食管鳞癌术后随访中国胸外科专家共识

外科手术是食管鳞癌最重要的治疗手段之一,术后随访是早期发现和治疗复发转移的有效方法,可提高患者的生活质量,改善预后。本共识旨在完善我国的食管鳞癌术后随访方案,为规范随访提供参考,进一步提高我国食管癌规范化诊疗水平。     

《非小细胞肺癌肺段切除术亚洲专家共识：改良Delphi研究》解读

随着肺癌发病率的逐年升高,肺段切除术作为经选择的早期非小细胞肺癌患者手术治疗的一种选择,越来越受到广大胸外科专家的青睐。但目前仍然缺乏关于肺段切除的具体指南。2023年4月,15名亚洲胸外科专家共同发布了《非小细胞肺癌肺段切除术亚洲专家共识：改良Delphi研究》,该共识在肺段切除术患者适应证、方法、淋巴结评估3个方面共提出了36项专家共识。本文旨在对该共识进行简要解读,以供广大同仁在临床实践中参考。     

人工智能一体化三维重建应用于胸外科的中国专家共识

为进一步规范三维重建在胸外科中的应用,《人工智能一体化三维重建应用于胸外科的中国专家共识》专家组讨论制定了本共识。本共识依据目前三维重建技术在胸外科各种场景中使用的临床经验和已有的前瞻性或回顾性研究,总结形成推荐意见,并附录目前存在争议、尚未进行充分的临床研究或仍在探索阶段的三维重建技术应用场景,为未来的临床研究和临床疾病诊治提供方向和证据,以期达成共识。     

血清癌胚抗原水平对于预测非小细胞肺癌术后早期复发的意义

目的　探讨影响非小细胞肺癌术后早期复发的临床病理因素 ,了解血清癌胚抗原(CEA)检测对预测非小细胞肺癌患者术后早期复发的作用。方法　对 2 0 0 0年 9月～ 2 0 0 2年 8月收治的 93例非小细胞肺癌患者行手术治疗 ,术前行血清CEA测定 ,术后随访 1年以上 ,记录第 1次复发的时间。应用Logistic回归分析观察影响非小细胞肺癌术后早期复发的临床病理因素 ,应用受试者工作特征 (ROC)曲线进行数据分析 ,比较各危险因素预测非小细胞肺癌术后早期复发的能力。结果血清CEA水平、临床分期和肿瘤分化与非小细胞肺癌术后早期复发有关。其中CEA >10 μg/L是预测非小细胞肺癌术后早期复发较好的指标 (ROC曲线下面积 :0 84 3,95 %CI :0 72 3～ 0 96 3,P =0 0 0 0 )。结论　对于可以手术切除的非小细胞肺癌患者 ,术前应行血清CEA水平测定 ,术前血清CEA >10 μg/L提示 ,术后复发的可能性较大     

高危非转移性肾癌术后辅助治疗中国专家共识(2020)

肾细胞癌(renal cell carcinoma,RCC)是泌尿系统最为常见的恶性肿瘤之一.据WHO统计,2018年全球RCC新发病例403 262例,造成超过175 000例患者死亡[1];中国RCC新发病例数和死亡病数分别为70 407例和43 486例,5年期生存率仅约60％～65％[2].手术切除肿瘤或患肾是...     

局部晚期非小细胞肺癌治疗的争议与共识

肺癌是发病率和病死率增长最快、对人类健康和生命威胁最大的恶性肿瘤。局部晚期非小细胞肺癌(locally advanced non-aucell lung cancer．LANSCLC)的治疗问题尤为棘手，有关其治疗的方法、模式等仍存在较多争议。本文拟就近年来国内外有关LANSCLC治疗的争议与共识作一介绍，希望对从事肺癌临床研究的同道有所裨益。     

