肺癌术后胸腔积液的治疗体会

目的探讨肺癌术后胸腔积液的治疗。方法收集2006年1月—2009年6月期间在我院诊治的肺癌术后胸腔积液68例,通过纤维支气管镜吸痰、调整抗生素、经胸管胸腔内注入滑石粉、注入50%葡萄糖、胸腔清理同时行支气管残端心包或奇静脉包埋、胸腔注入顺铂、乳糜胸结扎胸导管治疗胸腔积液。结果只有2例未能拔除胸管,带管出院,其余均治愈。结论胸腔积液是肺癌术后一种常见的并发症,积极治疗,效果较好。     

骨髓间充质干细胞促进肺癌转移的机制

BACKGROUND:So far the positive or negative effects of mesenchymal stem cells on tumor growth and metastasis are under discussion. OBJECTIVE:To explore the mechanism of bone marrow mesenchymal cells in promoting lung cancer metastasis. METHODS: Primary rat bone marrow mesenchymal stem cells were obtained by direct adherence method of the whole bone marrow, and differential adherence combined with digestion control method was performed to purify cells. Lung cancer cell lines were cultured, and the effects of bone marrow mesenchymal stem cells on the migration, invasion and metastasis of lung cancer cells were observed by scratch test, cell invasion and migration assays. Orthotopic lung cancer models were established in rats and bone marrow mesenchymal stem cells were seeded onto the left lung of rats. Then, pathological changes of lung tissues were observed at 14 days after transplannation. RESULTS AND CONCLUSION:After the scratch test, the migration rate of lung cancer cells became higher, and the scratches healed with time. And after cell transplantation, the number of migrated lung cancer cells increased, as well as the ability of lung cancer cells penetrating the Matrigel was strengthened. Besides, fibrous connective tissues could be found around the lung cancer tissues, and necrosis with distinct boundary and large tumor nuclei; the metastatic tissues showed obvious infiltration and necrosis with large tumor nuclei. These results suggest that bone marrow mesenchymal stem cells can promote the invasion, migration and metastasis of lung cancer cell lines.       

人脐带间充质干细胞分离鉴定及移植后对肺癌小鼠化疗的影响

BACKGROUND:Mesenchymal stem cells have pluripotent differentiation, and can promote cell engraftment and immune regulation. Therefore, we attempt to use human umbilical cord mesenchymal stem cells as a new source for treatment of lung cancer by exploring cell isolation, identification and transplantation combined with chemotherapy for lung cancer in mice. OBJECTIVE:To investigate the isolation and identification of human umbilical cord mesenchymal stem cells and its transplantation combined with chemotherapy for lung cancer in mice. METHODS: Human umbilical cord mesenchymal stem cells were isolated from fresh umbilical cord of newborns and identified using tissue culture and enzyme digestion. Twenty Balb/C nude mouse models of lung cancer were randomly divided into two groups: mice in chemotherapy group were given chemotherapy, and those in combined group given combination of chemotherapy with human umbilical cord mesenchymal stem cell transplantation. RESULTS AND CONCLUSION:Compared with the chemotherapy group, the gastrointestinal tract was rosy and shiny, intestinal mucosa was smooth and complete, and tumor mass and blood indexes significantly decreased in the combined group (P < 0.05). To conclude, mature human umbilical cord mesenchymal stem cells can be obtained by tissue culture and enzyme digestion, and the cell transplantation combined with chemotherapy can significantly reduce gastrointestinal tract damage and the make peripheral hemogram in a stable level.      

胸腔镜辅助小切口治疗非小细胞肺癌75例临床研究

目的 探讨电视胸腔镜辅助小切口（video-assisted minithoracotomy，VAMT）治疗非小细胞肺癌的手术方式和适应证。方法 应用VAMT行肺叶切除术＋淋巴结清扫75例。作1cm胸腔镜切口及腋下8-10cm切口操作，摒弃常规的血管吻合器等昂贵的一次性器械，采用常规开胸手术器械与内镜器械相结合的方式行直视＋腔镜下行肺叶切除术＋纵隔肺门淋巴结清扫，所有血管和支气管结扎均同常规开胸方式。与同期63例常规开胸肺叶根治术进行比较研究。结果 VAMT组手术完成顺利，手术时间较常规开胸手术多大约2．3min，但术中出血很少，术后恢复快，住院时间缩短，术后并发症少，总体费用少。与常规开胸组相比，淋巴结的清扫数量及程度上均没有差异，对患者而言，性价比明显高于常规开胸手术。结论 VAMT治疗非小细胞肺癌，既发挥了电视胸腔镜（video assisted thoracoscopic surgery，VATS）手术在微创方面的优势，避免了伴随而来的高昂费用，近期的治疗效果又不弱于传统开胸手术。但手术操作技术要求较常规开胸手术高，胸腔镜切口是手术得以完成的关键。     

三维重建在早期非小细胞肺癌胸腔镜下肺段切除术中的应用

目的 探讨三维重建技术在早期非小细胞肺癌胸腔镜下肺段切除术中的应用价值.方法 回顾性分析因肺部高危结节于2021年1—11月在郑州大学第一附属医院接受胸腔镜肺段切除术的60例患者的临床资料,其中经术前三维重建的患者30例,对照组30例.收集手术时长、术中出血量、术后引流量、引流管拔出时间、术后住院时间及围手术期并发症进...     

