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
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
BACKGROUND This case report examines the challenges associated with removing a totally implantable venous access port(TIVAP)used for long-term chemotherapy in a patient with breast cancer.Prolonged use of TIVAPs can r...BACKGROUND This case report examines the challenges associated with removing a totally implantable venous access port(TIVAP)used for long-term chemotherapy in a patient with breast cancer.Prolonged use of TIVAPs can result in complications such as catheter kinking,thrombosis,and adhesions between the catheter and surrounding tissues,potentially complicating their removal.CASE SUMMARY A breast cancer patient with bone metastasis presented with difficulty aspirating blood from a TIVAP that had been placed in the right internal jugular vein for 3 years.Initial removal attempts at the Department of Venous Access Center were unsuccessful,likely due to adhesions,necessitating a subsequent successful catheter extraction in a hybrid operating room.Imaging revealed no abnor-malities,and the catheter was removed using a mosquito clamp to detach it from surrounding tissues.CONCLUSION This case highlights the challenges of removing TIVAPs inserted via the internal jugular vein,particularly when the catheter traverses the sternocleidomastoid muscle.Repeated neck movements might lead to significant adhesions around the catheter,complicating its removal.Careful consideration should be given during catheter placement to avoid muscle-related adhesions and facilitate smoother extraction in long-term use.展开更多
BACKGROUND Cancer patients with an implanted venous access port(IVAP)often manage their care at home during chemotherapy intervals,including maintaining the device,monitoring complications,and following medication ins...BACKGROUND Cancer patients with an implanted venous access port(IVAP)often manage their care at home during chemotherapy intervals,including maintaining the device,monitoring complications,and following medication instructions.Home care ensures continued support after discharge.However,due to factors such as age,gender,culture,psychological status,and family support,the quality of home care varies significantly.Understanding these factors can help provide targeted guidance to improve the care of cancer patients.AIM To explore IVAP chemotherapy on home care quality and its association with mental health and family support for cancer patients.METHODS This investigative study was based on a medical records system.It investigated the relationship between psychological status,family support,and home care quality in 180 patients with cancer undergoing IVAP chemotherapy.Psychological status was assessed using the State Anxiety Inventory(S-AI);family support was assessed using the Perceived Social Support Scale(PSSS),and home care quality was evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire(EORTC QLQ-C30).Pearson’s correlation and Structural Equation Modeling were used to analyze the interplay between these factors.RESULTS The average S-AI score was 47.52±14.47,PSSS was 52.48±12.64,and EORTC QLQ-C30 was 70.09±17.32.A substantial inverse relationship was observed between the EORTC QLQ-C30 and S-AI scores(r=-0.712).A significant positive correlation was found between the EORTC QLQ-C30 and the PSSS,with a correlation coefficient of(r=0.744).The multiple linear regression analysis indicated that family social support,psychological status,and average monthly family income were the main factors influencing the variation in the quality of home care,explaining 71.9%of the variation.The Structural Equation Modeling results indicated that psychological status acted as a partial mediator in the association between family social support and home care quality of life,explaining 32.78%of the mediation effect.CONCLUSION Psychological status and family social support positively impacted cancer patients’home care quality,with psychology partially mediating this effect.展开更多
Objective: The objective of the current study was to evaluate the feasibility and safety of nonintubated nniportal video-assisted thoracoscopic surgery (VATS) for the management of primary spontaneous pneumothorax ...Objective: The objective of the current study was to evaluate the feasibility and safety of nonintubated nniportal video-assisted thoracoscopic surgery (VATS) for the management of primary spontaneous pneumothorax (PSP). Methods: From November 2011 to June 2013, 32 consecutive patients with PSP were treated by nonintubated uniportal thoracoscopic bullectomy using epidnral anaesthesia and sedation without endotracheal intubation. An incision 2 cm in length was made at the 6th intercostal space in the median axillary line. The pleural space was entered by blunt dissection for placement of a soft incision protector. Instruments were then inserted through the incision protector to perform thoracoscopic bullectomy. Data were collected within a minimum follow-up period of 10 months. Results: The average time of surgery was 49.0 rain (range, 33-65 rain). No complications were recorded. The postoperative feeding time was 6 h. The mean postoperative chest tube drainage and hospital stay were 19.3 h and 41.6 h, respectively. The postoperative pain was mild for 30 patients (93.75%) and moderate for two patients (6.25%). No recurrences ofpneumothorax were observed at follow-up. Conclusions: The initial results indicated that nonintubated uniportal video-assisted thoracoscopic operations are not only technically feasible, but may also be a safe and less invasive alternative for select patients in the management of PSP. This is the first report to include the use of a nonintubated uniportal technique in VATS for such a large number of PSP cases. Further work and development of instruments are needed to define the applications and advantages of this technique.展开更多
