肺癌肺叶切除术后肺功能状态影像学评价

目的 评价肺癌肺叶切除术后的胸部Ｘ线检查对肺功能状况估测的临床意义。方法 ６２例患者分别在肺地切除术后３个月、１２个月拍摄胸部Ｘ光片，同时测定肺活量ＶＣ）、最大通气量ＭＶＶ、１秒用力呼气容量（ＦＥＶ１）、动脉血氧分压（Ｐｏ２）地有关数据进行统计学处理。结果 膈肌活动度〈０．５ｃｍ组肺功能检测指标明显低于膈肌活动度〉０．５ｃｍ组，两组之间有显著性差异。结论 胸部Ｘ线检查测定膈肌动度可间接估测其肺功能     

无症状肺癌手术疗效分析

本院胸外科１９８９年５月至１９９９年５月收治无症状肺癌２５例,均为体检或偶然胸片检查发现,并经病理确诊。术前无自觉症状,全部进行了手术治疗,现报告如下。１临床资料本组２５例中男性１９例,女性６例,年龄４３～７６岁,平均年龄６０．３岁。其中１１例为体检中发现,１４例为偶然Ｘ线摄胸片时发现。２３例行肺叶切除术,右肺叶切除术１２例,左肺叶切除术１１例。鳞癌７例,腺鳞癌２例,腺癌１４例。肿瘤最小为２ｃｍＸＺ。ｍＸ２ｃｍ,最大６ｃｍＸ８ｃｍＸ５ｃｍ。另外有２例Ｘ线胸片检查发现时已有胸腔积液,胸腔液检查发现…     

111例食管癌锁骨上淋巴结转移放射治疗疗效分析

目的　探讨食管癌锁骨上淋巴结转移放射治疗的价值及影响预后因素。方法　１９８４ 年９ 月至１９９２ 年１２ 月收治食管癌锁骨上淋巴结转移１１１ 例,均采用６０Ｃｏ 外照射,食管ＤＴ６０ ～７０Ｇｙ,锁骨上ＤＴ５０～６６Ｇｙ。结果　治疗后的１、３ 、５ 年生存率分别为４９．６ ％ 、１０．８％ 、６．３ ％ ;病变长度≤５．０ ｃｍ 、５．１ ～８ ｃｍ 、＞ ８ ｃｍ 的５ 年生存率分别为１５％ 、２．５ ％ 、０（ Ｐ＜０．０５） ;疗终Ｘ线表现基本消失与部分消失的５ 年生存率分别为１２．５％ 、１．８％（ Ｐ＜ ０．０５）;锁骨上淋巴结＜３ ｃｍ 和≥３ ｃｍ 的５ 年生存率分别为８．１ ％ 、０ 。结论　食管癌锁骨上淋巴结转移应积极治疗,淋巴结大小、食管病灶长度、疗终Ｘ线表现、放疗剂量是影响预后的主要因素     

肝脏原发性鳞状细胞癌1例报告

１　病例报告患者,女性,５４岁。因上腹部阵发性胀痛,并向右侧肩背部放射,反复发作４个月,伴发热１个多月,于１９９６年９月２０日入院。既往史：１９７９年在外院行“胆囊切除术”,１９９２年行“胆总管切开取石,Ｔ型管引流术”。体检：右上腹局限性肌紧张及压痛。ＡＦＰ测定＜２０μｇ／Ｌ。Ｂ超检查：右叶肝内见约０．６ｃｍ×１．０ｃｍ强光团及索状强回声,后方可见声影,左外侧叶肝左下缘圆钝,可见约２．５ｃｍ×２．０ｃｍ增强光团,后方有声影。尚见１个６．５ｃｍ×４．５ｃｍ边缘不规整无回声不均匀区,无腹腔积液。考虑…     

青年直肠癌首发胸腹壁皮下转移一例

患者男性，２５岁。因右下胸部和右腹上区皮下结节发现半个月伴微疼，在他院行抗生素抗炎和局部热敷治疗无效就诊。检查一般情况好，浅表淋巴结不大。右胸锁骨中线第８肋间及右上腹腹直肌外缘皮下见２．０ｃｍ×２．０ｃｍ及１．５ｃｍ×１．５ｃｍ肿块，稍隆出皮肤，表面...     

胃血管球瘤1例报告

１病例报告患者,女性,４９岁。因进食后胃区饱胀感５个月,伴消瘦２个月,于１９９４年９月１６日入院。１９９４年７月２３日胃钡餐Ｘ线检查：于胃窦部近胃体前壁偏大弯侧见２．０ｃｍ×１．５ｃｍ圆形充盈缺损,切线位向胃腔内突出,边缘完整,基底部宽大。胃钡餐Ｘ线...     

