胸腔镜下胸交感神经干切断术治疗手汗症(附300例报告)

目的总结胸腔镜胸交感神经干切断术300例的临床经验。方法分析2003年1月至2006年1月经胸腔镜胸交感神经干T_2～T_4切断术治疗手汗症的临床资料。以患侧手掌皮肤温度较术前升高1℃～3℃或更高,转干燥者为有效。手掌皮肤温度较术前增加小于1℃仍为潮湿者为无效。结果300例手术均获成功,术后患者手掌多汗症状消失,双手转为干燥温暖状,术后掌温升高(2.8±0.8)℃;282例术后随访1～36个月无一例复发,术后转移代偿性多汗60例占21.2%。结论胸交感神经干切断术是治疗手汗症安全、微创和有效的方法。     

A new method of thoracoscopic sympathectomy in hyperhidrosis palmaris

Summary Although hyperhidrosis palmaris is a benign condition, it may cause considerable psychological, social, and occupational disturbances. There are many conservative measures used to treat hyperhidrosis, but surgical sympathectomy is the only permanent cure. Of the various surgical approaches to the upper thoracic sympathetic ganglia, one must select the approach that combines good functional results and a satisfactory cosmetic outcome with only minor complications. Twenty-one patients (10 men and 11 women) with hyperhidrosis palmaris underwent synchronous bilateral T2 sympathectomy between 1 October 1989 and 30 April 1990. These patients underwent a new method of thoracoscopic sympathectomy without preoperative pneumothorax. All were relieved of excessive sweating in their upper extremities immediately after the operation. In addition, the technique led to significant savings in operation and hospitalization time. We recommend thoracoscopic sympathectomy as the best approach for sympathectomy in cases of hyperhidrosis palmaris.     

Thoracoscopic wedge resection

Summary Thoracoscopic surgery is decidedly expanded by the ability to perform pulmonary wedge resections of the lung by using the Endo-GIA-stapler. In addition to thoracoscopic biopsies, since July 1991 we have carried out wedge resections in 12 patients suffering from spontaneous pneumothorax (nine) or peripheral bronchial carcinoma (three). Postoperatively one air fistula persisted over 9 days. The chest tube was removed within 48 h in all other patients. There was no other major complication. The postoperative hospitalization period lasted 4.6 days (1–9 days). Operating time was 44 min (30–70 min). The benefit for the patient consists in the little-impaired breathing mechanics, the short hospital stay, and the favorable cosmetic result.     

5A护理模式在行胸腔镜肺癌根治术肺癌患者中的应用效果

目的:观察5A护理模式在行胸腔镜肺癌根治术肺癌患者中的应用效果。方法:选取126例行胸腔镜肺癌根治术肺癌患者为研究对象,按随机数字表法将其分为对照组与研究组各63例。对照组采用常规护理,研究组在对照组基础上采用5A护理模式,比较两组护理前后肺功能指标[每分钟最大通气量(MVV)、第1秒用力呼气容积(FEV1)、用力肺活量(FVC)]水平、生命质量评分、疼痛评分和并发症发生率。结果:护理后,研究组MVV、FEV1、FVC水平均高于对照组,差异有统计学意义(P<0.05);研究组KPS评分高于对照组,VAS评分低于对照组,差异有统计学意义(P<0.05);研究组并发症发生率为3.17%,明显低于对照组的14.28%,差异有统计学意义(P<0.05)。结论:在常规护理基础上采用5A护理模式可提高行胸腔镜肺癌根治术肺癌患者的肺功能指标水平和KPS评分,降低VAS评分和并发症发生率,其效果优于单纯常规护理。     

Bilateral approach for thoracoscopic esophagectomy with lymph node dissection in the dorsal area of the thoracic aorta in patients with esophageal cancer: A report of two cases

