多原发肺癌外科诊疗策略进展

多原发肺癌是一类特殊的肺癌,其检出率逐年攀升,且尚无明确诊断及治疗策略,多原发肺癌的诊疗成为临床工作中的热点.早期且准确的鉴别诊断决定治疗方法和预后,分子遗传学正逐步改变仅依靠影像学与无瘤间期来鉴别肺内转移瘤与多原发肺癌的现状,是鉴别诊断并预测肺癌生物学行为的有效方法.我们总结自身经验与多方研究,建议无禁忌证患者首选外...     

同期双原发食管癌肺癌1例

病人　男 ,6 8岁。进食时胸骨后疼痛并梗噎感 2个月。查体 :右上肺叩诊呈局限性浊音 ,未及肿大的浅表淋巴结。胃镜示距门齿 2 9 0～ 32 5ｃｍ的食管前、右侧壁溃疡 ,边缘充血隆起 ,基底污浊、糜烂 ,组织僵硬 ,触之容易出血 ;活检报告鳞状细胞癌。Ｘ线胸片示右上肺 5 0ｃｍ× 5 0ｃｍ× 4 0ｃｍ大小的中空块状阴影 ,周围有毛刺征。ＣＴ示右上肺叶、尖后段肿块 ,约 5 0ｃｍ× 4 0ｃｍ× 4 0ｃｍ大小 ,周围纤维呈放射状 ,外侧部分抵达肺脏层胸膜 ,牵拉局部呈凹陷状 ,肿块内见偏心性坏死空洞 ,右侧肺门部见 2～ 3枚肿大淋巴结。入院诊断 …     

刘伦旭教授成功开展国际首例双侧单孔胸腔镜手术同期治疗多原发肺癌

患者,女,70岁,因右侧胸痛,CT检查发现双侧肺部有4个结节,右上肺有2个,左上肺、左下肺各1个,就诊我院胸外科,经分析判断,双侧4个结节都是原发性肺癌（同时性多原发肺癌）。患者年龄大,病灶多,如何诊治和手术是个非常棘手的问题,国际上也没有满意的解决办法。经过周密的准备,于2014年1月13日,主刀医师刘伦旭教授决定采用当前最先进的单孔胸腔镜技术,     

多原发早期肺癌诊疗专家共识

近年来,多原发肺癌检出率逐年增加,然而临床医生对多原发早期肺癌的认知和诊疗方法不统一,影响多原发早期肺癌患者的规范化治疗。因此,本团队在充分查阅国内外文献的基础上,提出聚焦多原发早期肺癌诊疗的专家共识,旨在为临床医生诊疗多原发早期肺癌提供参考,进一步提高我国肺癌规范化诊疗水平。     

子宫内膜与卵巢原发双癌的分子机制研究进展

女性生殖道原发双癌约占所有妇科肿瘤的1%～2%,其中最常见的是子宫内膜与卵巢原发双癌(SEOC)。原发双癌约占所有卵巢癌的10%,约占所有子宫内膜癌的5%。相对于单发肿瘤,双癌发病时肿瘤期别较早、病理分级较低,预后较好,因此,临床上对于原发早期双癌的治疗原则也有别与于单发的卵巢或子宫内膜转移癌。但目前原发的诊断标准及与转移癌的鉴别诊断标准尚存在诸多争议。本文旨在探讨SEOC的临床及分子生物学、分子遗传学特点,进而为临床诊疗提供更确切的理论依据。     

多原发性肺癌诊疗的研究进展

随着疾病谱变化和检查技术进步,临床上对肺部多发结节、肿块进行检查时,发现多原发性肺癌(multiple primary lung cancer,MPLC)的检出率有逐渐增多的趋势,患病率也越来越高.MPLC与其它肺部疾病或肺部癌变在治疗及预后上有明显差异,多建议尽早手术,因此需术前或治疗过程中对MPLC做出准确判断.新...     

异时第二原发肺癌的诊断及手术治疗

目的 探讨异时第二原发肺癌的诊断、手术治疗方式和预后。方法 对我院胸外科自1983年1月至2004年4月手术治疗的32例异时第二原发肺癌患者的临床资料进行回顾性分析。结果 15例有咳嗽、痰血、气短等症状,17例随诊中经影像学检查发现。第一原发肺癌均行肺叶切除或全肺切除。异时第二原发肺癌行肺叶切除或完成式全肺切除17例,局部切除14例,单纯探查1例;15例行淋巴结清扫,17例未清扫淋巴结;6例为姑息性切除。手术切除率和根治切除率分别为97％(31／32)和81％(26／32)。两次手术为同侧者17例(9例为右侧)。组织学类型：鳞癌11例,腺癌7例,腺鳞癌6例,肺泡细胞癌5例,小细胞肺癌、小细胞并鳞癌及腺样囊性癌各1例;第一、二原发肺癌组织学类型不同者24例,组织学类型相同但发现的时间间隔超过4年者7例。术后临床病理分期：Ⅰa期4例,Ⅰb期16例,Ⅱa期1例,Ⅱb期4例,Ⅲa期1例,Ⅲb期5例,左肺上下叶各有一Ⅰa期癌灶者1例。术后并发症发生率、手术死亡率分别为12％(4／32),3％(1／32),并发症为支气管胸膜瘘、心房纤颤和呼吸功能不全,死亡原因为呼吸衰竭;术后1,3,5年生存率分别为660k,(19／29),32％(9／28),19％(4／21)。结论 加强术后随诊和提高鉴别诊断能力是提高第二原发肺癌诊断率的关键。手术切除方式受限和淋巴结清扫不彻底可能是患者预后不佳的原因之一。     

