183例结核性肺病的微创手术治疗

目的探讨胸腔镜手术(video-assisted thoracotomy surgery,VATS)及胸腔镜辅助小切口手术(video-assisted minithoracotomy surgery,VAMTS)治疗结核性肺病的可行性和临床疗效。方法回顾性分析2010年1月至2014年12月我院胸外科利用VATS及VAMTS治疗的183例结核性肺病患者的临床资料。结果楔形切除术对肺结核病灶准确切除率达100%,痰菌阴转率为84.15%,结核复发或播散为4.37%,24(13.1%)例患者出现术后并发症,主要种类包括顽固性残腔、呼吸道感染、胸腔出血、伤口感染、持续性肺漏气、支气管胸膜瘘、胸腔感染、呼吸衰竭、气胸复发,术后随访(26.3±7.32)个月,死亡3例患者,死亡率1.6%,其余患者均治愈,未见中远期并发症,临床治愈率为98.4%。结论 VATS及VAMTS治疗结核性肺病安全可行,疗效满意。     

Early outcomes of lung resections in non-small cell lung cancer after COVID-19 pneumonia

ObjectiveThere is limited literature on patients with a history of COVID-19 pneumonia who underwent anatomical lung resection for non-small cell lung cancer (NSCLC). This study was aimed to share the early postoperative outcomes in patients who underwent lung resection after COVID-19 pneumonia.Materials and methodsWe retrospectively evaluated 30 patients who underwent lobectomy with thoracotomy and systematic mediastinal lymph node dissection due to NSCLC in a single center between November 2018 and September 2021. The patients were divided into two groups regarding COVID-19 pneumonia history; the COVID-19 group consisted of 14 patients (46.7%) and the non-COVID-19 group 16 (53.3%) patients. The patients’ age, gender, comorbidity, Charlson Comorbidity Index (CCI) score, forced expiratory volume in 1 s (FEV1) value, tumor type and size, resection type, postoperative air leak duration, total drainage volume, drain removal time, postoperative complications, and length of stay (LOS) were recorded.Results9 (30%) patients were female, and 21 (70%) were male. The mean age was 62.1 ± 8.91 years. Our comparison of postoperative air leak duration, total drainage volume, time to drain removal, postoperative complications, and LOS between the COVID-19 and non-COVID-19 groups revealed no statistically significant difference.ConclusionAnatomical lung resection can be performed safely in NSCLC patients with a history of COVID-19 pneumonia without significant difference in early postoperative morbidity and mortality.     

Early Distant Recurrence in Patients With Resected Stage I Lung Cancer: A Case Series of “Blast Metastasis”

BackgroundThe standard of care in the management of stage I non–small-cell lung cancer (NSCLC) has been anatomic lung resection with multistation lymph node sampling of ≥ 10 lymph nodes. The 5-year survival for NSCLC has ranged from 73% to 93% (for stage IB and stage IA, respectively) and will be more favorable for patients with fewer comorbidities and those with a higher state of premorbid functioning and who undergo surgical resection. Despite the positive prognosis for operable stage I NSCLC, a subset of patients will develop metastatic disease within as few as 12 months after resection. Using an institutional database, we have presented the data from 68 patients who had developed distant metastatic recurrence after resection of pathologic stage I NSCLC within 1 year after surgery.Patients and MethodsA retrospective study was conducted of a prospectively maintained intuitional database. The final cohort included patients with pathologic stage I NSCLC who had undergone anatomic resection but had subsequently presented with multiple sites of distant recurrence within 1 year. The study period extended from 2003 to 2020. Patients with broad local recurrence or recurrence at a single distant site were excluded. Kaplan-Meier analysis was used to estimate the 5-year survival.ResultsA total of 2827 patients had undergone surgical resection for stage I NSCLC during the 17-year period and 68 met the criteria for inclusion. Most of the patients (n = 48) were smokers, and the dominant histologic type was adenocarcinoma (n = 37). After recurrence, 22 patients (33%) had undergone chemoradiotherapy and 19 (28%) had received chemotherapy alone. The mean and median overall survival were 23.7 and 14 months, respectively. The 5-year survival from recurrence and surgery were both 13.2%.ConclusionsLimited data are available on the risk factors for early metastasis after resected stage I NSCLC. The results from our cohort have demonstrated poor survival after recurrence. These data might be the basis for determining a phenotype for patients prone to early widespread metastasis despite seemingly curative surgical resection.     

