Four hundred and eighty two paients suffering from intrahepatic bile duct stone undergoing lobectomy and segmental resection (from 1975 to 1994,9) has reported. 63% of the patient in this group underwent 1-5 operations, including different types of biliary-intestinal anastomosis (21.6%). 482 cases underwent different types of hepatectomy, including left lateral-lobetomy 321 cases (66.6%),left hemihepatectomy 80 cases(16.6%), right hemihepatectomy 19 cases (3.9%), and multiple segmental resections 39 cases (8.1%, including Ⅴ+Ⅷ 11 cases, Ⅵ+Ⅶ 28 cases). Other type hepatectomy combined with guadrate lobectomy 20 cases (4.1%). Postoperative complication rate was 10.2%, including diliary fistula. hemobilia and subdiaphragmatic and resectional surface infectioin, 85% of the patients were followed up with an excellent result of 88%. The authors emphsize that hepatic lobectomy nad segmental resection is the core of treatment and selection of operative methods depends on clinical-patholigic types of the disease.
Abstract： Objective To investigate strategies for prevention，early diagnosis，and prompt treatment for acute pulmonary embolism（PE）after video-assisted thoracoscopic surgery（VATS）lobectomy. Methods From January 2007 to November 2010, 1 115 patients with lung cancer underwent VATS lobectomy in the First Affiliated Hospital of Guangzhou Medical College. Among them, 13 patients had acute PE postoperatively, including 6 male patients and 7 female patients with their mean age of 62.3 years（ranging from 42 to 73 years）.All the patients were diagnosed by spiral CT pulmonary artery angiography（SCTPA）, and received anticoagulation therapy with low molecular weight heparin and warfarin. Results The incidence of acute PE after VATS lobectomy was 1.17%（13/1 115）, and the patients with low PE-related early mortality risk accounted for a large proportion（11/13）. There were 12 patients with right-side PE. All the patients’ signs and symptoms were significantly alleviated after administration of anticoagulation therapy. Nine patients received SCTPA review after treatment which showed that their PE had disappeared or been significantly absorbed. No hematological complications including thoracic hemorrhage or wound errhysis occurred after treatment. All surviving patients were followed up for 1 month to 3 months. During follow-up, these patients were alive without PE recurrence. Conclusion SCTPA is the first-choice examination for the diagnosis of acute PE after VATS lobectomy. Prophylaxis against PE and prompt treatment are necessary depending on individual manifestations. VATS lobectomy should be favored as a minimally invasive surgical treatment for patients with lung cancer, for the low incidence of postoperative PE and low PE-related early mortality risk.
Treatment of Non-small Cell Lung Cancer by Single-direction Four-hole Complete Video-assisted Thoracoscopic Lobectomy HUANG Jia, ZHAO Xiao-jing, LIN Hao, TAN Qiang, DING Zheng-ping, LUO Qing-quan. (Shanghai Lung Tumor Clinical Medical Center, Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai 200030, P. R. China) Corresponding author：LUO Qing-quan, Email：luoqingquan@hotmail. com Abstract： Objective To explore the feasibility and safety of single-direction four-hole video-assisted thoracoscopic lobectomy in the treatment of non-small cell lung cancer (NSCLC). Methods Between January 2007 and December 2010, 428 patients with NSCLC were surgically treated by single-direction complete video-assisted thoracoscopic lobectomy in Shanghai Chest Hospital. There were 186 males and 242 females; aged 33 to 78 years. All the patients were diagnosed as primary NSCLC at early clinical stage. Among the 428 patients, 134 patients underwent right upper lobectomy, 48 patients underwent right middle lobectomy, 98 patients underwent right lower lobectomy, 4 patients underwent right middle and lower lobectomy, 72 patients underwent left upper lobectomy, and 72 patients underwent left lower lobectomy. All the 428 patients were divided into two groups according to their surgical approach：a three-hole group (300 patients) and a four-hole group (128 patients).The clinical results of the two groups were analyzed. Results A total of 412 patients underwent complete video-assisted thoracoscopic lobectomy, and 16 patients (3.7%) underwent conversion to open surgery. The average operation time was 132.1 (120-180) min, average length of incision was 3.7 (3-5) cm, and average blood loss was 150.0 (50-800) ml. There was no statistical difference in extubation time, intraoperative blood loss, and postoperative hospital stay between the two groups. But the operation time of the four-hole group is significantly shorter than that of the three-hole group （P＜0.05）. The 16 patients who underwent conversion to open surgery received intraoperative blood transfusion. Five patients died of severe pulmonary infection, pulmonary embolism, and acute cerebral