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@#Objective To compare the effects of epidural anesthesia with intubated anesthesia in the postoperative recovery of patients with thoracoscopic resection of lung bullae. Methods Sixty patients (53 males, 7 females, aged 16-65 years) undergoing thoracoscopic resection of unilateral pulmonary bullae in our hospital from December 2014 to December 2015 were randomly divided into two groups: a group A (epidural anesthesia group) received thoracic epidural block combined with intraoperative interthoracic vagus nerve block; a group B (general anesthesia group) received general anesthesia with double lumen endobronchial intubation and pulmonary sequestration. Postoperative anesthesia-related complications and postoperative recovery were recorded. Results Both of the two anesthesia methods could meet the requirements of operation. The patients with the vocal cord injury and sore throat in the group B were more than those in the group A. The difference was statistically significant in the incidence of sore throat (P<0.01) . Arterial partial pressure of oxygen (PaO2) in the group A was significantly higher than that of group B before lung recruitment (P<0.01). Compared with the group B, the group A had less visual analogue scale (VAS) score (P<0.05), earlier activity and feeding, less postoperative ICU and hospital stay (P<0.01). Conclusion Epidural anesthesia combined with intraoperative interthoracic vagus nerve block can meet thoracoscopic bullectomy surgery requirements with few complications and fast postoperative recovery.
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@#Objective To analyze the outcome of fast track surgery after intercostal nerve block (INB) during thoracoscopic resection of lung bullae. Methods We recuited 76 patients who accepted thoracoscopic resection of lung bullae from February 2013 to March 2015. They were randomly divided into two groups: an intercostal nerve block and intravenous patient-controlled analgesia (INB+IPCA) group, in which 38 patients (30 males, 8 females, with a mean age of 23.63±4.10 years) received INB intraoperatively and IPCA postoperatively, and a postoperative intravenous patient-controlled analgesia (IPCA) group, in which 38 patients (33 males, 5 females, with a mean age of 24.93±6.34 years) only received IPCA postoperatively. Their general clinical data and the postoperative pain visual analogue scale (VAS) were recorded. Analgesia-associated side effects, rate of the pulmonary infection were observed. Expenses associated with analgesia during hospital were calculated. Results The score of VAS, the incidence of nausea and vomiting, fatigue and other side effects, pulmonary atelectasis and the infection rate in the INB+IPCA group were significantly lower than those in the IPCA group. Postoperative use of analgesic drugs was significantly less than that in the IPCA group. Medical expenses did not significantly increase. Conclusion INB+IPCA is beneficial for fast track surgery after thoracoscopic resection of lung bullae.
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Objective To analyze rick factors for postoperative recurrence of spontaneous pneumothorax surgery. Methods The clinic characteristics of 1128 patients who received spontaneous pneumothorax surgery in Tianjin Chest Hospital were collected from January 2009 to March 2015. The relationship between clinic characteristics and the pulmonary bullae was analyzed. Logistic regression analysis was used to assess factors affecting the postoperative relapse of spontaneous pneumothorax. Results The pulmonary bullae were found in 877 patients of 1128 during the operation. The incidence of pulmonary bullae was significantly high in patients with age below 25 years compared with patients over 25 years (P 3 d) were independent risk factors of postoperative recurrence for spontaneous pneumothorax (P<0.05). Conclusion Pulmonary bullae, pleurodesis without pleura friction and delayed drainage duration are risk factors of postoperative recurrence for spontaneous pneumothorax, which should be paid more attention in clinic.
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Infected bullae are frequently confused with a pulmonary abscess. There recognition is important to avoid unnecessary interventions. We describe a case of 70 years male patient, who came with complaints of breathlessness since 5 years, cough with a moderate amount of mucopurulent expectoration, pain in back and right shoulder and low-grade intermittent fever all since 20 days. Past history was unremarkable. There is a history of 100 pack-years. On examination, he was tachypneic, having oxygen saturation of 87% on room air. On respiratory examination; the finding was consistent with emphysema with right sided cavitary disease. Chest X-ray showed thin walled cavity with fluid level in the right upper zone with pneumothorax on the left side. Investigations revealed 17, 000 white blood cell with neutrophil predominance. He was not responding adequately so high-resolution computed tomography (HRCT) was ordered which showed multiple thin-walled bullae in both lung along with air-fluid level in one large bullae with surrounding pneumonitis on the right side. Infected emphysematous bullae should be suspected when a fluid level appears in a patient with clinical finding suggestive of emphysema. We propose that symptomatic patients with radiological signs of air-fluid level should be evaluated with HRCT to rule out similar condition and assessment of underlying condition.
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Objective To compare the effects of thoracoscopic 2 hole and 3 hole for congenital pulmonary bulla resection.Methods 38 cases of congenital pulmonary bulla patients,both in the VATS downlink congenital pulmonary bulla resection.According to the number of holes,thoracoscopic operation were divided into the two groups. To observe the use of group 19 cases of 2 holes,19 cases 3 holes were adopted in the control group.Pull the chest tube operation time,operation time of the two groups were compared after.and the average hospitalization time after opera-tion,postoperative analgesia drug application.Results The observation group operation time,operation time,pulling the chest tube after operation the average hospitalization time, analgesic drug application rate respectively were (46.89 ±9.11)min,(3.95 ±0.85) d,(7.37 ±1.34) d,21.1%,The control group were (66.05 ±12.09) min, (4.37 ±0.98)d,(7.32 ±1.57)d,52.6%.There were statistically significant differences in rate of the two groups in operation time,analgesic drug application.(t=-5.516,χ2 =4.071,P<0.05);38 cases were cured,followed up for 3-24 months,no recurrence occurred in 1 cases.Conclusion Video assisted thoracic descending congenital pulmona-ry bulla resection,the 2 hole 3 hole more than minimally invasive,short operation time,postoperative analgesic use rate is low.