Thoracic Surgery is a continuous evolving specialty. In the past, thoracic surgeons had to make large incisions in order to operate any pathology inside the chest. This often meant big, painful and ugly scars and long...Thoracic Surgery is a continuous evolving specialty. In the past, thoracic surgeons had to make large incisions in order to operate any pathology inside the chest. This often meant big, painful and ugly scars and long recovery times after surgery. But he history of thoracic surgery changed since the begining of video-assisted thoracoscoDic surgery (VATg3展开更多
BACKGROUND Situs inversus totalis(SIT)is a rare congenital condition that is characterized by a complete mirror image of the typical arrangement of the thoracic and abdominal viscera.Performing thoracoscopic segmentec...BACKGROUND Situs inversus totalis(SIT)is a rare congenital condition that is characterized by a complete mirror image of the typical arrangement of the thoracic and abdominal viscera.Performing thoracoscopic segmentectomy for a patient with lung cancer and SIT is an extremely skilled and challenging surgical procedure.CASE SUMMARY A 41-year old woman with a medical history of dextrocardia since childhood was admitted to our hospital with a mixed ground-glass opacity(mGGO)in her left lung field,discovered by computed tomography during her health checkup.In order to facilitate surgical orientation,three-dimensional computed tomography bronchography and angiography(3D-CTBA)was preoperatively carried out.The result of 3D-CTBA was consistent with the diagnosis of SIT and an mGGO in the posterior segment of the left upper lobe(LS2).Surgery was conducted in accordance with preoperative 3D-CTBA and designed surgical procedure,combined with intraoperative navigation.Final pathological examination revealed in situ adenocarcinoma.The patient’s postoperative condition was uneventful and no complications were observed.CONCLUSION We present the first case of lung cancer in a patient with SIT who successfully underwent thoracoscopic segmentectomy assisted by 3D-CTBA.This is a new technique that covers precise confirmation and dissection of targeted structures and intersegmental demarcation,and can help achieve a meticulous anatomical segmentectomy.展开更多
We aimed to describe a method for repositioning of right middle lobar torsion by using a 3-cm uniportal video-assisted thoracoscopic surgery(VATS) approach. Middle lobe torsion occurred after right upper and lower lob...We aimed to describe a method for repositioning of right middle lobar torsion by using a 3-cm uniportal video-assisted thoracoscopic surgery(VATS) approach. Middle lobe torsion occurred after right upper and lower lobectomy in a 74-year-old man. Immediate re-exploratory thoracotomy using the 3-cm uniportal VATS approach was performed. The torsion was corrected, and the lobe was anchored to the anterior chest wall with Prolene stitches. The patient recovered well postoperatively with daily improvements in chest radiographic findings. Follow-up examination was performed using fiberbronchoscopy, which revealed an unobstructed right middle lobe bronchus and sticky yellow sputum. Follow-up chest computed tomography was performed 3 months after the primary surgery and revealed increased expansion of the right middle lobe. We repositioned the right middle lobe successfully by using the 3-cm uniportal VATS approach, but more cases are needed to confirm the feasibility of the approach. Lobectomy remains the primary treatment option for such cases.展开更多
BACKGROUND Mediastinal mature teratoma is the most common histological type of primary extragonadal germ cell tumor.In this report,we describe a rare case of giant mature teratoma located primarily in the anterior med...BACKGROUND Mediastinal mature teratoma is the most common histological type of primary extragonadal germ cell tumor.In this report,we describe a rare case of giant mature teratoma located primarily in the anterior mediastinum and causing partial atelectasis of the upper and middle lobes of the right lung,as well as extrinsic compression of the right atrium.CASE SUMMARY A 31-year-old male with a giant mediastinal mature teratoma presented with progressive exertional dyspnea and chest pain for 1 mo.Computed tomography of the chest indicated the diagnosis of anterior mediastinal teratoma.The patient underwent right uniportal anterior approach video-assisted thoracoscopic surgery(VATS).En bloc resection of the giant teratoma,wedge resection of the upper and middle lobes of the right lung,resection of the thymus and partial excision of the pericardium were successfully performed.The pathological diagnosis revealed a mature cystic teratoma with foreign-body reaction that was closely related to the right lung,atrium dextrum,superior vena cava and ascending aorta.An atrophic thymic tissue was also discovered at the external teratoma surface.The patient was discharged on postoperative day 7.CONCLUSION This is the first report of the use of uniportal VATS for complete resection of a teratoma in combination with wedge resection of the right upper and middle lung lobes and partial resection of the pericardium.展开更多
