单向四孔法全胸腔镜肺叶切除术治疗非小细胞肺癌的临床研究

目的探讨单向4孔法全胸腔镜肺叶切除术治疗非小细胞肺癌的可行性、安全性。方法回顾性分析2007年1月至2010年12月上海市胸科医院采用单向式全胸腔镜肺叶切除治疗428例非小细胞肺癌患者的临床资料,其中男186例,女242例;年龄33～78岁。术前临床诊断为早期非小细胞肺癌。428例中行右肺上叶切除134例,右肺中叶切除48例,右肺下叶切除98例,右肺中下叶切除4例,左肺上叶切除72例,左肺下叶切除72例。将428例患者按手术方式分为单向3孔法组(300例)和单向4孔法组(128例);比较两组的临床效果。结果412例在全胸腔镜下完成肺叶切除术,16例中转常规开胸手术(中转开胸比率3.7%)。平均手术时间132.1(120～180)min,平均手术切口长度3.7(3～5)cm,平均术中出血量150.0(50～800)ml;两组患者平均拔管时间、术中出血量、术后住院时间差异均无统计学意义,但4孔法组较3孔法组手术时间缩短,且差异有统计学意义(P<0.05)。16例中转开胸患者接受术中输血。死亡5例,于术后1个月内分别死于严重肺部感染、肺栓塞和急性脑梗死。术后病理诊断:鳞状细胞癌52例,腺癌340例,腺鳞癌20例,低分化癌8例,大细胞癌6例,类癌2例。术后出现持续肺漏气4例,脓胸2例,肺部感染4例,心律失常26例,肺栓塞2例,乳糜胸2例,急性脑梗死2例。3年总生存率为83.6%(358/428)。结论单向式4孔法全胸腔镜肺叶切除术治疗非小细胞肺癌的有效性和安全性满意,符合肺癌手术的治疗规范。单向4孔法还能大大提高手术流畅程度和淋巴结清扫程度。     

胸部体疗训练促进肺叶切除术患者术后康复的作用

目的探讨胸部体疗训练对胸腔镜下肺叶切除术患者术后早期康复的影响。方法选取2013年1—12月在上海交通大学医学院附属新华医院心胸外科胸腔镜下行肺叶切除术患者120例,按入院时间先后分为观察组和对照组各60例。对照组按照《临床护理实践指南》采用常规护理方法;观察组患者进行胸部体疗训练,内容包括:呼吸功能训练、胸部体疗和早期活动方法等。比较两组患者术后胸部X线片、呼吸频率、指脉氧饱和度、体温和呼吸道并发症等情况。结果观察组患者手术后肺部恢复情况较好,胸管留置时间减少,离床活动时间提前,且肺部并发症发生率下降。与对照组比较,差异有统计学意义(P0.05)。结论对胸腔镜下行肺叶切除术患者采用胸部体疗训练,可改善患者手术后的呼吸功能,减少各种并发症的发生率,有利于促进患者早日康复。     

Giant pulmonary hydatid cyst in children

BackgroundLungs are the second most common site for hydatid disease after the liver. Giant hydatid cyst (GHC) of the lung is a special clinical entity in children and is related to higher lung tissue elasticity.AimTo compare clinical and imaging features, types of surgical interventions, and postoperative complications in pulmonary GHC and non-giant pulmonary hydatid cysts (NGHC) in children.MethodsA retrospective study was undertaken. The data analyzed were taken from medical records of children with pulmonary hydatid cyst (PHC) hospitalized in a pulmonary department in Tunisia between January 2004 and February 2019. Cysts were divided according to their size into GHC ( ≥10 cm) and NGHC (< 10 cm).ResultsIn the study period, 108 PHC were recorded in 84 children. GHC accounted for 21 (19.4%) and NGHC for 87 (80.6%). The median of age of the children was 11 years (IQR 1–9, IQR 3–14) and the mean age was 11.6 years (10.5 in GHC vs. 11.4 years in NGHC). Hemoptysis was found in 25% of the GHC group vs. 48.4% of the NGHC group (P = 0.27). Cysts were multiple in 23.8% of cases and predominated in the right in 64.3% of cases and in the inferior lobes in 71.4% of the cases. GHCs were less frequently complicated (60% vs. 78.1% in NGHC, P ≤ 0.11), although not significantly. Parenchymal resection was realized in 50% of GHC vs. 18.8% of NGHC (P = 0.006). No significant difference was found in postoperative complications between the two groups and there was no recurrence in either group.ConclusionGHC is a special clinical entity in children. It requires major surgery with parenchymal resection, and therefore early diagnostic and therapeutic management is warranted.     

