Objective
To observe the short-term efficacy and the incidence of adverse cardiovascular events in patients aged over 80 years with multivessel coronary artery disease following two-stage Hybrid surgery.
Methods
We retrospectively analysed the clinical data of 67 patients aged over 80 years with multivessel coronary artery disease undergoing surgery in our hospital. The were 44 males and 23 females with an anverage age of 82.4±2.1 years. According to the operation pattern, the patients were divided into two groups: a two-stage Hybrid surgery group (n=29, 19 males, 10 females, aged 83.2±3.1 years) and a traditional thoracotomy group (n=38, 25 males, 13 females, aged 83.3±3.4 years). We compared the clinical results of perioperation between the two groups.
Results
Conpared with the traditional thoracotomy group, the two-stage Hybrid surgery group had shorter postoperative duration of mechanical ventilation (6.7±2.2 hvs. 18.2±3.4 h) and hospitalization stay (15.7±3.0 dvs. 20.7±5.6 d) and had less volume of chest drainage during the first 24 h after surgery (176.5±32.3 mlvs. 443.8±51.5 ml). The incidence of adverse cardiovascular events in the two-stage Hybrid surgery group was significantly lower than that in the traditional thoracotomy group (6.9%vs. 23.1%, P<0.05).
Conclusion
The two-stage Hybrid surgery in patients aged over 80 years with multivessel coronary artery disease can significantly decrease the postoperative incidence of adverse cardiovascular events, shorten the postoperative duration of mechanical ventilation and hospitalization stay, reduce the volume of chest drainage during the first 24 h after surgery and improve prognosis of surgery for the elderly patients.
Objective To investigate the perioperative differences between video-assisted thoracoscopic surgery (VATS) and thoracotomy after neoadjuvant therapy in patients with non-small cell lung cancer (NSCLC). Methods Clinical data of NSCLC patients who underwent VATS or thoracotomy after neoadjuvant therapy at Shanghai Pulmonary Hospital from June 2020 to May 2022 were retrospectively collected. Perioperative outcomes were compared between the two groups. Results A total of 260 patients were enrolled, 184 (70.8%) patients underwent VATS and 76 (29.2%) patients underwent thoracotomy. After propensity matching, there were 113 (62.4%) patients in the VATS group and 68 (37.6%) patients in the thoracotomy group. VATS had similar lymph node dissection ability and postoperative complication rate with thoracotomy (P>0.05), with the advantage of having shorter operative time (146.00 min vs. 165.00 min, P=0.006), less intraoperative blood loss (50.00 mL vs. 100.00 mL, P<0.001), lower intraoperative blood transfusion rate (0.0% vs. 7.4%, P=0.003), less 3-day postoperative drainage (250.00 mL vs. 350.00 mL, P=0.011; 180.00 mL vs. 250.00 mL, P=0.002; 150.00 mL vs. 235.00 mL, P<0.001), and shorter postoperative drainage time (9.34 d vs. 13.84 d, P<0.001) and postoperative hospitalization time (6.19 d vs. 7.94 d, P=0.006). Conclusion VATS after neoadjuvant therapy for NSCLC is safer than thoracotomy and results in better postoperative recovery.
