全胸腔镜肺叶/肺段切除治疗肺癌112例

目的探讨全胸腔镜肺叶/肺段切除术治疗肺癌的效果及国产内镜器械的应用效能。方法将2009年1月至2012年12月全胸腔镜肺叶切除112例中的前后各56例分成两组,统计手术时间、淋巴结清扫数量、术中失血量、术后胸引量、带管时间、术后住院时间、疼痛评分、术后并发症、器械问题指标并进行对比。结果前后两组在手术时间、术中失血量、术后胸引量、术后住院天数、并发症差异显著,疼痛评分、医疗费用方面有统计学差异(P<0.05);淋巴结清扫数量和引流时间无统计学差异(P>0.05)。国产内镜器械和进口器械在使用中出现的相关问题差异无统计学意义(P>0.05)。结论全胸腔镜肺叶切除/肺段切除治疗肺癌,具有安全、快速、微创的优势。随着技术的提高和器械的改进,全胸腔镜肺叶手术技术将越来越适用于临床。国产内镜器械在使用上是安全的。     

肺叶切除并肺段支气管剔除术治疗多段型支气管扩张

1993年 2月～ 1999年 10月 ,我们应用肺叶切除并肺段支气管剔除术治疗多段型支气管扩张 2 5例 ,取得较好效果。现报告如下。材料与方法　 2 5例中男 10例 ,女 15例 ;年龄 18～ 4 2岁。病史 5～ 3 0年。均有反复咳嗽、咳脓痰 ;咯血 2 0例 ,间断发热 16例。经支气管碘油造影 ,胸部Ｘ线正侧位片或ＣＴ检查 ,确诊为多段型支气管扩张合并肺叶纤维化或实变。手术在双腔气管插管、静脉复合麻醉下施行。后外侧切口开胸。首先切除实变或严重纤维化的肺叶 ;然后根据术前支气管碘油造影或ＣＴ诊断结果 ,结合术中探查 ,找到扩张的肺段支气管 ,解剖分离 ,…     

虚拟现实导航技术在胸腔镜下肺段切除中的临床应用

目的探讨三维虚拟现实导航技术(VR)对于胸腔镜下肺段切除术中及术后的影响。方法选取解放军总医院2016年10月至2017年2月中8例胸腔镜下肺段切除手术作为研究对象,随机分为VR辅助组和传统组,对比术中出血量、手术时间及术后恢复时间的差异。结果 VR组术中出血量较传统组明显减少(12.25±2.22 vs.60.25±9.74)ml,VR组手术时间较传统组显著缩短(84.50±5.57 vs.116.50±6.61)min;VR组术后恢复时间较传统组略有缩短(4.25±0.96 vs.8.00±0.82)d。(P0.05)。结论利用虚拟现实导航技术进行术前评估,详细制定手术计划,规划手术路线,术中实时导航,预显示重要解剖结构,切实减少了肺段切除手术的难度,对于肺段切除手术的普及具有重大意义。     

肺部磨玻璃结节的CT影像特征评估肺腺癌浸润性的价值

目的探讨肺部磨玻璃结节的电子计算机断层扫描(CT)影像特征,对肺腺癌浸润性的评估价值。方法选取2016年2月-2018年10月来我院经CT扫描和病理检查确诊的62例磨玻璃结节患者,其中分为非浸润性腺癌组(n=34)和浸润性腺癌组(n=28),比较两组CT征象,采用Logistic回归分析法,分析影响肿瘤浸润的危险因素,采用受试者工作特征曲线(ROC)下面积(AUC)比较各危险因素对肺腺癌浸润性的预测价值。结果非浸润性腺癌组的病灶直径、CT值、相对CT值、病灶边缘、空气支气管征、胸膜凹陷征和磨玻璃类型与浸润性腺癌组比较,差异具有统计学意义(P 0. 05); Logistic回归分析显示,病灶直径和空气支气管征可作为评估浸润性腺癌的危险因素(P 0. 05);病灶直径的AUC值明显高于空气支气管征的AUC值(P 0. 05)。结论肺部CT扫描磨玻璃结节的病灶直径,有助于术前预测患者有无浸润性肺腺癌的可能,可用作临床治疗方案选择的参考。     

