电视胸腔镜肺楔形切除11例报导

我院从1994年年底到1996年7月应用电视胸腔镜外科手术24例,其中作肺楔形切除11例。用于治疗的7例,用于诊断的4例。肺肿瘤8例,良性肿瘤3例,转移性肿瘤5例。另外是机化性肺炎1例,特发性肺肺纤维化1例,支气管扩张1例。肿瘤大小1.5～4.Scm直径。所有病人均作全身麻醉,双腔支气管插管,单肺通气。3例病人因病灶较大,作辅助小切口5～7cm。这样以手指探查病灶和常规开胸手术器械也可以通过此切口进行操作。1例支气管扩张,因出血改开胸手术。全组病人引流管均于48小时拔除仅1例并发肺不张,引流管放置11天。3例良性肿瘤病人术后平均住院8.6天。4例用于诊断的病例均取得病理诊断,无漏气、切口感染和手术死亡等并发症。     

电视胸腔镜在肺外科的应用

1991年 Akabayashi和 Natbanson等报道电视胸腔镜下行肺大泡切除和恶性胸水治疗。以后 ,电视胸腔镜手术( VATS)得到了广泛应用 ,许多过去认为腔镜难以完成的治疗现在均能完成。本文介绍胸腔镜在肺外科的应用。1　肺活检术肺间质纤维化、肺弥漫性坏死性肉芽肿病、肺淀粉样变性、特发性含铁血黄素沉着症、纤维性肺泡炎和弥漫性肺泡细胞癌等一直是诊断上难点 ,以往的确诊方法有纤维支气管镜活检、经纤维支气管镜肺灌洗脱落细胞检查及肺穿刺活检 ,常常因为活检组织标本太小或脱落细胞数量太少而不能获得明确的诊断。开胸活检的创伤大 ,而且术…     

VATS在肺外科的临床应用（附200例报告）

目的 观察电视胸腔镜技术在肺外科常见疾病治疗中的价值。方法 对207例胸部常见疾病施行电视胸腔镜手术。结果 200例在胸腔镜下完成手术,7例转开胸手术。平均手术时间56．8分钟,平均住院日9．3天,术后并发症发生率4．6％。结论 电视胸腔镜技术是胸外科极有发展前途的微创外科技术。     

楔形肺切除术治疗肺结核病142例分析

１９８２年６月～１９９６年６月,我们对１４２例周边性肺结核球及结核空洞患者行楔形肺切除术,疗效满意。现报告如下。１　临床资料本组男９３例,女４９例;年龄１８～６３岁。临床表现为咯血或长期痰血４３例,反复脓痰、发热２９例,反复化疗后持续痰菌阳性４２例,肺癌或肺内其他良性病变不能排除２８例。其中肺结核空洞６８例,肺结核球７４例。病变位于右肺上叶３８例,右肺下叶２２例,中叶５例,左肺上叶４１例,左肺下叶１５例。上叶与下叶多处病变２１例（右侧１２例,左侧９例）。病变均位于肺叶周边位置。所有病例均接受规则…     

右上肺错构瘤1例报告

临床资料：患,男,50岁。体检发现右上肺肿块3年,随访该肿瘤增大明显。无阳性体征。于2006年7月5日,在全身静脉复合麻醉＋双腔气管插管下,在电视胸腔镜（VATS）下辅助胸部小切口,行右上肺肿瘤楔形切除术。术中冰冻提示：软骨瘤。术后病理：错构瘤。体会：如此较大的肺错构瘤临床少见。通过VATS辅助胸部小切口行肺楔形切除术,手术创伤小,患恢复快、美观、易接受。[第一段]     

胸腔镜肺楔形切除术、胸腔镜下肺段切除术、胸腔镜肺叶切除术治疗早期肺癌的疗效比较研究

目的 比较胸腔镜肺楔形切除术、胸腔镜下肺段切除术和胸腔镜肺叶切除术治疗早期肺癌的疗效.方法 回顾性选取2017-06-01至2019-09-30东莞市人民医院心胸外科收治的早期肺癌患者112例为研究对象.根据手术方法将患者分为A组(胸腔镜肺楔形切除术,38例)、B组(胸腔镜下肺段切除术,36例)、C组(胸腔镜肺叶切除术...     

电视胸腔镜手术治疗肺包虫病14例

目的 探讨胸腔镜在肺包虫病治疗中的应用价值. 方法 回顾性分析胸外科自2001年9月至2006年4月14例肺包虫病胸腔镜手术操作方法、手术效果及并发症. 结果 手术时间65～110min,平均87.5min,术中出血100～150mL,1例肺包虫患者因术后发生支气管胸膜瘘,肺膨胀不好,后行二次开胸处理残腔;1例患者因肺膨胀不良带胸管出院,其余患者均痊愈出院. 结论 应用胸腔镜治疗肺包虫病是安全、有效、微创的手术方法.     

