共查询到17条相似文献，搜索用时 1 毫秒
1.
2.
3.
4.
5.
6.
David S. Demos Mark F. Berry Leah M. Backhus Joseph B. Shrager 《The Journal of thoracic and cardiovascular surgery》2017,153(5):1182-1188
Objective
Surgeons have hesitated to adopt minimally invasive diaphragm plication techniques because of technical limitations rendering the procedure cumbersome or leading to early failure or reduced efficacy. We sought to demonstrate efficacy and durability of our thoracoscopic plication technique using a single running suture.Methods
We retrospectively reviewed patients who underwent our technique for diaphragm plication since 2008. We used a single, buttressed, double-layered, to-and-fro running suture with additional plicating horizontal mattress sutures as needed.Results
Eighteen patients underwent thoracoscopic plication from 2008 to 2015. There were no operative mortalities and 2 unrelated late deaths. Median hospital stay was 3 days (range, 1-12). Atrial fibrillation occurred in 1 patient (5.5%), pneumonia occurred in 2 patients (11%), reintubation occurred in 1 patient (5.5%), and ileus occurred in 1 patient (5.5%). Of 14 patients with complete follow-up, median follow-up was 29.4 months (range, 3.4-84.7). Significant increases between preoperative and postoperative pulmonary function tests (% predicted values) were found for mean forced expiratory volume in 1 second (73.5% ± 3.5% to 88.8% ± 4.5%, P = .002) and mean forced vital capacity (70.6% ± 3.5% to 82.3% ± 3.5%, P = .002). Preoperative mean Baseline Dyspnea Index was 8.1 ± 0.7. Mean Transitional Dyspnea Index 6 months postoperatively was 7.1 ± 0.6 (moderate to major improvement). Transitional Dyspnea Index at last contact (median 29.4 months postoperatively) was 7.2 ± 0.6 (P = .38). Compared with previously published results, this is at least equivalent.Conclusions
Thoracoscopic diaphragm plication with a running suture is safe and achieves excellent early and long-term improvements. This addresses technical challenges of tying multiple interrupted sutures by video-assisted thoracoscopic surgery without any apparent compromise to efficacy or durability. 相似文献7.
8.
9.
Hiroaki Nomori Atsushi Shiraishi Yue Cong Kazufusa Shoji Masafumi Misawa Hiroshi Sugimura Yu Oyama 《The Journal of thoracic and cardiovascular surgery》2018,155(5):2129-2137.e1
Objective
Our study aim was to determine whether there are differential changes in whole-lung and regional lung functions after lobectomy for lung cancer between propensity score-matched patients treated with and without induction chemoradiotherapy, by using single-photon emission computed tomography lung perfusion.Methods
This study was a retrospective matched cohort study of consecutively acquired data. Pulmonary function test and perfusion scintigraphy were conducted before lobectomy and 6 months after lobectomy in patients treated with induction therapy (n = 72) and in those not treated (n = 170), for measuring functional changes of whole lung, contralateral lung, and lobes. After exact matching on resected lobe site, propensity scores for age, smoking status, preoperative pulmonary functions, and predicted postoperative pulmonary function were used to match the groups.Results
After the matching, 46 patients were selected from the groups. Standardized mean differences of the 5 matched variables were <0.1. Whole lung function significantly decreased after lobectomy in the induction therapy group than in the noninduction therapy group (P < .001). Although ipsilateral preserved lobe function before surgery was not different between the groups (P = .33), postoperative value was significantly lower in the induction therapy group than in the noninduction therapy group (P < .001). Although both groups showed a significant increase of contralateral lung function after lobectomy (P < .01), the increases were not significantly different between the groups (P = .81).Conclusions
Induction chemoradiotherapy was associated with reduced pulmonary function after lobectomy because of a decrease in ipsilateral preserved lobe function, which could be caused by the chronic effects of the induction chemoradiotherapy. 相似文献10.
11.
12.
Cecilia Pompili Pierre Emmanuel Falcoz Michele Salati Zalan Szanto Alessandro Brunelli 《The Journal of thoracic and cardiovascular surgery》2017,153(4):957-965
Objective
The study objective was to develop an aggregate risk score for predicting the occurrence of prolonged air leak after video-assisted thoracoscopic lobectomy from patients registered in the European Society of Thoracic Surgeons database.Methods
A total of 5069 patients who underwent video-assisted thoracoscopic lobectomy (July 2007 to August 2015) were analyzed. Exclusion criteria included sublobar resections or pneumonectomies, lung resection associated with chest wall or diaphragm resections, sleeve resections, and need for postoperative assisted mechanical ventilation. Prolonged air leak was defined as an air leak more than 5 days. Several baseline and surgical variables were tested for a possible association with prolonged air leak using univariable and logistic regression analyses, determined by bootstrap resampling. Predictors were proportionally weighed according to their regression estimates (assigning 1 point to the smallest coefficient).Results
Prolonged air leak was observed in 504 patients (9.9%). Three variables were found associated with prolonged air leak after logistic regression: male gender (P < .0001, score = 1), forced expiratory volume in 1 second less than 80% (P < .0001, score = 1), and body mass index less than 18.5 kg/m2 (P < .0001, score = 2). The aggregate prolonged air leak risk score was calculated for each patient by summing the individual scores assigned to each variable (range, 0-4). Patients were then grouped into 4 classes with an incremental risk of prolonged air leak (P < .0001): class A (score 0 points, 1493 patients) 6.3% with prolonged air leak, class B (score 1 point, 2240 patients) 10% with prolonged air leak, class C (score 2 points, 1219 patients) 13% with prolonged air leak, and class D (score >2 points, 117 patients) 25% with prolonged air leak.Conclusions
An aggregate risk score was created to stratify the incidence of prolonged air leak after video-assisted thoracoscopic lobectomy. The score can be used for patient counseling and to identify those patients who can benefit from additional intraoperative preventative measures. 相似文献13.