肺磨玻璃结节CT三维重建精确定位在胸腔镜肺段切除中的应用

目的分析肺磨玻璃结节CT三维重建精确定位在胸腔镜肺段切除中的应用。 方法选取2019年5月至2021年1月我院收治择期行胸腔镜肺段切除术治疗的43例肺磨玻璃结节患者,根据检查方法分为对照组23例和观察组20例。术前对照组采用导丝针(医用胶)定位,观察组采用CT三维重建精确定位,记录定位病变的时间及手术时间;统计定位成功、定位有效例数,中转开胸患者比例;统计术后气胸、出血、严重胸痛患者比例。 结果两组患者中转开胸患者比例差异不大(P>0.05)。观察组患者定位病变时间、手术时间显著缩短,定位成功、有效率较对照组升高,术后气胸、出血、严重胸痛患者比例显著降低(P<0.05)。 结论CT三维重建定位技术可提高胸腔镜肺段切除手术术前肺磨玻璃结节定位的成功、有效率,缩短定位病变、手术时间,减少术后并发症发生率,在胸腔镜肺段切除手术治疗中具有较好的临床应用价值。     

miR-147在肺腺癌中的表达及意义

目的观察miR-147在肺浸润性腺癌中的表达,探讨其与细胞增殖和血管内皮生长因子(VEGF)的关系,分析其临床意义。方法选取2015年1月-2015年07月我院收治的65例肺浸润性腺癌患者作为研究对象,留取肿瘤组织作为观察组,留取正常肺组织作为对照组,应用实时荧光定量PCR法检测二组组织中miR-147的表达,应用免疫组化方法检测观察组中Ki67和VEGF的表达。结果观察组中miR-147的表达明显低于对照组(P<0.05),观察组中miR-147的表达在有无胸膜累犯、不同肿瘤最大径、有无淋巴结转移及不同TNM分期的表达中,差别有统计学意义(P<0.05)。miR-147的表达与增殖指数、miR-147和VEGF均呈负相关性(P<0.05)。生存分析显示miR-147的表达与生存时间相关(P<0.05)。结论肺浸润性腺癌中miR-147低表达是肿瘤形成的重要分子事件,其参与肿瘤的进展,miR-147的作用与对细胞增殖和VEGF的调节有关。miR-147的表达可能与预后有关。     

原发性肺黏液腺癌文献复习并3例报道

目的 分析原发性肺黏液腺癌(primary pulmonary mucinous adenocarcinoma, PPMA)的临床表现、影像学特征、病理特点、治疗等,提高临床对该病的认识。方法 选择2022年6月至2022年10月收治的3例原发性肺黏液腺癌的临床诊治经过,3例为女性,年龄73～85岁,为高龄。结合文献复习,提高对原发性肺黏液腺癌临床表现、影像学特征、病理特点等认识,提高诊断及治疗水平。结果 原发性肺黏液腺癌以浸润性黏液腺癌为主,临床表现无特异性,易被误诊,诊断主要依靠病理,治疗以早期手术为主。结论 原发性肺黏液腺癌是肺腺癌的一种特殊亚型,临床诊断缺乏特异性,诊断主要依赖活组织病理。     

胸腔镜在不能耐受肺叶切除肺癌治疗中的价值

目的探讨不能耐受肺叶切除的肺癌患者利用胸腔镜行肺局限切除的临床价值。方法 15例不能耐受肺叶切除的肺癌患者利用胸腔镜行肺局限切除术治疗,12例行根治性肺叶切除手术,比较两组患者的临床治疗效果。结果行局限切除后3年生存率为73.3%、复发率为26.7%、围手术期无并发症发生;根治性肺叶切除手术的3年生存率为66.7%、复发率为25%、围手术期出现并发症3例。比较组间生存率、复发率差异无统计学意义,P0.05;而围手术期并发症发生率差异有统计学意义,P0.05。结论心肺功能低下的不能耐受肺叶切除肺癌患者行局限性肺切除是一种较理想的选择。     

