电视纵隔镜对纵隔肿大淋巴结的诊断效果

目的探讨电视纵隔镜对纵隔淋巴结肿大的诊断效果。方法 2008年1月至2009年12月20例行电视纵隔镜检查患者的临床资料进行回顾性分析。结果全部20例患者均获得病理诊断,无手术并发症。讨论电视纵隔镜对于纵隔淋巴结肿大的诊断以及肺癌术前病理分期具有很高的准确性。     

电视纵隔镜在纵隔疾病诊断及肺癌分期中的应用

目的探讨电视纵隔镜检查术（video-mediastinoscopy,VM）在纵隔疾病诊断和肺癌合并纵隔淋巴结肿大术前分期中的价值。方法对41例CT等影像学检查发现有纵隔疾病患者和27例术前经胸部CT、PET、纤维支气管镜等检查诊断肺癌合并纵隔淋巴结肿大患者进行纵隔镜检查,根据病理结果行诊断和分期。结果41例纵隔疾病患者39例经电视纵隔镜术后确诊,2例诊断不明或可能误诊,其中1例转院失访,另1例经开胸活检证实为肺大B细胞淋巴瘤;27例肺癌合并纵隔淋巴结肿大患者经纵隔镜检查后,其中12例有纵隔淋巴结转移,15例无转移,后者经开胸手术病理确诊为肺癌无纵隔淋巴结转移。平均手术时间52min,平均出血40ml,术后无死亡,无切口感染,1例出血,3例喉返神经麻痹。结论电视纵隔镜术是纵隔疾病、肺癌术前病理分期的重要检查方法,具有诊断准确率高、安全可靠等优点。     

颈入路电视纵隔镜手术50例应用分析

目前影像学检查对判断肺癌是否有纵隔淋巴结转移以及诊断纵隔疾病仍有一定困难,而电视纵隔镜近年来以其安全可行且准确率高的特点,逐渐成为纵隔疑难疾病诊断和肺癌病理分期的最佳手段,在胸外科得到广泛应用.本文回顾性分析50例颈入路电视纵隔镜手术的临床资料,旨在探讨电视纵隔镜对单纯纵隔淋巴结肿大或纵隔肿物的诊断作用及其在对纵隔淋巴结肿大的肺癌分期中的应用价值.     

电视纵隔镜在胸部疾病诊断的应用价值

目的探讨应用电视纵隔镜行肺癌分期和纵隔疑难疾病诊断的价值和围手术期并发症的预防。方法回顾分析我院行纵隔镜检查的63例患者,其中颈部纵隔镜术58例,胸骨旁纵隔镜术5例,手术均在全麻下完成,单纯纵隔肺门疑难疾病48例,高度怀疑肺癌或诊断为非小细胞肺癌伴有纵隔淋巴结肿大的患者15例。结果15例怀疑或已确诊为肺癌患者,淋巴结病理阳性率为60．0％（9／15）,CMS病理假阴性率16．7％（1／6）。48例纵隔疑难疾病患者,47例获得病理诊断,1例临床证实,经验性治疗肿块明显缩小,疾病确诊率98％（47／48）。无手术死亡,1例大出血保守治疗成功。无其他相关的术后并发症。结论纵隔镜技术安全有效,对明确肺癌的分期和诊断纵隔疑难疾病检查准确率高。     

电视纵隔镜在胸部疾病应用的体会

目的 探讨电视纵隔镜在胸部疾病诊断和治疗中的价值。方法 对2006年3月～2006年10月开展的18例电视纵隔镜手术进行回顾性分析。结果本组手术时间20～100分钟,平均51分钟,术中出血0～200ml平均48．9ml。肺癌术前分期5例,纵隔淋巴结病理检查阴性2例,阳性3例;纵隔疑难疾病10例者,经过纵隔镜手术后8例明确诊断。术后1例纵隔淋巴结结核颈部切口感染,经换药治愈,全组病例均痊愈出院。结论 电视纵隔镜手术安全、可靠,可作为纵隔疑难疾病诊断和鉴别诊断的有效诊断方法以及肺癌术前分期的金标准。     

