经剑突下与经肋间胸腺扩大切除术治疗重症肌无力的回顾性队列研究

目的 比较经剑突下胸腔镜（subxiphoid video-assisted thoracoscopic surgery,XVATS）与经肋间VATS(conventional intercostal VATS,CVATS)胸腺扩大切除术治疗重症肌无力（myasthenia gravis,MG）的临床疗效。方法 回顾性分析2016年10月—2021年10月徐州市中心医院胸外科行胸腺扩大切除术MG患者的临床资料。筛选有疗效随访评价的病例,依据手术方式分为XVATS组与CVATS组。比较两组患者围术期指标及临床效果。结果 共纳入患者84例,其中男43例、女41例,平均年龄52.3岁。XVATS组41例,CVATS组43例。全组患者无死亡、心肺血栓、肺漏气或纵隔内感染。CVATS组5例（11.6%）中转开胸、1例（2.3%）术后MG危象、1例（2.3%）胸腔内出血、1例（2.3%）乳糜胸。两组在手术时间[（127.4±50.4）min vs.(122.9±38.6)min]、术中出血量[46.9(25.7,79.2)mL vs. 45.7(21.9,92.1)mL]、手术并发症发生率[0 v...     

剑突下与肋间入路胸腔镜胸腺扩大切除术的临床体会

目的探讨经剑突下入路与肋间入路胸腔镜(video-assisted thoracoscopic surgery, VATS)胸腺扩大切除术的特点。 方法回顾性分析2015年1月至2018年12月徐州市中心医院胸外科VATS胸腺扩大切除术的病例资料113例,依据术式不同分为经肋间多孔VATS (multiple-port VATS,MVATS)组46例(肋间MVATS组)、剑突下MVATS组40例与剑突下单孔VATS (uniportal VATS,UVATS)组27例(剑突下UVATS组)。比较手术相关参数的差异。 结果肋间入路组5例、剑突下入路组7例术前合并重症肌无力(myasthenia gravis, MG)。患者无中转开胸手术或死亡。剑突下UVATS组3例中转剑突下MVATS。肋间MVATS组与剑突下MVATS组、剑突下UVATS组比较,手术时间短[(64.0±15.1) min比(71.4±18.1) min比(87.4±18.7) min, P<0.05],胸腔引流时间短[(1.5±0.7) d比(2.3±1.1) d比(2.9±1.3) d, P< 0.05]、胸腔引流量少[(131.4±66.5) ml比(169.9±110.6) ml比(231.5±111.9) ml, P< 0.05]、术后住院时间短[(1.9±1.1) d比(3.1±2.0) d比(3.7±2.8) d, P< 0.05],而术后1 d视觉模拟评分高[(4.2±1.3)分比(3.7±1.1)分比(3.5±1.2)分,P< 0.05]。剑突下UVATS组2例术后出现MG危象。CT提示剑突下MVATS组1例、剑突下UVATS组5例术后前纵隔脂肪影残留。 结论剑突下入路VATS胸腺扩大切除术是可行的,但与肋间入路MVATS比较无显著优势。     

不插管单孔剑突下胸腔镜右全肺切除术一例

目的探讨不插管麻醉在单孔剑突下胸腔镜全肺叶切除术中的可行性和安全性。 方法选取同济大学附属上海市肺科医院胸外科中央型非小细胞肺癌患者一例,术前完善检查,无手术禁忌,手术采用不插管麻醉在单孔剑突下胸腔镜右全肺切除术。 结果患者术中和术后无意外及其他严重不良事件发生。 结论不插管麻醉在单孔剑突下入路胸腔镜全肺手术中具有可行性和一定优势,更多支持证据尚需大规模临床对照研究。     

改良模块化剑突下胸腔镜胸腺肿瘤切除术临床应用

目的 总结剑突下入路胸腔镜胸腺肿瘤切除术的临床疗效。方法 2021年2月～2023年3月我院行胸腔镜胸腺肿瘤切除术病人93例。按照手术入路分为剑突下组(40例)和侧进胸组(53例)。比较两组手术结果、围术期指标及术后疼痛情况。结果 两组病人均完成胸腔镜胸腺全切或胸腺扩大切除术,无中转开胸。剑突下组胸腺全切手术时间为(60.32±1.53)分钟,胸腺扩大切除手术时间为(114.52±11.63)分钟,术后带管时间为(3.20±0.91)天,术后住院时间为(4.00±0.16)天,侧进胸组分别为(66.62±1.45)分钟、(138.76±6.35)分钟、(4.00±1.22)天和(4.70±0.18)天,两组比较差异有统计学意义(P<0.05)。剑突下组术后24小时VAS评分为(3.8±0.8)分、48小时VAS评分为(3.0±0.7)分、72小时VAS评分为(2.6±0.9)分,侧进胸组分别为(5.7±0.9)分、(4.7±0.8)分和(3.2±0.8)分,两组比较差异有统计学意义(P<0.05)。两组病人术中失血量、住院费用、并发症发生率、术后30天感觉异常情况比较差异无...     

