Objective    To explore the treatment strategies for patients with fever and pulmonary complications after thoracic surgery during COVID-19 epidemic. Methods    The clinical data of 537 patients who ungerwent selective surgery at the Department of Thoracic Surgery, Shangjin Branch of West China Hospital between February and December 2020 were retrospectively analyzed, including 242 (45.1%) males and 295 (54.9%) females aged 53.3±13.4 years. We have established a procedure for the patients with fever and pulmonary complications after thoracic surgery to investigate the cause of the disease and track risk factors. Results    The overall postoperative complication rate was 16.4% (88/537), and 1 (0.2%) patient died. Of 537 patients, 179 (33.3%) patients were enrolled in our model according to the inclusion criteria: ratio of males [112 (62.6%) vs. 130 (36.3%), P<0.010], patients with a history of smoking [74 (41.3%) vs. 87 (24.3%), P<0.010], or with esophageal cancer surgery [36 (20.1%) vs. 15 (4.2%)], or with traditional thoracotomy [14 (7.8%)  vs. 4 (1.1%)] was higher than that of the other patients. Patients in our process due to fever or pulmonary complications had longer ICU stay and postoperative hospital stay (P=0.010). Logistic regression multivariate analysis showed that gender was an independent risk factor for postoperative fever or pulmonary complications. Conclusion    In low-risk areas of the epidemic, the treatment process is simple and feasible, and the cause traceability and corresponding treatment can basically be completed within 24 hours. At the same time, the treatment process has been running stably for a long time.

Objective    To investigate the efficacy of uniportal video-assisted thoracoscopic surgery (VATS) anatomic basal segmentectomy. Methods    The clinical data of 15 patients who underwent uniportal VATS anatomic basal segmentectomy between June 2020 and December 2020 were retrospectively reviewed. There were 4 males and 11 females with a median age of 53 (32-70) years. The incisions were placed in the fifth intercostal space across the mid-axillary line. All basal segmentectomies were performed through the interlobar fissure or inferior pulmonary ligament approach following the strategies of single-direction and stem-branch. Results    All patients underwent basal segmentectomy successfully with no conversion to multi-portal procedure or thoracotomy. The median operation time was 120 (90-160) min, median intraoperative blood loss was 20 (10-50) mL, median drainage time was 3 (2-5) d, and median postoperative hospital stay was 4 (4-10) d. The maximum diameter of the lesion in the resected basal segment was 1.2 (0.7-1.9) cm. The median resected lymph nodes were 7 (5-12). There was no evidence of nodal metastases. One patient suffered postoperative atelectasis and subsequent pneumonia. No perioperative death occurred. Conclusion    Uniportal VATS anatomic basal segmentectomy is feasible and safe. It can be performed in a simple manner following the strategy of single-direction.

Objective    To analyze the operation outcomes and learning curve of uniportal video-assisted thoracoscopic surgery (VATS). Methods    All consecutive patients who underwent uniportal VATS between November 2018 and December 2020 in Shangjin Branch of West China Hospital of Sichuan University were retrospectively enrolled, including 62 males and 86 females with a mean age of 50.1±13.4 years. Operations included lobectomy, segmentectomy, wedge resection, mediastinal mass resection and hemopneumothorax. Accordingly, patients' clinical features in different phases were collected and compared to determine the outcome difference and learning curve for uniportal VATS. Results    Median postoperative hospital stay was 5 days, and the overall complication rate was 8.1% (12/148). There was no 30-day death after surgery or readmissions. Median postoperative pain score was 3. Over time, the operation time, incision length and blood loss were optimized in the uniportal VATS lobectomy, the incision length and blood loss increased in the uniportal VATS segmentectomy, and the postoperative hospital stay decreased in the uniportal VATS wedge resection. Conclusion    Uniportal VATS is safe and feasible for both standard and complex pulmonary resections. While, no remarkable learning curve for uniportal VATS lobectomy is observed for experienced surgeon.