肺浸润性腺癌中肿瘤易感基因101和上皮型黏附蛋白的表达

目的检测肺浸润性腺癌中肿瘤易感基因(TSG)101和上皮型黏附蛋白(E-cadherin)的表达,探讨二者关系及意义。方法确诊为肺腺癌的术后标本68例作为观察组,选择距肿瘤边缘>3 cm的正常肺组织18例作为对照组,均留取术后石蜡包埋的组织,应用免疫组化SP法检测两组中TSG101和E-cadherin的表达。结果两组中TSG101和E-cadherin表达的阳性率差异有统计学意义(P<0.01),两组中TSG101和E-cadherin表达的阳性率与肿瘤的淋巴结转移密切相关(P<0.05),TSG101的表达与肿瘤的分化程度相关(P<0.05),E-cadherin的表达与肿瘤的胸膜累犯密切相关(P<0.05)。二者均与患者的性别、年龄无关(P>0.05)。线性相关分析显示二者在观察组中的表达无相关性(P>0.05)。结论 TSG101和Ecadherin在肺腺癌中异常表达可以促进肿瘤的形成和进展。TSG101和E-cadherin无明显的协同作用。     

全胸腔镜肺叶切除术在肺良恶性疾病治疗中的应用

目的探讨全胸腔镜（VATS）肺叶切除术治疗肺良恶性疾病临床疗效。方法总结2010年8月～2012年9月采用胸腔镜治疗17例肺良恶性疾病的临床资料,其中右肺上叶6例,右肺下叶2例,右肺中叶2例,右肺中上叶1例,右肺中下叶2例,左肺上叶2例,左肺下叶2例。术后病理：鳞癌11例,腺癌2例,支气管扩张2例,硬化性血管瘤1例,错构瘤1例。结果1例因胸腔严重粘连,镜下处理困难而中转开胸行VATS辅助小切口手术,余16例全胸腔镜下完成。全组无围手术期死亡。手术时间80一240rain,平均140．2min;手术出血量50～800ml,平均150ml;切除淋巴结4～25枚,平均15．2枚;胸腔引流管留置时间48～92h,平均69．3h;术后总引流量200～900ml,平均300．5ml;术后住院天数7～14d,平均10．5d。回访所有患者均生存良好。结论全胸腔镜肺叶切除治疗肺良恶性疾病能够完成肺门及纵隔淋巴结的清扫,同时具有手术创伤小,出血少,术后疼痛轻,恢复快,并发症少的优点。     

Introduction of robotic surgery leads to increased rate of segmentectomy in patients with lung cancer

BackgroundPulmonary segmentectomy provides an anatomic lung resection while avoiding removal of excess normal lung tissue. This may be beneficial in patients with minimal pulmonary reserve who present with early-stage non-small cell lung cancer (NSCLC). However, the operative performance of a segmentectomy using a video-assisted thoracoscopic approach can be technically challenging. We hypothesized that introduction of the robotic surgical system would facilitate the performance of a segmentectomy as measured by an increase in the proportion of segmentectomies being pursued.MethodsWe completed a retrospective analysis of thoracoscopic and robotic anatomic lung resections, including lobectomies and segmentectomies, performed in patients with primary lung cancer from the time of initiation of the robotic thoracic surgery program in November 2017 to November 2019. We compared the proportion of thoracoscopic and robotic segmentectomies performed during the first year compared to the second year of the data collection period.ResultsA total of 138 thoracoscopic and robotic anatomic lung resections were performed for primary lung cancer. Types of lung cancer resected (adenocarcinoma, squamous cell carcinoma, or other), tumor size based on clinical T staging (T1–T4), and tumor location were not significantly different between years (P=0.44, P=0.98, and P=0.26, respectively). The proportion of segmentectomies increased from 8.6% during the first year to 25.0% during the second year (P=0.01). One out of 6 (16.7%) segmentectomies were performed using the robot during the first year versus 15 out of 17 (88.2%) during the second year (P=0.003).ConclusionsUse of the robot led to a significant increase in the number of segmentectomies performed in patients undergoing anatomic lung resection. With increasing lung cancer awareness and widely available screening, a greater number of small, early-stage tumors suitable for segmentectomy will likely be detected. We conclude that robotic-assisted surgery may facilitate the challenges of performing a minimally invasive segmentectomy.     

