肌肉非损伤性开胸术治疗肺癌134例

目的 肌肉非损伤性开胸术(皮肤小切口)作为肺癌手术的常规切口和围术期的研究.方法 应用肌肉非损伤性开胸术对134例肺癌患者进行手术治疗.共行肺切除术130例,手术探查4例;右上叶切除37例(其中袖式切除1例),右中叶切除4例(其中加右胸壁大块切除1例),右中下肺叶切除16例,右下肺叶切除14例(其中加上肺楔形切除1例),右全肺切除11例,左上肺叶切除17例,左下肺叶切除20例(其中加胸壁大块切除1例),左全肺切除11例(其中心包内处理肺动脉1例).术中均行肺门、隆突及纵隔淋巴结清扫.结果 小切口能满足手术的需要,未出现严重并发症,围手术期输血8例.结论 肌肉非损伤性开胸术能提供充分的手术暴露,操作简便,不影响手术的彻底性,可以作为绝大多数肺癌手术的常规入路治疗.     

胸腔镜和开胸肺叶切除术治疗非小细胞肺癌的临床对比分析

目的分析探讨在胸腔镜和开胸肺叶切除术不同治疗方法下的非小细胞肺癌的治疗效果,为非小细胞肺癌患者在进行手术选择上提高治疗效果提供理论支持和科学指导。方法选择在2014年10月至2016年3月收治的非小细胞肺癌患者100例作为研究对象,将这100例非小细胞癌的患者随机分为两组,分别为对照组和实验组,每组50例患者。将对照组患者进行开胸肺叶切除术治疗,为实验组实施胸腔镜肺叶切除术治疗,在治疗结束后观察对比两组患者的治疗效果。结果所有患者均顺利进行了手术,在手术后实验组患者5例出现伤口愈合不全的情况,2例患者肺不张,3例局灶炎症,在对照组中术后出现伤口愈合不全的患者有8例,肺不张患者12例,局灶炎症19例,对比两组患者术后出现伤口愈合不全、肺不张、局灶炎症等不良情况,实验组患者均比对照组患者少,P<0.05,差异明显具有统计学意义;对照组患者术后各时段的视觉模拟评分法(VAS)评分明显高于实验组,P<0.05,差异明显具有统计学意义。结论对于非小细胞肺癌患者进行手术方式选择上,通过研究数据可知采用胸腔镜肺叶切除术治疗方式对患者进行治疗可以提高患者的治疗效果并降低患者并发症以及不良反应的发生率。胸腔镜肺叶切除术治疗非小细胞肺癌患者具有创伤小、并发症少、住院时间短等优点,术后功能恢复快,有利于患者生活质量的提高。值得在非小细胞肺癌患者的治疗中推广使用。     

胸腔镜与开胸肺叶切除术治疗非小细胞肺癌的随机对照研究

目的:探讨胸腔镜与开胸肺叶切除术治疗非小细胞肺癌的疗效.方法:选择2017年11月—2019年5月江西省丰城市人民医院心胸外科收治的非小细胞肺癌患者72例,依据随机对照原则分为两组,每组36例.对照组采取开胸肺叶切除术治疗.观察组采取腹腔镜肺叶切除术治疗.观察手术情况(手术切口、手术时间、术中出血量、清扫淋巴结数目)、...     

全胸腔镜肺叶切除与开胸肺叶切除治疗非小细胞肺癌的对比研究

目的探讨全胸腔镜肺叶切除与开胸肺叶切除治疗非小细胞肺癌的效果。方法选取2010年5月～2012年5月在本院进行治疗的非小细胞肺癌患者85例,随机分为胸腔镜组43例和开胸组42例,胸腔镜组采用全胸腔镜肺叶切除术,开胸组采用开胸肺叶切除术。观察两组平均手术时间、术中出血量、术后胸腔引流量、住院天数及术后并发症发生情况,采用视觉模拟评分（VAS）评估术后疼痛程度,并观察两组并发症发生率。结果胸腔镜组术中出血量、术后胸腔引流量及住院天数皆少于开胸组（P〈0．05）。手术时间显著长于开胸组（P〈0．05）。胸腔镜组VAS显著低于开胸组（P〈0．05）。胸腔镜组并发症发生率为11．63％,开胸组为38．10％,两组比较差异有统计学意义（P〈0．05）。结论全胸腔镜肺叶切除术治疗非小细胞肺癌较为安全、可靠,值得临床推广应用。     

