电视胸腔镜辅助小切口切除食管癌和肺癌20例报告

探讨电视胸腔镜辅助微创小切口在食管癌和肺癌治疗中的价值。电视胸腔镜辅助小切口行食管癌和肺癌切除术,其中食管癌切除食管、胃胸内器械吻合12例,肺癌肺叶切除8例。均在胸腔镜辅助下完成手术,平均手术时间108min,失血量110mL,住院时间11d,无手术死亡及严重并发症。初步研究结果提示,电视胸腔镜辅助小切口治疗食管癌和肺癌,是一种很有前途的微创外科技术。     

电视胸腔镜辅助小切口切除食管癌和肺癌20例报告

探讨电视胸腔镜辅助微创小切口在食管癌和肺癌治疗中的价值。电视胸腔镜辅助小切口行食管癌和肺癌切除术，其中食管癌切除食管、胃胸内器械吻合12例，肺癌肺叶切除8例。均在胸腔镜辅助下完成手术，平均手术时间108min，失血量110mL，住院时间11d，无手术死亡及严重并发症。初步研究结果提示，电视胸腔镜辅助小切口治疗食管癌和肺癌，是一种很有前途的微创外科技术。     

肺癌防治走进“精细”时代——访首都医科大学肺癌诊疗中心主任支修益

专家简介支修益男56岁我国著名胸外科专家控烟与肺癌防治专家1983年毕业于首都医科大学医疗系,从事肺癌外科和多学科综合治疗30余年。在早期肺癌诊断与鉴别诊断、老年肺癌微创外科手术和多学科综合治疗方面经验丰富,是我国肺癌外科领域领军人物。工作单位任职：首都医科大学肺癌诊疗中心主任北京宣武医院胸外科主任学术团体任职：北京医学会胸外科学会主任委员,     

未来的趋势——微创外科手术

癌症手术领域正在发生改变微创外科手术广义定义为手术切口比传统手术小,它正在改变癌症手术治疗的面貌。随着外科技术的突破性进展,包括机器人和电脑辅助工具的使用,微创外科手术越来越复杂。外科医生在使用微创技术来诊断和评估肿瘤的同时,也用微创技术来治疗和除去一些较小的肿瘤,包括早期肺癌、结肠癌、前列腺癌等。     

精准医学时代乳腺癌外科治疗的热点问题

肿瘤的精准医学是通过综合应用组学分析、分子检测、分子影像、分子病理、以及大数据分析等技术手段,实现手术、放疗、化疗及生物治疗的微创、精准、合理利用.微创精准外科理念,不仅是将原来的大切口变成小切口,更要求结合肿瘤基因的分型、大数据分析等技术手段,开展精确的诊断分期、精细的手术方案设计、微创而精湛的手术技术研究和精细的术...     

微创手术会增加肺癌术后的复发风险吗？

目前肺癌外科手术的最大进展是微创外科技术和腔镜技术的普及和推广。现在胸外科微创手术治疗主要包括两种方法：1.不损伤胸壁肌肉小切口开胸术（muscle-sparing thoracotomy,MST）;2.胸腔镜外科技术（video assisted thoracoscopic surgery,VATS）。~一、不损伤胸壁肌肉小切口开胸术不损伤胸壁肌肉小切口开胸术的切口长6~10cm,向后牵拉背阔肌,沿前锯肌肌肉纤维方向分开至肋间表面,切开肋间置入最小号撑开器,可以完成绝大多数的肺癌手术。MST开胸至关胸时间明显缩短,因其保持了胸壁肌肉的完整。     

肺癌的微创治疗

肺癌的外科治疗发生了巨大的变化,已经成为肺癌治疗最主要的治疗手段之一,它是早中期肺癌的首选治疗手段。随着科学技术的进步,外科手术技术及麻醉技术有了飞速的发展,选择性单肺通气的运用,使多数肺癌的外科治疗可以安全地通过微创手术完成。现在肺癌的微创手术治疗主要包括两种方法:①胸腔镜治疗肺癌;②微创肌肉非损伤性手术治疗肺癌。这两种方法与传统的胸部后外侧切口开胸手术比较,均具有创伤小,恢复快,出血、输血少,对心肺功能损伤小,开、关胸时间短,术后并发症少等优势。微创肌肉非损伤性开胸术操作简单,能提供较充分的手术视野,不会因术中暴露不足而影响手术的彻底性,几乎可以完成所有肺癌切除手术,可以作为肺癌手术的常规术式;但目前有关胸腔镜手术尚缺乏严格的前瞻性随机对照研究,而且胸腔镜手术纵隔淋巴结的完全廓清还有困难,住院时间、术后并发症和生存期并没有因为应用胸腔镜手术而改变。总之,胸腔镜手术和微创肌肉非损伤性开胸术都是微创治疗肺癌的新技术,这两种方法应用于肺癌手术是安全可行的。胸腔镜手术比较适合于较早期的选择性患者,微创肌肉非损伤性开胸术可满足完成各种肺癌手术的需要。     