BACKGROUND Esophageal liposarcoma is a rare malignant tumor and an esophageal dedifferentiated liposarcoma(DDL)is extremely rare.There are no reports on the treatment of DDL by thoracoscopic surgery.CASE SUMMARY A 38-...BACKGROUND Esophageal liposarcoma is a rare malignant tumor and an esophageal dedifferentiated liposarcoma(DDL)is extremely rare.There are no reports on the treatment of DDL by thoracoscopic surgery.CASE SUMMARY A 38-year-old woman presented with dysphagia and dyspnea.Imaging examination showed a large mass in the posterior mediastinum.The patient also developed respiratory failure and it was unclear whether this was caused by a mass from inside or outside the esophagus.We decided to perform thoracoscopic exploration to relieve the obstruction caused by tracheal compression.The upper segment of the esophagus was split longitudinally,and most of the mass could be removed from the esophageal lumen to the thoracic cavity.The pedicle was excised by linear cutting closers under mirrors.Little residual mass was visualized by gastroscopy.The mucous and muscular layers were closed by interrupted sutures.Pathological examination showed that the mass was a DDL.The patient did not have any dysphagia or dyspnea 2 wk postoperatively and refused any further treatment.Computed tomography and esophagoscopy did not find any recurrence at up to 20 mo postoperatively.CONCLUSION Thoracoscopy can be used to treat large esophageal masses.展开更多
BACKGROUND Pericardial rupture caused by blunt chest trauma is rare in clinical practice.Because of its atypical clinical symptoms,and because surgeons are often unfamiliar with the clinical and radiological manifesta...BACKGROUND Pericardial rupture caused by blunt chest trauma is rare in clinical practice.Because of its atypical clinical symptoms,and because surgeons are often unfamiliar with the clinical and radiological manifestations of the injury,preoperative diagnosis is difficult;it is easily misdiagnosed and causes serious consequences.CASE SUMMARY A 60-year-old man,previously healthy,was transported to the emergency room after falling from a great height.Upon arrival,his vital signs were stable.Electrocardiography and echocardiography were performed,and there was no sign of cardiac injury or ischemia.Chest and abdomen computerized tomography revealed pneumopericardium,hemopneumothorax,lung contusion,multiple rib fractures on the right side(Figure 1),and right scapula and clavicle fractures.He was admitted to the inpatient department for further observation after tube thoracostomy.The next day,the patient suddenly experienced rapid arrhythmia(the ventricular rate reached 150-180 beats/min)when turning onto his right side,accompanied by a blood pressure drop to 70/45 mm Hg and a chief complaint of palpitation.Thoracoscopy was performed urgently,and a large vertical tear(8 cm×6 cm)was found in the pericardium.The defect was successfully repaired using a heart Dacron patch.His postoperative condition was uneventful without any fluctuations in vital signs,and he was transferred to the orthopedics department for further surgery on postoperative day 8.CONCLUSION Although the possibility of pericardial rupture combined with cardiac hernia is extremely low,it is one of the causes of cardiogenic shock following blunt trauma.Therefore,clinicians need to be more familiar with its characteristic manifestations and maintain a high degree of vigilance against such injuries to avoid disastrous consequences.展开更多
BACKGROUND Azygos vein aneurysms are extremely rare,and their pathogenesis is not clear.The overwhelming majority of patients have no obvious clinical symptoms and are found to have the disease by physical examination...BACKGROUND Azygos vein aneurysms are extremely rare,and their pathogenesis is not clear.The overwhelming majority of patients have no obvious clinical symptoms and are found to have the disease by physical examination or by chance.There are few reports on the diagnosis of and treatment strategy for this disease.Moreover,the choice of therapeutic schedule and the treatment window are controversial.CASE SUMMARY We report a case of azygos vein arch aneurysm in a 53-year-old woman.The patient had symptoms of back pain,chest tightness,and choking.Enhanced chest computed tomography showed a soft-tissue mass in the right posterior mediastinum,which was connected to the superior vena cava.The enhancement degree in the venous phase was the same as that of the superior vena cava.The patient received video-assisted thoracoscopic surgery.After the operation,her back pain disappeared,and her dysphagia and chest tightness were also significantly relieved.The postoperative pathology confirmed hemangioma.The patient was discharged on the seventh day after surgery without any complications.CONCLUSION Some patients with hemangioma of the azygos vein arch may experience dysphagia and chest tightness caused by the tumor compressing the esophagus and trachea.Enhanced computed tomography scanning is vital for the diagnosis of azygos vein aneurysms.In addition,despite the difficulty and risk of surgery,thoracoscopic surgery for azygos vein aneurysms is completely feasible.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
Objective:To study the differences in the body pain and trauma degree between uniportal and three-portal video-assisted thoracoscopic surgery for the treatment of lung cancer.Methods:A total of 108 patients with non-s...Objective:To study the differences in the body pain and trauma degree between uniportal and three-portal video-assisted thoracoscopic surgery for the treatment of lung cancer.Methods:A total of 108 patients with non-small cell lung cancer who received radical operation in our hospital between February 2013 and February 2016 were selected and divided into the uniportal group (n=52) who received uniportal video-assisted thoracoscopic surgery and the three-portal group (n=56) who received three-portal video-assisted thoracoscopic surgery after the operation methods and related laboratory results were reviewed. Before operation and 24 h after operation, the differences in serum levels of pain mediators, oxidative stress indexes and inflammation indexes were compared between the two groups of patients.Results: Before operation, the differences in serum levels of pain mediators, oxidative stress indexes and inflammation indexes were not statistically significant between the two groups of patients. 