电视胸腔镜手术治疗创伤性血气胸的临床疗效及对血清hs-CRP及CRP水平的影响

目的:研究电视胸腔镜手术(VATS)治疗创伤性血气胸的临床疗效及对血清超敏C反应蛋白(hs-CRP)及C反应蛋白(CRP)水平的影响,为临床治疗提供依据。方法:选取2005年11月到2015年11月我院收治疗的创伤性血气胸患者60例,根据手术方式将患者分为研究组和对照组,每组30例,研究组应用VATS治疗,对照组应用开胸手术治疗,比较两组手术时间、术中出血量、胸腔引流量、引流时间、住院时间以及并发症,并观察术前、术后第1天、第3天和术后1周血清中hs-CRP和CRP水平。结果:研究组手术时间、引流时间和住院时间均显著短于对照组,术中出血量和胸腔引流量显著少于对照组,比较差异具有统计学意义(P0.05);研究组并发症发生率显著低于对照组,比较差异具有统计学意义(P0.05);术后第1天两组hs-CRP显著升高,且对照组显著高于研究组,术后第3天两组CRP明显升高,对照组明显高于研究组,hs-CRP明显下降,且研究组低于对照组,术后1周两组hs-CRP均较术后1天明显下降,CRP较术后3天明显下降,比较差异具有统计学意义(P0.05)。结论:VATS治疗创伤性血气胸手术时间短,对患者伤害小且并发症少,术后hs-CRP和CRP均不同程度增高,1周后开始降低。     

胸腔镜与传统手术方法对非小细胞肺癌患者的临床疗效

目的:比较电视胸腔镜手术与传统手术方法对非小细胞肺癌治疗的临床效果.方法:选择2010年5月至2012年6月本院收治的非小细胞肺癌患者84例,随机分为VATS组和OT组,各42例,VATS组行全胸腔镜肺叶切除术;OT组行传统开胸肺叶切除术.比较两组患者手术时间、淋巴结清扫数、术中出血量、术后引流时间、住院天数、术后疼痛和并发症发生情况,观察并比较两组患者术后3d血清CRP、TNF-α、IL-6、IL-10水平.结果:VATS组术后引流时间、住院时间明显短于OT组(P＜0.05);两组手术时间、淋巴结清扫数、术中出血量及并发症发生率比较无统计学差异(P＞0.05);VATS组术后1d、3d疼痛评分明显低于OT组(P＜0.05);VATS组术后3d血清CRP、TNF-α、IL-6、IL-10水平明显低于OT组(P＜0.05).结论:与传统手术相比,电视胸腔镜手术对患者创伤较小,患者术后炎症反应较低,痛苦较小,可作为非小细胞肺癌的推荐手术方式.     

硬膜外复合全身麻醉对老年开胸手术患者应激和血液流变学的影响

目的:探讨硬膜外复合全身麻醉对老年开胸手术患者应激和血液流变学的影响。方法:选取了100例开胸手术患者,按手术顺序编号将患者随机分为两组,对照组(46例)开胸手术术前给予全身麻醉,观察组(54例)开胸手术前给予硬膜外复合全身麻醉。通过观察并记录术前、术后1 h、6 h的应激指标、血液流变学指标及心率、呼吸频率,评价硬膜外复合全身麻醉对老年开胸手术患者应激和血液流变学的影响。结果:术前两组血糖、皮质醇和肾上腺素水平相比,无统计学差异(P0.05)。术后1 h,6 h两组血糖、皮质醇和肾上腺素水平均升高(P0.05),观察组术后1 h,6 h血糖、皮质醇和肾上腺素水平均低于对照组(P0.05);术后1 h,6 h两组全血低切粘度、高切粘度均下降,且观察组全血低切粘度、高切粘度更低(P0.05),术前术后两组血浆粘度、红细胞聚集指数相比,无统计学差异(P0.05);对照组患者术后1 h心率增加且高于观察组(P0.05),术后6 h心率趋近于术前心率。观察组患者术前术后心率无统计学差异(P0.05)。对照组患者术后1 h、6 h呼吸频率增加且高于观察组(P0.05),观察组患者术前术后呼吸频率无统计学差异(P0.05)。结论:采用硬膜外复合全麻对老年开胸手术患者的生命体征影响较小,可降低术后应激反应,改善患者体内血液流变学参数,值得临床推广使用。     

