Objective To explore the safety and efficacy for patients with central airway-pleural fistula (APF) treated by atrial septal defect (ASD) occluder. Methods This was a retrospective study. Between January 2017 and October 2021, a total of 16 patients with postoperative APF were treated with ASD occluder through bronchoscope under local anesthesia combined with sedation. The efficacy and complication were recorded during and after the procedure. Results Sixteen patients were recruited in this study and the average age was 60.7 years (range 31 - 74 years). The main etiology for APF was lobectomy/segmentectomy (n=12), pneumonectomy (n=2), radical esophagectomy (n=1) or decortication for chronic empyema (n=1). Totally, 4 fistulas were located in right main bronchus, 3 in left main bronchus, 3 in right upper bronchus, 1 in right middle bronchus, 2 in right lower bronchus and 3 in left upper bronchus. The median diameter of APF was 7.8 mm (ranged from 4 to 18 mm) and the median diameter of ASD occluder inserted was 10.0 mm (ranged from 6 to 20 mm). Successful occlusion of APF was observed in 15 patients (15/16) and 1 patient died of multiple organ failure caused by bacteremia 14 days after the procedure. Fourteen patients were recruited for long-term follow-up, on a median follow-up period of 16.2 months (ranged from 3 to 46 months). There were 12 patients of complete remission and 2 patients of partial remission and only one patient took a second operation due to the enlargement of fistula and translocation of occluder. At follow-up, 4 patients died and the reasons were directly related to the primary etiology, and no patient died due to APF recurrence. Conclusion Endobronchial closure of central APF using ASD occluder is a minimally invasive but effective modality of treatment with satisfactory long-term outcome.
Objective To investigate the postoperative treatment of pleuropneumonectomy for tuberculosis destroyed lung in ICU, in order to improve the therapeutical efficacy for these patients. Methods Clinical data of 52 patients who suffered from tuberculosis destroyed lung and underwent pleuropneumonectomy from June 2008 to June 2010 were analyzed retrospectively. All of subjects received routine treatment in ICU after the operation. Meanwhile，appropriate targeting treatments were applied including diagnosis and treatment of postoperative bleeding; application of fiberbronchoscope to aspirate the sputum after the operation,sequential non-invasive ventilation after the invasive ventilation for acute respiratory failure after operation ,etc.Results A total of 52 patients received the pleuropneumonectomy operation. Bleeding occurred in 11 cases after operation and stopped after the integrated therapy. 8 patients suffered from acute respiratory failure and attenuated after sequential ventilation. No patients died for postoperative bleeding or acute respiratory failure. Conclusions Patients who suffered from tuberculosis destroyed lung and received pleuropneumonectomy with postoperative bleeding and acute respiratory failure have a good prognosis after appropriate postoperative treatment in ICU.
ObjectiveTo compare the clinical efficacy of video-assisted thoracoscopy and thoracotomy for the treatment of encapsulated tuberculous pleurisy.
MethodsWe retrospectively analyzed the clinical data of 99 patients who had underwent surgery for encapsulated tuberculous pleurisy within 3 months of disease onset in our hospital from January through December 2013. Based on the surgical mode, patients were assigned to a video-assisted thoracoscopy group, including 49 patients (35 males and 14 females, a mean age of 26.78±9.36 years), to receive video-assisted thoracoscopic pleurectomy; or a thoracotomy group, including 50 patients (31 males and 19 females, a mean age of 31.84±11.08 years), to receive conventional thoracotomic pleurectomy. The first 43 patients in the video-assisted thoracoscopy group received thoracic catheter drainage, with the drainage volume of 659.08±969.29 ml; the first 48 patients in the thoracotomy group received thoracic catheter drainage, with the drainage volume of 919.03±129.97 ml. The clinical effects were compared between the two groups.
ResultsAll the patients in the video-assisted thoracoscopy group completed thoracoscopy without conversion to thoracotomy. The surgery duration and postoperative intubation time were shorter in the video-assisted thoracoscopy group than those in the thoracotomy group (surgery duration:103.00±53.04 min vs. 127.06±51.60 min, P<0.01; postoperative intubation time 3.02±0.83 d vs. 3.94±1.25 d, P<0.01). At the end of 6 months of follow-up, the forced expiratory volume in one second (FEV1>) was 2.83±0.64 L in the thoracos-copy group and 2.25±0.64 L in the thoracotomy group (P<0.01); forced vital capacity (FVC) was 3.02±0.72 L in the thora-coscopy group and 2.57±0.79 L in the thoracotomy group (P<0.05); and maximal voluntary ventilation (MVV) was 93.90± 15.86 L in the thoracoscopy group and 80.34±17.06 L in the thoracotomy group (P<0.01).
ConclusionThoracoscopic surgery is feasible for patients with encapsulated pleurisy within 3 months of onset. Furthermore video-assisted thoraco-scopy will be superior to thoracotomy.
ObjectiveTo explore and analyze the risk factors of pleural invasion in patients with small nodular type stage ⅠA pulmonary adenocarcinoma.MethodsFrom June 2016 to December 2017, 168 patients with small nodular type stage ⅠA pulmonary adenocarcinoma underwent surgical resection in the First Affiliated Hospital of Nanjing Medical University. There were 59 males and 109 females aged 58.7±11.5 years ranging from 28 to 83 years. The clinical data were analyzed retrospectively. Single factor Chi-square test and multivariate logistic regression were used to analyze the independent risk factors of pleural invasion.ResultsAmong 168 patients, 20 (11.9%) were pathologically confirmed with pleural invasion and 148 (88.1%) with no pleural invasion. Single factor analysis revealed significant differences (P<0.05) in nodule size, nodule status, pathological type, relation of lesion to pleura (RLP), distance of lesion to pleura (DLP), epidermal growth factor receptor (EGFR) mutation between patients with and without pleural invasion in stage ⅠA pulmonary adenocarcinoma. Logistic multivariate regression analysis showed that significant differences of nodule size, nodule status, RLP, DLP and EGFR mutation existed between the two groups (P<0.05), which were independent risk factors for pleural invasion.ConclusionImageological-pathological-biological characteristics of patients with small nodular type stage ⅠA pulmonary adenocarcinoma are closely related to pleural invasion. The possibility of pleural invasion should be evaluated by combining these parameters in clinical diagnosis and treatment.
