支气管袖状切除术治疗中央型肺癌79例

目的总结采用以支气管袖状成形肺叶切除术为核心的多种切除重建术式治疗79例中央型肺癌的临床疗效。方法1988年6月~2005年6月,对79例中央型肺癌患者施行以支气管袖状成形肺叶切除术为核心的多种切除重建手术。支气管环状切除成形及支气管袖状成形肺叶切除术57例;支气管肺动脉双袖状成形肺叶切除术15例;气管隆突及半隆突切除重建合并肺叶切除术6例。结果本组无手术死亡病例。发生手术并发症7例次,发生率为8.86%。术后1、3、5和10年生存率分别为78.5%,59.5%,35.4%,17.7%。结论以支气管袖状成形肺叶切除术为核心的多种切除重建术式能最大限度保护了肺功能,提高了中央型肺癌的治愈率和远期生存率。     

单操作孔胸腔镜支气管袖式切除术治疗中央型肺癌1例报告

文章报道1例行单孔胸腔镜支气管袖式切除术的中央型肺癌患者,结合文献讨论,认为单操作孔胸腔镜袖式支气管肺叶切除治疗早期中央型肺癌是一项安全、有效的手术方式.     

25例支气管肺叶袖式切除的临床体会

目的：探讨支气管肺叶袖状切除术治疗中央型肺癌的临床疗效,以提高手术疗效和患者生存率.方法：2003 年10 月-2008年12 月,对笔者所在医院25 例中央型肺癌患者行支气管肺叶袖式切除,其中有3 例行肺动脉侧壁切除,2 例在心包内处理肺静脉.结果：全组无死亡病例,术后并发症8 例（32%）,其中肺不张1 例,心律失常5 例,支气管胸膜瘘1 例,声音嘶哑1 例,随访时间8 个月-5 年,术后1、3、5 年生存率分别为：79.5%、42.1%、32.4%.结论：支气管袖式切除术扩大了肺癌患者的手术指征,避免了全肺切除,提高了患者的生存质量.     

支气管成形肺叶切除术21例分析

目的总结支气管袖状成形术、合并肺动脉成形术治疗中心型肺癌的经验。方法回顾分析1998年1月至2009年8月行支气管成形肺叶切除术治疗肺癌21例,其中合并肺动脉契形成形术4例。结果本组共发生并发症6例,其中肺不张4例,肺脓肿1例。房颤1例,经治疗痊愈。全组残端附肚3例,无死亡。结论对中央型肺癌根据病变所在部位不同．而采取适当的袖状切除气道重建方式,符合肺癌外科治疗原则,可获得较满意的疗效。     

袖状肺叶切除术治疗中心型肺癌42例分析

目的：探讨以支气管袖状肺叶切除术治疗42例肺癌的临床疗效。方法：回顾我院2000年12月～2004年12月期间收治的中心型肺癌42例,其中Ⅰb期14例（T2N0N0）,Ⅱb期25例（T2N1M0、T3N0M0）,Ⅲa期3例（T2N2M0）;支气管袖状肺叶切除34例,肺动脉和支气管双袖状肺叶切除8例。结果：42例患者无手术死亡病例,发生左侧脓胸1例,发生率2．4％（1／42）,肺炎、肺不张2例,发生率为4．8％（2／42）。患者1年生存率为80．9％,3年生存率38．1％。结论：以支气管或肺动脉袖状切除能提高中心型肺癌的手术切除率,并可最大限度保护肺功能,保证病人术后生活质量。     

袖式肺叶切除术治疗中央型支气管肺癌

目的 研究袖式肺叶切除术治疗肺癌的疗效.方法 回顾分析14例袖式肺叶切除治疗中央型肺癌患者的临床资料及手术方法 .结果 14例患者有5例术后排痰不畅,需行气管镜吸痰,1例出现肺部感染,14例患者住院期间无吻合口出血、瘘发生,未发生肺不张,均顺利痊愈出院.术后随访至今无死亡,但1例发生骨骼转移.结论 采用肺叶袖式切除,使某些病程较晚、心肺功能低下的患者获得手术机会,既可较彻底切除肿瘤组织,又最大限度地保留肺功能,提高了患者的生活质量,扩大了手术适应证,疗效满意.     

支气管袖状成形肺叶切除术治疗肺癌的疗效观察

目的观察支气管袖状成形肺叶切除术治疗肺癌的疗效。方法将本院收治的46例中心型肺癌患者依据治疗方式分为对照组与观察组。对照组采取全肺切除术进行治疗，观察组采取支气管袖状成形肺叶切除术进行治疗，对比两组患者术后情况及1～5年存活率。结果观察组VAS明显低于对照组，P〈0．05；观察组其余各项观察指标均显著优于对照组，P〈0．01。结论支气管袖状成形肺叶切除术治疗肺癌疗效确切。术后存活率高。     

全肺切除术后呼吸道的护理体会

目前临床肺癌就诊多属中、晚期,全肺切除可以提高手术率,减少不必要的开胸探查,一侧全肺切除常用于无法施行肺叶或袖型肺叶切除的中央型肺癌.术后并发症较多,呼吸道的管理尤其重要.笔者所在医院2004～2009年共行全肺切除术治疗原发性支气管肺癌患者28例,现将围手术期呼吸道的护理体会介绍如下.     

