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OBJECTIVE: Whether video-assisted thoracic surgery (VATS) is associated with less shoulder dysfunction when compared with posterolateral thoracotomy (PLT) remains unclear. We therefore conducted this prospective study to assess the shoulder function in patients following major lung resection using either the VATS or PLT approach. METHODS: Twenty-nine consecutive patients were prospectively recruited into the study. Eighteen patients underwent major lung resection through VATS (VATS group) and 11 patients through PLT (open group). Shoulder function was measured preoperatively, and postoperatively at 1 week, 1 month and at 3 months. All assessments were done by two experienced physiotherapists using the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form. RESULTS: Shoulder strength was significantly better preserved in the VATS group at 1 week after surgery when compared with the PLT group (92 versus 81% of preoperative value; P=0.024). VATS patients also had better range of motion especially with respect to external rotation at 1 week (98 versus 91%; P=0.015) and forward elevation at 1 month (98 versus 93%; P=0.024) and 3 months after surgery (100 versus 96%; P=0.021). Analgesic requirement was significantly less in the VATS group postoperatively at 1 week (P=0.009) and 1 month (P=0.004). CONCLUSIONS: VATS major lung resection is associated with significantly less shoulder dysfunction and pain medication requirement in the early postoperative period when compared to the PLT approach.  相似文献   

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The financial impact of employing minimally invasive techniques for lobectomy compared with traditional open thoracotomy was assessed. A retrospective review was conducted using ICD9 codes for thoracotomy, video-assisted thoracic surgery (VATS), and robotic VATS lobectomy to determine total average costs associated with the resultant hospital stay. The difference in total average costs was calculated for each group. Robotic VATS lobectomy had higher associated costs than VATS only, primarily attributed to increased costs of the first hospital day, but was still less costly than thoracotomy. The average cost of VATS is substantially less than thoracotomy primarily because of a decreased length of stay. The cost of robotic assistance for VATS is still less than thoracotomy, but greater than VATS alone.  相似文献   

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Open in a separate window OBJECTIVESThis study compares the uniportal with the 3-portal video-assisted thoracic surgery (VATS) by examining the data collected in the Italian VATS Group Database. The primary end point was early postoperative pain; secondary end points were intraoperative and postoperative complications, surgical time, number of dissected lymph nodes and length of stay.METHODSThis was an observational, retrospective, cohort, multicentre study on data collected by 49 Italian thoracic units. Inclusion criteria were clinical stage I–II non-small-cell lung cancer, uniportal or 3-portal VATS lobectomy and R0 resection. Exclusion criteria were cT3 disease, previous thoracic malignancy, induction therapy, significant comorbidities and conversion to other techniques. The pain parameter was dichotomized: the numeric rating scale ≤3 described mild pain, whereas the numeric rating scale score >3 described moderate/severe pain. The propensity score-adjusted generalized estimating equation was used to compare the uniportal with 3-portal lobectomy.RESULTSAmong 4338 patients enrolled from January 2014 to July 2017, 1980 met the inclusion criteria; 1808 patients underwent 3-portal lobectomy and 172 uniportal surgery. The adjusted generalized estimating equation regression model using the propensity score showed that over time pain decreased in both groups (P < 0.001). There was a statistical difference on the second and third postoperative days; odds ratio (OR) 2.28 [95% confidence interval (CI) 1.62–3.21; P < 0.001] and OR 2.58 (95% CI 1.74–3.83; P < 0.001), respectively. The uniportal-VATS group had higher operative time (P < 0.001), shorter chest drain permanence (P < 0.001) and shorter length of stay (P < 0.001).CONCLUSIONSData from the Italian VATS Group Database showed that in clinical practice uniportal lobectomy seems to entail a higher risk of moderate/severe pain on second and third postoperative days.  相似文献   

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Our objective was to evaluate the usefulness, safety, validity and benefits of video-assisted thoracoscopic surgery (VATS) for performing pulmonary lobectomy in 24 patients with clinical NO stage I primary non-small-cell lung cancer compared with 30 patients who underwent a conventional thoracotomy. There were no significant differences in the intra-operative blood loss, duration of operation, or duration of chest tube drainage between the VATS group and the standard lobectomy group, but in this VATS' experience, patients had less postoperative pain. Numbers and distributions of dissected lymph-nodes were similar in patients whether undergoing standard thoracotomy or VATS lobectomy. We can confirm that the safety and validity of VATS are virtually identical to those of the standard thoracotomy approach in the lobectomy. However, the former technique causes less discomfort to patients and requires a shorter recovery period of laboratory data and IL-6 concentrations in thoracic drainage fluid. We conclude that VATS major lung resection is technically feasible. Stringent patient selection is important and special training is needed.  相似文献   

