Objective: To define the indications for cardiac surgeries through right anterolateral thoracotomy, and render it clinically feasible in a carefully controlled scope. Methods: Ninety-eight patients requiring cardiac s...Objective: To define the indications for cardiac surgeries through right anterolateral thoracotomy, and render it clinically feasible in a carefully controlled scope. Methods: Ninety-eight patients requiring cardiac surgeries were operated through this approaach. Incisions were made in the fourth or on intercostal space. The upper costal cartilage near the incision was routinely removed. Aortic cannulation was performed through the lateral wall of the aorta. The procedures on the heart itself were the same as that of the median sternotomy. Results: The average lengths of the incisions, for the male and female patients, were (10.6±3.2) cm and (10.3 ± 2.2) cm respectively. The mean bypass time was (61.3 ±t 25. 1) min, and the mean heart arrest time was (49.5±19.2) min. The postoperative drainage was (410± 125) ml. All but 1 patient with aortic valve operation had satisfactory exposure . The complications included chest pain (n = 5), rib fracture (n =3), pleural effusion (n=5), and pneumothorax(n=6). Conclusion: The right anterolateral tholacotomy was a satisfactory alternative of median sternotomy for the surgeries that can be performed through a right atrium access.展开更多
<b><span style="font-family:Verdana;">Objectives and Aim:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-famil...<b><span style="font-family:Verdana;">Objectives and Aim:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">Thoracotomies are widely recognized to cause acute pain which is associated with many complications. The target study aimed to assess the safety and efficacy of SAPB compared to TEA for relieving severe thoracotomy pain.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Patients and Methods: </span></b><span style="font-family:Verdana;">Forty patients scheduled for thoracotomy randomly allocated either to receive SAPB or thoracic epidural (TEA). Visual analogue pain score (VAS) at rest and coughing every 6 hrs. Postoperative, hemodynamic parameters (heart rate and MAP), pain rescue analgesic consumption in the first 24 hrs., complications, and duration of hospital stay recorded. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> In our study, we found that the recently described SAPB, while maintaining stable blood pressure, provided excellent analgesia comparable to that offered by TEA for acute post-thoracotomy pain. Hypotension was more noteworthy in those who had epidurals than those with serratus anterior plane (SAP) catheters. Morphine rescue analgesia, as well as Visual Analogue Scale (VAS) pain scores during normal tidal breathing, were like in both groups. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">We recommend that the Serratus anterior plane block appears to be a safe and effective alternative for postoperative analgesia after thoracotomy.</span>展开更多
Achalasia cardia is a primary oesophageal motility disorder of unknown aetiology characterized manometrically by insufficient relaxation of the lower oesophageal sphincter (LES) and loss of oesophageal peristalsis;rad...Achalasia cardia is a primary oesophageal motility disorder of unknown aetiology characterized manometrically by insufficient relaxation of the lower oesophageal sphincter (LES) and loss of oesophageal peristalsis;radiographically by aperistalsis, oesophageal dilation with minimal LES opening, bird-beak appearance, poor emptying of barium;and endoscopically by dilated oesophagus with retained saliva, liquid and undigested food particles in the absence of mucosal stricturing or tumour. Achalasia cardia patients usually present with difficulty in swallowing both solids and liquids and this may be associated with regurgitation, heartburn and chest pains. Treatment options include medical or pharmacologic therapy, botulinum toxin injection, pneumatic dilation and oesophagocardiomyotomy or the Heller myotomy with or without antireflux procedure and recently the POEM (Perioral oesophageal myotomy). Herein, we present our experience with four cases managed surgically via thoracotomy without antireflux surgery over a 5-year period, from January 2015 to June 2019 at the Komfo Anokye Teaching Hospital, the second largest teaching hospital in Ghana.展开更多
Objective To investigate effect of respiratory training on respiratory function recovery following thoracotomy. Method Respiratory muscle training, productive drainage, exercise and respiratory function training, and ...Objective To investigate effect of respiratory training on respiratory function recovery following thoracotomy. Method Respiratory muscle training, productive drainage, exercise and respiratory function training, and appropriate rehabilitation were performed on 216 patients underwent thoracotomy. Result 206 patients showed favorable recovery of respiratory function,7 showed respiratory dysfunction, and 1 developed serious complication. Conclusion Respiratory training after thoracotomy significantly improve respiratory function.展开更多
Background: We experienced a very rare complication, that is, an unexpected postoperative paraplegia due to the incidental migration of oxidized regenerated cellulose used for hemostasis of intercostal space bleeding....Background: We experienced a very rare complication, that is, an unexpected postoperative paraplegia due to the incidental migration of oxidized regenerated cellulose used for hemostasis of intercostal space bleeding. Patients and Methods: The objective is to analyze the cause and to take measures against the very rare complication from an empirical analysis and the literature. For a 78-year-old male with suspected lung cancer in the right upper lobe (S1), a thoracotomy was performed. For hemostasis of the bleeding from the 5th intercostal thoracotomy space, we used and placed oxidized regenerated cellulose at the continuous oozing bleeding sites. On the 3rd postoperative day, paralysis beneath thoracic vertebrae level 6 was observed. Immediate computed-tomographic (CT) scanning and magnetic resonance imaging (MRI) displayed a 17 × 9 × 14 mm epidural hematoma in the spinal canal at level 5 of the thoracic vertebrae. An emergent laminectomy for the thoracic vertebra was performed to remove the oxidative cellulose and haematoma, and the compression was released. The paraplegia gradually began to recover and maintain a standing position. After 1 year from the event, the patient can walk by himself with a crutch. Results: The causes were that the oxidative cellulose materials were used for the intercostal bleeding at the open thoracotomy. The migration of the oxidative cellulose materials into the epidural space and into thoracic spinal canal through the intervertebral foramen, or gradual penetration of the oxidative cellulose materials into the spinal canal due to respiratory costal movement. As a measurement of prevention, the hemostat materials should be completely removed after finishing of the hemostasis. In the case of a difficult hemostasis, consultation of an orthopedist or neurosurgeon to perform the appropriate hemostasis in good cooperation is required. Conclusion: If postoperative paraplegia is suspected, immediate CT scanning and/or MRI examination would become powerful diagnostic procedures as soon as possible to start an interventional treatment.展开更多
Today, the ultrasound guidance (USG) in regional anesthesia is gold standard more and more often used for medial or paramedian approaches around to the spine, such as the paravertebral (PV) block. Local anatomical cha...Today, the ultrasound guidance (USG) in regional anesthesia is gold standard more and more often used for medial or paramedian approaches around to the spine, such as the paravertebral (PV) block. Local anatomical changes may greatly handicap the performance of this type of block. We present clinical, sonographic, and radiological data on successful PV block and catheter placement in four patients with vertebral diseases, targeting thoracotomy or lumbotomy postoperative pain after stabilization of the involved vertebral body and preliminary arthrodesis with laminectomy by the posterior approach. We emphasize the importance of USG in this special context involving local anatomical disturbance.展开更多