电视纵隔镜在胸部疑难疾病诊断中的应用价值

目的探讨电视纵隔镜在纵隔疑难疾病诊断中的可靠性、安全性及适应症。方法对2006年3月至2010年6月开展的90例电视纵隔镜手术资料进行回顾性分析,男52例,女38例,年龄18~74岁,平均51.6岁。其中颈部电视纵隔镜手术78例,胸骨旁电视纵隔镜手术6例,经肋间电视纵隔镜手术6例。结果 90例经电视纵隔镜手术,89例术后确诊：结节病30例,淋巴结慢性炎症16例,转移性腺癌14例,小细胞癌8例,转移性鳞癌7例,淋巴结核4例,霍奇金氏淋巴瘤4例,转移性低分化癌2例,恶性纤维组织细胞瘤1例,食管鳞状细胞癌1例,骨巨细胞瘤纵隔转移1例,促纤维组织增生性小圆细胞肿瘤1例。本组手术时间30~100 min,平均51 min,术中出血10~200 ml,平均45 ml。术中出血中转开胸1例,术后切口感染1例。结论电视纵隔镜手术是一种安全、有效、微创术式,适合于纵隔疑难疾病的诊断。     

电视纵隔镜技术在纵隔病变临床诊断中的应用及体会

目的探讨电视纵隔镜技术对诊断疑难纵隔疾病或胸部病变累及纵隔淋巴结时的临床应用价值。方法分析我科行纵隔镜检查术的50例患者,本组病例术前均行胸部CT、细胞学相关检查,其中9例行PET/CT检查,5例行EBUS-TBNA检查,将纵隔镜检查手术前后诊断符合率进行对比分析。结果术前相关检查中恶性24例,良性26例,所有病例均成功取得或切除目标组织,最终病理结果恶性19例,良性31例,经对比分析,影像学及细胞学等检查确诊率为61.53%,误诊率38.47%。全组无手术死亡病例,术中出血1例,成功压迫止血,术后颈部切口感染1例,经换药后愈合良好。结论影像学及细胞学等检查在纵隔疾病的诊断中,存在一定的误诊率,纵隔镜检查是获得病理诊断的最佳途径,确诊率较高,该技术安全有效。     

电视纵隔镜在胸部疾病诊断中的应用价值

目的探讨电视纵隔镜在纵隔疑难疾病诊断及肺癌术前分期中的应用价值。方法对160例电视纵隔镜手术资料进行分析。结果 160例经电视纵隔镜手术,158例术后确诊:结节病60例,淋巴结慢性炎症19例,转移性腺癌32例,小细胞癌15例,转移性鳞癌10例,淋巴结核13例,霍奇金氏淋巴瘤4例,转移性低分化癌5例,30例肺癌患者术前经纵隔镜淋巴结活检均获得准确的肺癌分期。结论电视纵隔镜手术是纵隔疑难疾病诊断和肺癌术前分期的安全、可靠、准确的检查方法。     

纵隔镜手术在胸部疾病的应用价值和进展

纵隔镜手术是明确纵隔病变及其性质的一种主要方法。通过颈部或胸骨旁小切口置入纵隔镜 ,直接对气管周围、气管隆突下及支气管区域的病变组织或肿大的淋巴结进行视诊、触诊和切除。其在临床用已上的应用已有 40多年 ,在欧美等发达国家它是胸外科医师必须掌握的常用技术之一 ,在     

电视纵隔镜在胸部疾病的应用与护理

纵隔镜手术主要应用于肺癌分期的诊断及纵隔疾病、纵隔肿瘤、纵隔肉芽肿和结节病的诊治。我科自2006年3月至2007年10月共实施了58例纵隔镜检查术,现将护理体会报告如下。     

胸外科肺癌1695例临床资料分析

目的通过对胸外科收治的原发性肺癌患者临床资料的分析,为肺癌的早期诊断、早期治疗提供经验。方法本研究对1695例本院胸外科肺癌患者的临床资料进行回顾性分析,分析目前胸外科收治患者的高发年龄、危险因素、诊断分期和治疗状况等。结果在胸外科肺癌患者中,男女构成比为2．4：1;患者平均吸烟指数39．80包年,其中男性平均40．62包年,女性平均29．52包年;病理类型分布：腺癌692例（50．47％）,鳞癌452例（32．97％）,小细胞癌86例（6．27％）;在腺癌中,男性占54．34％,女性占45．66％;在鳞癌中,男性占92．26％,女性占7．74％。肺癌合并COPD者167例（9．85％）,其中可行手术者105例,病理诊断鳞癌者最多（45例）;肺癌合并COPD术后并发症发生率为22．86％,30d内死亡率为2．86％,均高于一般患者（15．96％,1．82％）;术后30d内死亡患者26例,约70％为Ⅲ期及以上中晚期患者,影像学分期中央型17例,周围型9例,病理示鳞癌14例,腺癌8例。结论肺癌男性发病率高于女性,这与男性中的高吸烟指数相关,近年肺癌的构成已转变,腺癌目前发生最多,这可能与环境污染相关。COPD合并肺癌患者中,鳞癌居多,且COPD致使术后的高并发症及死亡率。周围型腺癌患者术后死亡率较低,早期的手术治疗对延长肺癌患者生存期至关重要。     