食管癌贲门癌开胸术后心律失常的危险因素及治疗措施

目的探讨食管癌贲门癌开胸术后心律失常的危险因素,加强术后监测和治疗。方法对2003年1月至2006年12月我科收治的食管癌贲门癌开胸手术病人1582例常规行心电监护,记录心律失常发生的相关数据。结论术后心律失常发生率42.2%,心律失常发生在术后48h之内者占86.7%。结论年龄≥70岁,术前合并心血管疾病、肺功能减低、贫血及低蛋白血症等是导致术后心律失常的危险因素,针对上述因素提出了相应治疗措施。     

鼠肺缺血预处理后肺组织中热休克蛋白27检测

目的:探讨鼠肺缺血预处理后肺组织中热休克蛋白27(HSP27)的变化.方法:30只SD大鼠,随机分为缺血预处理组、对照组和假手术组,每组10只.缺血预处理组和对照组大鼠常规开胸后建立左上肺缺血再灌注模型,均遭受了缺血再灌注损伤,但缺血预处理组在缺血再灌注前给予缺血预处理干预,假手术组大鼠开胸后不予特*中国博士后科学研究基金资助项目 2004036433;湖南省科技厅科研基金资助项目 05sk3063;湖南省卫生厅科研基金资助项目 B2004024殊处理.以免疫印迹方法比较不同组间肺组织中HSP27的表达差异.采用二维凝胶电泳分离缺血预处理组和对照组样本的总蛋白质,对相对分子质量介于20 000～30 000差异表达的蛋白质点进行基质辅助激光解吸电离飞行时间质谱分析.结果:缺血预处理组和对照组中HSP27的表达量均多于假手术组,但缺血预处理组中HSP27的表达量高于对照组.质谱分析显示有9个蛋白质斑点的表达量存在差异,其中3个斑点(点11、17和28)为同一个蛋白.结论:缺血预处理对肺脏缺血再灌注损伤有明显的改善作用,其作用可能与HSP27的高表达有关.     

肺隔离药物灌注治疗肺癌临床研究

目的　探讨肺隔离药物灌注(ILP)治疗晚期肺癌的临床疗效。方法　对3 9例不可切除的肺癌、肺功能不能耐受肺切除手术者或多发性转移性肺癌患者进行肺隔离药物灌注化疗,即建立与体循环完全隔离的受累肺/肺叶的体外循环并以阿霉素灌注,灌注起始浓度为6mg/L ,心泵流量(2 0 0±5 0 )ml/min分,维持平均肺动脉压在2 0～2 5mmHg(1mmHg =0 .13 3kPa) ,常温(3 7℃)灌注,持续转流45min。结果　(1)灌注前后生命体征平稳,ILP术后1hMPaP、PVR及PAP升高,PaO2 降低,但循环稳定。(2 )灌注时肺隔离完全,能达到有效的肺内血药浓度[(4 .0 5±1.0 4)mg/L～(4 .19±0 .3 3 )mg/L]。(3 )肿瘤细胞坏死率97.9%。(4 )全组肿瘤治疗总有效率89.7%。(5 )术后1年生存率76.9%。(6)术后并发症主要是肺损伤,但阿霉素起始灌注浓度在6mg/L时肺损伤是可逆的。结论　ILP直接通过肺动脉灌注给药,能大幅度提高局部化疗药物的浓度,提高患者的1年生存率,是治疗晚期肺癌的一种可供选择的有效方法之一     

覆膜内支架治疗食管胸膜瘘

目的 总结覆膜内支架治疗食管胸膜瘘的疗效。方法 该组4例病人，食管胸膜瘘确诊后立即给予胸腔闭式引流术和对症处理，病情稳定后，在透视下或者胃镜直视下行食管内覆膜支架植入术。结果 4例支架置入技术操作全部成功，放置位置合适，无并发症发生。置入支架后胸水明显减少或者消失，患者恢复顺利。结论 覆膜内支架治疗食管胸膜瘘安全、有效、并发症少，值得在临床上应用。