电视胸腔镜切除肺转移瘤

电视胸腔镜切除肺转移瘤金庆文，张熙曾，尤健，牛孜耕，哈金铭我院自１９９４年初应用电视胸腔镜手术（Ｖｉｄｅｏ－ＡｓｓｉｔｅｄＴｈｏｒａｃｉｃＳｕｒｇｅｒｙ）ＶＡＴＳ治疗恶性胸水及切除后纵隔神经性肿瘤后又使用ＶＡＴＳ切除１例左肾癌伴双肺转移，现报告如下。...     

电视胸腔镜诊治恶性胸腔积液18例报告

目的 评价电视胸腔镜手术（ＶＡＴＳ）在恶性胸腔积液诊治中的应用价值。方法 １８例恶性胸腔积液患者行胸腔镜知检和滑石粉胸膜固定术，术后加低负压胸腔引流。结果 １８例均获病理确诊，其中恶性胸膜间皮瘤２例，乳腺癌胸膜转移６例，肺癌胸，卵巢癌和胃癌胸膜转移各１例。胸膜固定成功１６例；失败２例，其原因为肺癌伴有肺不张。结论 ＶＡＴＳ可以大大提高恶性胸腔积液的确诊率和胸膜固定术的效果，术后低坟胸腔引渡以有利于     

电视胸腔镜食管癌切除术(附11例报告)

自１９９５年１２月至１９９６年５月，我们行电视胸腔镜食管癌切除术１１例，其中Ｔ２Ｎ０Ｍ０２例，Ｔ３Ｎ０Ｍ０７例，Ｔ３Ｎ０Ｍ０２例。病理诊断：均为鳞状上皮细胞癌。病变位于食管中段１０例，中下段１例。并发症：吻合口小瘘１例２３天治愈出院，１例术后第６天，突发全心衰竭死亡。余恢复顺利。作者对ＶＡＴＳ食管癌切除术的方法、适应症、肿瘤的游离和淋巴结的清扫等问题进行了探讨。     

电视胸腔镜食管癌切除术

自１９９５年１２月于１９９６年５月，我们行电视胸腔镜食管癌切除术１１例，其中Ｔ２Ｎ０Ｍ０２例，ＴＮ３Ｎ０Ｍ０７例，Ｔ３Ｎ０Ｍ０２例。病理诊断：均为鳞状上皮细胞癌。病变位于食管中段１０例，中下段１例。并发症：吻合口小瘘１例２３天治愈出院，１例术后第６天，突发全心衰竭死亡。余恢复顺利。作者对ＶＡＴＳ食管癌切除术的方法、适应症、肿瘤的游离和淋巴结的清扫等问题进行了探讨。     

电视胸腔镜下纵隔肿瘤摘除八例报告

电视胸腔镜下纵隔肿瘤摘除八例报告房师猛初向阳赵丽＊自１９９１年开展电视胸腔镜外科（ｖｉｄｉｏ－ａｓｓｉｓｔｅｄｔｈｏｒａ－ｃｏｓｃｏｐｉｃｓｕｒｇｅｒｙ，ＶＡＴＳ）以来，共行纵隔肿瘤摘除术８例，现报告如下：１临床资料１．１病例：全组８例，其中男...     

胸腔镜术后切口癌种植二例报告

胸腔镜术后肿瘤在切口种植很少见。自１９９４年７月至１９９８年７月,在我科完成的１１例肺部恶性肿瘤的电视胸腔镜手术（ＶＡＴＳ）,有２例出现切口癌种植,现报告如下。１病例报告例１,男性,６３岁,８月前因体检发现左肺上叶肿瘤住院治疗,术前辅助检查未能明确肿...     

电视辅助胸腔镜外科在肺肿瘤诊断治疗中的地位

0世纪初随着可控人工气胸的发展 ,胸腔镜技术亦应运而生。瑞典医生Ｊａ ｃｏｂｅａｕｓ首次于 1910年用膀胱镜来观察胸腔内结构 ,松解胸腔粘连 ,使肺萎陷以治疗肺结核[1、2 ] 。此项技术由此而在欧洲繁荣发展起来 ,被应用于诊断和治疗胸膜疾病 ,例如胸膜渗出、脓胸和原发及继发性胸膜恶性疾病。 80年代末 ,随着电视胸腔镜、电子技术以及胸腔镜专用切割缝合器械的发展 ,使胸腔镜技术逐渐完善 ,并被赋于一个新名字———电视辅助胸腔镜外科 (ＶＡＴＳ)。十几年来 ,ＶＡＴＳ已应用于多种胸部外科疾病手术中 ,并取得长足进步。本文主要讨论ＶＡ…     

