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Prevention of Postoperative Air Leak after Selective Lobectomy

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.

同种异体胸骨移植重建胸骨三例

目的 探讨胸骨切除后同种异体胸骨移植，一期重建胸骨手术的可行性、手术方法与技巧。 方法 2008年 1月至2009年12月青岛大学医学院附属医院收治胸骨肿瘤患者3例，其中男2例，女1例；年龄分别为19岁、44岁和52岁；病程2个月~2年。3例患者均行胸骨部分切除，同期以同种异体胸骨重建。异体胸骨预先冻存；手术切除范围距病变边缘至少2 cm，包括病变胸骨、相应部分肋软骨、软组织；异体胸骨植入后用钢丝固定，残腔以大网膜填充。 结果 3例手术均获成功，手术效果满意；3例分别随访6个月～2年，无肿瘤复发，无明显排斥反应，患者生活良好。 结论 以同种异体胸骨重建胸骨临床效果满意，有良好的可行性。

增生型糖尿病视网膜病变玻璃体切割手术前后生存质量比较

Diagnosis and Management of Concealed Intrathoracic Anastomotic Leak of Esophagus

Abstract：　Objective　To investigate diagnosis and treatment of concealed intrathoracic anastomotic leak of the esophagus.　Methods　We retrospectively analyzed the clinical data of 32 patients who presented with unexplained sepsis （temperature＞38 ℃ and elevated white blood cell count） after esophagectomy and intrathoracic anastomosis for esophageal　carcinoma or gastric cardia carcinoma in Affiliated Hospital, Medical College of Qingdao University from January 2006 to December 2010. All the patients underwent oral water-soluble contrast esophagogram and oral water-soluble contrast computerized tomography of the chest. None of the patients had any sign of contrast leak in these diagnostic examinations, but their chest computerized tomography all showed peri-anastomotic bubble and encapsulated effusion. Fifteen patients were treated as concealed intrathoracic anastomotic leak of the esophagus, including fasting, broad spectrum antibiotic treatment, prolonged gastrointestinal decompression and enteral nutrition via naso-intestinal feeding tube. The other 17 patients were not treated as anastomotic leak of the esophagus and only received broad spectrum antibiotic treatment. Results None of the 15 patients who were treated as concealed intrathoracic anastomotic leak finally developed anastomotic leak proved by oral water-soluble contrast esophagogram and computerized tomography of the chest （0%, 0/15）. Among the 17 patients　who were not treated as anastomotic leak, fourteen patients developed anastomotic leak later （82.4%, 14/17）, 2 patients died of aorto-esophageal fistula and 3 patients died of multiple organ dysfunction syndrome.　Conclusion　Peri-anastomotic bubble and irregular encapsulated effusion in oral water-soluble contrast esophagogram and computerized tomography of the chest should be considered as specific signs of concealed intrathoracic anastomotic leak of esophagus after esophagectomy and intrathoracic anastomosis. Patients with such signs should be treated as anastomotic leak.

下行性坏死性纵隔炎的诊断与治疗

目的　探讨下行性坏死性纵隔炎（DNM）的诊断和治疗方法。　方法　回顾性分析1988年1月至2009年12月青岛大学医学院附属医院收治11例DNM患者的临床资料，其中男8例，女3例；年龄25～71 （55±3）岁。早期收治的患者外科治疗采用颈部清创、引流，或经颈部纵隔引流；后期收治的患者采用颈、胸部同期清创、引流及术后冲洗。　结果　行单纯颈部清创、引流及经颈部纵隔引流的7例患者中死亡4例，均死于严重纵隔感染导致多器官功能衰竭，3例生存患者均为感染尚未侵犯下纵隔和胸腔；行颈、胸部清创、引流和冲洗的4例患者全部治愈。随访7例，随访时间3个月，患者恢复良好。　结论　DNM病情凶险，一旦发病迅速进展为脓毒血症，甚至死亡。重视口咽部和颈部感染患者的胸部症状、体征变化，及时行胸部CT检查是尽早诊断DNM的关键。尽早进行颈、胸部彻底清创、充分引流及有效冲洗是治疗DNM成功的关键。

Thoracoscopic Lobectomy of Single-port versus Multi-port Video-assisted Thoracoscopic Surgery for Peripheral Non-small Cell Lung Cancer: A Case Control Study

ObjectiveTo compare and analyze clinical effects of video-assisted thoracoscopic surgery (VATS) lobectomy and systematic lymph node harvests for peripheral non-small cell lung cancer (PNSCLC) patients between single-port (SP) and multi-port (MP) with a propensity-matched analysis. MethodsWe retrospectively analyzed the clinical data of 324 patients presented with PNSCLC and admitted in the Affiliated Hospital of Qingdao University from January 2013 through December 2015. Six-eight patients underwent single-port thoracoscopic lobectomy were as a SP group and 256 patients with multi-port thoracoscopic lobectomy. Another 68 patients were produced by a propensity-matched analysis in these 256 patients, to match with SP group as a MP group. There were 26 males and 42 females at age of 54-62 (59.3±10.3) years in the SP group. There were 32 males and 36 females at age of 50-66 (61.5±9.4) years in the MP group. Perioperative outcomes were compared between the two groups. ResultsAll operations were accomplished successfully, without conversion to thoracotomy. Most postoperative outcomes were similar in intraoperative blood loss (136.3±22.7 ml vs. 142.2±20.3 ml), conversion (4.4% vs. 7.4%), lymph node dissection number (19.9±3.5 vs. 20.0±3.0), station (7.9±2.3 vs. 8.3±2.1), postoperative drainage volume (761.4±182.3 ml vs. 736.9±176.4 ml), chest drainage duration (5.2±1.5 d vs. 5.8±1.8 d), length of hospital stay (5.5±2.0 d vs. 5.0±2.5 d), and postoperative complications (2.9% vs. 7.4%) between the two groups (P > 0.05). There were statistical differences in operation time (138.2±20.3 min vs. 126.4±22.4 min), downtrend of pain scores (P=0.03), and patients' satisfaction level (8.8±1.4 vs. 7.3±2.3, P < 0.05). Concision Single-port thoracoscopic lobectomy is not inferior to multi-port and is a safe and feasible surgical procedure for the management of PNSCLC.