Objective:To compare and analyze the effects of total laparoscopic wedge resection and lobectomy in the treatment of stage ⅠA non-small cell lung cancer(NSCLC).Methods:A retrospective cohort study was used to collect 113 cases of stage IA NSCLC treated with total endoscopic surgery in Yantai Affiliated Hospital of Binzhou Medical University from January 2018 to January 2020. The clinical data of patients with NSCLC, including 69 males and 44 females. The age was (65.65±5.19) years old. According to the different surgical methods, they were divided into two groups: wedge resection group ( n=57) and lobectomy group ( n=56). The wedge resection group underwent total laparoscopic and the lobectomy group underwent total laparoscopic lobectomy. The operation related indexes(operation time, intraoperative blood loss, postoperative drainage time, postoperative drainage volume, number of lymph node dissection, first time to get out of bed after operation, first time to exhaust after operation, first time to defecation after operation and hospitalization time), lung function before and after operation [forced expiratory volume in the first second(FEV1), forced vital capacity(FVC), maximum expiratory flow(PEF), maximum ventilation volume (MVV)], complications and prognosis were collected between the two groups. The measurement data of normal distribution were expressed as mean ± standard deviation ( ± s). Independent t-test was used for comparison between groups, and paired sample t-test was used for comparison within groups. The chi-square test was used for comparison of enumeration data between groups. If there were two expected counts < 5, the continuous correction chi-square test was used. Multiple time points were compared using repeated measures one-way analysis of variance. Kaplan-Meier survival curve was used to analyze the survival of the two groups of patients, and Log-Rank test was used to test the survival difference. Results:The postoperative drainage time, postoperative drainage volume, the first time to get out of bed, the first exhaust time and hospitalization time in the pulmonary wedge resection group were(3.25±0.76) d, (218.77±15.93) mL, (18.86±3.51) h, (19.25±2.35) h, (9.23±1.65) d, and those in the lobectomy group were (5.09±1.21) d, (359.74±19.55) mL, (21.55±4.27) h, (22.02±2.85) h, (13.96±3.21) d. The difference between the two groups was statistically significant ( P<0.05). Both groups showed a decrease in FEV1, FVC, PEF and MVV volume at 3 months and 1 year after surgery, but the above indicators increased at 1 year after surgery compared to 3 months after surgery in the lobectomy group ( P<0.05). There was no statistical significant difference in FEV1, FVC, PEF and MVV between the two groups before and 1 year after surgery ( P>0.05). However, FEV1, FVC, PEF and MVV in the wedge resection group were higher than those in the lobectomy group at 3 months after operation ( P<0.05). After 3 years of follow-up, the recurrence-free survival rate and overall survival rate of the wedge resection group were 84.2%, 86.0%, and those of the lobectomy group were 98.2%, 98.2%. The difference between the two groups was statistically significant ( P<0.05). Conclusions:The safety of the two surgical methods for treating stage ⅠA NSCLC is comparable. Compared to patients undergoing lobectomy, lung wedge resection has a better short-term prognosis, reduces postoperative drainage, promotes postoperative recovery, and has a relatively small impact on short-term lung function. However, in terms of long-term prognosis, total laparoscopic lobectomy can achieve a relatively ideal survival prognosis.

Objective To predict the prognosis of patients after cardiac surgery by implementing hemodynamic monitoring collective strategy—CHOLKIT protocol,and to explore the practical application value of CHOLKIT protocol,such as early intervention to improve tissue circulation and microcirculation,and predict the timing of extubation.Methods A prospective cohort study was used to analyse 88 patients who underwent cardiac surgery in the First Affiliated Hospital of Xinjiang Medical University from April to October 2020,and they were divided into the survival group (84 cases) and the death group (4 cases) with patient survival or death as the study endpoint.The CHOLKIT protocol was applied to score the central venous pressure (CVP),heart rate (HR),central venous oxygen saturation (ScvO2),lactic acid (Lac),potassium (K+),perfusion index (PI),and toe temperature (T) of patients at different time periods.The correlation between CHOLKIT score and prognosis was predicted based on the scores.Results Some monitoring indexes in the CHOLKIT protocol were related to the mortality,renal injury and duration of mechanical ventilation after cardiac surgery.Conclusion The CHOLKIT protocol can predict the timing of extubation and the change of the condition of patients after cardiac surgery,and early intervention can improve the prognosis of patients,duration of mechanical ventilation and number of days of stay in the intensive care unit.