Abstract： Appropriate prophylactic administration of antibiotics for thoracic and cardiovascular surgical procedure can reduce postoperative morbidity and decrease the overall cost due to infections. Prophylactic antibiotics should be given within 30 minutes preceding incision intravascularly. Serum levels of free drug above the minimal inhibitory concentration (MIC) for common contaminating bacteria should be maintained for the entire surgical period. Prophylactic antibiotics after operation are useless for patients without risk factors predisposing to postoperative infection. Heart and(or) lung transplant patients should be given antiviral and antifungal prophylaxis. Selection of antibiotics must be based on the pharmacokinetic, pharcodynamic and pharmacoeconomic properties of antibiotics and features of surgery. The policy of antibiotic prophylaxis must be modified in response to alterations in antibiotic resistance pattern which is constantly changing in hospital.
The incidence and mortality of lung cancer are increasing globally. With the spread of CT, more and more early-stage lung cancer can be detected and treated in a timely manner. As the main treatment of lung cancer, thoracoscopic anatomical segmentectomy in the treatment of non-small cell lung cancer is causing concern to the thoracic surgeons. Here, we will discuss the application of thoracoscopic anatomical segmentectomy in the treatment of early non-small cell lung cancer.
Objective To investigate the surgical indications of pulmonary aspergilloma, and to reduce postoperative complications. MethodsA total of 160 surgically treated patients with pulmonary aspergilloma were analyzed retrospectively from September 1975 to March 2006. All patients were divided into two groups: simple pulmonary aspergilloma(SPA,n=34) and complex pulmonary aspergilloma(CPA, n=126), according to the nature and extent of the underlying disease of the lung. The operative procedures included 154 pulmonectomy, 3 thoracoplasties with pulmonectomy or filling with the muscle flap, and 3 cavernostomy filling with the muscle flap. Results 156 of 160 cases had been cured with cure rate of 97.5% and no postoperative deaths. There were postoperative complications in 44 patients(27.5%) including: pneumonia(15 cases), incomplete reexpansion(12 cases), prolonged air leak(10 cases), empyema (5 cases), pulmonary abscess(5 cases), bronchopleural fistula(3 cases) and wound infection(2 cases). Postoperative complications of SPA group were lower than those in CPA group (P＜0.05). One hundred and fifty-one patients were followed up for 4 months to 5 years, no recurrence were observed. Conclusion Surgical resection for pulmonary aspergilloma should be selected first whenever the diagnosis of aspergilloma is confirmed. Objective and reliable preoperative evaluation is the key to reducing postoperative complications and surgery success. Because of minimal invasiveness, short length of hospital stay and less postoperative complications, video-assisted minithoractomy surgery may be superior to open thoracotomy in patients with localized underlying pulmonary disease and less pleural adhesions.
ObjectiveTo explore prognostic factors of non-small cell lung cancer(NSCLC)patients with preoperative clinical N0 staging but unexpected postoperative pathological N2 staging (cN0-pN2). MethodsClinical data of NSCLC patients with cN0-pN2 after radical lung cancer resection in Huashan Hospital Affiliated to Fudan University from January 2006 to December 2010 were retrospectively analyzed. Survival information was collected through followup, and follow-up expired on December 31, 2012. Prognostic factors of NSCLC patients with cN0-pN2 were analyzed using Cox proportional-hazard regression. ResultsA total of 263 patients were enrolled in this study. The followup rate was 91.63%. Overall 1-year, 3-year and 5-year survival rate was 94.6%, 55.2% and 26.3%, respectively. Videoassisted thoracoscopic surgery (VATS, P=0.017, RR=0.659, 95%CI 0.469-0.927), multiple stations of mediastinal lymph node metastases (P=0.003, RR=1.605, 95%CI 1.180-2.183), no adjuvant chemotherapy(P=0.012, RR=1.576, 95%CI 1.105-2.246) were independent predictive factors for NSCLC patients with cN0-pN2. For patients with single station N2, median survival after VATS was significantly longer than that after open thoracotomy (48.55 months vs. 37.34 months, P=0.018). For patients with multiple stations of mediastinal lymph node metastases, median survival without any adjuvant chemotherapy was significantly shorter than that after adjuvant chemotherapy (20.32 months vs. 31.55 months, P=0.001). ConclusionPrognosis of NSCLC patients with cN0-pN2 is related to operational methods, adjuvant chemotherapy and station number of mediastinal lymph node metastasis. Patients with single station of mediastinal lymph node metastasis are more likely to benefit from VATS while patients with multiple stations of mediastinal lymph node metastases are more likely to benefit from adjuvant chemotherapy.