电视胸腔镜术在老年小结节非小细胞肺癌患者治疗中的应用研究

目的:研究电视胸腔镜术在老年小结节非小细胞肺癌(Small nodules in non small cell lung cancer,sn NSCLC)患者治疗中的应用。方法:回顾2009年1月-2011年6月在我院接受电视胸腔镜术治疗的老年sn NSCLC88例患者的临床资料,按照手术方式将所有患者分为电视胸腔镜组与常规开胸组两个小组。电视胸腔镜组行电视胸腔镜术,常规开胸组行常规开胸术。观察两组患者手术指标、疼痛程度评分、手术前后1 d CRP、TNF-α、IL-6等炎性因子水平、术后并发症、1-3年生存率以及复发率等指标。结果:两组患者一般资料比较无统计学上的差异(P0.05)。电视胸腔镜组术中出血量、术后引流时间、下床活动时间以及疼痛程度评分及术后1 d CRP、TNF-α、IL-6等炎性因子水平及术后并发症发病率均显著低于常规开胸组(P0.05)。电视胸腔镜组术后1、2、3年生存率显著高于常规开胸组(P0.05),且术后复发率显著低于常规开胸组(P0.05)。结论:电视胸腔镜术治疗老年sn NSCLC创口小、恢复快,且有效避免过度激活炎性细胞,降低术后并发症发病率,值得应用于临床。     

胸腔镜肺癌根治术与开胸肺癌根治术对肺癌患者临床疗效的影响及机制

目的:比较胸腔镜肺癌根治术和传统开胸肺癌根治术治疗肺癌的临床疗效并探讨其可能作用机制。方法:选取2011年3月至2015年3月于本院进行肺癌根治术的120例患者为研究对象,随机分为观察组(胸腔镜手术组)60例与对照组(开胸手术组)60例,比较两组的手术时间、术中出血量、术后引流量和引流管留置时间;并比较两组患者术前1 d及术后1 d、3 d、7 d的血清炎症因子和疼痛物质水平的变化。结果:两组患者在手术时间、手术出血量和术后引流等临床指标方面差异无明显统计学意义(P0.05);两组肺癌患者术前1 d的血清炎症因子和疼痛物质水平比较无明显统计学意义(P0.05),而术后1 d、3 d及7 d胸腔镜手术组的细胞炎症因子及疼痛物质血清表达水平均低于对照组(P0.05),血液流变指标较小,存在显著差异(P0.05)。结论:相较于传统开胸根治术,胸腔镜肺癌根治术不仅减少了患者体表创口,亦减小了患者的炎症反应和应激反应,且对血液循环的影响亦较小。     

基层医院治疗肺大泡常用手术方式比较分析

目的:对基层医院治疗肺大泡常用手术方式作比较分析,探讨胸腔镜辅助小切口术式治疗肺大泡在基层医院的应用价值.方法:选择反复发作自发性气胸须行手术治疗病人72例,据患者对手术方式的选择分为胸腔镜辅助小切口组(VAMT,n=36)和电视胸腔镜手术治疗组(VATS,n=36),同时回顾我院2007年治疗白发性气胸34例为常规后外侧切口手术组(n=34).3组术中均行肺大泡切除修补术及壁层胸膜摩擦.以术中出血量、手术时间、术后胸腔引流量、术后中度以上疼痛发生率(VAS分级法)、术后住院时间、治疗费用为观察指标进行评价.结果:术中出血量、手术时间、术后胸腔引流量、术后中度以上疼痛率(VAS分级法)、术后住院时间等指标在VAMT、VATS两组间比较无显著差异(P＞0.05),VAMT组与常规后外侧切口手术组比较有显著差异(P＜0.05);VAMT组治疗费用显著低于VATS组(P＜0.05),与常规后外侧切口手术组比较无显著差异(P＞0.05);术后1年气胸复发率(复发例数/该组病例数)三组间比较无显著差异(P＞0.05).结论:在目前治疗引起反复自发性气胸的肺大泡手术方式中,常规后外侧切口术式创伤大、术后疼痛严重、恢复慢,缺点较多;VAMT和VATS术式有创伤小、疼痛轻、术后恢复快等优点,其中VAMT术式治疗费用低,在基层医院更值得推广应用.     

