Objective To evaluate the safety and efficacy of the operation performed under the video-assisted thoracoscope to release the anterior part of the spine of the patient with severe adolescent idiopathic scoliosis (AIS). Methods From April 2004 to July 2006, 24 patients with AIS (Illness course, 1.5-9 years; Lenke Ⅰ in 17 patients, Lenke Ⅱ in 7; right scoliosis in 22, left scoliosis in 2), among whom there were 9 males and 15 females, with an average age of 14.7 years (range, 11-21 years) at the time of the operation. Before operation, the thoracic vertebral Cobb anger at the coronal plane was averaged 78.3°(range, 65-125°). All the patients had normal muscle strength and muscle tension in their lower limbs, but 5 of the patients had a decrease of the superficial sensation in their lower limbs. All the patients had a moderately or severely decreased lung reserve function. Under general anesthesia, the patient was placed in the lateral position to set up a work channel for thoracoscopy. The releasing of the thoracic intervertebral space and the confluence of the bone grafts were performed. During Stage Ⅰ or Stage Ⅱ, the orthopedic procedures for the posterior part of the scoliosis spine, the internal fixation, and the confluence ofthe bone grafts were completed. ResultsAll the patients survived the periodof perioperation. During operation, there was a hemorrhage of 50-200 ml, averaged 100 ml, with a postoperative thoracic closely-drained fluid of 100-150 ml. The incision was healed by the first intention. Each patient underwent the releaseof 4-6 intervertebral spaces, with an average of 5.5 spaces released. The average coronal Cobb angle was 45.6°(range, 25-75°). The physiological curvatureat the sagittal plane was normal, with an improved shape of the spine. The follow-up for 3-18 months averaged 9.3 months revealed that the bilateral pulmonary markings were clear, with confluence of the orthopedic segment of the spine. The patients could live and work normally, and had a significantly-improved psychological condition and an active social participation because of their improved appearance. Conclusion The releasing of the anterior part of the spine under the video-assisted thoracoscope can effectively release the adolescent idiopathic scoliosis and improve the flexibility of the spine, with a smaller degree of the surgical wound and a faster and clearer exposure of the spinal column during operation.
ObjectiveTo explore the effectiveness and safety of treatment of thoracic tuberculosis with thoracoscope supported by digital technology. MethodsBetween June 2010 and February 2012, 11 patients with thoracic tuberculosis were treated and the clinical data were retrospectively analyzed. There were 7 males and 4 females with an average age of 23.6 years (range, 16-47 years) and an average disease duration of 16 months (range, 6-18 months). Two vertebral bodies and one intervertebral space were involved at T6-11. At preoperation, the neurologic function degree was classified as Frankel grade E. Three dimensional reconstruction of thorax and spine and surgical procedure design (including focal clearance, bone grafting, and screw fixation) were done at SUPERIMAGE workstation. Surgery procedures were conducted following the preoperative designs. ResultsThe operative procedures were consistent with preoperative designs. All of these operations were successfully performed. The mean time of operation was 146 minutes (range, 120-180 minutes); the mean blood loss was 120 mL (range, 100-150 mL); the mean indwelling time of closed thoracic drainage was 38 hours (range, 24-48 hours); and the mean hospitalization time was 4.6 days (range, 3-5 days). Eleven patients were followed up 12-25 months (mean, 16 months). No complication of nerve damage, incision pain and infection, or pulmonary infection was observed. Rigid fixation and born fusion were obtained at last follow-up; no obvious change of thoracic vertebral alignment was detected and no internal fixation failure occurred. ConclusionIt is a minimally invasive, effective, and safe method to treat thoracic tuberculosis with thoracoscope supported by digital technology.
ObjectiveTo introduce a new type thoracic vest designed according to the incision characteristics of female patients undergoing totally thoracoscopic cardiac surgery.MethodsSixty-one female patients undergoing totally thoracoscopic cardiac surgery from February 2019 to May 2020 in our department were enrolled. All female patients had hypermastia and (or) mastoptosis which covered the incision. They were randomly divided into a research group (group A, n=32) and a control group (group B, n=29). The group A used the new type thoracic vest, while the group B used the traditional single shoulder belt. The degree of satisfaction, visual analogue scale (VAS) score 24 hours after the thoracic drainage tube removed, the average time-consuming of dressing change, dressing frequency and the incision infection rate were compared between two groups.ResultsThe degree of satisfaction in the group A was higher than that of the group B (P<0.001). The VAS scores of pain, average time-consuming of dressing change and dressing frequency in the group A were less or lower than those of the group B (P<0.001). There was no statistical difference in the incision infection rate between the two groups (P=0.214), but incision infection rate of the group A was lower than that of the group B.ConclusionThe new type thoracic vest seems to be more beneficial for patients than traditional single shoulder belt. It is easy to use, increases the psychological satisfaction of patients, reduces the pain and the incision infection and improves work efficiency, which is worthy of clinical application.
