ObjectiveTo evaluate the efficacy of tubless therapy for pulmonary bulla resection under the concept of fast track surgery.MethodsWe retrospectively analyzed the clinical data of 45 patients (29 males and 16 females at an average age of 26.1 years) with pulmonary bullae in our hospital between January 2015 and December 2017. These patients were divided into two groups. Among them, 25 patients were treated with preoperative gastric tubes and catheters, tracheal intubation anesthesia and postoperative drainage tubes (a tube group). And 20 patients were treated with no preoperative gastric tube or catheter, sublaryngeal anesthesia and no postoperative drainage tube (a tubless group). ResultsThere was a statistical difference in postoperative pain index (2.60±1.14 vs. 5.16±1.24, P<0.001) and larynx complication (P=0.00) between the two groups. Shorter period of epidural analgesic tubes (1.40±0.50 d vs. 2.84±0.75 d, P<0.001), shorter operation and anesthesia time (15.00±2.59 min vs. 18.56±2.10 min, P<0.001; 95.30±4.38 min vs. 105.50±4.59 min, P<0.001), shorter hospital stay (9.45±1.66 d vs. 12.80±1.87 d, P<0.001), and less expense (20 245.96±1 113.02 yuan vs. 22 147.06±1 735.01 yuan, P<0.001) in the tubless group were found compared with the tube group. But there was no statistical difference in incidence of complication of lung (P=0.43) between the two groups.ConclusionTubless therapy in the treatment of pulmonary bulla resection can accelerate the postoperative recovery with shorter hospital stay and less expense, and is an advantageous treatment.
ObjectiveTo investigate the clinical value of multidisclplinary team (MDT) in the application of non-small cell lung cancer (NSCLC). MethodsWe retrospectively analyzed the postoperative clinical data of 80 patients with NSCLC in the First Hospital of Lanzhou University between January 2014 and May 2018. There were 56 males, 24 females at age of 59±10 years. Forty five patients were performed lobectomy with conventional model, 35 patients were also performed lobectomy after MDT discussion. The clinical effect of the two groups was compared. ResultsCompared to conventional model, MDT can shorten operation time, intraoperative blood loss, postoperative chest drainage, catheterization time, complications, length of stay and hospital costs. But there was no significant difference in intraoperative transthoracotomy proportion, delayed wound healing and postoperative pulmonary leakage between the two groups. ConclusionThe efficacy of MDT in the surgical treatment of NSCLC is satisfactory. The MDT is valuable during operation, which reduces surgical trauma and accelerate patients’ recovery, and deserves the clinical promotion.
目的 探讨自发性脑出血（ICH）术后常见并发症及其处理。 方法 回顾性分析2009年1月－2012年1月收治的178例ICH手术治疗患者的临床资料，根据血肿量大小及部位不同，行开颅血肿清除术83例（开颅组），微创穿刺碎吸术95例（穿刺组），分析其术后并发症发生率，组间比较采用χ2检验，并结合文献复习。 结果 178例患者，均有程度不同的一种或多种并发症。除开颅组肺部感染发生率（48.2%）明显高于穿刺组（29.5%）外（P=0.010），其余并发症发生率两组间差异无统计学意义（P＞0.05）。 结论 ICH术后并发症严重且发生率高，术后并发症的处理是否恰当直接影响患者的预后。
Objective To analyze clinical outcome of the technique of comprehensive aortic root and valve reconstruction (CARVAR) applying in aortic valve and root disease. Methods We retrospectively analyzed the clinical data of 106 patients with aortic valve and root disease underwent CARVAR technique in our hospital from July 2012 to July 2015. There were 72 males and 34 females at the average age of 57.3 (11-67) years. We operated the CARVAR technique and analyzed the early and midterm clinical outcomes. Results There was no mortality and low cardiac output syndrome postoperatively. But there were 2 cases of renal insufficiency or failure and 1 case of infective endocarditis. The average ejection fraction was 54%. The mean area of aortic valve orifice was 2.2±0.8 cm2. The aortic valve pressure gradient was 11.2±2.3 mm Hg. There were 2 cases of mild aortic valve regurgitation. The result of operation was satisfying with a stable hemodynamics and few complications. The follow-up after surgery showed that there was no obvious abnormity in aortic valve and root. Conclusion Using CARVAR technique to cure aortic valve and root disease is an effective treatment and it can achieve satisfactory early and midterm clinical outcomes.
ObjectiveTo systematically review the complications and quality of life (QoL) in patients with esophageal cancer after esophagectomy using gastric tube. MethodsRandomized controlled trials (RCTs) about the postoperative complications and QoL of patients using gastric tube and the whole stomach reconstruction were electronically searched in PubMed, EMbase, The Cochrane Library, Web of Knowledge, CBM, CNKI, VIP and WanFang Data from inception to September 30th, 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality. Then meta-analysis was performed using RevMan 5.2 software. ResultsA total of 10 RCTs involving 1 085 patients were included. The results of meta-analysis showed that, in terms of postoperative complications, the incidences of reflux esophagitis (OR=0.19, 95%CI 0.12 to 0.32, P < 0.000 01) and intrathoracic stomach syndrome (OR=0.11, 95%CI 0.04 to 0.32, P < 0.000 1) with gastric tube were significantly lower than those of the whole stomach; in terms of QoL, the scores of QoL in the 6th month (MD=18.71, 95%CI 7.72 to 29.71, P=0.000 9) and in the 12th month (MD=22.95, 95%CI 8.21 to 37.69, P=0.002) with gastric tube were significantly higher than those of the whole stomach. In terms of satisfaction degree of QoL, the satisfaction degree of QoL in the 6th month (OR=1.78, 95%CI 1.10 to 2.88, P=0.02) and the 12th month (OR=2.73, 95%CI 1.67 to 4.47, P < 0.000 1) with gastric tube were both significantly higher than those of the whole stomach. ConclusionCompared with the whole stomach reconstruction, the method of gastric tube reconstruction has beneficial effects in reducing the incidences of postoperative complications (such as reflux esophagitis, intrathoracic stomach syndrome) and improves patients' QoL. But there are many uncertain factors about postoperative anastomotic complication and its influence on patients' long-term QoL remains uncertain. Thus, further studies should be conducted.