24 h after operation, serum pain mediators NE, DA and 5-HT levels of observation group were lower than those of control group;oxidative stress indexes MDA and O2- levels were lower than those of control group while SOD and GSH-Px levels were higher than those of control group;inflammation indexes IL-6, IL-8, CRP and TNF-α levels were lower than those of control group.Conclusion: Uniportal video-assisted thoracoscopic surgery for the treatment of lung cancer causes less surgery trauma, and patients' postoperative pain and systemic inflammatory stress response are lighter.展开更多
Thanks to the recent improvements in video-assisted thoracoscopic techniques (VATS) and anesthetic procedures, a great deal of complex lung resections can be performed avoiding open surgery. The experience gained th...Thanks to the recent improvements in video-assisted thoracoscopic techniques (VATS) and anesthetic procedures, a great deal of complex lung resections can be performed avoiding open surgery. The experience gained through VATS techniques, enhancement of the surgical instruments ,improvement of high definition cameras and avoidance of intubated general anesthesia have been the greatest advances to minimize the trauma to the patient. Uniportal VATS for major resections has become a revolution in the treatment of lung pathologies since initially described 4 years ago. The huge number of surgical videos posted on specialized websites, live surgery events and experimental courses has contributed to the rapid learning of uniportal major thoracoscopic surgery during the last years. The future of the thoracic surgery is based on evolution of surgical procedures and anesthetic techniques to try to reduce the trauma to the patient. Further development of new technologies probably will focus on sealing devices for all vessels and fissure, refined staplers and instruments, improvements in 3D systems or wireless cameras, and robotic surgery. As thoracoscopic techniques continue to evolve exponentially, we can see the emergence of new approaches in the anesthetical and the perioperative management of these patients. Advances in anesthesia include lobectomies performed without the employment of general anesthesia, through maintaining spontaneous ventilation, and with minimally sedated patients. Uniportal VATS resections under spontaneous ventilation probably represent the least invasive approach to operate lung cancer.展开更多
Hypoxemia after general anesthesia is not uncommon.For patients after thoracotomy,the differential diagnosis is usually difficult.Surgical,anesthetic,and patient-associated factors may contribute to postoperative hypo...Hypoxemia after general anesthesia is not uncommon.For patients after thoracotomy,the differential diagnosis is usually difficult.Surgical,anesthetic,and patient-associated factors may contribute to postoperative hypoxemia.We described two patients who underwent videassisted thoracoscopic thymectomy and developed hypoxemia immediately after extubation.Phrenic nerve injury was suspected in both patients.One case recovered spontaneously without intervention.The second case who had been demonstrated as bilateral phrenic nerve injury after the operation was continuously on ventilator after physical therapy and respiratory training for 2 months.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
BACKGROUND Tension pneumothorax of the contralateral lung during single-lung ventilation(SLV)combined with artificial pneumothorax can cause cardiac arrest due to bilateral pneumothorax.If not rapidly diagnosed and ma...BACKGROUND Tension pneumothorax of the contralateral lung during single-lung ventilation(SLV)combined with artificial pneumothorax can cause cardiac arrest due to bilateral pneumothorax.If not rapidly diagnosed and managed,this condition can lead to sudden death.We describe the emergency handling procedures and rapid diagnostic methods for this critical emergency situation.CASE SUMMARY We report a case of bilateral pneumothorax in a neonatal patient who underwent thoracoscopic esophageal atresia and tracheoesophageal fistula repair under the combined application of SLV and artificial pneumothorax.The patient suffered sudden cardiac arrest and received emergency treatment to revive her.The recognition of dangerous vital sign parameters,rapid evacuation of the artificial pneumothorax,and initiation of lateral position cardiopulmonary resuscitation while simultaneously removing the endotracheal tube to the main airway are critically important.Moreover,even though the sinus rhythm was restored,the patient’s continued tachycardia,reduced pulse pressure,and depressed pulse oximeter waveform were worrisome.We should highly suspect the possibility of pneumothorax and use rapid diagnostic methods to make judgment calls.Sometimes thoracoscopy can be used for rapid examination;if the mediastinum is observed to be shifted to the right,it may indicate tension pneumothorax.This condition can be immediately relieved by needle thoracentesis,ultimately allowing the safe completion of the surgical procedure.CONCLUSION Bilateral pneumothorax during SLV combined with artificial pneumothorax is rare but can occur at any time in neonatal thoracoscopic surgery.Therefore,anesthesiologists should consider this possibility,be alert,and address this rare but critical complication in a timely manner.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
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.
