Objective: To sum up 121 cases of heart disease operations with the help of thoracoscope from May to August in 2000. Among these cases, 48 cases were atrial septal defect (ASD); the average age of patients is 20±...Objective: To sum up 121 cases of heart disease operations with the help of thoracoscope from May to August in 2000. Among these cases, 48 cases were atrial septal defect (ASD); the average age of patients is 20±10 years old; average weight is (43±16) kg. 67 patients with ventricular septal defects (VSD), average age13±9 years old; one male patient, 44 years old with Ebstein malformation; one female patient (21 years old) partial atrioventricular canal combined with cor triatriatum; one male (21 years old) with ruptared aneuryem of aortic sinus. 3 cases(all females ) with mitral stenosis combined with mitral valve incompetence. One male patient(aged 16)with pericardiun effusion after trauma. Methods: During operations, a patient with supine position, and his/her right shoulder was padded 30°higher. Tracheal cannula was inserted and air was piped in with high frequency jet ventilation. Three mini thoracotomies with a diameter of 2 to 3 cm were made in the 4th intercostals space of the right par sternum and the 4th and 7th intercostals spaces of the right middle axillary line respectively. An periphera extra corporeal circulation was made. the aortic clamp was clamped, cannula for cold perfusion. After the heart was sliced and a reformative operation was performed. The process of the operation of defects repairs was finished under the thoracoscope. The other operations were performed with the help of thoracoscope. 3 rheumatic heart disease patients got 25# mechanical mitral valve prosthesis. A 30# tricuspid plasty ring was applied to The Ebstein malformation patient. Results: all 121 patients were successfully operated on without death. Two VSD cases appeared transient third degree atrialventricular block.Because 4 cases had more chest drainage, so they were stanched bleeding twice. After the operation, heart murmur vanished, and ultrasonic inspection showed no diffluence inside the heart. Conclusion: Our experience showed that all atrium, ventricular septal defects can be repaired under the thoracoscope. This scope-assisted technology is more accepted by patients because of tiny incisions and also provides an alternative solution for cardiac surgeons.展开更多
Objective: To evaluate the safety, efficacy, feasibility of single-direction thoracoscopic lobectomy for peripheral lung cancer. Methods: From December 2009 to March 2011, 20 patients with peripheral lung cancer were ...Objective: To evaluate the safety, efficacy, feasibility of single-direction thoracoscopic lobectomy for peripheral lung cancer. Methods: From December 2009 to March 2011, 20 patients with peripheral lung cancer were treated with single-direction thoracoscopic lobectomy and systemic lymph nodes