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.
ObjectiveTo evaluate the clinical outcomes of sutureless aortic valve replacement (SU-AVR) and transcatheter aortic valve implantation (TAVI) for aortic valve disease. MethodsWe conducted a computer-based search of databases including CNKI, WanFang Data, VIP, CBM, PubMed, The Cochrane Library, EMbase and Web of Science from the inception of the databases to March 2024. Two reviewers independently screened articles, extracted data and used the Cochrane bias risk assessment tool to evaluate the quality of the included studies. Meta-analysis was performed using Stata 18 software. ResultsThe included 17 studies using propensity-matched analysis consisted of 6 630 patients, including 3 319 patients in the SU-AVR group and 3 311 patients in the TAVI group. The SU-AVR group had lower mortality than the TAVI group at 1-year ［RR=0.58, 95%CI(0.38, 0.87), P=0.009］, 2-year ［RR=0.61, 95%CI(0.43,0.85), P=0.004］ and 5-year ［RR=0.63, 95%CI(0.50,0.79), P=0.000］. The SU-AVR group had a significantly lower rate of new permanent pacemaker implantation (PPI) ［RR=0.75, 95%CI(0.58, 0.98), P=0.037］, moderate-to-severe paravalvular leak (PVL) ［RR=0.20, 95%CI（0.12, 0.32）, P=0.000］, myocardial infarction(MI)［RR=0.30, 95%CI (0.11,0.80), P=0.017］, more-than-mild residual aortic regurgitation (AR)［RR=0.29, 95%CI（0.17, 0.48）, P=0.000］. In addition, the SU-AVR group had a higher postoperative mean aortic gradient [SMD=0.39, 95%CI (0.17, 0.62), P=0.000］than the TAVI group. Conclusion The early and mid-term clinical outcomes of SU-AVR were superior compared to TAVI.
Objective To investigate the relationship between preoperative mean daily step counts and pulmonary complications after thoracoscopic lobectomy in elderly patients. Methods From 2018 to 2021, the elderly patients with pulmonary complications after thoracoscopic lobectomy were included. A 1∶1 propensity score matching was performed with patients without pulmonary complications. The clinical data were compared between the two groups. ResultsTotally, 100 elderly patients with pulmonary complications were enrolled, including 78 males and 22 females, aged 66.4±4.5 years. And 100 patients without pulmonary complications were matched, including 71 males and 29 females aged 66.2±5.0 years. There was no significant difference in the preoperative data between the two groups (P>0.05). Compared to the patients with pulmonary complications, the ICU stay was shorter (8.1±4.4 h vs. 12.9±7.5 h, P＜0.001), the first out-of-bed activity time was earlier (8.8±4.5 h vs. 11.2±6.1 h, P=0.002), and the tube incubation time was shorter (19.3±9.2 h vs. 22.5±9.4 h, P=0.015) in the patients wihout pulmonary complications. There was no statistical difference in other perioperative data between the two groups (P>0.05). The mean daily step counts in the pulmonary complications group were significantly less than that in the non-pulmonary complications group (4 745.5±2 190.9 steps vs. 6 821.1±2 542.0 steps, P＜0.001). The daily step counts showed an upward trend for three consecutive days in the two groups, but the difference was not significant. Conclusion The decline of preoperative mean daily step counts is related to pulmonary complications after thoracoscopic lobectomy in elderly patients. Recording daily step counts can promote preoperative active exercise training for hospitalized patients.
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.
Objective To investigate the perioperative clinical effects and follow-up results of minimally invasive coronary artery bypass grafting (MICS CABG) versus conventional coronary artery bypass grafting (CABG) in thoracotomy. Methods The patients who received off-pump CABG in Beijing Anzhen Hospital from January 2017 to October 2021 were collected. Among them, the patients receiving MICS CABG performed by the same surgeon were divided into a minimally invasive group, and the patients receiving median thoracotomy were into a conventional group. By propensity score matching, preoperative data were balanced. Perioperative and postoperative follow-up data of the two groups were compared. Results A total of 890 patients were collected. There were 211 males and 28 females, aged 60.54±9.40 years in the minimally invasive group, and 487 males and 164 females, aged 62.31±8.64 years in the conventional group. After propensity score matching, there were 239 patients in each group. Compared with the conventional group, patients in the minimally invasive group had longer operation time, shorter drainage duration, less drainage volume on the first postoperative day, shorter postoperative hospital stay, and lower rate of positive inotropenic drugs use, while there was no statistical difference in the mean number of bypass grafts, ICU stay, ventilator-assisted time, blood transfusion rate or perioperative complications (P＞0.05). During the median follow-up of 2.25 years, there was no statistical difference in major adverse cardiovascular and cerebrovascular events, including all-cause death, stroke or revascularization between the two groups (P＞0.05). ConclusionReasonable clinical strategies can ensure perioperative and mid-term surgical outcomes of MICS CABG not inferior to conventional CABG. In addition, MICS CABG has the advantages in terms of postoperative hospital stay, postoperative drainage volume, and rate of positive inotropic drugs use.
