腋下微创小切口治疗58例胸部肿瘤的临床应用

目的探讨腋下微创小切口术治疗胸部肿瘤的手术方法以及应用价值。方法利用腋下微创小切口术治疗58例胸部肿瘤患者,其中肺癌32例,肺部良性肿瘤11例,食管癌9例,纵隔肿瘤6例。结果所有患者手术无死亡病例。平均手术时间为3.5 h;清除淋巴结6.5枚/例;开胸时间平均6.8 min;关胸平均17.4 min;胸腔引流管平均放置时间3.75 d;术后平均住院时间为8.32 d。术后疼痛分级:1级56例,2级1例,3级1例。3例患者出现术后并发症,经治疗后全部治愈。结论腋下微创小切口术治疗胸部肿瘤损伤小,术后恢复快,疼痛程度轻,可作为临床治疗胸部肿瘤的方法推广使用。     

巨大原发纵隔肿瘤24例报告

巨大原发纵隔肿瘤的临床表现多变 ,解剖关系复杂 ,故其诊治较为困难。 1984年 1月～ 2 0 0 0年 5月 ,我院共收治巨大原发纵隔肿瘤 2 4例 ,均经手术及病理证实。现报告如下。临床资料 :本组男 9例 ,女 15例 ;年龄 2～ 70岁 ,平均31.7岁。肿瘤占据前纵隔为主 2 1例 ,后纵隔为主 3例 ;突入右胸腔 13例 ,突入左胸腔 10例 ,突入双侧胸腔 1例。均在气管插管、静脉复合麻醉下手术 ,经后外侧切口 3例 ,前外侧切口 2 0例 ,前外侧切口并胸骨横断入路 1例。肿瘤完整切除 2 2例 ,大部切除 2例。病理结果 :良性畸胎类肿瘤 11例 ,畸胎瘤恶变 1例 ,胸腺瘤 5…     

胸部刃器伤159例外科治疗体会

目的总结胸部刃器伤的外科治疗经验。方法 159例胸部刃器伤患者,行胸腔穿刺术34例,单纯胸腔闭式引流术68例,行剖胸和（或）经膈肌行剖腹探查术37例,行胸腔镜辅助小切口手术（VAMT）20例。结果本组死亡5例,其余均治愈出院。结论对胸部刃器伤患者,应尽快明确诊断,并选择合适的手术方式。     

完全电视胸腔镜手术在胸部疾病诊疗中的应用

目的：评价完全电视胸腔镜手术（ VATS）处理胸部疾病的临床价值。方法选择35例胸部疾病患者,均在完全VATS下手术,肺大泡切除17例,肺大泡结扎2例,肺尖切除2例,纵隔肿瘤切除5例,纵隔肿瘤活检2例,肺叶切除2例,全肺切除1例,同时行淋巴结清扫2例,肺楔形切除1例,心包开窗1例,胸内血肿清除2例（1例并乳内动脉结扎）。结果患者均成功完成手术,无中转开胸。3例辅助小切口,4例采用单操作孔。术后住院时间5～37（7．4±2．6）d。并发皮下气肿2例,乳糜胸1例,持续漏气1例,局限性肺不张1例,均治愈出院,无围术期死亡。随访2～39个月,死亡2例（均死于纵隔恶性肿瘤）,对侧发生气胸1例（行闭式引流治愈）,余均正常生活。结论完全VATS手术处理胸部疾病技术上是可行的,具有创伤小、恢复快等优点,只要病例选择得当,完全VATS是一种较好的术式选择,具有临床推广价值。     

