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Effect of endobronchial blocker tube in the pulmonary carcinoma with video-assisted thoracic surgery 被引量:1
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作者 Lairong Sun Lianbing Gu +2 位作者 Bihui Ren Ninglei Qju Lijun Wang 《The Chinese-German Journal of Clinical Oncology》 CAS 2011年第4期198-201,共4页
Objective:The aim of this study was to observe the effect of endobronchial blocker tube in the pulmonary carcinoma with video-assisted thoracic surgery.Methods:Forty patients of pulmonary carcinoma with video-assisted... Objective:The aim of this study was to observe the effect of endobronchial blocker tube in the pulmonary carcinoma with video-assisted thoracic surgery.Methods:Forty patients of pulmonary carcinoma with video-assisted thoracic surgery were randomly assigned into two groups with twenty cases each:endobronchial blocker tube group(group 1) and double-lumen endobronchial tube group(group 2).After anesthesia was induced,in group 1,single lumen tube was intubated at first,and then endobronchial blocker tube intubated to left or right primary bronchus under the guidance of fiber-optic bronchoscope according to operational necessary,injected 2-4 mL air to blocker balloon and blocker one lateral primary bronchus for one-lung ventilation necessarily;while in group 2,the position of double-lumen endobronchial tube was confirmed with fiber-optic bronchoscope after intubation.Blood samples were collected before anesthesia induction,double lumen ventilation,at the one-lung ventilation of 5 min,30 min,60 min,120 min and 180 min,SBP,DBP,HR,SpO2,partial pressure of end tidal carbon dioxide(PetCO2),pH,PaO2,PaCO2,PaO2/FiO2 were recorded.Results:Forty cases' intubations were all successful.There were no differences in SBP,DBP,HR,SpO2,PetCO2,pH,PaCO2 between two groups in different points(P > 0.05).Paw in group 1 was lower than group 2,PaO2 and PaO2/FiO2 in group 1 was higher than group 2 in the one lung ventilation of 5 min,30 min,60 min,120 min and 180 min.Conclusion:The endobronchial blocker tube can meet the request of video-assisted thoracic surgery,with the special advantages of simple insertion,lower airway and better oxygenation.Endobronchial blocker tube offer a new way for one-lung ventilation in the pulmonary carcinoma with video-assisted thoracic surgery. 展开更多
关键词 mechanical ventilation video assisted thoracic surgery blood gas analysis airway pressure
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Partial removal of the pulmonary artery in video-assisted thoracic surgery for non-small cell lung cancer 被引量:2
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作者 Keping Xu Zhi Zhang +3 位作者 Jianqiang Zhao Jianfeng Huang Rong Yin Lin Xu 《The Journal of Biomedical Research》 CAS 2013年第4期310-317,共8页
Lobectomy with partial removal of the pulmonary artery in video-assisted thoracic surgery (VATS) currently remains a challenge for thoracic surgeons. We were interested in introducing pulmonary vessel blocking techn... Lobectomy with partial removal of the pulmonary artery in video-assisted thoracic surgery (VATS) currently remains a challenge for thoracic surgeons. We were interested in introducing pulmonary vessel blocking techniques in open thoracic surgery into video-assisted thoracic surgery (VATS) procedures. In this study, we reported a surgical technique simultaneously blocking the pulmonary artery and the pulmonary vein for partial removal of the pulmonary artery under VATS. Seven patients with non-small-cell lung cancer (NSCLC) received