An retrospective analysis of 112 cases with localized left hepatolithiasis (LLH) treated in our center in recent two decades was made. The results showed: ①Coexisting involvements of both left external hepatic duct (LEHD) and left medial hepatic duct (LMHD) were the most common pathological pattern (83.08%), came next the only LEHD involvement (12.31%). There was no localized LMHD caculi in this group. ②The rate of concomitant LHD stricture was 59.82% and that of LMHD or LEHD were 84.85% and 84.00% respectively, in which severe degrees dominate. ③Lateral segmentectomy was the most common clinical practice for LLH (58.93%), and left lebectomy was much less frequently used (12.50%), although the latter led to a significantly smaller rate of residual (7.14% vs 21.21%) and had a satification follow-up rate of 85.71% being superior to lateral segmentectomy (46.97%), or cholangiojejunostomy (40.00%), bile duct exploration and drainage (0). ④The most common prognostic factors were residual or recurrent stones of LMHD (62.50%) and residual LHD stricture (37.50%). ⑤There was no significant difference between left lobectomy and lateral segmentectomy in length of operation, intraoperative bleeding, and postoperative complications. The results indicate that too much dependence on lateral segmentectomy in the management of LLH is one of the most important factors affecting the longterm results, for which left lobectomy is an applicable and safe therapy of choice.
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： Lung torsion is a very rare clinical event and characterized by rotation of entire lung or individual lobes around the proximal bronchus or blood vessel pedicle in a single direction. The outcomes of lung torsion vary according to different rotation degree. Mild lung rotation may cause hemodynamic changes of the rotated pulmonary tissue. Severe lung rotation may lead to pulmonary venous congestion， lung infarction， systemic intoxication symptoms， ischemia， hypoxia， respiratory failure， severe infection or even death. There are a number of causes of lung torsion， including thoracic surgery， blunt chest trauma， pneumonia， pneumothorax， pleural effusion and lung transplantation. The majority of lung torsion cases occur after thoracic surgeries especially lobectomy， with the right middle lobe being most easily endangered after right upper lobectomy. Lung torsion does not have typical clinical manifestations and thus is difficult to be differentiated from other diseases. Patients with lung torsion often cannot receive correct diagnosis， proper intervention and treatment in time， which may lead to a high mortality. This review focuses on the morbidity， pathogenesis， clinical manifestations， diagnosis， prevention and treatment of lung torsion.
Objective To investigate clinical outcomes of complete video-assisted thoracoscopic lobectomy and summarize our preliminary experience. Methods Clinical data of 60 consecutive patients who underwent complete video-assisted thoracoscopic lobectomy in General Hospital of Chengdu Military Command from March 2010 to August 2011 were retrospectively reviewed. There were 37 male patients and 23 female patients with their median age of 52.1 （17-77） years. There were 7 patients undergoing left upper lobectomy， 19 patients undergoing left lower lobectomy， 12 patients undergoing right upper lobectomy， 3 patients undergoing right middle lobectomy， 17 patients undergoing right lower lobectomy， and 2 patients undergoing combined right middle and lower lobectomy. Results The average operation time was 161 （50-270） minutes， average intra-operative blood loss was 310 （50-800） ml， average number of lymph node dissection was 13.4 （6-29）， average postoperative thoracic drainage was 950 （250-2 800） ml， average duration of thoracic drainage was 4.6 （3-11） days， average intensive care unit stay was 1.2 （1-3） days， and average postoperative hospital stay was 7.7（4-14） days. None of the patients had any severe postoperative complication. Fifty-two patients were followed up for 7 to 24 months， and 8 patients were lost during follow-up. During follow-up， 5 patients had lung cancer metastases， including 2 patients with mediastinal lymph node metastases and 3 patients with distant metastases. After chemoradiotherapy，3 patients lived well but 2 patients died. None of the other patients had any severe complication during follow-up. Conclusion Complete video-assisted thoracoscopic lobectomy is a safe and effective surgical strategy for patients with benign or malignantpulmonary disease.