ObjectiveTo systematically evaluate the effects of closed drainage and simply closed drainage combined with pleurodesis in the treatment spontaneous pneumothorax. MethodsWe searched PubMed, Web of Science, The Cochrane Library, CBM, WanFang Data and CNKI from their inception to December 2nd, 2014, to collect randomized controlled trials (RCTs) of simple closed drainage versus closed drainage combined with pleurodesis in the treatment of spontaneous pneumothorax. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and evaluated the risk of bias of included studies. Then, RevMan 5.3 software was used for meta-analysis. ResultsA total of 5 RCTs including 499 patients were included. The results of meta-analysis showed that:Compared with the simple closed drainage, the closed drainage combined with pleurodesis was superior in the effective rate of recurrence spontaneous pneumothorax (OR=6.85, 95%CI 3.26 to 14.39, P<0.000 01) and the recurrence rate of primary spontaneous pneumothorax (OR=0.32, 95%CI 0.18 to 0.57, P<0.001). But there were no statistical differences in both groups in the effective rate of primary spontaneous pneumothorax (OR=1.49, 95%CI 0.71 to 3.14, P=0.29), the hospital stays of primary spontaneous pneumothorax (SMD=0.08, 95%CI -0.16 to 0.31, P=0.52), the hospital stays of recurrence spontaneous pneumothorax (SMD=-1.67, 95%CI -3.96 to 0.61, P=0.15), and the duration of drainage of primary spontaneous pneumothorax (SMD=-0.11, 95%CI 0.79 to 0.58, P=0.76). ConclusionCurrent evidence suggests that closed drainage combined with pleurodesis could improve the effective rate of recurrence spontaneous pneumothorax and decrease the recurrence rate of primary spontaneous pneumothorax. Due to limited quantity and quality of included studies, the above conclusion should be validated by more high quality studies.
ObjectiveTo systematically review the efficacy and safety of laparoscopic Heller's myotomy (LHM) versus pneumatic dilatation (PD) for achalasia. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 8, 2015), Web of Knowledge, CNKI, CBM, WanFang Data and VIP were searched from inception to August 26th 2015, to collect randomized controlled trials (RCTs) of LHM versus PD for achalasia. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. ResultsA total of 5 RCTs involving 446 patients were included. The results of meta-analysis showed that, compared with PD, LHM could significantly improve the effective rates after 3-month and 1-year follow-up (OR=2.66, 95%CI 1.08 to 6.60, P=0.03; OR=2.24, 95%CI 1.29 to 3.87, P=0.004). There were no statistical differences between the two groups in effective rate after more than 2-year follow-up (OR=1.749, 95%CI 0.99 to 3.23, P=0.05) and incidence of complications (OR=0.27, 95%CI 0.06 to 1.13, P=0.07). ConclusionCurrent evidence shows that, compared with PD, LHM could improve the short-term effective rate but could not improve the long-term (2-3 years) effective rate and reduce the incidence of complications. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Objective To discuss the safety, feasibility and advantages of tubeless trans-subxiphoid thoracoscopic surgery in anterior mediastinal tumor resection. Methods A total of 32 patients suffering anterior mediastinal tumor were enrolled, including 17 patients (8 males and 9 females) with average age of 31.8±8.4 years who had been performed tubeless trans-subxipohoid tharcoscopic surgery and 15 patients (8 males and 7 females) with average age of 31.1±9.2 years who had been performed traditional trans-subxipohoid tharcoscopic surgery. The differences of surgical duration, the lowest intraoperative arterial oxygen saturation (SaO2), postoperative awaking time, postoperative pain visual analogue score (VAS), postoperative pulmonary recruitment time, duration of postoperative hospital stay and hospitalization cost were analyzed. Results Postoperative awaking time (18.5±1.8 min vs. 28.9±4.2 min, P=0.000), postoperative VAS (1.6±0.6 vs. 3.5±7.4, P=0.000), duration of postoperative hospital stay (2.5±7.2 d vs. 4.3±1.1 d, P=0.000) and hospitalization cost (3.2±1.1 ten thousand RMB vs. 4.9±1.1 10 ten thousand RMB, P=0.000) in the tubeless group were better than those in the control group. There was no significant difference in surgical duration (51.7±6.5 min vs. 55.1±8.5 min), the lowest intraoperative SaO2 (98.5%±0.9% vs. 98.1%±0.8%), postoperative pulmonary recruitment time (33.9±12.2 d vs. 38.4±15.2 d, P>0.05) between the two groups.Conclusion Tubeless trans-subxiphoid thoracoscopic surgery is safe, feasible and advanced in anterior mediastinal tumor resection.