Background: Emergency thoracotomies often challenge surgical logistics and they tend to produce inferior outcomes when compared with elective surgery. Aims: We sought to identify the specific indications and therapeut...Background: Emergency thoracotomies often challenge surgical logistics and they tend to produce inferior outcomes when compared with elective surgery. Aims: We sought to identify the specific indications and therapeutic challenges that go with patients who undergo thoracotomy within 24 hours of admission and the re-thoracotomies. Methodology: Spanning a 7-year period, the bio-data of patients who met our criteria for emergency thoracotomies were collated. We noted their indications for surgery, therapeutic challenges and outcome of care. Results: In all, 36 patients (28 males and 8 females) met the inclusion criteria. Majority, (66.7%) fell into the 20 - 39 year age range. Diaphragmatic rupture was the commonest indication, followed by massive intra-thoracic haemorrhage. Postoperative mortality occurred in 11.1% of patients. Postoperative ventilation was absolutely indicated in 6 patients. Discussion and Conclusion: Diaphragmatic rupture is the commonest indication for emergency thoracotomy. We noted the need for improvement in pre hospital care for trauma patients as a way to improve the management outcome of emergency thoracotomies.展开更多
<strong>Background:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">Atrial Septal Defect (ASD) closure is a common cardiac surgic...<strong>Background:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">Atrial Septal Defect (ASD) closure is a common cardiac surgical procedure performed worldwide. Due to favourable clinical outcome, minimal invasive approach is becoming popular. Hence this study was conducted to compare the outcome of two surgical approaches, median sternotomy and mini thoracotomy with total peripheral cannulation, in a developing country Nepal.</span><b><span style="font-family:Verdana;"> Methods: </span></b><span style="font-family:Verdana;">A prospective study of 62 ASD patients, randomized to undergo surgical closure either via right anterior mini thoracotomy or median sternotomy was conducted and followed up over three years. The clinical outcome parameters like intensive care unit stay, hospital stay, post-operative duration of ventilation, cardiopulmonary bypass time, aortic cross clamp time, mediastinal drainage, size of scar and complication were compared between two groups. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Cardiopulmonary bypass time and aortic cross clamp time were significantly longer in right anterior mini thoracotomy group as compared to median sternotomy group (43.97</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min ± 12.70</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min vs 34.42</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min ± 10.42</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min and 25.13</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min </span><span style="font-family:Verdana;">±</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">7.82</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min vs 19.48</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min ± 6.93</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min respectively, p</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">value</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;"><</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">0.05). There was no significant difference in duration of surgery (2.75</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs ± 0.43</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs vs 2.56</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs ± 0.41</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs, p-value</span><span style="font-family:Verdana;"> = </span><span style="font-family:Verdana;">0.09), post-operative ventilation (2.90</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs ± 1.22</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs and 2.88</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs ± 1.07</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs, p</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">value</span><span style="font-family:Verdana;"> = </span><span style="font-family:Verdana;">0.96) between two groups. Post-operative mediastinal drainage was significantly less in right anterior mini thoracotomy group (214.52</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">ml ± 91.79</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">ml vs 284.03</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">ml ± 158.91</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">ml, p</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">value</span><span style="font-family:Verdana;"> = </span><span style="font-family:;" "=""><span style="font-family:Verdana;">0.04). There was no significant difference in ICU stay and hospital stay. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Atrial septal defect can be safely closed by right anterior mini thoracotomy with a small, cosmetically acceptable submammary scar with less pain and bleeding.</span></span>展开更多
Objective:To compare the clinical effects of minimally invasive esophageal cancer radical resection and traditional esophageal cancer radical resection.Methods:200 cases of esophageal cancer radical resection were per...Objective:To compare the clinical effects of minimally invasive esophageal cancer radical resection and traditional esophageal cancer radical resection.Methods:200 cases of esophageal cancer radical resection were performed from July 2014 to July 2017 in our hospital.The cases were divided into experimental group and control group,82 cases in the experimental group and 118 cases in the control group.The experimental group was treated with minimally invasive esophageal cancer radical surgery,and the control group was treated with conventional thoracotomy.Record the comparison between the two groups:(1)surgical conditions,including the time of surgery,intraoperative blood loss,hospitalization time;(2)the number of lymph nodes cleaned;(3)the postoperative control group used conventional thoracotomy,including lung lesions,anastomotic fistula/narrow.Results:The parameters of operation time,intraoperative blood loss,hospitalization time,and number of lymph nodes cleaned in the experimental group were lower than those in the control group,and the difference was statistically significant(p<0.05).In addition to pulmonary infection(p<0.05),there was no significant difference in the incidence of other complications between the experimental group and the control group(p>0.05).Conclusion:Minimally invasive esophageal cancer radical resection and conventional thoracotomy have good clinical effects in the treatment of esophageal cancer.Minimally invasive esophageal cancer radical surgery can effectively reduce intraoperative trauma and postoperative reaction,which is worthy of popularization and application.展开更多