lobectomy with partial removal of the pulmonary artery using the technique between December 2007 and March 2012. Briefly, rather than using a small clamp on the distal pulmonary artery to the area of invading cancer, we replaced a vascular clamp with a ribbon and Hem-o-lock clip to block the preserved pulmonary veins so as to prevent back bleeding and yield a better view for surgeons. The mean occlusion time of the pulmonary artery and pulmonary veins were 44.0±10.0 and 41.3±9.7 minutes, respectively. The mean repair time of the pulmonary artery was 25.3±13.7 minutes. No complications occurred. No patients showed abnormal blood flow through the reconstructed vessel. There were no local recurrences on the pulmonary artery. In conclusion, the technique for blocking the pulmonary artery and veins is feasible and safe in VATS and reduces the risk of abrupt intraoperative bleeding and the chance of converting to open thoracotomy, and extends the indications of VATS lobectomy. 展开更多
关键词 video-assisted thoracic surgery (VATS) non-small-cell lung cancer (NSCLC) LOBECTOMY pulmonary artery reconstruction
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Case Report:Pulmonary actinomycosis:a case undergoing resection through video-assisted thoracic surgery (VATS) 被引量:1
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作者 LIN Ming-shian LIN Wea-lung +2 位作者 LUH Shi-ping TSAO Thomas Chang-yao WU Tzu-ching 《Journal of Zhejiang University-Science B(Biomedicine & Biotechnology)》 SCIE CAS CSCD 2007年第10期721-724,共4页
Actinomycosis is an uncommon disease, which is usually manifested as cervicofacial infection; related to poor oral hygiene or compromised immune function. Pulmonary actinomycosis is rare, but its diagnosis is changing... Actinomycosis is an uncommon disease, which is usually manifested as cervicofacial infection; related to poor oral hygiene or compromised immune function. Pulmonary actinomycosis is rare, but its diagnosis is changing due to its variable presentation; the similarity in appearance to other intrapulmonary diseases. Here we report an 80-year-old man with a solitary pulmonary nodule over the left upper lobe. Pulmonary neoplasm was highly suspected in this patient; thus resection of the mass was undertaken through video-assisted thoracic surgery (VATS). Histopathological examination demonstrated this patient had an Actinomyeces infection. While the application of VATS in patients with pulmonary actinomycosis has rarely been reported in literature, we conclude that VATS is valuable for the diagnosis; treatment of patients with undetermined pulmonary nodule(s). 展开更多
关键词 Pulmonary actinomycosis videoassisted thoracic surgery (VATS) RESECTION
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Video-Assisted Thoracic Surgery as a Less-Invasive Management for Acute Hemothorax in Blunt Trauma 被引量:1
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作者 Yoshihiko Kurimoto Atsushi Watanabe +5 位作者 Tetsuya Koyanagi Toshiro Ito Tetsuya Higami Kunihiko Maekawa Katsutoshi Tanno Yasufumi Asai 《Surgical Science》 2012年第3期136-140,共5页