Objective To explore the clinical value of pleura biopsy and partial pleura cryobiopsy via electronic bronchoscope in diagnosis of unknown exudative pleural effusion. Methods Diagnostic results of 563 patients with unknown exudative pleural effusion were analyzed retrospectively. Bronchoscope and routine pleura biopsy were performed in 187 patients. Bronchoscope and routine pleura biopsy plus partial pleura cryobiopsy were performed in 376 patients. Pathological positive rates of the two groups were compared. Results In the 187 patients examined by bronchoscope and routine pleura biopsy from 2006 to 2008, 161 patients obtained pathological positive results ( 86.1% ) . In the 376 patients examined by bronchoscope and routine pleura biopsy plus partial pleura cryobiopsy from 2009 to 2012, 354 patients acquired pathological diagnosis ( 94.1% ) . There was significant difference between the two groups ( P lt; 0.05) . The main complications were bleeding and local chest pain, and they can be controlled easily. Conclusions Electronic bronchoscope and pleura biopsy can obtain high detection rate of nearly 90% in diagnosis of unknown exudative pleural effusion especially when combined with cryobiopsy of partial pleura. Electronic bronchoscope combined with pleura biopsy or cryobiopsy is an alternative in clinical settings when thoracoscope is unavailable.
【Abstract】 Objective To study the short-term effects of thoracoscopic anterior spine release combined with posterior correction on the pulmonary function in patients with idiopathic scoliosis (IS). Methods Between April 2004 and June 2008, 21 cases of IS underwent thoracoscopic anterior spine release combined with posterior correction. There were 9 males and 12 females with a mean age of 15.6 years (range, 12 to 24 years). Of 11 patients, 2 had left protrusion deformity and 19 had right protrusion deformity, including 12 cases of Lenke type I and 9 cases of Lenke type II, with an average coronal Cobb’s angle of 79.6° (range, 65-125°). The disease duration ranged from 1 year and 6 months to 9 years (mean, 2.5 years). The results of pulmonary function tests (PFTs) were compared between pre-operation and postoperative 6th month, including lung capacity, ventilation function, and thoracic compliance. Results The opening time of the chest was 90 to 150 minutes (mean, 127 minutes) at the thoracoscopic anterior spine release and all incisions healed by first intention with no chest cavity infection. All the patients were followed up from 6 to 36 months (mean, 13.5 months). The average coronal Cobb’s angle was 43.7° (range, 36-75°) at 1 week after posterior correction. At 6 months after operation, the vital capacity and total capacity were significantly increased (P lt; 0.05), but no significant change was observed in the percentage of actual value and expected one when compared with pre-operation (P gt; 0.05). The functional residual capacity and the percentage of actual value and expected one of residual volume was significantly decreased when compared with those at pre-operation (P lt; 0.05). The forced expiratory volume in one second (FEV1) and FEV1/FEV were not significantly improved (P gt; 0.05) , but the maximum ventilatory volume was significantly increased when compared with the preoperative value (P lt; 0.05). In addition, the Raw Total, Raw Insp, and Raw Exp decreased significantly after operation (P lt; 0.05). Conclusion Although the thoracoscopic anterior spine release combined with posterior correction might disturb the function of the thoracic cavity, the PFTs of the patients could be improved at different aspects because of the shape changes of the thoracic cavity, and the pulmonary function still needed further observation.
Totally thoracoscopic surgery is a branch of minimally invasive cardiac surgeries, and its operational indicators are expanding with the development of the medical and imaging devices compared with median sternotomy and other minimally invasive cardiac surgeries (such as thoracoscope-assisted small incision surgery and robotic surgery). The learning curve is significantly shortened through the professional technique training. Totally thoracoscopic cardiac surgery has many advantages, such as minor trauma, few serious complications, fast recovery, high patient acceptance and being suitable to our country's current situation. Therefore it will be one main direction of minimally invasive cardiac surgery. This article mainly introduced the current status of totally thoracoscopic technology in the field of cardiac surgery in China.
ObjectiveBy establishing a set of evaluation system for thoracoscopic clinical function and applicability, to evaluate and compare the advantages and disadvantages of different brands of thoracoscopes, and to provide some suggestions for the innovation and upgrade of thoracoscopes, especially for the domestic thoracoscopes.MethodsThe project coordination team initially formulated the evaluation index system for the clinical function and applicability of thoracoscope by querying literature and brainstorming. The Delphi expert consultation method was used to distribute questionnaires to the selected experts. Experts provided scores which were based on the importance of each indicator, and clarified the basis of their judgment and the familiarity with the evaluation indicators. After two rounds of screening by Delphi method, a thoracoscopic clinical function and applicability satisfactory questionnaire was formed. The appropriate sample for pre-investigation was selected, and the reliability and validity were tested. The index composition was adjusted based on the results of the test to form a final evaluation scale.ResultsThe project coordination team initially formulated 24 thoracoscope-related evaluation indicators. After two rounds of experts consultation, the item "brightness adjustment" was deleted without any additional entries. The positive coefficients of the experts in the first round and the second round were 100.0% and 80.0%, respectively. The two rounds of authoritative coefficients were 0.86 and 0.90, and the coordination coefficients were 0.272 (P<0.001) and 0.523 (P<0.001), respectively. A total of 140 questionnaires were issued in this pre-investigation. The recovery rate was 100.0% and the effective rate was 90.0%. The Cronbach's α value of the scale was 0.936, and the Spearman-Brown split-half reliability coefficient was 0.972. The factor analysis finally extracted 3 common factors. The total variance of the cumulative interpretation was 70.9%. The three common factors were named "operation related", "image related" and "device related".ConclusionThe evaluation index system developed in this study has good reliability and validity, and can be used as a tool to evaluate the clinical function and applicability of thoracoscopes.