不插管麻醉在剑突下单孔胸腔镜手术中的临床实践

目的探讨不插管麻醉在剑突下单孔胸腔镜手术中的可行性和安全性。 方法收集同济大学附属上海市肺科医院2019年4月至2020年4月完成的60例不插管麻醉在经剑突下单孔胸腔镜手术中的病例资料。对围手术期并发症及处理措施、术后恢复和住院时间等情况进行分析总结,对不插管麻醉在剑突下单孔胸腔镜手术中的安全性和可行性进行评估。 结果60例患者均在不插管麻醉下行剑突下单孔胸腔镜手术,包括肺叶切除术21例、肺段切除术7例、肺楔形切除术24例、胸腺切除术8例;肺叶切除术、肺段切除术、肺楔形切除术、胸腺切除术的手术时间分别为(71.8±25.7)min、(68.9±27.3)min、(41.5±11.1)min、(103.9±22.3)min,术中出血量分别为(47.6±18.4)ml、(45.6±16.8)ml、(26.5±13.3)ml、(65.8±24.5)ml;其中29例(48.3%)术中需要放置口咽通气道、17例(28.3%)出现术中低血压、9例(15.0%)发生心律失常,无术中知晓事件发生,4例(6.7%)发生术后并发症,无严重不良事件发生;平均住院时间(7± 4.0)d。 结论不插管麻醉在经剑突下入路单孔胸腔镜手术中具有可行性和一定优势,更多支持证据尚需大规模临床对照研究。     

双悬吊拉钩辅助剑突下胸腔镜胸腺扩大切除术在胸腺占位合并重症肌无力中的临床应用

目的探讨双悬吊拉钩辅助剑突下胸腔镜胸腺扩大切除治疗胸腺占位合并重症肌无力(myasthenia gravis,MG)的疗效。方法采用回顾性研究,选择2018年1月至2018年12月在我科住院的胸腺占位合并重症肌无力患者41例,均行双悬吊拉钩辅助剑突下胸腔镜胸腺扩大切除术。结果41例患者均顺利完成手术,平均手术时间(83.43±24.32)min,均完整切除胸腺及周围脂肪组织,无使用双悬吊拉钩相关并发症,无其他手术相关并发症。结论应用双悬吊拉钩辅助行剑突下胸腔镜胸腺扩大切除术治疗胸腺占位合并重症肌无力患者,能扩大手术视野及操作空间,手术创伤小,手术过程顺利,安全可靠,值得推广运用。     

经剑突下单孔胸腔镜同期双肺下叶切除术2例CSCD

2014年9月始,我们开展剑突下单孔胸腔镜手术,并广泛运用于肺大疱、纵隔肿瘤及早期肺癌的诊治.利用剑突下切口可同时处理双侧病变的特点,对于双肺大疱切除或双肺结节活检等简单手术较经肋间切口优势明显[1-2].2016年以来,我们尝试利用该切口行同期双侧肺叶切除治疗早期肺癌,已成功施行2例,现报道如下.     

经剑突下与经肋间单孔胸腔镜肺叶切除术治疗非小细胞肺癌的对照研究

目的比较经剑突下单孔胸腔镜(SUVATS)与经肋间单孔胸腔镜(IUVATS)肺叶切除术治疗非小细胞肺癌的效果。方法纳入2019年7月1~31日于上海市肺科医院胸外科行单孔胸腔镜肺叶切除的428例非小细胞肺癌患者,按术式不同,将患者分为SUVATS组[80例,男42例、女38例,年龄(58.8±9.6)岁]和IUVATS组[348例,男161例、女187例,年龄(61.2±10.0)岁]。比较两组的临床效果。结果两组患者在性别(P=0.314)、年龄(P=0.052)、术前肺功能(P=0.701)、慢性合并症(合并心血管疾病,P=0.775;合并慢性阻塞性肺疾病,P=0.678)和术后病理类型(P=0.132)等方面差异无统计学意义。与IUVATS组比较,SUVATS组手术时间更长[(155.6±34.4)min vs.(141.3±27.0)min,P<0.001],术中出血量较少[(165.2±160.6)mL vs.(223.7±272.4)mL,P<0.001],置管时间更短[(4.3±2.0)d vs.(4.9±1.9)d,P=0.011];术后8 h(P<0.001)、1 d(P=0.019)、2 d(P=0.015)和出院前1 d(P<0.001)疼痛评分较低。结论采用SUVATS行肺叶切除安全有效,术后疼痛减轻,可有效促进患者快速康复。     

