Uniportal video-assisted thoracoscopic fissureless right upper lobe anterior segmentectomy for inflammatory myofibroblastic tumor:A case report

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.

Surgical approaches for stage Ⅰ and Ⅱ thymoma-associated myasthenia gravis:feasibility of complete video-assisted thoracoscopic surgery (VATS) thymectomy in comparison with trans-sternal resection

Complete resection could be achieved in virtually all myasthenic patients with Masaoka stage I and II thymoma us- ing the trans-sternal technique. Whether this is appropriate for minimally invasive approach is not yet clear. We evalu- ated the feasibility of complete video-assisted thoracoscopic surgery （VATS） thymectomy for the treatment of Ma- saoka stage I and Ⅱ thymoma-associated myasthenia gravis, compared to conventional trans-sternal thymectomy. We summarized 33 patients with Masaoka stage I and II thymoma-associated myasthenia gravis between April 2006 and September 2011. Of these, 15 patients underwent right-sided complete VATS （the VATS group） by us- ing adjuvant pneuomomediastinum, comparing with 18 patients using the trans-sternal approach （the T3b group）. No intraoperative death was found and no VATS case required conversion to median sternotomy. Significant differences between the two groups regarding duration of surgery and volume of intraoperative blood loss （P = 0.001 and P 〈 0.001, respectively） were observed. Postoperative morbidities were 26.7% and 33.3% for the VATS and T3b groups, respectively. All 33 patients were followed up for 12 to 61 months in the study. The cumulative probabilities of reaching complete stable remission and effective rate were 26.7% （4/15） and 93.3% （14/15） in the VATS group, which had a significantly higher complete stable remission and effective rate than those in the T3b group （P = 0.026 and P = 0.000, respectively）. We conclude that VATS thymectomy utilizing adjuvant pneuomo- mediastinum for the treatment of stage I and II thymoma-associated myasthenia gravis is technically feasible but deserves further investigation in a large series with long-term follow-up.

Nonintubated uniportal video-assisted thoracoscopic surgery for 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.

Safety and feasibility of video-assisted thoracoscopic surgery for stage IIIA lung cancer

Objective： The current study was prospectively designed to explore the application of video-assisted thoracoscopic surgery （VATS） radical treatment for patients with stage ⅢA lung cancer, with the primary endpoints being the safety and feasibility of this operation and the second endpoints being the survival and complications after the surgery. Methods： A total of 51 patients with radiologically or mediastinoscopically confirmed stage ⅢA lung cancer underwent VATS radical treatment, during which the standard pulmonary lobectomy and mediastinal lymph node dissection were performed after pre-operative assessment. The operative time, intraoperative blood loss/ complications, postoperative recovery, postoperative complications, and lymph node dissection were recorded and analyzed. This study was regarded as successful if the surgical success rate reached 90% or higher. Results： A total of 51 patients with non-small cell lung cancer （NSCLC） were enrolled in this study from March 2009 to February 2010. The median post-operative follow-up duration was 50.5 months. Of these 51 patients, 41 （80.4%） had N2 lymph node metastases. All patients underwent the thoracoscopic surgeries, among whom 50 （98%） received pulmonary lobectomy and mediastinal lymph node dissection completely under the thoracoscope, 6 had their incisions extended to about 6 cm due to larger tumor sizes, and 1 had his surgery performed using a 12 cm small incision for handling the adhesions between lymph nodes and blood vessels. No patient was converted to conventional open thoracotomy. No perioperative death was noted. One patient received a second surgery on the second post-operative day due to large drainage （〉1,000 mL）, and the postoperative recovery was satisfactory. Up to 45 patients （88.2%） did not suffer from any perioperative complication, and 6 （11.8%） experienced one or more complications. Conclusions： VATS radical treatment is a safe and feasible treatment for stage ⅢA lung cancer.

A single institution experience using the LigaSure vessel sealing system in video-assisted thoracoscopic surgery for primary spontaneous pneumothorax