Purpose: Right mini thoracotomy has been evaluated in many studies for mitral valve repair mainly in degenerative valvular disease but not in rheumatic heart disease. Mitral valve repair is more challenging in rheumat...Purpose: Right mini thoracotomy has been evaluated in many studies for mitral valve repair mainly in degenerative valvular disease but not in rheumatic heart disease. Mitral valve repair is more challenging in rheumatic etiology due to complexity of lesions. This prospective randomized case control study was designed to evaluate repair through mini right thoracotomy and to compare the clinical and echocardiographic outcomes with sternotomy in rheumatic patients. Methods: 25 patients of rheumatic heart disease underwent mitral valve repair through mini right thoracotomy (group I). Various clinical and functional parameters were compared with 25 patients of mitral valve repair through sternotomy (group II). On follow up the results were compared in both groups for clinical and echocardiographic parameters. Results: The various pre-operative demographic parameters were comparable in two groups. Equal rate of mitral valve repair (group I-21/25, 84% and group II-21/25, 84%) was achieved in both groups. The various intra-operative and post-operative clinical parameters were better in group I .There were equivalent functional and valve related outcomes in both groups in term of NYHA class (1.28 ± 0.613 vs 1.08 ± 0.276, P = 0.144), post-operative mitral valve area (2.43 ± 0.891 vs 2.82 ± 0.662, P = 0.090), incidence of more than mild mitral regurgitation (0) and mean pressure gradient across mitral valve (4.98 ± 3.33 vs 4.23 ± 1.5, P = 0.309). Conclusion: Mitral valve repair through mini right thoracotomy approach in rheumatic etiology is feasible and safe with equivalent rate of successful repair as compared to median sternotomy. It is associated with lesser morbidity, cosmetic advantage and lesser resource utilization.展开更多
Background: A survey was conducted on preferences for thoracotomy opening and closure as well as post-thoracotomy pain management among academic teaching staff of thoracic surgeons in Turkey. It was aimed to assess th...Background: A survey was conducted on preferences for thoracotomy opening and closure as well as post-thoracotomy pain management among academic teaching staff of thoracic surgeons in Turkey. It was aimed to assess the attitudes of the thoracic surgery training-center academicians on aforesaid topic. Methods: A 7-question questionnaire was performed by face-to-face interview or online by e-mail to the academic professionals working at resident-training centers. Eighty-eight randomly selected academicians were invited to complete the questionnaire, and 48 of them answered. Based on the complete and valid responses, the methods for opening and closure of thorax, the number of chest drains placed, the method of analgesia in per-or postoperative period and the analgesic agents used commonly were assessed. Results: Thirty-three (68.8%) of 48 were working at university hospitals and 24 (50.0%) were in age group of 40 - 49 years. Muscle-sparing (41.7%) and standard posterolateral thoracotomies (41.7%) were the most preferred incision. The most used method for closing thorax was pericostal sutures. Per-or postoperative analgesia was stated to be performed by all of the participants, while 45 (93.75%) of them reported that they preferred to administrate more than one procedure. Intercostal/paravertebral nerve block (26.4%), epidural analgesia (24.5%), systemic parenteral non-steroid drugs (24.5%) and systemic parenteral opioid (20.9%) were the most commonly used methods. Conclusion: Preventing intercostal nerve injury decreaseed post-thoracotomy pain, as well as the necessity of post-operative analgesic use. Conversely, most of the academic staff did not prefer the methods for preserving intercostal nerve. More than one analgesia procedure were said to be used by majority of the participants.展开更多
Objective:To explore the application of thoracic nerve block and propofol anesthesia in the treatment and perioperative period.Methods:A total of 40 patients with thoracotomy for esophageal cancer between May 2020 and...Objective:To explore the application of thoracic nerve block and propofol anesthesia in the treatment and perioperative period.Methods:A total of 40 patients with thoracotomy for esophageal cancer between May 2020 and September 2021 in the hospital were selected to participate in this study.All the patients were divided into reference and experimental groups according to the anesthesia protocol.For the experimental group,the parathoracic vertebral nerve block scheme was used under ultrasound guidance,with general anesthesia in the same manner,and after the surgical treatment of both groups,the patient-controlled intravenous analgesia(PCIA)regimen was applied to both patients.The time of surgery for the two patient groups,intraoperative propofol,postoperative pain conditions and postoperative blood glucose and NE,E,DA levels were measured and conducted for comparative analysis.Results:There is no significant differences between the two groups,besides,in the experimental group,propofol in surgery was less than that in the reference group;At the T6~T9 timepoint,patients in the experimental group had lower VAS scores in quiet and active conditions than those in the reference group;At the T9 timepoint,blood glucose and NE levels were higher than the T1,T4,T5 time point levels in each group;At the T4,T4 timepoint,E levels in both groups were lower than the T1,T9 time point level in each group;at T9 time point,the DA level was higher in the reference group than the T1,T4 time point level in each group;at T9 Time point,blood glucose and NE,E,DA were lower than those in the reference group.Conclusions:In the treatment of thoracotomy in elderly patients,thoracic paravertebral nerve block compound propofol anesthesia program can be used to patients,with striking anesthesia effect and remarkable recovery effect in perioperative period,which is conducive to relieving postoperative pain and worth promotion and application.展开更多
Objectives:Intraoperative conversion to thoracotomy from video-assisted thoracoscopic surgery(VATS)is associated with increased adverse events,which is a major concern.We aim to explore the related risk factors in lun...Objectives:Intraoperative conversion to thoracotomy from video-assisted thoracoscopic surgery(VATS)is associated with increased adverse events,which is a major concern.We aim to explore the related risk factors in lung cancer patients.Methods:In our study,the data from 1305 patients who underwent VATS between June 2017 and May 2020 were retrospectively collected,among which 67 patients underwent unexpected conversion to thoracotomy.All patients were divided into Non-conversion Group or Conversion Group according to whether they required a conversion to thoracotomy and the risk factors were explored by univariate and multivariate analyses.Results:The most common cause of conversion was fibrocalcified lymph nodes,found in 33 patients(49.3%).Multivariable logistic regression analysis demonstrates that the independent risk factors for the conversion were age≥65 y(OR=2.696,95%CI:1.487e4.887,p=0.001),tumor size>3 cm(OR=4.527,95%CI:2.490e8.233,p<0.001),and tumor location in the left upper lung(OR=3.809,95%CI:1.737 e5.492,p<0.001).Conclusions:Advanced age,bigger tumor size and tumor at the left upper lobe could lead to conversion.In the early VATS learning cases,surgeons should try to choose patients with lower risk of conversion to thoracotomy.展开更多
Penetrating injuries to anterior chest may result in life-threatening complications such as massive haemothorax,?as a result of injury to the internal mammary artery.?Isolated internal mammary injury is a very rare ca...Penetrating injuries to anterior chest may result in life-threatening complications such as massive haemothorax,?as a result of injury to the internal mammary artery.?Isolated internal mammary injury is a very rare cause of massive haemothorax and associated with high mortality.?We are presenting this?32-year-old gentleman who sustained a thoracic stab wound and had an emergency right anterior mini-thoracotomy?by extending the stab wound rather than standard thoracotomy or sternotomy.?This case of isolated penetrating IMA injury managed with mini-thoracotomy is the only documented case so far. We are publishing this case report with patient’s both written and informed consent and institutional approval.?This potentially life-threating injury can be managed by mini-thoracotomy with enhanced recovery;however, it is case specific and needs proper judgement.展开更多
