老年人电视胸腔镜手术73例分析

我院 1996年 6月至 1999年 5月 ,对 73例老年人施行电视胸腔镜手术 (ｖｉｄｅｏ ａｓｓｉｓｔｅｄｔｈｏｒａｃｉｃｓｕｒｇｅｒｙ ,ＶＡＴＳ) ,占同期老年人胸部手术 15 4例的 47 4% ,临床效果较好 ,现报道如下。　　一、临床资料　　 73例中男 5 4例 ,女 19例。年龄 6 0～ 82岁 ,平均 6 7 6岁。其中 6 0～ 6 9岁 46例 ,70～ 79岁 2 4例 ,80～ 82岁 3例。病种包括孤立性肺周围结节 33例 (周围型肺癌 16例 ,肺转移癌 11例 ,肺结核瘤 3例 ,肺炎性假瘤 2例 ,肺错构瘤 1例 ) ,不明原因胸腔积液 17例 (肺癌胸膜转移 10例 ,胸膜间皮瘤 3例 ,乳腺…     

145例自发性气胸的电视胸腔镜手术治疗

目的探讨自发性气胸的电视胸腔镜手术治疗的方法及临床评价。方法对145例胸腔镜手术治疗的自发性气胸进行回顾性分析。结果 145例均存在肺尖病灶。其中上肺单发病灶96例,多发病灶36例,多叶病灶13例。手术时间平均45 min,术后胸腔引流管平均引流量125 ml,拔胸腔引流管时间平均为2 d,术后住院时间平均为8 d,全组治愈出院。术后病理检查结果：大泡型肺气肿125例,囊泡型肺气肿18例,支气管型肺囊肿2例。有2例复发,保守治疗后治愈。结论电视胸腔镜手术是治疗自发性气胸的首选方法。     

电视胸腔镜手术治疗创伤性血气胸31例

目的总结胸腔镜治疗创伤性血气胸的临床意义及优点。方法对31例外伤性血气胸患者使用胸腔镜或辅助小切口行单纯肺叶修补、肺楔形切除、肋间动脉止血、膈肌修补术等治疗的结果进行总结。结果 31例均治愈出院。住院时间5~13d,平均9d。术后无并发症。结论外伤性血气胸使用胸腔镜治疗优点颇多,具有创伤小、恢复快、安全微创、并发症少等优点,是外伤性血气胸首选的治疗办法,值得临床推广。     

电视胸腔镜肺部手术316例临床分析

我院自2003年10月～2007年12月,共完成电视胸腔镜肺部手术316例,取得满意手术效果。现初步总结分析如下。     

电视胸腔镜手术300例体会

目的 探讨胸腔镜手术在胸外科领域的应用价值。方法 对胸部疾病施行VATS手术300例。结果 手术创伤小，患恢复快，出血少，手术时间及术后住院日明显缩短，术后并发症8例，占2.8%，明显低于常规开胸组。结论 恰当选例下，VATS在胸部微创手术领域中，有着广阔前景。     

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.     

电视胸腔镜手术并发症及其预防

电视胸腔镜手术 ( VATS)治疗胸外科疾病具有损伤小、术后恢复快等优点 ,但是其并发症不容忽视。1 997～ 2 0 0 1年 ,我们对 2 60例患者行 VATS2 78例次 ,发生并发症 2 4例。现对 VATS并发症的发生原因、预防及处理进行分析和探讨 ,以提高其治疗水平。1　临床资料本文 2 60例患者中 ,男 1 91例 ,女 69例 ;年龄 1 1～79岁 ,平均 48.3岁。共行 VATS2 78例次 (其中 1 8例两侧肺大疱者同期行两侧 VATS肺大疱切除术 ) ,原发疾病种类及手术方式见表 1 ,并发症情况见表 2、3。表 1　 2 6 0例患者原发病及 VATS手术方式　　　原发病例数　 …     

电视胸腔镜辅以胸部小切口手术40例

对４０例胸部疾病患者行电视胸腔镜辅以胸部小切口手术（ＶＡＭＴ），其中肺癌１７例，肺周围型病灶１０例，食管癌８例，食管平滑肌瘤、贲门失弛症、食管憩室、纵隔肿瘤、急性脓胸各１例；ＶＡＭＴ探查时间为２０￣３０分钟，ＶＡＭＴ手术时间为４０￣１５０分钟，小切口长５￣８ｃｍ；无手术死亡者。本文对ＶＡＭＴ的手术适应症、小切口设计及其临床价值进行了讨论。     

