ObjectiveTo investigate the safety, feasibility and advantages of subxiphoid uni-portal thoracoscopic thymectomy.MethodsClinical data of 65 patients undergoing subxiphoid uni-portal thoracoscopic thymectomy in our hospital from September 2018 to March 2019 were retrospectively analyzed. They were treated as a subxiphoid surgery group, including 36 males and 29 females, aged 49.5 (29-71) years. The incision with the length of about 3 cm was located approximately 1 cm under the xiphoid process. From January 2016 to December 2017, 65 patients received intercostal uni-portal thoracoscopic thymectomy, who were treated as a control group, including 38 males and 27 females, aged 48.9 (33-67) years. All patients who were clinically diagnosed with thymic tumor before surgery were treated with total thymectomy. After surgery, expectoration and analgesia were used.ResultsThere was no statistically significant difference in general clinical data, lesion size, intraoperative blood loss, postoperative catheterization time, postoperative hospital stay and postoperative pathology between the two groups. All operations were successfully completed, and the patients in both groups recovered uneventfully after surgery. Visual analogue scale scores on the 1st, 3rd, 7th and 30th day after surgery in the subxiphoid surgery group were lower than those in the control group.ConclusionThe subxiphoid uni-portal thoracoscopic approach can achieve total thymectomy with less trauma and faster postoperative recovery.
ObjectiveTo compare clinical effect of percutaneous radiofrequency ablation (RFA) and open repeated hepatectomy (ORH) in treatment of liver cancer with late recurrence (recurrence time >12 months) and single tumor diameter ≤5 cm.MethodsThe patients with advanced intrahepatic recurrence after first operation for liver cancer in this hospital from January 2013 to December 2019 were retrospectively collected, who were treated with ORH (ORH group) or percutaneous RFA (RFA group) and met the inclusion criteria. The overall survival rate and disease-free survival rate of the two groups were compared after 1∶1 matching by propensity score matching (PSM), while the factors affecting survival were stratified.ResultsA total of 244 patients with recurrent liver cancer were collected, including 134 patients in the ORH group, 110 patients in the RFA group. The patients in the two groups were matched with 1∶1 by PSM, 90 patients in each group. The median overall survival time of the ORH group and the RFA group was 54 months and 45 months, respectively. There were no significant differences in the curves of cumulative overall survival and cumulative disease-free survival between the two groups (P=0.221, P=0.199). The incidence of severe complications in the ORH group was higher than that in the RFA group (10.00% versus 2.22%, P=0.029). A further subgroup analysis showed that the overall survival time of the ORH group was longer than that of the RFA group when the diameter of recurrent liver cancer was 3 to 5 cm (P=0.035), which had no significant differences for the patients with AFP (>400 μg/L or ≤400 μg/L), tumors number (single or multiple), and tumor diameter ≤3 cm between the two groups (P>0.05).ConclusionsPercutaneous RFA is effective and safe in treatment of advanced recurrent liver cancer, its overall survival and disease-free survival are similar to ORH treatment. However, when diameter of recurrent tumor is3–5 cm, ORH treatment has a advantage in prolonging survival time of patients.
ObjectiveTo evaluate the short- and mid-term outcomes of sequential anastomosis and simple anastomosis of saphenous vein in off-pump coronary artery bypass grafting.MethodsThe clinical data of 438 patients who underwent sequential anastomosis of saphenous vein and 165 patients who underwent simple anastomosis of saphenous vein from 2015 to 2018 in Daxing Teaching Hospital were retrospectively analyzed. After propensity score matching, 130 pairs of patients were included in the sequential anastomosis group [78 males and 52 females, aged 60 (52, 68) years] and simple anastomosis group [80 males and 50 females, aged 61 (52, 70) years]. The short- and mid-term clinical outcomes were compared.ResultsThe two propensity score-matched groups had similar baseline clinical data. No significant difference was found between sequential anastomosis and simple anastomosis groups in the in-hospital outcomes, including in-hospital death (1.5% vs. 1.5%, P=1.000), the incidence of complications (4.6% vs. 6.2%, P>0.05), and the mean flow of grafts (30.0±11.8 mL/min vs. 28.0±9.5 mL/min, P=0.597). The operation time of the sequential anastomosis group was shorter than that of the simple anastomosis group (142.5±21.2 min vs. 186.3±27.6 min, P<0.001). The drainage of the sequential anastomosis group was less than that of the simple anastomosis group (204.7±39.6 mL vs. 271.3±48.3 mL, P<0.001). The follow-up time was 12-60 (28.3±8.9) months, during which the mortality of the two groups was not statistically different (3.2% vs. 4.0%, P=0.796).ConclusionThe saphenous vein sequential anastomosis of saphenous vein is superior to the simple anastomosis. Sequential anastomosis technique can reduce aortic anastomosis, shorten operation time, and reduce bleeding drainage during off-pump coronary artery bypass grafting. The short- and mid- term clinical effects are satisfactory.
