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 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 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 compare the postoperative chylothorax outcomes of robot-assisted thoracic surgery (RATS) and video-assisted thoracoscopic surgery (VATS), analyze the risk factors for postoperative chylothorax after minimally invasive radical lung cancer resection and explore possible prevention and control measures. MethodsBetween June 2012 and September 2020, 1083 patients underwent minimally invasive pulmonary lobectomy and systematic lymph node dissection in our hospital, including 578 males and 505 females with an average age of 60.6±9.4 years. Patients were divided into two groups according to the operation methods: a RATS group (499 patients) and a VATS group (584 patients). After propensity score matching, 434 patients were included in each group (868 patients in total). Chylothorax and other perioperative indicators were compared between the two groups. Univariate and multivariate logistic regression analyses were performed to identify risk factors for postoperative chylothorax. ResultsOverall, 24 patients were diagnosed with chylothorax after surgery. Compared with the VATS group, the rate of chylothorax was higher (3.9% vs. 1.6%, P=0.038), the groups and numbers of dissected lymph nodes were more (both P<0.001), and the intraoperative blood loss was significantly less (P<0.001) in the RATS group. There was no statistical difference in the postoperative hospital stay (P=0.256) or chest tube drainage time (P=0.504) between the two groups. Univariate analysis showed that gender (P=0.021), operation approach (P=0.045), smoking (P=0.001) and the groups of dissected lymph nodes (P<0.001) were significantly associated with the development of chylothorax. Multivariate analysis showed that smoking [OR=4.344, 95%CI (1.149, 16.417), P=0.030] and the groups of dissected lymph nodes [OR=1.680, 95%CI (1.221, 2.311), P=0.001] were the independent risk factors for postoperative chylothorax. ConclusionCompared with the VATS, the rate of chylothorax after RATS is higher with more dissected lymph nodes and less blood loss. The incidence of chylothorax after minimally invasive radical lung cancer resection is higher in the patients with increased dissected lymph node groups and smoking history.
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 evaluate the value of postoperative radiotherapy (PORT) in patients with stage ⅢA-N2 non-small cell lung cancer who received complete resection and chemotherapy. MethodsPatients with stage ⅢA-N2 non-small cell lung cancer who received complete resection and chemotherapy were chosen from the SEER Research Plus Database [17 Registries, November 2012 Submission (2000-2019)]. The patients were divided into a PORT group and a non-PORT group according to whether the PORT was used. To balance baseline characteristics between non-PORT and PORT groups, R software was used to conduct a propensity score matching (PSM) with a ratio of 1 : 1 and a matching tolerance of 0.01. Both the Cox regression analysis and Kaplan-Meier survival analysis were conducted to evaluate the value of PORT in terms of overall survival (OS) and disease-specific survival (DSS). ResultsIn total, 2468 patients with stage ⅢA-N2 non-small cell lung cancer were enrolled, including 1078 males and 1390 females with a median age of 65 (58-71) years. There were 1336 patients in the PORT group, and 1132 patients in the non-PORT group. Cox regression analysis showed that PORT was not significantly associated with OS (multivariate analysis: HR=1.051, 95%CI 0.949-1.164, P=0.338) and DSS (multivariate analysis: HR=1.094, 95%CI 0.976-1.225, P=0.123). No statistical difference was found in the OS or DSS between non-PORT group and PORT group after PSM analysis (P＞0.05). ConclusionPORT does not have a survival benefit for patients with stage ⅢA-N2 non-small cell lung cancer who received complete resection and chemotherapy.
ObjectiveTo compare the efficacy of mediastinoscope-assisted transhiatal esophagectomy (MATHE) and functional minimally invasive esophagectomy (FMIE) for esophageal cancer. MethodsPatients who underwent minimally invasive esophagectomy at Jining No.1 Hospital from March 2018 to September 2022 were retrospectively included. The patients were divided into a MATHE group and a FMIE group according to the procedures. The patients were matched via propensity score matching (PSM) with a ratio of 1 : 1 and a caliper value of 0.2. The clinical data of the patients were compared after the matching. ResultsA total of 73 patients were include in the study, including 54 males and 19 females, with an average age of (65.12±7.87) years. There were 37 patients in the MATHE group and 36 patients in the FMIE group. Thirty pairs were successfully matched. Compared with the FMIE group, MATHE group had shorter operation time (P=0.022), lower postoperative 24 h pain score (P=0.031), and less drainage on postoperative 1-3 days (P<0.001). FMIE group had more lymph node dissection (P<0.001), lower incidence of postoperative hoarseness (P=0.038), lower white blood cell and neutrophil counts on postoperative 1 day (P<0.001). There was no statistically significant difference in the bleeding volume, R0 resection, hospital mortality, postoperative hospital stay, anastomotic leak, chylothorax, or pulmonary infection between the two groups (P>0.05). ConclusionCompared with the FMIE, MATHE has shorter operation time, less postoperative pain and drainage, but removes less lymph nodes, which is deficient in oncology. For some special patients such as those with early cancer or extensive pleural adhesions, MATHE may be a suitable surgical method.
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 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.