电视胸腔镜手术的临床应用

1995年10月至1996年10月,我们成功地为5例患者施行胸腔镜手术,并取得了初步经验。现报告如下。1 临床资料 例1:男,68岁。查体发现胸部肿物1个月。胸部MRI示前纵隔、心包前有一7cm×5.8cm椭圆型阴影,边界光滑。诊断为纵隔肿瘤。全麻下行胸腔镜手术。取后倾45°卧位,咱左腋中线第6肋间入镜,左腋前线第4肋间及胸骨旁线第5肋间各置一套管作为操作孔。探查见肿瘤系囊性,卵圆型,包膜完整光滑,与周围组织疏松粘连。以电钩分离,游离后于左腋中线第6肋间切一长4cm小口,将肿物拉至切口处,以针穿刺,抽出咖啡色液体80ml。将囊壁拉出胸外,止血,于视孔处置一引流管,缝合切口。病理诊断为心包囊肿。     

电视胸腔镜手术治疗胸部肿瘤患者86例分析

目的 分析电视胸腔镜手术(Video Assisted Thoracoscopic Surgery,VATS)在胸部肿瘤治疗中的效果.方法 通过回顾分析2010年2月～2011年6月,来我院就诊并行电视胸腔镜手术的86例罹患胸部肿瘤的患者的临床资料,探讨VATS的治疗效果.结果 本组行全胸腔镜手术80例,术中转胸腔镜辅助小切口手术6例,无手术死亡病例.本组患者中肺楔形切除32例,肺叶切除42例,纵隔肿瘤9例,胸膜活检加肺固定术3例.手术持续时间平均89 min,术中平均失血量149 ml,均未输血,术后仅8例出现并发症,患者术后平均住院时间为8 d.结论 电视胸腔镜手术在治疗胸部肿瘤时具有创伤小、痛苦轻、并发症少、恢复快等优点,具有较高的临床推广价值;一次性缝合材料配合完全性肺叶切除可达到开胸手术相同的治疗效果,但仍需继续积累相关手术经验.     

Video-assisted thoracic surgery: A renaissance in surgical therapy

Within a few years, video-assisted thoracic surgery (VATS) has become the accepted or preferred approach over a wide range of thoracic procedures. The authors review the development of this technique, the basic operative strategies and the current surgical indications. Technical pitfalls and future developments are also discussed.     

Video-assisted thoracic surgery for spontaneous haemopneumothorax

BACKGROUND AND OBJECTIVE: The aim of this study was to review the treatment options for spontaneous haemopneumothorax (SHP) by video-assisted thoracoscopic surgery (VATS). METHODS: Records from 16 patients (14 male, age 16-38 years, mean age 26.1 years) with prominent SHP (blood loss over 400 cc in the first 24 h) undergoing VATS from July 1994 to December 2005 and treated by one thoracic surgeon in four medical centres or community hospitals of North and Mid-Taiwan were reviewed retrospectively. RESULTS: Thirteen patients (81.3%) were identified to have a prominent bleeding source intraoperatively. Torn engorged vessels from the parietal pleura to adjacent bullae were found in nine patients, and bleeders adjacent or over the parietal part of the adhered pleura were found in the other four. Ruptured bullae/blebs or air leakage were found in 14 (87.5%). All underwent removal of intrapleural blood clot, control of bleeders and their bullae/blebs were resected through three-port VATS (n = 13, 81.2%) or mini-thoracotomy and VATS (n = 3, because of unstable vital signs or conversion because of dense adhesion). Mechanical or chemical pleurodesis was carried out in all patients. The mean operative time was 53.8 +/- 21.7 min. There was no postoperative mortality. However, recurrent bleeding requiring reoperation occurred in one patient, and one other patient had a prolonged air leakage (>7 days) postoperatively and recovered spontaneously. The mean duration of chest tube drainage was 3.8 days and the median follow-up period was 3.2 years. CONCLUSION: SHP complicated by severe bleeding is a surgical emergency. VATS is a reasonable treatment for patients with SHP.     