Objective To compare clinical outcomes and safety between minimally invasive mitral valve replacement via right minithoracotomy （mini-MVR） and traditional mitral valve replacement （MVR）. Methods Clinical data of 68 patients with valvular heart diseases who underwent mini-MVR from February 2009 to December 2011 in Wuhan Asia Heart Hospital were retrospectively analyzed. There were 36 males and 32 females in this mini-MVR group with their mean age of 34.2±11.2 years. Preoperatively， there were 21 patients with mitral stenosis （MS）， 17 patients with mitral insufficiency （MI）， 30 patients with MS and MI， and 19 patients with tricuspid insufficiency （TI）. Another 200 patients with valvular heart diseases who underwent traditional MVR during the same period were included as the control group. There were 86 males and 114 females in the control group with their mean age of 49.4±13.2 years. Preoperatively， there were 85 patients with MS， 66 patients with MI， 49 patients with MS and MI， and 76 patients with TI. Hospital mortality， aortic crossclamp time， length of intensive care unit （ICU） stay， postoperative chest tube drainage， reexploration for bleeding and postoperative morbidities were compared between the two groups. Results There was no in-hospital death in the mini-MVR group. There was no statistical difference in hospital mortality， cardiopulmonary bypass time， incidence of reexploration for bleeding， postoperative arrhythmias， dialysis-requiring acute renal failure and wound infection between the two group （P＞0.05）. Aortic crossclamp time of the mini-MVR group was significantly longer than that of the control group. But postoperative mechanical ventilation time （10.2±3.1 h vs. 15.2±7.1 h， P=0.008）， chest tube drainage（92.0±28.0 ml vs. 205.0±78.0 ml， P=0.000）， blood transfusion （0.8±1.6 U vs. 1.9±2.1 U， P=0.006）， length of ICU stay （14.0±8.0 h vs. 26.0±12.0 h， P=0.003） and length of hospital stay （14.8±4.6 d vs. 19.7±3.2 d， P=0.006）of the mini-MVR group were significantly shorter or less than those of the control group. Conclusion The safety of mini-MVR is comparable to that of traditional MVR without causing higher postoperative morbidities， while the postoperative recovery after mini-MVR is better than traditional MVR.
We reported a case of a six-year-old boy diagnosed of single ventricle, pulmonary atresia and interrupted inferior vena cava. After modified Blalock-Taussig shunt and bidirectional Glenn procedure, he received the Fontan procedure. The Fontan procedure was done through a unilateral thoracotomy, using an autologous pericardial conduit to connect hepatic vein and azygos vein. The result of short-term follow-up was satisfactory.
ObjectiveTo analyze the safety and follow-up results of on-pump coronary artery bypass grafting (CABG) for the treatment of multivessel diseases via left anterolateral minithoracotomy.MethodsFrom January 2018 to March 2020, a total of 30 patients including 18 males and 12 females with an average age of 61.3±7.5 years having multivessel coronary heart diseases were treated in our hospital with on-pump CABG via left anterolateral minithoracotomy. Among them, 14 patients had three-vessel diseases and 16 patients had two-vessel diseases.ResultsThere were 29 internal mammary artery-to-left anterior descending bypass grafts harvested in total while the rest were saphenous-vein bypass grafts. The average number of bypass vessels was 2.3±0.5. There was no perioperative death in the whole group, one patient underwent rethoracotomy due to hemorrhage, and one patient suffered acute renal insufficiency. The average time of postoperative tracheal intubation was 16.0±5.8 hours, and the postoperative ICU stay was 30.1±11.5 hours. Twenty five patients were followed up, including coronary CT angiography examinations at 6 months and 1 year after operation. Proximal anastomotic stenosis in one patient and distal anastomosis occlusion in one patient occurred.ConclusionOn-pump CABG via left anterolateral minithoracotomy is safe for appropriately selected patients.
Objective To summarize the experience of surgical treatment of congenital heart diseases through right axillary mini-thoracotomy and analyse related problems. Methods Two hundred and twenty-four patients of congenital heart diseases underwent open heart surgery under cardiopulmonary bypass （CPB） through a right axillary mini-thoracotomy（3rd or 4th intercostal）. Among them repair of ventricular septal defect （VSD） in 168, repair of atrial septal defect （ASD） in 48, total correction of tetralogy of Fallot （TOF） in 6, double-outlet right ventricular in 1 and Ebstein syndrome in 1. Results There was 1 postoperative death （0.45%）, the cause of death was acute pulmonary edema. Postoperative complication occurred in thirteen cases （5.8%）. There were no significant changes in CPB time, aortic cross clamping time, ventilating time and hospital stay days between right axillary minithoracotomy and median sternotomy at the same period （Pgt;0. 05）, but the bleeding volume both intraoperative and postoperative in the patients of right axillary mini-thoracotomy were significantly less than those in the patients of median sternotomy （Plt;0. 01）. Two hundred and fourteen patients were followed up （follow-up time from 2 months to 7 years）, 3 of them had early mild cardiac function insufficiency（ejection fractionlt;0. 50）, small residual shunt were found in 2 patients after VSD operation and the others recovered satisfactorily. Conclusion There were merits in right axillary mini-thoracotomy approach for treatment of properly selected congenital heart diseases; safe and reliable, low operative bleeding volume, and good results of aesthetics. But the use of this incision for repair of TOF and more complex congenital heart diseases should be careful.