连接蛋白43在肺腺癌中表达的意义

目的检测肺腺癌组织及正常肺组织中缝隙连接蛋白43(Connexin 43)的表达。方法应用免疫组织化学法和原位杂交方法检测146例肺腺癌组织及20例正常肺组织中Connexin 43蛋白及mRNA的表达,并分析其表达与肺腺癌转移的关系。结果正常肺组织和肺腺癌组织中Connexin 43蛋白阳性表达率分别为95%(19/20)和39.9%(59/148);mRNA的阳性表达率分别为90%(18/20)和54.7%(81/148)。肺腺癌组织中Connexin 43蛋白及mRNA阳性表达率均低于正常肺组织(P0.05)。在高/中分化和低/未分化的肺腺癌组织中阳性表达率分别为48.7%和30.0%(P0.05);Cx43在无淋巴结转移和有淋巴结转移的肺腺癌组织中阳性表达率分别为56.3%和34.5%(P0.05);Connexin43在Ⅰ、Ⅱ期和Ⅲ、Ⅳ期肺腺癌组织中的阳性表达率分别为51.5%和34.0%(P0.05)。结论 Connexin 43蛋白和mRNA低表达与肺腺癌发生、发展及浸润、转移有关。     

Fascin as a useful marker for cancer-associated fibroblasts in invasive lung adenocarcinoma

Cancer-associated fibroblasts (CAFs) have been attracting attention in recent years, but their nature has not been fully elucidated. Although CAFs have been recognized as an important therapeutic target, therapeutic agents have not been developed to date. CAFs are characterized by their high migration rate and involvement in epithelial-to-mesenchymal transition with some displaying a dendritic morphology that is reminiscent of fascin expression.The present study was designed to immunohistochemically investigate fascin expression in lung adenocarcinoma including CAFs and compare the results with existing CAF markers.We immunohistochemically investigated fascin expression in not only cancer tissue but also CAFs from 26 autopsy cases of lung adenocarcinoma. Immunohistochemistry of α-smooth muscle actin and fibroblast activation protein was also performed.Fascin-positive staining in CAFs was observed in all cases, with a strong correlation observed with existing CAF markers α-smooth muscle actin and fibroblast activation protein (P < .001). In addition, the proportion of tumor cells showing fascin-positive staining was found to correlate with its expression in CAFs (P < .05).We propose that CAFs express fascin, and that fascin may mediate crosstalk between cancer tissue and CAFs. Fascin might be a novel therapeutic target for treatments that target the cancer stroma.     

Epidermal growth factor receptor targeted therapy with gefitinib in locally advanced and metastatic primary lung adenocarcinoma

OBJECTIVE: To describe the efficacy of monotherapy with the epidermal growth factor receptor-tyrosine kinase inhibitor, gefitinib in patients with locally advanced and metastatic primary lung adenocarcinoma. METHODS: A retrospective analysis was undertaken of patients who had locally advanced or metastatic lung adenocarcinoma treated with gefitinib 250 mg orally once daily until disease progression. All patients had either been previously treated with systemic cytotoxic chemotherapy and/or radiotherapy or had declined chemotherapy or were medically not fit for cytotoxic chemotherapy. RESULTS: A total of 23 patients (13 men) (15 never smokers) with a median age of 51 years (range 35-79 years) received gefitinib monotherapy. Disease control occurred in 14 patients (61%); there was a reduction in the size of the primary and/or metastatic tumours (partial response (PR)) in 11 patients (48%), and 3 patients (13%) had stable disease. The response rate was significantly higher in those who had never smoked (10 of 15 (67%)) compared with that of smokers (1 of 8 (13%)) (odds ratio (95% confidence interval), 14.0 (1.33-147.43) P=0.027). In total, 11 of 18 patients (61%) with a WHO performance status 1 or 2 showed a PR, whereas none with a performance status 3 or 4 responded (P=0.037). Response was not affected by the patient's age, gender, disease stage, prior chemotherapy treatment, interval between diagnosis and commencement of gefitinib or the development of skin toxicity. The median time to symptom improvement was 1.5 (range 0.5-6) weeks. The median progression-free survival time was: 60 (range 15-138) weeks in patients with PR and 34 (range 7-38) weeks in patients with stable disease (P=0.368). CONCLUSION: When given alone, gefitinib showed significant antitumour activity in patients with locally advanced and metastatic primary lung adenocarcinoma. An objective response was observed more frequently in never smokers and exclusively in patients with good performance status.     

