BACKGROUND Inflammatory myofibroblastic tumors(IMTs)are exceptionally rare neoplasms with intermediate malignant potential.Surgery is the accepted treatment option,aiming for complete resection with clear margins.CASE...BACKGROUND Inflammatory myofibroblastic tumors(IMTs)are exceptionally rare neoplasms with intermediate malignant potential.Surgery is the accepted treatment option,aiming for complete resection with clear margins.CASE SUMMARY A 39-year-old woman presented with a growing solitary pulmonary nodule measuring 2.0 cm in the right upper lobe(RUL)of the lung.The patient underwent a RUL anterior segmentectomy using uniportal video-assisted thoracoscopy.A preliminary tissue diagnosis indicated malignancy;however,it was later revised to an IMTs.Due to the absence of a minor fissure between the right upper and middle lobes,an alternative resection approach was necessary.Therefore,we utilized indocyanine green injection to aid in delineating the intersegmental plane.Following an uneventful recovery,the patient was discharged on the third postoperative day.Thereafter,annual chest tomography scans were scheduled to monitor for potential local recurrence.CONCLUSION This case underscores the challenges in diagnosing and managing IMTs,showing the importance of accurate pathologic assessments and tailored surgical strategies.展开更多
Objective: To explore the clinical effectiveness of combined use of intravenous pain pump with Parecoxib injection in alleviating pain in patients during the early postoperative period after thoracoscopic surgery. Met...Objective: To explore the clinical effectiveness of combined use of intravenous pain pump with Parecoxib injection in alleviating pain in patients during the early postoperative period after thoracoscopic surgery. Methods: Eighty patients who underwent thoracoscopic surgery in a tertiary hospital were selected as the study subjects and randomly divided into two groups, with 40 patients in each group. The control group received routine postoperative treatment with intravenous pain pump, while the experimental group received Parecoxib in addition to the standard postoperative pain pump treatment. Visual Analog Scale (VAS) pain scores were used to evaluate postoperative pain relief in both groups, along with adverse reactions, postoperative complications, and patient satisfaction with pain relief. Results: Patients who received Parecoxib injection in addition to the routine use of intravenous pain pump had VAS pain scores lower than 3 points at 6 h, 12 h, 24 h, and 36 h postoperatively compared to those in the control group. The incidence of postoperative lung collapse, pleural effusion, and pulmonary infections was also significantly lower in the experimental group. The differences between the two groups were statistically significant (P Conclusion: Early combined use of Parecoxib injection in the early postoperative period after thoracoscopic surgery has shown good clinical efficacy. It can reduce the level of pain in patients, promote effective coughing and expectoration, facilitate early mobilization of patients, improve patient compliance, reduce complications, shorten hospital stay, and expedite patient recovery. Therefore, it is worth promoting the widespread clinical application of Parecoxib injection in this setting.展开更多
BACKGROUND A Bochdalek hernia(BH)is a congenital diaphragmatic hernia that often develops in the neonatal period.BH typically occurs on the left side of the diaphragm.A right-sided BH in an adult is rare.CASE SUMMARY ...BACKGROUND A Bochdalek hernia(BH)is a congenital diaphragmatic hernia that often develops in the neonatal period.BH typically occurs on the left side of the diaphragm.A right-sided BH in an adult is rare.CASE SUMMARY A 45-year-old man was referred to our hospital because of an abnormal shadow seen on chest radiography during a medical check-up.A chest radiograph showed elevation of the right hemidiaphragm.Computed tomography showed prolapse of multiple intraabdominal organs into the right thoracic cavity,corresponding to a right-sided BH.The herniated contents included the stomach,transverse colon,and left lobe of the liver.The left lobe of the liver was enlarged,particularly the medial segment.Laparoscopic surgery was performed.However,the left lobe of the liver was completely trapped in the thoracic cavity.Therefore,thoracoscopic manipulation had to be performed to return the liver to the abdominal cavity.The hernia was repaired with interrupted nonabsorbable sutures and reinforced with mesh.CONCLUSION Combined laparoscopic and thoracoscopic surgery was successfully performed for right-sided BH with massive liver prolapse and abnormal liver morphology.展开更多