新华医院为5岁儿童实施支气管袖式肺叶切除手术

上海交通大学医学院附属新华医院儿外科近日成功为一例5岁左主支气管肿瘤惠儿实施支气管袖式肺叶切除手术,在完整切除其原发肿瘤前提下保全了原本需作切除的左上肺叶,是目前国内实施的同类型手术中年龄最小的病例。     

快讯

胸腔镜下，可切肺癌 中央型肺癌的袖式肺叶切除术是最复杂的肺部手术之一，即便是在开胸手术的情况下，难度也很大，而完全在胸腔镜下施行这一手术更是难上加难。近日，湖北省肿瘤医院胸外科专家成功完成省内首例胸腔镜下右上肺叶袖状切除术。医生以娴熟的手术技巧，在胸腔镜下为患者完全切除肺癌，同时“飞针走线”重建支气管，以最小的创伤保住了患者右肺70％的功能。目前患者已顺利出院，并如期开始后续放化疗。     

先天性肺囊肿100例外科治疗效果观察

目的探讨先天性肺囊肿的临床诊断与治疗的方法。方法对2009年3月-2010年8月湖南省儿童医院行X线摄片和CT检查予以确诊的100例先天性肺囊肿患者（婴幼儿占73%）行外科手术,其中行囊肿摘除术52例、单肺叶切除术39例、肺段切除术9例。结果本组无手术死亡,无严重术后并发症。术后3例并发支气管胸膜瘘,经引流治疗后痊愈。7例有轻度的咳嗽,随访2个月至3年,疗效良好无复发。结论先天性肺囊肿应早期诊断、早期治疗,肺叶切除是主要术式,部分病例可行全肺切除、楔型切除和囊肿切除。     

Is time-to-treatment associated with higher mortality in Korean elderly lung cancer patients?

Lung cancer is a leading cause of cancer-related deaths in many countries, including South Korea. As treatment delays after diagnosis may correlate with survival, this study aimed to investigate the association between time-to-treatment and one-and five-year overall mortality in patients aged 60 years or above. Survival analysis using the Cox proportional hazard model were conducted after controlling for all independent variables. Of a total of 1,535 individuals who received surgical treatment due to lung cancer, 837 patients received treatment within 30 days and 698 after 30 days of initial diagnosis. Individuals who received surgical treatment after 30 days of diagnosis were more likely to die within 1-year (Hazard Ratio, HR: 1.15, 95% Confidence Interval, CI: 1.01-1.32) and 5-year (HR: 1.16, 95% CI: 1.02-1.33) compared to those who received treatment within 30 days. The increase in mortality risk with time delay persisted when applying other cut-off times, including standards at 2, 3, and 6 months. We also found that the mortality rate of lung cancer patients differs depending on age (74 years or younger), household income (<80 percentile), patient severity, and the residing region. Our findings show that time delay is an important factor that can influence the outcome of lung cancer patients, highlighting the importance of monitoring and providing appropriate and timely treatment.     

64-MSCT多向调节MPR对周围型小肺癌征象的价值

肺癌是最常见的恶性肿瘤之一。周围型小肺癌一般是指瘤体直径≤2cm者称为小肺癌;周围型小肺癌的诊断一直是影像学诊断的难题之一,多层螺旋CT的临床应用使得周围型小肺癌的影像诊断研究进入到一个新的阶段,对小肺癌征象的显示更加清楚。本研究探讨多层螺旋CT多向调节MPR对周围型小肺癌不同征象的检出及其对周围型小肺癌诊断的应用价值。     

MiRNA及其与肺癌早期诊断的新认识

MicroRNA（MiRNA）是一类长约18～22个核苷酸的小分子非编码RNA,能调节转录后靶基因的表达,其在机体内的生长发育,细胞繁殖、代谢、凋亡等生理过程中发挥着重要作用。MiRNA具有癌基因或抑癌基因的双重作用,且具有组织特异性。MiRNA表达水平的变化与肿瘤形成密切相关。肺癌是严重危害人类健康的疾病,其发病率和病死率已占全球恶性肿瘤的首位。其恶劣预后多归因于早期诊断能力差和治疗效果欠佳。近年来,在肺癌诊断中具有高度敏感性和特异性的MiRNA备受关注。作为血清标志物,MiRNA将为肺癌早期诊断提供了新的重要的途径。     