Objective Rapid and effective vascularization of scaffolds used for bone tissue engineering is critical to bony repair. To study the cooperative and promotion effects of enhanced bioactive glass/collagen composite scaffold on vascularization for searching for a kind of el igible vascularized scaffold to repair bone defect. Methods The human umbil ical vein endothel ial cells (HUVECs) were collected from human umbil ical core, and identified through von Willebrandfactor (vWF) and CD34 immunofluorescence. The 1st passage of HUVECs were suspensed and seeded into the scaffold. The attachment and prol iferation of HUVECs on the scaffold were observed through scanning electron microscope (SEM). HUVECs were seeded on the scaffold as the experimental group, and on 96-well plate as the control group. The growth rate of HUVECs was detected through alarmarBlue at 1, 3, 5, 7, 9, and 11 days. Meanwhile, the mRNA expression levels of VEGF, fms-related tyrosine kinase 1 (Flt-1), and kinase insert domain receptor (Kdr) were detected through real-time fluorescence quantitative PCR. Twelve scaffolds were embedded subcutaneouly into 6 Sprague-Dawley rats. The enhanced scaffolds were used and the arteria and vein saphena bundle were embedded straightly through the central slot of scaffold in experimental group, and the common scaffolds were used in control group. Frozen section and HE staining of scaffolds were performed at 5 days and 10 days to observe the vascularization of embedded scaffold. Results HUVECs were identified through morphology, vWF and CD34 immunofluorescence. SEM results showed HUVECs could attach to the scaffold tightly and viably. HUVECs prol iferated actively on the scaffold in experimental group; the growth rate in experimental group was higher than that in control group at 3-11 days, showing significant differences within 5-11 days (P lt; 0.05). The real-time fluorescence quantitative PCR results showed thatthe mRNA expression levels of VEGF, Flt-1, and Kdr in experimental group were higher than those in control group at 3 days, showing significant differences (P lt; 0.05). Frozen section and HE staining of the scaffolds in experimental group showed that the embedded vessel bundle were still patency at 5 days and 10 days, that many new vessels were observed around the embedded vessel bundle and increased with time, host vessels infiltrated in the surrounding area of scaffold and fewer neo-vessels at the distant area. But there was only some fibrous tissue appeared in control group, and at 10 days, the common scaffold degradated, so few normal tissue appeared at the embedded area. Conclusion Enhanced bioactive glass/collagen composite scaffold can promote vascularization in vitro and in vivo, and may be used in bone tissue engineering.
ObjectiveTo assess the correlation of WHO pathological classification and Masaoka stage of thymomas with its prognosis.MethodsA total of 468 patients with thymomas who received surgeries during 2009-2019 in Huashan Hospital, Fudan University, were collected. There were 234 males and 234 females with an average age of 21-83 (49.6±18.7) years. A total of 132 patients underwent video-assisted thoracic surgery (VATS) and 336 patients underwent thymectomy with median sternal incision. The follow-up time was 5.7±2.8 years. The clinical data of the patients were analyzed.ResultsThe amount of intraoperative bleeding was 178.3±133.5 mL in the median sternal incision group, and 164.8±184.1 mL in the VATS group (P=0.537). The operative time was 3.3±0.7 h in the median sternal incision group and 3.4±1.2 h in the VATS group (P=0.376). Postoperative active bleeding, phrenic nerve injury and chylothorax complications occurred in 8 patients, 9 patients and 1 patient in the VATS group, respectively, and 37 patients, 31 patients and 7 patients in the median sternal incision group, respectively. There was no statistical difference between the two groups (P=0.102, 0.402, 0.320). The 5-year cumulative progression free survival (PFS) rates of patients with WHO type A, AB, B1, B2, B3 and C thymomas were 100.0%, 100.0%, 95.7%, 81.4%, 67.5% and 50.0%, respectively (P<0.001). The 5-year PFS rates of patients with Masaoka stageⅠ-Ⅳ thymomas were 96.1%, 89.2%, 68.6% and 19.3%, respectively (P<0.001). The 5-year PFS rate was 87.3% in patients with myasthenia gravis (MG) and 78.2% in patients without MG (P<0.001). The 5-year PFS rates of patients with different surgeries were 82.4% and 83.8%, respectively (P=0.904). ConclusionWHO pathological classification and Masaoka stage have significant clinical prognosis suggestive effect. Thymoma patients combined with MG have better prognosis, which suggests early diagnosis and treatment of thymoma are important.
Since December 2019, a novel coronavirus (2019-nCoV, SARS-CoV-2) pneumonia (COVID-19) outbreak has occurred in Wuhan, Hubei Province, and the epidemic situation has continued to spread. Such cases have also been found in other parts of the country. The spread of the novel coronavirus pneumonia epidemic has brought great challenges to the clinical practice of thoracic surgery. Outpatient clinics need to strengthen the differential diagnosis of ground glass opacity and pulmonary plaque shadows. During the epidemic, surgical indications are strictly controlled, and selective surgery is postponed. Patients planning to undergo a limited period of surgery should be quarantined for 2 weeks and have a nucleic acid test when necessary before surgery. For patients who are planning to undergo emergency surgery, nucleic acid testing should be carried out before surgery, and three-level protection should be performed during surgery. Patients who are planning to undergo emergency surgery in the epidemic area should be confirmed with or without novel coronavirus pneumonia before operation, and perform nucleic acid test if necessary. Surgical disinfection and isolation measures should be strictly carried out. Among postoperative patients, cases with new coronavirus infection were actively investigated. For the rescue of patients with novel coronavirus infection, attention needs to be paid to prevention and treatment and related complications, including mechanical ventilation-related pneumothorax or mediastinal emphysema, and injury after tracheal intubation.