Objective:To explore the situation of patients and the compare the effect between two methods,which are preserving spontaneous breathing without intubation and endotracheal intubation with one lung ventilation in the ...Objective:To explore the situation of patients and the compare the effect between two methods,which are preserving spontaneous breathing without intubation and endotracheal intubation with one lung ventilation in the single-hole thoracoscopic bulla suture.Method:42 patients who received single-hole thoracoscopic pulmonary bullae suture in our hospital from January 2020 to December 2021 were selected as the study subjects,including 19 patients who underwent endotracheal intubation and one lung ventilation as the control group and 23 patients who underwent single-hole thoracoscopic pulmonary bullae suture without intubation as the study group.The relevant indexes,postoperative general conditions,complications and pneumothorax recurrence of the two groups were analyzed and observed.Results:In the control group,the scores of anesthesia time(points),resuscitation time(points),surgical visual field score(points),surgical time(points),and surgical bleeding volume(points)were 20.8±4.6,19.9±7.9,1.7±0.5,44.9±7.9,and 11.4±2.4 respectively.In the study group,the scores of anesthesia time(points),resuscitation time(points),surgical visual field score(points),surgical time(points),and scores of surgical bleeding(points)were 17.9±4.3,15.4±3.4,1.9±0.4,48.4±7.1,10.9±2.2,respectively.There was no statistical difference in surgical visual field score,surgical time and surgical bleeding whereas there was a statistical difference between anesthesia time and resuscitation time.In the control group after operation,VAS score at 6 hours after operation,SaO_(2)(%)after operation,PaCO_(2)(mmHg)after operation,drainage volume(ML)after operation,feeding time(H)after operation,retention time of thoracic tube after operation(H),WBC(109)on the first day after operation,hospitalization time(d),and total hospitalization cost(RMB 1000)were 2.1±0.7,98.2±1.4,42.4±4.9,139.1±23.1,6.9±1.6,37.1±5.4,7.9±2.1,6.6±1.3,and 2.6±0.3 respectively.As for the study group,the VAS score at 6 hours after operation,SaO_(2)(%)after operation,PaCO_(2)(mmHg)after operation,drainage volume(ML)after operation,feeding time(H)after operation,retention time of thoracic tube after operation(H),WBC(109)on the first day after operation,hospitalization time(d),and total hospitalization cost(RMB 1000)were 1.9±0.4,97.9±1.2,42.8±5.1,151.8±21.9,4.3±1.4,15.3±2.6,5.2±2.3,4.2±1.2,and 1.8±0.4 respectively.Among them,there were no significant differences in visual analog scale(VAS)score at 6 hours after operation,SaO_(2) after operation and PaCO_(2) after operation between the two groups,but there were significant differences in other factors.The complication rate of the control group was 36.84%,which was significantly higher than that of the study group(4.35%),with statistical difference.The recurrence rate of the control group was 21.05%,which was not significantly different from that of the study group(4.35%).Conclusion:The single-hole thoracoscopic bullae suture without intubation can reduce the anesthesia time and resuscitation time of patients,reduce the hospitalization cost of patients,reduce the treatment burden,shorten the first feeding time,and reduce the complication rate of patients.Therefore,it is worthy of clinical promotion.展开更多
Objective: To sum up 121 cases of heart disease operations with the help of thoracoscope from May to August in 2000. Among these cases, 48 cases were atrial septal defect (ASD); the average age of patients is 20±...Objective: To sum up 121 cases of heart disease operations with the help of thoracoscope from May to August in 2000. Among these cases, 48 cases were atrial septal defect (ASD); the average age of patients is 20±10 years old; average weight is (43±16) kg. 67 patients with ventricular septal defects (VSD), average age13±9 years old; one male patient, 44 years old with Ebstein malformation; one female patient (21 years old) partial atrioventricular canal combined with cor triatriatum; one male (21 years old) with ruptared aneuryem of aortic sinus. 