dissection. Results: Surgeries were successfully performed. No significant complications occurred perioperatively. The average operation time was 193 min, the average blood loss was 234 ml, the average duration of drainage was 6 d, the postoperative hospital stay was 12 d, and the average number of lymph nodes dissected was 16. Conclusion: Single-direction thoracoscopic lobectomy is feasible and safe in the treatment of peripheral lung cancer and can simplify the surgical procedures.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
目的 探讨预先单肺通气(OLV)联合呼吸暂停对支气管封堵器(BB)用于胸腔镜手术行OLV时肺萎陷的影响。方法 选择择期行胸腔镜下左肺段或肺叶切除术的患者75例,随机分为预先OLV组(A组)、呼吸暂停组(B组)和预先OLV联合呼吸暂停组(C组),每组2...目的 探讨预先单肺通气(OLV)联合呼吸暂停对支气管封堵器(BB)用于胸腔镜手术行OLV时肺萎陷的影响。方法 选择择期行胸腔镜下左肺段或肺叶切除术的患者75例,随机分为预先OLV组(A组)、呼吸暂停组(B组)和预先OLV联合呼吸暂停组(C组),每组25例。记录3组打开胸膜到肺完全萎陷的时间、外科医生满意度、进胸前准备时间、OLV时间、手术时间和OLV开始至胸膜打开后20 min内低氧血症[经皮动脉血氧饱和度(SpO_(2))<90%]的发生情况;记录3组胸膜腔开放即刻(T_0)、胸膜腔开放后1 min (T_1)、5 min (T_2)、10 min (T_3)和20 min (T_4)的肺萎陷评分(LCS)。结果 与A组和B组比较,C组肺完全萎陷时间明显缩短,外科医生满意度明显提高,差异均有统计学意义(P <0.05),A组和B组肺完全萎陷时间和外科医生满意度比较,差异均无统计学意义(P> 0.05);与A组比较,B组T0时点LCS低于A组,而在T_1时点,则明显高于A组,C组T_(1)、T_(2)、T_(3)和T_(4)时点LCS明显高于A组和B组,差异均有统计学意义(P <0.05);C组T2时点SpO_(2)明显低于A组和B组,差异有统计学意义(P <0.05)。结论 对于用BB行OLV的胸腔镜手术患者,预先使用OLV联合呼吸暂停,可以改善非通气侧肺的肺萎陷效果,缩短了肺完全萎陷时间,提高了外科医生满意度,且OLV的早期LCS更高,但仍需监测OLV期间的SpO_(2)。展开更多
目的比较腹腔镜经腹入路与胸腹腔镜联合入路治疗食管胃连接部腺癌(AEG)的预后效果。方法选择2021年12月-2023年12月该院行AEG切除术,并行淋巴结清扫的患者110例。根据手术方式,将患者分为腹腔镜组(n=62)和胸腹腔镜联合组(n=48)。采用倾...目的比较腹腔镜经腹入路与胸腹腔镜联合入路治疗食管胃连接部腺癌(AEG)的预后效果。方法选择2021年12月-2023年12月该院行AEG切除术,并行淋巴结清扫的患者110例。根据手术方式,将患者分为腹腔镜组(n=62)和胸腹腔镜联合组(n=48)。采用倾向评分匹配(PSM)平衡组间差异,减少潜在混杂因素后,比较两组患者的一般资料、围手术期指标、营养状态指标、术后并发症和术后生存情况;采用广义估计方程(GEE),构建两组患者治疗前后的营养状态相关指标模型;采用Cox比例风险模型,分析治疗方式对AEG患者预后的影响。结果PSM前,两组患者性别、年龄、体重指数(BMI)、TNM分期、肿瘤最大直径和食管侵犯长度比较,差异均有统计学意义(P<0.05)。PSM后,两组患者一般资料比较,差异无统计学意义(P>0.05);胸腹腔镜联合组手术时间、术后卧床时间、术后住院时间明显长于腹腔镜组(P<0.05),术中出血量明显多于腹腔镜组(P<0.05),术后24 h视觉模拟评分法(VAS)明显高于腹腔镜组(P<0.05),淋巴结清扫数量、阳性淋巴结数量、纵隔淋巴结清扫数量和腹腔淋巴结清扫数量明显多于腹腔镜组(P<0.05),血红蛋白(Hb)、白蛋白(ALB)、前白蛋白(PAB)、转铁蛋白(TRF)和体重(W)术前术后差值明显大于腹腔镜组(P<0.05),两组患者术后并发症总发生率和1年生存率比较,差异均无统计学意义(P>0.05);GEE分析结果显示,腹腔镜治疗对Hb和TRF指标影响更大,胸腹腔镜联合治疗对ALB、PAB和W指标影响更大;腹腔镜治疗方式是AEG患者预后良好的保护因素(P<0.05)。结论腹腔镜治疗在手术时间、术后卧床时间、术后住院时间、术中出血量、24 h VAS和术后营养方面占优势;胸腹腔镜联合治疗在淋巴结清扫数量、阳性淋巴结数量,纵隔淋巴结清扫数量和腹腔淋巴结清扫数量方面占优势。综合考虑,腹腔镜治疗的短期预后更好。展开更多
目的总结胸腔镜手术治疗小儿纵隔前肠源性囊肿的经验。方法2019年7月~2023年7月我科采用侧胸入路全胸腔镜手术(三孔法)治疗纵隔前肠源性囊肿27例,健侧卧位,观察孔为肩胛下第5肋间,另外2个操作孔根据病变位置及腔镜菱形法建立,均为5 mm t...目的总结胸腔镜手术治疗小儿纵隔前肠源性囊肿的经验。方法2019年7月~2023年7月我科采用侧胸入路全胸腔镜手术(三孔法)治疗纵隔前肠源性囊肿27例,健侧卧位,观察孔为肩胛下第5肋间,另外2个操作孔根据病变位置及腔镜菱形法建立,均为5 mm trocar,CO_(2)气胸压力6 mm Hg。电钩打开囊肿脏层胸膜,肠钳固定牵拉囊肿,分离钳、电钩交替分离将囊肿完整剥除。结果无中转开胸。完整切除26例,残留部分囊壁1例。打开食管肌层9例。5例囊肿遮挡手术视野,不利于观察,穿刺囊肿抽液。手术时间45~120 min(中位时间70 min)。出血量3~10 ml(中位数5 ml)。术后住院时间2~5 d(中位数3 d)。27例随访1~43个月(中位数22个月),均无复发;2例被压迫的气管全部恢复,肺气肿均恢复。结论胸腔镜手术治疗小儿纵隔前肠源性囊肿安全可行,若病变周围结构较为复杂,必要时可联合支气管镜或胃镜手术。展开更多