化疗联合中药在非小细胞肺癌患者术后辅助治疗中的应用效果分析

目的 探讨化疗联合中药在非小细胞肺癌患者术后辅助治疗中的应用效果。方法 回顾性分析2016-01—2019-01鹤壁煤业(集团)有限公司总医院胸外肿瘤科行肺癌手术的56例非小细胞肺癌患者的临床资料。根据术后辅助治疗方法分为对照组和中西医组,每组28例。2组患者术后均采取吉西他滨与顺铂联合化疗,其中中西医组在化疗的基础上联合应用自拟养阴扶正固本汤治疗。比较2组患者干预后的中医证候积分、免疫功能、卡氏评分(KPS)、生活质量评分,以及毒副反应发生率和术后3 a无瘤生存率。结果 2组患者化疗前的中医证候评分、KPS评分、生活质量评分、免疫功能指标(NK、CD3⁺、CD4⁺、CD8⁺)差异均无统计学意义(P>0.05)。化疗后2组患者的中医证候评分、KPS评分、生活质量评分均较化疗前显著改善,且中西医组的改善效果优于对照组;化疗后2组患者的NK、CD3⁺、CD4⁺均较术前有显著降低或升高,其中中西医组的NK、CD3⁺、CD4⁺指标降低或...     

非小细胞肺癌术后支气管切缘癌与预后

为探讨肺癌术后支气管切缘癌的发生率及预后特点，提高肺癌５年生存率，回顾总结１９８１～１９９０年经手术治疗１０２４例非小细胞肺癌，显微镜下发现支气管残端癌阳性者８９例占８．７％。此８９例病人平均５年生存率２３．７％。中位数生存期２７．６个月。其中ＰＴＮＭＩ、ＩＩ、ＩＩａ和ＩＩｂ期病人平均生存期分别为４４．３、２７．１、１２．４和１２．６个月，鳞癌、腺癌、大细胞癌及鳞腺混合癌病人的平均生存期分别为３１．０、１９．３、１４．８和２８．３个月。结论：影响病人预后的因素主要是病变的ＴＮＭ分期及细胞类型，对有残端癌的病人应强调术后综合治疗     

VATS is an adequate oncological operation for stage I non-small cell lung cancer

Objectives: This study was designed to determine the long-term prognosis of video-assisted thoracic surgery (VATS) vs. open lung resections for patients with pathological stage I non-small cell lung cancer (NSCLC). Materials and methods: The medical records of all patients who underwent lung resection for a pathological stage I NSCLC were reviewed for the period from 1990 to 1999, by screening of a database into which data were entered prospectively. There were 511 patients (430 males and 81 females) whose age averaged 63±10 years who underwent 515 lung resections. Our VATS experience began in 1993 with selected stage I patients, and since that date an average of one patient on four was managed with VATS. Lung resections consisted of 25 wedge resections or segmentectomies (seven VATS), 390 lobectomies (92 VATS), 19 bilobectomies (one VATS) and 81 pneumonectomies (ten VATS). Lymph node dissection was performed in all cases. Results: There were significantly more females (P=0.01) and adenocarcinoma (P=0.02) in the VATS group (n=110) when compared to the open group (n=405). Tumour size averaged 4±2 cm in the open group and 3±2 cm in the VATS group (P=0.04). The distribution of T1/T2 tumours was 97/308 and 50/60, respectively (P=0.0001). At follow-up, cancer recurrence could be documented in 117 patients, with no difference of incidence between the two groups (22.5 vs. 24.5%; P=0.64). Estimated Kaplan–Meier 5-year survival rates, including the operative mortality as well as any cancer-related and unrelated death, were 62.8% (confidence interval (CI): 56.8–68.7%) vs. 62.9% (CI: 51.4–74.4%), respectively (P=0.60). The advent of VATS did not influence the patients' survival: 5-year survival rate was 63.9% (CI: 55.3–72.5%) for the period from 1990 to 1992, and 58.8% (CI: 51.7–65.9%) for the period from 1993 to 1999 (P=0.65). Subgroups survival analysis according to the T status did not show any statistically significant difference between the two groups. Conclusions: VATS lung resection with lymph node dissection achieved a 5-year survival similar to that achieved by the conventional approach. VATS is a valuable option for the management of selected patients with an early-stage NSCLC.     