ObjectiveTo investigate the effect of intermittent Pringle (IP) and continuous hemi-hepatic vascular inflow occlusion (CHVIO) on the prognosis of patients with hepatocellular carcinoma (HCC) complicated with cirrhosis in laparoscopic liver resection (LLR).MethodsRetrospective analysis of consecutive 107 LLR patients with HCC complicated with liver cirrhosis at West China Hospital of Sichuan University between January 2015 and December 2017 was performed. Patients were divided into an IP group and a CHVIO group according to the method of hepatic vascular occlusion, intraoperative and postoperative outcome indicators and short-term prognosis were compared between the two groups.ResultsPatients in the IP group had shorter operative time [(237+90) min vs (285+118) min, P=0.041] and less blood loss [(279+24) mL vs (396+35) mL, P=0.012], without a significant increase in postoperative liver function [including ALT, AST, TBIL, and ALB], postoperative complications, induced flow, 1-year disease-free survival, and1-year survival (P>0.05).ConclusionsIP can reduce the operative time and blood loss in patients with HCC complicated with cirrhosis in LLR, and will not lead to deterioration of liver function, it is a recommended hepatic inflowocclusion method.
Objective To explore the safety and costs of orthopedic robot-assisted treatment of calcaneal fractures. Methods The data of patients with calcaneal fractures treated by surgery in Beijing Jishuitan Hospital between January 2021 and July 2022 were retrospectively analyzed. Propensity score matching was used to match 1∶4 patients with orthopedic robotic-assisted closed reduction and internal fixation of calcaneal fractures (orthopedic robotic group) and traditional open reduction and internal fixation surgery (traditional surgery group). The safety and costs were compared between the two groups after matching. Results A total of 253 patients were included and divided into orthopedic robotic group (11 cases) and traditional surgery group (242 cases) according to different surgical methods. Before propensity score matching, there was no significant difference in age, gender, diagnosis and comorbidities between the two groups (P>0.05). After propensity score matching, there were 11 patients in the orthopedic robotic group and 44 patients in the traditional surgery group. There was no significant difference in age, gender, diagnosis and comorbidities between the two groups (P>0.05). There was no significant difference in height, weight, body mass index, operation duration, average postoperative pain score, and highest postoperative pain score between the two groups (P>0.05). The intraoperative blood loss [10.0 (10.0, 20.0) vs. 20.0 (20.0, 50.0) mL], total length of hospital stay [(4.5±1.3) vs. (8.7±3.7) d], and postoperative length of hospital stay [(2.3±1.1) vs. (4.5±2.3) d] in the orthopedic robotic group were less than the traditional surgery group (P<0.05). There was no significant difference in the total hospitalization costs, rehabilitation costs, inspection and examination costs between the two groups (P>0.05). The surgical cost of orthopedic robot group [1413.7 (1287.7, 1790.8) vs. 2331.2 (2195.1, 2548.6) yuan], total ward cost [(3154.5±1213.7) vs. (5711.9±2147.4) yuan], ward consumables cost [(1407.0±942.0) vs. (2409.4±1458.2) yuan], ward medication costs [(257.1±146.6) vs. (846.7±525.2) yuan], ward diagnosis and treatment costs [(901.6±366.6) vs. (2010.5±830.6) yuan], nursing care costs [(159.6±46.1) vs. (345.2±174.7) yuan], total postoperative costs [(2370.4±1324.0) vs. (3888.6±1554.9) yuan], postoperative care costs [(105.4±52.2) vs. ( 205.6±128.2) yuan] were lower than the traditional surgery group (P<0.05). Conclusion Orthopedic robot-assisted treatment of calcaneal fractures can effectively reduce intraoperative blood loss, shorten hospitalization time, and have good safety. At the same time, it can reduce operating costs, total ward costs, ward medication costs and nursing costs.