infarction. Fifty two patients had squamous cancer, 340 patients had adenocarcinoma, 20 patients had adenosquamous carcinoma, 8 patients had poorly differentiated carcinoma, 6 patients had big cell lung cancer, and 2 patients had carcinoid. Postoperative persistent lung air leak occurred in 4 patients, thoracic empyema in 2 patients, pulmonary infection in 4 patients, arrhythmia in 26 patients, pulmonary embolism in 2 patients, chylothorax in 2 patients, and acute cerebral infarction in 2 patients. The overall 3-year survival rate was 83.6%（358/428）. Conclusion Single-direction four-hole complete video-assisted thoracoscopic lobectomy is feasible, safe and consistent with the operation standard in the surgical treatment for NSCLC patient. It is also helpful to reduce the operation time and facilitate lymph node dissection. Key words： Video-assisted thoracoscopic surgery； Lobectomy； Single-direction； Four-hole； Non-small cell lung cancer
Objective To investigate the application and techni ques of endoscop ic linear stapling device in complete video-assisted thoracoscopic lobectomy, a n d to improve the safety and quality of the operation. Methods From September 2006 to January 2008,sixty consecutive complete video-assisted thoracoscopic lo b ectomies were performed. The patients include 30 men and 30 women with average a ge of 59.8 years old. Eight patients suffered from benign lung lesions, and 52 p atients suffered from primary lung cancers or other pulmonary malignancy. The op erations were performed under general anesthesia with doublelumen intubation a nd complete thoracoscopy.The procedures include 12 right upper lobectomies, 10 right middle lobectomies, 14 right lower lobectomies, 8 left upper lobectomies a nd 16 left lower lobectomies. All arteries, veins, bronchus involved were manag ed with endoscopic linear stapling devices. Results All the pr ocedures were successful with one conversion case（1.67%） due to tense lymph no des adhesion, no severe complications, as active bleeding, continuous air leak, foreign body reac tion or operation related death occured. Endoscopic linear stapling devices were used for stapling in 381 different procedures with average of 6.35 per case, am ong which 124 (2.06 per case)were for pulmonary arteries, 66(1.10 per case) for pulmonary veins, 60 for lobar bronchus and 131 for interlobar fissures.A period of 11.3 months (2-18 months) follow-up of all patients shows no dela yed bleeding, bronchialpleural fistula, pyothorax or pneumonia. Concl usion The application of endoscopic linear stapling device is one of th e major difficulty in complete video-assisted thoracoscopic lobectomy. Careful manipulation under some specific principles is the key for the security of the operation.
Abstract： Objective To evaluate the safety, feasibility, and clinical outcome of complete video-assisted thoracoscopic surgery （VATS） lobectomy for patients with early-stage non-small cell lung cancer （NSCLC）. Methods We retrospectively analyzed the clinical data of 160 consecutive patients（the VATS group, 83 males and 77 females with average age at 60.8 years）with early-stage NSCLC who underwent complete VATS lobectomy between January 2005 andDecember 2008 in Zhongshan Hospital of Fudan University，and compared them with 357 patients（the thoracotomy group, 222 males and 135 females with average age at 59.5 years）who underwent open thoracotomy in the same period. Results The conversion rate of the VATS group was 5.0%（8/160）. The operation time of the VATS group was significantly shorter than that of the thoracotomy group（113.0 min vs.125.0 min, P=0.039）. Length of postoperative hospital stay was not statistically different between the two groups（10.3±4.3 d vs.9.1±4.6 d，P=0.425）. The postoperative morbidity of the VATS lobectomy group and the thoracotomy group was 9.4%（15/160）and 10.1% （36/357） respectively，and the postoperative mortality of the two groups was 0.6%（1/160）and 2.0%（7/357）respectively. There was no statistical difference in the mean group of lymph node dissection （2.4±1.5 groups vs.2.4±1.7 groups，P=0.743） and the mean number of lymph node dissection （9.8±6.3 vs.10.1±6.4，P=0.626） between the two groups. The overall 5-year survival rate of the VATS group was significantly higher than that of the thoracotomy group （81.5% vs.67.8%, P=0.001）. Subgroup analysis showed that the 5-year survival rate of pⅠa stage, pⅠb stage, and pⅢa stage was 86.0%, 84.5%, and 58.8% respectively in the VATS group, and 92.9%, 76.4%, and 25.3% respectively in the thoracotomy group. Conclusion Complete VATS lobectomy is technically safe and feasible for patients with early-stage NSCLC. The lymph node dissection extension of complete VATS lobectomy is similar to that of open thoracotomy, and long-term outcome of complete VATS lobectomy is superior to that of open thoracotomy. Randomized controlled trials of large sample size are further needed to demonstrate superiority.
