 9月以来选择性地开展了电视胸腔镜手术 6 6例 ,其中肺大疱及自发性气胸 32例、肺结核球和结核性空洞 14例、肺恶性肿瘤 5例、肺良性肿瘤 5例、肺包虫囊肿 2例及纵隔肿瘤 3例 ,肺动静脉瘘、胸膜脂肪瘤、恶性胸膜间皮瘤、局限性结核性脓胸、外伤性膈疝各 1例。结果　VATS手术创伤小、失血量少、手术时间短、病人痛苦轻、恢复快、缩短住院日、无严重并发症。结论　VATS诊断和治疗胸部部分疾病是一种安全、有效、微创的手术方法。     

全胸腔镜与开胸手术治疗孤立性肺小结节的对比分析

目的 探讨全胸腔镜与开胸手术治疗孤立性肺小结节的疗效。方法 回顾性分析我院2014年1月~2016年6月手术治疗的100例孤立性肺小结节患者,按照手术方式分为开胸组和VATS组,各50例。开胸组采用传统开胸手术治疗,VATS组采用全胸腔镜手术治疗。比较两组患者的手术时间、术中出血、术后当日引流量、术后拔引流管时间、镇痛时间和住院时间。结果 两组患者生存率、病理性质比较,差异无统计学意义（P＞0.05）。与开胸组比较,VATS组手术时间短 [（114.3±29.5）min vs（151.2±47.3）min],术中出血少[（41.5±12.9）ml vs（145.1±65.8）ml],术后当日引流量少[（150.2±46.3）ml vs（220.1±55.4）ml],镇痛时间短[（2.2±1.3）d vs（7.5±1.6）d],术后拔引流管时间短[（2.2±1.3）d vs（5.8±2.6）d],术后住院时间短[（8.1±2.1）d vs（14.1±1.8）d],差异具有统计学意义（P＜0.05）。术后发生肺部感染、肺不张、心律失常VATS组分别为1例、1例、0例,开胸组为3例、2例、1例,两组差异无统计学意义（P＞0.05）。结论 全胸腔镜手术治疗孤立性肺小结节比开胸手术创伤小、术中出血少、手术时间短、疼痛轻、术后恢复快、并发症少,适合在临床基层医院开展应用。     

Management of persistent or recurrent pneumothorax with a two millimeter mini-videothoracoscope

The aim of this study was to assess whether a 2 mm mini-videothoracoscope could be used as a conventional videothoracoscope in the management of pneumothorax. Thirty patients of ages from 15 to 35 years with recurrent or persistent pneumothorax were involved in this study. The subjects consisted of 27 males and three females. The indications for videothoracoscopic surgery were ipsilateral recurrent pneumothorax in 12 (40%), persistent air leakage in 15 (50%), visible bullae in 2 (6%), and 1 bilateral pneumothorax (3%). The mean operation time was 42.9+/-12.9 min. The average number of uses for Endo-GIA was 1.9+/-1.3 times and chest tube indwelling time was 3.8+/-2.7 days. The average amount of keptoprofen (100 mg/2 mL/ampule) used on the first postoperative day was 1.2+/-1.1 ampules. No parenteral opioids were given to the patients for pain control after the procedures. After a follow up of 8 to 20 months, there was only one recurrence among the patients. In conclusion, a 2 mm videothoracoscope, in selective cases, can be successfully used as conventional videothoracoscope to manage persistent or recurrent pneumothorax with cosmetically excellent results.     

Pleural epidermoid carcinoma from displaced skin following extrapleural pneumothorax in a patient exposed to asbestos

This report illustrates a rare case of primary epidermoid carcinoma of the pleura in a patient previously treated by artificial extrapleural pneumothorax for active tuberculosis. The patient had also been occupationally exposed to asbestos. Light microscopic examination showed two different lesions: laminar pleural fragments were covered by normal squamous epithelium that was similar in all respects to epidermis, whereas nodular fragments were composed of well-differentiated infiltrating carcinoma. These findings support the hypothesis that the carcinoma arose from normal epidermis seeded in the pleural cavity during multiple air refills to maintain the pneumothorax. A possible interaction between asbestos fibres and chronic inflammation might have potentiated tumour development.     

红霉素胸膜粘连术对难治性自发性气胸的治疗价值

目的观察红霉素胸膜粘连术对难治性自发性气胸的治疗价值。方法经胸腔闭式引流管注人红霉素到胸膜腔治疗难治性自发性气胸28例为治疗组，以同期28例难治性自发性气胸经胸腔闭式引流治疗为对照组。结果以红霉素为硬化剂的胸膜粘连术治疗方法的治疗组28例复发3例，复发率约为10％。对照组28例复发11例，复发率约为39％，两组间差异有统计学意义（P=0．014）。结论胸腔引流管注人红霉素治疗难治性自发性气胸是简便易行，安全、费用低的一种有效方法，具有一定的治疗价值，可在基层医院推广。     

The early surgical period in robotic radical hysterectomy is related to the recurrence after surgery in stage IB cervical cancer

