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@#Objective To summarize the experience of robot-assisted lung basal segmentectomy, and analyze the clinical application value of intersegmental tunneling and pulmonary ligament approach for S9 and/or S10 segmentectomy. Methods The clinical data of 78 patients who underwent robotic lung basal segmentectomy in our hospital between January 2020 to May 2022 were retrospectively reviewed. There were 32 males and 46 females with a median age of 50 (33-72) years. The patients who underwent S9 and/or S10 segmentectomy were divided into a single-direction group (pulmonary ligament approach, n=19) and a bi-direction group (intersegmental tunneling, n=19) according to different approaches, and the perioperative outcomes between the two groups were compared. Results All patients successfully completed the operation, without conversion to thoracotomy and lobectomy, serious complications, or perioperative death. The median operation time was 100 (40-185) min, the blood loss was 50 (10-210) mL, and the median number of dissected lymph nodes was 3 (1-14). There were 4 (5.1%) patients with postoperative air leakage, and 4 (5.1%) patients with hydropneumothorax. No patient showed localized atelectasis or lung congestion at 6 months after the operation. Further analysis showed that there was no significant difference in the operation time, blood loss, thoracic drainage time, complications or postoperative hospital stay between the single-direction and bi-direction groups (P>0.05). However, the number of dissected lymph nodes of the bi-direction group was more than that of the single-direction group [6 (1-13) vs. 5 (1-9), P=0.040]. Conclusion The robotic lung basal segmentectomy for pulmonary nodules is safe and effective. The perioperative results of robotic S9 and/or S10 complex segmentectomy using intersegmental tunneling and pulmonary ligament approach are similar.
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Objective:To explore the feasibility and application value of case-based learning (CBL) combined with clinical pathway in thoracic surgery practice teaching.Methods:A total of 30 clinical undergraduate students who practiced from January 2018 to August 2018 were selected and randomly divided into the traditional group and the research group. The traditional group used traditional teaching mode, while the research group adopted the CBL combined with clinical pathway teaching. The scores of theoretical examination and practice skills assessment and the case analysis ability of the two groups were compared at the time of department. In addition, the evaluation of the teaching effect of the two groups of teachers and students was observed through anonymous questionnaires. SPSS 21.0 was used for t-test and Chi-square test. Results:The scores of the students in the research group were better than those in the traditional group, including score of theoretical examination [(88.20±4.02) vs. (80.76±4.62), P<0.001], score of practice skills assessment [(90.80±2.16) vs. (84.80±3.07), P<0.001] and case analysis ability [(89.80±3.34) vs. (81.86±4.31), P<0.001]. The differences were statistically significant. At the same time, the questionnaire showed that the research group was superior to the traditional group in improving students' learning interest, clinical skills, case analysis ability, clinical communication ability, theoretical knowledge understanding and clinical thinking ability, with a statistically significant difference ( P<0.05). While the two groups had no statistically significant difference in students' satisfaction with teachers ( P=0.083). Conclusion:The CBL method combined with clinical pathway teaching method can improve the teaching effect of thoracic surgery practice, which is worth popularizing.
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@#Objective To compare the perioperative outcomes of atypical segmentectomy between robotic-assisted thoracoscopic surgery (RATS) and conventional video-assisted thoracoscopic surgery (VATS) in early-stage non-small cell lung cancer (NSCLC). Methods The data of patients who underwent minimally invasive anatomic atypical segmentectomy in our hospital from October 2016 to December 2021 were collected. These patients were divided into a RATS group and a VATS group according to the operation method. Propensity score (PS) matching was used to select patients with close clinical baseline characteristics, and the perioperative results of the two groups were compared. Results A total of 1 048 patients were enrolled, including 320 males and 728 females, with a mean age of 53.51±11.13 years. There were 277 patients in the RATS group and 771 patients in the VATS group. After 1∶1 PS matching, 277 pairs were selected. Both groups were well balanced for age, sex, smoking history, body mass index, Charlson comorbidity index, pulmonary function, tumor size, tumor location, and histological type. All patients were R0 resection, and there were no deaths within 30 days after surgery. The RATS group had shorter operative time [85 (75, 105) min vs. 115 (95, 140) min, P<0.001] and less blood loss [50 (30, 100) mL vs. 60 (50, 100) mL, P=0.001]. There were no statistical differences between the two groups in lymph node resection, conversion to thoracotomy, thoracic drainage time, total amount of thoracic drainage or postoperative complications (P>0.05). Conclusion Both RATS and VATS atypical segment-ectomies are safe and feasible for early-stage NSCLC. RATS can effectively shorten the operative time, and reduce blood loss.