ObjectiveTo investigate therapeutic effect and influence on survival of complete laparoscopic transesophageal hiatus approach approach and transabdominal combined thoracotomy approach in treatment of Siewert type Ⅱesophageal gastric junction adenocarcinoma (AEG).MethodsFrom January 2012 to December 2014, the patients with Siewert type Ⅱ AEG were collected in the Department of General Surgery (Gastrointestinal Surgery) of Weifang People’s Hospital, then who were designed into a transabdominal group and transabdominal combined thoracotomy group according to the operative approach method. The intraoperative and postoperative statuses were compared between these two groups.ResultsIn this study, 142 patients with Siewert type Ⅱ AEG were included, 83 in the transabdominal group and 59 in the transabdominal combined thoracotomy group. There were no significant differences in the baseline data such as the gender, age, preoperative histological differentiation, TNM stage, etc. between the two groups (P>0.05). Compared with the transabdominal combined thoracotomy group, in terms of the operation time, the volumes of intraoperative blood loss and blood transfusion, and the proportion of patients with blood transfusion were better (P<0.05); the postoperative hospitalization time, time to use analgesics, time of the first activity out of bed, and time of removed electrocardiographic monitoring were also earlier (P<0.05); the numbers of lymphadenectomy and metastatic lymph nodes were less (P<0.05) in the transabdominal group. But there was no significant difference in the rate of lymph node metastasis between the two groups (P>0.05). The total incidence of complications in the transabdominal group was lower than that in the transabdominal combined thoracotomy group (χ2=9.871, P=0.002). The median survival time was 39 months in the transabdominal group and 34 months in the transabdominal combined thoracotomy group. The survival had no significant difference between the two groups by the Kaplan-Meier analysis (χ2=0.281, P=0.596). The result of multivariate analysis showed that the TNM stage and lymph node positive rate were the independent factors influencing the survival of the patients with Siewert type Ⅱ AEG.ConclusionsAccording to results of this study, it is safe and effective for patients with Siewert type Ⅱ AEG to adopt a complete laparoscopic transabdominal approach. For elderly patients with poor cardiopulmonary function who can not tolerate transthoracic surgery, it could reduce postoperative complications and improve safety.
Objective
To explore the risk factors and short-term clinical effect of conversion to open thoracotomy during thoracoscopic lobectomy for lung cancer patients.
Methods
We retrospectively analyzed the clinical data of 423 lung cancer patients who were scheduled for thoracoscopic lobectomy between March 2011 and November 2015.There were 252 males and 171 females at median age of 60 (24-83) years. According to the patients who were and were not converted to thoracotomy, they were divided into a conversion group (378 patients) and a video-assisted thoracic surgery group (a VATS group, 45 patients). Then, clinical data of two groups were compared, and the risk factors and short-term clinical effect of unplanned conversions to thoracotomy were analyzed.