Late sequelae of lobectomy for primary lung cancer: fibrobullous changes in ipsilateral residual lobes

Background: Late complications after lobectomy for primary lung cancer are rare. Progressive fibrobullous changes in the ipsilateral residual lobes were observed in some of the long-surviving patients after lobectomy for lung cancer. We report clinical details of this late complication. Methods: Between 1975 and 1997, we selected 39 patients (35 males and 4 females) from a total of 1321 patients who underwent lobectomy for primary lung cancer. Results: The incidence rate of this complication was 3%; this increased to 5.6% in patients who had survived for 5 years or more. A chest roentgenogram revealed fibrobullous changes on an average of 2.5 years (range 3 months–6 years) after lobectomy; these changes progressed throughout the ipsilateral lobes over several years. Ten patients (26%) required continuous oxygen therapy. The fibrobullous lungs of 21 (54%) patients were infected with nontuberculous mycobacterium, aspergillus, methicillin-resistant Staphylococcus aureus, and unidentified bacteria in 5, 4, 1, and 11 patients, respectively. Twenty-four patients died of the following causes: cancer (8, 33%), respiratory failure and chronic infections related to this complication (10, 42%), and other diseases (6, 25%). Three patients underwent successful surgical intervention for treating chronic infection of the destroyed lungs (omentopexy 1, completion pneumonectomy 2). Conclusions: Fibrobullous lung should be recognized as an important late complication that develops in lung cancer patients after lobectomy.     

电视胸腔镜辅助小切口肺叶切除35例临床分析

目的探讨胸腔镜辅助小切口肺叶切除在早期肺癌及肺良性病变治疗中的应用价值。方法回顾分析我院2002年2月～2006年6月行胸腔镜辅助小切口肺叶切除35例的临床资料。其中周围型肺癌(T1N0～1M0)31例,支气管扩张症3例,右肺中叶不张并脓肿1例。解剖性肺叶切除30例,非解剖性肺叶切除5例。结果本组无中转开胸,手术时间85～210min,(115±35)min。术中出血150～450ml,(210±55)ml。2例术后并发急性呼吸衰竭,使用呼吸机辅助机械通气分别治疗3、5d后顺利脱机;1例术后急性心肌梗死,经早期溶栓治疗痊愈。其余32例无术后并发症。全组拔除胸腔闭式引流管时间2～10d,平均5.4d。3例肺良性病变,随访41、33、13个月,无明显远期并发症;25例肺癌平均随访时间15.2月(3～53个月),其中随访3～12个月6例、12～24个月9例、24～36个月7例、36～53个月3例,因肺癌复发或转移死亡4例(16%),肿瘤复发带瘤生存2例(8%),无瘤生存19例(76%)。结论胸腔镜肺叶切除对周围型肺癌(T1N0～1M0)及肺部局限性良性病变是一种完全可行并且安全的手术方法。     

重度肺功能减退的肺癌患者术前肺功能改善及手术并发症分析

目的:分析重度肺功能减退患者肺叶切除手术前肺功能改善情况,手术效果及术后并发症.方法:回顾性分析我院2002～2008年收治的35例重度肺功能减退患者术前处理后,肺功能指标FEV1和PaO2改善情况,并与同时期54例轻度或正常肺功能患者的手术效果和术后并发症进行比较.结果:重度肺功能减退组FEV1和PaO2分别从入院的(0.72±0.14)L.(64.28±6.93)mmHg增加为处理后的(1.06±0.20)L、(74.2±7.04)mmHg,P＜0.001;两组患者总住院天数分别为(25.32±2.31)d和(18.74±1.76)d,P＜0.001;术后呼吸机使用时间分别为(8.81±3.6)h和(3.05±0.90)h,P＜0.001;低氧血症、心律失常、肺部感染、住院期间死亡率和总并发症率分别为48.1%、29.6%、33.3%、14.8%、59.3%和18.5%、11.1%、18.5%、0、31.1%,P值分别为0.005、0.038、0.138、0.04和0.016.结论:对重度肺功能减退的肺癌患者术前积极改善肺功,可提高患者手术耐受,但对肺功能严重减低的患者施行肺叶切除时,术后发生心肺并发症的机率明显增加,术后死亡率较高.     

