Abstract： Objective To analyze possible associated risk factors of postoperative pulmonary complications (PPC) after lung resection in order to decrease the incidence and mortality of PPC. Methods We reviewed the data of 302 patients including 228 males and 74 females undergoing lung resection from January 2007 to December 2009 in our department. The age of the patients ranged from 23 to 91 years old with an average age of 63.38 years. Based on the present definition of PPC, we recorded the related information and data before, during and after the operation, and observed the rate of PPC. The independent risk factors of PPC were evaluated by multiple logistic regression analysis. Results A total of 22 patients (7.28%) died during the operation and 75 patients (24.83%) experienced 110 times of PPC, the majority of which were prolonged air leak/bronchopleural fistula (8.94%, 27/302), nosocomial pneumonia (6.95%, 21/302) and acute respiratory failure (6.29%, 19/302). The results of logistic regression analysis showed that an American Society of Anesthesiology (ASA) score ≥3 (OR=2.400，P=0.020) and prolonged duration of immediate postoperative mechanical ventilation (OR=1.620，P=0.030) were independent factors associated with the development of PPC.Conclusions The ASA score based on the patients’ general condition and the function status of the main organs, and the prolonged duration of immediate postoperative mechanical ventilation are independent risk factors of PPC. In order to decrease the PPC rate, more attention should be paid to perfecting preoperative preparation, improving the function and condition of the organs, preserving pulmonary function and decreasing the duration of immediate postoperative mechanical ventilation for patients with high risk factors.
ObjectiveTo explore an effective and safe drainage method, by comparing open thoracic drainage and conventional thoracic drainage for lung cancer patients after thoracoscopic pneumonectomy.MethodsThe clinical data of 147 patients who underwent thoracoscopic pneumonectomy from January 2015 to March 2018 in our hospital were retrospectively analyzed, including 128 males and 19 females. Based on drainage methods, they were divided into an open drainage group (open group) and a conventional drainage group (regular group). The incidence of postoperative complications, chest tube duration, drainage volume at postoperative 3 days, postoperative hospital stay, hospitalization cost and quality of life were compared between the two groups.ResultsPostoperative complication rate was lower in the open group than that in the regular group (10.20% vs. 23.47%, P=0.04). The chest tube duration of the open group was longer compared with the regular group (5.57±2.36 d vs. 3.22±1.23 d, P<0.001). The drainage volume at postoperative 3 days was less in the regular group. In the open group, ambulation was earlier, thoracocentesis was less and re-intubation rate was lower (all P<0.001). The postoperative hospital stay in the regular group was significantly longer than that in the open group (8.37±2.56 d vs. 6.35±1.87 d, P<0.001) and hospitalization cost was significantly higher (66.2±5.4 thousand yuan vs. 59.6±7.3 thousand yuan, P<0.001). Besides, quality of life in 1 and 3 months after operation was significantly better than that in the open group (P<0.001).ConclusionCompared with the regular chest drainage, the effect of open thoracic drainage is better, which can help reduce postoperative complications, shorten the length of hospital stay, reduce the hospitalization cost and improve the quality of postoperative life. It is worthy of clinical promotion.
Abstract: Objective To summarize the clinical experiences and surgical treatment of pulmonary sequestration (PS) in order to improve the diagnosis and treatment of PS. Methods Between August 1993 and February 2007, our department enrolled 21 PS patients, 8 male patients and 13 female patients, with the age ranging from 13 to 70 years old. The patients were examined by chest radiography, computerized tomography (CT), computerized tomography angiography (CTA), magnetic resonance imaging (MRI), position emission tomographyCT(PET-CT) before the surgery. Sequestrectomy was performed on patients with extralobar sequestration (ELS) and lobectomy was performed on patients with intralobar sequestration (ILS). There were 10 cases of left lower lobectomy, 3 cases of right lower lobectomy, 4 cases of left sequestrectomy, 3 cases of right sequestrectomy and 1 case of total pneumonectomy. Results Postoperative pathology confirmed all cases of PS, including 7 cases of ELS and 14 cases of ILS. Seven patients were diagnosed to have PS by preoperative diagnostic procedures. During the surgery, we found aberrant supporting arteries from the general circulation in 18 cases among which 11 were supported by the thoracic aorta, 6 by the abdominal aorta and 1 by both the thoracic and abdominal aorta. The diameter of the aberrant artery was between 0.2 cm and 1.1 cm (mean 0.7 cm). Double ligation and transfixion were performed during the operation. In addition, we found venous drainage through the inferior pulmonary vein in 3 patients and double ligation was performed. No perioperative death or complications occurred. Followup was done till January 2009 on all the patients but one with a followup rate of 95.2% (20/21). The followup time ranged from 12 to 67 months. All patients survived well except that 1 died from liver metastasis 2 years after the operation because of lung cancer. Conclusion PS is rare and its symptoms are nonspecific, which can cause misdiagnosis and missed diagnosis. The diagnosis of PS mainly depends on CT, CTA, MRI and selected arteriography. Once diagnosed, PS should be removed by surgery. During the surgery, aberrant vessels should be separated and treated with double ligation and transfixion. As for those big aberrant vessels, transfixion can be performed after vascular decompression.