3 cases(all females ) with mitral stenosis combined with mitral valve incompetence. One male patient(aged 16)with pericardiun effusion after trauma. Methods: During operations, a patient with supine position, and his/her right shoulder was padded 30°higher. Tracheal cannula was inserted and air was piped in with high frequency jet ventilation. Three mini thoracotomies with a diameter of 2 to 3 cm were made in the 4th intercostals space of the right par sternum and the 4th and 7th intercostals spaces of the right middle axillary line respectively. An periphera extra corporeal circulation was made. the aortic clamp was clamped, cannula for cold perfusion. After the heart was sliced and a reformative operation was performed. The process of the operation of defects repairs was finished under the thoracoscope. The other operations were performed with the help of thoracoscope. 3 rheumatic heart disease patients got 25# mechanical mitral valve prosthesis. A 30# tricuspid plasty ring was applied to The Ebstein malformation patient. Results: all 121 patients were successfully operated on without death. Two VSD cases appeared transient third degree atrialventricular block.Because 4 cases had more chest drainage, so they were stanched bleeding twice. After the operation, heart murmur vanished, and ultrasonic inspection showed no diffluence inside the heart. Conclusion: Our experience showed that all atrium, ventricular septal defects can be repaired under the thoracoscope. This scope-assisted technology is more accepted by patients because of tiny incisions and also provides an alternative solution for cardiac surgeons.展开更多
Objective:Guided by the theory of syndrome differentiation of yin and yang in traditional Chinese medicine surgery,through visual observation of internal medicine thoracoscope,comprehensive observation of pleural cavi...Objective:Guided by the theory of syndrome differentiation of yin and yang in traditional Chinese medicine surgery,through visual observation of internal medicine thoracoscope,comprehensive observation of pleural cavity and immunohistochemistry of biopsy tissue,to classify malignant pleural effusion according to syndrome differentiation,and to explore the scientific nature of its theory.Methods:From March 1,2014 to February 28,2015,40 cases of malignant pleural effusion were treated in Beijing Chaoyang Hospital affiliated to Capital Medical University.According to the proposed TCM diagnostic criteria for yin and yang syndrome differentiation,and collect age,gender,course of disease,clinical symptoms,tumor primary focus,histomorphological manifestations and immunohistochemical results and other related information,and carry out statistical data processing.Results:The positive syndrome was mainly metastatic lung adenocarcinoma,which accounted for the majority of all MPE cases,up to 75%.The immunohistochemical results of biopsy tissues were mainly CEA and TTF-1 positive;While pleural effusion caused by pleural mesothelioma was the main type of yin syndrome,and the results of immunohistochemistry combined with biopsy were mainly positive for D2-40,Calretinin,WT-1 and CK5/6.Conclusion:TCM syndrome differentiation of MPE based on internal thoracoscopy combined with biopsy immunohistochemical results has sufficient theoretical basis and certain scientific nature,and further clinical research is needed to verify its effectiveness and practicability in the future.展开更多
Objective: To explore the clinical application effect of formulating the operating room nursing work procedure sheet for elderly lung cancer patients in thoracoscopic radical surgery. Methods: A total of 85 elderly pa...Objective: To explore the clinical application effect of formulating the operating room nursing work procedure sheet for elderly lung cancer patients in thoracoscopic radical surgery. Methods: A total of 85 elderly patients with lung cancer treated in our hospital from May 2022 to May 2023 were included as the study population for this research. They were divided into a study group of 42 cases and a regular group of 43 cases. The regular group of elderly patients received routine nursing care, while the study group of elderly patients was provided with the operating room nursing care work procedure sheet. The surgical duration, intraoperative blood loss, time to mobilization, and postoperative complication rate were compared and analyzed between the two groups. Results: Compared to the regular group, the study group had significantly shorter surgical duration and time to mobilization, as well as less intraoperative blood loss (P < 0.05). The overall incidence of postoperative complications in the study group (4.76%) was significantly lower than that in the regular group (19.05%) (P Conclusion: Formulating the operating room nursing work procedure sheet for elderly lung cancer patients can effectively improve surgical efficiency, reduce the incidence of postoperative complications, and promote patient prognosis in thoracoscopic radical surgery. Therefore, this model is worth promoting and adopting in clinical practice.展开更多