Purpose: We report our experience of Video-assisted thoracic surgery (VATS) to treat acute blunt traumatic hemothorax using mini-thoracotomy. Methods: We designed a prospective study to determine if VATS with mini-tho... Purpose: We report our experience of Video-assisted thoracic surgery (VATS) to treat acute blunt traumatic hemothorax using mini-thoracotomy. Methods: We designed a prospective study to determine if VATS with mini-thoracotomy benefits for patients with blunt traumatic hemothorax compared with conventional repair through full thoracotomy. Twenty-five patients underwent emergency operation for acute hemothorax from 2000. Five patients with less than 5% probability of survival (PS) were excluded, leaving 20 as the subjects. Results: Ten patients underwent conventional thoracotomy (conventional group) and the other 10 patients underwent VATS with mini-thoracotomy (VATS group). There was no difference between conventional group and VATS group in injury severity score (29.1 and 27.0) or PS (81.2% and 80.7%). Hospital mortality rates were 10% in conventional group and 0% in VATS group (N.S). Total amounts of intra-operative bleeding and post-operative transfusion until day 7 were 735 ml and 19.3 units in conventional group and 303 ml and 9.2 units in VATS group respectively (N.S). The length of ICU stay was 9.7 days in conventional group and 5.9 days in VATS group (N.S). Conclusion: VATS with mini-thoracotomy can be alternative for patients with blunt traumatic hemothorax in most emergency operations. 展开更多
关键词 HEMOTHORAX TRAUMA video-assisted thoracic surgery Emergency surgery Critical Care
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Video-Assisted Thoracic Surgery for Residual Aneurysm after Total Arch Replacement
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作者 Kayo Sugiyama Hirotaka Watanuki +5 位作者 Yasuhiro Futamura Masaho Okada Hiroki Numanami Masayuki Yamaji Satoshi Makino Katsuhiko Matsuyama 《Open Journal of Thoracic Surgery》 2021年第1期25-30,共6页
<strong>Background</strong>: Residual aneurysms after graft replacement are rare, but they can be detrimental if they are saccular and large. The etiology of residual aneurysms remains unknown, and their m... <strong>Background</strong>: Residual aneurysms after graft replacement are rare, but they can be detrimental if they are saccular and large. The etiology of residual aneurysms remains unknown, and their management is controversial. One treatment option is late open surgical conversion;however, postoperative respiratory complications resulting from the dissection of pleural adhesions, which is frequently necessary with this approach, are often unavoidable. <strong>Case presentation</strong>: Herein, we report a case of open surgical repair of a residual distal aortic arch aneurysm that occurred after total arch replacement and thoracic endovascular aortic repair. Contrast-enhanced magnetic resonance imaging was not possible in this case due to the patient’s severe renal dysfunction;however, contrast-enhanced computed tomography using minimal contrast did not detect remarkable leakage through the graft or stent graft into the aneurysm. Late open surgical conversion using video-assisted thoracic surgery was performed by thoracic surgeons, and the adhesion between the aortic wall and the lung was safely and effectively dissected. Because there was no significant pulsation or evidence of feeding arteries in the aortic wall, the aortic wall was opened carefully. No bleeding or backflow from any branch arteries into the aneurysm was noted, so the aortic wall was ligated with continuous sutures. The patient recovered without experiencing any major complications. <strong>Conclusions</strong>: This case report demonstrates that video-assisted thoracic surgery is safe and effective for late open conversion in cases of residual aneurysm;furthermore, this case suggests that video-assisted thoracic surgery may be particularly beneficial for the dissection of adhesions between the aortic wall and lung in these cases. 展开更多