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@#Objective To analyze the surgical efficacy and influencing factors of myasthenia gravis (MG) patients with thymic atrophy after thymectomy. Methods The clinical data of MG patients with thymic atrophy undergoing thymectomy between October 2014 and May 2018 in Daping Hospital of Army Medical University and Shijiazhuang People Hospital were retrospectively analyzed. Results A total of 71 patients were collected, including 40 males and 31 females with a mean age of 45.17±12.42 years. All patients received the surgery successfully. After the surgery, 20 (28.17%) patients were stable remission, 12 (16.90%) patients were minimal manifestation status,19 (26.76%) patients were improved, 5 (7.04%) patients showed no change, 3 (4.23%) patients were worsened, 10 (14.08%) patients were exacerbated and 2 (2.82%) patients were dead. Multivariate logistic regression analysis showed that the preoperative illness duration (OR=4.61, 95%CI 1.13-18.85, P=0.03), and postoperative pyridostigmine combined with immunosuppressive (OR=0.12, 95%CI 0.03-0.45, P=0.00) were independent risk factors for long-term efficacy of thymectomy for MG patients with thymic atrophy. Conclusion Early surgery after diagnosis of MG and postoperative pyridostigmine combined with immunosuppressive treatment is beneficial to the prognosis of MG patients with thymic atrophy.
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@#Objective To explore the clinical efficacy of thoracoscopy-assisted modified Nuss procedure for pectus excavatum (PE) in children. Methods The clinical data of patients with PE who underwent thoracoscopy-assisted modified Nuss procedure from October 2013 to October 2020 in Daping Hospital were retrospectively analyzed. Results A total of 86 patients were collected, including 79 males and 7 females with a mean age of 14.03±3.36 years. The operations were performed successfully in all patients without intraoperative cardiac vascular injury or perioperative death. The mean operation time was 87.30±33.45 min, bleeding volume was 19.94±14.60 mL, and the postoperative hospitalization stay time was 6.89±2.59 d. Early postoperative complications included 2 patients of pneumothorax, 2 patients of wound fat liquefaction and infection, 2 patients of bar flipping and displacement. One patient had bar displacement 1 year after the surgery. The total complication rate was 8.14%. All patients were followed up for 3-42 months. The bars were taken out about 36 months after the surgery. According to the evaluation criteria of orthopedic effect, 68 (79.07%) patients were excellent, 10 (11.63%) patients were good, 5 (5.81%) patients were moderate and 3 (3.49%) patients were poor. Conclusion Minimally invasive and individualized shaping via the Nuss procedure for PE children is safe and convenient, with satisfied effect. It is worthy of popularization in the clinic.
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@#Objective To investigate the feasibility and safety of single utility port Da Vinci robot-assisted lung resection via anterior approach. Methods The clinical data of 21 patients who underwent single utility port Da Vinci robot-assisted lung resection from February to March 2021 were retrospectively analyzed. There were 10 males and 11 females, with a median age of 50 (34-66) years. The operation time, blood loss, postoperative hospitalization time, postoperative complications and other indicators were analyzed. Results All patients completed the operation successfully with no transition to thoracotomy or perioperative death. Overall surgery time was 103 (70-200) min, Docking time was 5 (3-10) min, operation time was 81 (65-190) min. The blood loss was 45 (20-300) mL. All patients had malignant tumors, the number of dissected lymph node station was 3 (1-6), and the number of lymph nodes was 5 (2-16). The postoperative indwelling time was 3 (2-5) d. The postoperative hospitalization time was 5 (3-7) d. The pain score for the first 3 days after surgery was 3±1 points. Conclusion Single utility port robot-assisted lung resection via anterior approach is safe, less traumatic, more convenient and effective, which can be gradually promoted and applied to clinical trials.
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@#Myasthenia gravis (MG) is an autoimmune disease with indefinite pathogenesis. MG is closely related to thymic diseases, and thymectomy is an important way for MG treatment. However, there are some controversies regarding thymectomy, including indications, operation opportunities, operative procedures, surgical approaches, perioperative managements, and efficacy evaluations, etc. Therefore, based on the literature and the experience of Chinese experts, this consensus has been written after careful discussion and inquiry and 29 recommendations have been made, aiming to guide surgical treatment of MG and improve the clinical outcomes.