Objective: To identify the pattern of recurrence and assess the clinicopathologic prognostic factors for survival after robotic radical hysterectomy (RRH) in the treatment of stage IB cervical cancer.Methods: From December 2008 to March 2018, 64 cervical cancer patients who underwent RRH with pelvic lymph node dissection by a single surgeon were enrolled in this retrospective historical cohort timeline study. The patient''s status was estimated in terms of operative outcomes, pathologic results, and survival outcomes.Results: The median follow-up was 63 months. The recurrence rate was 9.4% (6/64). There were two recurrences at the vaginal vault, two in the pelvic cavity, and two at the peritoneum in the intraabdominal cavity. The overall survival rate was 95.3% (61/64). When patients were divided into three groups in order based on surgery date, the first surgical period showed significantly higher recurrence rate (21%) compared to both the second (10%) and the third period (0%) (p=0.037). Multivariate analysis showed that the early period of RRH (p=0.025) and clinical tumor size more than 3 cm (p=0.003) were prognostic factors related to the recurrence. Although there was no statistical significance, there has been no recurrence since a uterine manipulator was not used.Conclusion: The early surgical period and large tumor were related to the disease recurrence after RRH. We suggest that the achievement of proficiency and appropriate patient selection are critical for prognosis after RRH in stage IB cervical cancer.     

Recurrent pneumothorax in a child with Langerhans' cell histiocytosis

We are presenting a 16 months old boy, who has been previously developing normally, physically very active, and who suddenly developed right-sided pneumothorax with infiltrations in both lungs, initially defined as inflammatory. After placing suction drainage of the pleural cavity and antibiotic administration the child's condition improved quickly. The infiltration changes still remained in lungs arousing a suspicion of fibrocystic changes. During an attempt at changing the drainage into a water one, the symptoms of pneumothorax with hypertension increased again. A minithoracotomy with an edge resection of segment 4 and pleurectomy were performed, relating to the histopathological test of the sample, Largenhans' cell histiocytosis was diagnosed. The symptoms of diabetes insipidus appeared. The treatment according to the program DAL-HX83/90 modified by the Polish Group for Leukaemia and Malignant Lymphoma was introduced. During the treatment inducing remission a pneumothorax occurred two more times.     

Partial removal of the pulmonary artery in video-assisted thoracic surgery for non-small cell lung cancer

Lobectomy with partial removal of the pulmonary artery in video-assisted thoracic surgery (VATS) currently remains a challenge for thoracic surgeons. We were interested in introducing pulmonary vessel blocking techniques in open thoracic surgery into video-assisted thoracic surgery (VATS) procedures. In this study, we reported a surgical technique simultaneously blocking the pulmonary artery and the pulmonary vein for partial removal of the pulmonary artery under VATS. Seven patients with non-small-cell lung cancer (NSCLC) received lobectomy with partial removal of the pulmonary artery using the technique between December 2007 and March 2012. Briefly, rather than using a small clamp on the distal pulmonary artery to the area of invading cancer, we replaced a vascular clamp with a ribbon and Hem-o-lock clip to block the preserved pulmonary veins so as to prevent back bleeding and yield a better view for surgeons. The mean occlusion time of the pulmonary artery and pulmonary veins were 44.0±10.0 and 41.3±9.7 minutes, respectively. The mean repair time of the pulmonary artery was 25.3±13.7 minutes. No complications occurred. No patients showed abnormal blood flow through the reconstructed vessel. There were no local recurrences on the pulmonary artery. In conclusion, the technique for blocking the pulmonary artery and veins is feasible and safe in VATS and reduces the risk of abrupt intraoperative bleeding and the chance of converting to open thoracotomy, and extends the indications of VATS lobectomy.     

三维CT支气管血管重建技术在胸腔镜肺段切除术治疗早期肺癌中的应用

目的:观察三维CT支气管血管重建技术（3D-CTBA）在胸腔镜肺段切除术治疗早期肺癌中的应用价值。方法:回顾性分析60例早期非小细胞肺癌患者的临床资料,均行胸腔镜肺段切除术+淋巴结清扫（或采样）,其中30例采用3D-CTBA技术（三维重建组）,另外30例术前常规进行二维CT检查（CT组）,记录两组手术指标、住院总费用、术后恢复情况、并发症发生率及术后6个月复发情况。结果:三维重建组术中出血量显著少于CT组（P<0.05）,手术时间显著短于CT组（P<0.05）,切缘宽度显著大于CT组（P<0.05）;三维重建组术后胸管留置时间、住院时间显著短于CT组（P<0.05）,胸管引流量、住院总费用显著少于CT组（P<0.05）;三维重建组并发症总发生率显著低于CT组（P<0.05）;随访6个月,发现两组均无复发病例。结论:3D-CTBA技术应用于早期肺癌患者胸腔镜肺段切除术,可有效提高手术安全性,获得更好手术切除效果,同时减少术后并发症,更利于患者快速康复,降低住院费用。 【关键词】三维;支气管血管重建;肺癌;胸腔镜;肺段切除术     