肝癌指端转移一例

肝癌指端转移一例盛信秀康世均患者女，５１岁。因右上腹胀痛，纳差，消瘦５个月而入院。ＣＴ扫描发现肝左叶有一７．７ｃｍ×６．６ｃｍ×７．０ｃｍ之类圆形占位性病变；肝右叶病灶不规则，呈分叶状，大小为８．０ｃｍ×８．０ｃｍ×１２ｃｍ。胸部Ｘ线检查示双肺散在结...     

肺癌全肺及肺叶切除术后胸部X线与CT检查的对比研究

为探讨肺癌患者全肺或肺叶切除术后胸部改变的Ｘ线及ＣＴ诊断价值，将经手术切除全肺或肺叶后的７０例原发性肺癌患者的正位胸片与同期ＣＴ片进行对比研究。结果显示，膈肌升高７０例（１００．０％），纵隔器官移位６６例（９４．３％），纵隔脂肪组织移位９例（１２．９％），胸腔积液和随后形成的胸膜肥厚３４例（４８．６％）。Ｘ线正位片对术后两侧纵隔可作整体描述，ＣＴ可清楚显示主动脉弓回转３６例（５１．４％），对侧肺组织疝入１８例（３３．３％），右肺术后奇静脉食管窝变小或消失２６例（８３．９％），左肺术后扩大１７例（４３．６％）。ＣＴ诊断肺内肿瘤复发及转移各９例（１２．９％），Ｘ线诊断肺内肿瘤复发及转移为５例（７．１％）及６例（８．６％）；ＣＴ显示纵隔淋巴结肿大１５例（２１．４％）、Ｘ线为７例（１０．０％）。结果表明，常规Ｘ线片及ＣＴ对全肺或肺叶切除术后的评估各具优点，ＣＴ能直观地显示术后纵隔结构的再分布及术后空腔的细微变化，并可作密度值测量，能更多更早地发现术后胸内肿瘤复发转移及纵隔淋巴结肿大，因而更有价值。     

以胸骨旁淋巴结转移为首发表现的隐匿性乳腺癌一例

患者女,４７岁。因胸骨左侧肿物１月余就诊。查体：肿块位于胸骨左侧,约２ｃｍ×１ｃｍ×１ｃｍ大小,质硬、活动,乳腺检查未及肿块。于门诊手术室行肿块切除术。术后病理示：淋巴结转移腺癌。胸片、Ｂ超、消化道钡透、ＣＦ、全身骨扫描均未见异常,乳腺钼钯Ｘ线摄像提示可疑癌。行乳腺癌根治术。术后全乳腺次连续大切片检查,找到原发灶,约０．５ｃｍ×０．５ｃｍ×０．５ｃｍ,病理类型为浸润性导管瘤。讨论：隐匿性乳腺癌少见,国外文献报道其发病率占同期乳腺癌的０．３５％～１％,国内报道为０．３％～０．８％。乳腺肿块隐匿的原…     

36例肺癌患者放疗前后肺功能改变的观察

目的 ：观察胸部放射治疗时的肺功能损害，探讨肺功能预测放疗损伤的临床意义。方法：３６ 例肺部肿瘤患者在放疗前１ 周与放疗后１ 月内测定 Ｖ Ｃ、 Ｍ Ｂ Ｃ、 Ｆ Ｖ Ｃ、 Ｆ Ｅ Ｖ１ 、 Ｒ Ｖ／ Ｔ Ｌ Ｃ、 Ｂ Ｒ 及 Ｂ Ｒ％ 、 Ｄｌ Ｃ Ｏ等肺功能指标。结果： 放疗后 Ｄｌ Ｃ Ｏ 降低最为显著（１１４ ．６８ ±２３ ．１１ ，１１１ ．６９ ±２７ ．４０ ， Ｐ＜ ０ ．０１） ， Ｆ Ｖ Ｃ 下降，差异有显著性（９３ ．７９ ±１９６５ ，７４ ．４４ ±１９ ．２１ ， Ｐ＜ ０ ．０５） ， Ｆ Ｅ Ｖ１ 有所升高，其他指标改变不明显。结论：放疗后１ 月内肺功能损害以弥散功能损害为主， Ｄ Ｌ Ｃ Ｏ 明显降低，可作为一项预测指标。     

