A rare massive presentation of catamenial hemothorax

Catamenial hemothorax is a rare manifestation of thoracic endometriosis syndrome. It is commonly seen associated with pelvic endometriosis in nulliparous reproductive-age women. Most cases are minor and self-limiting. We present a case of a 32-year-old woman who presented with prolonged worsening dyspnea and was found to have a massive hemothorax on evaluation.     

Video-Assisted Thoracoscopic Surgery after Preoperative CT-Guided Lipiodol Marking of Small or Impalpable Pulmonary Nodules

Purpose: Small pulmonary lesions that include ground-glass attenuation have been increasingly discovered because of progressive imaging diagnostic technologies. Despite the detection of such small lesions, sometimes it is quite difficult to localize them because of their size or considerable depth from the visceral pleura. In the present study, we examined the usefulness of computed tomography-guided lipiodol marking for thoracoscopic resection of impalpable pulmonary nodules.Methods: Fifty-six patients with an undiagnosed peripheral lesion(s) of the lung who had undergone preoperative computed tomography-guided lipiodol marking followed by video-assisted thoracoscopic surgery were studied.Results: All of the nodules were successfully marked by computed tomography-guided lipiodol marking, and all except for one case were localized by means of intraoperative fluoroscopy as clear spots. With regard to complications, pneumothorax occurred in 21 patients (37.5%), and only one patient required transient drainage. Although hemorrhaging in the lung parenchyma and hemosputum occurred in nine patients (16.1%) and one patient (1.8%), respectively, no patients were in serious condition. No intra- or postoperative mortality or morbidity was observed.Conclusion: Preoperative computed tomography-guided lipiodol marking of small or impalpable pulmonary nodules is a safe and useful procedure for thoracoscopic resection of the lung.     

电视胸腔镜技术在胸部外伤中的应用

目的　探讨电视胸腔镜手术 (VATS)治疗胸部外伤的应用价值。方法　 1999年 5月～ 2 0 0 2年 10月行VATS 12例。研究手术方法 ,手术效果及并发症的预防。结果　VATS时间 35～ 180min ,平均 10 6min。手术成功 12例 ,无 1例死亡。结论　随着VATS技术和熟练程度的提高 ,并发症逐步降低。电视胸腔镜辅以小切口手术(VAMT)的应用更符合传统手术操作习惯 ,并能降低手术费用 ,适合我国国情。VATS治疗胸部外伤具有安全 ,疗效好等特点     

A VATS lobectomy for lung cancer in a patient with an anomalous pulmonary vein: Report of a case

A video-assisted right upper lobectomy was successfully performed on a 58-year-old man with an anomalnous segmental pulmonary vein. The tumor was a peripherally located adenocarcinoma. The anomalous vein behind the right main bronchus was identified and safely divided. This case emphasized that to perform this procedure successfully, (1) a careful preoperative evaluation of the anatomy, including the presence of any possible vascular and/or bronchial anomalies, is necessary, and (2) if any anatomical structures cannot be determined intraoperatively, a conversion into an open procedure must immediately be undertaken.     

A cost-effective thoracoscopic treatment strategy for pediatric spontaneous pneumothorax

Background: Recent data suggest that children have a higher incidence of recurrence than adults after nonoperative treatment of primary spontaneous pneumothorax (PSP). Video-assisted thoracoscopic surgery (VATS) allows efficacious therapy with significantly less morbidity. We attempt to define the most cost-effective clinically efficacious strategy using VATS to manage pediatric PSP. Methods: We retrospectively reviewed all admissions to a tertiary care children's hospital for PSP between January 1, 1991 and June 30, 1996. Results: Fifteen children had 29 primary or recurrent PSPs. Mean patient age was 14.8 ± 1.1 years, boy–girl ratio 4:1, median body mass index 18 (normal, 20–25), and 67% of pneumothoraces left sided. All patients were managed initially nonoperatively: 14 with tube thoracostomy drainage and 1 with oxygen alone. Of the children initially managed nonoperatively, 57% had a recurrent pneumothorax, and 50% of these patients eventually developed contralateral pneumothoraces. Nonoperative treatment for recurrence resulted in a 75% second recurrence rate. In contrast, eight children who underwent operative management had a 9% incidence of recurrence. The total for charges accrued in treating 29 pneumothoraces in these 15 patients was approximately $315,000. In the same population, the estimated charges for initial nonoperative therapy followed by bilateral thoracoscopy after a single recurrence would be $230,000. Conclusions: A cost-effective treatment strategy for pediatric primary spontaneous pneumothorax is tube thoracostomy at first presentation, followed by VATS with thoracoscopic bleb resection and pleurodesis for patients who experience recurrent pneumothorax. Received: 15 May 1998/Accepted: 15 January 1999     

电视胸腔镜在胸部肿瘤中的应用

电视胸腔镜外科（ＶＡＴＳ）在胸部肿瘤的临床应用尚存争议。自１９９６年１０月～１９９７年８月，我科共行胸腔镜手术１６例：肺癌切除２例，纵隔肿瘤切除３例，恶性胸水行胸膜固定术２例，恶性心包积液行心包开窗术４例，常规开胸术前诊断性探查５例，初期结果较为满意。结论：ＶＡＴＳ创伤较小，安全有效。可选择性地用于胸部良恶性肿瘤的诊断和治疗。     

胸腔镜辅助治疗早期结核性包裹性胸腔积液112例

目的：探讨胸腔镜辅助治疗结核性包裹性胸腔积液的效果。方法2003年10月～2012年9月，对112例早期结核性包裹性胸膜炎并胸腔积液患者行胸腔镜辅助治疗，将包裹分隔用胸腔镜活检钳及电凝钩分离，清除分隔内的干酪坏死组织、纤维板及胸腔积液，胸腔内放置中心静脉导管，术后用尿激酶溶解纤维素。术后给予抗结核药物治疗。结果111例肺完全复张，1例右下肺未完全膨胀。2例术后其他细菌感染，经抗生素治疗痊愈。112例随访9～12个月，平均9．4月，无复发。结论对内科反复穿刺及置管引流不.的早期结核性包裹性胸腔积液，胸腔镜辅助手术治疗安全有效，无明显并发症。