BACKGROUND It is difficult and risky for patients with a single lung to undergo thoracoscopic segmental pneumonectomy,and previous reports of related cases are rare.We introduce anesthesia for Extracorporeal membrane ...BACKGROUND It is difficult and risky for patients with a single lung to undergo thoracoscopic segmental pneumonectomy,and previous reports of related cases are rare.We introduce anesthesia for Extracorporeal membrane oxygenation(ECMO)-assisted thoracoscopic lower lobe subsegmental resection in a patient with a single left lung.CASE SUMMARY The patient underwent comprehensive treatment for synovial sarcoma of the right lung and nodules in the lower lobe of the left lung.Examination showed pulmonary function that had severe restrictive ventilation disorder,forced expiratory volume in 1 second of 0.72 L(27.8%),forced vital capacity of 1.0 L(33%),and maximal voluntary ventilation of 33.9 L(35.5%).Lung computed tomography showed a nodular shadow in the lower lobe of the left lung,and lung metastasis was considered.After multidisciplinary consultation and adequate preoperative preparation,thoracoscopic left lower lung lobe S9bii+S10bii combined subsegmental resection was performed with the assistance of total intravenous anesthesia and ECMO intraoperative pulmonary protective ventilation.The patient received postoperative ICU supportive care.After surgical treatment,the patient was successfully withdrawn from ECMO on postoperative Day 1.The tracheal tube was removed on postoperative Day 4,and she was discharged from the hospital on postoperative Day 15.CONCLUSION The multi-disciplinary treatment provided maximum medical optimization for surgical anesthesia and veno-venous ECMO which provided adequate protection for the patient's perioperative treatment.展开更多
BACKGROUND Esophageal atresia(EA)is a life-threatening congenital malformation in newborns,and the traditional repair approaches pose technical challenges and are extremely invasive.Therefore,surgeons have been active...BACKGROUND Esophageal atresia(EA)is a life-threatening congenital malformation in newborns,and the traditional repair approaches pose technical challenges and are extremely invasive.Therefore,surgeons have been actively investigating new minimally invasive techniques to address this issue.Magnetic compression anastomosis has been reported in several studies for its potential in repairing EA.In this paper,the primary repair of EA with magnetic compression anastomosis under thoracoscopy was reported.CASE SUMMARY A full-term male weighing 3500 g was diagnosed with EA gross type C.The magnetic devices used in this procedure consisted of two magnetic rings and several catheters.Tracheoesophageal fistula ligation and two purse strings were performed.The magnetic compression anastomosis was then completed thoracoscopically.After the primary repair,no additional operation was conducted.A patent anastomosis was observed on the 15th day postoperatively,and the magnets were removed on the 23rd day.No leakage existed when the transoral feeding started.CONCLUSION Thoracoscopic magnetic compression anastomosis may be a promising minimally invasive approach for repairing EA.展开更多
目的:探讨多学科围术期疼痛干预对胸腔镜肺叶切除术(VATS)术后疼痛、术后恢复和并发症的影响。方法:选取施行VATS治疗的116例患者为研究对象。依据干预方式不同将116例VATS患者分为对照组和观察组,每组各58例。对照组实施常规疼痛干预;...目的:探讨多学科围术期疼痛干预对胸腔镜肺叶切除术(VATS)术后疼痛、术后恢复和并发症的影响。方法:选取施行VATS治疗的116例患者为研究对象。依据干预方式不同将116例VATS患者分为对照组和观察组,每组各58例。对照组实施常规疼痛干预;观察组实施多学科围术期疼痛干预。比较两组疼痛情况[数字疼痛评分法(NRS)]、术后恢复情况、术后康复质量[Quality of Recovery-15,QoR-15]及并发症发生情况。结果:术后24 h及术后72 h观察组静息及咳嗽时NRS评分均低于对照组(P<0.05)。观察组术后首次下床活动时间、首次排气时间、首次经口进食时间及术后住院时间均短于对照组(P<0.05)。术后72 h,两组QoR-15评分均高于术后24 h(P<0.05),且观察组术后24、72 h QoR-15评分均高于对照组(P<0.05)。观察组总并发症发生率低于对照组(8.61%vs.22.41%,P<0.05)。结论:多学科围术期疼痛干预可降低VATS术后疼痛,促进术后恢复进程,提升康复质量,并能在一定程度上减少并发症发生。展开更多
