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纤维支气管镜代胸腔镜诊断不明原因胸腔积液28例临床分析

目的探讨纤维支气管镜代胸腔镜检查在诊断胸腔积液中的临床应用价值。 方法以我院2013年5月至2014年8月收治的不明原因胸腔积液患者28例为研究对象, 对其行纤维支气管镜代胸腔镜检查, 获取胸腔积液及病变组织行病理学检查。 结果28例患者中, 2例脓胸患者未行病理检查, 其余26例患者均行病理检查并明确诊断, 确诊率为92.86%。其中, 18例为恶性肿瘤病变, 包括腺癌10例, 鳞癌8例; 8例为肉芽肿样改变, 诊断为结核性胸腔积液, 经正规抗结核治疗胸腔积液消失。27例患者的人工气胸在术后1~3 d内完全吸收拔管, 无术中术后大出血、伤口感染以及胸腔积液新发感染等并发症发生。 结论纤维支气管镜代胸腔镜在检查胸腔积液病因中是一种安全有效、检出率高的检查方法, 值得临床大范围应用与推广。

The Value of Pleural Biopsy in the Etiological Diagnosis of Pleural Effussion

目的:探讨胸膜活检对胸腔积液病因诊断的价值。方法:对127例胸腔积液患者行首次胸膜活检术。结果:127例患者获取胸膜组织125例, 穿刺成功率98.4%,经病理检查有41例为正常胸膜组织,特异性病理诊断84例,病理诊断阳性率(67.2%)。恶性胸腔积液胸膜活检阳性38例(45.2%),结核性胸腔积液胸膜活检阳性31例(36.9%),非特异性炎15例(17.9%)。38例恶性肿瘤经免疫组织化学和特殊染色分类,腺癌27例,小细胞肺癌2例,鳞癌2例,恶性间皮瘤2例,转移癌3例,淋巴瘤1例,未分化癌1例。发生并发症者4例(3.1%),全部为气胸,肺压缩均小于15%,未做特殊处理数日后自行吸收。结论:胸膜活检是一项安全、简单、有效的胸膜疾病的重要的内科确诊手段。

Clinical Outcome of Complete Video-assisted Thoracoscopic Surgery Lobectomy for Patients with Early-stage Non-small Cell Lung Cancer

Abstract： Objective To evaluate the safety, feasibility, and clinical outcome of complete video-assisted thoracoscopic surgery （VATS） lobectomy for patients with early-stage non-small cell lung cancer （NSCLC）. Methods We retrospectively analyzed the clinical data of 160 consecutive patients（the VATS group, 83 males and 77 females with average age at 60.8 years）with early-stage NSCLC who underwent complete VATS lobectomy between January 2005 andDecember 2008 in Zhongshan Hospital of Fudan University，and compared them with 357 patients（the thoracotomy group, 222 males and 135 females with average age at 59.5 years）who underwent open thoracotomy in the same period. Results The conversion rate of the VATS group was 5.0%（8/160）. The operation time of the VATS group was significantly shorter than that of the thoracotomy group（113.0 min vs.125.0 min, P=0.039）. Length of postoperative hospital stay was not statistically different between the two groups（10.3±4.3 d vs.9.1±4.6 d，P=0.425）. The postoperative morbidity of the VATS lobectomy group and the thoracotomy group was 9.4%（15/160）and 10.1% （36/357） respectively，and the postoperative mortality of the two groups was 0.6%（1/160）and 2.0%（7/357）respectively. There was no statistical difference in the mean group of lymph node dissection （2.4±1.5 groups vs.2.4±1.7 groups，P=0.743） and the mean number of lymph node dissection （9.8±6.3 vs.10.1±6.4，P=0.626） between the two groups. The overall 5-year survival rate of the VATS group was significantly higher than that of the thoracotomy group （81.5% vs.67.8%, P=0.001）. Subgroup analysis showed that the 5-year survival rate of pⅠa stage, pⅠb stage, and pⅢa stage was 86.0%, 84.5%, and 58.8% respectively in the VATS group, and 92.9%, 76.4%, and 25.3% respectively in the thoracotomy group. Conclusion Complete VATS lobectomy is technically safe and feasible for patients with early-stage NSCLC. The lymph node dissection extension of complete VATS lobectomy is similar to that of open thoracotomy, and long-term outcome of complete VATS lobectomy is superior to that of open thoracotomy. Randomized controlled trials of large sample size are further needed to demonstrate superiority.

单孔胸腔镜下左肺上叶切除术中肺血管处理手术视频要点

Treatment of Malignant Pleural Effusion Caused by Lung Cancer with Thoracoscopic Intrapleural Perfusion Hyperthermochemotherapy

Abstract: Objective To summarize the method and effective result of thoracoscopic intrapleural perfusion hyperthermochemotherapy(TIPHC) for treating malignant pleural effusion caused by lung cancer. Methods Fiftyeight patients with malignant pleural effusion caused by lung cancer were randomly divided into therapeutic group(30 cases) and control group(28 cases) between February 1999 and March 2005. Pleural biopsy and TIPHC under general ansthesia with unilateral ventilation were performed in the therapeutic group, and intrapleural injection of cisplatin was administered in control group after drainage of pleural effusion. The effect on malignant pleural effusion， the change for the concentration of carcinoembryonic antigen(CEA)， cytokeratin-19 fragments (CYFRA21-1)， neuronspecific enolase (NSE) and the side effect were compared before and after the treatment. Results The therapeutic group achieved total response rate of 100.0%, but only 53.6% in control group, with significant difference(χ 2=3.863, Plt;0.05). Furthermore, the concentration of CEA， CYFRA21-1， NSE in therapeutic group dramatically descended than control group(t=2.562,Plt;0.05). But there was no significant difference in side effect (Pgt;0.05). The pathological diagnosis of all the patients were determined in the therapeutic group. Conclusion TIPHC has the advantage of both diagnosis and treatment of malignant pleural effusions. It is safe and effective, and also able to determine the diagnosis. Furthermore, it offers the superiority of small wound， best visualization and convenient pleural biopsy.