Objective To investigate the clinical effect of the DaVinci robot system and laparoscopic radical gastrectomy. Methods Propensity score matching and retrospective cohort study were adopted. Data of 446 patients who underwent robotic or laparoscopic radical gastrectomy in the Department of Gastrointestinal Surgery, Xijing Hospital, the First Affiliated Hospital of Air Force Military Medical University from January 2014 to April 2021 were collected. Among them, 174 cases underwent robotic and 272 cases underwent laparoscopic surgery. Using the method of propensity score matching, 133 cases were selected from robotic operation group and laparoscopic operation group respectively as the research object. The perioperative indexes of the two groups were compared. Kaplan-Meier survival analysis was used to draw the survival curve and calculate the survival rate. Cox regression model was used to analyze the risk factor of prognosis. Results There was no significant difference in baseline data between the robotic surgery group and the laparoscopic surgery group after propensity score matching (P>0.05). The operative time of the two groups [(236.47±50.32) min vs. (230.64±44.51) min, t=1.000, P=0.318], the number of lymph nodes dissected [(23.32±6.58) vs. (23.95±6.03), t=–0.826, P=0.410], the time of first anal exhaust [(3.46±0.77) days vs. (3.38±0.75) days, t=0.882, P=0.378], and the length of postoperative hospital stay [(6.98±2.84) days vs. (6.94±3.61) days, t=0.094, P=0.925] were similar, the differences were not statistically significant. Compared with the laparoscopic surgery group, the robotic surgery group had less intraoperative bleeding [(83.76±58.23) mL vs. (116.54±58.58) mL, t=–4.577, P<0.001], but the total hospitalization expenses was higher [(10.04±1.92) ten-thousand Yuan vs. (6.80±1.27) ten-thousand Yuan, t=16.211, P<0.001]. The incidence of postoperative complications between the two groups (χ2=0.057, P=0.812) and Clavien-Dindo classification of complications (Z=–0.440, P=0.965) were similar between the two groups, the differences were not statistically significant. The 3-year survival situation was similar between the two groups (P=0.356). Body mass index [RR=0.803, 95%CI (0.698, 0.924), P=0.002], TNM-staging [Ⅱ -stage vs.Ⅰ -stage, RR=4.152, 95%CI (1.121, 15.385), P=0.033; Ⅲ -stage vs.Ⅰ -stage, RR=5.476, 95%CI (1.458, 20.558), P=0.012] and postoperative complications [with vs. without, RR=3.262, 95%CI (1.283, 8.293), P=0.013] were prognostic factors for 3-year survival. Conclusion Compared with laparoscopic radical gastrectomy, robotic radical gastrectomy has the same short-term and long-term prognosis.
ObjectiveTo analyze and compare the perioperative efficacy difference between full-port Da Vinci robotic surgery and thoracoscopic surgery in patients with mediastinal tumor resection. MethodsThe data of 232 patients with mediastinal tumors treated by the same operator in the Department of Thoracic Surgery of the Second Affiliated Hospital of Harbin Medical University were included. There were 103 (44.4%) males and 129 (55.6%) females, with an average age of 49.7 years. According to the surgical methods, they were divided into a robot-assisted thoracic surgery (RATS) group (n=113) and a video-assisted thoracoscopic surgery (VATS) group (n=119). After 1 : 1 propensity score matching, 57 patients in the RATS group and 57 patients in the VATS group were obtained. ResultsThe RATS group was better than the VATS group in the visual analogue scale pain score on the first day after the surgery [3.0 (2.0, 4.0) points vs. 4.0 (3.0, 5.0) points], postoperative hospital stay time [4.0 (3.0, 5.5) d vs. 6.0 (5.0, 7.0) d] and postoperative catheterization time [2.0 (2.0, 3.0) d vs. 3.0 (3.0, 4.0) d] (all P<0.05). There was no statistical difference between the two groups in terms of intraoperative blood loss, postoperative complications, postoperative thoracic closed drainage catheter placement rate or postoperative total drainage volume (all P>0.05). The total hospitalization costs [51 271.0 (44 166.0, 57 152.0) yuan vs. 35 814.0 (33 418.0, 39 312.0) yuan], operation costs [37 659.0 (32 217.0, 41 511.0) yuan vs. 19 640.0 (17 008.0, 21 421.0) yuan], anesthesia costs [3 307.0 (2 530.0, 3 823.0) yuan vs. 2 059.0 (1 577.0, 2 887.0) yuan] and drug and examination costs [9 241.0 (7 987.0, 12 332.0) yuan vs. 14 143.0 (11 620.0, 16 750.0) yuan] in the RATS group was higher than those in the VATS group (all P<0.05). ConclusionRobotic surgery and thoracoscopic surgery can be done safely and effectively. Compared with thoracoscopic surgery, robotic surgery has less postoperative pain, shorter tube-carrying time, and less postoperative hospital stay, which can significantly speed up the postoperative recovery of patients. However, the cost of robotic surgery is higher than that of thoracoscopic surgery, which increases the economic burden of patients and is also one of the main reasons for preventing the popularization of robotic surgery.