文摘Objective: To sum up 121 cases of heart disease operations with the help of thoracoscope from May to August in 2000. Among these cases, 48 cases were atrial septal defect (ASD); the average age of patients is 20±10 years old; average weight is (43±16) kg. 67 patients with ventricular septal defects (VSD), average age13±9 years old; one male patient, 44 years old with Ebstein malformation; one female patient (21 years old) partial atrioventricular canal combined with cor triatriatum; one male (21 years old) with ruptared aneuryem of aortic sinus. 3 cases(all females ) with mitral stenosis combined with mitral valve incompetence. One male patient(aged 16)with pericardiun effusion after trauma. Methods: During operations, a patient with supine position, and his/her right shoulder was padded 30°higher. Tracheal cannula was inserted and air was piped in with high frequency jet ventilation. Three mini thoracotomies with a diameter of 2 to 3 cm were made in the 4th intercostals space of the right par sternum and the 4th and 7th intercostals spaces of the right middle axillary line respectively. An periphera extra corporeal circulation was made. the aortic clamp was clamped, cannula for cold perfusion. After the heart was sliced and a reformative operation was performed. The process of the operation of defects repairs was finished under the thoracoscope. The other operations were performed with the help of thoracoscope. 3 rheumatic heart disease patients got 25# mechanical mitral valve prosthesis. A 30# tricuspid plasty ring was applied to The Ebstein malformation patient. Results: all 121 patients were successfully operated on without death. Two VSD cases appeared transient third degree atrialventricular block.Because 4 cases had more chest drainage, so they were stanched bleeding twice. After the operation, heart murmur vanished, and ultrasonic inspection showed no diffluence inside the heart. Conclusion: Our experience showed that all atrium, ventricular septal defects can be repaired under the thoracoscope. This scope-assisted technology is more accepted by patients because of tiny incisions and also provides an alternative solution for cardiac surgeons.
文摘Objective: To evaluate the safety, efficacy, feasibility of single-direction thoracoscopic lobectomy for peripheral lung cancer. Methods: From December 2009 to March 2011, 20 patients with peripheral lung cancer were treated with single-direction thoracoscopic lobectomy and systemic lymph nodes dissection. Results: Surgeries were successfully performed. No significant complications occurred perioperatively. The average operation time was 193 min, the average blood loss was 234 ml, the average duration of drainage was 6 d, the postoperative hospital stay was 12 d, and the average number of lymph nodes dissected was 16. Conclusion: Single-direction thoracoscopic lobectomy is feasible and safe in the treatment of peripheral lung cancer and can simplify the surgical procedures.
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.