基金Supported by the Science and Technology Research Project of Jiangxi Provincial Education Department,No.GJJ2208202Science and Technology Program Project of Health Commission of Jiangxi Province,No.202510069+1 种基金Jiangxi Cancer Hospital Doctoral Start-up Fund,No.BSQDJ202309Jiangxi Province Gan Po Talent Support Program,No.20232BCJ23035.
文摘BACKGROUND This case report examines the challenges associated with removing a totally implantable venous access port(TIVAP)used for long-term chemotherapy in a patient with breast cancer.Prolonged use of TIVAPs can result in complications such as catheter kinking,thrombosis,and adhesions between the catheter and surrounding tissues,potentially complicating their removal.CASE SUMMARY A breast cancer patient with bone metastasis presented with difficulty aspirating blood from a TIVAP that had been placed in the right internal jugular vein for 3 years.Initial removal attempts at the Department of Venous Access Center were unsuccessful,likely due to adhesions,necessitating a subsequent successful catheter extraction in a hybrid operating room.Imaging revealed no abnor-malities,and the catheter was removed using a mosquito clamp to detach it from surrounding tissues.CONCLUSION This case highlights the challenges of removing TIVAPs inserted via the internal jugular vein,particularly when the catheter traverses the sternocleidomastoid muscle.Repeated neck movements might lead to significant adhesions around the catheter,complicating its removal.Careful consideration should be given during catheter placement to avoid muscle-related adhesions and facilitate smoother extraction in long-term use.
文摘BACKGROUND Cancer patients with an implanted venous access port(IVAP)often manage their care at home during chemotherapy intervals,including maintaining the device,monitoring complications,and following medication instructions.Home care ensures continued support after discharge.However,due to factors such as age,gender,culture,psychological status,and family support,the quality of home care varies significantly.Understanding these factors can help provide targeted guidance to improve the care of cancer patients.AIM To explore IVAP chemotherapy on home care quality and its association with mental health and family support for cancer patients.METHODS This investigative study was based on a medical records system.It investigated the relationship between psychological status,family support,and home care quality in 180 patients with cancer undergoing IVAP chemotherapy.Psychological status was assessed using the State Anxiety Inventory(S-AI);family support was assessed using the Perceived Social Support Scale(PSSS),and home care quality was evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire(EORTC QLQ-C30).Pearson’s correlation and Structural Equation Modeling were used to analyze the interplay between these factors.RESULTS The average S-AI score was 47.52±14.47,PSSS was 52.48±12.64,and EORTC QLQ-C30 was 70.09±17.32.A substantial inverse relationship was observed between the EORTC QLQ-C30 and S-AI scores(r=-0.712).A significant positive correlation was found between the EORTC QLQ-C30 and the PSSS,with a correlation coefficient of(r=0.744).The multiple linear regression analysis indicated that family social support,psychological status,and average monthly family income were the main factors influencing the variation in the quality of home care,explaining 71.9%of the variation.The Structural Equation Modeling results indicated that psychological status acted as a partial mediator in the association between family social support and home care quality of life,explaining 32.78%of the mediation effect.CONCLUSION Psychological status and family social support positively impacted cancer patients’home care quality,with psychology partially mediating this effect.