全胸腔镜手术治疗婴幼儿先天性膈疝的临床研究

目的 探讨全胸腔镜手术治疗婴幼儿先天性膈疝的临床效果以及安全性、可行性。方法 回顾性研究。纳入2015年4月—2021年3月南京医科大学附属儿童医院小儿心胸外科97例先天性膈疝患儿的临床资料。其中男61例、女36例,年龄2 d~3岁[（3.1 ± 7.2）个月];左侧51例,右侧46例。所有患儿均在胸腔镜下行膈疝修补术,术中观察疝内容物有无坏死、穿孔、损伤等情况,记录胸腔镜手术患儿的手术时间、术中出血量、术后胸腔引流量、引流管拔除时间、手术后住院时间。术后定期随访,观察切口感染、膈膨升、乳糜胸、气胸、肠梗阻等相关并发症发生情况,以及术后膈疝复发情况。结果 97例患儿均在全胸腔镜下顺利完成手术,无一例中转开胸手术。术中见疝囊内容物多为脾脏、胃、大网膜、结肠、小肠等,无肠穿孔坏死、肝脾出血等情况发生。手术时间75~150（90.5 ± 12.1） min,手术出血量6~15（8.3 ± 0.6） mL,术后胸腔引流量30~130（41.2 ± 7.6） mL,引流管拔除时间3~10（6.1 ± 1.3） d,手术后住院时间10~18（11.7 ± 2.1） d。住院期间因缝线脱落导致复发2例,再次行胸腔镜手术治愈;1例患儿术后第1天因左肺严重发育不良死亡。术后96例患儿均获随访,随访时间1个月~3年,平均9.2个月。随访期间无切口感染、乳糜胸、呼吸道感染、肠梗阻、肠穿孔等并发症发生,患儿生长发育良好,无一例复发。结论 全胸腔镜手术治疗婴幼儿先天性膈疝具有手术视野暴露清楚、术中出血量少、术后并发症少、住院时间短等优点,短期疗效可靠,安全可行。     

全胸腔镜下胸腺切除术治疗无重症肌无力早期胸腺瘤30例

目的：探讨全胸腔镜下胸腺切除术治疗无重症肌无力早期胸腺瘤的临床价值。方法：回顾性分析30例经全胸腔镜下胸腺切除术治疗无重症肌无力早期胸腺瘤患者的临床资料,总结其手术方法、分期、病理学类型、后续治疗、并发症、随访结果等。结果：30例患者全部经右侧胸腔镜完成胸腺切除术,其中男性12例、女性18例,无中转开胸,无围手术期死亡和严重并发症;手术时间40—200min,平均（91．7±38．1）min,出血量30～300ml,平均（106±75）ml;术后住院时间5—7d,平均（5．1±0．8）d。术后临床分期,I期17例（56．7％）、II期13例（43．3％）。病理学类型,A型14例、AB型10例、B1型5例、B2型1例。Ⅱ期患者术后均接受辅助放疗。患者全部随访,随访时间6—72个月,中位随访时间44个月。随访期内无一例复发或死亡,总生存率（OS）为（70．2±1．7）个月（95％CI：66．8—73．6）。结论：全胸腔镜下胸腺切除术治疗无重症肌无力早期胸腺瘤安全、有效,而且更加微创,值得临床推广应用。     

Neonatal pneumothorax from the perspective of a pediatric surgeon: classification and management protocol: a preliminary algorithm

Background/aimCurrent neonatal pneumothorax classifications based on air volume escaping in pleural space have no contribution on the treatment. Therefore, our aim was to classify neonatal pneumothorax to guide treatment management based on our experiences.Material and methodsThe records of all neonates admitted to our clinics from March 2017 to August 2020 were reviewed. The patients with pneumothorax were identified through the neonatology department patient database search. The study only included the patients with symptomatic pneumothorax and these patients were evaluated into 3 groups based on the changes in peripheral oxygen saturation (SpO2) and clinical features immediately after the tube thoracostomy (TT) procedure. Accordingly, neonatal pneumothorax was divided into 3 types: patients with SpO2 increasing immediately after TT were included in type I, patients whose SpO2 did not change after TT were included in type II, and patients with SpO2 decreasing immediately after TT were included in type III pneumothorax.Results A total of 82 patients were included in the study. Sixty-one percent of these patients had type I, 24% had type II, and 15% had type III pneumothorax. None of the neonates died in type I and II pneumothoraces while 9 of 12 neonates (75%) died within the neonatal period in type III pneumothorax. Although we applied treatments such as high-frequency oscillatory ventilation, selective intubation, continuous negative aspiration, and surgical treatment to our patients that were lost due to type III pneumothorax, we were not successful. We successfully managed our surviving type III pneumothorax patients with a simple pressure cycle ventilator, using a combination of high rates, modest peak airway pressures [18 to 22 cm H2O and no positive end-expiratory pressure (PEEP)], and an autologous blood patch.Conclusion Classification of pneumothoraces into different types significantly contributes to patient treatment planning through a predetermined strategy, not through trial-and-error. High frequency and zero PEEP ventilation can provide significant improvement in risky cases.