中青年单侧自发性气胸同期双侧微创手术治疗的临床研究

目的探讨中青年单侧自发性气胸患者同期行双侧微创手术治疗的可行性、安全性及有效性。方法对2003年3月—2008年12月在我科接受经腋下小切口(LAT)或电视胸腔镜(VAT)同期双侧微创手术治疗的413例中青年单侧自发性气胸患者的临床资料进行回顾性分析,并与同时间段行单侧微创手术治疗的458例中青年单侧自发性气胸患者进行对比研究。结果患者均治愈,无手术死亡病例,术后病检证实均有肺大疱存在。双侧组手术时间长于单侧组,术中失血量多于单侧组,住院费用亦高于单侧组,差异有统计学意义(P<0.05);两组术后留置胸引管时间、术后住院时间、并发症发生率比较,差异无统计学意义(P>0.05)。术后随访602例,双侧组随访287例(69.5%),单侧组随访315例(68.8%);随访时间(21.5±9.3)个月,双侧组无气胸复发;单侧组1例术侧复发气胸,19例(6.0%)对侧发生气胸,两组比较差异有统计学意义(P<0.05)。结论中青年单侧自发性气胸患者往往双侧肺叶都有相对称的肺大疱病变存在,主要位于上叶尖段;同期双侧微创手术切除肺大疱,能有效地预防气胸复发和对侧发作气胸,疗效确切,安全性高,值得临床推广。     

右胸三切口与左胸二切口入路手术治疗胸中段食管鳞癌效果对比

目的比较右胸三切口、左胸二切口入路行食管癌切除并胃食管颈部吻合手术治疗胸中段食管鳞癌的效果。方法接受手术治疗并经病理检查证实为胸中段食管鳞癌的患者97例,均行食管癌切除并胃食管颈部吻合手术,其中55例采用右胸三切口入路(三切口组),42例采用左胸二切口入路(二切口组)。对比两组淋巴结清扫个数、切缘癌残留情况、手术时间、术中失血量、术后首日胸腔引流量、胸腔总引流量、胸腔引流时间、术后住院时间、术后并发症发生情况及术后生存期。结果三切口组肿瘤完整切除54例(98.2%)、切缘阳性0例,二切口组肿瘤完整切除40例(95.5%)、切缘阳性0例,两组相比,P均>0.05。三切口组清扫淋巴结990个,其中淋巴结转移阳性236个(23.8%);二切口组清扫淋巴结504个,其中阳性63个(12.5%),两组相比,P<0.05。三切口组手术时间较二切口组延长,失血量较二切口组增多(P均<0.05)。三切口组肺部感染、心律失常发生率高于二切口组(P均<0.05)。三切口组中位生存时间为54.75个月、5年生存率为45.5%,二切口组分别为30.33个月、21.4%,两组相比,P均<0.05。结论右胸三切口入路行食管癌切除并胃食管颈部吻合手术治疗胸中段食管鳞癌淋巴结清扫更方便、彻底,术后5年生存率高;但对于肥胖患者,尤其年龄较大、心肺功能较差者,宜选左胸二切口入路。     

复杂纵隔肿瘤的外科治疗

目的探讨各类复杂纵隔肿瘤的外科治疗方法及特点。方法对13例复杂纵隔肿瘤患者的外科治疗方法进行回顾性分析。结果取颈部低位领状(和胸骨半劈开)切口切除巨大胸骨后甲状腺肿6例;3例合并上腔静脉综合征患者分别行纵隔肿瘤切除、人工血管置换或自体心包修补术;再次手术完整切除纵隔肿瘤2例;手术治疗因肿瘤反复破溃引起纵隔感染、冻结2例。结论一些复杂纵隔肿瘤的手术难度及危险性较大,应根据不同情况,采取适当术式,以达到理想的治疗效果。     

Ⅲ、Ⅳa期侵袭性胸腺瘤的手术、综合治疗及预后分析

目的四年期间以手术为主治疗29例Ⅲ、Ⅳa期恶性胸腺瘤的治疗经验。方法按肿瘤大小及位置分别采用正中劈胸骨切口或后外侧切口施行手术,切除肿瘤全部或大部,术后均行放疗并相应化疗。结果 23例Ⅲ期恶性胸腺瘤患者术中将肿瘤彻底或大部切除,6例Ⅳa期者亦尽量将心包或胸腔内的转移灶清除,难以清除者予以电灼促进坏死。所有患者术后分别接受放疗及化疗,无治疗期间死亡病例。随访1～6年,平均随访34.7个月,Ⅲ期患者的1、3、5年生存率分为100%(23/23)、91.3%(21/23);86.9%(20/23)。Ⅳa期手术组的1、3、5年生存率分为100%(6/6)、66.7%(4/6)、50%(3/6)。结论Ⅳa期并非手术的绝对禁忌证,尽可能以手术方式减低肿瘤负荷再辅以综合治疗可取得较好疗效。     