不同麻醉深度对全麻老年手术患者应激反应、免疫功能及血清IL-1β、HMGB1水平的影响

目的:探讨不同麻醉深度对全麻老年手术患者应激反应、免疫功能及血清IL-1β、HMGB1水平的影响。方法:采用随机、双盲、平行法将2015年2月至2018年2月于海南省人民医院拟行全麻手术的200例老年患者分为研究组(n=102)和对照组(n=98),研究组术中脑电双频指数(BIS)维持在50-59之间,对照组BIS维持在40-49之间。分别于麻醉诱导前(T_0)、手术2h(T_1)、术后24 h(T_2)检测患者血清皮质醇(Cor)、促肾上腺皮质激素(ACTH)、内皮素-1(ET-1)、T淋巴细胞(CD3~+、CD4~+、CD8~+)、NK细胞(CD3-CD16+CD56+)、血清白介素-1β(IL-1β)、高迁移率族蛋白B1(HMGB1)水平,并观察两组患者术后并发症发生情况。结果:对照组Cor水平先升高后降低,且研究组T_1、T_2时Cor水平低于对照组(P0.05);两组患者ACTH水平先升高后降低,且研究组低于对照组(P0.05);研究组T_1、T_2时ET-1水平低于T_0时及对照组(P0.05)。两组CD3~+、CD4~+、CD8~+、CD3~-CD16~+CD56~+水平呈逐渐下降趋势,且研究组T_1、T_2时各指标水平均高于对照组(P0.05)。两组IL-1β水平均先升高后降低,研究组T_1时IL-1β水平低于对照组(P0.05),两组HMGB1水平持续上升,研究组T_1、T_2时HMGB1水平低于对照组(P0.05)。两组并发症发生率比较差异无统计学意义(P0.05),但研究组术后认知功能障碍发生率低于对照组(P0.05)。结论:维持BIS50-59的浅度麻醉可降低老年全麻手术患者围术期应激反应水平,促进术后免疫功能恢复,降低HMGB1水平及认知功能障碍发生风险,减轻围术期炎症反应。     

创伤性血气胸合并多发肋骨骨折的临床疗效对比

目的:比较电视胸腔镜手术(VATS)与传统开胸手术治疗创伤性血气胸合并多发肋骨骨折的临床疗效.方法:将我科收治的85例外伤致血气胸合并多发肋骨骨折的患者随机分为两组,其中VATS手术组(观察组)40例,采用VATS进行治疗;传统开胸手术组(对照组)45例,采用传统胸部后外侧切口,经肋间进胸探查并治疗.结果:两组患者治愈率均为100％,疗效差异不显著;观察组手术时间、术中出血量、住院时间均明显少于对照组(P＜0.05).结论:传统开胸手术和VATS手术均有较好疗效,但VATS优势更明显,值得临床推广应用.     

两孔、三孔胸腔镜与传统开胸手术肺叶切除联合系统性淋巴结清扫手术治疗肺癌的疗效观察

目的:探讨两孔、三孔胸腔镜与传统肺叶切除联合系统性淋巴结清扫手术治疗肺癌的临床效果。方法:选择2015年1月~2016年1月在我院接受肺叶切除的肺癌患者110例,根据VATS肺叶切除技术不同将其分为A(48人)、B(62人)两组,另选取2008-2010在我院接受传统后外侧开胸肺叶切除患者49例作为C组,比较3组手术时间、出血量、输血量、清扫淋巴结数和站数、胸腔引流时间、术后前3天引流量、术后住院时间及并发症发生情况等。结果:(1)三组患者手术时间和前三天总引流量无统计学意义(P0.05),而输血量、出血量、胸管留置时间以及术后住院时间差异均具有统计学意义(P0.05),且A组患者各项参数均明显优于B、C组;(2)三组在淋巴结清扫数和清扫站数、N2淋巴结清扫数和清扫站数、淋巴结分期情况差异均无统计学意义(P0.05);(3)N1和N2期患者中,A组患者的住院时间最短、出血量最小,三组患者差异具有统计学意义(P0.05),其他各项如手术时间、术后3天总引流量、清扫淋巴结数和站数、病理阳性淋巴结数和站数差异均无统计学差异(P0.05)。结论:两孔胸腔镜肺叶切除及系统性淋巴结清扫手术对于肺癌患者的治疗效果与三孔法同样安全有效,并且能相对减少降低机体损伤,便于患者术后恢复。     

