郎格罕细胞／树突状细胞在人食管癌抗瘤免疫中的作用

抗原呈递细胞（ＡｎｔｉｇｅｎＰｒｅｓｅｎｔｉｎｇＣｅｌ，ＡＰＣ）是能捕捉、加工处理抗原并将抗原呈递给特异性淋巴细胞的一类免疫细胞。它们包括巨噬细胞及树突状细胞（ＤｅｎｄｒｉｔｉｃＣｅｌｓ，ＤＣ）等，而与食管粘膜上皮关系密切的是ＤＣ。ＤＣ是一簇来源于骨...     

肺减容术治疗重度肺气肿患者临床分析

Objective To study effectiveness and safety of lung volume reduction surgery(LVRS) in treatment for severe chronic emphysema(chronic obstructive pulmonary disease).Methods Clinical data of 24 patients of severe chronic emphysema undergone with LVRS during January 2004 to June 2007 were analyzed retrospectively.LVRS was performed for the patients after respiratory tract preparation based on their pulmonary function,results of blood gas analysis,cardiac function,as well as physical activity capacity.and surgical incision Was selected based on"target"location of emphysema with chest computerized tomography and isotope lung perfusion scanning,22 cases with standard unilateral LVRS via outer post-lateral incision and two with bilateral LVRS via mid-sternal incison.A linear device for cutting and stitching was used in surgical operation to excise the lung tissues of severe emphysema with strips of bovine pericardium to prevent air leakage.Results All the patients were followed-up for 19 months in average and complications occurred in seven of them after operation,including four with leakage of the alveoli.two with cardiac arrhythmia and one with pneumonia,and no death was observed.Pulmonary function and symptoms of dyspnea improved obviously in all the patients after operation,and they all could care for themselves,in general,with scales of dyspnea increased to grade Ⅰ in one case,to grade Ⅱ in 10 cases and to grade Ⅲ in three cases.Conclusions LVRS can improve pulmonary function of selected patients with severe emphysema,to certain extent,and its safety will depend on strict selection of the patients and correct peri-operative care.     

肺减容术治疗重度肺气肿患者临床分析

Objective To study effectiveness and safety of lung volume reduction surgery(LVRS) in treatment for severe chronic emphysema(chronic obstructive pulmonary disease).Methods Clinical data of 24 patients of severe chronic emphysema undergone with LVRS during January 2004 to June 2007 were analyzed retrospectively.LVRS was performed for the patients after respiratory tract preparation based on their pulmonary function,results of blood gas analysis,cardiac function,as well as physical activity capacity.and surgical incision Was selected based on"target"location of emphysema with chest computerized tomography and isotope lung perfusion scanning,22 cases with standard unilateral LVRS via outer post-lateral incision and two with bilateral LVRS via mid-sternal incison.A linear device for cutting and stitching was used in surgical operation to excise the lung tissues of severe emphysema with strips of bovine pericardium to prevent air leakage.Results All the patients were followed-up for 19 months in average and complications occurred in seven of them after operation,including four with leakage of the alveoli.two with cardiac arrhythmia and one with pneumonia,and no death was observed.Pulmonary function and symptoms of dyspnea improved obviously in all the patients after operation,and they all could care for themselves,in general,with scales of dyspnea increased to grade Ⅰ in one case,to grade Ⅱ in 10 cases and to grade Ⅲ in three cases.Conclusions LVRS can improve pulmonary function of selected patients with severe emphysema,to certain extent,and its safety will depend on strict selection of the patients and correct peri-operative care.     

电视辅助胸腔镜在食管外科中的应用进展

20世纪90年代初期电视辅助胸腔镜外科(videoassisted thoracoscopic surgery，VATS)出现后，在世界范围内迅速普及，被认为是自体外循环问世以来胸外科领域的又一重大技术革命。与常规开胸手术相比较，电视胸腔镜手术具有创伤小、术后疼痛轻和病人恢复快的优点，特别适用于年老体弱、心肺功能差者。经过十几年的发展，目前电视辅助胸腔镜与腹腔镜相结合，其应用范围几乎涵盖了食管疾病的各种外科治疗。     

恶性胸腺瘤患者手术疗效及其预后因素分析

目的:观察恶性胸腺瘤患者的手术疗效,并分析其与肿瘤分期、放疗、L/B病理分型及与预后的关系.方法:对63例恶性胸腺瘤患者进行手术治疗并辅以放疗,并按不同术式、Masaoka外科-病理分期、L/B病理分型比较,采用多因素Logistic回归分析其与预后的关系.结果:接受根治性手术,Masaoka外科-病理分期较早的患者3、5年生存率较高(P＜0.05).术后加用放射性治疗与否也与3、5年生存率有关系.不同病理(L/B)类型的患者,3、5年生存率差别无统计学意义.结论:恶性胸腺瘤患者早期手术并辅以放疗可提高生存率;Masaoka外科-病理分期和预后密切相关;L/B病理分型与预后无明显相关性.     