Objective. To investigate the changes and influencing factors of early postoperative pulmonary functionof thoracotomy.Methods. Pre-and early postoperative pulmonary function was studied in 64 consecutive cases withopt...Objective. To investigate the changes and influencing factors of early postoperative pulmonary functionof thoracotomy.Methods. Pre-and early postoperative pulmonary function was studied in 64 consecutive cases withoptimal thoracotomy. Pain assessment was done before pulmonary function test, and the chief complaintsof patients were recorded after the procedure. The changing curves of pulmonary function were done andthe differences associated with groups, surgical styles, pain assessment, epidural analgesia, chief com-plaint and preoperative conditions were analyzed.Results. Pulmonary function was severely lowered to about 40% of the base line on the first day,and it was rehabilitated to about 60% of the base line on the eighth day. There was a greater gradienton the recovery curve on the 3rd and 4th days. Epidural analgesia was able to improve pain relaxationand pulmonary function in some degree. Single-factor analysis showed that postoperative pain, postopera-tive day and surgical style were the significant influencing factors for early postoperative pulmonary func-tion. By multiple-factor analysis, preoperative pulmonary function, age and postoperative pain were themain factors, while surgical style had only weak effect on it.Conclusions. Early postoperative pulmonary function is severely impaired by thoracotomy. It rehabili-tate gradually with time. Improvement of preoperative pulmonary function, reducing surgical procedure in-juries, especially injury to respiratory muscle system, and enough postoperative pain relief are the mostimportant means that would reduce pulmonary function impairment and consequently reduce postoperativepulmonary complications.展开更多
BACKGROUND: Cryoanalgesia at -50 ℃ for 90 seconds yields effective pain relief followingthoracotomy. In China, -50 ℃ is a common temperature for intercostal cryoanalgesia followingthoracotomy. However, experimental ...BACKGROUND: Cryoanalgesia at -50 ℃ for 90 seconds yields effective pain relief followingthoracotomy. In China, -50 ℃ is a common temperature for intercostal cryoanalgesia followingthoracotomy. However, experimental results vary.OBJECTIVE: To explore intercostal nerve pathological changes at-70 ℃ for various freezing timesby studying canines, and to evaluate long-term clinical efficacy of intercostal nerve cryoanalgesia forpostoperative pain relief based on the animal experiments.DESIGN, TIME AND SETTING: A comparative animal study was performed at the AnimalExperimental Center of the General Hospital of the People's Liberation Army. Based on results fromthe animal study, a randomized, controlled, clinical trial was performed at the Department ofThoracic Surgery of the General Hospital of the People's Liberation Army between October 2006and October 2008.PARTICIPANTS: A total of 120 patients undergoing posterolateral single incision Iobectomy at theDepartment of Thoracic Surgery of PLA General Hospital between October 2006 and October 2008were selected. Nervous system diseases were excluded.METHODS: Animal experiment: 8 anaesthetized, mixed-breed dogs were used. The intercostalnerves (costal bone 6-10) were frozen at -70 ℃ for varying times (30, 60, 90, 120, and 180seconds). Clinical study: 120 patients were randomly assigned to 2 groups (n = 60). In thecryoanalgesia group, the intercostal nerves were frozen prior to chest closure, and 4 costal nerves(1 at incision level, 2 above and below incision, and 1 at drainage tube level) were frozen for 90seconds at -70 ℃, respectively. Intercostal nerves were not frozen in the control group patients.Dolantin was used to relieve postoperative pain in patients from both groups.MAIN OUTCOME MEASURES: Pathological changes in frozen intercostal nerves were examined atdays 1, 10, 30, and 60 following freezing. Following surgery, the degree of postoperative pain in allpatients was evaluated by visual analogue scale at days 1,3, 5, 9, 30, 60, 90, and 180. Dolantindoses at days 1, 3, 5, 9 post-surgery and postoperative complications were noted.RESULTS: Nerve damage progressively increased with length of freezing time at-70 ℃, andrecovery time from damage was gradually increased. After freezing for 90 seconds, the nervesexhibited obvious histopathological damage, and then completely recovered. In addition, afterfreezing for 180 seconds, the histopathological changes in nerves were reversible. In the clinicalstudy, visual analogue scale scores were significantly less in the cryoanalgesia group compared withthe control group (P < 0.01), which was maintained over 30 days. In the cryoanalgesia group, themean dolantin dose administered and postoperative complications were significantly reducedcompared with the control group (P< 0.01).CONCLUSION: Freezing of the intercostal nerve at -70 ℃ for 90 seconds is a safe and long-termeffective method for relieving post-thoracotomy pain.展开更多
BACKGROUND:Traumatic cardiac arrest(TCA)is a major contributor to mortality and morbidity in all age groups and poses a significant burden on the healthcare system.Although there have been advances in treatment modali...BACKGROUND:Traumatic cardiac arrest(TCA)is a major contributor to mortality and morbidity in all age groups and poses a significant burden on the healthcare system.Although there have been advances in treatment modalities,survival rates for TCA patients remain low.This narrative literature review critically examines the indications and eff ectiveness of current therapeutic approaches in treating TCA.METHODS:We performed a literature search in the PubMed and Scopus databases for studies published before December 31,2022.The search was refi ned by combining search terms,examining relevant study references,and restricting publications to the English language.Following the search,943 articles were retrieved,and two independent reviewers conducted a screening process.RESULTS:A review of various studies on pre-and intra-arrest prognostic factors showed that survival rates were higher when patients had an initial shockable rhythm.There were conflicting results regarding other prognostic factors,such as witnessed arrest,bystander cardiopulmonary resuscitation(CPR),and the use of prehospital or in-hospital epinephrine.Emergency thoracotomy was found to result in more favorable outcomes in cases of penetrating trauma than in those with blunt trauma.Resuscitative endovascular balloon occlusion of the aorta(REBOA)provides an advantage to emergency thoracotomy in terms of occupational safety for the operator as an alternative in managing hemorrhagic shock.When implemented in the setting of aortic occlusion,emergency thoracotomy and REBOA resulted in comparable mortality rates.Veno-venous extracorporeal life support(V-V ECLS)and veno-arterial extracorporeal life support(V-A ECLS)are viable options for treating respiratory failure and cardiogenic shock,respectively.In the context of traumatic injuries,V-V ECLS has been associated with higher rates of survival to discharge than V-A ECLS.CONCLUSION:TCA remains a signifi cant challenge for emergency medical services due to its high morbidity and mortality rates.Pre-and intra-arrest prognostic factors can help identify patients who are likely to benefit from aggressive and resource-intensive resuscitation measures.Further research is needed to enhance guidelines for the clinical use of established and emerging therapeutic approaches that can help optimize treatment effi cacy and ameliorate survival outcomes.展开更多