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@#Objective To investigate the effects of robotic versus thoracoscopic lobectomy on body trauma and lymphocyte subsets in patients with non-small cell lung cancer (NSCLC). Methods The clinical data of 120 patients with NSCLC who underwent lobectomy in the same operation group at the same period were collected and divided into a robot group (n=60) and a thoracoscope group (n=60) according to different surgical methods. The operation time, intraoperative blood loss, postoperative drainage time, drainage volume, postoperative hospital stay, complication rate, pain visual analogue scale (VAS) and other perioperative indicators were recorded in the two groups. Inflammatory markers: C-reactive protein (CRP), interleukin-6 (IL-6) and lymphocyte subsets (CD3+, CD4+, CD8+, CD4+/CD8+) levels were measured before and 1 d, 3 d after surgery. The effects of the two surgical methods on the body trauma and lymphocyte subsets were compared. Results The operation time, intraoperative blood loss, postoperative drainage time, drainage volume and VAS of the robot group were lower than those of the thoracoscope group, and the differences were statistically significant (P<0.05). On the 1st day after surgery, IL-6 of the thoracoscope group was higher than that of the robot group, while CD3+, CD4+ and CD8+ were lower than those of the robot group, with statistically significant differences (P<0.05). Conclusion Compared with thoracoscopic lobectomy, robotic lobectomy has less trauma, less inflammatory response, faster recovery, less inhibitory effect on lymphocyte subsets, and has clinical advantages.
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@#Objective To evaluate the feasibility and clinical value of robot-assisted lobectomy through anterior approach. Methods We retrospectively analyzed the clinical data of 180 patients who underwent robot-assisted lobectomy through anterior approach in our hospital between April 2017 and February 2018. There were 97 males and 83 females, aged 59.5 (32.0-83.0) years. The clinical effects were analyzed. Results One patient was transferred to thoracotomy due to tumor invasion of adjacent blood vessels and injury to the blood vessels, and there was no perioperative death. There were 8.5 (1.0-35.0) dissected lymph nodes for each patient. The median operation time was 120 (50-360) min, including robot Docking time 5 (1-23) min and robot operation time 65 (7-270) min. The median blood loss was 50 (5-1 500) mL, 132 (73.3%) patients had malignant tumors and median drainage time was 5 (2-30) d. The mean postoperative pain score was 3.4±0.7 points and the postoperative hospital time was 8 (2-32) d. At the median follow-up of 24 months, 11 patients developed recurrence and metastasis, and 3 died. Conclusion Robot-assisted lobectomy through anterior approach is a safe and convenient operation method, which is worthy of clinical application.
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@#Objective To explore the clinical value of three-dimensional computed tomography bronchography and angiography (3D-CTBA) in robotic lung segmentectomy. Methods A non-randomized control study was performed and continuously enrolled 122 patients who underwent robotic lung segmentectomy in our hospital from January 2019 to January 2020. 3D-CTBA was performed before operations in 53 patients [a 3D-CTBA group, including 18 males, 35 females, with a median age of 52 (26-69) years] and not performed in the other 69 patients [a traditional group, including 23 males, 46 females, with a median age of 48 (30-76) years]. The clinical data of the patients were compared between the two groups. Results All the patients were successfully completed the surgery and recovered from hospital, with no perioperative death. The baseline characteristics of the patients were not significantly different between the two groups (P>0.05). No significant difference was found in the operative time [120 (70-185) min vs. 120 (45-225) min, P=0.801], blood loss [50 (20-300) mL vs. 30 (20-400) mL, P=0.778], complications rate (17.0% vs. 11.6%, P=0.162), postoperative hospital stay [7 (4-19) d vs. 7 (3-20) d, P=0.388] between the two groups. In the 3D-CTBA group, 5 (9.4%) patients did not find nodules after segmentectomy, and only 1 (1.9%) of them needed lobectomy, but in the traditional group, 8 (11.6%) patients did not find nodules and had to carry out lobectomy, the difference was statistically significant (P<0.05). The follow-up time was 10 (1-26) months, and during this period, there was no recurrence, metastasis or death in the two groups. Conclusion 3D-CTBA is helpful for accurate localization of nodules and reasonable surgical planning before operations, and reducing wrong resections in segmentectomy, without increasing the operation time, blood loss and complications. It is safe and effective in anatomical lung segmentectomy.
