Abstract: Objective To evaluate the feasibility and safety of combined laparoscopic and thoracoscopic esophagectomy and intrathoracic esophagogastric anastomosis for the treatment of esophageal cancer. Methods We retrospectively analyzed clinical data of 40 patients with esophageal cancer who underwent esophagectomy in Beijing Chaoyang Hospital of Capital Medical University from March 2010 to March 2012. All the 40 patients were divided into 2 groups according to their different surgical approach， including 22 patients who underwent combined laparoscopic and thoracoscopic esophagectomy and intrathoracic esophagogastric anastomosis （minimally invasive surgery group） and 18 patients who underwent Ivor Lewis esophagectomy （open surgery group）. Operation time， intra-operative blood loss， lymph node dissection， postoperative morbidity， hospital stay and cost were compared between the two groups. Results The hospitalcost of minimally invasive surgery group was significantly higher than that of open surgery group ［（78 181.5±8 958.8） yuan vs. （61 717.2±35 159.4） yuan， Z=4.078，P=0.000］ . There was no statistical difference in operation time ［（292.0±74.8） min vs. （256.1±41.0） min， t=1.838，P=0.074］， intra-operative blood loss ［（447.7±597.0） ml vs. （305.6±125.9） ml， Z=0.401，P=0.688］， total number of dissected lymph nodes （230 vs. 215， t=1.714，P=0.095）， postoperative morbidity ［22.7% （5/22） vs. 33.3% （6/18）， χ2=0.559，P=0.498］， time to resume oral intake ［（8.5±3.5） d vs. （11.1±9.6） d，t=1.202，P=0.237］， and postoperative hospital stay ［（11.6±5.7） d vs. （13.3±9.4） d， t=0.680， P=0.501）］ between the two groups. The minimally invasive surgery group was further divided into two subgroups according to operation date， including 10 patients in the early stage subgroup and 12 patients in the later stage subgroup. The operation time of the later stage subgroup was significantly shorter than that of the early stage subgroup ［（262.9±64.9） min vs. （327.5±73.0） min， t=2.197， P=0.040］， but not statistically different from that of the open surgery group ［（262.9±64.9） min vs. （256.1 ±41.0） min， t=0.353， P=0.727］. Intra-operative blood loss of the later stage subgroup was significantly reduced compared with those of the early stage subgroup ［（220.8±149.9） ml vs. （720.0±808.0） ml， Z=3.279， P=0.001)］ and the open surgery group ［（220.8±149.9）ml vs. （305.6±125.9） ml， Z=2.089， P=0.037）］. Conclusion Combined laparoscopic and thoracoscopic esophagectomy and intrathoracic esophagogastric anastomosis is a safe and effective surgical procedure for the treatment of esophageal cancer.
It has been absent from an accepted criteria for normalization and quality control of the thoracic surgery until now. The ideal assessing instrument which will be used to evaluate the technical skills and surgical procedures should present a few vital characterizations below: objectivity, speciality in the content, detailed structure, and quantifiability. Objective structured assessment of technical skills (OSATS) has developed as a reliable method of surgical skills measurement. This article focuses on the history of OSATS and its prospect in the thoracic surgery area by reviewing relevant literatures.
There is still a lack of experience in the perioperative strategy for esophageal cancer patients in China during the epidemic of COVID-19. In December 2022, a 59-year-old male patient with esophageal cancer was admitted to our department. He received 2 cycles of neoadjuvant therapy before surgery, and developed COVID-19 perioperatively. After treatment, the infection symptoms of the patient were improved, and the postoperative recovery was satisfactory.
ObjectiveTo provide experimental data and theoretical support for further studying the maturity of cardiac patches in other in vitro experiments and the safety in other in vivo animal experiments, through standard chemically defined and small molecule-based induction protocol (CDM3) for promoting the differentiation of human induced pluripotent stem cells (hiPSCs) into myocardium, and preliminarily preparing cardiac patches. MethodsAfter resuscitation, culture and identification of hiPSCs, they were inoculated on the matrigel-coated polycaprolactone (PCL). After 24 hours, the cell growth was observed by DAPI fluorescence under a fluorescence microscope, and the stemness of hiPSCs was identified by OCT4 fluorescence. After fixation, electron microscope scanning was performed to observe the cell morphology on the surface of the patch. On the 1st, 3rd, 5th, and 7th days of culture, the cell viability was determined by CCK-8 method, and the growth curve was drawn to observe the cell growth and proliferation. After co-cultured with matrigel-coated PCL for 24 hours, hiPSCs were divided into a control group and a CDM3 group, and continued to culture for 6 days. On the 8th day, the cell growth was observed by DAPI fluorescence under a fluorescence microscope, and hiPSCs stemness was identified by OCT4 fluorescence, and cTnT and α-actin for cardiomyocyte marker identification. ResultsImmunofluorescence of hiPSCs co-cultured with matrigel-coated PCL for 24 hours showed that OCT4 emitted green fluorescence, and hiPSCs remained stemness on matrigel-coated PCL scaffolds. DAPI emitted blue fluorescence: cells grew clonally with uniform cell morphology. Scanning electron microscope showed that hiPSCs adhered and grew on matrigel-coated PCL, the cell outline was clearly visible, and the morphology was normal. The cell viability assay by CCK-8 method showed that hiPSCs proliferated and grew on PCL scaffolds coated with matrigel. After 6 days of culture in the control group and the CDM3 group, immunofluorescence showed that the hiPSCs in the control group highly expressed the stem cell stemness marker OCT4, but did not express the cardiac markers cTnT and α-actin. The CDM3 group obviously expressed the cardiac markers cTnT and α-actin, but did not express the stem cell stemness marker OCT4. ConclusionhiPSCs can proliferate and grow on matrigel-coated PCL. Under the influence of CDM3, hiPSCs can be differentiated into cardiomyocyte-like cells, and the preliminary preparation of cardiac patch can provide a better treatment method for further clinical treatment of cardiac infarction.