多层螺旋CT与胸部X线诊断早期肺癌的效果观察

目的探讨多层螺旋CT与胸部X线诊断早期肺癌的应用效果。方法选取2020年3月至2021年2月间延安大学附属医院收治的72例疑似早期肺癌患者,均行胸部X线和多层螺旋CT检查,病理学诊断结果为金标准,比较两种检查方式所用时间、费用、征象检出率和诊断结果。结果多层螺旋CT检查的检查时间比胸部X线长,差异有统计学意义(P <0.05),检查费用更高。多层螺旋CT检查的各征象检出率均较胸部X线更高,差异有统计学意义(均P <0.05)。72例疑似患者中,经病理学诊断证实60例(83.3%)为早期肺癌,其中中央型34例,周围型26例,其余12例为其他肺部疾病。胸部X线检查检出阳性49例,阴性7例,误诊漏诊16例。多层螺旋CT检查检出阳性57例,阴性10例,误诊漏诊5例。多层螺旋CT检查的诊断敏感度、准确性和阴性预测值均较胸部X线检查高,差异有统计学意义(均P <0.05)。结论同胸部X线比较,多层螺旋CT检查早期肺癌诊断效能更高,但检查时间长、价格高,可结合实际情况选择检查方式。     

纵隔镜手术在肺癌分期中的应用价值

目的:探讨纵隔镜手术在肺癌纵隔淋巴结分期中的应用价值.方法:回顾性总结1999年11月至2003年7月69例经纵隔镜检查肺癌患者的临床资料,其中颈部纵隔镜手术57例,胸骨旁纵隔镜手术7例,颈部加胸骨旁纵隔镜手术5例.术前所有患者胸部CT均发现纵隔淋巴结肿大(最小直径大于1.0cm).结果:本组69例患者,经纵隔镜检查证实纵隔淋巴结转移(阳性)者50例,未见纵隔淋巴结转移(阴性)者19例.阳性者放弃手术,予以化疗.阴性者中15例中转开胸行肺叶切除或肺楔型切除加纵隔淋巴结清扫,术后病理证实14例纵隔淋巴结未见转移,1例隆突后淋巴结可见癌转移(纵隔镜检查假阴性).纵隔镜手术敏感性、特异性和准确性分别为98.0%、100%和98.5%.全组术后发生声音嘶哑1例,并发症发生率为1.4%(1/69).无围手术期死亡.结论:纵隔镜手术安全、可靠,可作为明确肺癌分期的常规方法.     

A case whose lung metastasis was detected and resected eleven years after resection of primary colon cancer

In July 1999, a 79-year-old man underwent sigmoidectomy and D3 lymphadectomy for sigmoid colon cancer (ss, n(-), stage II, cur A). In September 2000, hepatectomy of right lobe and cholecystectomy were performed for his liver metastasis. Every three to six months follow-up had been kept since adjuvant chemotherapy (200 mg/day of 5-FU per os for two years) completed. Eleven years and two months after sigmoidectomy (in September 2010), a chest X-ray examination detected a small nodule in upper area of his right lung, which was diagnosed as either primary lung cancer or metastatic lung tumor followed by chest CT scan and PET-CT examination. In November 2010, laparoscopy-assisted partial resection of his right lung was performed. Histochemical examination of the resected lung tumor resulted cytokeratin 7(-), cytokeratin 20(+) and TTF-1(-), confirming its final diagnosis as lung metastasis from sigmoid colon cancer. He has been alive for six months without any recurrence since resection of his lung metastasis. It was a very rare case to have more than ten-year interval between colon cancer resection and detection of its lung metastasis. However, when we diagnosed the patient with lung tumor, who had undergone a colorectal resection, we should consider if he had a lung metastasis from colorectal cancer.     

Radiological examination for peripheral lung cancers and benign nodules less than 10 mm