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Objective:To summarize the experience of robotic and thoracoscopic segmentectomy in Daping Hospital, Army Medical University, and comparison analysis the clinical application value for early-stage lung cancer.Methods:A retrospective cohort study was conducted to continuously enroll 190 patients, 100 who received robotic(33 males and 67 females, median age of 51 years)and 90 who received VATS(34 males and 56 females, median age of 54 years), who underwent segmentectomy between June 2018 and October 2019. Perioperative outcomes(the operation time, intraoperative blood loss, postoperative thoracic drainage volume and time, pain score, complications, postoperative hospital stay and survival and mortality) were compared.Results:All the patients successfully completed the surgery and recovered from hospital, with no perioperative death.The baseline characteristics(sex, age, clinical symptoms, smoking status, underlying disease, tumor size, pathological type) and type of segmentectomy were comparable. There was significant difference in operative time[120(interquartile range, IQR 60-225)min vs. 155( IQR 75-330)min, P<0.001], blood loss[30( IQR 20-400) ml vs. 100( IQR 20-1 600) ml, P<0.001] between the robotic and VATS groups, respectively. But there was no significant difference in postoperative thoracic drainagevolume[4( IQR 1-15) days vs. 4( IQR 2-29) days, P=0.547], postoperative thoracic time[755( IQR 200-3 980)ml vs. 815( IQR 280-3 920)ml, P=0.902], pain score[2.33( IQR 0.88-4.75) points vs. 3.13( IQR 0.95-5.29)points, P=0.199], complications[7.4%(14/190) vs. 6.3%(12/190), P=0.303], postoperative hospital stay[7( IQR 3-19) days vs. 6( IQR 4-21) days, P=0.405] , number of lymph nodes[(4.83±3.18) vs.(6.15±4.1), P=0.255] between the robotic and VATS groups, respectively. The follow-up time was 6.5( IQR 1-26) months in the two groups, without recurrence, metastasis or death. Conclusion:Robotic lung segmentectomy is safe and feasible. This approach might lead to a better in operative time and blood loss. The short-term efficacy is similar with thoracoscopy, and the long-term efficacy needs further follow-up time.
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Objective To summarize the early experience of thymectomy by robot-assisted thoracoscopic surgery (RATS) with the da Vinci S Surgical System.Methods A total of 16 patients was underwent thymectomy from October 2016 to May 2017 by RATS.Among them,there were 10 cases of thymic hyperplasia,5 cases of thymoma and 1 case of thymic small cell carcinoma,including 11 cases of myasthenia gravis (MG).The Osserman types were as follows:type Ⅰ (5),type ⅡA (3),type ⅡB (2),and type Ⅲ (1).Clinical data were collected and analyzed.Results The operations were successfully accomplished by RATS in all the 16 patients without any conversion to open surgery and major complication.The docking time was 2-45 (11.69 ± 11.03) min.The operation time was 47-152 (84.06 ± 25.67) min.The blood loss was 0-150 (57.50 ± 37.32) ml.The diameter of thymus or tumor was 4-19.5 cm and (8.22 ± 3.64) cm.Fourteen cases were removed tracheal intubation in the operation day,and the other 2 cases taked off in 6th and 8th days.One case occurred myasthenia gravis crisis after surgery.All patients were followed up for 2-7 months after discharge without MG recurrence.Conclusions The da Vinci S Surgical System can be safely,accurately and stably used for thymectomy.
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Objective To assess the value of fuorine-18-fluom deoxy glucose positron emission tomography /computer tomography (18F-FDG PET/CT) in diagnosis of lymph node metastasis in the cases with non-small cell lung cancer ( NSCLC) .Methods From March 2012 to March 2015,167 patients underwent 18F-FDG PET/CT and contrast enhanced CT inspection within 10 days prior to the surgery and were pathologically diagnosed as non-small cell lung cancer(NSCLC) after surgery.With regard to estimation of the lymphatic metastasis,we com-pared the sensitivity,specificity,accuracy,positive and negative predictive value ,and Youden index between the PET/CT and contrast en-hanced CT.Results There were 731 lymph node stations from the 167 patients.Referred to the final pathological results ,PET/CT has screened 143 lymph node stations in true positive set ,26 lymph node stations in false positive set ,61 lymph node stations in false negative set , and 501 lymph node stations in true negative set .Furthermore,the sensitivity,specificity,the positive and negative forecast values ,and Youden index of PET/CT and CT was 70.10%vs.54.19%(P<0.05),95.07%vs.92.23%(P<0.05),88.10%vs.81.67%(P<0.05),84.62%vs.72.85%(P<0.05),89.15%vs.81.67%(P<0.05) and 0.65 vs.0.46 (P<0.05),respectively.Conclusion It is more effective to to precisely validate lymphatic metastasis of NSCLC by using PET /CT than using contrast enhanced CT inspection .Additionally,PET/CT can provide more information for the preoperative diagnosis , staging and the follow-up treatment of lung cancer .