胸腔镜与开胸手术治疗非小细胞肺癌根治性及围术期恢复情况分析

目的观察胸腔镜及开胸手术治疗非小细胞肺癌的根治性及围术期恢复情况。方法选择我院收治的非小细胞肺癌患者作为研究对象并进行分组治疗。研究组应用胸腔镜进行治疗,对照组应用开胸术进行治疗。将两组患者的手术相关数据以及围术期各项指标进行比较分析。结果研究组手术时间、术后引流时间显著短于对照组,术中出血量以及术后引流量显著少于对照组(均P0.05);研究组术后并发症发生率为7.50%,显著低于对照组的18.75%(P0.05)。两组患者均顺利完成手术,无围手术期死亡病例,术后2天血检WBC、Cor以及CRP指标均显著高于术前,而且研究组显著低于对照组(P0.05);术后1天疼痛评分研究组患者显著低于对照组,住院时间亦显著短于对照组(P0.05)。结论非小细胞肺癌患者应用胸腔镜治疗的痛苦小、术后应激反应轻、恢复快,效果更明显,有利于改善患者预后。     

应用电视胸腔镜诊治病因不明胸腔积液的疗效观察

目的:探讨电视胸腔镜(video-assisted thoracoscopic surgery VATS)在诊治病因不明胸腔积液中的应用价值.方法:回顾分析2005年4月～2011年4月196例病因不明胸腔积液经电视胸腔镜手术的临床资料.均应用电视胸腔镜进行探查,根据病变情况选择切口部位.排净胸腔积液后,分离粘连,进行胸膜活检后恶性患者行胸膜固定术.结果:196例均明确诊断:140例恶性胸腔积液,36例结核胸腔积液,20例炎性胸腔积液.胸腔镜手术178例,胸腔镜辅助胸壁小切口手术18例.手术时间30～75min,平均54 min.出血量10～120mL,平均53 mL.10例出现术后肺漏气,胸腔引流量＜50 mL/24h拔除胸腔引流管,胸管留置时间4～19天,平均9.4天.191例成功控制胸腔积液,全组无院内死亡.22例接受化疗的恶性胸腔积液患者,随访14～34个月,平均23个月,复查胸片显示无胸腔积液、积气.结论:电视胸腔镜安全、有效、微创,便于操作,可作为诊治病因不明胸腔积液的主要方法.     

电视胸腔镜在闭合性胸外伤诊治中的应用

目的:探讨电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)在闭合性胸外伤中诊断、治疗中的价值。方法:2004年6月～2011年6月选择68例闭合性胸外伤患者,应用VATS进行探查、诊断,同时进行肺修补、肺楔形切除、肋间血管止血、肋骨骨折固定等操作以及小切口辅助手术。结果:68例经VATS探查损伤情况:肺裂伤30例,凝固性血胸15例,肋间血管损伤10例,肋骨骨折需手术复位、固定12例,肺内血肿形成5例,膈疝3例,胸廓内血管损伤2例。VATS行肺修补术25例,肺楔形切除术7例,血管止血术12例,肋骨骨折复位、固定术12例,VATS辅助胸壁小切口肺叶切除术3例,膈疝修补术3例。VATS手术时间25～125 min,平均71.7 min。术后1～7 d胸腔少量积液、积气9例,少量咯血8例。68例随访2～17个月,平均9.2个月,复查胸片显示患肺复张良好,胸腔无积液、积气。结论:闭合性胸外伤患者应用VTAS诊治,可使诊断及时、准确,患者创伤小、恢复快,疗效满意。     