关键词 Late Open Surgical Conversion Total Arch Replacement video-assisted thoracic surgery
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Uniportal Video-Assisted Thoracoscopic Surgery and Outcomes for Recurrent Primary Spontaneous Pneumothorax: Single-Institution Experience 被引量:2
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作者 Iskander Al-Githmi 《Surgical Science》 2018年第3期122-127,共6页
Introduction: Primary spontaneous pneumothorax is relatively common condition in young adults. Uniportal video-assisted thoracoscopic surgery (uniportal VATS) has been accepted as a less invasive technique for the tre... Introduction: Primary spontaneous pneumothorax is relatively common condition in young adults. Uniportal video-assisted thoracoscopic surgery (uniportal VATS) has been accepted as a less invasive technique for the treatment of primary spontaneous pneumothorax. Strong evidence suggests that Uniportal VATS procedures are technically feasible and safe with excellent outcomes comparable to conventional VATS approach. Objectives: This article aims to discuss our experience with uniportal thoracoscopic approach as a valuable option in patients with recurrent spontaneous pneumothorax. Study Design: A retrospective study analysis between January 2014 and December 2016. Materials and Methods: From January 2014 to December 2016, 22 consecutive patients with unilateral recurrent spontaneous pneumothorax were to undergo uniportal video-assisted thoracic surgery (uniportal VATS). Their chronic residual postoperative pain, hospital stay and recurrence rate were analyzed. Results: Twenty-two patients with unilateral recurrent spontaneous pneumothorax were included;all received uniportal video-assisted thoracic surgery (uniportal VATS) and mechanical pleurodesis. Conclusions: We conclude that uniportal video-assisted thoracic surgery (uniportal VATS) demonstrated benefits to patients with primary spontaneous pneumothorax a safe, effective and also faster recovery, and decreased postoperative pain and short hospital stay. 展开更多
关键词 Primary PNEUMOTHORAX Uniportal video-assisted thoracic surgery
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Video-assisted Thoracoscopic Surgery for the Treatment of Mediastinal Lymph Node Tuberculous Abscesses 被引量:3
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作者 左涛 龚凤云 +2 位作者 陈宝钧 倪正义 张定宇 《Journal of Huazhong University of Science and Technology(Medical Sciences)》 SCIE CAS 2017年第6期849-854,共6页
The mediastinal lymph node tuberculous abscesses(MLNTAs) are secondary to mediastinal tuberculous lymphadenitis. Surgical excision is often required when cold abscesses form. This study was aimed to examine video-as... The mediastinal lymph node tuberculous abscesses(MLNTAs) are secondary to mediastinal tuberculous lymphadenitis. Surgical excision is often required when cold abscesses form. This study was aimed to examine video-assisted thoracoscopic surgery(VATS) for the treatment of MLNTA. Clinical data of 16 MLNTA patients who were treated in our hospital between December 1, 2013 and December 1, 2015 were retrospectively analyzed. All of the patients underwent the radical debridement and drainage of abscesses, and intrathoracic lesions were removed by VATS. They were also administered the intensified anti-tuberculosis treatment(ATT), and engaged in normal physical activity and follow-up for 3 to 6 months. The results showed that VATS was successfully attempted in all of the 16 MLNTA patients and they all had good recovery. Two patients developed complications after surgery, with one patient developing recurrent laryngeal nerve injury, and the other reporting poor wound healing. It was concluded that VATS is easy to perform, and safe, and has high rates of success and relatively few side-effects when used to treat MLNTA. 展开更多