电视辅助胸腔镜外科在胸部肿瘤中的应用

近年来，电视辅助胸腔镜外科发展迅速，反映出现代胸外科向微创化方向发展的趋势。本文对目前ＶＡＴＳ在胸部肿瘤临床诊治中的作用进行了总结和评价。     

立体定向放射治疗肺肿瘤临床初步报告：附21例分析

目的　探讨立体定向放射治疗肺肿瘤的近期疗效。方法　立体定向放射治疗２１ 例肺肿瘤。肿瘤体积８～３８８ ｃｍ ３。鳞状细胞癌１０ 例，腺癌７ 例，小细胞癌２ 例，恶性黑素瘤肺转移１ 例，骨肉瘤肺转移１ 例。 Ｓ Ｔ Ａ Ｒ１０００立体定向计划系统制作计划，直线加速器８ Ｍ Ｖ Ｘ 射线实施治疗。 Ｂ Ｅ Ｖ 方向５～８ 个非共面照射野， Ｐ Ｔ Ｖ 一次治疗剂量５～１０ Ｇｙ，总剂量为２５～５０ Ｇｙ。 Ｓ Ｒ Ｔ 疗程为１～２ 周。结果　６ 周后 Ｃ Ｔ 复查， Ｃ Ｒ 率４８％ ， Ｐ Ｒ 率４３％ ，总有效率９１％ 。结论　 Ｓ Ｒ Ｔ 临床应用可提高肿瘤局部的控制率。 Ｓ Ｒ Ｔ治疗剂量与亚临床淋巴引流区的常规放疗剂量应一同计划设计。 Ｓ Ｒ Ｔ 的合理应用尚需进一步的临床研究和随访。     

脉络丛乳头状瘤术后放射治疗4例报告和文献复习

目的　报告４ 例脉络丛乳头状瘤（ Ｐ Ｃ Ｐ） 术后放射治疗结果，复习相关文献，探讨间变型脉络丛乳头状瘤（ Ｐ Ａ Ｃ Ｐ） 病理诊断标准和放射治疗在脉络丛肿瘤治疗中的作用。方法　作者对４ 例术后残存的第４ 脑室脉络丛肿瘤行瘤床局部放射治疗。放射治疗采用６ 或８ Ｍ Ｖ Ｘ 线，靶区包括术前 Ｃ Ｔ 显示瘤床外１ ～２ ｃ ｍ ，常规分割， Ｄ Ｔ４０ ～５５ Ｇｙ 。复习１９７５ 年以来的部分相关文献。结果　１ 例疗后失随。３ 例经２ 年随访，１ 例成人无复发，正常工作生活；２ 例儿童分别于疗后２１ ，２４ 个月野内复发，其中１ 例（ 例３） 伴广泛脑脊膜种植转移。结论　脉络丛肿瘤的病理诊断与其临床生物学行为不完全一致， Ｐ Ａ Ｃ Ｐ病理诊断标准有待完善。绝大多数 Ｐ Ｃ Ｐ 可经手术彻底切除治愈； Ｐ Ａ Ｃ Ｐ 术后应行全脑全脊髓放射治疗。     

Video-assisted thoracoscopic resection of pulmonary lesions

AIMS: To determine the role of video-assisted thoracoscopic resection in the diagnosis of benign or malignant peripheral pulmonary lesions. PATIENTS AND METHOD: In 157 patients, between 1996 and 2001, video-assisted thoracoscopy was used to remove a pulmonary lesion. Conversion rate, complications and histology are presented. RESULTS: In 21 patients, conversion to a thoracotomy was necessary, four times because the pulmonary lesion was malignant and seventeen times due to technical difficulties. In patients without any previous history of malignant disease (n=100), 80% of the lesions were benign. In patients with malignant pulmonary lesions (n=21), curative resection was possible, 3 through VATS and 4 through thoracotomy. Pulmonary lesions in patients with a previous history of malignant disease were malignant in 42 patients. Curative VATS resection of a solitary lesion was performed in 9 patients, in 10 patients thoracotomy was necessary to remove multiple lesions. CONCLUSIONS: With a pre-operative selection of the patients the rate of secondary thoracotomies due to bronchial carcinoma is low (4%). In patients with a previous history of malignant disease, 22% of the pulmonary lesions are benign. VATS is a safe diagnostic method, with little discomfort for the patient.     

