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Cheng Q.,China Meitan General Hospital | Zhang J.,Minimal Invasive Tumor Therapy Center | Wang H.,Minimal Invasive Tumor Therapy Center | Zhang R.,Beijing United Family Hospital | And 2 more authors.
PLoS ONE | Year: 2015

Background: The aim of this study is to investigate the effect of acute hypercapnia on surgery outcomes among patients receiving bronchoscopic interventions under general anesthesia. Furthermore, independent predictive factors for surgery complications were analyzed. Method: A total of 323 patients with airway stenosis were enrolled in this retrospective study. Each patient underwent interventional rigid bronchoscopy under general anesthesia. Arterial blood gas (ABG) was measured intraoperatively. In light of PaCO2 levels in ABG, patients were divided into three groups: Group C (control) (PaCO2:< 60 mmHg), Group M (moderate) (PaCO2:61-100 mmHg), and Group S (severe) (PaCO2: >100 mmHg). Parameters, including PaO2 levels and recovery delays, were compared across three groups. Complications among patients receiving bronchoscopic interventions were evaluated as well. Independent predictive factors for surgery related complications were analyzed by multivariable regression method. Results: Significant differences in weight (p=0.04), ASA IV (p=0.008), dyspnea index (p=0.003), COPD (p=0.02), dynamic airway collapse (p=0.002), severe stenosis severity (p=0.02), and stenosis locations among three groups were observed. Mild (PaCO2:∼60 mmHg) to moderate (PaCO2:60-100 mmHg) hypercapnia was not associated with delayed recovery, whereas severe hypercapnia (PaCO2:>100 mmHg) was associated with delayed recovery, as well as declined PaO2 (p=0.00) and elevated blood glucose levels (p=0.00). The complications of bronchoscopic interventions included postoperative congestive heart failure (14 cases, 4.3%), tracheorrhagia (8 cases, 2.5%), delayed recovery (19 cases, 5.9%), and transfers to ICU after surgery (10 cases, 3.1%). The multivariable regression analysis showed that procedure duration (p=0.003), lobectomy (p=0.007), dynamic airway collapse (p=0.01), severe bronchial stenosis (p=0.01) and hypercapnia (p=0.02) were independent predictive factors for surgery related complications. Conclusions: Acute hypercapnia lower than 100 mmHg was not associated with detrimental consequences, whereas severe hypercapnia (PaCO2: >100 mmHg) was associated with lower levels of PaO2. Hypercapnia was an independent predictive factor for bronchoscopic intervention complication, which may help physicians to optimize the therapeutic choices. © 2015 Cheng et al. Source


Wang H.,Minimal Invasive Tumor Therapy Center | Zhou Y.,Minimal Invasive Tumor Therapy Center | Yamaguchi E.,Aichi Medical University | Li D.,Minimal Invasive Tumor Therapy Center | And 3 more authors.
Journal of Bronchology and Interventional Pulmonology | Year: 2011

Background: Metallic airway stents must be removed when stent-related complications cause airway injury or obstruction. This study compared the techniques and complications associated with endoscopic removal of covered metallic stents (CMSs) and uncovered metallic stents (UCMS). Methods: A retrospective analysis of data from 48 patients with airway disorders treated with 40 CMSs and 18 UCMSs, in whom endoscopic stent removal was indicated between January 2005 and January 2010 was carried out. Procedures were performed under general anesthesia with a rigid bronchoscope or local anesthesia with a flexible bronchoscope. The airway wall of 54 stents was pretreated with argon plasma coagulation and/or cryoablation before stent removal. Balloon dilation, argon plasma coagulation, CO2 cryoablation, or chemotherapy was performed to prevent restenoses after the stent removal in selected patients. Results: Of the stents, 84.5% (49 of 58) were eventually removed, including 36 CMSs and 13 UCMSs; 4 CMSs and 5 UCMSs could not be removed. Strut fracture was more common in UCMSs (77.8%) than in CMSs (5%; P<0.001). Of patients with CMS, 91.7% underwent successful removal of intact stents, whereas 92.3% of patients with UCMS were removed damaged or piecemeal. In CMS or UCMS, major complications of stent removal included mucosal tear with bleeding and unveiling of significant granulation tissue from behind the stent. No deaths occurred during the procedure. Conclusions: CMSs can be effectively and safely removed by a flexible bronchoscope with a retrieval hook without major sequelae, whereas UCMSs are very difficult to remove, and complications are very common. Metallic stents should be used only as a last resort in patients with airway disorders. Copyright © 2011 by Lippincott Williams & Wilkins. Source