关键词 mediastinal diseases thoracic surgery video-assisted tuberculosis lymph node
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术前运用Hook-wire与医用胶定位行胸腔镜手术切除孤立性肺小结节的效果
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作者 郑伟 闻武 程冠球 《当代医学》 2024年第8期135-138,共4页
目的探讨术前运用Hook-wire与医用胶定位方式行胸腔镜手术(VATS)切除孤立性肺小结节(SPN)的效果。方法选取2020年1月至2022年2月福州市长乐区医院收治的81例行VATS切除SPN的患者作为研究对象,按照随机数字表法分为观察组(n=41)与对照组(... 目的探讨术前运用Hook-wire与医用胶定位方式行胸腔镜手术(VATS)切除孤立性肺小结节(SPN)的效果。方法选取2020年1月至2022年2月福州市长乐区医院收治的81例行VATS切除SPN的患者作为研究对象,按照随机数字表法分为观察组(n=41)与对照组(n=40)。对照组术前予以Hook-wire定位,观察组术前予以医用胶定位,比较两组定位和手术情况、定位相关并发症发生率及病理结果。结果两组定位时间、穿刺深度比较差异无统计学意义;观察组定位成功率高于对照组,术中结节切除时间短于对照组,定位费用少于对照组,差异有统计学意义(P<0.05)。观察组定位相关并发症发生率为24.39%,低于对照组的47.50%,差异有统计学意义(P<0.05)。两组良性、非典型增生、微浸润癌、浸润性癌、原位癌、转移瘤病理结果比较差异无统计学意义。结论对VATS切除SPN术前运用医用胶定位可提高定位成功率,缩短手术时间,节省手术费用,降低定位相关并发症发生率,且不影响病理诊断结果。 展开更多
关键词 孤立性肺小结节 胸腔镜手术 医用胶定位 Hook-wire定位 并发症发生率 病理结果
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菱形肌-肋间肌-低位前锯肌平面阻滞改善胸腔镜下肺癌根治术后早期恢复质量的有效性
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作者 郝倩 代红雨 +2 位作者 李春艳 周红梅 朱志鹏 《中国现代医生》 2024年第8期25-29,共5页
目的验证菱形肌-肋间肌-低位前锯肌平面阻滞对胸腔镜下肺癌根治术患者术后早期恢复质量的改善作用;比较不同阻滞时机改善术后早期恢复质量的差异性。方法选取2022年1月至2023年1月拟行胸腔镜下肺癌根治术患者共75例,年龄18~75岁,美国麻... 目的验证菱形肌-肋间肌-低位前锯肌平面阻滞对胸腔镜下肺癌根治术患者术后早期恢复质量的改善作用;比较不同阻滞时机改善术后早期恢复质量的差异性。方法选取2022年1月至2023年1月拟行胸腔镜下肺癌根治术患者共75例,年龄18~75岁,美国麻醉医师协会(American Society of Anesthesiologists,ASA)Ⅰ~Ⅱ级。随机分为3组:空白对照组(C组)、术前阻滞组(PR组)、术后阻滞组(PO组)。PR组与PO组分别在术前及术后接受超声引导下菱形-肋间-低位前锯肌平面阻滞,药物为0.375%罗哌卡因共30ml。通过术后恢复质量评分量表(postoperative recovery quality rating scale,QoR-40)评价患者术后24h、48h恢复质量;记录术后0.5、1、2、4、8、12、24、48h静息及活动状态数字疼痛评分(numeric rating scale,NRS)疼痛评分;记录术中及术后阿片类药物的消耗量、术后自控静脉镇痛(patient-controlled intravenous analgesia,PCIA)有效按压次数及恶心、呕吐发生率。结果与C组比较,PR组术中阿片类药物消耗量明显减少,PR组及PO组术后24h QoR-40得分更高,术后1~8h静息状态与1~12h活动状态NRS评分明显降低,PCIA有效按压次数及阿片类药物消耗量明显减少(P<0.05);与PR组比较,PO组术中阿片类药物消耗更多,术后0.5hNRS评分更高(P<0.05);术后Qo R-40得分、PCIA有效按压次数、阿片类药物消耗量差异无统计学意义(P>0.05);3组术后恶心、呕吐发生率差异无统计学意义(P>0.05)。结论菱形肌-肋间肌-低位前锯肌平面阻滞能改善胸腔镜下肺癌根治术患者术后早期恢复质量,减轻患者术后疼痛程度,减少围术期阿片类药物用药量,且其有效性与阻滞时机无关。 展开更多
关键词 区域平面阻滞 菱形-肋间-低位前锯肌阻滞 胸腔镜手术 肺癌根治术
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机器人与胸腔镜肺段切除术治疗早期非小细胞肺癌疗效的对比研究 被引量:1
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作者 贾卓奇 王绩钊 +4 位作者 王哲 张勇 吴齐飞 张广健 付军科 《现代肿瘤医学》 CAS 2024年第9期1648-1652,共5页
目的:对比分析达芬奇机器人与胸腔镜肺段切除术治疗早期非小细胞肺癌(non-small cell lung cancer,NSCLC)的临床疗效。方法:回顾性分析2016年06月至2020年12月,于我院胸外科行微创肺段切除术的早期非小细胞肺癌患者,共纳入134例,分为机... 目的:对比分析达芬奇机器人与胸腔镜肺段切除术治疗早期非小细胞肺癌(non-small cell lung cancer,NSCLC)的临床疗效。方法:回顾性分析2016年06月至2020年12月,于我院胸外科行微创肺段切除术的早期非小细胞肺癌患者,共纳入134例,分为机器人组(robot-assisted thoracic surgery,RATS)47例,胸腔镜组(video-assisted thoracic surgery,VATS)87组,对比分析两组临床特征及手术指标、术后主要并发症情况及费用。结果:手术时间、术中出血、平均住院日、术后引流时间等,RATS组优于VATS组,但两组差异无统计学意义(P>0.05)。术后并发症如肺炎、胸腔积液、心律失常、肺不张发生率,两组间差异无统计学意义(P>0.05)。超过5天漏气率RATS组为6.3%,低于VATS组的10.3%,差异有统计学意义(P<0.05)。两组术后NRS疼痛评分差异无统计学意义(P>0.05)。RATS组住院费用明显高于胸腔镜组,差异有统计学意义(P<0.05)。两组1年生存率和2年生存率差异均无统计学意义(P>0.05)。结论:机器人肺段切除术治疗早期非小细胞肺癌安全可行,与胸腔镜相比,术后长期漏气发生较少,值得推广应用。 展开更多
关键词 非小细胞肺癌 达芬奇机器人手术 电视胸腔镜手术 肺段切除术
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Uniportal versus biportal video-assisted thoracoscopic sympathectomy for palmar hyperhidrosis 被引量:15