右心肿瘤的外科治疗

目的总结右心系统肿瘤的发生部位、肿瘤性质、诊断及外科治疗方法.方法 1979年1月～2003年5月我们对27例右心系统肿瘤患者行手术治疗,占同期心脏肿瘤患者的14.1%,男16例,女11例.年龄17～70岁,平均(39.9±13.6)岁.其中良性肿瘤25例,恶性肿瘤2例.结果手术死亡1例,死亡率3.7%.余26例术后随访3个月至15年,2例恶性肿瘤分别于术后5个月、9个月死亡,1例黏液瘤于术后10个月复发.结论临床右心肿瘤以黏液瘤多见,彻底切除肿瘤是防止心脏肿瘤复发的关键.心脏恶性肿瘤手术切除近远期效果差.     

Primary gastrointestinal lymphoma

Sixteen cases of primary malignant lymphoma of the gastrointestinal tract were reviewed because of some controversy concerning its proper management. An intraabdominal disease staging system with prognostic correlation was used. Treatment employed was either (biopsy plus) irradiation alone or surgical resection of abdominal neoplasm with postoperative radiotherapy. Conventional megavoltage locoregional or subtotal/whole abdomen irradiation with an often given total dosage of 3,000-4,000 cGy up to 5.5 weeks was applied. Overall 4-year disease-free survival rate was 71%. Operative removal of neoplasm appeared important for an improved prognosis. Definitive radiotherapy alone did not have a dismal outcome.     

电视胸腔镜治疗胸部肿瘤11例报告

作者自1996年6月以来,采用电视胸腔镜手术治疗胸部肿瘤。共治疗11例,其中良性肿瘤4例,恶性肿瘤7例。行胸腔镜肺切除术2例,肺楔形切除术7例,胸膜活检及固定术2例,手术均获成功,效果良好,无严重并发症,文中重点介绍了胸腔镜肺叶切除术、胩楔形切除术、胸膜活检及固定术。胸膜粘连的手术处理方法。结果显示,电视胸腔镜治疗肿瘤具有手术创伤小、出血少,病人恢复快、效果好的特点。为胸部肿瘤的治疗开拓了广阔的前景。     

计算机断层扫描三维重建联合带钩钢丝定位对ⅠA期肺癌的诊疗价值研究

目的探讨计算机断层扫描(CT)三维重建联合带钩钢丝(Hookwire)定位在ⅠA期肺癌诊疗中的应用效果。方法选取94例孤立性肺结节(SPN)患者作为研究对象,根据术后病理分为恶性SPN组(60例)和良性SPN组(34例)。记录并比较两组患者术前病灶影像学特征,记录患者电视胸腔镜手术(VATS)手术情况,包括手术时间、术中出血量、住院时间及Hookwire定位操作和VATS手术相关并发症。结果良恶性SPN病灶血管集束征、空泡征及左右肺分布比例比较,差异均无统计学意义(P﹥0.05)。恶性SPN边界不规则、毛刺征、分叶征、胸膜凹陷征、内部钙化灶和肺上叶比例均高于良性SPN病灶,差异均有统计学意义(P﹤0.05)。Hookwire定位针首次定位成功率为98.94%(93/94),二次定位成功率为100%。术中发现定位针脱落2例(2.13%),VATS楔形切除手术成功率为98.94%,1例因胸膜粘连严重转行微创开胸手术。VATS楔形切除手术时间为(20.75±8.22)min,术中出血量(26.58±9.43)ml,术后住院时间(5.45±2.16)d。定位操作和术后并发症发生率分别为17.02%(16/94)和4.26%(4/94)。结论CT三维重建联合Hookwire定位较好地解决了ⅠA期肺癌精准定位切除的问题,但也存在定位针脱落等风险,仍需进一步研究论证。     

Multicentric carcinoma of the esophagus and double primary malignant neoplasm of the upper alimentary tract--report on 44 patients

During the past fifteen years, 44 patients with multicentric carcinoma of the esophagus or double primary malignant neoplasm of the upper alimentary tract, collected from 5316 patients with cancer of esophagus or gastric cardia in the same period, were treated in our hospital. The incidence was 0.83%. All were proven by pathology. Exploratory thoracotomy was done in 32 patients and 26 lesions were resected with a resection rate of 81.3%. All patients with cancer resected survived over 1 year, 6 out of 9 survived over 3 years and 2 out of 3, over 5 years. In the 18 patients who received chemotherapy alone, 12 were followed and all died within 1 year. It is shown that multicentric carcinoma of the esophagus or double malignant neoplasm of the upper alimentary tract should be given energetic treatment. Finally, the incidence, diagnosis criteria, diagnosis method, etiology and management are discussed with a review of literature.     