目的 探讨预先单肺通气(OLV)联合呼吸暂停对支气管封堵器(BB)用于胸腔镜手术行OLV时肺萎陷的影响。方法 选择择期行胸腔镜下左肺段或肺叶切除术的患者75例,随机分为预先OLV组(A组)、呼吸暂停组(B组)和预先OLV联合呼吸暂停组(C组),每组2...目的 探讨预先单肺通气(OLV)联合呼吸暂停对支气管封堵器(BB)用于胸腔镜手术行OLV时肺萎陷的影响。方法 选择择期行胸腔镜下左肺段或肺叶切除术的患者75例,随机分为预先OLV组(A组)、呼吸暂停组(B组)和预先OLV联合呼吸暂停组(C组),每组25例。记录3组打开胸膜到肺完全萎陷的时间、外科医生满意度、进胸前准备时间、OLV时间、手术时间和OLV开始至胸膜打开后20 min内低氧血症[经皮动脉血氧饱和度(SpO_(2))<90%]的发生情况;记录3组胸膜腔开放即刻(T_0)、胸膜腔开放后1 min (T_1)、5 min (T_2)、10 min (T_3)和20 min (T_4)的肺萎陷评分(LCS)。结果 与A组和B组比较,C组肺完全萎陷时间明显缩短,外科医生满意度明显提高,差异均有统计学意义(P <0.05),A组和B组肺完全萎陷时间和外科医生满意度比较,差异均无统计学意义(P> 0.05);与A组比较,B组T0时点LCS低于A组,而在T_1时点,则明显高于A组,C组T_(1)、T_(2)、T_(3)和T_(4)时点LCS明显高于A组和B组,差异均有统计学意义(P <0.05);C组T2时点SpO_(2)明显低于A组和B组,差异有统计学意义(P <0.05)。结论 对于用BB行OLV的胸腔镜手术患者,预先使用OLV联合呼吸暂停,可以改善非通气侧肺的肺萎陷效果,缩短了肺完全萎陷时间,提高了外科医生满意度,且OLV的早期LCS更高,但仍需监测OLV期间的SpO_(2)。展开更多
文摘BACKGROUND Inflammatory myofibroblastic tumors(IMTs)are exceptionally rare neoplasms with intermediate malignant potential.Surgery is the accepted treatment option,aiming for complete resection with clear margins.CASE SUMMARY A 39-year-old woman presented with a growing solitary pulmonary nodule measuring 2.0 cm in the right upper lobe(RUL)of the lung.The patient underwent a RUL anterior segmentectomy using uniportal video-assisted thoracoscopy.A preliminary tissue diagnosis indicated malignancy;however,it was later revised to an IMTs.Due to the absence of a minor fissure between the right upper and middle lobes,an alternative resection approach was necessary.Therefore,we utilized indocyanine green injection to aid in delineating the intersegmental plane.Following an uneventful recovery,the patient was discharged on the third postoperative day.Thereafter,annual chest tomography scans were scheduled to monitor for potential local recurrence.CONCLUSION This case underscores the challenges in diagnosing and managing IMTs,showing the importance of accurate pathologic assessments and tailored surgical strategies.
文摘Objective: To explore the clinical effectiveness of combined use of intravenous pain pump with Parecoxib injection in alleviating pain in patients during the early postoperative period after thoracoscopic surgery. Methods: Eighty patients who underwent thoracoscopic surgery in a tertiary hospital were selected as the study subjects and randomly divided into two groups, with 40 patients in each group. The control group received routine postoperative treatment with intravenous pain pump, while the experimental group received Parecoxib in addition to the standard postoperative pain pump treatment. Visual Analog Scale (VAS) pain scores were used to evaluate postoperative pain relief in both groups, along with adverse reactions, postoperative complications, and patient satisfaction with pain relief. Results: Patients who received Parecoxib injection in addition to the routine use of intravenous pain pump had VAS pain scores lower than 3 points at 6 h, 12 h, 24 h, and 36 h postoperatively compared to those in the control group. The incidence of postoperative lung collapse, pleural effusion, and pulmonary infections was also significantly lower in the experimental group. The differences between the two groups were statistically significant (P Conclusion: Early combined use of Parecoxib injection in the early postoperative period after thoracoscopic surgery has shown good clinical efficacy. It can reduce the level of pain in patients, promote effective coughing and expectoration, facilitate early mobilization of patients, improve patient compliance, reduce complications, shorten hospital stay, and expedite patient recovery. Therefore, it is worth promoting the widespread clinical application of Parecoxib injection in this setting.
文摘BACKGROUND A Bochdalek hernia(BH)is a congenital diaphragmatic hernia that often develops in the neonatal period.BH typically occurs on the left side of the diaphragm.A right-sided BH in an adult is rare.CASE SUMMARY A 45-year-old man was referred to our hospital because of an abnormal shadow seen on chest radiography during a medical check-up.A chest radiograph showed elevation of the right hemidiaphragm.Computed tomography showed prolapse of multiple intraabdominal organs into the right thoracic cavity,corresponding to a right-sided BH.The herniated contents included the stomach,transverse colon,and left lobe of the liver.The left lobe of the liver was enlarged,particularly the medial segment.Laparoscopic surgery was performed.However,the left lobe of the liver was completely trapped in the thoracic cavity.Therefore,thoracoscopic manipulation had to be performed to return the liver to the abdominal cavity.The hernia was repaired with interrupted nonabsorbable sutures and reinforced with mesh.CONCLUSION Combined laparoscopic and thoracoscopic surgery was successfully performed for right-sided BH with massive liver prolapse and abnormal liver morphology.