经缩小的额外侧入路手术治疗鞍结节脑膜瘤

目的观察经缩小的额外侧入路手术治疗鞍结节脑膜瘤的疗效。方法鞍结节脑膜瘤患者25例,采用缩小的额外侧入路进行手术治疗。结果 25例肿瘤全切除（SimpsonⅠ、Ⅱ级）23例、次全切除（SimpsonⅢ级）2例,术后视力障碍和视野缺损有不同程度恢复20例、无改善3例,视力下降2例。术后随访5～38个月,未见肿瘤复发。结论经缩小的额外侧入路手术治疗鞍结节脑膜瘤,手术切口小、术野合理、肿瘤完整切除率高、并发症少。     

后纵隔哑铃型神经源性肿瘤的诊断和外科治疗

目的探讨后纵隔哑铃型神经源性肿瘤的临床病理特征、诊断、鉴别诊断及外科治疗方法,提高临床诊治水平。方法回顾性分析16例后纵隔哑铃型神经源性肿瘤的相关临床资料,并结合文献进行复习。结果16例中男9例,女7例,12例有胸闷、胸痛、咳嗽和肢体麻木等临床症状,1例双下肢瘫痪,3例无症状。全部病例经胸部CT和磁共振检查提示诊断,均行一期完整切除肿瘤,治愈出院。结论手术方案应根据肿瘤大小、部位和生长形态等因素选择手术方案。采用后正中切口联合胸腔镜辅助手术是治疗后纵隔哑铃型神经源性肿瘤较佳手术方式。     

A case of sternal chondrosarcoma with multiple pulmonary embolisms]

A 63-year-old man was admitted to our hospital because of a large, firm tumor in the upper region of the anterior chest wall. The tumor measured 8 x 10 cm in diameter. A diagnosis of chondrosarcoma of the sternum was made cytologically from a percutaneous fine needle aspiration biopsy. The primary tumor was completely resected, but the sternum, ribs and clavicles were only partially resected. Another tumor was detected five months after resection and metastasis to the brain was recognized in December 2000. The patient, now suffering headaches and vomiting due to the intracranial hemorrhage around the metastatic lesion in the brain, was readmitted. Although temporary improvement of his general condition was achieved by conservative treatment, he suddenly died of respiratory failure because of multiple tumor emboli in the pulmonary artery. This was a very interesting case in that the chondrosarcoma was of sternal origin and was complicated by tumor emboli in the pulmonary artery.     

电视胸腔镜肺楔形切除11例报导

我院从1994年年底到1996年7月应用电视胸腔镜外科手术24例,其中作肺楔形切除11例。用于治疗的7例,用于诊断的4例。肺肿瘤8例,良性肿瘤3例,转移性肿瘤5例。另外是机化性肺炎1例,特发性肺肺纤维化1例,支气管扩张1例。肿瘤大小1.5～4.Scm直径。所有病人均作全身麻醉,双腔支气管插管,单肺通气。3例病人因病灶较大,作辅助小切口5～7cm。这样以手指探查病灶和常规开胸手术器械也可以通过此切口进行操作。1例支气管扩张,因出血改开胸手术。全组病人引流管均于48小时拔除仅1例并发肺不张,引流管放置11天。3例良性肿瘤病人术后平均住院8.6天。4例用于诊断的病例均取得病理诊断,无漏气、切口感染和手术死亡等并发症。     

Resecting a giant malignant lung tumor in a patient with unilateral acute interstitial pneumonitis

Acute interstitial pneumonia is a rare and fulminant form of idiopathic interstitial lung disease. Here, we report a case of a giant malignant sarcomatoid tumor of the left lung with unilateral lung infiltration. The tumor was resected under venovenous extracorporeal membrane oxygenation support. Right middle lung lobe biopsy revealed alveolar epithelial hyperplasia, mild interstitial fibrosis, and interstitial edema. The patient was diagnosed with acute interstitial pneumonitis, and effectively treated with steroid pulse therapy followed by prednisolone. In this case, the contralateral lung expansion accomplished with tumor resection, definitive diagnosis based on lung biopsy, and corticosteroid treatment possibly improved the outcome.     