Objective To summarize the early experience of modified Nuss procedure with thoracoscope for repairing pectus excavatum in children. Methods Fiftythree pediatric pectus excavatum were treated by modified Nuss procedure with thoracoscope from June 2004 to July 2006, theage ranged from 2.4 to 16.0 years, the average age was 8.1 years. Thirtysix patients were symmetric pectus excavatum and 17 patients were asymmetric pectus excavatum. Results The operation in all patients were successful, the average blood loss was less than 10ml. Pericardium perforation occurred in 2 earlier patients during the operation, pneumothorax occurred in 6 patients postoperatively,pleural effusion occurred in 3 patients, and all resolved by corresponding treatments. The average hospital length of stay was 5.5 days. All patients had a satisfied deformity correction and no needs of transfusion. The depression was thoroughly corrected in 48 patients, residual depression was less than 20% of preoperative degrees in 5 patients. Therapeutic results evaluation showed excellent in 46 patients and good in 7 patients. All patients were followed up in 1-25 months without any complaints, the activity ability was same as normal children; there were no bar displacement and injury event occurred. The bar had been removed in 1 patient 24 months after surgery who still kept in excellent results. Conclusion Modified Nuss procedure is easy to be performed with minimal invasion and good shortterm results. Thoracoscopic visualization facilitates the safety of this technique. It is recommendable to be tried and extended applied.
ObjectiveTo analyze the short-term outcomes of cardiac surgery via minimally invasive approach under thoracoscope in a single-center. Methods The clinical data of patients who underwent cardiac surgery via minimally invasive approach under thoracoscope between July 2017 and February 2022 were retrospectively analyzed. Results A total of 453 patients were enrolled, including 150 males and 303 females at an average age of 42.2±14.6 years. The main disease types included atrial septal defect in 314 patients, partial atrioventricular septal defect in 26 patients, and cardiac tumor in 105 patients. There was no death during the perioperative period. The mean operative time was 3.9±0.8 h, cardiopulmonary bypass time was 101.2±34.0 min, aortic occlusion time was 42.1±25.1 min, ventilator assistance time was 11.6±9.4 h, ICU stay time was 22.6±13.9 h and postoperative hospital stay was 6.0±1.7 d. Intraoperative and postoperative complications occurred in 18 (4.0%) patients, including 2 patients with conversion to sternotomy, 3 with incision expand, 3 with reoperation for bleeding, 1 with of redo operation, 4 with incision infection, 2 with respiratory insufficiency, 2 with cerebrovascular accident, and 1 with ventricular fibrillation. The follow-up time was 22.6±15.4 months, during which 1 patient died, 4 patients had moderate mitral regurgitation, 1 patient had mild-moderate mitral regurgitation, and 1 patient had mild-moderate tricuspid regurgitation. Conclusion Minimally invasive cardiac surgery under thoracoscope is safe with small invasions and few complications, and has satisfactory short-term outcomes.
ObjectiveTo evaluate the impact of video-assisted thoracoscopic surgery (VATS) esophagectomy and routine operation on the short-term quality of life in patients with esophageal cancer. MethodsFrom January 2012 through January 2014, 157 esophageal cancer patients were classified into a VATS group (n=42) and a routine operation group (n=115) in our hospital. All patients in the two groups completed the Chinese versions of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ)-C30 and QLQ-OES18 at one, six and 12 months after operation separately. ResultsAt the end of 6, 12 months after operation, the evaluation on global health status was higher in the VATS group(68.8±12.3 vs. 62.7±13.7, P<0.05; 76.2±10.4 vs. 68.6±8.8, P<0.05). At the end of 1, 6, 12 months after operation, the scores of symptom pain were less significantly in the VATS group than those in the routine operation group (P<0.05). One month after operation, the score of active ability in the VATS group was higher (P<0.05). At the end of 6, 12 months after operation, the score of emotional function and social role in the VATS group was higher (P<0.05). At the end of 12 months after operation, the score of role function and cognitive function in the VATS group was also higher (P<0.05). ConclusionVATS is of better effect on improving short-term quality of life of esophageal cancer patients compared with routine operation.