胰腺神经内分泌肿瘤外科治疗理念的四种转变

胰腺神经内分泌肿瘤(pancreatic neuroendocrine neoplasm,pNEN)是一类具有高度异质性的肿瘤。外科手术是pNEN综合治疗的重要环节,但pNEN较低的发病率和较强的异质性导致其外科领域进展相对缓慢。在治疗理念上,pNEN的外科治疗策略逐渐由病情导向转变为预后导向,对肿瘤特征的评估更加依赖形态学联合分子病理学的方法。此外,pNEN手术治疗正在向个体化、微创化、精细化的方向发展,手术的介入时机也逐步拓展至患者的全诊疗周期。本文将结合国内外相关领域研究进展,分析现阶段pNEN外科治疗面临的问题与挑战,并探讨治疗理念的转变及潜在的突破方向。     

精准医学时代乳腺癌外科治疗的热点问题

肿瘤的精准医学是通过综合应用组学分析、分子检测、分子影像、分子病理、以及大数据分析等技术手段,实现手术、放疗、化疗及生物治疗的微创、精准、合理利用。微创精准外科理念,不仅是将原来的大切口变成小切口,而是要求结合肿瘤基因的分型、大数据分析等技术手段,开展精确的诊断分期、精细的手术方案设计、微创而精湛的手术技术研究和精细的术后管理,这也是区别于传统仅围绕手术技术创新的理念创新。本文就乳腺癌外科治疗的最新进展来探讨微创、精准医学理念指导下乳腺癌的外科治疗策略的变化。     

肺癌外科手术进展

近年来微创技术在各期肺癌的检测、诊断和治疗中的应用出现爆发.这些技术的应用提高了手术的风险-收益比,并且使考虑肺癌手术治疗的患者更易接受手术.同时它们为晚期肺癌患者综合治疗的实施提供了便利.该综述总结了代表肺癌胸外科手术前沿的现有外科技术.     

A structured strategy to combine education for advanced MIS training in surgical oncology training programs

Changing realities in surgery and surgical technique have heightened the need for agile adaptation in training programs. Current guidelines reflect the growing acceptance and adoption of the use of minimally invasive surgery (MIS) in oncology. North American general surgery residents are often not adequately skilled in advanced laparoscopic surgery skills at the completion of their residency. Presently, advanced laparoscopic surgery training during surgical oncology fellowship training occurs on an ad-hoc basis in many surgical oncology programs.We present a rational and template for a structured training in advanced minimally invasive surgical techniques during surgical oncology fellowship training. The structure of the program seeks to incorporate evidence-based strategies in MIS training from a comprehensive review of the literature, while maintaining essential elements of rigorous surgical oncology training. Fellows in this stream will train and certify in the Fundamentals of Laparoscopic Surgery (FLS) course. Fellows will participate in the didactic oncology seminar series continuously throughout the 27 months training period. Fellows will complete one full year of dedicated MIS training, followed by 15 months of surgical oncology training. Minimal standards for case volume will be expected for MIS cases and training will be tailored to meet the career goals of the fellows.We propose that a formalized MIS-Surgical Oncology Fellowship will allow trainees to benefit from an effective training curriculum and furthermore, that will allow for graduates to lead in a cancer surgery milieu increasingly focused on minimally invasive approaches.     

无管化麻醉在胸科手术中的应用研究进展

电视胸腔镜手术（video-assisted thoracoscopic surgery,VATS）是目前治疗肺癌最常用的微创外科方式,但在提高患者舒适度和促进快速康复方面仍有待改进。一种新的无管化电视胸腔镜手术（tubeless VATS）正在逐渐发展,可以避免给患者使用气管插管、中心静脉导管、硬膜外导管、胸腔引流管和导尿管。Tubeless VATS结合当前最先进、创伤最小的麻醉、视频辅助外科和围术期护理方法,可确保手术的安全性和可行性,并且能够使患者在术后实现早期进食、下床和出院,使胸科日间手术成为可能。Tubeless VATS在肺癌手术乃至胸外科手术中的应用,见证了胸腔镜手术从微创到超微创的发展,使患者从快速康复外科治疗中最大获益。      

Uptake and survival effects of minimally invasive surgery for lung cancer: A population-based study