Objective To investigate the security and feasibility of silk ligating for pulmonary artery in video-assisted thoracoscopic lobectomy, and to summarize the clinical skills. Methods We retrospectively analyzed the clinical data of 68 patients underwent the video-assisted thoracoscopic lobectomy from April 2013 to March 2015. There were 49 males and 19 females with the mean age of 59.6±10.3 years, ranging from 38 to 76 years. We divided the patients into an ECR60W cut-up group (31 patients) and a silk ligation group (37 patients). There were 22 males and 9 females patients with the average age of 59.3±9.9 years with ECR60W. There were 27 males and 10 females patients with the average age of 59.9±10.5 years with silk ligation. We observed the effect of hemostasis, and analyzed the amount of bleeding loss during operation, postoperative suction drainage and the cost of operation material between the two groups. Results There were 4 patients out of 68 converted to the open lobectomy, and all of them used ECR60W. The application of silk ligation for pulmo-nary artery could effectively control bleeding loss and avoid massive amount of bleeding due to the vascular tear in opera-tions. Furthermore, the application can reduce the rate of severe complications such as massive bleeding resulting from postoperative silk ligation slippage. There was a statistical difference between the two groups on the cost of operation mate-rials (P < 0.01). Conclusions Silk ligation for pulmonary artery in video-assisted thoracoscopic lobectomy is simple and prac-tical to apply. Compared with the ECR60W, it can significantly reduce the cost of operation material. It's worth to popularize in clinic.
Abstract: Objective To evaluate the impact of shortterm preoperative pulmonary rehabilitation (PR) on the exercise capacity of lung cancer patients with moderate to severe chronic obstructive pulmonary disease（COPD）. Methods Between March 2009 and August 2010, 30 lung cancer patients with moderate or severe COPD were treated with preoperative comprehensive PR for two weeks in Department of Thoracic Surgery, West China Hospital. The sample was comprised of 18 males and 12 females with an average age of 62.5±7.7 years. Twelve of the patients had moderate COPD, while 18 had severe COPD. We collected information on the length of postoperative hospital stay for each patient,as well as any pulmonary complications. Results (1) The forced expiratory volume in one second (FEV1), forced expiratory volume in one second % (FEV1%), forced expiratory volume in/ forced vital capacity (FEV1/FVC),and maximal ventilatory volume (MVV) (1.30±0.30 L, 59.19±18.00 L, 47.74±1200 L, 56.63±13.00 L) values after PR were slightly better than those before PR(1.24±0.40 L, 51.89±14.00 L, 46.59±10.00 L, 49.67±13.00 L), but not significantly so(Pgt;0.05). The results for carbon monoxide diffusion capacity were similar. (2) The sixminute walking distance (before: 502.67±157.00 m, after: 594.87±116.00 m), peak expiratory flow (before: 209.33±66.00 L/min, after: 255.33±70.00 L/min), dyspnea index (Borg index) (before: 0.26±0.20, after: 0.12±0.10), and fatigue index (before:0.24±0.20, after: 0.12±0.10) all improved significantly aftercomprehensive PR (Plt;0.05). (3) All 30 patients underwent surgery, and none died during the perioperative period. Eight patients experienced cardiopulmonary complications. The average hospitalization time after surgery was 8.0±2.4 days. Conclusion Preoperative comprehensive PR appears to significantly improve exercise capacity and reduce the rate of postoperative lung complications in lung cancer, patients with lower cardiopulmonary function.