Importance:Scimitar syndrome(SS)is a rare type of congenital heart disease characterized by total or partial anomalous venous drainage of the right lung to the inferior vena cava.However,the surgical repair techniques...Importance:Scimitar syndrome(SS)is a rare type of congenital heart disease characterized by total or partial anomalous venous drainage of the right lung to the inferior vena cava.However,the surgical repair techniques for SS vary according to patients'anatomical and pathological features.Objective:This study was performed to analyze the mid-term results of a less invasive surgical correction technique for SS in children.Methods:Eleven patients with SS who underwent surgical repair from January 2012 to March 2020 were retrospectively analyzed.The anomalous scimitar vein(SV)was directly reimplanted to the left atrium,and the concomitant atrial septal defect was simultaneously repaired with cardiopulmonary bypass.Results:Three male and eight female patients were included in the study.Their mean age was 3.1±1.3 years,and their mean body weight was 12.8±3.0 kg.Most patients had symptoms,such as upper respiratory tract infection,dyspnea,and recurrent pneumonia,and two patients had pulmonary hypertension.None of the 11 patients who underwent direct SV reimplantation by right thoracotomy developed bleeding,arrhythmia,heart failure,or perioperative death,and no patients required reoperation during a mean follow-up period of 36.6±15.2 months.Postoperative echocardiography revealed no restenosis or obstruction of the anastomosis in any patients.Interpretation:Surgical repair for SS by right thoracotomy and direct anastomosis of the SV to the posterior wall of the left atrium is safe and effective,with good long-term patency of the reimplanted SV and a low mortality rate.展开更多
文摘Objective: To define the indications for cardiac surgeries through right anterolateral thoracotomy, and render it clinically feasible in a carefully controlled scope. Methods: Ninety-eight patients requiring cardiac surgeries were operated through this approaach. Incisions were made in the fourth or on intercostal space. The upper costal cartilage near the incision was routinely removed. Aortic cannulation was performed through the lateral wall of the aorta. The procedures on the heart itself were the same as that of the median sternotomy. Results: The average lengths of the incisions, for the male and female patients, were (10.6±3.2) cm and (10.3 ± 2.2) cm respectively. The mean bypass time was (61.3 ±t 25. 1) min, and the mean heart arrest time was (49.5±19.2) min. The postoperative drainage was (410± 125) ml. All but 1 patient with aortic valve operation had satisfactory exposure . The complications included chest pain (n = 5), rib fracture (n =3), pleural effusion (n=5), and pneumothorax(n=6). Conclusion: The right anterolateral tholacotomy was a satisfactory alternative of median sternotomy for the surgeries that can be performed through a right atrium access.
文摘<b><span style="font-family:Verdana;">Objectives and Aim:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">Thoracotomies are widely recognized to cause acute pain which is associated with many complications. The target study aimed to assess the safety and efficacy of SAPB compared to TEA for relieving severe thoracotomy pain.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Patients and Methods: </span></b><span style="font-family:Verdana;">Forty patients scheduled for thoracotomy randomly allocated either to receive SAPB or thoracic epidural (TEA). Visual analogue pain score (VAS) at rest and coughing every 6 hrs. Postoperative, hemodynamic parameters (heart rate and MAP), pain rescue analgesic consumption in the first 24 hrs., complications, and duration of hospital stay recorded. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> In our study, we found that the recently described SAPB, while maintaining stable blood pressure, provided excellent analgesia comparable to that offered by TEA for acute post-thoracotomy pain. Hypotension was more noteworthy in those who had epidurals than those with serratus anterior plane (SAP) catheters. Morphine rescue analgesia, as well as Visual Analogue Scale (VAS) pain scores during normal tidal breathing, were like in both groups. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">We recommend that the Serratus anterior plane block appears to be a safe and effective alternative for postoperative analgesia after thoracotomy.</span>
文摘Achalasia cardia is a primary oesophageal motility disorder of unknown aetiology characterized manometrically by insufficient relaxation of the lower oesophageal sphincter (LES) and loss of oesophageal peristalsis;radiographically by aperistalsis, oesophageal dilation with minimal LES opening, bird-beak appearance, poor emptying of barium;and endoscopically by dilated oesophagus with retained saliva, liquid and undigested food particles in the absence of mucosal stricturing or tumour. Achalasia cardia patients usually present with difficulty in swallowing both solids and liquids and this may be associated with regurgitation, heartburn and chest pains. Treatment options include medical or pharmacologic therapy, botulinum toxin injection, pneumatic dilation and oesophagocardiomyotomy or the Heller myotomy with or without antireflux procedure and recently the POEM (Perioral oesophageal myotomy). Herein, we present our experience with four cases managed surgically via thoracotomy without antireflux surgery over a 5-year period, from January 2015 to June 2019 at the Komfo Anokye Teaching Hospital, the second largest teaching hospital in Ghana.
文摘Objective To investigate effect of respiratory training on respiratory function recovery following thoracotomy. Method Respiratory muscle training, productive drainage, exercise and respiratory function training, and appropriate rehabilitation were performed on 216 patients underwent thoracotomy. Result 206 patients showed favorable recovery of respiratory function,7 showed respiratory dysfunction, and 1 developed serious complication. Conclusion Respiratory training after thoracotomy significantly improve respiratory function.
文摘Background: We experienced a very rare complication, that is, an unexpected postoperative paraplegia due to the incidental migration of oxidized regenerated cellulose used for hemostasis of intercostal space bleeding. Patients and Methods: The objective is to analyze the cause and to take measures against the very rare complication from an empirical analysis and the literature. For a 78-year-old male with suspected lung cancer in the right upper lobe (S1), a thoracotomy was performed. For hemostasis of the bleeding from the 5th intercostal thoracotomy space, we used and placed oxidized regenerated cellulose at the continuous oozing bleeding sites. On the 3rd postoperative day, paralysis beneath thoracic vertebrae level 6 was observed. Immediate computed-tomographic (CT) scanning and magnetic resonance imaging (MRI) displayed a 17 × 9 × 14 mm epidural hematoma in the spinal canal at level 5 of the thoracic vertebrae. An emergent laminectomy for the thoracic vertebra was performed to remove the oxidative cellulose and haematoma, and the compression was released. The paraplegia gradually began to recover and maintain a standing position. After 1 year from the event, the patient can walk by himself with a crutch. Results: The causes were that the oxidative cellulose materials were used for the intercostal bleeding at the open thoracotomy. The migration of the oxidative cellulose materials into the epidural space and into thoracic spinal canal through the intervertebral foramen, or gradual penetration of the oxidative cellulose materials into the spinal canal due to respiratory costal movement. As a measurement of prevention, the hemostat materials should be completely removed after finishing of the hemostasis. In the case of a difficult hemostasis, consultation of an orthopedist or neurosurgeon to perform the appropriate hemostasis in good cooperation is required. Conclusion: If postoperative paraplegia is suspected, immediate CT scanning and/or MRI examination would become powerful diagnostic procedures as soon as possible to start an interventional treatment.