14.
Zoraida Verde Catalina Santiago Luis M. Chicharro Fernando Bandrés Félix Gómez-Gallego Jose Miguel Rodríguez González-Moro Pilar de Lucas 《Archivos de bronconeumologia》2019,55(3):128-133
Introduction
Cigarette smoking is a major risk factor in the development of chronic obstructive pulmonary disease (COPD). Serotonin levels have been associated with COPD and smoking has been as a significant modulator. Elevated levels of serotonin are responsible for bronchoconstriction and pulmonary vasoconstriction and also nicotine dependence, thus serotonin response could be affected by genetic polymorphisms in transporters and receptors of serotonin.Objectives
The aim of the current study was to analyze the effect of SLC6A4 (5HTT_LPR) (rs25531) and HTR2A-1438G/A (rs6311) genetic polymorphisms on the relation between smoking habits and COPD.Methods
The association between SLC6A4 (5HTT_LPR) (rs25531), HTR2A-1438G/A (rs6311), smoking degree and COPD was analyzed in a total of 77 COPD patients (active smokers) and 90 control subjects (active healthy smokers). The DNA was extracted of peripheral leukocytes samples and genotyping was performed using an allele specific polymerase chain reaction.Results
The distribution of SLC6A4 genotypes did not vary between healthy smokers and COPD patients (P = 0.758). On the other hand, the A allele of HTR2A (rs6311) was significantly associated with COPD incidence in the trend model (P = 0.02; 1.80 [1.04–3.11]). Among all smokers, this allele was also associated with the number of pack years smoked (P = 0.02) and also, we observed a marginal association with FEV1/FVC values (P = 0.06).Conclusion
Our results point a possible role of the A allele of HTR2A (rs6311) in COPD pathogenesis, suggesting that this effect depends partly on tobacco consumption due to a gene-by-environment interaction. 相似文献15.
16.
《The Journal of thoracic and cardiovascular surgery》2023,165(3):828-839.e5
ObjectiveMultimodality treatment for resectable non–small cell lung cancer has long remained at a therapeutic plateau. Immune checkpoint inhibitors are highly effective in advanced non–small cell lung cancer and promising preoperatively in small clinical trials for resectable non–small cell lung cancer. This large multicenter trial tested the safety and efficacy of neoadjuvant atezolizumab and surgery.MethodsPatients with stage IB to select IIIB resectable non–small cell lung cancer and Eastern Cooperative Oncology Group performance status 0/1 were eligible. Patients received atezolizumab 1200 mg intravenously every 3 weeks for 2 cycles or less followed by resection. The primary end point was major pathological response in patients without EGFR/ALK+ alterations. Pre- and post-treatment computed tomography, positron emission tomography, pulmonary function tests, and biospecimens were obtained. Adverse events were recorded by Common Terminology Criteria for Adverse Events v.4.0.ResultsFrom April 2017 to February 2020, 181 patients were entered in the study. Baseline characteristics were mean age, 65.1 years; female, 93 of 181 (51%); nonsquamous histology, 112 of 181 (62%); and clinical stages IIB to IIIB, 147 of 181 (81%). In patients without EGFR/ALK alterations who underwent surgery, the major pathological response rate was 20% (29/143; 95% confidence interval, 14-28) and the pathological complete response rate was 6% (8/143; 95% confidence interval, 2-11). There were no grade 4/5 treatment-related adverse events preoperatively. Of 159 patients (87.8%) undergoing surgery, 145 (91%) had pathologic complete resection. There were 5 (3%) intraoperative complications, no intraoperative deaths, and 2 postoperative deaths within 90 days, 1 treatment related. Median disease-free and overall survival have not been reached.ConclusionsNeoadjuvant atezolizumab in resectable stage IB to IIIB non–small cell lung cancer was well tolerated, yielded a 20% major pathological response rate, and allowed safe, complete surgical resection. These results strongly support the further development of immune checkpoint inhibitors as preoperative therapy in locally advanced non–small cell lung cancer. 相似文献