文摘Objective:To explore the situation of patients and the compare the effect between two methods,which are preserving spontaneous breathing without intubation and endotracheal intubation with one lung ventilation in the single-hole thoracoscopic bulla suture.Method:42 patients who received single-hole thoracoscopic pulmonary bullae suture in our hospital from January 2020 to December 2021 were selected as the study subjects,including 19 patients who underwent endotracheal intubation and one lung ventilation as the control group and 23 patients who underwent single-hole thoracoscopic pulmonary bullae suture without intubation as the study group.The relevant indexes,postoperative general conditions,complications and pneumothorax recurrence of the two groups were analyzed and observed.Results:In the control group,the scores of anesthesia time(points),resuscitation time(points),surgical visual field score(points),surgical time(points),and surgical bleeding volume(points)were 20.8±4.6,19.9±7.9,1.7±0.5,44.9±7.9,and 11.4±2.4 respectively.In the study group,the scores of anesthesia time(points),resuscitation time(points),surgical visual field score(points),surgical time(points),and scores of surgical bleeding(points)were 17.9±4.3,15.4±3.4,1.9±0.4,48.4±7.1,10.9±2.2,respectively.There was no statistical difference in surgical visual field score,surgical time and surgical bleeding whereas there was a statistical difference between anesthesia time and resuscitation time.In the control group after operation,VAS score at 6 hours after operation,SaO_(2)(%)after operation,PaCO_(2)(mmHg)after operation,drainage volume(ML)after operation,feeding time(H)after operation,retention time of thoracic tube after operation(H),WBC(109)on the first day after operation,hospitalization time(d),and total hospitalization cost(RMB 1000)were 2.1±0.7,98.2±1.4,42.4±4.9,139.1±23.1,6.9±1.6,37.1±5.4,7.9±2.1,6.6±1.3,and 2.6±0.3 respectively.As for the study group,the VAS score at 6 hours after operation,SaO_(2)(%)after operation,PaCO_(2)(mmHg)after operation,drainage volume(ML)after operation,feeding time(H)after operation,retention time of thoracic tube after operation(H),WBC(109)on the first day after operation,hospitalization time(d),and total hospitalization cost(RMB 1000)were 1.9±0.4,97.9±1.2,42.8±5.1,151.8±21.9,4.3±1.4,15.3±2.6,5.2±2.3,4.2±1.2,and 1.8±0.4 respectively.Among them,there were no significant differences in visual analog scale(VAS)score at 6 hours after operation,SaO_(2) after operation and PaCO_(2) after operation between the two groups,but there were significant differences in other factors.The complication rate of the control group was 36.84%,which was significantly higher than that of the study group(4.35%),with statistical difference.The recurrence rate of the control group was 21.05%,which was not significantly different from that of the study group(4.35%).Conclusion:The single-hole thoracoscopic bullae suture without intubation can reduce the anesthesia time and resuscitation time of patients,reduce the hospitalization cost of patients,reduce the treatment burden,shorten the first feeding time,and reduce the complication rate of patients.Therefore,it is worthy of clinical promotion.
文摘Objective: To sum up 121 cases of heart disease operations with the help of thoracoscope from May to August in 2000. Among these cases, 48 cases were atrial septal defect (ASD); the average age of patients is 20±10 years old; average weight is (43±16) kg. 67 patients with ventricular septal defects (VSD), average age13±9 years old; one male patient, 44 years old with Ebstein malformation; one female patient (21 years old) partial atrioventricular canal combined with cor triatriatum; one male (21 years old) with ruptared aneuryem of aortic sinus. 3 cases(all females ) with mitral stenosis combined with mitral valve incompetence. One male patient(aged 16)with pericardiun effusion after trauma. Methods: During operations, a patient with supine position, and his/her right shoulder was padded 30°higher. Tracheal cannula was inserted and air was piped in with high frequency jet ventilation. Three mini thoracotomies with a diameter of 2 to 3 cm were made in the 4th intercostals space of the right par sternum and the 4th and 7th intercostals spaces of the right middle axillary line respectively. An periphera extra corporeal circulation was made. the aortic clamp was clamped, cannula for cold perfusion. After the heart was sliced and a reformative operation was performed. The process of the operation of defects repairs was finished under the thoracoscope. The other operations were performed with the help of thoracoscope. 3 rheumatic heart disease patients got 25# mechanical mitral valve prosthesis. A 30# tricuspid plasty ring was applied to The Ebstein malformation patient. Results: all 121 patients were successfully operated on without death. Two VSD cases appeared transient third degree atrialventricular block.Because 4 cases had more chest drainage, so they were stanched bleeding twice. After the operation, heart murmur vanished, and ultrasonic inspection showed no diffluence inside the heart. Conclusion: Our experience showed that all atrium, ventricular septal defects can be repaired under the thoracoscope. This scope-assisted technology is more accepted by patients because of tiny incisions and also provides an alternative solution for cardiac surgeons.