Luo L.,Minimal Invasive Tumor Therapy Center | Wang H.,Minimal Invasive Tumor Therapy Center | Ma H.,Minimal Invasive Tumor Therapy Center | Zou H.,Minimal Invasive Tumor Therapy Center | And 2 more authors.
Chinese Journal of Lung Cancer | Year: 2010

Background and objective: TACE, Ar-He target cryosurgery and radioactive seeds implantation are the mainly micro-invasive methods in the treatment of lung cancer. This article summarizes the survival quality after treatment, the clinical efficiency and survival period, and analyzes the advantages and shortcomings of each methods so as to evaluate the clinical effect of non-small cell lung cancer with multiple minimally invasive treatment. Methods: All the 139 cases were nonsmall cell lung cancer patients confirmed by pathology and with follow up from July 2006 to July 2009 retrospectively, and all of them lost operative chance by comprehensive evaluation. Different combination of multiple minimally invasive treatments were selected according to the blood supply, size and location of the lesion. Among the 139 cases, 102 cases of primary and 37 cases of metastasis to mediastinum, lung and chest wall, 71 cases of abundant blood supply used the combination of superselective target artery chemotherapy, Ar-He target cryoablation and radiochemotherapy with seeds implantation; 48 cases of poor blood supply use single Ar-He target cryoablation; 20 cases of poor blood supply use the combination of Ar-He target cryoablation and radiochemotheraoy with seeds implantation. And then the pre- and post-treatment KPS score, imaging data and the result of follow up were analyzed. Results: The KPS score increased 20.01 meanly after the treatment. Follow up 3 years, 44 cases of CR, 87 cases of PR, 3 cases of NC and 5 cases of PD, and the efficiency was 94.2%. Ninety-nine cases of 1 year survival (71.2%), 43 cases of 2 years survival (30.2%), 4 cases with over 3 years survival and the median survival was 19 months. Average survival was (16±1.5)months. There was no severe complications, such as spinal cord injury, vessel and pericardial aspiration. Conclusion: Minimally invasive technique is a highly successful, micro-invasive and effective method with mild complications. To non-small cell lung cancer, we can improve the middle and long term clinical effect by using the different combination of multiple minimally invasive treatments according to the patient's condition. Source


Luo L.,Minimal Invasive Tumor Therapy Center | Wang H.,Minimal Invasive Tumor Therapy Center | Ma H.,Minimal Invasive Tumor Therapy Center | Zou H.,Minimal Invasive Tumor Therapy Center | And 2 more authors.
Chinese Journal of Lung Cancer | Year: 2010