自荧光气管镜在支气管肺癌诊断中的临床应用

[目的]探讨自荧光气管镜(AFB)在支气管肺癌早期诊断中的价值.[方法]对198例临床怀疑支气管肺癌患者采用AFB联合白光气管镜(WLB)检查的诊断结果进行回顾性分析,将病理诊断为恶性肿瘤和不典型增生定义为阳性,正常黏膜、增生、慢性炎症定义为阴性,统计AFB与WLB镜下异常表现及病理结果,比较其对早期肺癌诊断的敏感度.[结果]198例中AFB表现异常者186例,WLB表现异常者133例,160例病理阳性结果中癌变黏膜156例,重度不典型增生4例.AFB发现异常病理证实癌变者156例,假阳性30例,敏感性97.5％,假阳性率16.1％,WLB发现异常病理证实者128例,假阳性5例,敏感性80.0％,假阳性率3.7％,两者在敏感性和假阳性率的差异均有统计学意义(P＜0.05).[结论]对于支气管内癌前病变和早期肺癌的定位诊断,AFB检查比WIB更加敏感.     

循环肿瘤细胞的检测及其在肺癌患者中的临床应用

循环肿瘤细胞在早期发现患者术后复发与远处转移、评估疗效与预后等方面的应用价值已经成为临床研究的热点.外周血循环肿瘤细胞非常少,仅能通过肿瘤特异性抗原来检测.本文主要介绍了循环肿瘤细胞富集、检测过程、常用标记物及其在肺癌患者中的临床应用.     

Quality of life after lung cancer surgery: video-assisted thoracic surgery versus thoracotomy

OBJECTIVE: To assess the benefit of video-assisted thoracic surgery (VATS), we compared time-related quality of life (QOL) after lobectomy performed by VATS to that performed by thoracotomy. METHODS: Thirty-three patients underwent surgery for lung cancer during the period April 2001 through November 2002 completed a mailed questionnaire after surgery. RESULTS: Over time, improved QOL was reported in six dimensions by VATS patients but in only two dimensions by thoracotomy patients. There was significant improvement in bodily pain subscores in both groups during the 36 months after surgery. At 3 months after surgery, QOL scores for all eight dimensions were lower in the VATS group, but QOL scores for all eight dimensions did not differ significant between groups at 3 or 12 months after surgery. At 36 months after surgery, QOL scores for six dimensions were higher in the VATS group, and the difference was significant in scores for two dimensions. CONCLUSION: We found recovery was quicker in patients who underwent VATS than in those who underwent thoracotomy.     

Pulmonary arterioplasty using video-assisted thoracic surgery mechanical suture technique

Lung cancer invading pulmonary trunk is a locally advanced condition, which may indicate poor prognosis. Surgical resection of the lesion can significantly improve survival for some patients. Lobectomy/Pneumonectomy with pulmonary arterioplasty via thoracotomy were generally accepted and used in the past. As the rapid development of minimally invasive techniques and devices, pulmonary arterioplasty is feasible via video-assisted thoracic surgery (VATS). However, few studies have reported the VATS surgical techniques. In this study, we reported the techniques of pulmonary arterioplasty via VATS.     