This study sought to report our 6-year experience with the LigaSure vessel sealing system（LVSS） in videoassisted thoracoscopic surgery（VATS） for primary spontaneous pneumothorax.A series of 180 consecutive patients with primary spontaneous pneumothorax were operated on in our institution from May 2005 to December 2010.Intraoperatively,large lesions（bullae or blebs） with a diameter more than 2 cm were resected by staplers,and the residual lesions were treated by LVSS.LVSS was also used to ablate the apical area when no lesions were found.Conventional apical pleural abrasion was done in all cases.All patients were successfully treated using VATS with minimal perioperative bleeding.The mean operating time was 76 minutes（range,43-160 minutes） for single-side procedures and 169 minutes（range,135-195 minutes） for bilateral procedures,the mean number of applied staples was 1.93 per patient（range,0-8 days）,the duration of drainage was 3.8 days（range,2-15 days）,and the duration of hospital stay was 5.8 days（range,3-16 days）.Postoperative complications included persistent air leak（〉 5 days） in 11 cases（6.1%） and residual pneumothorax in 6（3.3%）.None required reoperation.The mean duration of follow-up was 57 months（range,24-105 months）.Recurrence was seen in three cases（1.7%）,and all underwent another operation thereafter.None of the lesions in the relapse cases received ablation with LVSS in the first operation.LVSS can optimize VATS for primary spontaneous pneumothorax and reduces the use of single-use staples.The method is safe,easy to use,and cost-effective and produces satisfactory results.

Uniportal video-assisted thoracoscopic surgery for complex mediastinal mature teratoma:A case report

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.

Middle lobe torsion after right upper and lower lobectomy:repositioning of lobar torsion using a3-cm uniportal video-assisted thoracoscopic surgery

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.

Comparison of the body pain and trauma degree between uni-portal and three-portal video-assisted thoracoscopic surgery for the treatment of lung cancer

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.

Risk factors for conversion to thoracotomy from video-assisted thoracoscopic surgery of lung cancer

Objectives:Intraoperative conversion to thoracotomy from video-assisted thoracoscopic surgery(VATS)is associated with increased adverse events,which is a major concern.We aim to explore the related risk factors in lung cancer patients.Methods:In our study,the data from 1305 patients who underwent VATS between June 2017 and May 2020 were retrospectively collected,among which 67 patients underwent unexpected conversion to thoracotomy.All patients were divided into Non-conversion Group or Conversion Group according to whether they required a conversion to thoracotomy and the risk factors were explored by univariate and multivariate analyses.Results:The most common cause of conversion was fibrocalcified lymph nodes,found in 33 patients(49.3%).Multivariable logistic regression analysis demonstrates that the independent risk factors for the conversion were age≥65 y(OR=2.696,95%CI:1.487e4.887,p=0.001),tumor size>3 cm(OR=4.527,95%CI:2.490e8.233,p<0.001),and tumor location in the left upper lung(OR=3.809,95%CI:1.737 e5.492,p<0.001).Conclusions:Advanced age,bigger tumor size and tumor at the left upper lobe could lead to conversion.In the early VATS learning cases,surgeons should try to choose patients with lower risk of conversion to thoracotomy.

Phrenic Nerve Injury Is a Differential Diagnosis of Hypoxemia after Video-Assisted Thoracoscopic Thymectomy:2 Cases Report and Literature Review

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.

Long-term survival outcomes of video-assisted thoracic surgery for patients with non-small cell lung cancer

Background： Video-assisted thoracic surgery （VATS） has been shown to be a safe alternative to conventional thoracotomy for patients with non-small cell lung cancer （NSCLC）. However, popularization of this relatively novel technique has been slow, partly due to concerns about its long-term outcomes. The present study aimed to evaluate the long-term survival outcomes of patients with NSCLC after VATS, and to determine the significant prognostic factors on overall survival. Methods： Consecutive patients diagnosed with NSCLC referred to one institution for VATS were identified from a central database. Patients were treated by either complete-VATS or assisted-VATS, as described in previous studies. A number of baseline patient characteristics, clinicopathologic data and treatment-related factors were analyzed as potential prognostic factors on overall survival. Results： Between January 2000 and December 2007, 1,139 patients with NSCLC who underwent VATS and fulfilled a set of predetermined inclusion criteria were included for analysis. The median age of the entire group was 60 years, with 791 male patients （69%）. The median 5-year overall survival for Stage Ⅰ, Ⅱ, Ⅲ and Ⅳ disease according to the recently updated TNM classification system were 72.2%, 47.5%, 29.8% and 28.6%, respectively. Female gender, TNM stage, pT status, and type of resection were found to be significant prognostic factors on multivariate analysis. Conclusions： VATS offers a viable alternative to conventional open thoracotomy for selected patients with clinically resectableNSCLC

