贲门癌进胸切除术式的改进

对贲门癌剖胸术式进行改进，采用左后外切口第八或第九肋床进胸，弧形广泛切开膈肌，腹腔有充分暴露，先清扫胸内淋巴结，离断食管将胃底贲门区向下翻开，清扫，N7，8，9组方便，达到R2以上根治性切除，经病例对照分析，改良组明显优于方法切除组（P＜0．05）。     

贲门癌进胸切除术式改进

贲门癌进胸切除术时因腹腔内暴露较差,淋巴清扫较为困难,仅能达 R_1或 R_1~+。这对中晚期贲门癌来说是不够的。本科自1988年9月以来对贲门癌行左后外切口,采用第八或第九肋床进胸,弧形广范切开膈肌,充分暴露上腹腔脏器,作近端胃大部切除,能达到 R_2以上的淋巴清扫,近期效果满意。     

食管贲门癌切除术后胸胃穿孔三例诊治体会

目的　探讨食管贲门癌切除术后胸胃穿孔的诊断、发生原因及防治措施。方法　收治食管贲门癌 2 16例 ,全部行癌肿切除 +胃食管吻合术。结果　术后发生胸胃穿孔 3例 ,2例治愈 ,1例好转。结论　病人的应激性反应和手术操作的技巧因素是导致本并发症的主要原因。治疗方法采取先予胸腔闭式引流、胃肠减压、空肠造瘘、抗感染及加强营养支持等保守治疗 ,必要时行二次开胸穿孔修补术。     

食管贲门癌切除术后胸胃穿孔三例诊治体会

目的 探讨食管贲门癌切除术后胸胃穿孔的诊断，发生原因及防治措施。方法 收治食管贲门癌216例，全部行癌肿切除。胃食管吻合术。结果 术后发生胸胃穿孔3例。2例治愈。1例好转。结论 病人的应激性反应和手术操作的技巧因素是导致本并发症的主要原因。治疗方法采取先予胸腔闭式引流，胃肠减压，空肠造瘘，抗感染及加强营养支持等保守治疗，必要时行二次开胸穿孔修补术。     

食管贲门癌术后乳糜胸的诊治

 目的 探讨食管贲门癌术后乳糜胸的病因、诊断治疗方法与预防措施。方法 对 1992年至2006年2月共920例食管贲门癌手术后并发8例乳糜胸的临床资料进行分析。结果 5例患者经二次术后痊愈。1例经再次术后乳白色胸液仍存在，最后全身衰竭死亡，2例经保守治疗痊愈。结论 术后乳糜胸一经确诊应进行积极的术前准备和试验性治疗。对于每日血性淡黄或乳白色胸液在500 ~ 1 000 ml，连续2 d未见明显减少者即应立即手术治疗。     

经左肋软骨切断上腹正中切口贲门癌切除术

经左肋软骨切断上腹正中切口贲门癌切除130例,此手术优点是扩大了手术适应证,凡心肺功能较差不适于开胸者,均可耐受此种手术,手术不影响膈肌功能,又无胸腔干扰,出血量一般不超过200ml,作者认为本术式是治疗贲门癌的一种可行术式,但长期效果尚待进一步随访。     

肺切除术后大出血再次剖胸手术的指征探讨

１９８７年７月至１９９１年７月，作者对１９例肺切除术后大出血患者再次剖胸止血治疗。再次剖胸止血手术的并发症发生率及死亡率分别为３１．５％（６／１９）和１０．５％（２／１９）。作者认为剖胸止血应慎重，再次剖胸止血的指征，要根据定量补血条件下血压监测、引流量和胸内积血三方面情况综合考虑；并对出血原因和预防措施进行了讨论。     

食管贲门癌切除术后胸胃部分坏死穿孔八例临床分析

本文报告了我院自１９７５年１２月至１９９２年１２月底施行食管贲门癌切除４２１６例，发生吻合口瘘９２例，其中被证实为胸胃部分坏死穿孔者８例，发生率为０．２％；死亡５例，致死率为６２．５％。本文结合有关文献和临床资料，讨论了胸胃部分坏死穿孔的原因，与吻合口瘘的鉴别和治疗原则，还初步探索了该并发症的实际发生率和命名。     