IntroductionDespite growing evidence supporting the safety of minimally invasive surgery (MIS) in the treatment of lung cancer, its uptake is still variable and its outcomes debated. This study examines the factors associated with MIS uptake and its effects on survival in patients with non-small cell lung cancer (NSCLC).MethodsAll patients in the Canadian province of Ontario with early stage NSCLC (stage I/II) from 2007 to 2017 were included. A logistic regression identified the predictors of MIS uptake, and a flexible parametric model was used to estimate survival rates based on MIS versus open resection.ResultsIn total, 8,988 patients underwent surgical resection; 53.6% had MIS. Year of diagnosis was associated with MIS uptake (OR = 1.33, p < 0.001); patients in later years were more likely to receive MIS. Rurality was a significant predictor of MIS, though distance from nearest regional cancer center did not predict MIS utilization. Patients with stage II disease were less likely to receive MIS compared to those with stage I disease (OR = 0.44, p < 0.001). MIS had a significantly higher 5-year survival compared to open resection for stage I and II disease. Patients >70 years had the greatest 5-year survival benefit from MIS.ConclusionsWe observed a substantial long-term survival benefit in patients undergoing MIS for early stage NSCLC. This difference was most pronounced in the oldest age group. These findings support the use of MIS in the treatment of lung cancer and challenge the notion that MIS compromises oncologic outcomes.     

Video-assisted thoracoscopic pneumonectomy: a minimally invasive approach for a rare inidication

Minimally invasive video-assisted thoracoscopic surgery (VATS) is considered as an alternative to thoracotomy for early stage lung cancer. Since 2009, we use a VATS approach for all early stage lung tumors as well as benign indications for lung lobectomy. As experience with the technique is growing, indications are expanded. Here, we report our first minimally invasive pneumonectomies of two patients with non-small cell lung cancer (NSCLC). Case 1: A 60-year-old man was diagnosed with a centrally located tumor of the right lung invading all three lobes without any obvious lymph node metastasis in the preoperative work-up. The patient was scheduled for a right-sided VATS pneumonectomy. Case 2: A 62-year-old woman was diagnosed with a centrally located tumor of the left lung with an ipsilateral positron emission tomography (PET) positive lymph node (aortopulmonary window). After neoadjuvant treatment, the patient was scheduled for a left-sided pneumonectomy. Written informed consent was given in both cases. The procedures were completed using three incisions. A complete mediastinal lymph node dissection was performed. The postoperative courses were uneventful. VATS pneumonectomy is feasible in highly selected cases. It offers all advantages known from minimally invasive lung lobectomy with less pain and faster rehabilitation, which might facilitate the delivery of adjuvant treatment.     

Role of diagnostic and ablative minimally invasive surgery for pediatric malignancies

BACKGROUND: The use of minimally invasive surgery (MIS) in pediatric cancer is a matter of debate. The diagnostic and ablative roles of MIS were evaluated in a consecutive series of children with malignancies. METHODS: A prospective study, including all patients, who underwent abdominal and thoracic surgery for confirmed or highly suspected pediatric cancer was performed from September, 2000, to December, 2005. An interdisciplinary panel approved the indication for minimally invasive or conventional surgery. RESULTS: At a single institution, 301 operations were performed on 276 children with cancer. A minimally invasive approach was attempted in 90 of these patients (30%) and successfully employed in 69 (77%) of the operations. However, 21 operations (23%) were converted to an open approach. Regarding the abdominal operations attempted laparoscopically, 41 abdominal operations for biopsy or staging purposes were attempted laparoscopically (53%), but 6 were converted. In all, 139 abdominal resections were performed and 24 were attempted laparoscopically. Ten of these (42%) were converted. In 34 thoracic operations requiring biopsy, thoracoscopy was attempted in 14 (41%) and was successful in all but 1 (93%). Fifty-one thoracic tumors were resected and the thoracoscopic approach was attempted in 11 (22%) and successful in 7 (14%). Conversions from a minimally invasive operation to an open procedure occurred mainly due to limited visibility. Three bleeding complications occurred with 1 patient requiring a blood transfusion. In addition, 1 small bowel injury occurred with immediate laparoscopic closure. There were no port site recurrences after a median of 39 months. CONCLUSIONS: MIS is a reliable diagnostic tool for pediatric abdominal and thoracic malignancy. The role of ablative MIS in pediatric cancer remains limited.     

胸腹腔镜联合微创手术在新辅助治疗食管癌中的应用分析

目的探讨胸腹腔镜联合微创治疗新辅助放化疗食管癌的安全性及可行性。方法回顾分析2012年1月-2013年12月在我院进行新辅助放化疗的35例食管癌患者的临床资料,比较常规三切口手术（常规组）与胸腹腔镜联合微创手术（微创组）的手术时程、术中出血、淋巴结清扫情况、术后引流及围手术期并发症。结果常规组（18例）和微创组（17例）的术后引流量及淋巴结清扫数量差异无统计学意义（P〉0．05）;手术时程及术中出血量方面两组差异具有统计学意义（P〈0．05）,微创组的手术时程长于开胸组,但术中出血量少于开胸组;两组其他术后观察指标的结果差异无统计学意义（P〉0．05）;术后并发症主要为呼吸功能障碍、吻合口瘘,两组均无术后严重并发症致死。结论胸、腹腔镜联合微创治疗新辅助放化疗食管癌安全可行,值得深入研究并推广应用。     