全胸腔镜与开胸肺叶切除术治疗非小细胞肺癌疗效的对比研究

非小细胞肺癌non—small cell cancer,NSCLC）是目前世界上最常见的恶性肿瘤之一,严重威胁着人类健康,经过多年的发展,其治疗效果明显提高,NSCLC现代治疗的观点是以外科治疗为主的多学科综合治疗。随着电视胸腔镜手术（video—assisted thoracoscopic surgery,VATS）技术的不断发展,现已广泛应用于临床胸部疾病的诊治。     

胸腔镜与开胸手术治疗早期非小细胞肺癌的临床观察

目的探讨胸腔镜与开胸手术治疗早期非小细胞肺癌的临床治疗效果。方法选择我院收治的90例早期非小细胞肺癌患者,将所有患者随机分为观察组和对照组。观察组采用胸腔镜手术治疗,对照组采用传统的开胸手术治疗。观察两组患者的临床治疗效果及手术情况。结果所有患者手术均获得成功,两组存活率对比差异不具有统计学意义(P>0.05)。观察组术中出血量、引流管留置时间、术后镇痛时间以及住院时间均明显少于对照组,两组对比差异均具有统计学意义(P<0.05)。结论胸腔镜治疗早期非小细胞肺癌疗效确切,治疗效果明显优于传统开胸手术,手术创伤小,出血量少,且术后恢复快。     

胸腔镜辅助小切口与开胸肺叶切除术治疗非小细胞肺癌的疗效对比

随着电视胸腔镜技术的不断发展,电视胸腔镜辅助小切口（video-assisted mini-thoracotomy,VAMT）手术已在胸心外科普遍开展[1]。VAMT肺叶切除术因其创伤小、术后疼痛轻、并发症少、恢复快等优点在手术治疗非小细胞肺癌（non-small cell cancer,NSCLC）方面起着重要角色,也取得了满意的疗效。     

电视胸腔镜肺叶切除术和传统开胸肺叶切除术治疗Ⅰ-Ⅱ期非小细胞肺癌的疗效

目的 观察电视胸腔镜肺叶切除术和传统开胸肺叶切除术治疗Ⅰ-Ⅱ期非小细胞肺癌的疗效和安全性.方法 将218例Ⅰ-Ⅱ期非小细胞肺癌患者分为电视胸腔镜组和传统手术组,分别对2组围手术期指标、生存情况及实验室指标进行比较.结果 电视胸腔镜组患者手术切口,手术时间、术中出血量、住院时间、胸引流管留置时间及并发症的发生率明显低于传统开胸组(P＜0.05).传统开胸组和电视胸腔镜组患者在淋巴结清扫数量、术后引流总量及1年生存期等比较差异无统计学意义(P＞0.05).2组患者C反应蛋白在术后1,2,3d明显增加,但电视胸腔镜组CRP水平明显低于传统开胸组(P＜0.05).结论 电视胸腔镜肺叶切除术治疗早期非小细胞肺癌安全、可靠.     

电视胸腔镜与传统开胸肺叶切除术在基层医院治疗原发性非小细胞肺癌中的分析

目的探讨电视胸腔镜肺叶切除术治疗原发性非小细胞肺癌(NSCLC),在县级医院临床应用。方法 2010年1月至2013年6月,我科手术治疗NSCLC患者76例,其中34例接受电视胸腔镜肺叶切除术(VATS组),男16例,女18例,平均年龄62.2岁;42例接受传统开胸肺叶切除术(传统开胸组),男30例,女12例,平均年龄56.8岁,比较分析两组患者围手术期相关临床变化。结果两组患者均无严重并发症和围手术期死亡。VATS组与传统开胸组比较,在切口长度(5.2±1.9)cm、(29.1±4.1)cm,t=-35.270,P=0.000;术后杜冷丁用量(130±115)mg、(285±115)mg,t=-3.864,P=0.005;术后住院时间(9.0±4.3)d、(16.0±4.5)d,t=-6.532,P=0.016等方面差异有统计学意义。两组在手术时间(210±54)min、(180±42)min,t=1.839,P=0.069;淋巴结清扫数量(15±8)个、(15±9)个,t=-0.088,P=0.930方面差异无统计学意义。结论电视胸腔镜肺叶切除术可彻底清扫淋巴结,术后创伤小,疼痛轻,住院时间短,在严格选择患者的条件下,可以作为县级医院治疗早期NSCLC的一种手术途径。     