Video-assisted thoracic surgery lobectomy reduces the morbidity after surgery for stage I non-small cell lung cancer

Objective: We conducted this study to evaluate the surgical invasiveness and the safety of video-assisted thoracic surgery lobectomy for stage I lung cancer. Methods: Video-assisted thoracic surgery lobectomies were performed on 43 patients with clinical stage IA non-small cell lung cancer. We compared the surgical invasiveness parameters with 42 patients who underwent lobectomy by conventional thoracotomy. Results: Intraoperative blood loss was significantly less than that in the conventional thoracotomy group (151±149 vs. 362±321 g, p<0.01). Chest tube duration (3.0±2.1 vs. 3.9±1.9 days) was significantly shorter than those in the conventional thoracotomy group (p<0.05). The visual analog scale which was evaluated as postoperative pain level on postoperative day 7, maximum white blood count and C-reactive protein level were significantly lower than those in the conventional thoracotomy group (p<0.05). The morbidity rate was significantly lower than that in the conventional thoracotomy group (25.6% vs. 47.6%, p<0.05). Sputum retention and arrhythmia were significantly less frequent than in the conventional thoracotomy group (p<0.05). We experienced no operative deaths in both groups. Conclusion: We conclude that video-assisted thoracic surgery lobectomy for stage I non-small cell lung cancer patients is a less invasive and safer procedure with a lower morbidity rate compared with lobectomy by thoracotomy.     

不同手术方式下应用RATS和VATS治疗非小细胞肺癌的研究进展

机器人辅助胸腔外科手术(Robot-assisted thoracic surgery,RATS)近几年来逐渐开始用于早期非小细胞肺癌(Non-small cell lung cancer,NSCLC)患者的手术治疗,但其与已经发展较为成熟的视频辅助胸腔外科手术(Video-assisted thoracic surgery,VATS)相比,优劣对比仍存争议。近期研究发现,在解剖性肺叶切除术中,相较于VATS,虽然RATS的手术时间延长、成本明显增加,但由于RATS具有更好的术中稳定性和安全性,患者依旧可以从中获益,包括术中出血少、中转开胸率低和淋巴结清扫多,患者30d死亡率、住院时间等也明显减少。在袖式肺叶切除术中,RATS在支气管吻合、气道重建和术后并发症等方面也展现了独特的优势。本文就近几年RATS与VATS在不同手术方式下治疗NSCLC中的研究进展进行综述。     

《单孔胸腔镜手术治疗肺癌中国专家共识》解读

单孔胸腔镜手术是肺癌微创治疗的重要方式.2010年,单孔胸腔镜手术首次应用于肺癌治疗;2019年、2020年,欧洲共识和中国共识相继发表.最新发表的中国共识分别从单孔胸腔镜手术的定义、用于肺癌治疗的适应证、安全性及可行性、手术技巧、学习曲线、短期及长期结果等方面为单孔胸腔镜手术标准化提供建议,对提高手术质量及减少相关并...     

Video-assisted thoracic surgery for lung cancer

Objective|The objective of this study was to confirm the safety and feasibility of video-assisted thoracic surgery (VATS) for primary lung cancer and to compare prognoses with that of conventional procedures, and then to examine whether VATS would supplant a conventional thoracotomy for stage I lung cancer. Methods: From September 1995 through March 2002, 144 patients with primary lung cancer, included 118 patients with postoperative state I, underwent VATS lobectomy. We reviewed the previous cases whether they could be candidates for VATS lobectomy according to present indications. 166 cases were supposed to be candidates for VATS, and 121 cases of postoperative stage I disease were recruited into the “conventional thoracotomy” group. Results: There was no mortality or major complication except one case, and mean follow-up was 31.8 months in VATS. The number of removed lymph nodes was not significantly less than the number by conventional thoractomy (p=0.061). Five-year survival for patients with pathological stage IA adenocarcinoma was 92.4% (n=66) in VATS and 86.9% (n=50) in conventional thoracotomy, and a statistical significance could not be recognized (p=0.980). The length of hospital stay was significantly short in VATS lobectomy (p<0.0001). Conclusions: VATS lobectomy for stage I lung cancer can be performed safely with minimal morbidity, satisfying survival comparable with that of lobectomy through conventional thoractomy. VATS approach is a feasible surgical technique for patients with stage I lung cancer.     