胸腔镜辅助单孔与多孔肺段切除术治疗早期NSCLC的应用价值

目的探讨胸腔镜下单孔与多孔肺段切除术对早期非小细胞肺癌(Non-small cell lung cancer,NSCLC)患者代谢反应及心肺耐力的影响。方法选取2017年6月-2022年10月南通市第一人民医院早期NSCLC患者92例,根据简单随机数字表法分为多孔组与单孔组,各46例。单孔组采取胸腔镜单孔肺段切除术,多孔组采取胸腔镜多孔肺段切除术。比较两组围术期情况、术前及术后3 d代谢反应指标[视黄醇结合蛋白(Retinol-binding protein,RBP)、转铁蛋白(Transferrin,TRF)、前白蛋白(Prealbumin,PA)]水平、心肺耐力[6 min步行距离(6 min walking distance,6MWT)、疲劳指数、呼气峰流速(Peak expiratory velocity,PEF)、第1 s用力呼气容积(Forced expiratory volume 1 s,FEV1)]和并发症发生率。结果(1)两组手术时长、淋巴结清扫数目比较,差异无统计学意义(P>0.05),单孔组术中失血量、引流量少于多孔组,引流管放置时间、住院时长短于多孔组,差异有统计学意义(P<0.05)。(2)术后3 d两组PA、TRF、RBP水平较术前下降,但单孔组PA、TRF、RBP水平高于多孔组,差异有统计学意义(P<0.05)。(3)术后3 d两组6MWT、PEF、FEV1较术前降低,疲劳指数较术前增高,但单孔组6MWT、PEF、FEV1高于多孔组,疲劳指数低于多孔组,差异有统计学意义(P<0.05)。(4)单孔组并发症发生率(4.35%)低于多孔组(17.39%),差异有统计学意义(P<0.05)。结论采取胸腔镜单孔及多孔肺段切除术治疗早期NSCLC均可取得良好效果,但单孔术式可减少失血量,对代谢状态及心肺耐力影响较小,利于机体功能及早康复,且可降低并发症发生风险。

单操作孔电视胸腔镜肺癌根治术治疗非小细胞肺癌患者的疗效观察

目的观察单操作孔电视胸腔镜(VATS)肺癌根治术对非小细胞肺癌(NSCLC)血管内皮生长因子受体2(VEGFR2)、胸苷激酶1(TK1)水平的影响。方法我院收治的245例NSCLC患者,按手术方式分为对照组(三孔胸腔镜肺癌根治术,n=115)和观察组(单操作孔VATS肺癌根治术,n=130),比较两组围术期指标、视觉模拟(VAS)评分、肺功能、炎性因子、肿瘤标志物、VEGFR2、TK1水平及并发症。结果观察组术中出血量较对照组少(P<0.05);术后,观察组VAS评分、炎性因子、肿瘤标志物和VEGFR2、TK1水平低于对照组,肺功能高于对照组(P<0.05)。结论单操作孔VATS肺癌根治术治疗NSCLC出血量少、疼痛轻,可改善肺功能,降低炎性因子、肿瘤标志物和VEGFR2、TK1水平,且不增加术后并发症,值得临床推广。

单操作孔全胸腔镜与传统开胸二尖瓣置换术的效果比较

目的:比较单操作孔全胸腔镜与传统开胸二尖瓣置换手术的效果。方法:选取2021年4月至2023年2月收治的二尖瓣病变患者97例,按手术方式分为胸腔镜组51例与开胸组46例,比较2组术中创伤及术后恢复情况、围术期甲状旁腺素(PTH)、心肌肌钙蛋白T(cTnT)水平及并发症情况。结果:腔镜组手术时长、体外循环时间、主动脉阻断时间长于开胸组,使用悬浮红细胞及血浆、切口范围小于开胸组(P<0.05);腔镜组使用呼吸机时间、重症监护病房(ICU)停留时间、引流管拔除时间、住院时间短于开胸组,引流量、术后第1 d疼痛视觉模拟评分低于开胸组(P<0.05),2组术后心脏结构与功能指标差异无统计学意义;胸腔镜组体外循环停机即刻PTH、cTnT高于开胸组,2组术后24、48 h上述指标差异无统计学意义;胸腔镜组术后并发症发生率9.80%低于开胸组28.26%,(P<0.05)。结论:单操作孔全胸腔镜二尖瓣置换术创伤小,恢复快,并发症少,疗效确切,安全性与实用性较高。