胸腔镜下肺叶切除治疗早期非小细胞肺癌45例的临床分析

目的对比分析胸腔镜肺叶切除术(VATS)与常规开胸肺叶切除术(CT)在治疗早期非小细胞肺癌的优越性。方法收集我科2010年1月至2014年12月所开展的45例胸腔镜肺叶切除术(VATS)与45例传统开胸肺叶切除术(CT)在治疗早期非小细胞肺癌方面做对照研究,就两组术中所用时间,术中出血量、切口长短、淋巴结清扫数目、胸腔引流管保留时间、术后胸腔积液引流量、切口疼痛程度、术后并发症、术后住院天数,以及肿瘤坏死因子(TNF-α)、白介素1β(IL-1β)、C反应蛋白(CRP)指标差异性进行对比分析。结果VATS组中在术中所用时间、切口长度、术中出血量、胸腔引流管保留时间、术后胸腔积液引流量、以及术后住院天数,明显优于CT组,VATS组术后1、3、5天切口疼痛程度、血清TNF-α、IL-1β及CRP水平均明显低于同时间点CT组(P均0.05),但术后并发症及淋巴结清扫数量组间无差异(P均0.05)。结论胸腔镜肺叶切除术在治疗早期非小细胞肺癌中是一种安全有效并且更加微创的手术方式,值得推广。     

Case of multiple thin-walled cavitary pulmonary metastasis from bladder cancer]

A 71-year-old man was admitted to the urological section of our hospital because of hematuria. Cystoscopy revealed a bladder tumor. Transurethral resection of the bladder tumor (TUR-Bt) was performed. This tumor was diagnosed pathologically as bladder cancer (transitional cell carcinoma pT2). His chest computed tomogram showed multiple thin-walled cavitary nodules in both lungs. The pathological images of the specimen that was resected by video assisted thoracic surgery (VATS) showed transitional cell carcinoma. A diagnosis of pulmonary metastasis from bladder cancer was made. This is a rare case.     

A case report of large cell lung cancer detected in the course of antituberculous therapy after a giant bullectomy

A case of a 60-year-old who male developed lung cancer after surgical resection of a emphysematous giant bulla. At first, he showed a emphysematous giant bulla associated with infected bulla in the right lung on the chest roentgenograph. After a giant bullectomy the resected specimen, suggested possible pulmonary tuberculosis. Thereafter, he was followed for one year with antituberculous therapy. Nevertheless, the chest roentgenograph taken one year after surgery, showed a new tumor density (1.5 x 2.0 cm) in the right lung. Due to the rapid growth of the lung tumor, right upper lobectomy was performed. The histological diagnosis was a large cell lung cancer (giant cell type). The postoperative staging of the tumor proved to be T2N0M0. He was treated with systemic chemotherapy of CDDP 120 mg, VDS 4.5 mg, and MMC 12 mg. Unfortunately, he died of cancer recurrence 5 months after lobectomy. Clinical evaluation of the emphysematous giant bulla associated with lung cancer was performed.     

