Abstract: Objective To explore the protection of pulmonary function by shortening the thoracic opening time inesophagectomy of esophageal carcinoma. Methods A retrospective review of the postoperative pulmonary function of 54 patients with upper esophageal cancer undergoing esophagectomy with triple incisions in Tongji Hospital from January 2007 to April 2010 was conducted. The patients were divided into two groups. Twentyeight patients including 25 males and 3 females aged at 58.9±8.2 years were in in the classic procedure group, accepting classical esophagectomy with triple incision approach. Among them, there were 26 patients with squamous carcinoma and 2 with adenocarcinoma. Twentysix patients including 22 males and 4 females aged at 54.7±9.4 years were in the improved procedure group, accepting improved esophagectomy with triple incision approach. Among them, 25 patients had squamous carcinoma and 1 had adenocarcinoma. We analyzed the difference of the thoracic opening time, onelung ventilation time during the operation, arterial oxygen pressure (PaO2), arterial carbon dioxide differential pressure(PaCO2), pulse oximeter saturation (SpO2), postoperative mechanical ventilation time, intensive care unit (ICU) stay time, postoperative oxygen support days, postoperative inhospital days, and the incidence of pulmonary infection and respiratory failure between the two groups. Results There was a statistical difference between the two groups in thoracic opening time (4.7±1.2 hours versus 2.6±0.8 hours, t=7.51, Plt;0.05) and onelung ventilation time (3.7±15 hours versus 23±0.8 hours, t=4.23, Plt;0.05). The PaO2 and SpO2 on the 1st day and the 3rd day after operation were significantly lower than those before operation in both the classic procedure group (on the 1st day after [CM(159mm]operation, PaO2: F=516.03, Plt;0.05; SpO2: F=129.63, Plt;0.05; on the 3rdday after operation, PaO2: F=213.99, Plt;005; SpO2: F=61.84, Plt;0.05) and the improved procedure group (on the 1st day after operation, PaO2: F=423.56, Plt;0.05; SpO2: F=184.24, Plt;0.05; on the 3st day after operation, PaO2: F=136.78, Plt;0.05). On the 1st day after operation, PaO2 and SpO2 in the improved procedure group were significantly higher than those in the classic procedure group (F=36.20, Plt;0.05; F=93.42, Plt;0.05), while PaCO2 in the improved procedure group was significantly lower than that in the classic procedure group (F=155.49, Plt;0.05). On the 3rd day after operation, PaO2 in the improved procedure group was significantly higher than that in the classic procedure group (F=29.23, Plt;0.05). The postoperative mechanical ventilation time and ICU stay time in the improved procedure group were significantly shorter than those in the classic procedure group (t=3.81, P=0.00; t=4.65, Plt;0.05). Conclusion Improved esophagectomy of carcinoma with triple incision approach can significantly shorten the thoracic opening time and onelung ventilation time during operation, which plays a good role in protecting pulmonary function and lowering the incidence of pulmonary complications.
ObjectiveTo explore the safety and feasibility of the application of video-assisted thoracic surgery (VATS) anatomic segmentectomy in single-stage bilateral thoracic surgery for the treatment of bilateral localized bronchiectasis.MethodsFrom June 2014 to June 2018, 19 patients with bilateral localized bronchiectasis underwent single-stage bilateral thoracic surgery with VATS anatomic segmentectomy, including 11 males and 8 females aged 38.0±12.5 years. The clinical efficacy of the surgery was evaluated.ResultsAll surgeries were successfully completed, of which 17 were bilateral VATS, 2 were unilateral VATS with the other lateral converted to thoracotomy. The average number of bilateral resected segments was 4-8 (5.9±1.2). Mean operation time was 330.0±40.0 min and mean blood loss was 150.0±60.0 mL. Mean ventilator-assisted breathing time was 6.0±1.8 h, mean duration of chest-tube placement was 4.0±1.0 d and mean hospital stay time was 14.0±1.5 d. Three patients suffered pulmonary infection and 1 patient received tracheotomy. No perioperative death occurred. Arterial oxygen pressures on postoperative day (POD) 1 (F=340.18, P<0.05) and POD 3 (F=131.26, P<0.05) were significantly lower than that before operation, arterial carbon dioxide pressures on POD 1 (F=46.62, P<0.05) and POD 3 (F=48.21, P<0.05) were significantly higher than that before operation, and pulse oximeter saturation on POD 1 was significantly lower than that before operation (F=210.82, P<0.05). The patients were followed up for one to five years without recurrence.ConclusionApplication of VATS anatomic segmentectomy in single-stage bilateral thoracic surgery for the treatment of bilateral localized bronchiectasis is safe and feasible with strictly selected patients. Postoperative airway management is very important. The surgery is worthy of wide clinical practice.