ObjectiveTo compare the incidence of complications after removal of chest drainage tube in the early and late stages after sublobectomy for non-small cell lung cancer (NSCLC), and to analyze the factors affecting postoperative pleural drainage volume (PDV), so as to explore the countermeasures and achieve rapid postoperative rehabilitation. MethodsThe patients with NSCLC who underwent minimally invasive sublobectomy in our hospital from January to October 2021 were enrolled. According to the median time of extubation, the patients were divided into an early extubation group (time with tube≤3 days) and a late extubation group (time with tube>3 days). The patients were matched via propensity score matching with a ratio of 1:1 and a caliper value of 0.02. The incidence of complications and perioperative parameters after removal of the thoracic drainage tube were analyzed and compared between the two groups, and univariate and multiple linear regression analyses were performed. ResultsA total of 157 patients were enrolled, including 79 males and 78 females, with an average age of (58.22±11.06) years. There were 76 patients in the early extubation group, 81 patients in the late extubation group, and 56 patients were in each group after propensity score matching. Compared with late extubation group, there was no significant difference in the incidence of infection after extubation (10.7% vs. 16.1%, P=0.405) or pleural effusion after extubation (5.4% vs. 3.6%, P=0.647) in early extubation group, and there was no second operation in both groups. Univariate analysis showed that smoking history (P=0.001), postoperative serum albumin reduction value (P=0.017), surgical approach (P=0.014), lesion location (P=0.027), differentiation degree (P=0.041), TNM stage (P=0.043), number of dissected lymph nodes (P=0.016), and intraoperative blood loss (P=0.016) were infuencing factors for increased postoperative PDV. Multiple linear regression analysis showed that smoking history (P=0.002), postoperative serum albumin reduction value (P=0.041), and the number of dissected lymph nodes (P=0.023) were independent risk factors for increased postoperative PDV. ConclusionThere is no significant difference in the incidence of complications after extubation between early and late extubations. Preoperative smoking history, excessive postoperative serum albumin decreases, and excessive number of dissected lymph nodes during the surgery are independent risk factors for increased postoperative PDV.
ObjectiveTo compare the intraoperative, postoperative indicators and economic costs of varicose veins patients between day surgery and inpatient surgery, and to explore the safety and benefit of large-scale varicose veins day surgery in China.MethodsA retrospective study was conducted to collect varicose veins patients in West China Hospital of Sichuan University from January 2016 to January 2019. Patients were divided into the day surgery group and the inpatient surgery group, and the subjects were matched by the propensity score matching (PSM) method according to the basic characteristic data. Intraoperative and postoperative indicators and economic costs were compared between the two groups.ResultsA total of 1 806 varicose vein patients were enrolled in the study, and 502 patients were enrolled in each of the two groups after PSM matching. After matching, there were no statistically significant differences in gender, age, nationality, marriage status, working status, residence, number of operative legs, medical insurance type, grade of American Society of Anesthesiologists, and complications (including hypertension, diabetes, coronary heart disease, and respiratory system diseases) between the two groups (P>0.05), which were comparable and the differences were not statistically significant. Compared with the inpatient surgery group, the day surgery group had shorter hospital stay, less intraoperative infusion volume, lower total cost, bed cost, nursing cost, drug cost, examination cost, medical insurance, and out-of-pocket (P<0.05). ConclusionThe varicose veins day surgery is not only safe and effective, but also can reduce the medication insurance payment.
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.