Results
Lymph nodes of hilar or/and interlobar fissure closely adhered to adjacent vessels and bronchi was the most common cause of unexpected conversions to thoracotomy in 15 patients (33.3%), followed by sleeve lobectomy in 11(24.4%) patients, uncontrolled hemorrhage caused by intraoperative vessel injury in 8 patients, tumor invasion or extension in 5 patients, difficulty of exposing bronchi in 3 patients, close adhesion of pleural in 2 patients, incomplete interlobar fissure in 1 patient. Conversion did translate into higher overall postoperative complication rate (P=0.030), longer operation time (P<0.001), more intraoperative blood loss (P<0.001). In the univariable analysis, the type of operation, the anatomical site of lung cancer, the lymph node enlargement of hilar in CT and the low diffusion capacity for carbon monoxide (DLCO) were related to conversion. Logistic regression analysis showed that the independent risk factors for conversion were sleeve lobectomy (OR=5.675, 95%CI 2.310–13.944, P<0.001), the lymph node enlargement of hilar in CT (OR=3.732, 95%CI 1.347–10.341, P=0.011) and DLCO≤5.16 mmol/(min·kPa)(OR=3.665, 95%CI 1.868–7.190, P<0.001).
Conclusions
Conversion to open thoracotomy during video-assisted thoracic surgery lobectomy for lung cancer does not increase mortality, and it is a measure of reducing the risk of surgery. Therefore, with high-risk patients who may conversion to thoracotomy, the surgeon should be careful selection for VATS candidate. And, if necessary, the decision to convert must be made promptly to reduce short-term adverse outcome.
ObjectiveTo explore the early outcomes of the surgical treatment for patent ductus arteriosus (PDA) combined with intracardiac abnormities via right vertical infra-axillary thoracotomy (RVIAT).MethodsA total of 7 children with PDA combined with intracardiac defects underwent surgery through RVIAT at the Second Affiliated Hospital of Nanjing Medical University from 2016 to 2018. There were 4 males and 3 females, with an average age of 5.3±4.5 years and weight of 18.0±11.2 kg.ResultsIn all patients, PDA was ligated before the repair of intracardiac abnormities. No patient died in hospital. All patients were followed up, with a mean follow-up time of 18.0±8.0 months. No other complications such as residual shunts, arrhythmias, hemorrhaging or wound infection occurred after operations or during the follow-up period.ConclusionRVIAT is an emerging technique used for the surgical repair of PDA combined with intracardiac defects. It yields satisfying cosmetic results, without increasing postoperative complications or mortality.
Abstract: Objective To investigate the feasibility of the diagnosis and treatment of pleurallung diseases by minithoracotomy and videoassisted thoracic surgery(VATS) under local anesthesia. Methods From February 2002 to March 2005,30 cases were performed by thoracotomy under local anesthesia,which were divided into two groups including minithoracotomy group and VATS group according to the different approaches; inithoracotomy group was used just for the biopsy of thicken pleura and diffuse pulmonary diseases on the state of open pneumothorax, and VATS group was for the diagnosis and treatment of malignant effusion and recurrent pneumothorax on the state of closed pneumothorax,all of them were ompleted under local anesthesia. Results Minithoracotomy group: biopsy of pleura were performed on 13 cases, 10 cases of which has been diagnosed with metastasis, one case was amyloidosis of pleura, two cases were proliferation of pleura.Three cases on diffuse pulmonary diseases were done for biopsy, 2 of which were pulmonary interstitial fibrosis, 1 of which was pulmonary tuberculosis (type Ⅱ). VATS group: Except one was converted to general anesthesia and minithoracotomy to resect the lesion due to heavy pleural adhesion, other patients who had thicken pleura and diffuse pulmonary diseases were performed operation for biopsy, bullarectomy was done on recurrent pneumothorax,and pleurodesis was done on ntractable pleuaral effusion under local anesthesia. 4 cases on pleural effusion were done by diagnostic thoracoscope under local anesthesia, 1 of which was liverrelated pleural effusion. 14 cases has been done by remedial thoracoscope, 8 cases of which malignant pleural effusion were done for pleurodesis, the other cases which have recurrent pneumothorax were given bullaectomy and pleurodesis. Spontaneous breathing and hemodynamics was maintained well during the operation. There was neither severe complication nor mortality in two groups. Conclusion Videoassisted thoracoscopic resection of peripheral pulmonary nodule and biopsy of pleura through minithoracotomy can be performed safely under local anesthesia. The novel approach will be the cost-effective procedure for management of pulmonary nodules in the present time.