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目的总结探讨全电视胸腔镜肺叶切除的安全手术方法。方法在自2008年7月至2010年3月以来共完成全电胸腔镜下肺叶切除57例,男34例,女23例,年龄45~78岁。临床诊断支气管扩张症3例,肺曲菌球病2例,肺硬化性血管瘤2例,慢性肺部炎症1例,肺癌49例。腋中线第7或第8肋间作镜孔(1.5~2cm),肩胛下角线第7或第8肋间作操作孔(1.5~2cm),腋前线与锁骨中线间第4肋间(上中叶切除)或第5肋间(下叶切除)作一长约4~6cm辅助切口,便于游离肺门血管和取出被切肺叶。术中应用血管切割缝合器处理血管、支气管。结果切除左肺上叶12例,左肺下叶13例,右肺上叶11例,右肺中叶5例,右肺下叶16例。术后平均胸管引流量50~150ml/d。平均住院时间10.5d。全组无死亡病例。结论全电视胸腔镜肺叶切除具有出血少、疼痛小、住院时间短和病程恢复快等优点。胸外科医师经过相关训练完全能掌握这项微创技术进行安全手术。  相似文献   

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BACKGROUND: Data regarding pulmonary function and prognosis after video-assisted thoracic surgery lobectomy are limited. METHODS: From September 1992 to April 2000, 204 video-assisted thoracic surgery lobectomies were performed, and their preoperative and postoperative pulmonary function test results and prognoses were evaluated. RESULTS: The postoperative to preoperative ratio of pulmonary function tests (vital capacity and forced expiratory volume in 1 s) were better in video-assisted thoracic surgery lobectomy than in open thoracotomy (p < 0.0001). Furthermore, the 5-year survival rate of pathologic stage I lung cancers after video-assisted thoracic surgery was 97.0%, whereas that after open thoracotomy was 78.5% (p = 0.0173; Mantel-Cox). CONCLUSIONS: Pulmonary function and prognosis were far better after video-assisted thoracic surgery lobectomy than after open thoracotomy.  相似文献   

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Zhang Y  Jiang GN  Wang Q  Zhu YM  Ding JA  Chen C  Chen XF  Wang H  Xie BX  Li WT  Tong WP 《中华外科杂志》2010,48(17):1285-1288
目的 比较电视胸腔镜手术(VATS)与开胸手术(OT)肺叶切除术治疗早期非小细胞肺癌(NSCLC)中急性炎症反应和免疫抑制的差异.方法 前瞻性随机对照研究.按照入组标准筛选病例,随机分组后手术,收集临床资料,并检测手术前后IL-6、IL-8和IL-10的血浆浓度.2007年1月至2008年6月最终入选病例271例,其中VATS组133例,OT组138例;男性132例,女性139例;年龄19~70岁,平均(56±8)岁.结果 在术后住院时间[(8.2±2.5)d比(9.8±6.2)d,P=0.03]和术后并发症发生率(11.3%比21.7%,P=0.02)上,VATS组优于OT组.VATS组患者的IL-6血浆浓度在术后第1天[(35±25)%比(65±43)%,P=0.00]、术后第3天[(14±22)%比(55±44)%,P=0.00]以及IL-10血浆浓度在术后第1天的升幅[(25±20)%比(43±35)%,P=0.00]低于OT组.结论 相比于OT,VATS治疗早期NSCLC具有术后炎症反应轻、免疫抑制弱的特点.  相似文献   

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Atrial arrhythmias, especially supraventricular tachycardia (SVT) and atrial fibrillation, are common after thoracotomy and lung surgery. There are few existing data on the incidence of postoperative arrhythmias after video-assisted thoracoscopy (VAT). The purpose of the present investigation was to retrospectively determine the incidence of postoperative arrhythmias in patients who underwent VAT compared with those who underwent thoracotomy, and which factors are associated with an increased risk for arrhythmias in both groups. A retrospective investigation. A metropolitan university hospital. The medical records of 124 patients who underwent thoracotomy and 81 patients who underwent VAT over a 2-year period were reviewed.

There was a 17% incidence of atrial arrhythmias after thoracotomy and 10% after VAT, but the difference was not statistically significant. In both groups, atrial fibrillation was the most common atrial arrhythmia. Patients receiving digoxin were at higher risk for postoperative arrhythmias. Patients older than 65 years were at risk for arrhythmias after thoracotomy and patients older than 80 years were at risk for arrhythmias after VAT. Patients who had postoperative arrhythmias had prolonged hospital stays compared with patients who did not have arrhythmias.  相似文献   