肺减容术治疗重度肺气肿患者临床分析

Objective To study effectiveness and safety of lung volume reduction surgery(LVRS) in treatment for severe chronic emphysema(chronic obstructive pulmonary disease).Methods Clinical data of 24 patients of severe chronic emphysema undergone with LVRS during January 2004 to June 2007 were analyzed retrospectively.LVRS was performed for the patients after respiratory tract preparation based on their pulmonary function,results of blood gas analysis,cardiac function,as well as physical activity capacity.and surgical incision Was selected based on"target"location of emphysema with chest computerized tomography and isotope lung perfusion scanning,22 cases with standard unilateral LVRS via outer post-lateral incision and two with bilateral LVRS via mid-sternal incison.A linear device for cutting and stitching was used in surgical operation to excise the lung tissues of severe emphysema with strips of bovine pericardium to prevent air leakage.Results All the patients were followed-up for 19 months in average and complications occurred in seven of them after operation,including four with leakage of the alveoli.two with cardiac arrhythmia and one with pneumonia,and no death was observed.Pulmonary function and symptoms of dyspnea improved obviously in all the patients after operation,and they all could care for themselves,in general,with scales of dyspnea increased to grade Ⅰ in one case,to grade Ⅱ in 10 cases and to grade Ⅲ in three cases.Conclusions LVRS can improve pulmonary function of selected patients with severe emphysema,to certain extent,and its safety will depend on strict selection of the patients and correct peri-operative care.     

乌司他丁对普胸患者围手术期免疫功能的影响

我们通过本研究在围手术期使用乌司他丁 ,与对照组相比较 ,初步评估其对普胸手术患者围手术期免疫功能的影响。一、材料与方法1.一般资料 :我科于 2 0 0 2年 3月～6月 ,将普胸外科手术的患者随机分为乌司他丁用药组和对照组各 2 0例。其中男 2 4例、女 16例 ;年龄 2 2～ 74岁 ,平均年龄 5 3岁 ;术式有肺叶切除术 2 9例、食管癌切除术 5例、纵隔肿瘤切除术 6例。两组患者在性别、年龄、病种和术式等方面差异均无显著性 (P >0 .0 5 )。2 .用药方法 :用药组于手术当天、术后第 1天和第 2天 ,连续 3d采用静脉滴注乌司他丁。方法为 5 %葡萄糖液 …     

非小细胞肺癌肺内第12和13组淋巴结转移规律及临床意义

目的:探讨非小细胞肺癌肺内第12和13组淋巴结的转移规律及临床意义.方法:对141例行肺切除和淋巴结清扫术的非小细胞肺癌患者进行临床病理分析.结果:共取得淋巴结2154枚,平均每例15.3枚,转移率为13.1％.141例患者中55例有胸内淋巴结转移,其中N115例,N1+N2 28例,跳跃性N212例,转移率为39.0％.常规病理检测无纵膈及肺内淋巴结转移患者93例中检出单纯第12或13组淋巴结转移者7例,检出率为7.5％.T2期肺内第12和13组淋巴结转移率明显高于T1期(P＜0.05),第12和13组淋巴结在低分化及中分化肺癌中的转移率分别为25.0％和8.9％(P＜0.05),周围型肺癌肺内第12和13组淋巴结转移率要显著高于中央型肺癌(P＜0.05).结论:非小细胞肺癌肺内第12和13组淋巴结转移与原发肿瘤大小、临床病理类型及分化程度均有密切关系.对早期非小细胞肺癌患者第12和13组淋巴结进行病理检测,可以为临床工作提供重要的指导.     

阻塞性通气障碍患者机械通气时呼吸系统黏性阻力变化的研究

目的:应用脉冲振荡肺阻力测定法(IOS)探讨间歇正压控制性机械通气(IPPV)时呼吸系统黏性阻力变化规律.方法:择期左肺肿瘤切除成年男性患者25例,根据术前肺功能测定指标分为非阻塞性肺病组(NOLD组)15例和阻塞性肺病组(OLD组)10例,所有受试者麻醉后于仰卧位和右侧卧位行双肺及右肺通气测试.应用IOS方法测定Carlen双腔气管导管5 Hz(R5)、10 Hz(R10)和15 Hz(R15)黏性阻力.结果:相同振荡频率双肺通气OLD组黏性阻力显著增加,与NOLD组比较,差异有统计学意义(P＜0.05).不同潮气量和呼吸频率侧卧位单肺机械通气时NOLD组患者黏性阻力变化差异无统计学意义.当潮气量≤8 mL·kg-1、呼吸频率≥12次·min-1单肺通气时,组间R5差异有统计学意义(均P＜0.05).结论:术前肺通气功能正常或仅轻度损伤的患者,围术期用Carlen双腔管做侧卧位非手术侧单肺通气,潮气量4～10 mL·kg-1,呼吸频率10～18次·min-1,不改变其呼吸动力学特性.     

白血病患者合并肺部霉菌感染的外科治疗

白血病患者由于疾病本身以及接受细胞毒性化疗、造血干细胞移植(HSCT)、免疫抑制剂应用和放疗等治疗,易发生机体免疫功能低下,中性粒细胞减少及功能减弱,容易发生霉菌感染.肺部是霉菌感染最常见的部位,对于药物治疗效果不佳的肺部霉菌感染的白血病患者,手术治疗是重要的辅助手段[1].手术后的患者接受化疗或HSCT等治疗时,采用抗真菌药物进行再发预防也是非常重要的预防措施.天津市胸科医院胸外科自2004年6月至2010年3月对12例合并肺部霉菌感染的白血病患者进行了手术治疗,效果良好,现报告如下.