机器人结直肠癌手术中国专家共识(2020版)

机器人微创手术是当代外科技术发展的重要趋势.为推动我国机器人结直肠癌手术的发展,我国相关学术组织于2015年编撰了《机器人结直肠癌手术专家共识(2015版)》.5年来,机器人手术的设备与技术均取得了长足进步,故对其进行修订,形成《机器人结直肠癌手术中国专家共识(2020版)》,以期为目前正在或将要开展机器人结直肠癌手术...     

快速康复外科在非小细胞肺癌患者围术期中的应用

目的探讨快速康复外科（fast—track surgery,FTS）在非小细胞肺癌（nonsmall—cell lung cancer,NSCLC）患者围术期中的应用。方法2007年9月至2010年5月对40例NSCLC患者围术期采用FTS模式（PTS组）;同期40例按传统手术外科（conservative treatment surgery,CTS）围术期处理的同种手术患者（CTS组）作对照。比较两组患者术后肺部并发症（肺部感染、肺不张、持续漏气大于7d）的发生率;同时分析两组的心血管事件、外科技术并发症、术后辅助通气时间、手术结束时体温、ICU停留时间（length of stay,LOS）及住院天数等。结果两组患者的年龄、性别、术前肺功能（forced expiratory volume in one second, FEV1 ）以及美国麻醉学会（ American Society of Anethesiologists, ASA）评分等差异无统计学意义。FTS组术后早期肺功能（FEV1）恢复较CTS组快（P〈0．05）,术后肺部并发症的发生率显著减少（34．21％比8．33％,P〈0．05）。两组LOS的中位数相差1d;FTS组住院天数明显低于CTS组,差异有统计学意义[（11．1±3．6）d比（16．6±5．7）d,P〈0．05]。结论FTS模式对NSCLC患者进行围术期处置,可减少术后肺部并发症等的发生率,促进患者早期康复。     

单操作孔完全胸腔镜非小细胞肺癌根治术

目的总结单操作孔完全胸腔镜手术行非小细胞肺癌根治术中的经验。方法行单操作孔全胸腔镜下肺癌根治术60例,右上肺叶切除19例,右肺中叶切除4例,右下肺叶切除20例。左上肺叶切除12例,左肺下叶切除5例。胸腔镜观察孔取腋中线第7肋间,做2 cm左右切口,操作孔根据病灶部位选择第4或5肋间取腋前线至腋中线间,切口长约4~5 cm,经单操作孔完成肺癌根治术。结果全组患者手术顺利,无围手术期死亡患者,无严重术后并发症。清扫淋巴结平均(12.5±2.1)枚。平均手术时间(185.2±10.4)分钟。术中出血平均(150.5±30.6)ml。胸腔引流管拔除时间平均(3.5±1.5)天。术后住院时间平均(5.5±1.2)天。结论和传统腔镜手术比较,单操作孔减少了背部伤口,进一步减小创伤。单操作孔完全胸腔镜手术常规胸腔镜器械可完成,不需增加特殊器械。患者选择恰当并且按正确顺序操作,是单操作孔胸腔镜手术成功的重要保证。     

78例NSCLC血清VEGF表达临床意义分析

目的检测非小细胞肺癌患者化疗前外周血血管内皮生长因子的水平,探讨其与化疗疗效、预后的关系。方法鹪联免疫吸附试验检测78例NSCLC患者化疗前血清VEGF水平,并采用x2检验、Kaplan—Meier生存曲线比较与VEGF表达相关因素及其对生存期的影响。结果在NSCLC中,血清VEGF阳性率为30．8％（24／78）。VEGF的表达与淋出结转移、远处转移、TNM分期、化疗疗效密切相关,但与年龄、性别、病理类型等无关。VEGF阳性组的生存期与阴性绀相比接近统计学意义（P=0．0741）。结论检测NSCLC患者外周血VEGF,可能有利于协助预测转移、评价化疗疗效及判断预后。