磁锚定技术辅助胸腔镜肺楔形切除术三例

Video-assisted thoracoscopic lung resection in tuberculosis treatment: A retrospective cohort study

ObjectiveTo investigate the feasibility of video-assisted thoracoscopic surgery (VATS) lung resection in the treatment of tuberculosis.MethodsWe retrospectively analyzed the clinical data of 164 tuberculosis patients who underwent lung resection in Xi'an Chest Hospital from 2013 to 2017. Patients were divided into two groups according to the surgical procedure: a VATS group (85 patients, 56 males and29 females) and a thoracotomy group (79 patients, 52 males and 27 females). The clinical effect of the two groups was compared.Results Compared to the thoracotomy group, the VATS group had less operation time (151.59±76.75 min vs. 233.48±93.89 min, P<0.001), amount of intraoperative blood loss (200.00 ml vs. 600.00 ml, P<0.001), the postoperative drainage (575.00 ml vs. 1 110.00 ml, P=0.001), extubation time (4 d vs. 6 d, P<0.001) and hospital stay (13.00 d vs. 17.00 d, P<0.001). There was no statistical difference in postoperative complications (10 patients vs.17 patients, P=0.092) between the two groups. A total of 97 patients underwent lobectomy, including 36 of the VATS group and 61 of the thoracotomy group. The operation time (211.39±70.88 min vs. 258.20±87.16 min, P=0.008), the intraoperative blood loss (400.00 ml vs. 700 ml, P<0.010), the postoperative drainage (800.00 ml vs. 1 250.00 ml, P=0.001), extubation time (5.00 d vs. 8.00 d, P=0.002) and hospital stay (13.11±4.45 d vs. 19.46±7.74 d, P<0.010) in the VATS group were significantly better than those in the thoracotomy group. There was no statistical difference in postoperative complication rate (4 patients vs. 14 patients, P=0.147) between the two[1], groups.ConclusionCompared with conventional thoracotomy, VATS lung resection has obvious advantages in treatment of tuberculosis, which may be the preferred technique.

食管癌术后不同引流方法的临床效果比较

目的 探讨食管癌术后更有利于患者术后恢复及减少并发症发生的胸腔引流方法。 方法 泸州医学院附属医院对200例食管癌患者行外科手术治疗，按手术后放置胸腔引流管的数量不同分为两组，双胸腔引流管组（双引流管组）：2008年8月至2009年8月收治的100例食管癌患者（男80例，女20例；年龄61.8±11.4岁），术后行双胸腔引流管引流；单胸腔引流管组（单引流管组）：2006年1月至2008年7月收治的100例食管癌患者（男76例，女24例；年龄57.5±9.3岁）作为对照，术后均行单胸腔引流管引流。术后观察两组患者胸腔引流时间、胸腔引流总量、气胸或肺不张发生情况、术后拔管后胸腔穿刺或再次胸腔引流情况，并进行对比分析。 结果 双引流管组患者术后胸腔引流时间明显短于单引流管组（50.8±7.3 h vs. 75.6±9.4 h，Plt;0.05），术后气胸或肺不张发生率明显低于单引流管组（2％ vs.12％，Plt;0.05）。双引流管组患者术后拔管后仅有2例因术侧胸腔内有残余积液需行胸腔穿刺，无须行再次胸腔引流；单引流管组拔管后有10例因胸腔内有积液或气胸需行胸腔穿刺，有6例需行再次胸腔引流，两组间比较差异有统计学意义（Plt;0.05）。 结论 食管癌患者手术后放置双胸腔引流管引流更有利于肺充分复张，缩短胸腔引流时间，减少患者术后并发症的发生。

Analysis of the safety and feasibility of two closed thoracic drainage methods after video-assisted thoracoscopic lung volume reduction surgery

ObjectiveTo investigate the effects of closed thoracic drainage with single tube or double tubes after video-assisted thoracoscopic lung volume reduction surgery.MethodsRetrospective analysis was performed on 50 patients (39 males, 11 females) who underwent three-port thoracoscopic lung volume reduction surgery in our hospital from January 2013 to March 2019. Twenty-five patients with single indwelling tube after surgery were divided into the observation group and 25 patients with double indwelling tubes were divided into the control group.ResultsThere was no significant difference in pulmonary retension on day 3 after surgery, postoperative complications, the patency rate of drainage tube before extubation, retention time or postoperative hospital stay (P>0.05). Postoperative pain and total amount of nonsteroidal analgesics use in the observation group was less than those in the control group (P<0.05). ConclusionIt is safe and effective to perform closed thoracic drainage with single indwelling tube after video-assisted thoracoscopic lung volume reduction surgery, which can significantly reduce the incidence of related adverse drug reactions and facilitate rapid postoperative rehabilitation with a reduction of postoperative pain and the use of analgesic drugs.

电视胸腔镜辅助食管癌切除术

目的 探讨电视胸腔镜辅助食管癌切除术的方法。方法 2000年12月-2001年5月我科用胸腔镜辅助施行食管癌切除术5例，均为食管中段癌，0期1例。Ⅰ期2例，Ⅱa期1例，Ⅱb期1例。结果 手术经过均顺利，无1例中转开胸手术，手术时间平均180min，术中出血量平均210ml，无严重术后并发症发生，无手术死亡，均治愈出院。结论 随着胸腔手术设备和器械的改进，手术操作技术的熟练，选择适当的患者采用电视胸腔镜辅助食管癌切除术是可行的，且手术效果良好。