Video-assisted thoracic surgery right sleeve lobectomy

A 50-year-old active male with a smoking history of 30 years (20 cigarettes per day) was admitted to hospital because of more than one month’s cough without sputum. No comorbidity was present. The preoperative examination showed: blood test normal, ECG normal, cardio-pulmonary function normal, chest computed tomography (CT) display right upper lobe (RUL) mass of 5 cm diameter. Bronchoscopy examination and biopsy indicated large cell neuroendocrine carcinoma (LCNEC) in the take-off of RUL bronchus. No metastatic focus was found after emission computed tomography (ECT) scan of whole body bone, abdominal US scanning and brain MR. After initial evaluation, the clinical stage before operation was cT2bN0M0 (IIA stage). A selective video-assisted thoracic surgery (VATS) operation was arranged after 9 days of smoking cessation. Lateral position, one 10 mm trocar for camera in the 7th intercostals space in the mid-auxiliary line, 4 cm trocar for operation in the 4th intercostal space in the anterior axillary line, 15 mm trocar for auxiliary operation in the 8th intercostal space in the scapula line, the patient received VATS RUL lobectomy, plus systemic mediastinal lymph nodes dissection. The procedure of 200 minutes operation was smooth with blood loss of about 150 mL. Chest tube was removed 6 days after operation, and the patient discharged 11 days after the operation; The post-operation pathological examination showed RUL LCNEC, and the pathological stage was pT2bN0M0R0 (IIA stage). The patient has received four cycles of EP adjuvant chemotherapy per 21 days and is still alive without disease recurrence and metastasis after re-examination.     

电视胸腔镜与正中胸骨切开心脏手术的比较

目的通过比较电视辅助胸腔镜与正中胸骨切开心脏间隔缺损手术在疼痛、呼吸功能、血液系统改变及术后恢复等方面的差异,来明确电视辅助胸腔镜手术（VATS）的安全性及其优缺点。方法抽取行VATS和MS的患者各120例,为VATS组和正中胸骨切开术（MS）组。比较两组间术后疼痛,术后恢复的迅速程度,血液细胞记数改变,失血量以及输血量和呼吸功能等。结果二组间在主动脉阻闭时间和住院时间上无明显差异。在5岁以上VATS组患者101人中,用吗啡类止痛药物的16人,而MS组84人中有24人使用吗啡类止痛药物（P<0.05）。两组间动脉分析氧分压,养合指数以及呼吸机辅助时间无显著差异。VATS组手术时间长于MS组,而其ICU滞留时间短（P<0.01）。VATS组患者手术后失血及输血量少于对照组。结论VATS同MS同样安全可靠,虽然其手术时间长,但与MS组相比较,其术后恢复较快,术后疼痛轻,并且其失血及输血量少。     

Video-assisted thoracic surgery for pulmonary sequestration: a safe alternative procedure

Background

Pulmonary sequestration (PS), a rare congenital anatomic anomaly of the lung, is usually treated through resection by a conventional thoracotomy procedure. The efficacy and safety of video-assisted thoracic surgery (VATS) in PS treatment has seldom been evaluated. To address this research gap, we assessed the efficacy and safety of VATS in the treatment of PS in a large Chinese cohort.

Methods

We retrospectively reviewed 58 patients with PS who had undergone surgical resection in our department between January 2003 and April 2014. Of these patients, 42 (72.4%) underwent thoracotomy, and 16 (27.6%) underwent attempted VATS resection. Clinical and demographic data, including patients’ age, sex, complaints, sequestration characteristics, approach and procedures, operative time, resection range, blood loss, drainage volume, chest tube duration, hospital stay, and complications were collected, in addition to short-term follow-up data.

Results

Of the 58 participating patients, 55 accepted anatomic lobectomy, 2 accepted wedge resection, and 1 accepted left lower lobectomy combined with lingular segmentectomy. All lesions were located in the lower lobe, with 1–4 aberrant arteries, except one right upper lobe sequestration. Three cases (18.8%) in the VATS group were converted to thoracotomy because of dense adhesion (n=1), hilar fusion (n=1), or bleeding (n=1). No significant differences in operative time, postoperative hospital stay, or perioperative complications were observed between the VATS and thoracotomy groups, although the VATS patients had less blood loss (P=0.032), a greater drainage volume (P=0.001), and a longer chest tube duration (P=0.001) than their thoracotomy counterparts.