全胸腔镜下肺叶切除60例体会

目的探讨全胸腔镜下肺叶切除术的可行性、安全性。方法我院共施行全胸腔镜下肺叶切除60例,其中施行右肺上叶切除15例,右肺中叶3例,右肺下叶16例,左肺上叶10例,左肺下叶16例,肺癌同时行纵隔及肺门淋巴结清扫。结果全组60例患者中57例在全胸腔镜下顺利完成肺叶切除,3例因肺门血管解剖困难,术中出血中转开胸手术。术后病理诊断为肺癌38例,结核瘤10例,炎性假瘤4例,支气管扩张8例。手术时间65～320 min(218±42 min),术中出血量150～800 ml(260±285 ml),无严重并发症发生,无手术死亡。术后发生肺不张2例,经纤维支气管镜吸痰后好转;肺断面持续漏气3例,予延长胸腔闭式引流2周后,无漏气后拔管。术后住院时间10±14 d(10.6±3.2)。结论全胸腔镜下肺叶切除是一种安全、有效的微创手术方式,主要适用于周围性肺癌和肺部良性疾病。     

183例结核性肺病的微创手术治疗

目的探讨胸腔镜手术(video-assisted thoracotomy surgery,VATS)及胸腔镜辅助小切口手术(video-assisted minithoracotomy surgery,VAMTS)治疗结核性肺病的可行性和临床疗效。方法回顾性分析2010年1月至2014年12月我院胸外科利用VATS及VAMTS治疗的183例结核性肺病患者的临床资料。结果楔形切除术对肺结核病灶准确切除率达100%,痰菌阴转率为84.15%,结核复发或播散为4.37%,24(13.1%)例患者出现术后并发症,主要种类包括顽固性残腔、呼吸道感染、胸腔出血、伤口感染、持续性肺漏气、支气管胸膜瘘、胸腔感染、呼吸衰竭、气胸复发,术后随访(26.3±7.32)个月,死亡3例患者,死亡率1.6%,其余患者均治愈,未见中远期并发症,临床治愈率为98.4%。结论 VATS及VAMTS治疗结核性肺病安全可行,疗效满意。     

VATS治疗自发性气胸术后复发影响因素分析

目的 总结电视胸腔镜手术(VATS)治疗自发性气胸后复发的影响因素.方法 回顾性分析行VATS治疗的351例自发性气胸患者的临床资料.结果 影响其VATS治疗自发性气胸术后复发的因素有自发性气胸伴其他肺部疾病、复发性气胸、肺大疱数量等.结论 VATS治疗自发性气胸时应当重视其影响因素,以降低术后复发率.     

Uniportal video-assisted thoracoscopic left basilar segmentectomy

Uniportal video-assisted thoracoscopic surgery (VATS) has recently been introduced as an acceptable alternative to the traditional three-port VATS. Uniportal VATS lobectomy and segmentectomy actually gained increasing popularity. Until now there have been few reports about uniportal VATS basilar segmentectomy; we herein reported our experience with a patient who suffered from recurrent hemoptysis with 1-cm nodule in the basilar segment of the left lower lobe. A left basilar segmentectomy was performed through a single port. Operating time was 90 minutes, and postoperative course was uneventful. Pathology revealed cryptococcosis. Follow-up at 6 months after surgery demonstrated a normal chest computed tomographic (CT) scan and complete recovery without complications.     

Video-assisted thoracoscopic surgery resection and reconstruction of thoracic trachea in the management of a tracheal neoplasm

Intratracheal tumor is a rare tumor, accounting for only 2% of upper respiratory tract neoplasms. Its symptoms are similar to those of head and neck cancers, including coughing up blood, sore throat, and airway obstruction. The diagnosis of this disease is often based on the findings of fibrobronchoscopy or computed tomography (CT). Surgery remains the treatment of choice for tracheal tumor. In patients with benign neoplasms or if the tumors have limited involvement, fibrobronchoscopic resection of the tumor can be performed. For malignant tumors, however, radical resection is required. In the past, open incision is used during the surgery for tumors located in thoracic trachea. Along with advances in video-assisted thoracoscopic surgery (VATS) minimally invasive techniques and devices, VATS resection and reconstruction of the trachea can achieve the radical resection of the tumor and meanwhile dramatically reduce the injury to the patients. In this article we describe the application of VATS resection and reconstruction of trachea in the management of a tracheal neoplasm.     

Outcomes of a hybrid technique for video-assisted thoracoscopic surgery (VATS) pulmonary resection in a community setting

Background

Video-assisted thoracoscopic surgery (VATS) for pulmonary resection was first described 18 years ago; however, it has yet to gain widespread acceptance in community hospitals in the United States. The majority of surgeons who routinely perform VATS resections work in academic or government institutions. There is little data reporting outcomes of VATS pulmonary resections by community-based surgeons. This article reports the outcomes of a hybrid technique for VATS pulmonary resection in a single-surgeon, community-based practice.