老年患者全胸腔镜肺叶切除术后去止血治疗的安全性研究

目的:探讨全胸腔镜肺叶切除术后老年患者不应用止血药物的安全性。方法:回顾性分析65例成功施行全胸腔镜肺叶切除手术老年患者(年龄≥65周岁),按术后不同治疗方案分为研究组29例(术后未应用任何止血药物)及对照组36例(常规应用止血药物),对比两组患者术后胸腔引流情况、拔除引流管时间、住院时间、相关不良反应及并发症,评价全胸腔镜肺叶切除术后老年患者不应用止血药物的安全可靠性。结果:研究组术后24 h(310.6±54.6 m LVS 262.3±67.2 mL,P0.05)及48 h(225.4±47.3m LVS 195.5±66.4 mL,P0.05)胸腔引流量高于对照组,拔除引流管时间(4.23±2.84天VS 4.02±3.37天,P0.05)、住院时间(6.82±2.23天V S 6.53±3.21天,P0.05)及发生出血(3例V S 2例,P0.05)、栓塞风险均无显著差异,但应用止血药物增加了药物自身相关不良反应的风险,对照组中应用贝瑞凝止血治疗后,11例患者出现了消化道不适反应,1例患者出现头痛。结论:全胸腔镜肺叶切除术后老年患者,经术中严密止血后术后不应用止血药物是安全可靠的。     

Evaluation of Video-Assisted Thoracoscopic Surgery for Pulmonary Metastases: A Meta-Analysis

Background

To evaluate the evidence comparing video-assisted thoracic surgery (VATS) and open thoracotomy in the treatment of metastatic lung cancer using meta-analytical techniques.

Methods

A literature search was undertaken until July 2013 to identify the comparative studies evaluating disease-free survival rates and survival rates. The pooled odds ratios (OR) and the 95% confidence intervals (95% CI) were calculated with the fixed or random effect models.

Results

Six retrospective studies were included in our meta-analysis. These studies included a total of 546 patients: 235 patients were treated with VATS, and 311 patients were treated with open thoracotomy. The VATS and the thoracotomy did not demonstrate a significant difference in the 1-,3-,5-year survival rates and the 1-year disease-free survival rate. There were significant statistical differences between the 3-year disease free survival rate (p = 0.04), which favored open thoracotomy.

Conclusions

The VATS approach is a safe and feasible treatment in terms of the survival rate for metastatic lung cancer compared with the thoracotomy. The 3-year disease-free survival rate in the VATS group is inferior to that of open thoracotomy. The VATS approach could not completely replace open thoracotomy.     

Video-Assisted Thoracic Surgery in Lung Cancer Resection: A Meta-Analysis and Systematic Review of Controlled Trials

OBJECTIVES:: This meta-analysis sought to determine whether video-assisted thoracic surgery (VATS) improves clinical and resource outcomes compared with thoracotomy (OPEN) in adults undergoing lobectomy for nonsmall cell lung cancer. METHODS:: A comprehensive search was undertaken to identify all randomized (RCT) and nonrandomized (non-RCT) controlled trials comparing VATS with OPEN thoracotomy available up to April 2007. The primary outcome was survival. Secondary outcomes included any other reported clinical outcome and resource utilization. Odds ratios (OR), weighted mean differences (WMD), or standardized mean differences (SMD), and their 95% confidence intervals (95% CI) were analyzed as appropriate. RESULTS:: Baseline prognosis was more favorable for VATS (more females, smaller tumor size, less advanced stage, histology associated with peripheral location and with more indolent disease) than for OPEN in non-RCTs, but not RCT. Postoperative complications were significantly reduced in the VATS group compared with OPEN surgery when both RCT and non-RCT were considered in aggregate (OR 0.48, 95% CI 0.32-0.70). Although overall blood loss was significantly reduced with VATS compared with OPEN (-80 mL, 95% CI -110 to -50 mL), the incidence of excessive blood loss (generally defined as >500 mL) and incidence of re-exploration for bleeding was not significantly reduced. Pain measured via visual analog scales (10-point VAS) was significantly reduced by <1 point on day 1, by >2 points at 1 week, and by <1 point at week 2 to 4. Similarly, analgesia requirements were significantly reduced in the VATS group. Postoperative vital capacity was significantly improved (WMD 20, 95% CI 15-25), and at 1 year was significantly greater for VATS versus OPEN surgery (WMD 7, 95% CI 2-12). The incidence of patients reporting limited activity at 3 months was reduced (OR 0.04, 95% CI 0.00-0.82), and time to full activity was significantly reduced in the VATS versus OPEN surgery (WMD -1.5, 95% CI -2.1 to -0.9). Overall patient-reported physical function scores did not differ between groups at 3 years follow-up. Hospital length of stay was significantly reduced by 2.6 days despite increased 16 minutes of operating time for VATS versus OPEN. The incidence of cancer recurrence (local or distal) was not significantly different, but chemotherapy delays were significantly reduced for VATS versus OPEN (OR 0.15, 95% CI 0.06-0.38). The need for chemotherapy reduction was also decreased (OR 0.37, 95% CI 0.16-0.87), and the number of patients who did not receive at least 75% of their planned chemotherapy without delays were reduced (OR 0.41, 95% CI 0.18-0.93). The risk of death was not significantly reduced when RCTs were considered alone; however, when non-RCTs (n = 18) were included, the risk of death at 1 to 5 years was significantly reduced (OR 0.72, 95% CI 0.55-0.94; P = 0.02) for VATS versus OPEN. Stage-specific survival to 5 years was not significantly different between groups. CONCLUSIONS:: This meta-analysis suggests that there may be some short term, and possibly even long-term, advantages to performing lung resections with VATS techniques rather than through conventional thoracotomy. Overall, VATS for lobectomy may reduce acute and chronic pain, perioperative morbidity, and improve delivery of adjuvant therapies, without a decrease in stage specific long-term survival. However, the results are largely dependent on non-RCTs, and future adequately powered randomized trials with long-term follow-up are encouraged.     