超声引导联合全麻对老年肺癌肺叶切除术患者NGF-β、MBP及术后转归分析

目的分析超声引导联合全麻对老年肺癌肺叶切除术患者血清神经生长因子-β(NGF-β)、髓鞘碱性蛋白(MBP)及术后转归影响。 方法选择2020年2月至2021年3月我院收治的65例老年肺癌患者,随机分为观察组35例和对照组30例,观察组采用超声引导联合,全麻对照组采用全麻。对比两组手术相关情况,术中各时间点平均动脉压、心率,术后早期肺活量情况,术后镇痛效果,术前术后NGF-β、MBP水平变化,术后早期康复质量,术后认知功能障碍发生率,术后不良反应发生率。 结果两组手术时间、麻醉时间、苏醒时间、住院时间均无显著差异(P>0.05);观察组插管时、切皮时、拔管时均显著低于对照组(P<0.05);观察组术后12 h、术后24 h、术后48 h早期肺活量均显著高于对照组(P<0.05);观察组术后镇痛补救率、镇痛泵按压次数、输注总量、术后6 h视觉模拟评分法(VAS)、术后12 h VAS均显著低于对照组(P<0.05);观察组术后NGF-β水平显著低于对照组,MBP水平显著高于对照组(P<0.05);观察组术后12 h、术后48 h、术后72 h的术后恢复质量量表(QOR-40)评分均显著高于对照组(P<0.05);观察组术后6 h、术后12 h、术后24 h认知障碍发生率均显著低于对照组(P<0.05);观察组不良反应总发生率显著低于对照组(P<0.05)。 结论超声引导联合全麻可有效改善老年肺癌肺叶切除术患者血清NGF-β、MBP水平,提高镇痛效果,促进术后早期转归。     

Low thoracic muscle mass index on computed tomography predicts adverse outcomes following lobectomy via thoracotomy for lung cancer

 Open in a separate windowOBJECTIVESThe aim of this study was to determine whether the preoperative thoracic muscle mass is associated with postoperative outcomes in patients undergoing lobectomy via thoracotomy for lung cancer.METHODSConsecutive patients undergoing lobectomy were retrospectively reviewed. The thoracic muscle mass index (TMMI) was obtained at the level of the fifth thoracic vertebra on preoperative thoracic computed tomography (CT). Patients were analysed comparatively by being dividing into low and high muscle index groups by the median of sex-specific TMMI. The primary outcomes were the incidence of any or postoperative pulmonary complications. The secondary outcomes were postoperative intensive care unit (ICU) admission, length of stay (LOS) in the ICU, total hospital LOS, readmission and mortality.RESULTSThe study population consisted of 120 patients (63.6 ± 9.8 years; 74% male). Each groups included 60 patients. Major complications occurred in 28.3% (34/120) and readmission in 18.3% (22/120) of patients. The adjusted multivariable analysis showed that each unit increase in TMMI (cm²/m²) was independently associated with the rates of less any complications [odds ratio (OR) 0.92, P = 0.014], pulmonary complications (OR 0.27, P = 0.019), ICU admission (OR 0.76, P = 0.031), hospitalization for >6 days (OR 0.90, P = 0.008) and readmission (OR 0.93, P = 0.029).CONCLUSIONSLow TMMI obtained from the preoperative thoracic CT is an independent predictor of postoperative adverse outcomes in patients following lobectomy via thoracotomy for lung cancer. TMMI measurements may contribute to the development of preoperative risk stratification studies in the future.