胸腔镜下胸腺扩大切除术患者的护理

对8例腰椎间盘突出症患者行人工髓核假体置换治疗。结果均顺利完成手术,随访3～l2个月．优6例．良2例。提出术前做好心理护理,术后密切观察病情变化、及时处理并发症、早期实施康复护理是手术成功的重要保证。     

Video-assisted thoracoscopic surgery thymectomy versus open thymectomy in patients with myasthenia gravis: a meta-analysis

Background: Video-assisted thoracoscopic surgery (VATS) thymectomy has become a feasible treatment for myasthenia gravis (MG) in recent years. The objective of the present meta-analysis was to evaluate the perioperative characteristics, safety, and completely stable remission rate in patients with MG who received VATS or open thymectomy (OT).

Methods: We searched PubMed, Embase, ScienceDirect, Web of Science, and CNKI for related articles using combinations of the search terms video-assisted thoracoscopic thymectomy, transsternal thymectomy, and MG. The inter-study heterogeneity was assessed by χ²-based Q statistics, and the extent of inconsistency was generated by I² statistics.

Results: A total of 12 studies with 1173 patients were included, and there was no difference in the operation time (p?=?0.08) and ICU time (p?=?0.14) between the two groups, but VATS thymectomy was associated with less intra-operation blood loss and hospital time (p?p?=?0.03) and myasthenic crisis (OR = 0.51; 95% CI, 0.28–0.92; p?=?0.03), but the rates of pneumonia (OR = 0.59; 95% CI, 0.29–1.32; p?=?0.21) and complete remission rate (CSR) (OR = 0.64; 95% CI, 0.38–1.09; p?=?0.10) had no obvious differences between the VATS and OT groups.

Conclusion: Patients with MG undergoing VATS thymectomy achieved better surgical outcomes and fewer complications than those who received OT.     

Uniportal versus Multiportal Thoracoscopic Complex Segmentectomy: Propensity Matching Analysis

Purpose: Uniportal video-assisted thoracoscopic surgery (VATS) complex segmentectomy has been challenging for thoracic surgeons. This study was designed to compare the perioperative outcomes between uniportal and multiportal VATS complex segmentectomy.Methods: Data on a total of 122 uniportal and 57 multiportal VATS complex segmentectomies were assessed. Propensity score (PS) matching yielded 56 patients in each group. A crude comparison and PS matching analyses, incorporating preoperative variables, were conducted to elucidate the short-term outcomes between uniportal and multiportal VATS complex segmentectomies.Results: The uniportal group had a significantly shorter operation time (173 min vs. 195 min, p = 0.004), pleural drainage duration (2.5 d vs. 3.5 d, p <0.001), and postoperative hospital stay (4.2 d vs. 5.3 d, p <0.001) before matching, and a significant difference was also observed after matching for pleural drainage duration (2.5 d vs. 3.6 d, p <0.001) and postoperative hospital stay (4.5 d vs. 5.2 d, p = 0.001). The numbers of dissected lymph nodes in N1 and N2 stations, the intraoperative and postoperative complication rates were not significantly different between these two groups.Conclusions: The uniportal VATS complex segmentectomy was not inferior to multiportal VATS in terms of perioperative outcomes and therefore should be considered as a viable surgical approach for treatment.     

Comparison between the right side and subxiphoid bilateral approaches in performing video-assisted thoracoscopic extended thymectomy for myasthenia gravis

Background This study aimed to compare the efficacy of the right thoracoscopic (RtT) approach and the subxiphoid bilateral thoracoscopic (SxBiT) approach in performing thymectomy for myasthenia gravis.Methods Between March 2001 and April 2003, 27 myasthenic patients were enrolled in this prospective study. The operations were conducted by two surgical teams in a single institute. The surgical procedures included RtT for 12 patients and SxBiT for 15 patients. The operation time, resected thymus weights, and thoracic drainage periods were compared.Results Subxiphoid video-assisted thoracoscopic extended thymectomy (SxVATET) and right-side thoracoscopic extended thymectomy (RtVATET) were performed for 27 consecutive myasthenic patients. The mean operation time, weights of resected specimens, and duration of hospital stay for the SxVATET and RtVATET groups were, respectively, 151.3 min (range, 120–200 min) versus 191.5 min (range, 120–225 min) (p = 0.0012), 73.3 g (range, 40–90 g) versus 50.8 g (range, 5–90 g) (p = 0.0029), and 3.1 days (range, 2–4 days) versus 3.8 days (range, 2–4 days) (p = 0.914). Ten patients (37%) had complete remission, observed during a mean follow-up period of 18.5 months (range, 6–30 months).Conclusions During this consecutive experience, both the RtT and SxBiT approaches showed satisfactory results for nonthymomatous myasthenic patients. However, a better view of the bilateral pleural cavities and more radical thymectomy could be achieved only by the SxBiT approach.     