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Objective To assess the therapeutic efficacy of a recombined adenovirus expressing p53 (rAd-p53) via intrapleural injec-tion in the treatment of lung cancer with malignant pleural effusion. Methods Thirty-six cases with lung cancer and malignant pleural effu-sion were randomly divided into two groups,which were given intravenous injection of Nedaplatin with (observation group,n=20) or without (control group,n=16) intrapleural injection of rAd-p53,respectively. Between the two groups,the efficacy in treatment of pleural effusion, the amelioration of maximal ventilatory volume ( MVV) ,Kamofsky scoring ( KPS) and quality of life were compared. Results The efficacy in treatment of pleural effusion in observation group are significantly higher than that in control group(17/20 vs. 50%,P<0. 05). The cases with KPS≥80 in observation group were significantly increased following treatment (5/20 vs. 11/20,P <0. 05). However,there was no difference with the cases in control group. Conclusion Intrapleural injection of recombinant adenovirus expressing p53 (rAd-p53) is effec-tive to reduce the occurrence of malignant pleural effusion and increase the quality of life remarkably.
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Objective To investigate whether EGFR gene mutations are correlated with the gene expression of ERCC1 and TYMS in non-small-cell lung cancer .Methods Collected February to December 2013 of non-small cell lung cancer(NSCLC) pa-tients eligible for enrolled 97 patients ,tumor tissue specimens obtained by intraoperative cut or puncture ,Gene expression of ERCC1 and TYMS were determined by branched-DNA liquid chip ,while somatic mutations in EGFR(E18 ,E19 ,E20 ,E21) gene were detec-ted by xTAG-liquid chip;And analysis of EGFR gene mutation associated with ERCC1 ,TYMS mRNA expression .Results Totally 29 cases of EGFR mutation were detected in all 97 specimens ,with a mutation rate of 30% (29/97) ,and a relatively high detection rate was observed in female ,adenocarcinoma and non-smoking patients(P0 .05) .Conclusion In NSCLC tissues ,EGFR mutation is relevant to the expression of ERCC1 but irrelevant to the expression of TYMS .
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Objective To investigate the promotion effect of human transcriptional positive cofactor 4 (PC4) overexpression on lymphatic metastasis in lung adenocarcinoma .Methods 96 samples of lung adenocarcinoma tissue were collected .The immuno‐histochemistry(IHC) and real‐time quantitative polymerase chain reaction (qRT‐PCR) were adopted for detecting the expression levels of PC4 protein and mRNA .The correlation of PC4 expression with lymphatic metastasis and TNM stage was analyzed .Re‐sults The expression of PC4 protein was positively correlated mRNA in lung adenocarcinoma (r=0 .63 ,P<0 .01);the expression of PC4 protein was positively correlated with lymph node metastasis (χ2 =8 .29 ,P<0 .01) and TNM stage (χ2 =4 .71 ,P<0 .05);the expression of PC4 mRNA was also positively correlated with lymph node metastasis (χ2 = 8 .40 ,P< 0 .01) and TNM stage (χ2 =5 .10 ,P<0 .05) .Conclusion PC4 overexpression is found to be closely associated with the lymph node metastasis and TNM stage .PC4 may facilitate the lymph node metastasis of lung adenocarcinoma .
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Objective Describes the changes of arterial blood gas analysis and pulmonary functions of emphysematous rabbits after unilateral and bilateral lung volume reduction surgery.Methods Sixty rabbits were randomly and equally divided into 6 groups:control group(A),emphysema group( B),unilateral sham operation group(C),unilateral lung volume reduction surgery group( D),bilateral sham operation group( E ) and bilateral lung volume reduction surgery group(F).Obstructive emphysema was induced with somg and papain in tie rabbits of the remaining groups except the control one.Eight weeks later,arterial blood gas analysis and pulmonary functions were detected.Results Compared with group B,pH,PaO2,PaCO2,SaO2,forced expirratory volume in 0.5 s,froced expiratory capacity,functional residual capacity,total lung capacity,dynamic compliance,and resistance in expiartory phase could be improved in group D ( P < 0.05 ).The amelioration of those results were more obvious in group F ( P <0.05).Two rabbits in group F died after opertation.Conclusion Bilateral lung volume reduction surgery could more markedly improve the arterial blood gas analysis and pulmonary functions of emphysematous rabbits than unilateral operation.