食管癌贲门癌术后乳糜胸的处理

目的　探讨食管瘤贲门癌切除术后并发乳糜胸的处理方法。方法　本组13例病人中8例行外科手术治疗，术前2小时给予患者500ml牛奶和100～2009动物油口服，通常选择乳糜胸侧开胸切口，双侧乳糜胸则经右侧入路。结果　8例手术者6例痊愈，5例行保守治疗的病人中3例死亡。结论　食管癌贲门癌术后乳糜胸应以外科手术为首选治疗方法，保守治疗只能选择性地应用。     

Muscle-Sparing开胸术与传统开胸术对患者术后应激程度的比较研究

目的:了解微创Muscle-Sparing开胸术(MST)与标准后外侧切口开胸术(SPT)对肺癌患者手术创伤程度的差别。方法:60例患者随机分入SPT组和MST组各30例。对每例患者术前、术后第1、3、7天清晨、空腹抽取静脉血,用ELISA方法测量血清中IL-1β、IL-6、TNF的浓度,应用速率散射比浊法测量超敏C反应蛋白和血清淀粉样蛋白A的浓度。应用SPSS统计软件比较术前、术后两组患者炎性因子和急性反应期蛋白浓度的变化。结果:两组患者术后炎性因子和急性反应期蛋白较术前有明显变化(P<0．05)。IL-1β、TNF变化程度在两个手术组之间没有明显差异(P>0．05)。IL-6的浓度在术后第3天MST组浓度变化较SPT组要低(P<0．05)。超敏C反应蛋白、血清淀粉样蛋白A的浓度在术后第1、3、7天MST组浓度变化均较SPT组要低。结论:微创Muscle-Sparing开胸术相对于传统标准后外侧切口开胸术对机体造成的创伤较小。     

改良开胸手术切口的临床应用价值

目的　探讨减少胸部肿瘤手术切口创伤的方法。方法　 2 0 0 0年 1 0月至 2 0 0 1年 9月间 ,采用不同的手术切口对 40例胸部肿瘤患者进行外科手术 ,其中男性 2 6例 ,女性 1 4例 ,年龄 2 0～ 79岁 ,平均 5 7.4岁 ;肺癌 1 5例 ,肺炎性假瘤、胸腺瘤各 2例 ,支气管类癌、肺囊肿合并感染各 1例 ,食管癌 1 9例。分别采用前外侧切口、腋下直切口—保留胸壁肌肉的切口 (muscle sparingthoracotomy)、保留前锯肌的后外侧切口进行肺叶切除术 1 7例 ,肺段切除术、右中肺叶 +右中间支气管袖状切除术各 1例 ,胸腺瘤切除术 2例和食管癌切除术 1 9例。以传统后外侧切口为对照组 ,观察术后疼痛程度、肩部及上肢活动功能和切口拆线时间 ;肺叶切除术病例还进行了术前后肺功能变化情况及术后住院天数的对照。数据分析采用均数±标准差、t检验、χ2 检验等统计学方法。结果　与传统后外侧切口相比 ,患者术后疼痛明显减轻 ,肩部及上肢活动功能明显改善 ,拆线及住院时间缩短 ,对肺功能的影响也明显减轻。结论　根据病情及局部解剖知识并手术切口进行合理设计能够减少胸部肿瘤手术切口的创伤。     

Long-term outcomes after minimal right lateral thoracotomy for the resection of cardiac tumors