Objective    To explore the safety and feasibility of the modified and improved thoracoscopic surgery for esophageal cancer using the concept of "single-direction" thoracoscopic technique. Methods    The clinical data of 65 patients undergoing this modified minimally invasive esophagectomy based on "single-direction" thoracoscopic system between June 2018 and April 2019 were retrospectively analyzed, including 54 males and 11 females aged 62.5±7.8 years. Results    The thoracoscopic operation time was 133.4±28.6 min, and intraoperative blood loss was 61.9±29.2 mL. No intraoperative blood transfusion was needed. One patient was transferred to open thoracotomy (due to severe pleural adhesion atresia). Major complications included anastomotic leak, pneumonia, chylothorax, incisional infection, recurrent laryngeal nerve paralysis and gastric emptying disorders, which were recovered by conservative treatment. No postoperative death occurred. The median number of lymph nodes and lymph node station harvested was 19 and 10, respectively. The median postoperative hospital stay was 10 days. The volume of chest drainage was 1 117.3±543.4 mL. Conclusion    The minimally invasive operation mode of esophageal cancer based on "single-direction" thoracoscopic system is safe and feasible, and has good field vision and smooth and simplified procedure.

Objective    To analyze the results and diagnostic value of postoperative chylous test of pleural effusion and to verify the clinicopathological factors affecting the results of chylous test. Methods    The clinical data of 265 consecutive patients undergoing selective surgery at the Department of Thoracic Surgery, Shangjin Nanfu Hospital between May and August 2020 were retrospectively analyzed, including 106 males and 159 females with an average age of 53.0±12.2 years. According to the results of the chylous test on the operation day and postoperative first and second days, the patients were divided into two subgroups, including a positive group and a negative group, and the clinical data of the two groups were compared. Sensitivity and specificity of the chylous test were calculated. The influencing factors for chylous test were analyzed by multiple logistic regression analysis. Results    The positive rate of chylous test was 91.7%, 95.8% and 87.9% on the operation day and postoperative first and second days, respectively. There was no statistical difference in age, sex, surgical type, surgical approach, surgical site, surgical time, degree of lymph node dissection, treatment of thoracic duct, 24 hours pleural fluid drainage or 24 hours protein and fat food intake between the positive group and the negative group (P>0.05). The diagnostic sensitivity and specificity of the chylous experiment were 100.0%and 4.0%, respectively. Multiple logistic regression analysis showed that the surgical site (left/right chest) might be an influencing factor for the results of the chylous test (P=0.043, OR=0.458, 95%CI 0.216-0.974). Conclusion    The positive rate of chylous test of pleural effusion after thoracic surgery is very high. The chylous test produces a high misdiagnosis rate of chylothorax. The surgical site (left/right chest) may be an influencing factor for chylous test. The positive result of chylous test is not recommended as the direct diagnostic basis for postoperative chylothorax and guidance of the subsequent treatment.

Gradual distraction with an external fixator is a widely used treatment for severe postburn ankle contracture (SPAC). However, application of external fixators is complex, and conventional two-dimensional (2D) imaging-based surgical planning is not particularly helpful due to a lack of spatial geometry. The purpose of this study was to evaluate the surgical planning process for this procedure with patient-specific three-dimension-printed models (3DPMs). In this study, patients coming from two centers were divided into two cohorts (3DPM group vs. control group) depending on whether a 3DPM was used for preoperative surgical planning. Operation duration, improvement in metatarsal-tibial angle (MTA), range of motion (ROM), the American Orthopedic Foot and Ankle Society (AOFAS) scores, complications, and patient-reported satisfaction were compared between two groups. The 3DPM group had significantly shorter operation duration than the control group ((2.0±0.3) h vs. (3.2±0.3) h,