同时性多原发大肠癌的诊断与治疗

从Czerny,Fenger,Billroth[1]等最初报告同时性多原发大肠癌至今已有一百多年,但仍有很多问题没有达成共识。一、诊断标准多原发大肠癌(multiple pri marycolorectal carcinoma,MPCC)包括同时性多原发大肠癌(synchronous colorectalcarcinoma,SCC)和异时性多原发大肠癌(metachronous colorectal carcinoma,MCC)。SCC的诊断标准,目前国内外的文献多采用Warren、Moertel以及蔡成机等提出的标准[1-6]。可归纳为:①结肠、直肠内同时有两个或两个以上经病理证实的原发癌,发生在不同部位,互不连续,两处病变一般间隔正常肠壁5cm以上。②所…     

同时性多原发肺癌淋巴结转移规律的临床研究

目的 探讨多原发肺癌的诊疗手段及淋巴结转移情况。方法 回顾性分析2015年1月至2019年12月江门市中心医院胸外科收治的93例多原发肺癌病例,根据主病灶直径分为A组（≤10 mm）、B组（>10 mm,≤20 mm）和C组（>20 mm,≤30 mm）分析其年龄、吸烟史、肿瘤标记物和淋巴结转移情况等。结果 多原发肺癌随年龄递增,主病灶直径增大,而吸烟史与主病灶直径无关。A组CEA（2.00±1.80）μg/mL、Cyfra21-1（2.38±1.09）ng/mL与B组CEA（2.81±2.52）μg/mL、Cyfra21-1（2.53±0.76）ng/mL均在正常值内;但C组CEA（23.61±46.14）μg/mL与Cyfra21-1（3.54±1.31）ng/mL较A、B组均明显增高,差异有统计学意义（P<0.05）。A组中仅第10组淋巴结转移（5.26%）,而其他组淋巴结均未见转移;B组第10、11组淋巴结转移（6.90%、3.57%）,并有N2淋巴结转移,第5组淋巴结转移（16.67%）;C组N2淋巴结转移情况更多见,第2、4、7组淋巴结转移率分别为5.44%、4.60%和2.22%。不同类型肺癌淋巴结转移情况不同。肺结节位于一侧行同期肺结节切除,位于双侧则分期肺结节切除,间隔3~12月。1年PFS、OS均为100%。结论 多原发肺癌位于同侧行同期肺结节切除,位于双侧则分期肺结节切除,无严重并发症,安全性高。多原发肺癌主病灶直径≤1 cm时,建议行选择性淋巴结切除清扫或淋巴结取样（肺门淋巴结）;主病灶直径>1 cm时,则应行系统性淋巴结清扫。     

原发肺癌合并小肠肿瘤一例

1病例介绍 患者男,74岁,因腹痛1月、排气排便减少7d,于2010年2月15日入院。既往有左侧肺癌病史10个月（纤维支气管镜病理学活组织检查：中分化鳞状细胞癌）,未行手术治疗,行6个周期化学治疗和35次放射治疗。     

双镜联合治疗同时性多原发肺癌13例临床分析

目的 评估电视辅助胸腔镜手术(video-assisted thoracoscopic surgery,VATS)联合电磁导航支气管镜(electromagnetic navigation bronchoscopy,ENB)引导微波消融(microwave ablation,MWA)治疗同时性多原发肺癌(Synchro...     