To clarify the differences in radiological findings between primary lung cancers and benign nodules measuring less than 10mm, we examined chest computed tomography (CT) findings. Of 82 patients with solitary pulmonary nodules less than 10mm in diameter who had undergone surgical biopsy, 21 patients with primary lung cancer and 45 patients with benign lesions (9 patients with tuberculosis, 12 with non-specific inflammation, 10 with benign lung tumor, 10 with intrapulmonary lymph nodes and 4 with others) were examined. Seven patients with atypical adenomatous hyperplasia and nine patients with metastatic lung cancer were excluded. Primary lung cancers had an ill-defined tumor margin and spiculation significantly more frequently than benign nodules (P<0.01). Involvement of bronchi or vessels was observed significantly more frequently in primary lung cancers than in benign nodules (P<0.05), while pleural indentation did not show significant differences in frequency. Retrospective chest X-ray or CT films were reviewed for seven patients with primary lung cancers and 12 with benign nodules, with a mean interval of 24+/-17 months. Primary lung cancers enlarged or appeared as new nodules more frequently than benign lung nodules (P<0.05). Among 17 lung cancer patients who underwent mediastinal lymph node dissection, the cancer was at a more advanced stage than T1N0M0 in four (24%). We conclude that ill-defined margins, spiculation, involvement of bronchi or vessels, and tumor enlargement visualized by CT are still important signs of malignancy even for nodules less than 10mm in size. Tumor size, even for lung cancers measuring less than 10mm, is not an indication for limited resection.     

低剂量胸部CT筛查早期肺癌的临床应用研究

目的:探讨低剂量CT(low-dose chest CT,LDCT)胸部平扫在健康体检中筛查早期肺癌的应用效果及价值。方法:收集2018年1月至2018年12月在我院健康体检高危人群,采用低剂量胸部CT 1 100例及胸部X线平片750例。结果:低剂量胸部CT与胸部X线片比较,发现肺结节病灶,阳性肺结节以及疑似肺癌的比例均具有统计学意义（P<0.05）;低剂量CT组确诊为肺癌的患者,腺癌占比90%,女性肺癌占比40%,男性肺癌占比60%,50岁以上肺癌占比60%,基因检测结果提示驱动基因阳性占比42.5%。结论:低剂量CT胸部检查与胸片比较,恶性肿瘤检出率高,是一种适用于肺癌的早期筛查方法。     

Detection of K-ras mutations of bronchoalveolar lavage fluid cells aids the diagnosis of lung cancer in small pulmonary lesions.

An increased prevalence of K-ras oncogene mutation in lung adenocarcinoma has been shown by PCR-primer-introduced restriction with enrichment for mutation alleles (PCR-PIREMA) experiments. In the present study we investigated whether this method is useful for the diagnosis of lung cancer in small pulmonary lesions, which are difficult to diagnose cytologically as lung cancer by bronchoscopic examination. We examined bronchoalveolar lavage fluid (BALF) cells from 33 patients with single nodular pulmonary lesions of less than 2 cm in diameter (measured on chest computed tomography scans) for K-ras (codon 12) mutation, by PCR-PIREMA. Transbronchial fiberscopic examinations had not revealed lung cancer cytologically in any of the patients. The final diagnoses for the 33 lesions were 20 adenocarcinomas, 5 cases of focal fibrosis, 5 cases of pneumonia, 1 case of tuberculosis, 1 hamartoma, and 1 case of lymph node swelling. BALF cell lysates were amplified and digested with a restriction enzyme to detect the K-ras oncogene. Only the normal K-ras was observed after the first amplification and digestion for each of the 33 patients. Three amplifications and digestions were performed for each sample. We detected mutation of K-ras in BALF cells from 15 (75%) of 20 lung cancer patients and in cells from only 4 (31%) of 13 patients with nonmalignant lesions. The detection rate of the K-ras mutation in lung cancer was significantly greater than that in nonmalignant lesions (P = 0.012). Our results indicate that the detection of the codon 12 K-ras mutation in BALF cells by PCR-PIREMA aids the diagnosis of lung cancer in patients with small pulmonary lesions with negative cytological findings.     

肺癌侵犯胸壁的外科治疗

目的探讨肺癌侵犯胸壁的手术切除方式及影响患者生存的因素.方法对30例侵犯胸壁的肺癌患者的外科治疗结果进行综合分析.结果全组中肺叶切除26例,双肺叶切除2例,全肺切除2例;壁层胸膜外切除6例,胸壁肌肉和肋骨切除(整块切除)24例.根治性切除25例,根治切除率83.3%(25/30).手术并发症发生率6.7%(2/30),手术死亡率3.3%(1/30).鳞癌18例,腺鳞癌8例,腺癌3例,大细胞未分化癌1例.T3N0M0 20例,T3N1M0 5例,T3N2M0 5例.采用寿命表法(life table)计算生存率,用对数秩和检验(Logrank test)其显著性.1、3、5年生存率分别为40.2%、10.8%和10.8%.根治性切除患者5年生存率为13.2%,姑息性切除者中无5年生存者(P＞0.05).根治性切除无淋巴结转移者5年生存率为15.5%,有淋巴结转移者中无5年生存者(P＞0.05).不考虑淋巴结转移情况,根治性切除患者中,肿瘤侵犯胸壁局限于壁层胸膜者的5年生存率为15.0%,而侵犯胸壁肌肉和肋骨者中则无5年生存者(P＞0.05).结论胸膜外切除或胸壁整块切除是外科治疗肺癌侵犯胸壁的主要手段.能否根治切除、有无淋巴结转移以及胸壁受侵程度是影响患者术后生存的重要因素.     