文摘Today, the ultrasound guidance (USG) in regional anesthesia is gold standard more and more often used for medial or paramedian approaches around to the spine, such as the paravertebral (PV) block. Local anatomical changes may greatly handicap the performance of this type of block. We present clinical, sonographic, and radiological data on successful PV block and catheter placement in four patients with vertebral diseases, targeting thoracotomy or lumbotomy postoperative pain after stabilization of the involved vertebral body and preliminary arthrodesis with laminectomy by the posterior approach. We emphasize the importance of USG in this special context involving local anatomical disturbance.
文摘Background: Emergency thoracotomies often challenge surgical logistics and they tend to produce inferior outcomes when compared with elective surgery. Aims: We sought to identify the specific indications and therapeutic challenges that go with patients who undergo thoracotomy within 24 hours of admission and the re-thoracotomies. Methodology: Spanning a 7-year period, the bio-data of patients who met our criteria for emergency thoracotomies were collated. We noted their indications for surgery, therapeutic challenges and outcome of care. Results: In all, 36 patients (28 males and 8 females) met the inclusion criteria. Majority, (66.7%) fell into the 20 - 39 year age range. Diaphragmatic rupture was the commonest indication, followed by massive intra-thoracic haemorrhage. Postoperative mortality occurred in 11.1% of patients. Postoperative ventilation was absolutely indicated in 6 patients. Discussion and Conclusion: Diaphragmatic rupture is the commonest indication for emergency thoracotomy. We noted the need for improvement in pre hospital care for trauma patients as a way to improve the management outcome of emergency thoracotomies.
文摘<strong>Background:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">Atrial Septal Defect (ASD) closure is a common cardiac surgical procedure performed worldwide. Due to favourable clinical outcome, minimal invasive approach is becoming popular. Hence this study was conducted to compare the outcome of two surgical approaches, median sternotomy and mini thoracotomy with total peripheral cannulation, in a developing country Nepal.</span><b><span style="font-family:Verdana;"> Methods: </span></b><span style="font-family:Verdana;">A prospective study of 62 ASD patients, randomized to undergo surgical closure either via right anterior mini thoracotomy or median sternotomy was conducted and followed up over three years. The clinical outcome parameters like intensive care unit stay, hospital stay, post-operative duration of ventilation, cardiopulmonary bypass time, aortic cross clamp time, mediastinal drainage, size of scar and complication were compared between two groups. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Cardiopulmonary bypass time and aortic cross clamp time were significantly longer in right anterior mini thoracotomy group as compared to median sternotomy group (43.97</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min ± 12.70</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min vs 34.42</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min ± 10.42</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min and 25.13</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min </span><span style="font-family:Verdana;">±</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">7.82</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min vs 19.48</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min ± 6.93</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min respectively, p</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">value</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;"><</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">0.05). There was no significant difference in duration of surgery (2.75</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs ± 0.43</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs vs 2.56</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs ± 0.41</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs, p-value</span><span style="font-family:Verdana;"> = </span><span style="font-family:Verdana;">0.09), post-operative ventilation (2.90</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs ± 1.22</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs and 2.88</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs ± 1.07</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs, p</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">value</span><span style="font-family:Verdana;"> = </span><span style="font-family:Verdana;">0.96) between two groups. Post-operative mediastinal drainage was significantly less in right anterior mini thoracotomy group (214.52</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">ml ± 91.79</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">ml vs 284.03</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">ml ± 158.91</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">ml, p</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">value</span><span style="font-family:Verdana;"> = </span><span style="font-family:;" "=""><span style="font-family:Verdana;">0.04). There was no significant difference in ICU stay and hospital stay. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Atrial septal defect can be safely closed by right anterior mini thoracotomy with a small, cosmetically acceptable submammary scar with less pain and bleeding.</span></span>
文摘Objective:To compare the clinical effects of minimally invasive esophageal cancer radical resection and traditional esophageal cancer radical resection.Methods:200 cases of esophageal cancer radical resection were performed from July 2014 to July 2017 in our hospital.The cases were divided into experimental group and control group,82 cases in the experimental group and 118 cases in the control group.The experimental group was treated with minimally invasive esophageal cancer radical surgery,and the control group was treated with conventional thoracotomy.Record the comparison between the two groups:(1)surgical conditions,including the time of surgery,intraoperative blood loss,hospitalization time;(2)the number of lymph nodes cleaned;(3)the postoperative control group used conventional thoracotomy,including lung lesions,anastomotic fistula/narrow.Results:The parameters of operation time,intraoperative blood loss,hospitalization time,and number of lymph nodes cleaned in the experimental group were lower than those in the control group,and the difference was statistically significant(p<0.05).In addition to pulmonary infection(p<0.05),there was no significant difference in the incidence of other complications between the experimental group and the control group(p>0.05).Conclusion:Minimally invasive esophageal cancer radical resection and conventional thoracotomy have good clinical effects in the treatment of esophageal cancer.Minimally invasive esophageal cancer radical surgery can effectively reduce intraoperative trauma and postoperative reaction,which is worthy of popularization and application.
文摘Purpose: Right mini thoracotomy has been evaluated in many studies for mitral valve repair mainly in degenerative valvular disease but not in rheumatic heart disease. Mitral valve repair is more challenging in rheumatic etiology due to complexity of lesions. This prospective randomized case control study was designed to evaluate repair through mini right thoracotomy and to compare the clinical and echocardiographic outcomes with sternotomy in rheumatic patients. Methods: 25 patients of rheumatic heart disease underwent mitral valve repair through mini right thoracotomy (group I). Various clinical and functional parameters were compared with 25 patients of mitral valve repair through sternotomy (group II). On follow up the results were compared in both groups for clinical and echocardiographic parameters. Results: The various pre-operative demographic parameters were comparable in two groups. Equal rate of mitral valve repair (group I-21/25, 84% and group II-21/25, 84%) was achieved in both groups. The various intra-operative and post-operative clinical parameters were better in group I .There were equivalent functional and valve related outcomes in both groups in term of NYHA class (1.28 ± 0.613 vs 1.08 ± 0.276, P = 0.144), post-operative mitral valve area (2.43 ± 0.891 vs 2.82 ± 0.662, P = 0.090), incidence of more than mild mitral regurgitation (0) and mean pressure gradient across mitral valve (4.98 ± 3.33 vs 4.23 ± 1.5, P = 0.309). Conclusion: Mitral valve repair through mini right thoracotomy approach in rheumatic etiology is feasible and safe with equivalent rate of successful repair as compared to median sternotomy. It is associated with lesser morbidity, cosmetic advantage and lesser resource utilization.