Long-term survival of thoracoscopic surgery compared with open surgery for clinical N0 adenocarcinoma

BackgroundEarly stage non-small cell lung cancer (NSCLC) is good candidate for video-assisted thoracoscopic surgery (VATS). Long-term outcome compared between VATS and open surgery remains unclear. The aim of this study was to assess the long-term outcome of VATS in early stage adenocarcinoma.MethodsA retrospective study was performed in 546 patients which were operated between January 2006 and December 2010 in our institute and of those, 240 (220 lobectomies, and 20 segmentectomies) were clinical N0 adenocarcinoma. One hundred and thirty-five patients underwent VATS and 105 patients for open surgery. Long-term oncological outcomes were compared in both groups.ResultsThere were significant differences in age, gender, Blinkman index, clinical T factor and tumor size between two groups. VATS group showed statistically longer operation time (P=0.01), less blood loss (P=0.005), shorter length of stay (P=0.001), and less dissected number of lymph nodes (P<0.001) compared with open surgery. Disease-free survival in VATS was significantly better than open surgery (5- and 10-year survival; VATS, 91.4%, 79.0%; open, 85.1%, 73.6%; respectively, P=0.04). Overall survival in VATS was not different from open (P=0.58). Propensity matched disease-free and overall survival was not significantly different between two groups. Multivariate Cox regression analysis showed that age [P=0.04, 95% confidence interval (CI): (1.02–6.81)] in overall and T factor [P=0.01, 95% CI: (1.41–17.3)] in disease-free survival was prognostic significant after propensity matching.ConclusionsOur study demonstrated that long-term outcome in VATS for early stage adenocarcinoma was equivalent to open surgery. VATS may be a treatment of choice for promising long-term prognosis.     

肺超声的临床应用进展

超声在肺部的应用远不如在心脏、腹部等领域.近年来经胸壁超声检查肺和胸膜病变的临床应用逐渐增多.由于床旁X线的低敏感性和重症患者搬运到CT室的高风险,且传统的X线和CT不能实时监测疾病的发展和转归,肺超声对危重患者的床旁评估显得特别有价值.床旁肺超声是一个对传统X线和CT检查的很好补充,可以常规应用并减少甚至替代传统放射学检查.     

Clinicopathologic correlates of postoperative N1 or N2 nodal upstaging in non-small cell lung cancer

Background

Clinical and pathologic determinations of lymph node staging are critical in the treatment of lung cancer. However, up- or downstaging of nodal status frequently is necessitated by postsurgical findings. This study was conducted to evaluate clinicopathologic features that impact nodal upstaging in patients staged primarily via positron emission tomography/computed tomography (PET/CT) and chest CT prior to surgery.

Methods

Between years 2011 and 2014, 634 patients underwent surgical treatment for non-small cell lung cancer (NSCLC) at our institution. Excluding 37 patients (given induction chemotherapy), 103 patients pathologically staged as N1 or N2 NSCLC. Nodal upstaging patients were classified into group A and non-upstaging patients into group B. We compared clinical characteristics and pathological results of group A with group B.

Results

Ultimately, 59 patients (57.3%) were assigned to group A and 44 patients (42.7%) to group B. Patients in group A (vs. group B) were significantly younger (61.6 vs. 68.4 years; P<0.001) and more often were female (47.5% vs. 15.9%; P=0.001), with shorter smoking histories (12.2 vs. 28.8 pack years; P<0.001) and lower maximum standardized uptake values (SUVmax) (7.3 vs. 10.4; P=0.001). Most upstaged (group A) tumors (50/59, 84.7%) were adenocarcinomas, displaying micropapillary (MPC; n=36) and lepidic (n=35) component positivity with significantly greater frequency (both, P<0.001); and the frequency of epidermal growth factor receptor (EGFR) mutation (n=36) was significantly greater in this subset (P=0.001). Multivariate analysis (logistic regression) indicated a significant correlation between MPC positivity and nodal upstaging (P=0.013).

Conclusions

In patients upstaged postoperatively to N1 or N2 stage of NSCLC, occult lymph node metastasis and MPC positivity were significantly related.     

Left lower lobectomy and systematic lymph node dissection by complete video-assisted thoracic surgery

A 50-year-old female was administered with left lower lobe lesion for 10 days. A preoperative chest computed tomography (CT) revealed a mass in the left basilar segment of the lung, about 2.1 cm × 1.7 cm in size. Therefore, video-assisted thoracic surgery (VATS) left lower lobectomy was performed. The operation takes 60 minutes. During the operation, the estimated blood loss was 15 mL. The patient was discharged on postoperative day (POD) 6 with no complications. And the pathological results confirmed the diagnosis of adenocarcinoma with no lymph nodes metastasis.