Predilection of contralateral upper lung metastasis in upper lobe lung adenocarcinoma patients

Background

Lung cancer with lung to lung metastasis is common. The objective of this study was to investigate the association among the distribution of contralateral lung metastases versus primary lung tumor location, clinical characteristics, and epidermal growth factor receptor (EGFR) mutations status.

Methods

The study included treatment-naïve stage IV lung adenocarcinoma with contralateral lung metastases from 2012 through 2013.

Results

In total, 103 patients were enrolled after excluding lung cancer with histology other than adenocarcinoma, synchronous multiple primary lung cancers, or other active malignancy. The median age was 65 years (range, 28–93 years); 47 male patients (45.6%); 69 non-smoker (NS) patients (67.0%); 68 Eastern Cooperative Oncology Group performance status (ECOG PS) 0–1 patients (66.0%); 38 M1a patients (38.9%); and 60 EGFR mutation patients (58.3%). There were 51 cases (49.5%) with primary lung cancer located over upper lobes. Among them, 36 (70.6%) had contralateral upper lung predominance metastasis, 9 (17.6%) had lower lung predominance, and 6 (11.8%) had equal distribution. Among the 52 lower lobe tumors, 17 (32.7%), 19 (36.5%), and 16 (30.8%) had upper, lower lung predominance, and equal distribution metastasis, respectively. Univariate analysis showed only male gender and primary tumor location over upper lobes were significantly associated with contralateral upper lung predominance metastases. After multivariate analysis, only primary tumor location over upper lobes was significantly associated with contralateral upper lung predominance metastases (adjusted OR 5.49, 95% CI, 2.15–14.03, P<0.001).

Conclusions

Upper lobe lung adenocarcinoma was significantly associated with contralateral upper lung predominance metastases. Further research is needed to elucidate the mechanisms underlying this phenomenon.     

LKB1和VEGFR2评价肺腺癌预后的意义

目的探讨LKB1、VEGFR2在肺腺癌中的表达情况,分析其预后意义。方法应用免疫组化方法检测46例肺腺癌中LKB1、VEGFR2的表达情况。结果 LKB1在癌旁正常肺组织、淋巴结转移阴性组肺腺癌、Ⅰ～Ⅱ期肺腺癌中的表达阳性率明显高于肺腺癌组织、淋巴结转移阳性组肺腺癌和ⅢA期肺腺癌(82.61%vs 63.04%、75.00%vs 44.44%、75.00%vs35.71%),差异有统计学意义(P<0.05)。VEGFR2在癌旁正常肺组织、淋巴结转移阴性组肺腺癌、Ⅰ～Ⅱ期肺腺癌中的表达阳性率则明显低于肺腺癌组织、淋巴结转移阳性组肺腺癌和ⅢA期肺腺癌(34.78%vs 58.70%、46.43%vs 77.78%、46.88%vs85.71%),差异有统计学意义(P<0.05)。结论 LKB1、VEGFR2在肺腺癌中的表达情况可能与肺腺癌患者的预后有关,LKB1低表达、VEGFR2高表达可能提示预后不良。     