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目的 探讨单孔与三孔电视胸腔镜治疗自发性气胸的临床疗效.方法 回顾性分析2012年4月-2013年4月就诊于咸阳市中心医院胸外科诊断为自发性气胸的患者58例,按照随机数字表法将患者随机分配至单孔电视胸腔镜组28例,三孔电视胸腔镜组30例,并用电话随访法进行随访.采用SPSS19.0统计学软件对两组患者的临床指标、并发症发病率及生存资料进行统计学分析.结果 与传统三孔电视胸腔镜手术相比,单孔电视胸腔镜手术具有术后住院时间更短(t=-4.151,P=0.001)、引流持续时间更短(t=-3.436,P=0.001)、切口满意度评分更高(t=-6.141,P=0.001)、术后6h疼痛视觉评分更低(t=-4.942,P=0.006)、术后24 h疼痛视觉评分更低(t=-3.326,P=0.02)及术后胸腔积液的发病率更低(Z=-2.096,P=0.036)的优点,但手术时间长(t=6.369,P=0.000),在其他并发症发病率、总生存时间(x2 =0.001,P=0.979)及中位无疾病进展生存时间(x2=1.797,P=0.180)方面差异无明显统计学意义(P>0.05).结论 与三孔电视胸腔镜手术相比,单孔电视胸腔镜手术在住院时间短、术后疼痛轻等方面具有一定的优势,但不能明显缩短手术时间和改善患者术后生活质量.  相似文献   

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Objective: Video-assisted thoracoscopic surgery (VATS) lobectomy has been employed for the treatment of lung cancer. Many investigators have reported that the outcomes of VATS lobectomy for lung cancer are comparable to those of thoracotomy; however, several controversial issues remain. One of the critical concerns is the safety. VATS lobectomy often requires an emergency conversion to thoracotomy, for example, in the event of massive bleeding. In this study, cases in which VATS lobectomy for lung cancer was converted to thoracotomy intra-operatively (converted VATS lobectomy) were identified. The safety of the converted VATS lobectomy was evaluated. Methods: Between 2003 and 2007, VATS lobectomy was converted to thoracotomy in 24 out of 492 cases. Information regarding the patients’ characteristics, reasons for the conversion and perioperative complications as well as the recurrence and survival data were carefully reviewed. The reasons for the conversion were classified into two groups: (1) problems related to the VATS procedure (VATS-related problems) and (2) problems not related to the VATS procedure (non-VATS-related problems). Results: Of the 24 converted cases, 19 (79%) had a history of smoking. Nine patients (38%) had a history of lung disease. Left upper lobectomy was the most frequently associated with conversion (11/24, 46%), followed by right lower lobectomy and right upper lobectomy. The most frequent reasons for the conversion were hilar lymphadenopathy and bleeding (seven patients each), followed by fused fissure. Eight of the conversions were considered to be attributable to VATS-related problems. Perioperative complications were observed in four patients, consisting of prolonged air leak in three patients and transient recurrent laryngeal nerve palsy in one patient. However, there were no life-threatening complications. The median follow-up period was 26 months. Recurrence occurred in two patients: pleural dissemination in one and bone metastasis in the other. Two deaths were observed during the follow-up period: one related to lung cancer and another related to other type of cancer. Conclusions: The safety of the conversion was acceptable. Our findings suggest that VATS lobectomy for lung cancer is feasible from the viewpoint of safety, even after taking into account the potential need for conversion to thoracotomy in some patients.  相似文献   

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In terms of perioperative management, it is extremely difficult to perform a video-assisted thoracic surgery lobectomy for primary lung cancer in patients previously undergoing a contralateral pneumonectomy. We herein describe the successful video-assisted thoracic surgery lobectomy with systematic mediastinal lymph node dissection in a single-lung patient with clinical stage IA nonsmall cell lung cancer. Our experience indicates surgeons may consider the procedure if the following conditions are met: (1) satisfactory pulmonary function, (2) the selective bronchial blockade of the lobe to be resected, and (3) the effective retraction of the inflated lung.  相似文献   

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Surgery remains the mainstay for the treatment of lung cancer. While pulmonary resection has been safe for years, there is a trend toward minimally invasive (VATS) pulmonary resections. Studies have now shown that standard complete cancer operations performed via VATS offer patients a shorter hospital stay and quicker recovery without compromising the cure rate for an operation performed via a thoracotomy.  相似文献   

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Objective

To further understand the effects of video-assisted thoracic surgery (VATS) with one-port versus three-port VATS for primary spontaneous pneumothorax (PSP).

Methods

In this study, we searched information from the PubMed, Cochrane Library, Embase, ScienceDirect, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang Data databases from inception to September 2015 to collect data of randomized controlled trials (RCTs) and cohort studies about one-port VATS versus three-port VATS for PSP. Two independent authors were committed to screen literature, extract data, and assess the risk of bias of related studies. Then, we used the RevMan 5.20 software for a meta-analysis of one-port VATS versus three-port VATS for PSP.