文摘Objective: The objective of the current study was to evaluate the feasibility and safety of nonintubated nniportal video-assisted thoracoscopic surgery (VATS) for the management of primary spontaneous pneumothorax (PSP). Methods: From November 2011 to June 2013, 32 consecutive patients with PSP were treated by nonintubated uniportal thoracoscopic bullectomy using epidnral anaesthesia and sedation without endotracheal intubation. An incision 2 cm in length was made at the 6th intercostal space in the median axillary line. The pleural space was entered by blunt dissection for placement of a soft incision protector. Instruments were then inserted through the incision protector to perform thoracoscopic bullectomy. Data were collected within a minimum follow-up period of 10 months. Results: The average time of surgery was 49.0 rain (range, 33-65 rain). No complications were recorded. The postoperative feeding time was 6 h. The mean postoperative chest tube drainage and hospital stay were 19.3 h and 41.6 h, respectively. The postoperative pain was mild for 30 patients (93.75%) and moderate for two patients (6.25%). No recurrences ofpneumothorax were observed at follow-up. Conclusions: The initial results indicated that nonintubated uniportal video-assisted thoracoscopic operations are not only technically feasible, but may also be a safe and less invasive alternative for select patients in the management of PSP. This is the first report to include the use of a nonintubated uniportal technique in VATS for such a large number of PSP cases. Further work and development of instruments are needed to define the applications and advantages of this technique.
文摘Thoracic Surgery is a continuous evolving specialty. In the past, thoracic surgeons had to make large incisions in order to operate any pathology inside the chest. This often meant big, painful and ugly scars and long recovery times after surgery. But he history of thoracic surgery changed since the begining of video-assisted thoracoscoDic surgery (VATg3
基金Supported by The National Natural Science Foundation of China,No.81800050Natural Science Fund of Yangzhou City,No.YZ2017119Science and Technology Innovation Cultivation Program of Yangzhou University,No.2017CXJ122
文摘BACKGROUND Situs inversus totalis(SIT)is a rare congenital condition that is characterized by a complete mirror image of the typical arrangement of the thoracic and abdominal viscera.Performing thoracoscopic segmentectomy for a patient with lung cancer and SIT is an extremely skilled and challenging surgical procedure.CASE SUMMARY A 41-year old woman with a medical history of dextrocardia since childhood was admitted to our hospital with a mixed ground-glass opacity(mGGO)in her left lung field,discovered by computed tomography during her health checkup.In order to facilitate surgical orientation,three-dimensional computed tomography bronchography and angiography(3D-CTBA)was preoperatively carried out.The result of 3D-CTBA was consistent with the diagnosis of SIT and an mGGO in the posterior segment of the left upper lobe(LS2).Surgery was conducted in accordance with preoperative 3D-CTBA and designed surgical procedure,combined with intraoperative navigation.Final pathological examination revealed in situ adenocarcinoma.The patient’s postoperative condition was uneventful and no complications were observed.CONCLUSION We present the first case of lung cancer in a patient with SIT who successfully underwent thoracoscopic segmentectomy assisted by 3D-CTBA.This is a new technique that covers precise confirmation and dissection of targeted structures and intersegmental demarcation,and can help achieve a meticulous anatomical segmentectomy.
文摘We aimed to describe a method for repositioning of right middle lobar torsion by using a 3-cm uniportal video-assisted thoracoscopic surgery(VATS) approach. Middle lobe torsion occurred after right upper and lower lobectomy in a 74-year-old man. Immediate re-exploratory thoracotomy using the 3-cm uniportal VATS approach was performed. The torsion was corrected, and the lobe was anchored to the anterior chest wall with Prolene stitches. The patient recovered well postoperatively with daily improvements in chest radiographic findings. Follow-up examination was performed using fiberbronchoscopy, which revealed an unobstructed right middle lobe bronchus and sticky yellow sputum. Follow-up chest computed tomography was performed 3 months after the primary surgery and revealed increased expansion of the right middle lobe. We repositioned the right middle lobe successfully by using the 3-cm uniportal VATS approach, but more cases are needed to confirm the feasibility of the approach. Lobectomy remains the primary treatment option for such cases.
文摘BACKGROUND Mediastinal mature teratoma is the most common histological type of primary extragonadal germ cell tumor.In this report,we describe a rare case of giant mature teratoma located primarily in the anterior mediastinum and causing partial atelectasis of the upper and middle lobes of the right lung,as well as extrinsic compression of the right atrium.CASE SUMMARY A 31-year-old male with a giant mediastinal mature teratoma presented with progressive exertional dyspnea and chest pain for 1 mo.Computed tomography of the chest indicated the diagnosis of anterior mediastinal teratoma.The patient underwent right uniportal anterior approach video-assisted thoracoscopic surgery(VATS).En bloc resection of the giant teratoma,wedge resection of the upper and middle lobes of the right lung,resection of the thymus and partial excision of the pericardium were successfully performed.The pathological diagnosis revealed a mature cystic teratoma with foreign-body reaction that was closely related to the right lung,atrium dextrum,superior vena cava and ascending aorta.An atrophic thymic tissue was also discovered at the external teratoma surface.The patient was discharged on postoperative day 7.CONCLUSION This is the first report of the use of uniportal VATS for complete resection of a teratoma in combination with wedge resection of the right upper and middle lung lobes and partial resection of the pericardium.