单向式全胸腔镜肺叶切除术与传统开胸肺叶切除术治疗早期非小细胞肺癌的对照研究

目的 比较单向式全胸腔镜肺叶切除术与传统开胸肺叶切除术治疗早期非小细胞肺癌(NSCLC)的临床效果.方法 92例NSCLC患者随机平均分为胸腔镜组(n=46)和开胸组(n=46),2组患者分别实施单向式全胸腔镜肺叶切除术和传统开胸肺叶切除术,比较2组平均手术时间、术中出血量、术后胸腔引流量、住院天数及术后并发症发生情况,采用视觉模拟评分(VAS)评估术后疼痛程度,并随访观察2组术后1年无瘤生存率.结果 92例患者均顺利完成手术.胸腔镜组术中出血量及胸腔引流量均少于开胸组(P<0.05),术后住院天数较开胸组缩短(P<0.05),术后VAS评分较开胸组低(P<0.05),并发症发生率(8.70%)较开胸组(19.57%)低(P<0.05).2组平均手术时间及术后1年无瘤生存率差异无统计学意义(P>0.05).结论 单向式全胸腔镜肺叶切除术治疗早期NSCLC安全、有效、创伤小、术中出血少、恢复快,值得临床推广应用     

培美曲塞治疗晚期非小细胞肺癌的临床观察

目的:探讨培美曲塞治疗晚期转移件非小细胞肺癌(NSCLC)的疗效和不良反应.方法:经病理学确诊的晚期转移性肺癌4例,1例初治,3例为复治患者,评分0～3分,采用单药培美曲塞或联合顺铂或联合卡铂方案,即第一天培美曲塞500 mg/m2静脉注射/常规剂量应用联合顺铂或卡铂,每3N为1个周期重复,每2个周期评估疗效及不良反应.结果:4例均可评价疗效者,1例CR,2例PR,1例PD.因3例尚存活,不作生存期(率)评价.主要不良反应为中性粒细胞减少、胃肠道反应和末梢神经感觉障碍,其中1例有明显相关的疲乏感.结论:培美曲塞治疗晚期转移性非小细胞肺癌疗效良好,不良反应可接受.     

Management of NSCLC: focus on crizotinib

Introduction: Presence of Anaplastic lymphoma kinase (ALK) translocations identifies a distinct subgroup of NSCLC with different prognosis and therapeutic opportunities. In cancer cells, ALK gene fusion acts as oncogenic driver, representing an attractive therapeutic target in NSCLC.

Areas covered: For the purpose of this review article, data from preclinical and clinical trials with crizotinib were collected and analyzed.

Expert opinion: Available data demonstrated that crizotinib is the best option we can offer today to ALK-positive NSCLC not previously exposed to ALK inhibitors, irrespective of line of therapy. In two large Phase III trials, crizotinib demonstrated to improve response rate and progression-free survival when compared to standard chemotherapy, both in first- and second-line treatment. Furthermore, results from pivotal Phase I and II studies indicated that crizotinib was active even in heavily pretreated populations. In addition, crizotinib displayed a favorable toxicity profile with a broad spectrum of adverse events, most of which is easily to manage and rarely require dose reduction or interruption. Unfortunately, almost all patients became refractory to crizotinib due to emergence of acquired resistance. The optimal management of these patients has not yet been defined. Novel ALK inhibitors are under investigation.     

抗非小细胞肺癌药物奥希替尼研究进展

年3月22日中国食品药品监督管理局(CFDA)批准表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKI)奥希替尼(Osimertinib)用于治疗EGFR T790M基因突变阳性的局部晚期或转移性非小细胞肺癌(NSCLC)。奥希替尼是第三代EGFR-TKI,治疗效果显著,副作用更小,尤其适用于对第一、二代EGFR-TKI耐药或者脑转移的病人。与含铂类治疗药物的二联化学疗法相比,奥希替尼可使NSCLC病人中位无进展生存期(PFS)延长5.7个月,疾病进展风险下降70%。该文就奥希替尼的作用机制、研究历程、药效学、药动学、不良反应,耐药机制进行综述,为临床使用提供参考。     

Anamorelin hydrochloride for the treatment of cancer-anorexia-cachexia in NSCLC

Introduction: Cancer anorexia-cachexia syndrome (CACS) is associated with increased morbidity and mortality. Anamorelin is a novel, orally active ghrelin receptor agonist in clinical development for the treatment of CACS in NSCLC. The aim of this review is to summarize preclinical and clinical studies evaluating anamorelin as a potential promising treatment for CACS in NSCLC.