Lung cancer in Spain: the current situation. 2008 SESPAS Report

Lung cancer is currently the most frequent cause of death from cancer worldwide, warranting periodic analysis of the development and results of strategies aimed at reducing the incidence, mortality and morbidity related to this disease in Spain. PREVENTIVE ASPECTS: Mortality reduction among men contrasts with the increase observed in women, reflecting changes in tobacco exposure in the last few decades. Prevention programs aimed specifically at women and youngsters should be developed. In addition, the current law of smoking prevention should be amplified and vigorously applied. ASPECTS RELATED TO EARLY DIAGNOSIS: So far, there is insufficient scientific evidence to initiate a population-based lung cancer screening program. Preferential health care circuits are required to guarantee coordination among centres and levels of care and to substantially reduce current delays in the diagnosis and treatment of patients with lung cancer. TREATMENT-RELATED ASPECTS: Therapeutic decisions in all lung cancer patients should be based on teamwork and scientific evidence. Palliative care deserves the same priority as oncological treatments. Lung cancer patients should participate more fully in therapeutic decisions. Better information systems are required for clinical assessment and research on this disease.     

Clinical characteristics of pulmonary hamartoma resected surgically as undiagnosed pulmonary nodule

Pulmonary hamartoma is the most common tumor in benign lung neoplasm. We reviewed the clinical characteristics of 9 patients who had undergone surgical resection for pulmonary hamartoma between 2000 and 2009. There were 1 male and 8 female patients. The age of the patients ranged from 42 to 77 years old (mean 59). Calcification was not observed by computed tomography scan except in 1 patient. Although transbronchial lung biopsy (TBLB) was performed in 5 patients, no definitive diagnosis was obtained. Six patients underwent 18F-fluorodeoxyglucose (FDG)-positron emission tomography, and none of them showed any accumulation of FDG except for 1 patient. Concerning the operative procedures, a sleeve lobectomy was performed in 1 patient, a segmentectomy in 1, a lobectomy in 2, a partial resection of the lung in 3, and a nucleation in 2 patients. The postoperative courses were uneventful, and no findings of recurrence were observed in any of the patients after surgery. As a preoperative diagnosis of pulmonary hamartoma is often difficult in TBLB, it is necessary to perform surgical resection in the differential diagnosis of lung cancer or metastatic lung tumor, unless there are typical findings of pulmonary hamartoma in clinical imaging.     

Generalizability of results from the National Lung Screening Trial

Lung cancer is the major cause of cancer-related death worldwide, with a 5-year survival of only 16?%. Most lung cancer cases are diagnosed at an advanced incurable stage. As earlier stages have a better prognosis, the key to reducing mortality could be early diagnosis of the disease. At present, low-dose computed tomographic (CT) screening has shown promising data. Lung cancer death rates were reduced by 20?% when CT screening is compared to chest radiography in a high-risk group. There are many advantages of CT screening in lung cancer, however there are also some important issues that should be taken into account. Therefore, the applicability of the results to clinical practice is not clear yet. In this Commentary we discuss different aspects that play important roles in the balance between harms and benefits of screening, including overdiagnosis, availability of treatment options worldwide, ethical considerations, costs, and prolonged life expectancy. We conclude that clinicians should be cautious in generalizing findings to the total population of smokers and take into account that the use of lung cancer screening in clinical practice may have limitations.     

肺癌早期诊断方法的研究进展

目的 肺癌是全球发病率及死亡率最高的恶性肿瘤，患者5年生存率仍低于20%，提高早期诊断及筛查至关重要，本文对肺癌早期诊断方法进行文献综述。方法 检索PubMed、知网、万方、维普等数据库，选择与肺癌筛查相关的文献，进一步选择如CT、核磁共振、MiRNA、自身抗体等文献，提炼其相关结果结论。结果 肺癌早期诊断方法较多，每一种诊断方法均有其优缺点。结论 目前尚无任何一种技术被证实能独立完成早期肺癌的筛查，需要将目前早期诊断技术加以优化组合，以提高早期肺癌的诊断率。     

Reappraisal of the present situation in prevention and control of lung cancer

Lung cancer is a significant health problem in developed countries and is rapidly becoming a problem in developing countries. This report reviews the available information on the epidemiology, pathology, diagnosis, therapy, early detection and primary prevention of lung cancer. Minimum essential diagnostic and therapeutic procedures are proposed. Priority approaches to the implementation of lung cancer prevention programmes and research activities are outlined.     

结肠癌致肠梗阻的外科诊治

目的探讨结肠癌致肠梗阻的诊治方法。方法回顾性分析本院自2000至2010年间共收治35例结肠癌致肠梗阻的患者临床诊治方法。结果一期结肠癌根治术24例,二期手术5例,肿瘤无法切除行结肠侧侧吻合或造瘘6例。术后并发症11例（31.4%）,围手术期死亡率1例（2.86%）。结论对结肠癌致肠梗阻应手术治疗并遵循个体化原则,做好围手术期处理,积极创造条件,力争一期手术解除肠梗阻,提高其疗效。