同时支气管肺动脉联合成形术治疗中央型肺癌

背景与目的：近年来支气管肺动脉联合成形术愈来愈广泛的应用于肺功能不佳的肺癌患者中，该术式符合最大限度地切除肺癌和最大限度地保留肺功能的肺癌手术原则，该项手术技术有着很好的前景。我们总结近年来采用支气管肺动脉联合成形术治疗中央型肺癌的体会来探讨该项手术的应用指征和方法。方法：1993年12月-2003年12月，对63例中央型肺癌施行支气管肺动脉联合成形肺叶切除，包括支气管肺动脉双袖状切除术43例，其中右肺上叶袖切＋肺动脉袖切20例；左肺上叶袖切＋肺动脉袖切23例；切除肺动脉的长度为1．5～4．5cm，平均2．5cm．支气管肺动脉双禊形切除术3例；其中右肺上叶禊切＋肺动脉楔切2例；左肺上叶楔切＋肺动脉楔切1例。支气管袖切并肺动脉禊切17例，其中右肺上叶袖切＋肺动脉楔切5例；左肺上叶袖切＋肺动脉禊切12例。结果：本组无死亡及吻合门瘘发生：结论：支气管肺动脉联合成形术使肺癌手术指征扩大，符合最大限度地切除肿瘤及最大限度保留肺功能的肺癌手术基本原则，是一种安全、有效、可行的术式。     

A case of rapidly growing pulmonary carcinosarcoma

We report herein a case of rapidly growing pulmonary carcinosarcoma, a rare and highly malignant lung neoplasm characterized by a biphasic histopathological pattern consisting of both epithelial and sarcomatous components, and we also summarize the clinical features of this entity based on previously reported cases. A 65-year-old man was referred for further examination of a lung tumor after a routine chest X-ray (CXR) showed a tumor shadow in the right upper lung zone. Chest computed tomography (CT) found a 2.0 cm pulmonary mass with suspected chest wall invasion in the right upper lobe, although cytological evidence of malignancy could not be obtained despite repeated preoperative bronchoscopy. The tumor grew rapidly, indicating the possibility of lung cancer. A right upper lobectomy with chest wall excision was performed. The postoperative definitive diagnosis was carcinosarcoma consisting of adenocarcinoma and chondrosarcoma. The pathological stage was p-T3N0M0. The patient subsequently received adjuvant chemotherapy with cisplatin and vinorelbine. Routine follow-up chest CT 7 months after the surgery showed pleural dissemination. Consequently he underwent radiotherapy, but the disseminated tumors enlarged further while he received this treatment. The patient is receiving best supportive care at present. Findings based on previously reported cases and our case suggest that early surgical intervention and combined therapeutic strategy are the most important aspects of treatment for pulmonary carcinosarcoma.     

A case of endobronchial squamous cell lung cancer successfully treated with weekly chemotherapy of carboplatin and paclitaxel

A 69-year-old man had undergone low anterior resection and a right lobe resection of the liver for rectum cancer and metastatic liver tumor at the age of 66 years. He presented at our hospital because of an abnormal shadow on a CT chest scan, which indicated a tumor shadow 2.5 cm in size in the lingular lobe and enlarged hilar and mediastinal lymph nodes. A bronchoscopic tumor biopsy revealed pulmonary metastasis from the rectum cancer. Bronchoscopic examination also identified an endobronchial squamous cell lung cancer, which almost completely obstructed the orifice of B1 and B2. We concluded that the patient had squamous cell lung cancer with metastases in the mediastinal lymph nodes. He was initially treated with weekly chemotherapy with carboplatin (AUC 1.25) and paclitaxel (70 mg/m2). The endobronchial tumor was markedly reduced in size after 2 weeks of the chemotherapy. Furthermore, after 6 weeks of the chemotherapy, the tumor had disappeared completely, and 11 days later, lower division segmentectomy and hilar and mediastinal lymph node dissection were performed. Pathological examination revealed no metastases in the lymph nodes. The patient has continued to receive chemotherapy as an outpatient and has been well without recurrence of any metastases for over 16 months.