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作者 CHEN Yong-bing YE Wu YANG Wen-tao SHI Li GUO Xu-feng XU Zhong-hua QIAN Yong-yue 《Chinese Medical Journal》 SCIE CAS CSCD 2009年第13期1525-1528,共4页
Background Video-assisted thoracoscopic sympathectomy had replaced open surgery. The aim of this study was to compare the outcomes of using a single port and two ports to perform video-assisted thoracoscopic sympathec... Background Video-assisted thoracoscopic sympathectomy had replaced open surgery. The aim of this study was to compare the outcomes of using a single port and two ports to perform video-assisted thoracoscopic sympathectomy for palmar hyperhidrosis. Methods Between April 2006 and February 2008, 20 cases underwent video-assisted thoracoscopic sympathectomy through one port (uniportal group) and 25 cases through two ports (biportal group). The variables including the operating time, hospital stay, pain scores, postoperative complications, incidence of symptom recurrence and patient satisfaction were compared. The mean postoperative follow-up period was 11.5 months (range, 3-25 months). Results The hands of all patients were warm and dry after operation. No conversion to open surgery was necessary, and no operative mortality was recorded in either group. The mean inpatient pain scores were significantly higher in the biportal group (1.2±0.6) than that in the uniportal group (0.8±0.5, P=0.025). For the first three weeks after operation, four out of 20 (20%) patients in the uniportal group constantly suffered from mild or moderate residual pain while eight out of 25 (32%) cases in the biportal group (P=0.366). Among them, two cases in the uniportal group and five cases in the biportal group need to take analgesics. Our mean operative time (bilateral sympathectomy) in the uniportal group ((39.5±10.0) minutes) was shorter than that in biportal group ((49.7±10.6) minutes, P=0.02). There were no significant differences between two groups in terms of the mean hospital stay, compensatory sweating, and patient satisfaction. Two patients in the biportal group and three in the uniportal group experienced a unilateral pneumothorax. None of them required chest drainage. No patient experienced Homer's syndrome, and no recurrent symptoms were observed in either groups Conclusions Both uniportal and biportal video-assisted thoracoscopic sympathectomy are effective, safe, and minimally invasive for palmar hyperhidrosis. Comparing with the biportal approach, the uniportal approach causes less postoperative pain and less operative time, and is a more reasonable procedure in treatment of palmar hyperhidrosis. 展开更多
关键词 uniportal HYPERHIDROSIS thoracic surgery video-assisted SYMPATHECTOMY
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不同剂量艾司氯胺酮联合罗哌卡因前锯肌平面阻滞对胸腔镜手术病人术后镇痛的影响 被引量:1
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作者 丁冰 寇清晏 +3 位作者 王艳婷 王羽 李琳 牛泽军 《青岛大学学报(医学版)》 CAS 2024年第2期279-283,共5页
目的评价不同剂量艾司氯胺酮联合罗哌卡因前锯肌平面阻滞(SAPB)对胸腔镜手术病人术后镇痛的影响。方法选择择期行胸腔镜手术病人96例,随机分为单纯罗哌卡因组(A组,SAPB局麻药为5 g/L罗哌卡因30 mL)、0.25 mg/kg艾司氯胺酮组(B组,在5 g/... 目的评价不同剂量艾司氯胺酮联合罗哌卡因前锯肌平面阻滞(SAPB)对胸腔镜手术病人术后镇痛的影响。方法选择择期行胸腔镜手术病人96例,随机分为单纯罗哌卡因组(A组,SAPB局麻药为5 g/L罗哌卡因30 mL)、0.25 mg/kg艾司氯胺酮组(B组,在5 g/L罗哌卡因的基础上加用0.25 mg/kg艾司氯胺酮)、0.50 mg/kg艾司氯胺酮组(C组,在5 g/L罗哌卡因的基础上加用0.50 mg/kg艾司氯胺酮)。记录术后2、6、12、24、48 h时的数字等级评定量表(NRS)评分,术后48 h吗啡用量,术后首次按压静脉自控镇痛(PCIA)装置时间,术后需要PCIA病人比例,术中舒芬太尼的用量及不良反应发生情况。结果与A组相比较,C组术后12、24 h NRS评分均显著降低(H=9.006、8.785,P<0.05),术后48 h吗啡用量减少(H=7.400,P<0.05),首次按压PCIA时间明显延长(P<0.05)。3组需要PCIA病人比例和术中舒芬太尼用量差异无统计学意义(P>0.05)。3组不良反应发生率差异无统计学意义(P>0.05)。结论与单纯应用罗哌卡因相比,0.50 mg/kg艾司氯胺酮联合罗哌卡因SAPB用于胸腔镜手术病人可增强术后镇痛效果,减少术后48 h吗啡用量,延长SAPB镇痛持续时间,且无明显不良反应。 展开更多