文摘BACKGROUND Esophageal liposarcoma is a rare malignant tumor and an esophageal dedifferentiated liposarcoma(DDL)is extremely rare.There are no reports on the treatment of DDL by thoracoscopic surgery.CASE SUMMARY A 38-year-old woman presented with dysphagia and dyspnea.Imaging examination showed a large mass in the posterior mediastinum.The patient also developed respiratory failure and it was unclear whether this was caused by a mass from inside or outside the esophagus.We decided to perform thoracoscopic exploration to relieve the obstruction caused by tracheal compression.The upper segment of the esophagus was split longitudinally,and most of the mass could be removed from the esophageal lumen to the thoracic cavity.The pedicle was excised by linear cutting closers under mirrors.Little residual mass was visualized by gastroscopy.The mucous and muscular layers were closed by interrupted sutures.Pathological examination showed that the mass was a DDL.The patient did not have any dysphagia or dyspnea 2 wk postoperatively and refused any further treatment.Computed tomography and esophagoscopy did not find any recurrence at up to 20 mo postoperatively.CONCLUSION Thoracoscopy can be used to treat large esophageal masses.
基金The 13th Five-Year Key Project for Traditional Chinese Medicine of Zhejiang Province,No.2A11951.
文摘BACKGROUND Pericardial rupture caused by blunt chest trauma is rare in clinical practice.Because of its atypical clinical symptoms,and because surgeons are often unfamiliar with the clinical and radiological manifestations of the injury,preoperative diagnosis is difficult;it is easily misdiagnosed and causes serious consequences.CASE SUMMARY A 60-year-old man,previously healthy,was transported to the emergency room after falling from a great height.Upon arrival,his vital signs were stable.Electrocardiography and echocardiography were performed,and there was no sign of cardiac injury or ischemia.Chest and abdomen computerized tomography revealed pneumopericardium,hemopneumothorax,lung contusion,multiple rib fractures on the right side(Figure 1),and right scapula and clavicle fractures.He was admitted to the inpatient department for further observation after tube thoracostomy.The next day,the patient suddenly experienced rapid arrhythmia(the ventricular rate reached 150-180 beats/min)when turning onto his right side,accompanied by a blood pressure drop to 70/45 mm Hg and a chief complaint of palpitation.Thoracoscopy was performed urgently,and a large vertical tear(8 cm×6 cm)was found in the pericardium.The defect was successfully repaired using a heart Dacron patch.His postoperative condition was uneventful without any fluctuations in vital signs,and he was transferred to the orthopedics department for further surgery on postoperative day 8.CONCLUSION Although the possibility of pericardial rupture combined with cardiac hernia is extremely low,it is one of the causes of cardiogenic shock following blunt trauma.Therefore,clinicians need to be more familiar with its characteristic manifestations and maintain a high degree of vigilance against such injuries to avoid disastrous consequences.
基金Science and Technology Development Plan Project of Jilin Province,China,No.JJKH20201060KJ.
文摘BACKGROUND Azygos vein aneurysms are extremely rare,and their pathogenesis is not clear.The overwhelming majority of patients have no obvious clinical symptoms and are found to have the disease by physical examination or by chance.There are few reports on the diagnosis of and treatment strategy for this disease.Moreover,the choice of therapeutic schedule and the treatment window are controversial.CASE SUMMARY We report a case of azygos vein arch aneurysm in a 53-year-old woman.The patient had symptoms of back pain,chest tightness,and choking.Enhanced chest computed tomography showed a soft-tissue mass in the right posterior mediastinum,which was connected to the superior vena cava.The enhancement degree in the venous phase was the same as that of the superior vena cava.The patient received video-assisted thoracoscopic surgery.After the operation,her back pain disappeared,and her dysphagia and chest tightness were also significantly relieved.The postoperative pathology confirmed hemangioma.The patient was discharged on the seventh day after surgery without any complications.CONCLUSION Some patients with hemangioma of the azygos vein arch may experience dysphagia and chest tightness caused by the tumor compressing the esophagus and trachea.Enhanced computed tomography scanning is vital for the diagnosis of azygos vein aneurysms.In addition,despite the difficulty and risk of surgery,thoracoscopic surgery for azygos vein aneurysms is completely feasible.
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.
基金Projects of Natural Science Foundation of China No:81373941.