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 the safety，efficacy，short- and long-term clinical outcomes of complete video-assisted thoracoscopic surgery （VATS） lobectomy for non-small cell lung cancer （NSCLC）. Methods Clinical data of231 consecutive patients with NSCLC who underwent complete VATS lobectomy in the First Affiliated Hospital of NanjingMedical University between June 2006 and March 2011 were retrospective analyzed. There were 132 male and 99 femalepatients with their age of 15-81 （59.51±11.90） years. Preoperative cancer staging wasⅠa in 149 patients，Ⅰb in 50 patients，Ⅱa in 14 patients，Ⅱb in 13 patients and Ⅲa in 5 patients. There were 152 patients with adenocarcinoma，41 patients with squamous carcinoma，23 patients with bronchioalveolar carcinoma，5 patients with adenosquamous carcinoma，4 patients with large cell carcinoma，and 6 patients with other carcinoma. Follow-up data were statistically analyzed，and short-and long-term survival rates were calculated. Results No perioperative mortality was observed. Operation time was 60-370（199.14±51.04） minutes，and intraoperative blood loss was 10-2 300 （168.19±176.39） ml. Thirty-seven patients had postoperative complications including air leak，pulmonary infection，atelectasis，arrhythmia，subcutaneous emphysema andothers，who were all cured after conservative treatment. Mean number of dissected lymph nodes was 11.14±5.49，and meannumber of explored nodal stations was 3.66±1.52. There were 51 patients （22.08%） whose postoperative cancer staging wasmore advanced than preoperative cancer staging. Postoperative hospital stay was 3-36 （10.79±5.13） days. Primary causesof prolonged postoperative hospitalization included pulmonary air leak，pulmonary infection，preoperative concomitant chronic pulmonary diseases （COPD，asthma），and moderate to severe pulmonary dysfunction. A total of 228 patients werefollowed up for a mean duration of 40.83 months （22-82 months），and 3 patients were lost during follow-up. Overall 5-yearsurvival rates were 85.78%，52.54% and 32.70% for stageⅠ，stageⅡand stageⅢ-Ⅳpatients respectively. Five-year cancerfreesurvival rates were 80.00%，45.37% and 20.99% for stageⅠ，stageⅡand stageⅢ-Ⅳpatients respectively. ConclusionThe advantages of VATS lobectomy include smaller surgical incision，less injury and postoperative pain，quicker postoperative recovery and shorter hospital stay. Long-term survival rate is comparable to previous international and Chinese studies. VATS lobectomy can anatomically achieve complete tumor resection and systematic lymph node dissection. VATS lobectomy will become a standard surgical procedure for NSCLC patients.
Abstract： Currently, there are two significant tendencies in the advancement and progress of video-assisted thoracoscopic surgery（VATS）, firstly, the widening surgical indications for VATS techniques, and secondly, the use of single-port VATS which is less invasive and more cosmetic. This article focuses in particular on four aspects of single-port VATS, including；（1）the individualized incision approach and its characteristics of single-port VATS；（2）single-port VATS for the treatment of pneumothorax and the development of related techniques and equipment；（3）single-port VATS for the diagnosis and treatment of thoracic diseases such as lung lobectomy；（4）the advantages and disadvantages of single-port VATS in clinical practice.
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
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.
Abstract： Objective To compare clinical outcomes of complete video-assisted thoracoscopic surgery （cVATS） lobectomy with routine thoracotomy lobectomy for the treatment of bronchiectasis, and evaluate the feasibility, safety and specific considerations of cVATS lobectomy for the treatment of bronchiectasis. Methods We retrospectively analyzed the clinical data of 115 patients who underwent lobectomy for the treatment of bronchiectasis in Beijing Chaoyang Hospital from May 2009 to January 2012. According to the way of operation, these patients were divided into two groups （cVATS group and thoracotomy group）. In the thoracotomy group, there were 62 patients （28 males and 34 females with an age of 46.2±11.9 years） who underwent routine thoracotomy lobectomy. In the cVATS group, there were 53 patients （19 males and 34 females with an age of 45.7±12.2 years） who underwent cVATS lobectomy. Operation time, intra-operative blood loss, postoperative thoracic drainage, complications and hospitalization, and cost of hospitalization were compared between the two groups. Results There was no perioperative death in all patients. There was no statistical difference in operation time between the two groups. Intra-operative blood loss of thoracotomy group patients was significantly higher than that of cVATS group patients （228.8±121.7 ml vs. 157.1±123.8 ml, t=2.592, P=0.011）. Postoperative thoracic drainage （866.7±439.5 ml vs. 1 805.3±466.7 ml, t=9.003，P=0.000）, duration of chest tube drainage （6.6±3.3 d vs. 9.8±4.6 d,t=3.339，P=0.001）, and postoperative hospitalization （7.5±2.2 d vs. 11.2±5.4 d, t=3.424，P=0.001） of cVATS group were significantly lower than those of thoracotomy group. The cost of hospitalization of cVATS group was significantly higher than that of thoracotomy group （38 543.6±11 051.8 yuan vs. 30 523.4±10 028.5 yuan，t=3.423, P=0.001）. There was no statistical difference in postoperative complications between the two groups （P＞0.05）. Forty-five patients in cVATS group were followed up for 2 to 14 months. Among them, 42 patients completely had no sputum or haemoptysis and 3 patients still intermittently had some sputum. Conclusion cVATS lobectomy is safe and feasible for the treatment of bronchiectasis. Compared with routine thoracotomy lobectomy, cVATS lobectomy does not increase surgical risk, but can significantly reduce operation injury and length of hospital stay. During cVATS, the lung residual should be handled cautiously especially for patients with nonanatomic pulmonary resection, and the non-single-order operation is recommended.