ObjectivesCardiac tumors are a rare and heterogeneous entity, with a cumulative incidence of up to 0.02%. This study aimed to investigate one of the largest patient cohorts for long-term outcomes after minimally-invasive cardiac surgery using right-anterior thoracotomy and femoral cardiopulmonary bypass (CPB) cannulation.MethodsBetween 2009 and 2021, patients who underwent minimally-invasive cardiac tumor removal at our department were included. The diagnosis was confirmed postoperatively by (immune-) histopathological analysis. Preoperative baseline characteristics, intraoperative data, and long-term survival were analyzed.ResultsBetween 2009 and 2021, 183 consecutive patients underwent surgery for a cardiac tumor at our department. Of these, n = 74 (40%) were operated on using a minimally-invasive approach. The majority, n = 73 (98.6%), had a benign cardiac tumor, and 1 (1.4%) had a malignant cardiac tumor. The mean age was 60 ± 14 years, and n = 45 (61%) of patients were female. The largest group of tumors was myxoma (n = 62; 84%). Tumors were predominantly located in the left atrium in 89% (n = 66). CPB-time was 97 ± 36min and aortic cross-clamp time 43 ± 24 min s. The mean hospital stay was 9.7 ± 4.5 days. The perioperative mortality was 0%, and all-cause mortality after ten years was 4.1%.ConclusionMinimally-invasive tumor excision is feasible and safe, predominantly in benign cardiac tumors, even in combination with concurrent procedures. Patients who require cardiac tumor removal should be evaluated for minimally-invasive cardiac surgery at a specialized center, as it is highly effective and associated with good long-term survival.     

70岁以上高龄食管贲门癌的外科治疗

目的：为总结高龄食管贲门癌病人外科治疗经验，进一步降低手术死亡率，提高外科治疗效果。方法：回顾性分析３３例７０岁以上高龄食管贲门癌手术治疗资料（食管癌９例，贲门癌２４例）。结果：高龄患者术前多伴发心肺系统疾病，术后并发症发生率较高（２７．３％），以肺部感染为主；五年生存率：食管癌２５％，贲门癌２７．３％。结论：对高龄食管贲门癌的手术治疗应持积极态度，手术适应证应全面衡量患者的生理年龄及病灶情况；降低手术死亡率的关键在于做好充分的术前准备，加强术中管理和积极处理术后并发症。     

对比研究胸腔镜与剖胸手术诊治孤立性肺结节

目的 对比研究胸腔镜与剖胸手术楔形肺切除诊治孤立性肺结节的有效性及临床应用价值。方法 回顾性分析73例临床诊断为孤立性肺结节且无明确病理诊断的患者，分别接受胸腔镜或剖胸手术行肺楔形切除。结果 两组的手术时间、术后恢复观察时间、胸腔闭式引流时间和引流量、术后止痛药物的用量、病变大小、活检准确性以及总住院时间、术后住院时间、住院费用等均无统计学差异，所有病例都获得病理确诊。结论 胸腔镜与剖胸手术对孤立性肺结节的诊断和病灶切除无显著性差别，两者都是可接受的手术方式。     

肺癌患者开胸术后发生肺不张的预防及治疗

背景与目的肺不张是开胸术后的常见并发症,严重时会危及患者生命。本文旨在分析和探讨肺癌患者行开胸术后发生肺不张的原因和围手术期的预防和处理措施,以便降低肺不张的发生率,并提高其治愈率,以进一步降低围手术期死亡率。方法回顾性统计和分析我科因肺癌行开胸手术的374例患者中发生肺不张的资料和处理措施。结果374例肺癌患者行开胸手术后发生肺不张的有14例,经积极有效地治疗后肺不张的肺叶均复张。结论肺癌开胸术后肺不张发生率不高,有效的术前准备、良好的围术期处理和术后治疗可以降低开胸术后肺不张的发生率,提高治愈率。背景与目的肺不张是开胸术后的常见并发症,严重时会危及患者生命。本文旨在分析和探讨肺癌患者行开胸术后发生肺不张的原因和围手术期的预防和处理措施,以便降低肺不张的发生率,并提高其治愈率,以进一步降低围手术期死亡率。方法回顾性统计和分析我科因肺癌行开胸手术的374例患者中发生肺不张的资料和处理措施。结果374例肺癌患者行开胸手术后发生肺不张的有14例,经积极有效地治疗后肺不张的肺叶均复张。结论肺癌开胸术后肺不张发生率不高,有效的术前准备、良好的围术期处理和术后治疗可以降低开胸术后肺不张的发生率,提高治愈率。     

Growth rate of newly developed metastatic brain tumors after thoracotomy in patients with non-small cell lung cancer