文摘Background: A survey was conducted on preferences for thoracotomy opening and closure as well as post-thoracotomy pain management among academic teaching staff of thoracic surgeons in Turkey. It was aimed to assess the attitudes of the thoracic surgery training-center academicians on aforesaid topic. Methods: A 7-question questionnaire was performed by face-to-face interview or online by e-mail to the academic professionals working at resident-training centers. Eighty-eight randomly selected academicians were invited to complete the questionnaire, and 48 of them answered. Based on the complete and valid responses, the methods for opening and closure of thorax, the number of chest drains placed, the method of analgesia in per-or postoperative period and the analgesic agents used commonly were assessed. Results: Thirty-three (68.8%) of 48 were working at university hospitals and 24 (50.0%) were in age group of 40 - 49 years. Muscle-sparing (41.7%) and standard posterolateral thoracotomies (41.7%) were the most preferred incision. The most used method for closing thorax was pericostal sutures. Per-or postoperative analgesia was stated to be performed by all of the participants, while 45 (93.75%) of them reported that they preferred to administrate more than one procedure. Intercostal/paravertebral nerve block (26.4%), epidural analgesia (24.5%), systemic parenteral non-steroid drugs (24.5%) and systemic parenteral opioid (20.9%) were the most commonly used methods. Conclusion: Preventing intercostal nerve injury decreaseed post-thoracotomy pain, as well as the necessity of post-operative analgesic use. Conversely, most of the academic staff did not prefer the methods for preserving intercostal nerve. More than one analgesia procedure were said to be used by majority of the participants.
文摘Objective:To explore the application of thoracic nerve block and propofol anesthesia in the treatment and perioperative period.Methods:A total of 40 patients with thoracotomy for esophageal cancer between May 2020 and September 2021 in the hospital were selected to participate in this study.All the patients were divided into reference and experimental groups according to the anesthesia protocol.For the experimental group,the parathoracic vertebral nerve block scheme was used under ultrasound guidance,with general anesthesia in the same manner,and after the surgical treatment of both groups,the patient-controlled intravenous analgesia(PCIA)regimen was applied to both patients.The time of surgery for the two patient groups,intraoperative propofol,postoperative pain conditions and postoperative blood glucose and NE,E,DA levels were measured and conducted for comparative analysis.Results:There is no significant differences between the two groups,besides,in the experimental group,propofol in surgery was less than that in the reference group;At the T6~T9 timepoint,patients in the experimental group had lower VAS scores in quiet and active conditions than those in the reference group;At the T9 timepoint,blood glucose and NE levels were higher than the T1,T4,T5 time point levels in each group;At the T4,T4 timepoint,E levels in both groups were lower than the T1,T9 time point level in each group;at T9 time point,the DA level was higher in the reference group than the T1,T4 time point level in each group;at T9 Time point,blood glucose and NE,E,DA were lower than those in the reference group.Conclusions:In the treatment of thoracotomy in elderly patients,thoracic paravertebral nerve block compound propofol anesthesia program can be used to patients,with striking anesthesia effect and remarkable recovery effect in perioperative period,which is conducive to relieving postoperative pain and worth promotion and application.
文摘Objectives:Intraoperative conversion to thoracotomy from video-assisted thoracoscopic surgery(VATS)is associated with increased adverse events,which is a major concern.We aim to explore the related risk factors in lung cancer patients.Methods:In our study,the data from 1305 patients who underwent VATS between June 2017 and May 2020 were retrospectively collected,among which 67 patients underwent unexpected conversion to thoracotomy.All patients were divided into Non-conversion Group or Conversion Group according to whether they required a conversion to thoracotomy and the risk factors were explored by univariate and multivariate analyses.Results:The most common cause of conversion was fibrocalcified lymph nodes,found in 33 patients(49.3%).Multivariable logistic regression analysis demonstrates that the independent risk factors for the conversion were age≥65 y(OR=2.696,95%CI:1.487e4.887,p=0.001),tumor size>3 cm(OR=4.527,95%CI:2.490e8.233,p<0.001),and tumor location in the left upper lung(OR=3.809,95%CI:1.737 e5.492,p<0.001).Conclusions:Advanced age,bigger tumor size and tumor at the left upper lobe could lead to conversion.In the early VATS learning cases,surgeons should try to choose patients with lower risk of conversion to thoracotomy.
文摘Penetrating injuries to anterior chest may result in life-threatening complications such as massive haemothorax,?as a result of injury to the internal mammary artery.?Isolated internal mammary injury is a very rare cause of massive haemothorax and associated with high mortality.?We are presenting this?32-year-old gentleman who sustained a thoracic stab wound and had an emergency right anterior mini-thoracotomy?by extending the stab wound rather than standard thoracotomy or sternotomy.?This case of isolated penetrating IMA injury managed with mini-thoracotomy is the only documented case so far. We are publishing this case report with patient’s both written and informed consent and institutional approval.?This potentially life-threating injury can be managed by mini-thoracotomy with enhanced recovery;however, it is case specific and needs proper judgement.
文摘Objective. To investigate the changes and influencing factors of early postoperative pulmonary functionof thoracotomy.Methods. Pre-and early postoperative pulmonary function was studied in 64 consecutive cases withoptimal thoracotomy. Pain assessment was done before pulmonary function test, and the chief complaintsof patients were recorded after the procedure. The changing curves of pulmonary function were done andthe differences associated with groups, surgical styles, pain assessment, epidural analgesia, chief com-plaint and preoperative conditions were analyzed.Results. Pulmonary function was severely lowered to about 40% of the base line on the first day,and it was rehabilitated to about 60% of the base line on the eighth day. There was a greater gradienton the recovery curve on the 3rd and 4th days. Epidural analgesia was able to improve pain relaxationand pulmonary function in some degree. Single-factor analysis showed that postoperative pain, postopera-tive day and surgical style were the significant influencing factors for early postoperative pulmonary func-tion. By multiple-factor analysis, preoperative pulmonary function, age and postoperative pain were themain factors, while surgical style had only weak effect on it.Conclusions. Early postoperative pulmonary function is severely impaired by thoracotomy. It rehabili-tate gradually with time. Improvement of preoperative pulmonary function, reducing surgical procedure in-juries, especially injury to respiratory muscle system, and enough postoperative pain relief are the mostimportant means that would reduce pulmonary function impairment and consequently reduce postoperativepulmonary complications.