单孔全胸腔镜解剖性肺段切除术与肺叶切除术治疗非小细胞肺癌的疗效比较

目的比较分析单孔全胸腔镜解剖性肺段切除术与肺叶切除术治疗非小细胞肺癌的疗效。方法回顾性分析2018年6月到2023年6月信阳市中心医院收治的行单孔全胸腔镜解剖性肺段切除术治疗的60例非小细胞肺癌患者(A组)和行单孔全胸腔镜解剖性肺叶切除术治疗的60例非小细胞肺癌患者(B组),比较2组围手术期指标、肺功能指标、炎症指标、并发症发生情况等。结果A组手术时间长于B组,术中出血量、术后12 h引流量、住院时间均低于B组(t=2.272,P=0.025;t=9.660,P<0.001;t=12.703,P<0.001;t=11.706,P<0.001)。A组和B组术后3个月第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、每分钟最大通气量(MVV)均低于术前1 d(P<0.05),且A组术后3个月FVC、FEV1、MVV高于B组(t=5.166,P<0.001;t=4.108,P<0.001;t=5.861,P<0.001)。A组术后1 d、术后3 d肿瘤坏死因子-α(TNF-α)、白介素-1β(IL-1β)、IL-6、C反应蛋白(CRP)均低于B组,A组和B组术后3 d TNF-α、IL-1β、IL-6、CRP均低于术后1 d(P均<0.05)。A组并发症总发生率低于B组(χ^(2)=0.901,P=0.343)。结论单孔全胸腔镜解剖性肺段切除术与肺叶切除术治疗非小细胞肺癌均有较好的预后,并发症发生风险小,且单孔全胸腔镜解剖性肺段切除术对患者肺功能影响更小,炎症反应更轻,术后恢复更快。

细节护理在单操作孔全胸腔镜下肺癌手术患者中的效果

目的:分析细节护理在单操作孔全胸腔镜下肺癌手术患者中的效果。方法:选取2021年11月—2022年11月滨州医学院附属医院收治的拟行单操作孔全胸腔镜手术的肺癌患者100例为研究对象,根据随机数表法分为对照组和观察组,各50例。对照组采取一般护理,观察组在对照组的基础上采取细节护理。比较两组恢复指标、护理满意度、术后并发症发生率、生活质量评分。结果:观察组术后下床活动时间、拔管时间、术后首次排气时间、住院时间短于对照组,差异有统计学意义(P<0.001)。观察组护理满意度高于对照组,差异有统计学意义(P=0.021)。观察组术后并发症发生率低于对照组,差异有统计学意义(P=0.035)。护理前,两组躯体功能、情感功能、角色功能、物质生活评分比较,差异无统计学意义(P>0.05);护理后,两组躯体功能、情感功能、角色功能、物质生活评分高于干预前,观察组高于对照组,差异有统计学意义(P<0.05)。结论:细节护理可促进单操作孔全胸腔镜下肺癌手术患者尽快恢复,缩短术后恢复时间,提高护理满意度与生活质量,减少并发症。

Completely video-assisted thoracoscopic lobectomy versus open lobectomy for non-small cell lung cancer greater than 5 cm：a retrospective study

Background Completely video-assisted thoracoscopic Iobectomy is a reasonable treatment for early-stage non-small-cell lung cancer （NSCLC）.At present,the indication for this procedure is stage la and Ib peripheral lung cancer （（〈-）5 cm）; however,for larger tumors,it remains controversial whether this surgical technique is comparable to open Iobectomy.This study aimed to evaluate the safety,completeness,and efficacy of thoracoscopic Iobectomy,and to compare this technique with open Iobectomy for the treatment of non-small-cell lung cancer when the tumor＇s diameter was greater than 5 cm.Methods From May 2001 to April 2011,802 patients underwent a Iobectomy for treatment of non-small-cell lung cancer at our center.In 133 patients,the tumor was 〉 5 cm.There were 98 men and 35 women,median age 63 years （range：29-81 years）.We divided the patients into two groups,group V （completely video-assisted thoracoscopic surgery）,and group T （open Iobectomy）,and evaluated the two groups for age,gender,tumor size,pathological type,location,duration of surgery,blood loss,lymph node dissection,pathological stage,time of drainage,hospitalization,complications,overall survival and recurrence.Results There were 46 cases in group V and 87 cases in group T.Age,gender,tumor size,location,pathological type and stage were similar between the two groups.Group V had shorter operative duration （（186.5±62.8） minutes vs.（256.7±67.5） minutes,P 〈0.001） and reduced bleeding （（218.5±174.6） ml vs.（556.9±187.2） ml,P 〈0.001）.There were no significant differences between the two groups in complications,lymph node dissection,time of drainage and hospitalization.The recurrence between the two groups was equivalent （2.4% vs.3.8%,P=0.670）.The overall survival at 1,2 and 3 years was 95.1%,81.6% and 69.6% for group V and 88.3%,78.8% and 64.0% for group T.Kaplan-Meier survival curves showed that there was no significant differences between the two groups （P=0.129）.Conclusions Completely video-assisted thoracoscopic lobectomy was similar to open lobectomy in safety,completeness,and efficacy,but had a shorter operative duration,and reduced bleeding.This is a minimally invasive procedure that is feasible for a subset of non-small-cell lung cancer patients with tumor size 〉 5 cm.