Penetrating chest wound: a case report.

An unusual penetrating chest injury was caused by a ball-point pen. Because of apparent penetration of the heart, preparations were made for an emergency open-heart procedure before emergency thoracotomy was undertaken, with the pen still in situ. The pen had bruised the epicardium but had not penetrated the pericardial sac. After removal of the pen, the wound was closed and a chest tube left in place. Recovery, apart from minor degrees of basal atelectasis, pleural effusion and wound infection, was uneventful. The outcome was consistent with that associated with current aggressive management of penetrating chest injuries. Management is based on three approaches. The primary one is intercostal thoracostomy tube drainage and fluid and blood replacement. In cases of massive hemorrhage or air leak, thoracotomy is necessary. The third approach is to prevent post-traumatic pulmonary insufficiency by using fine, high-efficiency filters during blood transfusion, avoiding excessive administration of intravenous fluids, performing tracheostomy after prolonged endotracheal intubation, and using a volume respirator with positive end-expiratory pressure. The average mortality for penetrating wounds of the heart is 25%.     

清胰利胆颗粒对重症急性胰腺炎患者血清HMGB1, HSP70, HSP27,IL-8水平的影响

目的:研究清胰利胆颗粒对重症急性胰腺炎患者血清高迁移率族蛋白1(HMGB1)、热休克蛋白70(HSP70)、热休克蛋白27(HSP27)、白介素-8(IL-8)水平的影响。方法:选取2015年8月至2016年7月我院收治的84例重症急性胰腺炎患者,根据随机数字法分为观察组和对照组,42例每组。对照组采取常规方案完成治疗,观察组在此基础上使用清胰利胆颗粒治疗。比较两组患者临床疗效,血淀粉酶恢复至正常时间、白细胞恢复至正常时间、胃肠功能恢复至正常时间、腹痛缓解时间及血清HMGB1、HSP70、HSP72、IL-8水平。结果:治疗后,观察组临床总有效率显著高于对照组[92.86%(39/42)比71.43%(30/42)](P0.05)。观察组的血淀粉酶恢复至正常时间、白细胞恢复至正常时间、胃肠功能恢复至正常时间及腹痛缓解时间显著短于对照组(P0.05)。治疗前,两组患者HMGB1、HSP70、HSP72、IL-8水平比较无显著差异(P0.05),治疗后,两组患者HMGB1、HSP70、HSP72、IL-8水平和治疗前相比显著下降(P0.05),和对照组相比,观察组的HMGB1、HSP70、HSP72、IL-8水平较低(P0.05)。结论:清胰利胆颗粒能有效降低重症急性胰腺炎患者血清HMGB1、HSP70、HSP27、IL-8水平,且可提高临床疗效。