Conclusions

VATS is a viable alternative procedure for PS in some patients. Simple sequestration without a thoracic cavity or hilum adhesion is a good indication for VATS resection, particularly for VATS anatomic lobectomy. Thoracic cavity and hilum adhesion remain a challenge for VATS.     

Inflammatory cytokines in robot-assisted thoracic surgery versus video-assisted thoracic surgery

BackgroundCytokines play a crucial role in the inflammatory response and are essential modulators of injury repair mechanisms. While minimally invasive operations have been shown to induce lower levels of cytokines compared to open thoracotomy, the inflammatory cytokine profile difference between video-assisted (VATS) and robotic-assisted thoracic surgery (RATS) techniques has yet to be elucidated.MethodsIn this prospective observational study of 45 patients undergoing RATS (n=30) or VATS (n=15) lung resection for malignancy, plasma levels of interleukin (IL)-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, vascular endothelial growth factor (VEGF), interferon (IFN)-γ, tumor necrosis factor (TNF)-α, monocyte chemo-attractant protein (MCP)-1, and endothelial growth factor (EGF) were measured before and after surgery via immunoassay.ResultsLevels of IL-6 and MCP-1 were significantly higher in patients undergoing VATS than in patients undergoing RATS (P<0.001 and P=0.005, respectively) 2 hours following surgery. MCP-1 levels were also found to be significantly higher in the VATS group (P<0.001) 24 hours following surgery. IL-1α, IL-1β, IL-2, IL-4, IL-8, IL-10, IFN-γ, TNF-α, and EGF levels were not significantly different at any time-point comparing VATS to RATS.ConclusionsThe VATS approach is associated with a more robust pro-inflammatory cytokine response through the upregulation of MCP-1 and IL-6 when compared to the RATS approach in patients undergoing anatomic lung resection. Further studies are necessary to validate the clinical significance of this finding.     

全胸腔镜与开胸肺叶切除术对比观察

目的对比观察全胸腔镜肺叶切除术与开胸肺叶切除术的安全性及术后患者生活质量。方法行全胸腔镜肺叶切除术者30例(VATS组),同期行开胸肺叶切除术者30例(开胸组),比较两组手术期、围术期相关指标及术后随访结果。结果两组患者均顺利完成手术,无术中及围手术期死亡。两组手术时间、肺癌患者淋巴结清扫站数、清扫淋巴结数量及住院总费用相近;术中出血量、术后胸液量、胸管保留时间、住院时间和术后患者的生活质量,VATS组优于开胸组,两组相比,P均<0.05。结论全胸腔镜肺叶切除术安全性、手术效果均不逊于开胸手术,且全胸腔镜手术患者围术期痛苦少、恢复快,术后生活质量较高。     

Video-assisted thoracic surgery for pneumothorax in LAM

Spontaneous pneumothorax is one of the more common presentations of lymphangioleiomyomatosis; however, recurrences are common which can be challenging to manage particularly in bilateral pneumothorax. We present a case of recurrent bilateral spontaneous pneumothorax associated with lymphangioleiomyomatosis, diagnosed intra-operatively, and confirmed by the resected lung specimen. Video-assisted thoracic surgery bullectomy and mechanical as well as talc pleurodesis was required to prevent further recurrences. The case discusses the unusual clinical course, radiological, operative and pathologic findings of the disease, and management difficulties that are distinct from other causes of spontaneous pneumothorax.     

Video-assisted thoracic surgery left upper lobectomy with systematic lymphadenectomy

A 62-year-old woman was referred to the Thoracic Surgery Department after computed tomography (CT) revealed a 1.0 cm × 1.1 cm mass peripherally in the left upper lobe with spicular formation during her routine medical examination. The nature of the mass was confirmed to be adenocarcinoma by transpercutaneous lung biopsy. No metastasis or contraindication for surgery was found. Video-assisted thoracic surgery (VATS) left upper lobectomy with systematic lymphadenectomy was performed. Total surgery time was 80 min and blood loss was 50 mL. Postoperative pathological exam suggested adenocarcinoma, without evidence of lymph node metastasis in any station (T1aN0M0 stage IA). The patient was discharged home on the 10^th postoperative day.     

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.