Results

Six cohort studies involving 310 patients were finally selected in this meta-analysis. The results of our study indicate that one-port VATS had a shorter hospital stay (SMD = ?0.39, 95 % CI ?0.69 to 0.09, P = 0.01), lower VAS score of 24-h post-operative pain (SMD = ?0.78, 95 % CI ?1.40 to ?0.52, P < 0.00001), shorter chest drainage time (SMD = ?0.68, 95 % CI ?1.15 to ?0.22, P = 0.004), and lower incidence of post-operative paraesthesia (OR = 0.13, 95 % CI 0.06 to 0.29, P < 0.00001) compared with three-port VATS. However, one-port VATS had a lower patient satisfaction score at 24 h (SMD = ?0.65, 95 % CI ?0.95 to ?0.35, P < 0.0001) and 48 h (SMD = ?0.46, 95 % CI ?0.71 to ?0.21, P = 0.0002). No differences in the recurrence of pneumothorax (OR = 0.58, 95 % CI 0.20 to 1.67, P = 0.32), the operation time (SMD = 1.01, 95 % CI ?4.63 to 2.60, P = 0.58), and the satisfaction score at 72 h (SMD = ?0.11, 95 % CI ?0.44 to 0.22, P < 0.00001) were noted between the groups.

Conclusion

Current evidence suggests that one-port VATS may have certain advantages over three-port VATS for PSP. More large-scale and high-quality studies are needed for authentication.
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Background:Video-assisted lobectomy has been adopted by many thoracic surgeons, because it is a less invasive approach to small peripheral lung cancers. However, some authors disagree that video-assisted lobectomy is less invasive than traditional thoracotomy and lobectomy. The purpose of this study was to evaluate the advantages of video-assisted lobectomy over posterolateral thoracotomy and lobectomy in terms of pain-related morbidity. Methods: A total of 70 patients with clinical T1N0M0 non-small-cell lung carcinomas underwent lobectomy with complete mediastinal lymphadenectomy. Of these 35 underwent posterolateral thoracotomy (between April 1994 and December 1995; open group), and 35 underwent video-assisted thoracic surgery (VATS) (between January and December 1996; VATS group). Results: Although the operative time was significantly longer in the VATS group (p=0.04), the intraoperative blood loss was significantly less (p=0.03). No significant differences were found for the two groups with respect to the total number of mediastinal lymph nodes dissected or duration of chest tube drainage. Postoperative pain was less severe as determined by the number of doses of analgesics required between postoperative days 0 and 7 (p<0.0001), and the length of postoperative hospitalization was shorter in the VATS group (p<0.0001). Conclusion: Video-assisted lobectomy is associated with decreased postoperative pain and shortened length of postoperative hospitalization, when compared with posterolateral thoracotomy and lobectomy.  相似文献   

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Chylothorax after video-assisted thoracic surgery   总被引:3,自引:0,他引:3  
A 27-year-old male was admitted to our hospital with an abnormal shadow on chest X-ray. Chest computed tomography (CT) showed a localized mediastinal tumor. Thoracoscopic resection of the tumor was performed and the pathological diagnosis was bronchogenic cyst. Chylothorax occurred on postoperative day 1. Low fat diet therapy was performed. The discharge of chyliform pleural effusion was stopped on postoperative day 10. Thoracic drainage tube was removed and the patient discharged from hospital on postoperative day 19. He has been well for 10 months since operation, with no recurrence of the tumor or chylothorax.  相似文献   

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目的 与开胸肺叶切除对比,探讨全胸腔镜(VATS)下肺叶切除治疗早期肺癌的安全性和有效性.方法 回顾分析2002年1月至2008年1月接受肺叶切除的165例Ⅰ期非小细胞肺癌病人,VATS组41例,开胸组124例.对比两组术前、术中、术后近期情况.结果 两组在年龄、性别分布、术前主要合并症、肺功能、手术切除的肺叶、术后病理类型、分期等方面差异无统计学意义(P<0.05).VATS组与开胸组相比,手术时间(195±57)min对(224±54)min(P<0.05);术中出血(227±153)ml对(349±158)ml(P<0.05);淋巴结清扫组数4.1±1.3对4.5±1.5(P<0.05);术后胸引流总量(1595±1038)ml对(1828±1074)ml(P<0.05);术后肺炎发生率4.9%对12.1%(P<0.05);1年无瘤生存率Ⅰ A期均为100%,ⅠB期分别为90.0%和91.3%(P>0.05);住院费用(4.6±1.1)万元对(3.5±1.1)万元.结论 两种术式在治疗早期肺癌具有相似的完全性和彻底性,VATS肺叶切除术较开胸肺叶切除术的手术时间略短,术中出血略少,术后肺炎发生率略低,但平均住院费用略高.  相似文献   

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