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Effect Analysis on Singledirection Lobectomy for Primary Nonsmall Cell Lung Cancer in the Early Stage by Videoassisted Thoracic Surgery

Abstract： Objective To investigate the effect of singledirection lobectomy plus systematic lymphnode dissection for primary nonsmall cell lung cancer (NSCLC) in the early stage by videoassisted thoracic surgery (VATS). Methods We retrospectively analyzed the clinical data of 89 patients who received VATS lobectomy plus systematic lymphnode dissection for earlystage primary NSCLC in the Second People’s Hospital of Chengdu between June 2006 and December 2009. Based on the operative approach, the patients were divided into two groups: VATSminithoracotomy group and singledirection lobectomy VATS group. In the former group, there were 46 patients, including 36 males and 10 females, with an age of 58.76±14.78 years. For patients in this group, minithoracotomy was carried out assisted by VATS. In the latter group, there were 43 patients, including 37 males and 6 females, with an age of 61.34±12.56 years, and singledirection lobectomy VATS was performed for patients in this group. Moreover, 42 patients undergoing routine posterior lateral open thoracotomy were chosen to form the control group (thoracotomy group, included 37 males and 5 females with an age of 56.30±15.59 years). The clinical features, such as operative time, operative blood loss, the number of systematic dissected lymph nodes, postoperative drainage quantity, postoperative complications and visual analogue scale (VAS) of chest pain were retrospectively analyzed to evaluate the early outcomes. Results No operative death occurred in all three groups. There were significant differences among the three groups in the postoperative drainage time (P=0.024), postoperative drainage quantity (P=0.019), operative blood loss (P=0.009), early outofbed activity time (P=0.031), and the incidence of cardiopulmonary complications (P=0.048). Compared with the VATSminithoracotomy group, the singledirection lobectomy VATS group was significantly lower or shorter (Plt;0.05) in postoperative drainage quantity (208.33±50.39 ml vs. 245.98±45.32 ml), operative blood loss (78.79±24.23 ml vs. 112.63±64.32 ml), and the early outofbed activity time (2.31±0.27 d vs. 3.56±0.31 d). The rate of using Dolantin in the control group was significantly higher than the other two groups (P=0.046, 0.007). The change of VAS score among the three groups after operation was also statistically significant (F=5.796, P=0.002). A total of 109 patients (37 in the VATSminithoracotomy group, 37 in the singledirection lobectomy VATS group, and 35 in the control group) were followed up after operation with a period of 2 to 48 months. Twentytwo patients were lost in the followup. There were 10, 9, and 8 deaths during the followup in the three groups respectively, and the median survival time was 40 months, 37 months, and 37 months respectively. There was no significant difference among the three groups in survival time (P=0.848). Conclusion VATS, especially VATS assisted single direction lobectomy and systematic lymphnode dissection for primary NSCLC in the early stage has the same surgical efficacy as the traditional open thoracotomy, and is minimally invasive, which contributes to a quick recovery. Consequently, it is a reliable approach for lung cancer in the early stage. 

胸腺脂肪瘤一例

可吸收线胃食管分层连续缝合法行胃食管吻合术

目的 为了减少食管、贲门癌切除、胃食管吻合术后吻合口瘘和吻合口狭窄的发生率,总结可吸收线胃食管分层连续缝合法的经验. 方法 食管、贲门癌切除后,采用国产3-0带针可吸收线在食管不同平面分层连续缝合行胃食管吻合术40例. 结果 全组无死亡,发生吻合口瘘1例,经治疗痊愈;轻度吻合口狭窄3例,进软食无梗阻,经行吻合口扩张后能正常进食. 结论 采用可吸收线分层连续缝合法行胃食管吻合术是可行的,吻合口瘘发生率低,吻合口狭窄发生少、程度轻.

肺切除术支气管残端处理技术的改进

目的 为了避免或减少肺切除术后支气管胸膜瘘等并发症,探讨其处理技术,以提高手术疗效. 方法 采用支气管钳钳夹支气管后,从钳夹的浅面做肺切除术,支气管残端用3-0带针编织涤纶线在钳夹的深面做间断8字和水平交叉褥式缝合,施行肺切除术128例,并观察术后并发症发生情况. 结果 全组无支气管胸膜瘘发生,手术显露好,操作方便,支气管残端短,缝合牢固,术后无残端液体潴留和肉芽肿形成,避免了术后顽固性呛咳和脓胸等并发症. 结论 此方法是一种较好的支气管残端处理方法.