Abstract： The principles of 2010 National Comprehensive Cancer Network（NCCN） clinical practice guidelines in non-small cell lung cancer address that anatomic pulmonary resection is preferred for the majority of patients with non-small cell lung cancer and video-assisted thoracic surgery (VATS) is a reasonable and acceptable approach for patients with no anatomic or surgical contraindications. By reviewing the literatures on general treatment, pulmonary segmentectomy, pulmonary function reserve, and the anatomic issue of early stage non-small cell lung cancer surgery, the feasibility and reliability of thoracoscopic pulmonary segmentectomy are showed.
Objective To evaluate the surgical efficacy of unilateral pneumonectomy for the treatment of tuberculous destroyed lung, analyze the causes of severe postoperative complications, and explore clinical management strategies. Methods A retrospective analysis was conducted on the clinical data of patients with tuberculous destroyed lung who underwent unilateral pneumonectomy at the Public Health Clinical Center of Chengdu from 2017 to 2023. Postoperative severe complications were statistically analyzed. Patients were divided into a non-severe complication group and a severe-complication group, and the causes, management, and outcomes of complications were analyzed. Results A total of 134 patients were included, comprising 69 males and 65 females, with a mean age of 17-73 (40.43±12.69) years. There were 93 patients undergoing left pneumonectomy and 41 patients undergoing right pneumonectomy. Preoperative sputum smear was positive in 35 patients, all of which converted to negative postoperatively. There were 58 patients with hemoptysis preoperatively, and none experienced hemoptysis postoperatively. Postoperative incisional infection occurred in 8 (5.97%) patients, and postoperative pulmonary infection in 26 (19.40%) patients. Severe postoperative complications occurred in 17 (12.69%) patients, including empyema in 9 (6.72%) patients, bronchopleural fistula with empyema in 1 (0.75%) patient, severe pneumonia in 3 (2.24%) patients, postpneumonectomy syndrome in 1 (0.75%) patient, chylothorax in 1 (0.75%) patient, ketoacidosis in 1 (0.75%) patient, and heart failure with severe pneumonia in 1 (0.75%) patient. Perioperative mortality occurred in 2 (1.49%) patients, both of whom underwent right pneumonectomy. Multivariate logistic regression analysis revealed that a history of ipsilateral thoracic surgery, concomitant Aspergillus infection, and greater blood loss were independent risk factors for severe complications following unilateral pneumonectomy for tuberculous destroyed lung (P<0.05). ConclusionUnilateral pneumonectomy for patients with tuberculous destroyed lung can significantly improve the clinical cure rate, sputum conversion rate, and hemoptysis cessation rate. However, there is a certain risk of severe perioperative complications and mortality, requiring thorough perioperative management and appropriate management of postoperative complications.
In recent years, the number of lung surgeries has increased year by year, and the number of patients with postoperative cough has also increased gradually. Chronic cough after lung surgery seriously affects patients' quality of life and surgical outcome, and has become one of the clinical problems that clinicians need to solve. However, there is currently no guideline or consensus for the treatment of chronic cough after lung surgery in China, and there is no standardized treatment method. Therefore, we searched databases such as PubMed, Web of Science, CNKI, and Wanfang databases ect. from 2000 to 2023 to collected relevant literatures and research data, and produced the first expert consensus on chronic cough after lung surgery in China by Delphi method. We gave 11 recommendations from five perspectives including timing of chronic cough treatment, risk factors (surgical method, lymph node dissection method, anesthesia method), prevention methods (preoperative, intraoperative, postoperative), and treatment methods (etiological treatment, cough suppressive drug treatment, traditional Chinese medicine treatment, and postoperative physical therapy). We hope that this consensus can improve the standardization and effectiveness of chronic cough treatment after lung surgery, provide reference for clinical doctors, and ultimately improve the quality of life of patients with chronic cough after lung surgery.
目的探討Coopdech支氣管封堵器用于全肺切除術后對側胸腔內手術麻醉的可行性及療效。
方法回顧性分析上海市肺科醫院2012年1～12月3例全肺切除術后患者需要進行對側胸腔內手術時，在纖維支氣管鏡引導下置入Coopdech支氣管封堵器隔離目標肺葉，進行選擇性肺葉通氣麻醉。比較3例患者封堵前后生命體征和血氣分析。
結果3例患者均順利完成手術，術中調整呼吸參數（封堵后，減少潮氣量、增加呼吸頻率）維持脈搏血氧飽和度（SpO2）大于96%、動脈血氧分壓（PaO2）大于75 mm Hg、動脈血二氧化碳分壓（PaCO2）35～45 mm Hg、pH值7.32～7.40，術中目標肺葉萎陷良好，給外科醫生提供了良好的手術視野，術畢患者清醒拔管回ICU。
結論Coopdech支氣管封堵器可以用于全肺切除術后對側胸腔內手術的麻醉。