The use of iodine seed (I-125) as a marker for the localisation of lung nodules in minimal invasive pulmonary surgery

Aim

Video assisted thoracic surgery (VATS) is an important tool in the field of thoracic pathology both for therapeutic and diagnostic purposes. The standard technique for localisation of non-visible or non-palpable lung lesions is the use of image guided insertion of a guide-wire. However, this method is associated with complications such as pneumothorax, bleeding and wire-dislocation. The aim of this study was to investigate the feasibility of using of iodine seeds (I-125) as a marker of lung lesions during VATS.

Methods

28 consecutive patients with parenchymal lung lesions had I-125 seed localisation performed prior to VATS. After seed placement all patients underwent VATS with wedge resection.

Results

During surgery all lesions could be identified and radically resected. In six (21.4%) patients the seed was not placed optimally but none of these cases were associated with seed dislocation after placement. In four and in 5 patients the placement of the I-125 seed was complicated by a haematoma and pneumothorax respectively. However, in all of these patients a wait-and-see policy would have been justified. In one patient a conversion to a thoracotomy was necessary due to seed displacement.

Conclusion

In patients with parenchymal lung lesions undergoing VATS and wedge resection I-125 seed localisation is a feasible technique. Complication rates are comparable to standard guide-wire localisation. Although I-125 seeds can be positioned under CT-guidance an optimal placement is of utmost importance for VATS wedge resection. Further research is needed to investigate the possible advantages of this technique.     

外科治疗肺孤立性结节45例临床分析

目的：探讨肺孤立性结节的临床特点和治疗方法。方法：回顾性分析我科2003年1月至2009年5月手术治疗45例肺孤立性结节（直径≤3cm）的临床资料,其中开胸肺叶切除术25例,胸腔镜下肺叶切除5例,肺楔形切除术14例,肺肿瘤摘除术1例。结果：术后病理诊断腺癌13例,鳞癌5例,小细胞癌2例,肺泡细胞癌1例,腺样囊性癌1例,转移性癌3例,结核球或肉芽肿8例,炎性假瘤8例,肺曲菌病3例,硬化性血管瘤1例。所有患者均无严重并发症痊愈出院。结论：肺孤立性结节病因复杂,诊断有一定的困难,恶性病变比例较高,尽早手术是明确诊断和提高治愈率的关键。     

Metachronous leiomyosarcoma in colostomy after abdominoperineal resection for rectal carcinoma

Leiomyosarcoma of the colon is a rare neoplasm. It is widely known that primary malignant lesions may present either simultaneously (synchronous tumor) or at different times (metachronous tumor). The incidence of metachronous colonic mucosal carcinoma is generally considered to range from 3 to 5%. Metachronous leiomyosarcoma in colostomy 4 years after abdominoperineal resection for rectal carcinoma is unusual and we have found no reports on this in the literature. The clinical symptoms, diagnostic features, and mode of treatment are discussed.     

38例无症状肺孤立性微小结节的电视辅助胸腔镜手术诊治

目的：探讨电视辅助胸腔镜手术（VATS）在无症状肺部孤立性微小结节的诊断、鉴别诊断以及治疗中的可行性和意义.方法：对38例无症状肺部孤立性微小结节患者进行了VATS诊治;结节直径均＜1.5cm,最小者0.3 cm;13例（34%）术前拟诊为肺癌,余25例（66%）拟诊为肺部良性病变;所有患者术前均未能获得明确病理学诊断.结果：所有患者均顺利完成手术,无严重术中、后并发症和围手术期死亡.全组患者均获得明确病理学诊断,确诊率100%.其中恶性病变11例（29%）,良性病变27例（71%）.5例（38%）术前拟诊为恶性病变的患者最终确诊为良性病变;3例（12%）术前拟诊为良性病变的患者最终确诊为恶性病变.本组中27例良性病例经VATS手术均获得临床治愈.11例肺癌患者中9例接受了根治性肺叶切除＋纵隔淋巴结清扫术;另2例患者仅接受姑息性结节楔形切除术.结论：VATS技术可应用于无症状肺孤立性微小结节的确诊,对良性或恶性病变均可获得满意的疗效,可行性良好,与传统诊疗方法相比具有明显的优势,有助于肺癌的早期诊断与治疗.