Objective To investigate the indication,techniques,safety and efficacy of medical suture versus traditional suturein thoracoscopic surgery incision closure.Methods From October 2014 to January 2016,121 patients undergoing thoracoscopic surgery were divided into two groups according to the method of incision closure:53 cases of traditional suture group and 68 cases of medical suture hasp group.The time of closure,healing time,wound healing scores and patient's satisfaction were recorded and statistically analyzed.Results All patients were successfully operated without perioperative death.One patient underwent postoperative bleeding in the medical suture hasp group.The medical suture hasp was found to be reliable and easy to remove in secondary operation.The postoperative incision was changed to traditional suture.Two patients in each group had delayed healing.Two patients of medical suture hasp group were caused by incision bleeding,of whom one case switched to traditional suture,and one patient was treated with pressure bandage and healed.The wound closure time of the medical suture hasp group was significantly shorter than that of the traditional suture group:(110.0 ± 12.7) s vs.(305.0 ± 31.6) s,P ＜ 0.01.The wound healing scores of medical suture hasp group were higher than those of traditional suture group 2 weeks and 1 month after surgery (P ＜ 0.01).There was no significant difference in healing rate between two groups (P ＞ 0.05).The satisfaction scores of the patients in medical suture hasp group were higher than those in traditional suture group (P ＜ 0.01).Conclusions The use of medical suture hasp in the thoracoscopic surgical incision closure process is safe and reliable.It can accelerate the early repair of incision,and improve patient's satisfaction.

Objective To assess the choice between direct operation and followed- up observation for subclinical esophageal submucosal mass. Methods The clinical data of 133 patients with subclinical esophageal submucosal mass from February 1996 to October 2013 were retrospectively analyzed. The patients were divided into 2 groups according to the modes of intervention: direct operation group (82 cases) and followed-up group (51 cases). Their clinical data, imaging, endoscopy information, modes of intervention and final outcome were compared. Results All of the 133 patients were considered as esophageal leiomyoma. The age and body examination detection rate in direct operation group were significantly lower than those in followed-up group: (47.7 ± 13.1) years vs. (52.2 ± 10.1) years and 15.9% (13/82) vs. 37.3% (19/51), the tumor diameter, case history and incidence of chest and abdominal pain were significantly higher than those in followed-up group: (2.2 ± 1.4) cm vs. (1.7 ± 1.0) cm, 51 (44, 60) months vs. 47 (40, 55) months and 28.0% (23/82) vs. 9.8% (5/51), and there were statistical differences (P＜0.05 or ＜0.01). There was no operative mortality in direct operation group, and the incidence of mild surgical complication was 8.5% (7/82); the pathological result showed that esophageal leiomyoma and other benign diseases were in 70 cases, and malignant disease in 12 cases (12 cases of malignant diseases who missed diagnosis before operation were mostly caused by incomplete examination.). In followed-up group, the mean observation time was 35.5 (3 to 240) months, disease progression was in 23 cases (45.1%, 23/51), 3 cases developed new-onset symptoms, 20 cases increased in diameter, and the average doubling time was 856 (126 to 2 891) d. Twenty-seven patients eventually underwent surgery (52.9%, 27/51, post-observation intervention group), without perioperative death, and the incidence of surgical complication was 7.4% (2/27). The pathological result showed that esophageal leiomyoma and other benign diseases were in 23 cases, and malignant disease in 4 cases. Compared with direct operation group, post-observation intervention group had no delayed treatment due to the observation and did not increase the surgery risk and difficulty, and no malignant transformation occurred. Conclusions Subclinical esophageal submucosal mass could be followed up, but endoscopic ultrasonography, CT and gastrointestinal angiography must be performed and must be followed up closely.

Objective To investigate the effect of the amputation order of pulmonary artery and pulmonary artery on pulmonary residual blood volume in total thoracoscopic lobectomy.Methods Sixtyeight patients who were scheduled to underwent total thoracoscopic lobectomy from June 2015 to April 2019 in Beijing Aerospace General Hospital were selected.The patients were divided into first amputation pulmonary artery group and first amputation pulmonary vein group by random envelope method with 34 cases in each group.Five cases in first amputation pulmonary artery group and 4 cases in first amputation pulmonary vein group were excluded because of the procedure modification or the fragmentation of the specimen during the course of operation.In the end,29 cases were enrolled in first amputation pulmonary artery group and 30 cases in first amputation pulmonary vein group.In first amputation pulmonary vein group,all arteries were ligated before interruption of the veins;and in first amputation pulmonary artery group had a reverse sequence.The perioperative period status were recorded,and the crude pulmonary quality,dry pulmonary quality,pulmonary residual blood volume and adjusted pulmonary residual blood ratio were measured or calculated.Results All 59 patients were operated successfully.No serious complications occurred,no perioperative death occurred,and no patients needed blood transfusion.There was no statistical difference in the incidence of minor complications between first amputation pulmonary artery group and first amputation pulmonary vein group:27.6％ (8/29) vs.33.3％ (10/30),P＞0.05.There were no statistical differences in operative time,transoperative bleeding volume,pulmonary residual blood volume,crude pulmonary quality,dry pulmonary quality,adjusted pulmonary residual blood ratio,hemoglobin difference before and after surgery,postoperative drainage time and postoperative hospitalization time between 2 groups (P＞0.05).Conclusions The amputation order of pulmonary artery and pulmonary vein sequence of vessel interruption during total thoracoscopic lobectomy has no effect on the pulmonary residual blood volume,can be reasonably selected according to the intraoperative situation.