吉西他滨联合顺铂对晚期肺鳞癌及肺腺癌治疗的临床疗效比较

目的观察吉西他滨联合顺铂的化疗方案对晚期肺鳞癌及肺腺癌的临床疗效及生存差异。方法肺鳞癌组47例及肺腺癌37例患者给予吉西他滨（1000mg／m2）联合顺铂（75mg／m。）化疗,每21天为一周期,共化疗4个周期。结果肺鳞癌组PR为14例（29．8％）,SD为21例（44．7％）,PD为12例（25．5％）,RR为29．8％,中位生存期为13个月,1年生存率为53．2％;肺腺癌组PR为10例（27．0％）,SD为18例（48．6％）,PD为9例（24．3％）,RR为27．0％,中位生存期为9个月,1年生存率为27．0％;结论吉西他滨联合顺铂对晚期肺癌及鳞癌的临床疗效相当,但肺鳞癌较肺腺癌具有较好的1年生存率及生存时间。     

CKAP2 overexpression correlates with worse overall survival in patients with lung adenocarcinoma

Background:Adenocarcinoma is a non–small-cell lung cancer that is common cancer in both genders, and has poor clinical outcomes. We aimed to evaluate the role of cytoskeleton-associated protein 2 (CKAP2), its prognostic significance, and the relationship between CKAP2 expression and lung adenocarcinoma driver genes.Methods:The expression of CKAP2 was studied by immunohistochemical staining of specimens from 88 patients with lung adenocarcinoma. The correlation between clinicopathological features and CKAP2 expression was analyzed. Kaplan-Meier analysis and Cox proportional hazard models were used to examine the prognostic value of CKAP2 in terms of overall survival (OS). The correlation between epidermal growth factor receptor (EGFR) mutation, anaplastic lymphoma kinase (ALK) rearrangement, and CKAP2 expression was analyzed. All histological samples were detected by fluorescence in situ hybridization for EGFR mutations and ALK rearrangements.Results:Eighty-eight patients with positive CKAP2 expression were observed in this study. Patients with high levels of CKAP2 expression were associated with OS (P = .021). Multivariate Cox regression analysis disclosed that positive CKAP2 expression (P = .043) could independently predict unfavorable OS. In addition, CKAP2 expression was not associated with EGFR mutation (P = .219) and ALK rearrangement (P = .389) in lung adenocarcinoma patients.Conclusion:High expression of CKAP2 may serve as a marker of poor prognosis in lung adenocarcinoma.     

Interest of anatomical segmentectomy over lobectomy for lung cancer: a nationwide study

BackgroundAnatomical segmentectomy is an alternative to lobectomy for early-stage lung cancer (LC) or in patients at high risk. The main objective of this study was to compare the morbidity and mortality associated with these two types of pulmonary resection using data from the French National Epithor database.MethodsAll patients who underwent lobectomy or segmentectomy for early-stage LC from January 1^st 2014 to December 31^st 2016 were identified in the Epithor database. The primary endpoint was morbidity; the secondary endpoint was postoperative mortality. Propensity score matching was implemented and used to balance groups. The results were reported as odds ratios (OR) and 95% confidence intervals (CI).ResultsDuring the study period, 1,604 segmentectomies (9.78%) and 14,786 lobectomies (90.22%) were performed. After matching, the segmentectomy group experienced significantly less atelectasis (OR 0.54; 95% CI: 0.4–0.75, P<0.0001), pneumonia (OR 0.72; 95% CI: 0.55–0.95, P=0.02), prolonged air leaks (OR 0.75; 95% CI: 0.64–0.89, P=0.001) or bronchopleural fistula (OR 0.35; 95% CI: 0.14–0.83, P=0.017), and fewer patients had at least one complication (OR 0.7; 95% CI: 0.62–0.78, P<0.0001). According to the Clavien-Dindo classification, postoperative complications were significantly less severe in the segmentectomy group (OR 0.52; 95% CI: 0.37–0.74, P<0.0001). There was no significant difference in postoperative mortality at 30 days (OR 0.67; 95% CI: 0.38–1.20, P=0.18), 60 days (OR 0.78; 95% CI: 0.42–1.47, P=0.4), or 90 days (OR 0.77; 95% CI: 0.45–1.34, P=0.36).ConclusionsAnatomical segmentectomy is an alternative surgical approach that could reduce postoperative morbidity, but it does not appear to affect mortality.