定时与自主湿化气道对肺叶切除术后患者排痰效果的疗效分析

目的探讨定时与自主湿化气道对肺叶切除术后患者排痰效果的影响。方法选择肺叶切除术后患者97例，随机分成实验组49例、对照组48例。实验组患者在术后采用定时予自主湿化气道方法促进痰液排出；对照组患者采用常规方法湿化气道促进痰液排出。观察两组患者术后痰液黏稠程度显著低于对照组，咳痰能力和术后并发症的发生率。结果实验组与对照组比较，实验组术后12h、18h、24h、30h痰液黏稠度、咳痰能力优于对照组，差异有显著意义（P〈0．005）；术后并发症的发生率实验组低于对照组，差异有显著意义（P〈0．05）。结论肺叶切除术后采用定时与自主湿化气道法促进患者排痰效果显著优于常规湿化气道法，可广泛应用于临床。     

Risk Factors for Major Adverse Events of Video-Assisted Thoracic Surgery Lobectomy for Lung Cancer

Aims: The purpose of this study was to identify the risk factors for major adverse events of VATS (Video-Assisted Thoracic Surgery) lobectomy for primary lung cancer.Methods: 1806 Patients (1032 males, 57.1%) planned to undergo VATS lobectomy for stage IA-IIIA lung cancer from July 2007 to June 2012. The Thoracic Morbidity and Mortality Classification TM&M system was used to evaluate the presence and severity of complications. Postoperative complications were observed during a 30-day follow up. Univariate and multivariate analysis were used to analyze the independent risk factors for major adverse events.Results: Successful rate of VATS lobectomy was 97.6% (1763/1806). Major complications occurred in 129 patients (7.3%), with a mortality of 0.3% (5/1763). Pulmonary complications contribute up to 90.7% of the major complications and 80% of mortality. Logistic regression indicated that comorbidities, elder age ≥70y, operative time ≥240min and hybrid VATS were predictors for major adverse events (P<0.05). Hybrid and converted VATS lobectomy result in higher major adverse events compared with complete VATS, 15.1%, 20.9% and 7.4% respectively (P=0.013).Conclusions: The overall complication rate and mortality of VATS lobectomy are low, while major complications sometimes occur. Pulmonary complications are the most common major complications and cause of mortality. Age ≥70y, comorbidities, operative time ≥240min and Hybrid VATS are predictors of major adverse events.     

Lobectomy Is Associated with Better Outcomes than Sublobar Resection in Spread through Air Spaces (STAS)-Positive T1 Lung Adenocarcinoma: A Propensity Score–Matched Analysis

Introduction

Spread through air spaces (STAS) is a form of invasion wherein tumor cells extend beyond the tumor edge within the lung parenchyma. In lung adenocarcinoma (ADC), we investigated the (1) association between STAS and procedure-specific outcomes (sublobar resection and lobectomy), (2) effect of surgical margin-to-tumor diameter ratio in STAS-positive patients, and (3) potential utility of frozen sections (FSs) for detecting STAS intraoperatively.

胸腔镜肺叶切除术对非小细胞肺癌患者炎性因子及免疫功能的影响

目的 分析胸腔镜肺叶切除术对非小细胞肺癌患者炎性因子及免疫功能的影响.方法 选取105例早期非小细胞肺癌患者作为研究对象,根据患者的病情及选择治疗方式的意愿,将其分为实验组(59例)和对照组(46例),实验组患者接受胸腔镜肺叶切除术,对照组患者接受常规开胸手术,记录两组患者切口长度、术中淋巴结清扫数目、术中出血量、术后引流量及手术时间等临床指标,分别于手术前后测定两组患者血清中白介素-6(IL-6)、白介素-8(IL-8)、C-反应蛋白(CRP)、肿瘤坏死因子-ɑ(TNF-ɑ)与降钙素原(PCT)等炎症因子水平及免疫球蛋白G(IgG)、免疫球蛋白A(IgA)与免疫球蛋白M(IgM)的水平,并于手术前后检测两组外周血T淋巴细胞亚群cd3+、cd4+、cd8+、cd4+/cd8+的水平,分析比较两组患者手术前后炎性因子水平变化及免疫功能状态.结果 与对照组比较,实验组患者的手术切口长度及手术时间明显缩短,患者术中出血量及术后引流量明显减少(P<0.05);术后两组IL-6、IL-8、CRP、TNF-ɑ与PCT等炎性因子水平较术前明显升高,且实验组患者术后炎性因子水平明显低于对照组(P<0.05);与术前水平比较,术后两组免疫球蛋白IgG、IgA与IgM水平有所下降,以IgG下降较为明显,且实验组术后IgG水平明显高于对照组(P<0.05);术后两组外周血T淋巴细胞亚群cd3+、cd4+、cd8+、cd4+/cd8+的水平明显低于术前水平,且实验组水平高于对照组(P<0.05).结论 胸腔镜肺叶切除术治疗非小细胞肺癌可明显减轻患者机体炎症反应,同时对患者机体免疫功能影响较小,且具有手术切口小、手术时间短,术中出血量少等特点,值得临床推广应用.