Lobectomy Is Associated with Better Outcomes than Sublobar Resection in Spread through Air Spaces (STAS)-Positive T1 Lung Adenocarcinoma: A Propensity Score–Matched Analysis

Introduction

Spread through air spaces (STAS) is a form of invasion wherein tumor cells extend beyond the tumor edge within the lung parenchyma. In lung adenocarcinoma (ADC), we investigated the (1) association between STAS and procedure-specific outcomes (sublobar resection and lobectomy), (2) effect of surgical margin-to-tumor diameter ratio in STAS-positive patients, and (3) potential utility of frozen sections (FSs) for detecting STAS intraoperatively.

Risk Factors for Major Adverse Events of Video-Assisted Thoracic Surgery Lobectomy for Lung Cancer

Aims: The purpose of this study was to identify the risk factors for major adverse events of VATS (Video-Assisted Thoracic Surgery) lobectomy for primary lung cancer.Methods: 1806 Patients (1032 males, 57.1%) planned to undergo VATS lobectomy for stage IA-IIIA lung cancer from July 2007 to June 2012. The Thoracic Morbidity and Mortality Classification TM&M system was used to evaluate the presence and severity of complications. Postoperative complications were observed during a 30-day follow up. Univariate and multivariate analysis were used to analyze the independent risk factors for major adverse events.Results: Successful rate of VATS lobectomy was 97.6% (1763/1806). Major complications occurred in 129 patients (7.3%), with a mortality of 0.3% (5/1763). Pulmonary complications contribute up to 90.7% of the major complications and 80% of mortality. Logistic regression indicated that comorbidities, elder age ≥70y, operative time ≥240min and hybrid VATS were predictors for major adverse events (P<0.05). Hybrid and converted VATS lobectomy result in higher major adverse events compared with complete VATS, 15.1%, 20.9% and 7.4% respectively (P=0.013).Conclusions: The overall complication rate and mortality of VATS lobectomy are low, while major complications sometimes occur. Pulmonary complications are the most common major complications and cause of mortality. Age ≥70y, comorbidities, operative time ≥240min and Hybrid VATS are predictors of major adverse events.     

完全胸腔镜下肺叶切除加纵隔淋巴结清扫术在肺癌治疗中的应用研究

目的比较完全胸腔镜下肺叶切除加纵隔淋巴结清扫术与小切口辅助胸腔镜肺叶切除加纵隔淋巴结清扫术两种手术方法治疗非小细胞肺癌的优缺点。方法将46例周围型非小细胞肺癌且有相应手术指征的患者分成两组,即完全胸腔镜组（完全胸腔镜手术加纵隔淋巴结清扫术）与小切口辅助胸腔镜组（小切口辅助胸腔镜手术加纵隔淋巴结清扫术）。比较两组在胸腔内操作时间、术中出血量、淋巴结清扫数量、术后引流液量、止痛药物使用时间、拔管时间、术后并发症、住院时间、病理情况及手术并发症。结果两组患者均顺利完成手术。无中转开胸及大出血情况发生,无围术期死亡病例。完全胸腔镜组出血量（155.2±42.7）ml、止痛药物使用时间（6.8±1.2）d、引流液量（517.4±76.1）ml、拔管时间（4.8±0.8）d及住院时间（7.3±0.8）d均少于或短于小切口辅助组[（213.3±56.1）ml、（8.2±1.3）d、（633.0±80.5）ml、（5.8±1.0）d、（8.9±1.0）d],手术时间（129.8±23.9）min长于小切口辅助组（112.8±16.0）min,差异均有统计学意义（均P＜0.01）。两组患者淋巴结清扫数量[（14.2±2.2）个vs(13.9±2.1）个]及并发症发生率差异均无统计学意义（均P＞0.05）。结论完全胸腔镜下肺叶切除加纵隔淋巴结清扫术治疗非小细胞肺癌适合于早中期肺癌,可以作为早中期非小细胞型肺癌的一种可行的、比较安全的手术方式,并可以成为一种标准的手术方式。     

全胸腔镜下与开胸肺叶切除术治疗早期肺癌的疗效对比

目的 全胸腔镜下(c-VATS)与开胸(OT)肺叶切除术治疗早期肺癌的疗效.方法 选取心胸外科2014年1月至2016年12月治疗的91例肺癌患者,按治疗方法不同分为c-VATS切除组48例、OT切除组43例;比较两组治疗后的临床疗效.结果 c-VATS切除组的术后一般情况,包括拔管时间、输血量等指标均显著优于OT切除组;术后c-VATS切除组的一秒用力呼气容积(FEV1)、用力肺活量(FVC)优于OT切除组,OT切除组的并发症发生率为30.23％,c-VATS切除组为12.50％.结论 在c-VATS下行肺叶切除手术治疗肺癌的效果优于OT切除术.     