Areas covered: Pharmacodynamics, pharmacokinetics and metabolism, clinical efficacy, safety and tolerability of anamorelin for the treatment of CACS in NSCLC were reviewed. Anamorelin administration may lead to increases in food intake, body weight and lean body mass, and a stimulatory effect on growth hormone secretion in NSCLC patients. Anamorelin is well tolerated with no dose-limiting toxicities identified to date.

Expert opinion: Targeting ghrelin receptors presents the advantage of potentially addressing multiple mechanisms of CACS simultaneously including appetite, muscle protein balance, adipose tissue metabolism, energy expenditure and inflammation. Clinical data suggest that anamorelin is well tolerated and it effectively increases appetite, body weight and lean mass in patients with advanced NSCLC. Long-term safety remains unknown at this time. The potential synergistic effects of anamorelin with nutritional support or exercise as well as its efficacy/safety in other tumor types are also unknown.     

Targeting the MET pathway for potential treatment of NSCLC

Introduction: The mesenchymal-epithelial transition (MET) protein is the only known receptor for hepatocyte growth factor and has recently been identified as a novel promising target in several human cancers, including NSCLC. Activation of the MET signaling pathway can occur via different mechanisms. A number of compounds targeting MET have been evaluated in clinical trials, and recent clinical data have begun to afford some insight into the tumor types and patient populations that might benefit from treatment with MET pathway inhibitors.

Areas covered: We review recent publications and information disclosed at public conferences and summarize the epidemiology of dysregulation of MET signaling, and the associations thereof with other driver genes and therapeutic inhibitors useful to treat NSCLC.

Expert opinion: The MET pathway is emerging as a target for advanced NSCLC that is either resistant to EGFR tyrosine kinase inhibitors or that arises de novo. MET inhibitors currently being evaluated in clinical trials have yielded compelling evidence of clinical activities when used to treat various solid tumors, especially NSCLC. Remaining challenges are the identification of patient populations who might benefit from the use of MET inhibitors, and the most effective diagnostic methods for such patients.     

Emerging paradigms in targeted treatments for Asian patients with NSCLC

Introduction: EGFR-targeted drugs have been successfully approved in many countries and have demonstrated higher efficacy and lower toxicity than chemotherapy in molecularly defined subgroups of patients. Significant advances in clinical trials and studies focusing on targeted therapies have rapidly developed in Asia.

Areas covered: In the present review article, all of the published data or meeting abstracts on completed or ongoing trials of targeted treatment for Asian patients with NSCLC were collected and analyzed.

Expert opinion: Routine molecular testing has been used clinically to identify mutations/fusions and guide patient selection for targeted therapies. Based on the evidence presented, we provided up-to-date treatment recommendations for Asian patients with advanced NSCLC. Future directions, including dividing Del19 and L858R patients into two distinct populations, will optimize therapeutic strategies for L858R patients and may inform rational trial design by considering the proportion of type of sensitive EGFR mutation as a stratification factor. Another important aspect to consider involves how to monitor resistance to TKIs, which will improve the outcome for lung cancer patients with driver gene mutations.     

气管肿瘤的外科切除和气道重建的临床应用

目的探讨气管肿瘤的外科切除与气道重建的手术方法及效果。方法1998年1月至2011年3月,采用气管环形切除、对端吻合技术治疗15例气管肿瘤,其中5例继发性气管肿瘤行联合切除、气道重建手术;1例行气管隆突切除重建术;2例突发窒息病例经抢救复苏后气管切除、气道重建术。结果15例均痊愈出院。术后生存10年以上2例,5年以上2例,3年以上2例,1年左右6例;2年后死亡1例,1年内死亡2例。结论气管环形切除、对端吻合技术治疗气管肿瘤有效,尤其是治疗窒息患者的有效方法。     