Survival after resection of synchronous bilateral lung cancer

Objective: Due to recent advances in imaging, the incidence of patients presenting with bilateral lung lesions is increasing. A single contralateral lung lesion can be an isolated metastasis or a synchronous second primary lung cancer. For the revision of the TNM in 2009, the International Association for the Study of Lung Cancer Staging Committee proposes that patients with contralateral lung nodules remain classified as M1 disease. In this retrospective study, the survival after resection of synchronous bilateral lung cancer is evaluated. Methods: From our database of bronchial carcinoma, all patients with bilateral synchronous lung lesions between 1990 and 2007 were retrieved. We analysed 57 patients in which, after functional assessment and thorough staging, the decision was taken to treat the disease with bilateral resection. All these files were retrospectively reviewed. Twenty-one patients were excluded from this analysis because only one side was resected (n = 15) or one of the lesions was non-neoplastic on final pathology (n = 6). Results: Thirty-six patients underwent bilateral resection for synchronous multiple primary lung cancer. All resections were performed as sequential procedures. In 23 patients, one side was anatomically resected (2 pneumonectomies) and the contralateral side was resected by limited resection. In 10 patients a bilateral lobectomy was performed, and 3 patients had bilateral limited resections. Postoperative mortality was 2.8%. Eighteen patients had a tumour with a different histological pattern, confirmed by comparing both specimens by an experienced senior pathologist. The median survival after resection of synchronous bilateral lung cancer in our series was 25.4 months with a 5-year survival rate of 38%. There was no significant difference in survival between patients with different versus same histology. This survival is much higher compared to the survival of assumed stage IV disease. Conclusions: Our study shows that selected patients with bilateral lung cancer may benefit from an aggressive approach, with acceptable morbidity and mortality, and rewarding long-term survival. Patients with a single contralateral lung lesion should not be treated as disseminated disease (stage IV). After extensive searching for metastatic spread, bilateral surgical resection should be considered in fit patients.     

同时性多原发结直肠癌的诊断和治疗

目的:探讨同时性多原发结直肠癌的诊断和外科治疗方法.方法:回顾性分析36例同时性多原发结直肠癌患者的临床资料.结果:全部病例均行同期手术切除,其中姑息性切除1例.根治性切除35例.其5年、10年生存率分别为58.3%及41.7%,与同期单结直肠癌病例相比无显著性差别.结论:结直肠癌患者术前或术中应常规行全程结肠镜检查,术中应常规解剖标本.根治性切除是治疗同时性多原发结直肠癌的治疗原则.     

多原发同时结直肠癌39例临床病理分析

目的探讨多原发同时结直肠癌的临床病理特征。方法回顾性分析39例多原发同时结直肠癌的临床资料,并与同期528例单发结直肠癌患者的临床资料进行比较。结果多原发同时结直肠癌在Dukes分期上,主癌分期明显较合并癌晚;且主癌的局部淋巴结转移及脉管浸润较合并癌多见;在病理类型上,主癌分化程度较合并癌差。多原发同时结直肠癌的腺瘤性息肉发生率（59.0%）明显高于单发结直肠癌患者（25.0%,P〈0.01）。手术前结肠镜明确为同时多原发癌的阳性率为76.9%,明显优于钡灌肠与术中探查（P〈0.01）。多原发同时癌患者的5年生存率（5.1%）明显低于单发癌者（28.2%）（P〈0.05）;行根治性手术的多原发同时癌患者5年总生存率则与单发癌患者相似（P〉0.05）;多原发同时癌接受根治性手术者的生存期明显高于姑息性手术者（P〈0.01）。Cox多因素分析显示,Dukes分期、淋巴结转移、脉管瘤栓、手术方式是影响患者生存的独立预后因素。结论多原发同时结直肠癌与单发结直肠癌的临床病理特征及预后是不尽相同的,提高多原发同时结直肠癌患者生存率的关键在于早期诊断和及时进行根治性手术切除。     

Pneumothorax manifesting primary lung cancer

Pneumothorax is a rare lung cancer manifestation. We report 2 patients in which pneumothorax occurred as a first manifestation of lung cancer. Postoperative lung tissue examination after pneumothorax showed lung cancer by chance. One patient had dissemination suspected due to ruptured bulla with adenocarcinoma. Both immediately underwent additional lobectomy with mediastinal lymphadenectomy after lung cancer was diagnosed, but we detected lung cancer recurrence in the bottom of the pleural cavity on the same side some 11 months after radical surgery in the patient suspected of dissemination. We could resect it completely, followed by adjuvant radiotherapy. The possibility of lung cancer should thus be considered in pneumothorax patients, even if middle-aged.     

Synchronous growth of triple lung cancer

The case of a 75-year-old man with three synchronous carcinomas of the lung (large cell carcinoma, adenocarcinoma, and small cell carcinoma) is reported. This is the eighth well-documented case report in the literature; however, our case is the first to be reported with the newly described histological combination.     

Bilateral sleeve lobectomy for metachronous multiple primary lung cancer

In a patient with metachronous multiple primary lung cancer, bilateral lobectomy was performed, using bronchoplastic procedures. This case may be one of very few such cases reported in the literature. A 56-year-old man with squamous cell carcinoma was surgically treated for lung cancer. At the first operation, right upper lobectomy with wedge resection of the right main bronchus was performed, as the tumor occupied the orifice of the right main bronchus. Six months later, re-operation for stricture at the anastomotic line was done because of granulation. By means of sleeve resection of the strictured right main bronchus, the airway was reconstructed. The patient remained well for five years, then a similar cancer at the orifice of the left lower lobe and bulging into the left main bronchus became evident. Left lower sleeve lobectomy was done for the second primary cancer. The postoperative course was uneventful and he is well with no signs of recurrence 6 years and 10 months after the first operation and 19 months after the second sleeve lobectomy