全胸腔镜下与传统二尖瓣置换、三尖瓣环形成术的比较

目的比较全胸腔镜下和传统胸正中切口行二尖瓣置换、三尖瓣环形成术的临床效果。 方法选择2017年1月至2018年12月于海口市人民医院(中南大学湘雅医学院附属海口医院)和暨南大学附属第一医院就诊的患者60例，按照患者意愿选择手术方式，全胸腔镜下手术为试验组31例，传统胸正中切口手术为对照组29例。试验组做全胸腔镜下二尖瓣置换、三尖瓣环形成术，对照组做传统胸正中切口二尖瓣置换、三尖瓣环形成术。记录两组患者的手术时间、升主动脉阻断时间、心肺转流时间、切口范围、术后机械呼吸时间、监护室停留时间、术后住院时间、胸液引流量和引流管拔除时间，并观察患者术后并发症的发生情况。 结果试验组的手术时间、心肺转流时间、切口范围、关胸时间均小于对照组(P<0.05)，而升主动脉阻断时间差异无统计学意义(P>0.05)。试验组术后机械呼吸时间、监护室停留时间、术后住院时间、胸液引流量和引流管拔除时间均小于对照组(P<0.05)。试验组气胸发生1例，肺部感染发生2例，心律失常发生1例，总不良反应发生率为6.56%，对照组气胸发生2例，肺部感染发生4例，心律失常发生3例，总不良反应发生率为14.52%(P<0.05)。 结论全胸腔镜下二尖瓣置换、三尖瓣环形成术的手术时间、心肺转流时间、关胸时间、术后机械呼吸时间、监护室停留时间、术后住院时间、引流管拔除时间更短，手术切口更小，术后引流物少，并且并发症少，安全性和实用性较高。     

电视胸腔镜辅以胸部小切口手术40例

对４０例胸部疾病患者行电视胸腔镜辅以胸部小切口手术（ＶＡＭＴ），其中肺癌１７例，肺周围型病灶１０例，食管癌８例，食管平滑肌瘤、贲门失弛症、食管憩室、纵隔肿瘤、急性脓胸各１例；ＶＡＭＴ探查时间为２０￣３０分钟，ＶＡＭＴ手术时间为４０￣１５０分钟，小切口长５￣８ｃｍ；无手术死亡者。本文对ＶＡＭＴ的手术适应症、小切口设计及其临床价值进行了讨论。     

The figure-L unilateral mini-sternotomy for anterior mediastinal tumor

We performed a figure-L unilateral mini-sternotomy for anterior mediastinal tumor resection in ten patients. Pathological diagnosis among the ten included six thymomas, three mature teratomas including one with a seminoma component, and one thymic cyst. Mean tumor length was 7 x 5 x 4 cm. The required skin incision was 8 cm in mean length. The third intercostal space was transected in six cases, the fourth intercostal space in four cases. Bilateral internal thoracic arteries were preserved in all cases. All tumors were completely resected without complications during the procedure. Mean operating time was 106 minutes (range 85 to 120 minutes). Postoperative hospital stay ranged from three to seven days without any complications. All patients were alive at the end of a mean follow-up period of 39 months (range 3 to 60 months). The figure-L unilateral mini-sternotomy is considered an effective and useful minimally invasive approach for anterior mediastinal tumors.     

Chest wall resection for bronchogenic carcinoma

The incidence rate of chest wall invasion in bronchogenic carcinoma is difficult to estimate, but is possibly as high as 5%. These cancers can be locally extensive without systemic dissemination. From 1973 to 1982, 9 patients in our hospital underwent en bloc pulmonary and partial chest wall resection for bronchogenic carcinoma with local invasion of the thoracic wall. All the patients were male, their ages ranging from 49 to 67 years. Pain was the most prominent symptom. Bronchoscopy examination revealed no tumors in 7 of the 9 patients, in one a tumor was seen in the apex of the right lower lobe and in another in the apex of the right upper lobe. Seven lobectomies and 2 pneumonectomies were performed. The macroscopic size of the tumour ranged from 3 to 17 cm, the number of partially resected ribs ranged from 1 to 4. In 8 cases squamous cell carcinoma was found, in one adenocarcinoma. After operation 7 patients were classified as T3N0M0 and 2 as T3N1M0. One T3N0M0 patient died shortly after operation due to a lung embolism. Two out of the 6 patients with T3N0M0 neoplasm survived more than 5 years, none of the patients with T3N1M0 neoplasm survived more than 3 months. Late deaths were due to recurrent carcinoma in the chest wall (2 cases), cerebral metastasis (1 case), cardiac failure (1 case) and unknown causes (2 cases). In cases where the lymph nodes are not involved, the survival rate is not unfavorably influenced by chest wall invasion. In the literature the mean operative mortality rate is 12%, the median survival time approximately one year and the mean 5-year survival rate 18%; resection is also of great importance in relieving pain.