ObjectiveTo explore the key points and difficulties of intraoperative frozen section diagnosis of pulmonary diseases. MethodsThe intraoperative frozen section and postoperative paraffin section results of pulmonary nodule patients in Beijing Chaoyang Hospital, Capital Medical University from January 2021 to January 2022 were collected. The main causes of misdiagnosis in frozen section diagnosis were analyzed, and the main points of diagnosis and differential diagnosis were summarized. ResultsAccording to the inclusion criteria, a total of 1 263 frozen section diagnosis results of 1 178 patients were included in the study, including 475 males and 703 females, with an average age of 58.7 (23-86) years. In 1 263 frozen section diagnosis results, the correct diagnosis rate was 95.65%, and the misdiagnosis rate was 4.35%. There were 55 misdiagnoses, including 18 (3.44%) invasive adenocarcinoma, 17 (5.82%) adenocarcinoma in situ, 7 (35.00%) mucinous adenocarcinoma, 4 (2.09%) minimally invasive adenocarcinoma, 3 (100.00%) IgG4 related diseases, 2 (66.67%) mucinous adenocarcinoma in situ, 1 (16.67%) atypical adenomatous hyperplasia, 1 (14.29%) sclerosing pulmonary cell tumor, 1 (33.33%) bronchiolar adenoma, and 1 (100.00%) papillary adenoma. ConclusionIntraoperative frozen section diagnosis still has its limitations. Clinicians need to make a comprehensive judgment based on imaging examination and clinical experience.
Objective To investigate the surgical procedure selection, operation technique and safety of anatomic sublobar resection for pulmonary nodules. Methods The clinical data of 242 patients with clinical stage ⅠA lung cancer who underwent anatomic sublobar resection in our hospital between 2017 and 2020 were retrospectively analyzed. There were 81 males and 161 females with a median age of 57.0 (50.0, 65.0) years. They were divided into 4 groups according to the surgical methods, including a segmentectomy group (n=148), a combined segmentectomy group (n=31), an enlarged segmentectomy group (n=43) and an anatomic wedge resection group (n=20). The preoperative CT data, operation related indexes and early postoperative outcomes of each group were summarized. Results The median medical history of the patients was 4.0 months. The median maximum diameter of nodule on CT image was 1.1 cm, and the consolidation/tumor ratio (CTR) was ≤0.25 in 81.0% of the patients. A total of 240 patients were primary lung adenocarcinoma. The median operation time was 130.0 min, the median blood loss was 50.0 mL, the median chest drainage time was 3.0 d, and the hospitalization cost was (53.0±12.0) thousand yuan. The operation time of combined segmentectomy was longer than that of the segmentectomy group (P=0.001). The operation time (P=0.000), intraoperative blood loss (P=0.000), lymph nodes dissected (P=0.007) and cost of hospitalization (P=0.000) in the anatomic wedge resection group were shorter or less than those in the other three groups. There was no significant difference in the drainage time, total drainage volume, air leakage or postoperative hospital stay among the four groups (P>0.05). Conclusion The combined application of segmentectomy and wedge resection technique provides a more flexible surgical option for the surgical treatment of early lung cancer with ground glass opacity as the main component.
With the change of coronavirus disease 2019 (COVID-19) prevention and control strategy in China, the number of COVID-19 cases has increased significantly recently, which has also brought new challenges to the perioperative risk control of thoracic surgery. This paper puts forward several suggestions, aiming to standardize the preoperative screening and evaluation during the COVID-19 period, strictly grasp the indications and timing of surgery, optimize the medical management process, individualize surgical decision-making, and minimize the risk of COVID-19 infection to surgery.
Objective To study the correlation of preoperative hemoglobin amount with venous thromboembolism (VTE) after surgical treatment of bronchiectasis and the clinical significance. Methods A retrospective study was performed on patients with bronchiectasis who underwent surgical treatment in our center from June 2017 to November 2021. The differences in blood parameters between the VTE patients and non-VTE patients were compared. The relationship between preoperative hemoglobin and VTE was confirmed by quartile grouping and receiver operating characteristic (ROC) curve. Results A total of 122 patients were enrolled, including 50 males and 72 females, with a mean age of 52.52±12.29 years. The overall incidence of VTE after bronchiectasis was 9.02% (11/122). Preoperative hemoglobin amount (OR=0.923, 95%CI 0.870-0.980, P=0.008) and D-dimer amount (OR=1.734, 95%CI 1.087-2.766, P=0.021) were independent influencing factors for VTE after bronchiectasis. The incidence of VTE after bronchiectasis decreased gradually with the increase of preoperative hemoglobin amount. The area under the ROC curve (AUC) of postoperative D-dimer alone was 0.757, whereas the AUC of postoperative D-dimer combined with preoperative hemoglobin amount was 0.878. Conclusion Low preoperative hemoglobin is an independent risk factor for postoperative VTE. Postoperative D-dimer combined with preoperative hemoglobin amount has a better predictive performance compared with postoperative D-dimer alone for postoperative VTE.