Hybrid combination of small subxiphoid incision and thoracoscopic thymectomy for juvenile myasthenia gravis

Background/Purpose

Myasthenia gravis is an autoimmune disease that usually responds positively to treatment with thymectomy. Various approaches via video-assisted thoracic thymectomy as a substitute for conventional sternotomy have been reported. We reported a less invasive technique for thymectomy in pediatric groups.

Methods

Four adolescents with juvenile myasthenia gravis all underwent hybrid combination of small subxiphoid incision and thoracoscopic thymectomy at our institute. Clinical characteristics and surgical outcome were consecutively collected.

Results

In these 4 patients, 2 presented with Osserman class III and 2 with class IIb. The mean operative time was 180 minutes. There was no conversion to sternotomy, and there was only minimal blood loss. Follow-up duration was 3 to 64 months. Postoperatively, 1 patient had complete remission and 3 patients had improvement in clinical symptoms.

Conclusion

Hybrid combination of small subxiphoid incision and thoracoscopic thymectomy may be an effective alternative with low surgical invasiveness for treating juvenile myasthenia gravis.     

Functional recovery after discharge in enhanced recovery video-assisted thoracoscopic lobectomy: a pilot prospective cohort study

Little is known about functional recovery following patient discharge in an established enhanced recovery programme after video-assisted thoracoscopic lobectomy. We conducted a single-centre pilot prospective observational cohort study. We hypothesised that patients achieved early functional recovery after discharge. A total of 32 patients aged ≥ 18 years were enrolled. A digital device was used for objective activity measurements, and patient-reported outcomes were collected as subjective measurements. Primary outcomes were the difference in physical activity; sleep duration; pain; fatigue; and average quality of life scores between pre-operative baseline and 7 days following discharge. The secondary outcome was the reason for reduced daily activity during the first 7 days after discharge. Median (IQR [range]) length of stay was 3 (2–5 [1–13]) days. Up to post-discharge day 7, total, lower intensity and moderate-to-vigorous activities were lower than pre-operative activity (p < 0.001; p = 0.005 and p = 0.027, respectively). Numerical rating scale (0–10) pain scores increased postoperatively at rest (mean difference 1.2, p < 0.001) and during walking (mean difference 1.4, p < 0.001). Fatigue assessed by the Christensen Fatigue Scale (1–10) was also increased postoperatively (mean difference 1.7, p = 0.001). There was a reduction in quality of life scores, while sedentary activity and sleep duration were unchanged postoperatively. Dominant reasons for not recovering daily activity included fatigue in 43% and pain in 33% of patients. Despite compliance with an enhanced recovery programme with a median length of hospital stay of 3 days after video-assisted thoracoscopic lobectomy, functional recovery was not achieved within 7 days after hospital discharge. Reduction in postoperative pain and fatigue are important factors to enhance functional recovery.     

重症肌无力电视胸腔镜与胸骨部分劈开行胸腺扩大切除比较

目的 探讨电视胸腔镜手术(VATS)在重症肌无力(MG)治疗中的价值.方法 应用随机对照研究前瞻性分析2005年至2008年开展的VATS和胸骨部分劈开行胸腺切除治疗MG疗效,比较两组在手术时间、术中出血量、术后胸管放置时间、术后住院时间、术后发生重症肌无力危象及疗效等方面差异.结果 VATS组中26例手术顺利,1例因电凝钩伤及头臂静脉中转开胸.与部分胸骨劈开组比较,VATS组术中出血少、手术时间短、术后放置胸管时间及术后住院时间缩短.VATS组与胸骨劈开组比较发生肌无力危象0例对3例,肺部感染2例对9例,胸骨上窝或伤口感染0例对3例.随访6～24个月,VATS和胸骨劈开组有效率分别为81%(21/26例)和85%(23/27例),差异无统计学意义.结论 VATS下胸腺扩大切除治疗重症肌无力,技术是安全、可行的,具有创伤小、痛苦轻、并发症少、疗效可靠等优点,临床应用前景良好.     

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.