多西紫杉醇卡铂结合三维适形放疗治疗晚期非小细胞肺癌

目的探讨多西紫杉醇（Docetaxel）联合卡铂（Carboplatin）同步放化疗的模式治疗局部晚期非小细胞肺癌（NSXLC）的临床疗效。方法59例局部晚期非小细胞肺癌患者随机进入同步组（39例）和序贯组（20例）,同步组即治疗组,采用三维适形放疗,同期给予TP方案[多西紫杉醇40mg/m^2（第1天）＋卡铂AUC=2（第1天）,每周一静脉滴注,共4-6周],同步放化疗结束后休息3至4周,再行2个周期的巩固化疗,方案为多西紫杉醇75mg/m^2（第1天）＋卡铂AUC=5（第1-3天） 序贯组即对照组,放疗前先给予多西紫杉醇75mg/m^2（第1天）＋卡铂AUC=5（第1-3天）,行2个周期诱导化疗,诱导结束后休息1-2周开始放疗,放疗结束后休息3-4周再行原方案2个周期巩固化疗。结果59例患者全部完成治疗计划。同步组（治疗组）：肺原发灶完全缓解（CR）占7.7%（3/39）,部分缓解（PR）占66.7%（26/39）,无变化（NC）占15.4%（6/39）,进展（P/D）占10.2%（4/39）,有效率（CR＋PR）为74.4%（29/39）。中位疾病进展期56.4%（22/39）、35.9%（14/39）。2-3级白细胞下降发生率为46.2%（18/39）,2-3级急性放射性肺炎发生率为25.6%（10/39）,2-3级急性放射性食管炎发生率为33.3%（13/39） 序贯组（对照组）：肺原发灶完全缓解（CR）占5.0%（1/20）,部分缓解（PR）占60.0%（12/20）,无变化（NC）占15.0%（3/20）,进展（P/D）占20.0%（4/20）,有效率（CR＋PR）为65.0%（13/20）。中位疾病进展期（TTP）10个月,中位生存期（MST）15个月,1、2年生存率分别为50.0%（10/20）、30.0%（6/20）。2-3级白细胞下降发生率为45.0%（9/20）,2-3级急性放射性肺炎发生率为25.0%（5/20）,2-3级急性放射性食管炎发生率为30.0%（6/20）。结论同步组（多西紫杉醇联合卡铂同步放化疗）较序贯组疗效更好,而不良反应两者相当,能为绝大多数患者耐受,多西紫杉醇联合卡铂同步放化疗可以作为治?     

A novel animal model for investigating persistent airway hyperresponsiveness

The present study investigates the development and maintenance of airway hyperresponsiveness in neonatally immunized rabbits. Rabbits were immunized within 24 hr of birth with the antigen Altermaria tenuis together with aluminum hydroxide as an adjuvant, followed by repeated antigen and adjuvant administration up to 3 months of age. Anesthetized, spontaneously breathing rabbits immunized according to this protocol exhibited a 3.7- (p < 0.01) and 1.8-fold (p < 0.05) increase in airway responsiveness to inhaled histamine when compared with groups of naive or sham-immunized rabbits, respectively. In the absence of further antigen challenge, these changes in airway responsiveness to histamine in a subpopulation of antigen-immunized rabbits persisted for up to 12 months of age. This hyperresponsiveness was not associated with an alteration in either total or differential inflammatory cell numbers as assessed by bronchoalveolar lavage (BAL), and no significant differences in isolated bronchial smooth muscle responsiveness to methacholine, histamine, theophylline, or electrical field stimulation were observed. These results demonstrate that neonatal immunization of rabbits with Alternaria tenuis can lead to the development of persistent airway hyperresponsiveness, and that the maintenance of this state is unrelated to either a detectable alteration in cellular infiltration within the airway lumen or changes in bronchial smooth muscle responsiveness. It is suggested that neonatal exposure to antigen and adjuvant may be important determinants for the development of persistent airway hyperresponsiveness. This animal model may provide a useful way to investigate the effects of drugs on airway hyperresponsiveness.     

中药对晚期非小细胞肺部化疗增效的研究

目的：对于不能手术治疗的晚期非小细胞肺癌NSCLC，仍无有效的治疗方法，化疗仅能有限的缓解病情，延长生存期，疗效并不尽人意。本研究旨在讨论对NSCLC化疗中加用抗癌中药的疗效。方法：本研究用NFP方案，化疗NSCLC的同时服用活血化瘀，清热解毒提高免疫力及抗癌中药，用中药一年以上或用至病人不能服用药物对为止。结果：取得CR1例，PR6例，全组总有效率为54％，复治者有效率为25％。结论：MFP方案化疗NSCLC的同时长年服用抗癌中药，疗效确切，明显延长了病人的生存期，使NSCLC的化疗疗效，接近了小细胞肺癌的化疗水平。