文摘目的 探讨预先单肺通气(OLV)联合呼吸暂停对支气管封堵器(BB)用于胸腔镜手术行OLV时肺萎陷的影响。方法 选择择期行胸腔镜下左肺段或肺叶切除术的患者75例,随机分为预先OLV组(A组)、呼吸暂停组(B组)和预先OLV联合呼吸暂停组(C组),每组25例。记录3组打开胸膜到肺完全萎陷的时间、外科医生满意度、进胸前准备时间、OLV时间、手术时间和OLV开始至胸膜打开后20 min内低氧血症[经皮动脉血氧饱和度(SpO_(2))<90%]的发生情况;记录3组胸膜腔开放即刻(T_0)、胸膜腔开放后1 min (T_1)、5 min (T_2)、10 min (T_3)和20 min (T_4)的肺萎陷评分(LCS)。结果 与A组和B组比较,C组肺完全萎陷时间明显缩短,外科医生满意度明显提高,差异均有统计学意义(P <0.05),A组和B组肺完全萎陷时间和外科医生满意度比较,差异均无统计学意义(P> 0.05);与A组比较,B组T0时点LCS低于A组,而在T_1时点,则明显高于A组,C组T_(1)、T_(2)、T_(3)和T_(4)时点LCS明显高于A组和B组,差异均有统计学意义(P <0.05);C组T2时点SpO_(2)明显低于A组和B组,差异有统计学意义(P <0.05)。结论 对于用BB行OLV的胸腔镜手术患者,预先使用OLV联合呼吸暂停,可以改善非通气侧肺的肺萎陷效果,缩短了肺完全萎陷时间,提高了外科医生满意度,且OLV的早期LCS更高,但仍需监测OLV期间的SpO_(2)。
文摘目的比较腹腔镜经腹入路与胸腹腔镜联合入路治疗食管胃连接部腺癌(AEG)的预后效果。方法选择2021年12月-2023年12月该院行AEG切除术,并行淋巴结清扫的患者110例。根据手术方式,将患者分为腹腔镜组(n=62)和胸腹腔镜联合组(n=48)。采用倾向评分匹配(PSM)平衡组间差异,减少潜在混杂因素后,比较两组患者的一般资料、围手术期指标、营养状态指标、术后并发症和术后生存情况;采用广义估计方程(GEE),构建两组患者治疗前后的营养状态相关指标模型;采用Cox比例风险模型,分析治疗方式对AEG患者预后的影响。结果PSM前,两组患者性别、年龄、体重指数(BMI)、TNM分期、肿瘤最大直径和食管侵犯长度比较,差异均有统计学意义(P<0.05)。PSM后,两组患者一般资料比较,差异无统计学意义(P>0.05);胸腹腔镜联合组手术时间、术后卧床时间、术后住院时间明显长于腹腔镜组(P<0.05),术中出血量明显多于腹腔镜组(P<0.05),术后24 h视觉模拟评分法(VAS)明显高于腹腔镜组(P<0.05),淋巴结清扫数量、阳性淋巴结数量、纵隔淋巴结清扫数量和腹腔淋巴结清扫数量明显多于腹腔镜组(P<0.05),血红蛋白(Hb)、白蛋白(ALB)、前白蛋白(PAB)、转铁蛋白(TRF)和体重(W)术前术后差值明显大于腹腔镜组(P<0.05),两组患者术后并发症总发生率和1年生存率比较,差异均无统计学意义(P>0.05);GEE分析结果显示,腹腔镜治疗对Hb和TRF指标影响更大,胸腹腔镜联合治疗对ALB、PAB和W指标影响更大;腹腔镜治疗方式是AEG患者预后良好的保护因素(P<0.05)。结论腹腔镜治疗在手术时间、术后卧床时间、术后住院时间、术中出血量、24 h VAS和术后营养方面占优势;胸腹腔镜联合治疗在淋巴结清扫数量、阳性淋巴结数量,纵隔淋巴结清扫数量和腹腔淋巴结清扫数量方面占优势。综合考虑,腹腔镜治疗的短期预后更好。