Comparative study of video-assisted thoracoscopic surgery ablation and radiofrequency catheter ablation on treating paroxysmal atrial fibrillation： a randomized, controlled short-term trial

Background It is unclear whether the effect of video-assisted thoracoscopic surgery ablation is better than catheter ablation on paroxysmal atrial fibrillation （PAF） or not. This study aimed to compare the effects of catheter ablation and video-assisted thoracoscopic surgery ablation on PAF. Methods From March 2008 to March 2012, 138 consecutive patients with PAF were randomly assigned to receive either video-assisted thorecoscopic surgery ablation （thoracoscopy group, n=66） or the traditional catheter ablation （catheter group, n=72）. Results No patient died during the study and all were successfully followed and included in analysis. There were no significant differences in clinical and echocardiographic characteristics between the two groups. All patients were evaluated at 1 week, 1 month, 3 months, 6 months, and 12 months after discharge by physical examination and related laboratory tests. Preoperative left atrium dimensions （LADs） of the recurrent AF were （47±4） mm in the thoracoscopy group and （46±8） mm in the catheter group, whereas the LADs were （40±5） and （39±9） mm, respectively, in non-recurrent PAF. Conclusions The short-term outcome of video-assisted thoracoscopic surgery ablation is safe and effective; and the indications are wider than those for catheter ablation. The larger left atrium diameter is related to the recurrence of atrial fibrillation. Chin Med J 2014;127 （14）： 2567-2570

Lobectomy by video-assisted thoracoscopic surgery(VATS)for early stage of non-small cell lung cancer

Video-assisted thoracoscopic surgery(VATS)provides a new approach for treating early-stage lung cancer.Lobectomy by VATS has many advantages over conventional thoracotomy,such as shorter recovery time,less postoperative pain,and faster resumption of a normal lifestyle.However,there is still much debate on the role of VATS in lobectomy for the treatment of lung cancer.Concerns regarding safety,the extent of mediastinal lymph node dissection,and long-term survival have made some surgeons apprehensive of its validity for lung cancer.In this paper,we review the development of thoracoscopy,the present status of VATS for early stage of non-small cell lung cancer(NSCLC),and comparison between VATS and open thoracotomy in the management of NSCLC.

CT引导硬化剂与体表定位联合单孔胸腔镜下解剖性肺部分切除术治疗非小细胞肺癌的效果

目的:研究CT引导硬化剂与体表定位联合单孔胸腔镜下解剖性肺部分切除术治疗非小细胞肺癌(NSCLC)患者的临床效果。方法:选取2019年3月—2021年12月在我院治疗的NSCLC患者202例,根据患者住院病历号末尾奇偶数分为观察组(n=110)和对照组(n=92)。两组患者均给予单孔胸腔镜下解剖性楔形切除术,其中观察组应用CT引导硬化剂与体表定位。观察两组手术时间、术中出血量等指标,以及手术前后肺功能、肿瘤标志物及预后情况。结果:观察组手术时间、术中出血量、术后引流量分别为(154.31±34.45)min、(270.50±40.06)mL和(410.50±91.14)mL,明显少于对照组(P<0.05),胸腔置管引流时间为(5.60±1.09)d,明显短于对照组(P<0.05)。观察组一次性定位成功率为98.18%,明显高于对照组的88.04%(P<0.05)。观察组术后1个月最大通气量(MVV)、峰值呼气流速(PEF)、第一秒用力呼气容积(FEV1)和用力肺活量(FVC)分别为(77.79±8.16)L、(58.87±6.03)L/min、(1.81±0.44)L和(2.60±0.81)L,明显高于对照组(P<0.05)。观察组和对照组术后1个月细胞角蛋白19的可溶性片段(CYFRA21-1)、癌胚抗原(CEA)、糖类抗原199(CA199)和鳞状细胞癌抗原(SCC)比较,差异无统计学意义(P<0.05)。观察组和对照组术后1个月QLQ-C43量表各项目评分比较,差异无统计学意义(P>0.05)。观察组和对照组中位无病生存期、总生存期差异比较,差异无统计学意义(P>0.05)。结论:CT引导硬化剂与体表定位联合单孔胸腔镜下解剖性肺部分切除术对NSCLC患者肺功能损伤轻,对患者预后无明显影响。