Abstract： Air leak is still a common postoperative complication after selective lobectomy. The majority of patients undergoing lobectomy have some risk factors of postoperative air leak or persistent air leak. Nowadays，preventive measures of postoperative air leak mainly include preoperative, intraoperative （surgical technique，reinforcement material，pleural cavity reduction），and postoperative （pleurodesis，chest drainage management） strategies. Many of these new measures have been applied in clinical practice with satisfactory outcomes.
Objective To evaluate clinical outcomes of complete video-assisted thoracoscopic surgery （VATS） lobectomy for patients with peripheral lung cancer.?Methods?We retrospectively analyzed clinical data of 90 consecutive patients with peripheral lung cancer who underwent complete VATS lobectomy from July 2009 to December 2011 in Provincial Hospital Affiliated to Anhui Medical University. There were 55 male patients and 35 female patients with their age of 33-79 （62.5 ±11.5） years. Lymph node dissection group and number, operation time, intraoperative blood loss, length of postoperative chest drainage, length of postoperative hospitalization, postoperative morbidity and pain score were analyzed.?Results?There was no hospital death in this group. Operation time was 135.0±32.5 min, intraoperative blood loss was 230.0±80.4 ml, length of postoperative chest drainage was 4.8±2.1 days, and pain score on the third postoperative day was 5.3±1.2. A total of 520 groups and 1 568 lymph nodes were dissected during the operation, with 5.8 groups and 17.4 lymph nodes dissected in each patient. There were 71 groups with lymph node metastasis, a positive rate of 13.7% （71/520）. Postoperatively, 2 patients had hoarseness and 3 patients had chylothorax, who were all cured after proper treatment. Ninety patients were followed up for 1-24 months. During follow-up, 4 patients died of tumor metastasis, and other patients were all alive with good quality of life.?Conclusion?Complete VATS lobectomy is a minimally invasive technique for patients with peripheral lung cancer with better postoperative recovery and reduced pain level. The safety and degree of radical resection of complete VATS lobectomy is similar to those of routine thoracotomy lobectomy. Complete VATS lobectomy can be recommended as a surgical treatment for patients with peripheral lung cancer.
ObjectiveTo investigate the feasibility,safety and short-term clinical outcomes of complete videoassisted thoracoscopic surgery (VATS) lobectomy for patients with early-stage lung cancer (LC). MethodsClinical data of 138 consecutive patients with early-stage LC who underwent lobectomy in the First People's Hospital of Jining from January 2012 to May 2013 were retrospectively analyzed. There were 71 patients undergoing complete VATS lobectomy including 39 male and 32 female patients with their age of 57.9±10.6 years (VATS group) and 67 patients undergoing lobectomy via traditional thoracotomy including 36 male and 31 female patients with their age of 60.3±8.2 years (thoracotomy group). Operation time,intraoperative blood loss, groups and number of lymph node dissection,thoracic drainage duration, postoperative hospital stay,vision analogue scores (VAS) on the 1st,3rd and 30th postoperative day, and postoperative morbidity were compared between the 2 groups. ResultsAll the patients in both groups success fully received their operation. Intraoperative blood loss (147±113 ml vs. 146±91 ml) number of lymph node dissection (9.9±3.6 vs. 10.0±3.6) group of lymph node dissection (3.1±1.3 vs. 3.4±1.3) and VAS on the 1st and 3rd postoperative day of VATS group were not statistically different from those of the thoracotomy group (P>0.05). Operation time (119±27 minutes vs. 135±29 minutes) thoracic drainage duration (3.0±0.9 days vs. 3.8±1.2 days) postoperative hospital stay (8.0±2.1 days vs. 10.2±5.4 days) VAS on the 30th postoperative day (2.6±0.7 vs. 3.2±1.1) and postoperative morbidity (8.5% vs. 19.4%) of VATS group were significantly shorter or lower than those of the thoracotomy group (P<0.05). Fifty-nine patients in VATS group and 58 patients in the thoracotomy group were followed up for 2-18 months after disc harge. During follow-up,there was no death in either group. There was 1 patient with brain metastasis,1 patient with liver metastasis,and 2 patients with bone metastasis. ConclusionComplete VATS lobectomy is safe and feasible for the treatment of early LC with the advantages of minimal invasiveness,less morbidity,better postoperative recovery and less chronic incision pain. Complete VATS lobectomy can also achieve similar standardization of lymph node dissection as routine thoracotomy.