微创手术治疗前列腺癌的疗效研究

目的：探讨经腹腔入路腹腔镜微创手术治疗前列腺癌患者的临床效果。方法选取经腹腔入路腹腔镜微创手术治疗的53例患者作为微创组,及采用开放经耻骨前列腺癌根治术治疗的47例患者作为对照组,比较两组患者手术相关指标及并发症的发生率。结果两组患者术后淋巴结阳性率、精囊阳性率、切缘阳性率差异均无统计学意义（P﹥0.05）;微创组患者的手术时间长于对照组患者,差异有统计学意义（P﹤0.05）;微创组患者术中出血量、导尿管留置时间、胃肠道功能恢复时间、术后下床时间、住院时间均低于对照组患者,差异有统计学意义（P﹤0.05）;术后3个月、6个月,两组患者尿控率、生化复发率差异均无统计学意义（P﹥0.05）。结论经腹腔入路腹腔镜微创手术治疗前列腺癌与传统开腹手术效果相当,但是具有手术创伤小、恢复快的优势。     

Minimally invasive surgery and childhood cancer

Over the last 2 decades, minimally invasive surgery (MIS) has become a significant tool for the diagnosis and treatment of malignant disease in adults. Despite initial reports of port-site metastases and peritoneal spread following laparoscopic resection of colorectal cancer in the 1990s, MIS is now commonly used for many applications in adult surgical oncology, including biopsy and resection of malignant disease in the chest and abdominal cavities, mediastinal and retroperitoneal lymph node dissection, staging of abdominal, pelvic and thoracic malignancies, and management of therapeutic complications. The use of MIS techniques in children is growing with the availability of smaller instruments and equipment more suitable to the pediatric patient. Herein, we review the role of MIS in the diagnosis, staging and treatment of malignant disease in children. We will also evaluate MIS as it applies to the palliation of disease and the management of treatment complications in childhood cancer.     

Recent advances in uniportal video-assisted thoracoscopic surgery

Thanks to the recent improvements in video-assisted thoracoscopic techniques(VATS) and anesthetic procedures, a great deal of complex lung resections can be performed avoiding open surgery. The experience gained through VATS techniques, enhancement of the surgical instruments,improvement of high definition cameras and avoidance of intubated general anesthesia have been the greatest advances to minimize the trauma to the patient. Uniportal VATS for major resections has become a revolution in the treatment of lung pathologies since initially described 4 years ago. The huge number of surgical videos posted on specialized websites, live surgery events and experimental courses has contributed to the rapid learning of uniportal major thoracoscopic surgery during the last years. The future of the thoracic surgery is based on evolution of surgical procedures and anesthetic techniques to try to reduce the trauma to the patient. Further development of new technologies probably will focus on sealing devices for all vessels and fissure, refined staplers and instruments, improvements in 3D systems or wireless cameras, and robotic surgery. As thoracoscopic techniques continue to evolve exponentially, we can see the emergence of new approaches in the anesthetical and the perioperative management of these patients. Advances in anesthesia include lobectomies performed without the employment of general anesthesia, through maintaining spontaneous ventilation, and with minimally sedated patients. Uniportal VATS resections under spontaneous ventilation probably represent the least invasive approach to operate lung cancer.     

Primary and Metastatic Lung Cancer: Rationale,Indications, and Outcomes of Thermal Ablation

The widespread use of imaging as well as the efforts conducted through screening campaigns has dramatically increased the early detection rate of lung cancer. Historically, the management of lung cancer has heavily relied on surgery. However, the increased proportion of patients with comorbidities has given significance to less invasive therapeutic options like minimally invasive surgery and image-guided thermal ablation, which could precisely target the tumor without requiring general anesthesia or a thoracotomy. Thermal ablation is considered low-risk for lung tumors smaller than 3 cm that are located in peripheral lung and do not involve major blood vessels or airways. The rationale for ablative therapies relies on the fact that focused delivery of energy induces cell death and pathologic necrosis. Image-guided percutaneous thermal ablation therapies are established techniques in the local treatment of hepatic, renal, bone, thyroid and uterine lesions. In the lung, and specifically in the setting of metastatic disease, the 3 main indications for lung ablation are to serve as (1) curative intent, (2) as a strategy to achieve a chemo-holiday in oligometastatic disease, and (3) in oligoprogressive disease. Following these premises, the current paper aims to review the rationale, indications, and outcomes of thermal ablation as a form of local therapy in the treatment of primary and metastatic lung disease.