Objective:To compare the results of thinned latissimus dorsi muscle flap combined with skin grafting and dorsal free flaps in repairing traumatic dorsal foot defects.Methods:From January 2005 to December 2019, 41 patients with large soft tissue defects in the dorsum of the foot were admitted to our department. Inclusion criteria: unilateral dorsal foot and ankle soft tissue defects, accompanied by tendon and/or bone exposure, cannot be repaired by simple methods such as skin grafting and local flaps, and the affected area has blood vessels that can be used for anastomosis. Exclusion criteria: primary or secondary vascular diseases, systemic conditions intolerant to prolonged surgery. According to the patient’s choices, the latissimus dorsi flap or the scapular flap were used for repair, namely the traditional flap group. Or latissimus dorsi muscle flap was used to fill and cover the defect, and then the surface of the muscle flap was sealed with split-thickness or full-thickness skin grafting, which is the combined transplantation group. Postoperative follow-up was mainly focused on the recovery of foot function, whether the shoes were worn normally, the appearance of the flap, and the rate of second operation.Results:A total of 41 patients were included in this study. All the flaps survived without infection and tissue necrosis. Twenty three cases, 16 males and 7 females, age from 6 to 52 years with an average of 27.6 years, were repaired with latissimus dorsi flap or scapula flap. The area of soft tissue defects was from 5.5 cm×8.0 cm to 19.5 cm×23.0 cm, with an average areaof 10.1 cm×16.2 cm. The follow-up time was from 6 to 24 months with an average of 9.7 months. All walking function of the foot was basically restored, and the texture of the flap was good. Eighteen patients had bloated flap appearance, 15 of which affected shoe-wearing, and 14 had debulking surgery, 2 had developed hypertrophic scar. Eighteen cases, 14 males and 4 females, age from 19 to 49 years with an average of 30.7 years, were repaired with latissimus dorsimuscle flap combined with split-thickness or full-thickness skin grafts. The area of soft tissue defects was from 4.0 cm×6.5 cm to 20.5 cm×23.0 cm, and the average area was 11.7 cm × 17.3 cm. All donor-site incisions are sutured in one stage without skin grafting. The follow-up time was from 4 to 20 months with an average of 8.3 months. The walking function of all operative feet, with good shape and without bloating, was basically restored. The contour and curve was similar to the healthy side and no skin injury and ulcer was observed. All patients were satisfied with wearing shoes and walking function, and no secondary surgery was required. However, 9 patients had developed hypertrophic scar.Conclusions:Compared with the traditional flap, the free latissimus dorsi muscle flap combined with skin grafting can effectively cover large area of soft tissue defect on the dorsal foot, without bloated flap appearance and secondary surgery. However, the risk of scar hyperplasia after combined transplantation increased.