IntroductionThe incidence of lymph node metastasis in the dorsal area of the thoracic aorta (DTA) is relatively low in patients with esophageal cancer. It is difficult to approach the DTA using surgical procedures, such as an open thoracotomy and thoracoscopy in the left decubitus position.Case presentationCase 1: A 70-year-old man with esophageal cancer underwent thoracoscopic esophagectomy with mediastinal lymph node dissection via a right thoracoscopic approach, followed by lymphadenectomy in the DTA via left thoracoscopy in the prone position. Microscopic findings revealed two metastatic lymph nodes in the DTA. The definitive diagnosis was squamous cell carcinoma of the esophagus, and the pathological stage was T2N3M0 (Union for International Cancer Control [UICC], 7th edition). The patient showed lung metastasis 8 months after the surgery. Case 2: A 72-year-old man with esophageal cancer underwent esophagectomy via a bilateral approach in the prone position, using a similar procedure as in case 1. The definitive diagnosis was squamous cell carcinoma of the esophagus, and the pathological stage was T3N2M0. The patient showed a metastatic mediastinal lymph node 4 months after the surgery.ConclusionBilateral thoracoscopic esophagectomy in the prone position can be safely performed, and it might be an alternative curative surgery for esophageal cancer. However, both our cases showed metastasis in the early postoperative period. The long-term outcome and significance of dissection of lymph nodes in the DTA in patients with esophageal cancer remains controversial. Further studies are required to establish the indications and efficacy of this therapeutic approach.     

超声引导竖脊肌平面阻滞与胸椎旁神经阻滞用于胸腔镜肺叶切除术患者术后镇痛的临床对比研究

目的探究与分析超声引导竖脊肌平面阻滞与胸椎旁神经阻滞用于胸腔镜肺叶切除术患者术后镇痛的效果。方法选取浙江省衢州市中医医院自2016年12月至2018年12月收治的经胸外科就诊的胸腔镜肺叶切除术患者156例,采取随机数字表法分为竖脊肌平面阻滞组与胸椎旁神经阻滞组,每组各78例,竖脊肌平面阻滞组给予超声引导竖脊肌平面阻滞处理,胸椎旁神经阻滞组给予超声引导胸椎旁神经阻滞处理,对比两组的阻滞范围、不同时间点下静息、咳嗽时的视觉模拟评分(VAS)、术后24-48 h内镇痛泵按压的次数、吗啡的用药量以及不良反应发生率。结果通过采用冰块法对阻滞范围进行测量时发现,竖脊肌平面阻滞组在接受阻滞20 min之后,17例患者为T2~T6脊神经支配区域,22例患者平面为T2至T7脊神经支配区域。胸椎旁神经阻滞组在接受阻滞20 min之后,全部78例患者的平面为T2至T7脊神经支配区域。两组患者术后12 h镇痛泵按压的次数及吗啡的用药量相比无明显差异(P>0.05)。两组患者术后6 h、12 h静息、咳嗽时的VAS评分无明显差异(P>0.05)。竖脊肌平面阻滞组相比于胸椎旁神经阻滞组而言术后24 h、术后28 h静息、咳嗽时的VAS评分较低,组间差异具有统计学意义(P<0.05)。竖脊肌平面阻滞组相比于胸椎旁神经阻滞组术后24h的镇痛泵按压的次数较少,吗啡的用药量较少,组间差异具有统计学意义(P<0.05)。两组患者皮肤瘙痒、恶心呕吐以及呼吸抑制发生率无明显差异(P>0.05)。结论超声引导竖脊肌平面阻滞相比于超声引导胸椎旁神经阻滞用于胸腔镜肺叶切除术患者中能够发挥较强的术后镇痛效果,且不会增加不良反应,安全性较高。     

Clinical analysis of thoracoscopic surgery combined with intraoperativeautologous blood transfusion in the treatment of traumatic hemothorax

From January 2013 to January 2015, 19 patients of traumatic hemothorax with hemorrhagic shock were treated in our department by thoracoscopic surgery combined with autologous blood transfusion. This study retrospectively analyzed the therapeutic effect and shared our experience. The average amount of blood transfused back was 662.41 ml ± 269.15 ml. None of the patients developed transfusion reaction and were all discharged uneventfully. Thoracoscopic surgery combined with autologous blood transfusion is effective in the rescue of patients with progressive hemothorax and hemorrhagic shock. When corresponding indications are well managed, treatment for these patients is quicker, safer, and more effective.