文摘BACKGROUND: Cryoanalgesia at -50 ℃ for 90 seconds yields effective pain relief followingthoracotomy. In China, -50 ℃ is a common temperature for intercostal cryoanalgesia followingthoracotomy. However, experimental results vary.OBJECTIVE: To explore intercostal nerve pathological changes at-70 ℃ for various freezing timesby studying canines, and to evaluate long-term clinical efficacy of intercostal nerve cryoanalgesia forpostoperative pain relief based on the animal experiments.DESIGN, TIME AND SETTING: A comparative animal study was performed at the AnimalExperimental Center of the General Hospital of the People's Liberation Army. Based on results fromthe animal study, a randomized, controlled, clinical trial was performed at the Department ofThoracic Surgery of the General Hospital of the People's Liberation Army between October 2006and October 2008.PARTICIPANTS: A total of 120 patients undergoing posterolateral single incision Iobectomy at theDepartment of Thoracic Surgery of PLA General Hospital between October 2006 and October 2008were selected. Nervous system diseases were excluded.METHODS: Animal experiment: 8 anaesthetized, mixed-breed dogs were used. The intercostalnerves (costal bone 6-10) were frozen at -70 ℃ for varying times (30, 60, 90, 120, and 180seconds). Clinical study: 120 patients were randomly assigned to 2 groups (n = 60). In thecryoanalgesia group, the intercostal nerves were frozen prior to chest closure, and 4 costal nerves(1 at incision level, 2 above and below incision, and 1 at drainage tube level) were frozen for 90seconds at -70 ℃, respectively. Intercostal nerves were not frozen in the control group patients.Dolantin was used to relieve postoperative pain in patients from both groups.MAIN OUTCOME MEASURES: Pathological changes in frozen intercostal nerves were examined atdays 1, 10, 30, and 60 following freezing. Following surgery, the degree of postoperative pain in allpatients was evaluated by visual analogue scale at days 1,3, 5, 9, 30, 60, 90, and 180. Dolantindoses at days 1, 3, 5, 9 post-surgery and postoperative complications were noted.RESULTS: Nerve damage progressively increased with length of freezing time at-70 ℃, andrecovery time from damage was gradually increased. After freezing for 90 seconds, the nervesexhibited obvious histopathological damage, and then completely recovered. In addition, afterfreezing for 180 seconds, the histopathological changes in nerves were reversible. In the clinicalstudy, visual analogue scale scores were significantly less in the cryoanalgesia group compared withthe control group (P < 0.01), which was maintained over 30 days. In the cryoanalgesia group, themean dolantin dose administered and postoperative complications were significantly reducedcompared with the control group (P< 0.01).CONCLUSION: Freezing of the intercostal nerve at -70 ℃ for 90 seconds is a safe and long-termeffective method for relieving post-thoracotomy pain.
文摘BACKGROUND:Traumatic cardiac arrest(TCA)is a major contributor to mortality and morbidity in all age groups and poses a significant burden on the healthcare system.Although there have been advances in treatment modalities,survival rates for TCA patients remain low.This narrative literature review critically examines the indications and eff ectiveness of current therapeutic approaches in treating TCA.METHODS:We performed a literature search in the PubMed and Scopus databases for studies published before December 31,2022.The search was refi ned by combining search terms,examining relevant study references,and restricting publications to the English language.Following the search,943 articles were retrieved,and two independent reviewers conducted a screening process.RESULTS:A review of various studies on pre-and intra-arrest prognostic factors showed that survival rates were higher when patients had an initial shockable rhythm.There were conflicting results regarding other prognostic factors,such as witnessed arrest,bystander cardiopulmonary resuscitation(CPR),and the use of prehospital or in-hospital epinephrine.Emergency thoracotomy was found to result in more favorable outcomes in cases of penetrating trauma than in those with blunt trauma.Resuscitative endovascular balloon occlusion of the aorta(REBOA)provides an advantage to emergency thoracotomy in terms of occupational safety for the operator as an alternative in managing hemorrhagic shock.When implemented in the setting of aortic occlusion,emergency thoracotomy and REBOA resulted in comparable mortality rates.Veno-venous extracorporeal life support(V-V ECLS)and veno-arterial extracorporeal life support(V-A ECLS)are viable options for treating respiratory failure and cardiogenic shock,respectively.In the context of traumatic injuries,V-V ECLS has been associated with higher rates of survival to discharge than V-A ECLS.CONCLUSION:TCA remains a signifi cant challenge for emergency medical services due to its high morbidity and mortality rates.Pre-and intra-arrest prognostic factors can help identify patients who are likely to benefit from aggressive and resource-intensive resuscitation measures.Further research is needed to enhance guidelines for the clinical use of established and emerging therapeutic approaches that can help optimize treatment effi cacy and ameliorate survival outcomes.
基金The research is supported by Pediatric Special Key Project from Beijing Hospitals Authority Pediatric Collaborative Development Center,Grant No.XTYB201819。
文摘Importance:Scimitar syndrome(SS)is a rare type of congenital heart disease characterized by total or partial anomalous venous drainage of the right lung to the inferior vena cava.However,the surgical repair techniques for SS vary according to patients'anatomical and pathological features.Objective:This study was performed to analyze the mid-term results of a less invasive surgical correction technique for SS in children.Methods:Eleven patients with SS who underwent surgical repair from January 2012 to March 2020 were retrospectively analyzed.The anomalous scimitar vein(SV)was directly reimplanted to the left atrium,and the concomitant atrial septal defect was simultaneously repaired with cardiopulmonary bypass.Results:Three male and eight female patients were included in the study.Their mean age was 3.1±1.3 years,and their mean body weight was 12.8±3.0 kg.Most patients had symptoms,such as upper respiratory tract infection,dyspnea,and recurrent pneumonia,and two patients had pulmonary hypertension.None of the 11 patients who underwent direct SV reimplantation by right thoracotomy developed bleeding,arrhythmia,heart failure,or perioperative death,and no patients required reoperation during a mean follow-up period of 36.6±15.2 months.Postoperative echocardiography revealed no restenosis or obstruction of the anastomosis in any patients.Interpretation:Surgical repair for SS by right thoracotomy and direct anastomosis of the SV to the posterior wall of the left atrium is safe and effective,with good long-term patency of the reimplanted SV and a low mortality rate.