Objective:To compare the results of thinned latissimus dorsi muscle flap combined with skin grafting and dorsal free flaps in repairing traumatic dorsal foot defects.Methods:From January 2005 to December 2019, 41 patients with large soft tissue defects in the dorsum of the foot were admitted to our department. Inclusion criteria: unilateral dorsal foot and ankle soft tissue defects, accompanied by tendon and/or bone exposure, cannot be repaired by simple methods such as skin grafting and local flaps, and the affected area has blood vessels that can be used for anastomosis. Exclusion criteria: primary or secondary vascular diseases, systemic conditions intolerant to prolonged surgery. According to the patient’s choices, the latissimus dorsi flap or the scapular flap were used for repair, namely the traditional flap group. Or latissimus dorsi muscle flap was used to fill and cover the defect, and then the surface of the muscle flap was sealed with split-thickness or full-thickness skin grafting, which is the combined transplantation group. Postoperative follow-up was mainly focused on the recovery of foot function, whether the shoes were worn normally, the appearance of the flap, and the rate of second operation.Results:A total of 41 patients were included in this study. All the flaps survived without infection and tissue necrosis. Twenty three cases, 16 males and 7 females, age from 6 to 52 years with an average of 27.6 years, were repaired with latissimus dorsi flap or scapula flap. The area of soft tissue defects was from 5.5 cm×8.0 cm to 19.5 cm×23.0 cm, with an average areaof 10.1 cm×16.2 cm. The follow-up time was from 6 to 24 months with an average of 9.7 months. All walking function of the foot was basically restored, and the texture of the flap was good. Eighteen patients had bloated flap appearance, 15 of which affected shoe-wearing, and 14 had debulking surgery, 2 had developed hypertrophic scar. Eighteen cases, 14 males and 4 females, age from 19 to 49 years with an average of 30.7 years, were repaired with latissimus dorsimuscle flap combined with split-thickness or full-thickness skin grafts. The area of soft tissue defects was from 4.0 cm×6.5 cm to 20.5 cm×23.0 cm, and the average area was 11.7 cm × 17.3 cm. All donor-site incisions are sutured in one stage without skin grafting. The follow-up time was from 4 to 20 months with an average of 8.3 months. The walking function of all operative feet, with good shape and without bloating, was basically restored. The contour and curve was similar to the healthy side and no skin injury and ulcer was observed. All patients were satisfied with wearing shoes and walking function, and no secondary surgery was required. However, 9 patients had developed hypertrophic scar.Conclusions:Compared with the traditional flap, the free latissimus dorsi muscle flap combined with skin grafting can effectively cover large area of soft tissue defect on the dorsal foot, without bloated flap appearance and secondary surgery. However, the risk of scar hyperplasia after combined transplantation increased.

Objective    To explore the current situation of the readiness for hospital discharge and the quality of discharge teaching in lung cancer patients based on enhanced recovery after surgery, and to analyze their correlation. Methods    We conducted a cross-sectional study and 141 postoperative patients with lung cancer in our hospital from July to August 2018 were investigated by general information questionnaire, readiness for hospital discharge scale and quality of discharge teaching scale. There were 65 males and 76 females at age of 18-85 (55.35±12.15) years. Results    Totally 88.65% of postoperative patients with lung cancer reported that they were ready for discharge, and the total score of readiness for hospital discharge was 78.36±16.48, and the total score of quality of discharge teaching was 90.94±18.62. There was a positive correlation between the readiness for hospital discharge and the quality of discharge teaching in postoperative patients with lung cancer (r=0.57, P<0.01). Conclusion    The readiness for hospital discharge of postoperative patients with lung cancer keeps in medium level, while the quality of discharge teaching is good, and the readiness for hospital discharge is positively correlated with the quality of discharge teaching. Medical staff should pay more attention to the cognitive level of lung cancer patients' disease-related information and their physical function recovery, and enrich the discharge guidance content, in order to improve the readiness of postoperative patients with lung cancer.

Objective    To investigate the preoperative psychological state of patients with pulmonary nodules in order to make the content of the education more "individualized and humanized". Methods    We conducted a consecutive questionnaire study for 107 patients who were planning to undergo pulmonary resection surgery from May 2018 to July 2018 in our department. There were 54 males and 53 females with an average age of 56.8±11.2 years. The questionnaire content included two parts: personal basic information and 20 questions about surgery, complications, follow-up and hospitalization expense. Results    There were 60.7% of the patients diagnosed with pulmonary nodules by CT scan during physical examination, and 52.3% of the patients had strong will to undergo pulmonary surgery to resect nodules; 64.5% of patients wanted doctors to tell them the extent of the disease and whether the tumor could be cured by surgery, and 30.0%of patients concerned whether chief surgeon would complete the whole surgery. The surgery risk and postoperative complications were ignored by patients easily (5.6% and 14.9% respectively). The hospital expenses were not the primary concern of patients. Only 1.9% of patients believed that doctors used nonessentials which deliberately led to increased costs. Network follow-up was accepted by most patients (94.4%). Conclusion    It will contribute to improve preoperative education rationality and effectiveness by understanding true psychological state of patients.