文摘Objective:Guided by the theory of syndrome differentiation of yin and yang in traditional Chinese medicine surgery,through visual observation of internal medicine thoracoscope,comprehensive observation of pleural cavity and immunohistochemistry of biopsy tissue,to classify malignant pleural effusion according to syndrome differentiation,and to explore the scientific nature of its theory.Methods:From March 1,2014 to February 28,2015,40 cases of malignant pleural effusion were treated in Beijing Chaoyang Hospital affiliated to Capital Medical University.According to the proposed TCM diagnostic criteria for yin and yang syndrome differentiation,and collect age,gender,course of disease,clinical symptoms,tumor primary focus,histomorphological manifestations and immunohistochemical results and other related information,and carry out statistical data processing.Results:The positive syndrome was mainly metastatic lung adenocarcinoma,which accounted for the majority of all MPE cases,up to 75%.The immunohistochemical results of biopsy tissues were mainly CEA and TTF-1 positive;While pleural effusion caused by pleural mesothelioma was the main type of yin syndrome,and the results of immunohistochemistry combined with biopsy were mainly positive for D2-40,Calretinin,WT-1 and CK5/6.Conclusion:TCM syndrome differentiation of MPE based on internal thoracoscopy combined with biopsy immunohistochemical results has sufficient theoretical basis and certain scientific nature,and further clinical research is needed to verify its effectiveness and practicability in the future.
文摘Objective: To explore the clinical application effect of formulating the operating room nursing work procedure sheet for elderly lung cancer patients in thoracoscopic radical surgery. Methods: A total of 85 elderly patients with lung cancer treated in our hospital from May 2022 to May 2023 were included as the study population for this research. They were divided into a study group of 42 cases and a regular group of 43 cases. The regular group of elderly patients received routine nursing care, while the study group of elderly patients was provided with the operating room nursing care work procedure sheet. The surgical duration, intraoperative blood loss, time to mobilization, and postoperative complication rate were compared and analyzed between the two groups. Results: Compared to the regular group, the study group had significantly shorter surgical duration and time to mobilization, as well as less intraoperative blood loss (P < 0.05). The overall incidence of postoperative complications in the study group (4.76%) was significantly lower than that in the regular group (19.05%) (P Conclusion: Formulating the operating room nursing work procedure sheet for elderly lung cancer patients can effectively improve surgical efficiency, reduce the incidence of postoperative complications, and promote patient prognosis in thoracoscopic radical surgery. Therefore, this model is worth promoting and adopting in clinical practice.
基金Supported by the Special Scientific Research Project of the National Traditional Chinese Medicine Clinical Research Base,No.JDZX201926.
文摘BACKGROUND It is difficult and risky for patients with a single lung to undergo thoracoscopic segmental pneumonectomy,and previous reports of related cases are rare.We introduce anesthesia for Extracorporeal membrane oxygenation(ECMO)-assisted thoracoscopic lower lobe subsegmental resection in a patient with a single left lung.CASE SUMMARY The patient underwent comprehensive treatment for synovial sarcoma of the right lung and nodules in the lower lobe of the left lung.Examination showed pulmonary function that had severe restrictive ventilation disorder,forced expiratory volume in 1 second of 0.72 L(27.8%),forced vital capacity of 1.0 L(33%),and maximal voluntary ventilation of 33.9 L(35.5%).Lung computed tomography showed a nodular shadow in the lower lobe of the left lung,and lung metastasis was considered.After multidisciplinary consultation and adequate preoperative preparation,thoracoscopic left lower lung lobe S9bii+S10bii combined subsegmental resection was performed with the assistance of total intravenous anesthesia and ECMO intraoperative pulmonary protective ventilation.The patient received postoperative ICU supportive care.After surgical treatment,the patient was successfully withdrawn from ECMO on postoperative Day 1.The tracheal tube was removed on postoperative Day 4,and she was discharged from the hospital on postoperative Day 15.CONCLUSION The multi-disciplinary treatment provided maximum medical optimization for surgical anesthesia and veno-venous ECMO which provided adequate protection for the patient's perioperative treatment.