全胸腔镜系统性纵隔淋巴结清扫术的临床效果观察

目的：探讨非小细胞肺癌全胸腔镜肺叶切除术与常规开胸肺叶切除术的淋巴结清扫差异。方法共70例非小细胞肺癌患者入选本研究,其中37例接受全胸腔镜手术（试验组）,33例为开胸手术（对照组）,对2组患者术中出血量、术后住院时间、淋巴结清扫数量和站数等指标进行分析。结果与对照组相比,试验组手术切口明显缩短、术中出血量少、术后拔管时间短、住院时间短。试验组清扫淋巴结数为（17.6±7.8）枚,对照组为（19.4±5.7）枚,组间差异无统计学意义（P>0.05）;试验组患者术后胸腔总引流量低于对照组的,但差异无统计学意义（P>0.05）;2组均无死亡。结论全胸腔镜纵隔淋巴结清扫可以达到等同传统开胸手术的效果,同时胸腔镜手术具有微创、术后恢复快等优点。     

肝内胆管结石的外科手术治疗

目的 探讨肝内胆管结石外科治疗效果。方法 收集总结我科１９９１．１－１９９８．５期间手术治疗肝内胆管结石病人的３６５例,分析结石部闰与手术时机,手术方式之间的关系。结果３６５例病人,３５８例治愈,７例死亡,肝内胆管残余结７１例,肝功能衰竭７例。结论肝内胆管结石是一个较难的问题,肝叶切除是治疗的最佳方法。对于不适合行肝叶切除及术后残余结石者应采取多元化系统化的治疗。     

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.     

胆肠内引流术在肝内胆管结石治疗中的应用

目的评价各型胆肠内引流术在治疗肝内胆管结石中的作用。方法回顾性分析我院1982~2001年手术治疗的1232例肝内胆管结石病人资料,对其中的334例胆肠内引流术病例的适应证、方法及其效果进行总结。结果胆肠内引流组发生术后并发症57例(发生率17.1%)。死亡5例,分别死于腹腔内出血、吻合口瘘及肝功能衰竭等。近5年中因肝内胆管结石而行胆肠内引流术者无1例死亡及发生严重并发症。结论胆肠内引流术在肝内胆管结石的处理上有重要的作用,但随着肝切除在临床上推广,胆肠内引流术逐步减少,其适应证亦愈来愈严格;它对不能切除的胆管狭窄有重要意义;胆总管十二指肠内引流术治疗肝内胆管结石的方法应摒弃。     

全胸腔镜肺叶切除治疗支气管扩张症

目的探讨全胸腔镜下肺叶切除治疗支气管扩张症的安全性、可行性和有效性。方法回顾性分析我中心2007年4月～2009年11月完成的24例全胸腔镜肺叶切除手术治疗支气管扩张症的临床资料。全胸腔镜下解剖性肺叶切除,不牵开肋骨,以切割缝合器分别处理肺血管和支气管。如遇严重粘连或出血等则中转开胸手术。记录手术时间、出血量、术后带管时间以及并发症等。结果全组中2例(8.3%)因为胸腔内粘连重,叶间裂分化差或肺门处严重粘连并有大量迂曲扩张的血管,镜下处理困难而中转开胸行VATS辅助小切口手术。余22例在全胸腔镜下完成,肺切除范围包括右肺上叶1例,右肺中叶1例,右肺下叶3例,左肺上叶2例,左肺下叶13例,左肺下叶+左肺上叶舌段1例,左肺下叶+右肺中叶1例。手术时间(173.6±57.1)min(80～280min),出血量(173.9±65.9)ml(50～300ml),术后带管时间(6.1±3.8)d(2～19d),术后住院时间(8.6±3.9)d(4～22d)。术后病理均符合支气管扩张症改变。无围手术期死亡。并发症4例,均为肺持续漏气7d,引流7～19d后自愈拔除胸腔引流管。全组随访1～31个月,平均13.7月,其中13例12个月。15例(62.5%)术后咳痰或咯血症状完全消失,7例(29.2%)痰量明显减少,但仍间断有咳痰或咯血等症状。2例(8.3%)咯血量或痰量较前无明显变化。结论全胸腔镜肺叶切除术是治疗支气管扩张症的一种安全有效的方法 。