文摘Objective:To study the differences in the body pain and trauma degree between uniportal and three-portal video-assisted thoracoscopic surgery for the treatment of lung cancer.Methods:A total of 108 patients with non-small cell lung cancer who received radical operation in our hospital between February 2013 and February 2016 were selected and divided into the uniportal group (n=52) who received uniportal video-assisted thoracoscopic surgery and the three-portal group (n=56) who received three-portal video-assisted thoracoscopic surgery after the operation methods and related laboratory results were reviewed. Before operation and 24 h after operation, the differences in serum levels of pain mediators, oxidative stress indexes and inflammation indexes were compared between the two groups of patients.Results: Before operation, the differences in serum levels of pain mediators, oxidative stress indexes and inflammation indexes were not statistically significant between the two groups of patients. 24 h after operation, serum pain mediators NE, DA and 5-HT levels of observation group were lower than those of control group;oxidative stress indexes MDA and O2- levels were lower than those of control group while SOD and GSH-Px levels were higher than those of control group;inflammation indexes IL-6, IL-8, CRP and TNF-α levels were lower than those of control group.Conclusion: Uniportal video-assisted thoracoscopic surgery for the treatment of lung cancer causes less surgery trauma, and patients' postoperative pain and systemic inflammatory stress response are lighter.
文摘Thanks to the recent improvements in video-assisted thoracoscopic techniques (VATS) and anesthetic procedures, a great deal of complex lung resections can be performed avoiding open surgery. The experience gained through VATS techniques, enhancement of the surgical instruments ,improvement of high definition cameras and avoidance of intubated general anesthesia have been the greatest advances to minimize the trauma to the patient. Uniportal VATS for major resections has become a revolution in the treatment of lung pathologies since initially described 4 years ago. The huge number of surgical videos posted on specialized websites, live surgery events and experimental courses has contributed to the rapid learning of uniportal major thoracoscopic surgery during the last years. The future of the thoracic surgery is based on evolution of surgical procedures and anesthetic techniques to try to reduce the trauma to the patient. Further development of new technologies probably will focus on sealing devices for all vessels and fissure, refined staplers and instruments, improvements in 3D systems or wireless cameras, and robotic surgery. As thoracoscopic techniques continue to evolve exponentially, we can see the emergence of new approaches in the anesthetical and the perioperative management of these patients. Advances in anesthesia include lobectomies performed without the employment of general anesthesia, through maintaining spontaneous ventilation, and with minimally sedated patients. Uniportal VATS resections under spontaneous ventilation probably represent the least invasive approach to operate lung cancer.
文摘Hypoxemia after general anesthesia is not uncommon.For patients after thoracotomy,the differential diagnosis is usually difficult.Surgical,anesthetic,and patient-associated factors may contribute to postoperative hypoxemia.We described two patients who underwent videassisted thoracoscopic thymectomy and developed hypoxemia immediately after extubation.Phrenic nerve injury was suspected in both patients.One case recovered spontaneously without intervention.The second case who had been demonstrated as bilateral phrenic nerve injury after the operation was continuously on ventilator after physical therapy and respiratory training for 2 months.
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BACKGROUND Tension pneumothorax of the contralateral lung during single-lung ventilation(SLV)combined with artificial pneumothorax can cause cardiac arrest due to bilateral pneumothorax.If not rapidly diagnosed and managed,this condition can lead to sudden death.We describe the emergency handling procedures and rapid diagnostic methods for this critical emergency situation.CASE SUMMARY We report a case of bilateral pneumothorax in a neonatal patient who underwent thoracoscopic esophageal atresia and tracheoesophageal fistula repair under the combined application of SLV and artificial pneumothorax.The patient suffered sudden cardiac arrest and received emergency treatment to revive her.The recognition of dangerous vital sign parameters,rapid evacuation of the artificial pneumothorax,and initiation of lateral position cardiopulmonary resuscitation while simultaneously removing the endotracheal tube to the main airway are critically important.Moreover,even though the sinus rhythm was restored,the patient’s continued tachycardia,reduced pulse pressure,and depressed pulse oximeter waveform were worrisome.We should highly suspect the possibility of pneumothorax and use rapid diagnostic methods to make judgment calls.Sometimes thoracoscopy can be used for rapid examination;if the mediastinum is observed to be shifted to the right,it may indicate tension pneumothorax.This condition can be immediately relieved by needle thoracentesis,ultimately allowing the safe completion of the surgical procedure.CONCLUSION Bilateral pneumothorax during SLV combined with artificial pneumothorax is rare but can occur at any time in neonatal thoracoscopic surgery.Therefore,anesthesiologists should consider this possibility,be alert,and address this rare but critical complication in a timely manner.
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.