Background and objective: Transcatheter arterial chemotherapy and embolization is the main method in the treatment of lung cancer, but most of the reports do not study individually to small cell lung cancer (SCLC), non-small cell lung cancer (NSCLC), hypovascular and hypervascular lung cancer. The pre-embolization perfusion of hemotherapeutics is still being used routinely and seldom report to iodized oil embolization. The article summarized the quality of life after the treatment, clinical efficiency, survival time and complications to evaluate the clinical effect of primary hypervascular NSCLC treated with embolization of emulsion of chemotherapeutics and iodized oil. Methods: The study totally analyzed 41 cases which confirmed by pathology and follow up study from January, 2008 to January 2009. The CT scan with IV contrast demonstrates over moderate enhanced lesion which indicate hypervascular. Within the 41 cases, 23 cases of central, 18 cases of peripheral. Suqamous carcinoma 21 cases, adenocarcinoma 15 cases and squamoadenocarcinoma 5 cases. Stage IIIb 34 cases, stage IV 7 cases. Superselective incubation with microcatheter under DSA, to embolize the capillary bed with liquefied iodized oil and the emulsion of pharmorubicin, to embolize the supply artery of the tumor with gelatin foam microparticle. The liquefied iodized oil 5 mL-10 mL, pharmorubicin 10 mg-30 mg. The longest follow up is 12 months and to compare with the references of 2007-2009. Results: The KPS is widely acclaimed after the treatment (P<0.05), no complete response (CR), 31 cases of partial response (PR), 7 cases of no change (NC) and 3 cases of progressive disease (PD), the total efficiency (CR+PR) is 75.6%. The clinical efficiency (CR+PR+NC) is 92.68%. 33 cases of total survival tome over 12 months (80.48%), IIIb stage 29/34 (85.29%), IV stage 4/7 (57.14%). 1 case with severe complication-spinal injury. Conclusion: To treat primary hypervascular NSCLC with simple embolization of emulsion of chemotherapeutics and iodized oil is very useful and can avoid the side effect of chemotherapeutics. The key point to avoid spinal injury and other severe complications is to distinguish the spinal aretery and intratumor AV fistula by using superselective incubation with microcatheter under DSA. Source


Luo L.,Minimal Invasive Tumor Therapy Center | Wang H.,Minimal Invasive Tumor Therapy Center | Ma H.,Minimal Invasive Tumor Therapy Center | Cai C.,Minimal Invasive Tumor Therapy Center | And 2 more authors.
Chinese Journal of Lung Cancer | Year: 2011

Background and objective The locations of mediastinal malignant tumor lesions are deep and occult, and are close to the pericardium, trachea, or major vessels. Therefore, the possibility of surgical resection is slim, and cryoablation and thermal ablation are restricted. In current study, image and life quality data were compared before and after 125I seeding therapy to investigate its safety and clinical effects. Methods From July 2010 to July 2011, a 43-patient follow-up of pathologically confirmed cancers, including 21 cases of primary mediastinal squamous lung cancer, 9 cases of primary esophagus cancer, and 13 cases of lymph node metastases were completed. Among these, 18 cases presented with tracheal stenosis >50%, 9 cases had esophageal obstruction, and 9 cases had superior vena cava reflux disorder. Each lesion was implanted with 10 to 60 pieces of 125I particles, with an average of 30.79±14.23. CT data at 2, 4, 6, and 12 months after therapy were obtained to evaluate the local lesion outcome. The quality of life of the patients as well as survival data was also recorded. Results The overall success rate of the operation was 100%. The longest time of follow-up was 12 months. At 6 months, 37 patients were alive, and the half-year survival rate was 85.0%. In terms of local lesions, 30 cases of PR and 7 cases of NC were found. The clinical effective rate was 81.08%, and the clinical beneficial rate was 100%. At 12 months after therapy, 31 patients were alive, and the one-year survival rate was 60.5%. In terms of local lesions, 16 cases of CR, 7 cases of PR, 2 cases of NC, and 6 cases of PD were found. The clinical effective rate was 74.19%, and the clinical beneficial rate was 80.65%. The KPS score increased after the treatment (P=0.000). Three cases of pneumothorax presented after treatment, and no severe complications, such as vessel, trachea, recurrent laryngeal nerve, or pericardiocentesis injuries, were found. Conclusion Radiation seed implantation in mediastinal malignant tumors is a relatively safe technique with high success rate, considerable efficacy, and clear clinical value in advanced cancer treatment. Source

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