ObjectiveTo explore the clinical efficacy of single-branch intraoperative stent combined with modified bilateral cerebral perfusion in type A aortic dissection. MethodsA retrospective analysis was conducted on the clinical data of patients who underwent surgery for type A aortic dissection at the First Affiliated Hospital of Anhui Medical University from January 2021 to May 2024. Patients were divided into the experimental group (single branch stent combined with modified bilateral cerebral perfusion) and the control group (traditional surgical method, straight stent+unilateral cerebral perfusion) according to the surgical method. Propensity score matching analysis was used to match the two groups of patients with a ratio of 1:1, and the perioperative data and clinical efficacy after matching were compared. ResultsA total of 14 patients were included in the experimental group, including 13 males and 1 female, with an average age of (47.4±16.1) years. There were 56 patients in the control group, including 38 males and 18 females, with an average age of (52.1±11.7) years. After propensity score matching, 14 patients were included in each group. Compared with the control group, the ventilator support time [(27.4±24.3) h vs. (93.4±88.0) h, P=0.018], length of stay in the intensive care unit [(2.8±1.8) d vs. (8.7±6.5) d, P=0.009], and postoperative awakening time [(5.4±2.2) h vs. (8.8±4.8) h, P=0.047] in the experimental group were shorter than those in the control group, with statistically significant differences. ConclusionSingle-branch intraoperative stent combined with modified bilateral cerebral perfusion can effectively shorten ventilator support time, length of stay in the intensive care unit, and postoperative awakening time, and is safe and effective for the treatment of type A aortic dissection, which is worth further promotion.
ObjectiveTo investigate the associations of preoperative red cell distribution width (RDW) with mortality and morbidity in patients underwent liver transplantation. MethodsThis investigation was a retrospective study, the patients underwent liver transplantation met the inclusion criteria from June 2017 to May 2020 in the West China Hospital of Sichuan University were enrolled. The patients were divided into RDW≤14.5% group and RDW>14.5% group according to the normal RDW critical value (14.5%). The propensity score matching (PSM) was used to adjust the baseline characteristics. The primary outcome was 1-year mortality. The secondary outcomes included 1-year survival, 30-day mortality, incidence of early allograft dysfunction, acute kidney injury, renal replacement therapy, and pulmonary complications, as well as ICU stay and postoperative hospital stay. ResultsA total of 303 patients who met the analysis conditions were included. After PSM, 57 patients in each group were matched. There were no significant differences between the two groups in the baseline data such as the gender, age, body mass index (BMI), initial diagnosis, MELD score, Child-Pugh grade of the recipients, and the gender, age, and BMI of the donors (P>0.05). The 1-year [22.8% (13/57) versus 5.3% (3/57), χ2=7.27, P=0.007] and 30-day [15.8% (9/57) versus 3.5% (2/57), χ2=4.93, P=0.026] mortality of the patients with RDW >14.5% were higher than that of the patients with RDW ≤14.5% . The Kaplan-Meier survival curve showed that the 1-year survival of the patients with RDW ≤14.5% after liver transplantation was better than that of the patients with RDW >14.5% [hazard ratio=4.75, 95%CI (1.78, 12.67), P=0.007], but there were no significant differences between the two groups in the incidence of early graft dysfunction, acute renal injury, renal replacement therapy, and pulmonary complications, as well as postoperative hospital stay and ICU stay (P>0.05). ConclusionPreliminary results of this study indicate that preoperative RDW of patients underwent allogeneic liver transplantation is associated with1-year mortality, 30-day mortality, and 1-year survival.