Objective To analyze the changes of the cost and structure of coronary intervention patients before and after the centralized procurement of coronary stents in Zhejiang Province.Methods It was conducted on the medical expenses of patients in the FM1 group(percutaneous coronary stent implantation)of a Class A tertiary hospital in Zhejiang Province from February to December in each 2020 and 2021.The number of cases was 1 403 and 1 698,re-spectively.A nonparametric test was conducted on the patient expenses before and after the reform.Results There are significant differences in total medical expenses,material expenses,treatment expenses,operation expenses and drug expenses before and after centralized purchase(P＜0.01);After the implementation of centralized procure-ment,material cost of patients decreased significantly,while the treatment cost increased;At the same time,the more coronary stents were placed,the greater the decrease in the total medical expenses and material expenses.Conclusion The centralized procurement of coronary stents can reduce the medical burden of patients,improve the structure of medical expenses,enhance the value of technical labor services of medical personnel,and promote DRG cost control.

Objective:The purpose of this study was to investigate the clinical value of CT-guided localization of pulmonary nodules with soft wire hook-wire by trailing technique.Methods:The clinical data of 211 pulmonary nodules of 185 patients from November 2020 to March 2022 in Beijing Aerospace General Hospital were retrospectively analyzed. The pulmonary nodules were localized with soft wire hook-wire by trailing technique before video-assisted thoracic surgery (VATS). The success rate, complications, pathological results and localization operations related data were statistically analyzed.Results:The success rate of localization was 97.63% (206/211), and the success rate of VATS removal was 99.53% (210/211). The average operation time was (7.19 ± 2.62) min, and the average time required for resection of lesions was 27 min (10 to 126 min). During the surgery, the soft wire hook-wire of two patient was found to be dislocated and retracted into the chest wall. The pulmonary nodules were successfully located and removed according traces left by puncture points on the lung surface. It was found that the hook-wire was located in the interlobar fissure in 3 patients. The pulmonary nodules were successfully removed by the hook-wire position and appropriately expanding the resection range. A minor pneumothorax occurred in 49 patients, but no closed drainage was needed; 12 patients developed intrapulmonary hematoma; 15 patients with chest pain were treated with analgesia.Conclusions:For small pulmonary nodules requiring thoracoscopic surgery, the computed tomography-guided pulmonary nodule localization with soft wire hook-wire by trailing technique is more convenient, safe and effective, and is worthy of promotion to use.

BACKGROUND: Localization of multiple small lung nodules is the technical difficulty of minimally invasive operation resection. However, there are few clinical studies on the preoperative localization of multiple small lung nodules. This study was designed to evaluate the clinical value of preoperative computed tomography (CT) guided microcoil localization for multiple small lung nodules compared with single small lung nodule before video-assisted thoracoscopic surgery (VATS). METHODS: A retrospective analysis of the clinical data of 235 patients with preoperative pulmonary nodules microcoil localization was performed. According to whether the nodules were single, they were divided into single nodule group (184 cases) and multiple nodules group (51 cases) (multiple nodules group). The single nodule group was positioned under CT-guided conventional methods. The multiple nodules group were CT guided localized by microcoil in batches according to priority before VATS. The success rate, complications, pathological results and localization operations related data were statistically analyzed. RESULTS: The success rate of localization in multiple nodule groups was 90.2%, there was no significant difference compared with the single nodule group (90.2% vs 94.6%, P=0.205). The occurrence rate of pneumothorax in multiple nodule group and single nodule group was no statistical difference (21.6% vs 14.1%, P=0.179), however, the operation time in the multiple nodule group was significantly longer than the single nodule group [(30.6±6.6) min vs (19.9±7.4) min, P=0.000]. There were no serious complications such as massive hemoptysis, air embolism or hemothorax. There was no conversion to thoracotomy due to failure of localizing the nodules during operation. Sub-lobectomy was the main method of operation. The majority of postoperative pathologies were non-invasive carcinomas. CONCLUSIONS For multiple small lung pulmonary nodules requiring thoracoscopic surgery, according to certain strategies, preoperative CT-guided localized by microcoil in batches according to priority before VATS is safe and effective, and worthy of promotion.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Lung Neoplasms ; diagnostic imaging ; pathology ; surgery ; Male ; Middle Aged ; Multiple Pulmonary Nodules ; diagnostic imaging ; pathology ; surgery ; Preoperative Period ; Retrospective Studies ; Surgery, Computer-Assisted ; Thoracic Surgery, Video-Assisted ; instrumentation ; Tomography, X-Ray Computed ; Treatment Outcome ; Tumor Burden