文摘BACKGROUND Esophageal atresia(EA)is a life-threatening congenital malformation in newborns,and the traditional repair approaches pose technical challenges and are extremely invasive.Therefore,surgeons have been actively investigating new minimally invasive techniques to address this issue.Magnetic compression anastomosis has been reported in several studies for its potential in repairing EA.In this paper,the primary repair of EA with magnetic compression anastomosis under thoracoscopy was reported.CASE SUMMARY A full-term male weighing 3500 g was diagnosed with EA gross type C.The magnetic devices used in this procedure consisted of two magnetic rings and several catheters.Tracheoesophageal fistula ligation and two purse strings were performed.The magnetic compression anastomosis was then completed thoracoscopically.After the primary repair,no additional operation was conducted.A patent anastomosis was observed on the 15th day postoperatively,and the magnets were removed on the 23rd day.No leakage existed when the transoral feeding started.CONCLUSION Thoracoscopic magnetic compression anastomosis may be a promising minimally invasive approach for repairing EA.
文摘目的:探讨多学科围术期疼痛干预对胸腔镜肺叶切除术(VATS)术后疼痛、术后恢复和并发症的影响。方法:选取施行VATS治疗的116例患者为研究对象。依据干预方式不同将116例VATS患者分为对照组和观察组,每组各58例。对照组实施常规疼痛干预;观察组实施多学科围术期疼痛干预。比较两组疼痛情况[数字疼痛评分法(NRS)]、术后恢复情况、术后康复质量[Quality of Recovery-15,QoR-15]及并发症发生情况。结果:术后24 h及术后72 h观察组静息及咳嗽时NRS评分均低于对照组(P<0.05)。观察组术后首次下床活动时间、首次排气时间、首次经口进食时间及术后住院时间均短于对照组(P<0.05)。术后72 h,两组QoR-15评分均高于术后24 h(P<0.05),且观察组术后24、72 h QoR-15评分均高于对照组(P<0.05)。观察组总并发症发生率低于对照组(8.61%vs.22.41%,P<0.05)。结论:多学科围术期疼痛干预可降低VATS术后疼痛,促进术后恢复进程,提升康复质量,并能在一定程度上减少并发症发生。
文摘目的 探讨预先单肺通气(OLV)联合呼吸暂停对支气管封堵器(BB)用于胸腔镜手术行OLV时肺萎陷的影响。方法 选择择期行胸腔镜下左肺段或肺叶切除术的患者75例,随机分为预先OLV组(A组)、呼吸暂停组(B组)和预先OLV联合呼吸暂停组(C组),每组25例。记录3组打开胸膜到肺完全萎陷的时间、外科医生满意度、进胸前准备时间、OLV时间、手术时间和OLV开始至胸膜打开后20 min内低氧血症[经皮动脉血氧饱和度(SpO_(2))<90%]的发生情况;记录3组胸膜腔开放即刻(T_0)、胸膜腔开放后1 min (T_1)、5 min (T_2)、10 min (T_3)和20 min (T_4)的肺萎陷评分(LCS)。结果 与A组和B组比较,C组肺完全萎陷时间明显缩短,外科医生满意度明显提高,差异均有统计学意义(P <0.05),A组和B组肺完全萎陷时间和外科医生满意度比较,差异均无统计学意义(P> 0.05);与A组比较,B组T0时点LCS低于A组,而在T_1时点,则明显高于A组,C组T_(1)、T_(2)、T_(3)和T_(4)时点LCS明显高于A组和B组,差异均有统计学意义(P <0.05);C组T2时点SpO_(2)明显低于A组和B组,差异有统计学意义(P <0.05)。结论 对于用BB行OLV的胸腔镜手术患者,预先使用OLV联合呼吸暂停,可以改善非通气侧肺的肺萎陷效果,缩短了肺完全萎陷时间,提高了外科医生满意度,且OLV的早期LCS更高,但仍需监测OLV期间的SpO_(2)。