Congenital Pulmonary Airway Malformation in Children: Advantages of an Additional Trocar in the Lower Thorax for Pulmonary Lobectomy

Aim: To present the use of an additional trocar (AT) in the lower thorax during thoracoscopic pulmonary lobectomy (TPL) in children with congenital pulmonary airway malformation.Methods: For a lower lobe TPL (LL), an AT is inserted in the 10th intercostal space (IS) in the posterior axillary line after trocars for a 5-mm 30° scope, and the surgeon's left and right hands are inserted conventionally in the 6th, 4th, and 8th IS in the anterior axillary line, respectively. For an upper lobe TPL (UL), the AT is inserted in the 9th IS, and trocars are inserted in the 5th, 3rd, and 7th IS, respectively. By switching between trocars (6th↔8th for the scope, 4th↔6th for the left hand, and 8th↔10th for the right hand during LL and 5th↔7th, 3rd↔5th, and 7th↔9th during UL, respectively), vital anatomic landmarks (pulmonary veins, bronchi, and feeding arteries) can be viewed posteriorly. The value of AT was assessed from blood loss, operative time, duration of chest tube insertion, requirement for post-operative analgesia, and incidence of perioperative complications.Results: On comparing AT+ (n = 28) and AT– (n = 27), mean intraoperative blood loss (5.6 vs. 13.0 ml), operative time (3.9 vs. 5.1 h), and duration of chest tube insertion (2.2 vs. 3.4 days) were significantly decreased with AT (p < 0.05, respectively). Differences in post-operative analgesia were not significant. There were three complications requiring conversion to open/mini-thoracotomy: AT– (n = 2; bleeding), AT+: (n = 1; erroneous stapling).Conclusions: An AT and switching facilitated posterior dissection during TPL in children with congenital pulmonary airway malformation enhancing safety and efficiency.

Complete Thoracoscopic Segmentectomy and Pulmonary Lobectomy in the Treatment of Small Pulmonary Nodules

Objective: To compare the clinical effect of complete thoracoscopic segmentectomy and pulmonary lobectomy for pulmonary nodules. Methods: In this study, 176 patients with pulmonary nodules were treated in Changshu Hospital Affiliated to Nanjing University of Chinese Medicine from January 2019 to June 2021; according to the type of surgery, the patients were divided into group A (complete thoracoscopic segmentectomy) and group B (complete thoracoscopic pulmonary lobectomy), and the clinical effects were analyzed. Results: The intraoperative blood loss, postoperative drainage volume, postoperative hospitalization days, and lung function of patients in group A were significantly better than those in group B (P < 0.05), while there was no significant difference in the number of dissected lymph nodes. Conclusion: The clinical effect of complete thoracoscopic segmentectomy for patients with small pulmonary nodules is more significant; it does not only ensure lymph node dissection, but also improve surgical-related indicators and treatment safety as well as speed up the recovery of pulmonary function. Its clinical application value is worthy of key analysis by medical institutions.

Lung Adenocarcinoma Isolated Metastasizing to Pancreas a Case Report and Review

BACKGROUND: Lung cancers are prone to metastasis. It is commonly associated with metastases in the brain, bone, and liver.However, isolated pancreatic metastasis are extremely rare in lung adenocarcinoma patients。CASE SUMMARY: A Chinese man underwent pulmonary lobectomy for adenocarcinrcinoma 6 years ago. He was referred to our department because that postoperative reexamination(Abdomen CT) revealed space occupying lesions in the pancreatic neck,and no abnormality was found in any other organ. Therefore, it was considered to pancreatic carcinoma. Pancreatectomy of the pancreatic body and tail, as well as splenectomy, were performed,and he was given four courses of Pemetrexed and Carboplatin chemotherapy after one month of operation. Then the gefitinib was given.A year after surgery, the patient survived without tumor.CONCLUSION: Secondary pancreatic tumors are rare in clinical practice.It is the longer tumor-free survival in patients with isolated pancreatic metastasis of lung adenocarcinoma.However,the value of surgical treatment for isolated metastasis of lung adenocarcinoma needs further discussion.

Classification and Diagnosis of Pulmonary Nodules in Thoracic Surgery Using CT Image Segmentation Algorithm

This study was aimed at studying the pulmonary nodule (PN) classification and diagnosis through computed tomography (CT) images based on segmentation algorithms. 120 PN patients were taken as research subjects. Linear filter fine segmentation algorithm under 3D region growth was compared with the initial segmentation algorithm and applied to images of PN patients. The results showed that the segmentation effect of the proposed algorithm was at the upper-middle level. The cases of patients with smoking history were greatly more than those without (χ2 = 1.256, P < 0.05 ). Benign and malignant PNs were classified, and morphological features included rough ones and round-like ones. The size characteristics included edge length and area. The gray-scale features included the uniformity of the gray-scale value and the mean value of the gray-scale value. The operation time of pulmonary lobectomy (76.2 ± 23.1 min) was obviously longer than that of pulmonary wedge resection (27.5.2 ± 4.5 min) ( P < 0.05 ). The surgical blood loss of patients who underwent pulmonary lobectomy (125 ± 42 mL) was remarkably higher versus patients who underwent pulmonary wedge resection (51.6 ± 13.8 mL) ( P < 0.05 ). After the operation, the length of stay of patients who underwent lobectomy (8.6 ± 1.4 days) was evidently longer than that of patients who underwent wedge resection (6.4 ± 1.2 days) ( P < 0.05 ). The classification of benign and malignant PNs can effectively obtain the shape and size characteristics of PNs. Preoperative positioning surgery based on classification can shorten the operation time, reduce the amount of bleeding during the operation, and help improve the success rate of surgical resection.