Methods

A retrospective study was performed on all VATS pulmonary resections performed from January 2000 to March 2008 by a community-based, solo-practice surgeon using a hybrid VATS technique, which utilizes dual access through a thoracoscopy port and a utility incision.

Results

A total of 1170 VATS pulmonary resections were performed over the study period, which is the largest single-surgeon series on VATS pulmonary resection to our knowledge. Among them, 746 cases were for malignant disease. Mean operative time was 52 minutes (median 48 minutes). Mean length of stay was 7 days (median 4 days). Mean length of ICU stay was 1.4 days, with 83% of patients having no days spent in the ICU. Mean length of chest tube duration was 4.5 days. The morbidity rate was 21.1 %, with neuropraxia as the most frequent complication. Perioperative mortality was 4.3% and overall mortality was 16.4%, with a mean follow-up of 425 days.

Conclusions

This series shows that our hybrid VATS approach to pulmonary resection is safe and feasible at community hospital-based practices.     

非插管与插管电视胸腔镜肺叶切除术治疗肺癌的比较

目的本研究旨在比较非插管和插管电视胸腔镜肺叶切除术治疗肺癌的早期手术效果。方法回顾分析2019年5月至2020年5月于我科同一医疗组行胸腔镜手术的患者的68例电视胸腔镜肺叶切除术(非插管式肺叶切除术34例,插管式肺叶切除术34例)。结果两组患者在年龄、性别、BMI、FEV;、DLCO、吸烟史、肺叶切除、组织学类型和病理分期等方面具有可比性。非插管组和插管组术后平均住院时间分别为9.3±3.8天和8.7±5.3天(P=0.624),闭式引流留置时间分别为3.6±2.0天和4.2±1.4天(P=0.867)。在麻醉持续时间、手术时间、出血量和术后并发症方面,两组的手术结果相似。非插管组肺叶切除术所需时间较短(非插管组平均为112.6±20.1分钟,插管组为123.7±30.4分钟)。两组间唯一有统计学意义的手术结果是淋巴结清扫数(未插管组的平均淋巴结数为13.9±7.0个,插管组为17.6±6.4个,P=0.004)。非插管组中有1例因出血需要改行单肺插管和小切口手术,插管组无中转手术。两组均无死亡病例。结论非插管电视胸腔镜肺叶切除术的早期疗效与插管组相当。非插管电视胸腔镜肺叶切除术是安全的,在技术上是可行的。然而,还需要进一步的前瞻性随机研究,以便更好地比较非插管和插管式胸腔镜肺叶切除术。     

Air leakage on the postoperative day: powerful factor of postoperative recurrence after thoracoscopic bullectomy

Background

Primary spontaneous pneumothorax (PSP) is a relatively common disorder in young patients. Although various surgical techniques have been introduced, recurrence after video-assisted thoracoscopic surgery (VATS) remains high. The aim of study was to identify the risk factors for postoperative recurrence after thoracoscopic bullectomy in the spontaneous pneumothorax.

Methods

From January 2011 through March 2013, two hundreds and thirty two patients underwent surgery because of pneumothorax. Patients with a secondary pneumothorax, as well as cases of single port surgery, an open procedure, additional pleural procedure (pleurectomy, pleural abrasion) or lack of medical records were excluded. The records of 147 patients with PSP undergoing 3-port video-assisted thoracoscopic bullectomy with staple line coverage using an absorbable polyglycolic acid (PGA) sheet were retrospectively reviewed.

Results

The median age was 19 years (range, 11−34 years) with male predominance (87.8%). Median postoperative hospital stay was 3 days (range, 1−10 days) without mortality. Complications were developed in five patients. A total of 24 patients showed postoperative recurrence (16.3%). Younger age less than 17 years old and immediate postoperative air leakage were risk factors for postoperative recurrence after thoracoscopic bullectomy by multivariate analysis.

Conclusions

Immediate postoperative air leakage was the risk factor for postoperative recurrence. However, further study will be required for the correlation of air leakage with recurrence.     