关键词 氯胺酮 罗哌卡因 神经肌肉阻滞 胸外科手术 电视辅助 疼痛 手术后
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CT引导下Hook-wire精确定位并微创切除肺结节 被引量:33
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作者 王通 马少华 +4 位作者 闫天生 宋金涛 王可毅 贺未 白洁 《中国肺癌杂志》 CAS CSCD 北大核心 2015年第11期680-685,共6页
背景与目的肺小结节尤其是磨玻璃结节(ground glass opacity,GGO)病灶的定位是微创手术切除的难点,报道的方法很多但均有不足。本研究旨在探讨计算机断层扫描(computed tomography,CT)引导下Hook-wire术前定位在胸腔镜下(video-assisted... 背景与目的肺小结节尤其是磨玻璃结节(ground glass opacity,GGO)病灶的定位是微创手术切除的难点,报道的方法很多但均有不足。本研究旨在探讨计算机断层扫描(computed tomography,CT)引导下Hook-wire术前定位在胸腔镜下(video-assisted thoracoscopic surgery,VATS)肺结节切除术中的临床应用价值,并初步探讨GGOs积极微创手术治疗的必要性和可行性。方法 2013年5月-2015年6月共25例患者的26枚肺结节于术前行CT引导下Hookwire定位,然后施行胸腔镜楔形切除术。统计Hook-wire定位时间、成功率、并发症及楔形切除时间、住院时间等,计算病灶组织学分型中的恶性几率,讨论肺部GGOs积极手术治疗的必要性。结果共25例患者26个结节(男性10例,女性15例,6个实性结节,20个GGOs),病灶直径5 mm-20 mm(平均8 mm),病灶距离胸膜垂直距离5 mm-30mm(平均14 mm),CT引导下Hook-wire定位成功率为100%。VATS楔形切除术成功率为100%。CT定位时间平均10min(5 min-15 min),微创切除病灶所需时间平均20 min(15 min-40 min),平均住院时间为4 d(3 d-6 d)。4例患者定位后发生微量气胸,但无需闭式引流处理。术中定位针脱落1例,但仍于胸腔镜下观察到穿刺点脏层胸膜下血肿后,准确定位并成功切除。20个GGOs术后组织学诊断结果为:16个混合性GGOs(mixed GGO,m GGO)中,微浸润腺癌2例,腺癌5例,小细胞肺癌(small cell lung cancer,SCLC)1例,炎性病灶8例;4个纯GGOs(pure GGO,p GGO)中原位腺癌1例,非典型性腺瘤样增生(atypical adenomatoid hyperplasia,AAH)1例,炎性病灶2例。结论 CT引导下Hook-wire肺结节尤其是GGOs术前定位准确率高,相关并发症轻微,是一种安全、有效的方法,能快速确定下一步诊疗方案,值得临床推广;肺部m GGOs是恶性病灶的几率很大,积极微创手术治疗是非常必要的。 展开更多
关键词 肺磨玻璃样结节 电视胸腔镜手术 CT引导下Hook-wire定位
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胸腔镜下肺段切除术治疗犬肺血管肉瘤
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作者 许一晨 朱晓英 +3 位作者 万建军 吴秀娟 夏炉明 盛文伟 《中国动物检疫》 CAS 2024年第6期115-120,共6页
与传统手术方式相比,内窥镜手术对动物损伤较小,具有术后动物出血量少、疼痛轻、组织黏连少、恢复快等优点,已被广泛应用于国内外兽医临床。然而,胸腔镜手术因难度大、术后并发症多等在我国兽医临床较少实施。本文从病例基本情况、检查... 与传统手术方式相比,内窥镜手术对动物损伤较小,具有术后动物出血量少、疼痛轻、组织黏连少、恢复快等优点,已被广泛应用于国内外兽医临床。然而,胸腔镜手术因难度大、术后并发症多等在我国兽医临床较少实施。本文从病例基本情况、检查、诊断以及手术过程等方面,详细介绍了用胸腔镜成功为一例罹患肺转移性血管肉瘤的10岁金毛犬施行部分肺叶切除术的案例,并且分析了电视胸腔镜手术的设备器械选择、单肺气体插管方法,以及胸腔镜手术需要注意的一些细节,以期为同行开展兽医临床胸腔镜手术提供参考。 展开更多
关键词 肺叶切除术 胸腔镜手术 电视辅助胸腔外科学
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同步法Hook-wire多针定位在多发肺结节胸腔镜切除术中的应用 被引量:14
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作者 李明明 李智 +3 位作者 沈健 毛国才 张帅 倪才方 《介入放射学杂志》 CSCD 北大核心 2020年第11期1136-1139,共4页
目的探讨运用Hook-wire多针同步穿刺同侧肺多发结节进行电视胸腔镜手术(videoassisted thoracic surgery,VATS)前定位的安全性和可行性。方法回顾性分析2016年4月至2020年6月使用同步法Hook-wire多针穿刺进行胸腔镜术前定位的52例同侧... 目的探讨运用Hook-wire多针同步穿刺同侧肺多发结节进行电视胸腔镜手术(videoassisted thoracic surgery,VATS)前定位的安全性和可行性。方法回顾性分析2016年4月至2020年6月使用同步法Hook-wire多针穿刺进行胸腔镜术前定位的52例同侧肺多发性结节患者资料。记录定位成功率、定位时间、CT扫描次数及手术完整切除率,评估定位方法的可行性;记录气胸、肺内出血等穿刺相关并发症发生率,评估定位方法安全性。结果 52例患者共定位105枚结节,定位成功率100%,平均定位用时(9.98±1.02) min,CT扫描次数(3.17±0.38)次。VATS术中验证无定位针脱钩发生,病灶完整切除率100%。定位后气胸发生率30.8%(16/52例),均为无症状少量气胸,肺内出血发生率9.5%(10/105枚),均为无症状肺内少量出血。结论同步法Hook-wire多针定位同侧肺多发结节,避免了穿刺过程中气胸对结节精准定位的干扰,定位成功率高,安全可行。 展开更多
关键词 HOOK-WIRE 肺多发结节 术前定位 胸腔镜手术
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超声引导下胸椎旁神经阻滞和菱形肌-肋间肌阻滞对胸腔镜术后恢复质量的影响 被引量:20
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作者 马楚洲 陈琼仪 +2 位作者 林梓霞 郑良杰 吴萍 《临床麻醉学杂志》 CAS CSCD 北大核心 2021年第10期1061-1064,共4页
目的观察超声引导下胸椎旁神经阻滞(TPVB)和菱形肌-肋间肌阻滞(RIB)对胸腔镜手术患者术后早期疼痛及术后康复质量的影响。方法选择全麻下行胸腔镜肺癌根治术患者78例,男51例,女27例,年龄50-70岁,ASAⅠ或Ⅱ级。随机分为两组:超声引导下T... 目的观察超声引导下胸椎旁神经阻滞(TPVB)和菱形肌-肋间肌阻滞(RIB)对胸腔镜手术患者术后早期疼痛及术后康复质量的影响。方法选择全麻下行胸腔镜肺癌根治术患者78例,男51例,女27例,年龄50-70岁,ASAⅠ或Ⅱ级。随机分为两组:超声引导下TPVB组(A组)和超声引导下RIB组(B组),每组39例。全麻诱导前,A组、B组分别采用0.33%罗哌卡因25 ml行超声引导下TPVB和RIB。记录阻滞操作时间和阻滞持续时间。记录术后2、6、24静息和活动时VAS疼痛评分。记录术后24 h内舒芬太尼用量和补救镇痛例数。记录开始进食时间、开始下地时间和术后住院时间。记录PACU低氧血症、气胸、穿刺部位出血或血肿、局麻药中毒、术后谵妄、术后肺不张、恶心呕吐等并发症的发生情况。结果B组阻滞操作时间明显短于A组(P<0.05)。两组阻滞持续时间、不同时点静息和活动时VAS疼痛评分、术后24 h内舒芬太尼用量、补救镇痛率、开始进食时间、开始下地时间、术后住院时间差异无统计学意义。两组并发症发生率差异无统计学意义。结论在胸腔镜肺癌根治术中,行超声引导下菱形肌-肋间肌阻滞的患者术后恢复质量不差于行胸椎旁神经阻滞的患者。 展开更多