ObjectiveTo investigate the effectiveness and safety of robotic lobectomy in clinical N0 lung malignant tumor≥3 cm. MethodsWe retrospectively analyzed the clinical data of 182 patients with lung malignant tumor≥3 cm receiving robotic or thoracoscopic lobectomy at Shanghai Chest Hospital in 2019. The patients were divided into a robotic surgery group (RATS group) and a thoracoscopic surgery group (VATS group). There were 39 males and 38 females with an average age of 60.55±8.59 years in the RATS group, and 51 males and 54 females with an average age of 61.58±9.30 years in the VATS group. A propensity score matching analysis was applied to compare the operative data between the two groups. ResultsA total of 57 patients were included in each group after the propensity score matching analysis. Patients in the RATS group had more groups of N1 lymph node dissected (2.53±0.83 groups vs. 2.07±0.88 groups, P=0.005) in comparison with the VATS group. No statistical difference was found in operation time, blood loss, postoperative hospital stay, number of N1 and N2 lymph nodes dissected, groups of N2 lymph node dissected, lymph node upstage rate or postoperative complications. The hospitalization cost of RATS was higher than that of VATS (P＜0.001). ConclusionIn contrast with thoracoscopic lobectomy, robotic lobectomy has similar operative safety, and a thorough N1 lymphadenectomy in patients with clinical N0 lung malignant tumor≥3 cm.
ObjectiveTo analyze the incidence of complications, duration of chest tube indwelling, and nutritional status in tuberculosis (TB) patients undergoing pulmonary surgery, and to explore perioperative nutritional management strategies and rehabilitation measures by identifying nutritional factors influencing postoperative chest tube duration. MethodsA retrospective analysis was conducted on clinical data of TB patients who underwent lobectomy at the Department of Thoracic Surgery, Chengdu Public Health Clinical Medical Center from 2022 to 2023. Patients were grouped based on chest tube duration (≤7 days vs. >7 days) and propensity score matching (PSM) was performed. Complications, drainage volume, and nutritional status were compared between groups. Univariate and multivariate logistic regression analyses were used to identify factors associated with prolonged chest tube duration. ResultsAmong 276 enrolled patients, 163 had chest tube duration ≤7 days [pre-PSM: 91 males, 72 females, mean age of (34.88±14.10) years] and 113 had duration >7 days [pre-PSM: 69 males, 44 females, mean age of (39.04±13.28) years]. After PSM (45 patients per group), no significant differences were observed in pleural or pulmonary infection rates between groups (P>0.05). Univariate analysis revealed statistical differences in preoperative albumin-to-globulin ratio (A/G), 24-hour postoperative A/G, 24-hour postoperative prognostic nutritional index (PNI), pre-discharge A/G, and pre-discharge hemoglobin (P<0.05). Multivariate logistic regression identified the following independent risk factors for prolonged chest tube duration: preoperative A/G, 24-hour postoperative A/G, 24-hour postoperative PNI, pre-discharge A/G, and pre-discharge hemoglobin. ConclusionPreoperative A/G, 24-hour postoperative A/G and PNI, and pre-discharge A/G and hemoglobin significantly influence chest tube duration in TB patients. Preoperative nutritional-immunological indicators independently predict prolonged drainage, while dynamic postoperative monitoring provides comprehensive recovery assessment. Integrating these parameters enables early identification of high-risk patients, facilitates personalized drainage management, and may reduce hospitalization duration while improving prognosis.
ObjectiveTo explore the effect of body mass index (BMI) on the outcomes of laparoscopic surgery for esophageal hiatal hernia.MethodsWe divided the patients who underwent hiatal hernioraphy and fundoplication surgery in our hospital between July 2013 and June 2018 into two groups according to the BMI: a group A, BMI ≥24 kg/m2, 77 patients, 41 males, 36 females, with an average age of 42 years; a group B: BMI<24 kg/m2, 63 patients, 38 males, 25 females, with an average age of 67 years, and the age, gender, type of hiatal hernia, score of subjective feeling of symptoms, level of reflux esophagitis were analyzed with the propensity score matching method. Fifty one patients were successfully matched in each group, and the curative effect of surgery was compared between the two groups.ResultsThere was no statistical difference in the type of surgery, intraoperative complications, postoperative complications, and hospital stay between the two groups (P>0.05). The operative time of the group A was significantly longer than that of the group B (P=0.023). There was no statistical difference between the two groups in postoperative recurrence (P=0.741).ConclusionThe operative time in overweight patients is significantly longer than that in the non-overweight patients, but it has no effect on the surgical outcomes and complications.