Surgical incision in complete video-assisted mitral valve replacement

Background Prosthetic mitral valve replacement is a common surgical treatment of mitral valve disease.Complete video-assisted mitral valve replacement represents the contemporary minimally invasive cardiac surgery in valve disease surgical therapy. In the field of minimally invasive cardiac surgery, the success of the operation is largely depending on surgical incision, it also reflects the surgeon's technique level. Method From February 2010 to February 2013, 80 cases of cardiac patients with mitral valve pathological changes in our department who had received surgical treatment of complete video-assisted mitral valve replacement were recruited, they were divided into two groups according to the surgical incision: midclavicular group(M group,n = 50) and parasternal group(P group, n = 30). The clinical data were recorded including: cardiopulmonary bypass time, aortic clamping time, volume of thoracic drainage after operation, ICU tracheal intubation time,postoperative days of hospital stay and time for observing the postoperative complications. The comparison between two groups was performed using t-test analysis. Result Both M Group and P Group had favorable surgical view, there were no emergency situation of redo median sternotomy during initial operative period or intraoperative death, no pericardial tamponade, no infection, and no other serious postoperative complications.Whereas, there were 2 cases of redo operation for stanch bleeding in M Group and 1 case of perivalvular leakage in P Group. Nevertheless, 3 months later, the result of reexamine showed that the perivalvular leakage had vanished. The clinical data was shown as follow(M Group vs. P Group): cardiopulmonary bypass time(90.2 ± 28.7 vs. 87.3 ± 24.5 min, P 0.05), aortic clamping time(65.2 ± 17.4 vs. 68.6 ± 21.9 min, P 0.05),1st day volume of thoracic drainage after operation 1(75.8 ± 35.6 vs. 53.2 ± 25.6 mL, P 0.05), ICU tracheal intubation time(9.6 ± 3.4 vs. 8.4 ± 4.5 hours, P 0.05), postoperative days of hospital stay(7.3 ± 2.2 vs. 6.9± 3.2 days, P 0.05). T-test analysis of the data of each groups showed that there were no significant statistically difference. Conclusions Appropriate surgical incisions guarantee a favorable surgical view and the success of the whole process during intraoperative period. In both midclavicular and parasternal approaches, the complete video-assisted mitral valve replacement is able to be accomplished safely and successfully. Due to the current development level of thoracoscopic instruments and equipment, the surgical incision and approach for video-assisted mitral valve replacement are diversified. As a result, diversified surgical incisions can be customized according to the variegated pathological changes of cardiac patients.     

胸腔镜下肺癌根治术的临床疗效及安全性观察

目的观察胸腔镜下实施肺癌根治术的临床疗效及安全性。方法选取我院收治的90例肺癌根治术患者作为研究对象,按照手术方法不同分为观察组与对照组各45例,观察组给予胸腔镜下肺癌根治术治疗,对照组给予传统开胸肺癌根治术治疗,比较两组患者的手术近期疗效及并发症。结果两组患者手术时间比较无明显差异(P>0.05),其他指标如出血量、拔管时间、肢体关节活动恢复时间、住院时间等比较均有明显差异(P<0.01),具有统计学意义。观察组并发症发生率明显低于对照组(P<0.01),随访6～18个月复发及死亡率比较无明显差异(P>0.05)。结论胸腔镜下实施肺癌根治术具有疗效好、创伤小、术后易恢复、术后并发症低等优点。     

Surgical techniques and outcome analysis of uniportal video-assisted thoracic surgery complex sleeve lung resection: a 20 case-series study

BackgroundOur study aims to explore the feasibility of uniportal video-assisted complex sleeve lung resection and summarize the surgical techniques and clinical outcomes.MethodsFrom June 2016 to April 2020, a total of 20 complex sleeve pulmonary and distal tracheal resections were performed by the single surgical team at the Thoracic Surgery Department of the Shanghai Pulmonary Hospital. We defined cases as complex sleeve pulmonary resections if they required pulmonary segment sleeve resection, extended sleeve resection (lobectomy plus segmentectomy of the remaining lobe), sleeve pneumonectomy, lobectomy plus carinoplasty or neo-carina construction, pulmonary-sparing main bronchus resection plus carina reconstruction, and distal trachea resection with end to end anastomosis.ResultsThe 20 cases comprised lung squamous cell carcinoma (n=11), lung adenocarcinoma (n=2), hamartoma (n=3), adenoid cystic carcinoma (n=2), carcinoid tumor (n=1), and pleomorphic carcinoma (n=1). The average blood loss during the operation was 250±126.17 mL (50–800 mL). The average operation time was 192.0±61.1 minutes. The average number of lymph node stations removed was 5.82±1.33, including station seven in all cases, and the median number of lymph nodes removed was 4.18±5.89. On the day of surgery, the drainage volume was 266±192.01 mL. The mean postoperative hospital stay was 5.37±1.86 days. Twelve of the 16 patients diagnosed with malignancy received postoperative chemotherapy. Granuloma formation at the anastomosis level led to stenosis in one case, and tumor recurrence occurred in one case. Broncho-esophageal fistula occurred in one patient after radiochemotherapy. The postoperative follow-up time was 15.6±10.7 months. The 30-day mortality was zero, and at one-year follow-up, only one patient had died of metastatic disease after the operation.ConclusionsUniportal video-assisted complex sleeve pulmonary resections are feasible when conducted by experienced teams.