关键词 菱形肌-肋间肌阻滞 胸椎旁神经阻滞 胸腔镜手术 术后早期疼痛 恢复质量
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肺癌患者胸腔镜肺切除术后闭式引流切口愈合不良影响因素分析
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作者 陈玉果 季聪颖 +3 位作者 邓翼鸥 王敏涛 张玮 郭红 《中国医学前沿杂志(电子版)》 CSCD 北大核心 2024年第9期63-67,共5页
目的探讨肺癌患者胸腔镜肺切除术后闭式引流切口愈合不良的影响因素,为临床干预提供依据。方法选取2022年1月1日至2023年12月31日经病理诊断为肺癌并行胸腔镜肺切除术的704例患者为研究对象。根据是否发生闭式引流切口愈合不良将患者分... 目的探讨肺癌患者胸腔镜肺切除术后闭式引流切口愈合不良的影响因素,为临床干预提供依据。方法选取2022年1月1日至2023年12月31日经病理诊断为肺癌并行胸腔镜肺切除术的704例患者为研究对象。根据是否发生闭式引流切口愈合不良将患者分为愈合不良组(128例)和愈合组(576例)。对可能影响患者术后闭式引流切口愈合不良因素,如性别、年龄、体质量指数(body mass index,BMI)、其他既往史(手术侧乳腺癌根治性切除术史、免疫系统疾病)、高血压、糖尿病、吸烟史、手术时间、切除范围、闭式引流位置、引流管切口缝合针数、留置引流管时间、引流管口拆线时间、术前白蛋白水平进行单因素分析及多因素Logistic回归分析。结果单因素分析结果显示,年龄、BMI、糖尿病与发生闭式引流切口愈合不良有关(P<0.05)。多因素Logistic回归分析结果显示,年龄(OR=1.615,95%CI:1.081~2.413,P=0.019)、BMI(OR=2.086,95%CI:1.382~3.148,P<0.001)、糖尿病(OR=2.103,95%CI:1.216~3.638,P=0.008)是闭式引流切口愈合不良独立危险因素。结论年龄、BMI、糖尿病是肺癌患者行胸腔镜术后闭式引流切口愈合不良的独立危险因素,医护人员应重点关注,围手术期做好准备工作,术后关注伤口变化,给予针对性措施,以减少闭式引流切口愈合不良的发生。 展开更多
关键词 肺癌 胸腔镜手术 胸腔闭式引流术 切口愈合不良
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二切口胸腔镜与开胸术对血浆细胞因子白介素-6水平和术后疼痛的影响 被引量:17
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作者 徐海 张金峰 +1 位作者 徐世东 马建群 《哈尔滨医科大学学报》 CAS 北大核心 2014年第4期329-331,共3页
目的从血浆细胞因子水平和疼痛分级关系研究比较开胸与胸腔镜手术(VATS)对患者的创伤影响。方法 28例T1N0M0患者被随机分配至VATS(10例,4例退出)或开胸组(14例)行肺叶切除及淋巴结清扫术,在术后0,1,2,7,14天对术后疼痛进行分级,并在相... 目的从血浆细胞因子水平和疼痛分级关系研究比较开胸与胸腔镜手术(VATS)对患者的创伤影响。方法 28例T1N0M0患者被随机分配至VATS(10例,4例退出)或开胸组(14例)行肺叶切除及淋巴结清扫术,在术后0,1,2,7,14天对术后疼痛进行分级,并在相对应的术后时间同时采集血液标本检测血浆细胞因子白介素-6(IL-6)水平。结果术后0,1,7,14天的疼痛分级VATS组明显低于开胸组,血浆IL-6水平在开胸组中术后0天为(11.91±5.247)pg/mL,与VATS组(7.375±5.3)pg/mL比较明显升高,P=0.0177。结论 VATS与开胸术比较,可减少血浆细胞因子IL-6的释放,减轻手术引起的疼痛。 展开更多
关键词 肺癌 电视胸腔镜手术 开胸术 白介素-6 术后疼痛
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叶内型肺隔离症合并肺隐球菌病1例并文献复习
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作者 田菲 王汉生 +1 位作者 余丹 任涛 《中国真菌学杂志》 CSCD 2024年第4期389-392,共4页
报道1例52岁男性叶内型肺隔离症合并肺隐球菌病患者,因咳嗽、咳痰和胸闷入院,胸部CT显示右下肺脊柱旁有1个椭圆形肿块,左下肺有1个结节。CT引导下经皮肺活检证实右下肺肿块为肺隔离症,左下肺结节为隐球菌感染。行电视辅助外科胸腔镜手... 报道1例52岁男性叶内型肺隔离症合并肺隐球菌病患者,因咳嗽、咳痰和胸闷入院,胸部CT显示右下肺脊柱旁有1个椭圆形肿块,左下肺有1个结节。CT引导下经皮肺活检证实右下肺肿块为肺隔离症,左下肺结节为隐球菌感染。行电视辅助外科胸腔镜手术切除肺隔离叶,通过口服氟康唑治疗患者左下肺隐球菌结节。术后3年定期随访,增强CT示左下肺隐球菌结节消失,右下肺隔离症术后良好。该文总结了1例肺隔离症合并隐球菌病的临床表现、治疗及转归,旨在提高临床医师对该病的认识。 展开更多
关键词 肺隔离症 肺隐球菌 电视辅助外科胸腔镜 氟康唑
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胸腔镜手术视频在临床解剖教学中的应用探索
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作者 王沛杰 梁洪森 +5 位作者 张奇伟 殷茵 严冬青 郑鸿杰 张军航 李昀 《中国继续医学教育》 2024年第20期124-128,共5页
目的探讨胸腔镜手术视频在临床解剖教学中的应用效果。方法于2022年11—12月选取中山大学医学院2020级临床医学五年制本科生两个大班的129名学生为研究对象,按照随机分配法则分为试验组和对照组,其中试验组66名,对照组63名。对照组采用... 目的探讨胸腔镜手术视频在临床解剖教学中的应用效果。方法于2022年11—12月选取中山大学医学院2020级临床医学五年制本科生两个大班的129名学生为研究对象,按照随机分配法则分为试验组和对照组,其中试验组66名,对照组63名。对照组采用传统临床解剖教学法,试验组采用胸腔镜手术视频结合传统临床解剖教学方式。比较2组的理解教学目的、教学内容丰富、教学重点突出、有利于提高对胸部解剖课程的兴趣、教学方式满意度、对胸部相关临床知识有所了解、愿意深入了解胸部疾病相关知识、对胸部解剖相关知识的掌握程度、对胸部解剖基本技能掌握程度评分以及课程总体评分,总结学生对本课程的印象、意见和建议。结果试验组收集有效问卷49份,对照组收集有效问卷52份。试验组的教学重点突出[(4.80±0.46)分]、对胸部相关临床知识有所了解[(4.76±0.48)分]、对胸部解剖相关知识的掌握程度[(4.51±0.68)分]评分高于对照组[(4.46±0.94)分、(4.19±1.12)分、(4.08±1.21)分],差异有统计学意义(P<0.05)。试验组29名学生反映“喜欢带有临床知识的课程”“临床手术视频很清晰,对理论理解更深刻”“挑选的素材很用心,对胸部的解剖结构有了较深刻的理解”“授课方式很生动”“授课方式值得提倡”“希望以后多采用基础知识结合临床实际案例授课”;同时,2名学生觉得“手术对于本科生有点难”“手术视频中的神经难看清,结构不易区分”。对照组22名学生感觉“老师讲得很好”“课程不错”,3名学生建议“希望老师多讲基础知识和理论”“展示解剖操作的具体步骤和需要观察学习的内容”。结论胸腔镜手术视频结合传统解剖教学的模式能有效提高胸部临床解剖教学质量及学生对临床的兴趣,适用于临床解剖教学。 展开更多
关键词 胸外科手术 电视辅助 解剖学 教育 医学 传统教学法
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