Among 1372 lung cancer patients without brain metastasis that underwent resection of lung cancer at our center from 2001 to 2007, brain metastases developed in 72 patients (5.2%) during their hospital course. We hypothesized that there were micro-metastases in the brain at the time of lung surgery in these patients, even though there were no detectable brain metastases on the MRI. The purpose of this study was to evaluate the growth rates of metastatic brain tumors in this unique subset of patients, and to compare the findings with our previous study that calculated the growth rate of brain metastases during chemotherapy. Among 72 patients, 23 with cystic or hemorrhagic metastases were excluded. Seventy-six metastatic brain tumors in 49 patients were reviewed. Twenty-five patients underwent adjuvant or neoadjuvant chemotherapy; however, for the rest of the patients, chemotherapy was not added after lung cancer surgery. The tumor volume was determined using V-works software (v. 4.0) (Cybermed, Seoul, Korea) and T1 gadolinium enhanced MR images. The overall median tumor growth rate was 11.7 mm³/day (interquartile range, 4.9-26.8). There were no statistically significant differences in the tumor growth among the lung cancer stages and the growth rate was similar regardless of the use of chemotherapy. The growth rate reported in this study shows consistency with that of our previous report (12.1 mm³/day). These findings may help optimize patient management during follow up.     

Evaluation of an early exercise intervention after thoracotomy for non-small cell lung cancer (NSCLC), effects on quality of life, muscle strength and exercise tolerance: Randomised controlled trial

Deterioration in exercise tolerance and impairment in quality of life (QoL) are common consequences of lobectomy. This study evaluates additional exercise and strength training after lung resection on QoL, exercise tolerance and muscle strength. Fifty-three (28 male) patients attending thoracotomy for lung cancer, mean age, range 64 (32-82) years; mean pack years (SD) 31.9 (26.8); BMI 25.6 (4.2); FEV1 2.0 (0.7) l were randomised to control (usual care) or intervention (twice daily training plus usual care). After discharge the intervention group received monthly home visits and weekly telephone calls, the control group received monthly telephone calls up to 12 weeks. Assessment pre-operatively, 5 day and 12 weeks post-operatively consisted of quadriceps strength using magnetic stimulation, 6 Minute Walking Distance (6MWD) and QoL-EORTC-QLQ-LC13. QoL was unchanged over 12 weeks; 6MWD showed significant deterioration at 5 days post-operatively compared with pre-operatively, mean difference (SD)−131.6 (101.8) m and −128.0 (90.7) m in active and control groups respectively (p = 0.89 between groups) which returned to pre-operative levels by 12 weeks in both groups. Quadriceps strength over the 5 day in-patient period showed a decrease of −8.3 (11.3) kg in the control group compared to increase of 4.0 (21.2) kg in the intervention group (p = 0.04 between groups). Strength training after thoracotomy successfully prevented the fall in quadriceps strength seen in controls, however, there was no effect on 6MWD or QoL. 6MWD returned to pre-operative levels by 12 weeks regardless of additional support offered.     

血管正常化提高肿瘤治疗疗效

抗血管生成治疗作为肿瘤靶向治疗方式已得到临床广泛应用。抗血管生成治疗诱导的血管正常化效应机制,可以逆转肿瘤内部结构和功能异常的新生血管,改善肿瘤微环境的组织间隙高压、低氧和酸中毒,提高放化疗及免疫治疗的疗效。     

微创肌肉非损伤性开胸术治疗肺癌

目的：研究微创肌肉非损伤性开胸术在肺癌手术中的应用。方法：采用肌肉非损伤性开胸术对30例肺癌患者进行了手术治疗。结果：肺叶切除24例,支气管袖状切除2例,肺楔形切除2例,全肺切除2例,2例经心包内处理肺血管。手术能充分暴露,无围术期并发症,28例没有输血,结论：微创肌肉非损伤性开胸术,能提供充分的手术暴露,同时肌肉损伤轻微,减少术中出血和术后并发症的发生,肩关节功能术后恢复快,这种方法是手术治疗肺癌的可选择的方法。