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电视胸腔镜下胸腺切除术治疗重症肌无力

目的探讨电视胸腔镜手术（VATS）下行胸腺切除治疗重症肌无力的可行性和治疗效果。方法19例重症肌无力患者，按照Osserman临床分型标准，Ⅰ型10例，Ⅱa型5例，Ⅱb型3例，Ⅲ型1例，均在VATS下行胸腺扩大切除术。结果19例患者均顺利完成手术，无手术死亡，平均手术时间120min，术中出血量均小于100ml，术后发生重症肌无力危象3例，经及时治疗治愈。术后对所有患者均进行了随访，随访时间〉6个月，重症肌无力病情完全缓解9例，好转6例，无变化4例，总有效率79％（15／19）。结论在VATS下行胸腺扩大切除术治疗重症肌无力是可行的，且创伤小、疼痛轻，以期望减少术后并发症。

肺曲霉菌病的外科治疗

目的探讨肺曲霉菌病的临床特点与外科治疗原则。方法回顾分析32例肺曲霉菌病患者的临床资料和手术治疗结果，手术施行采用标准后外侧切口肺叶切除术6例，楔形切除术3例，胸腔镜或胸腔镜辅助改良后外侧微创小切口楔形切除术15例，肺叶切除术6例，肺段切除术2例。结果21例无肺原发疾病，11例有肺原发疾病。痰菌检查阳性率为13．3％（2／15），术前诊断符合率为28．1％（9／32）；术后并发症发生率为15．6％（5／32），其中切口皮下积液、肺膨胀不良各2例，气胸1例；随访32例，随访10～160个月，无咯血或血痰、肺曲霉菌病复发或播散。结论肺曲霉菌病多数无肺原发疾病和症状，无论有否症状均应手术治疗，而微创外科手术治疗并发症少且较轻，是首选的治疗方法。

电视胸腔镜肺癌根治术5年临床疗效

目的 探讨电视胸腔镜辅助小切口肺癌根治术的5年疗效. 方法 应用胸腔镜辅助小切口对肺癌患者行肺叶或全肺切除、肺癌根治术2 200例,取其中1995年完成的130例作5年生存率统计,术式包括单肺叶切除术110例,双肺叶切除术11例,全肺切除术9例.所有数据作Cox回归生存分析. 结果 术后住院时间3～15天,平均住院时间8天,恢复生活自理时间7～13天;Ⅰ期肺癌5年生存率87.8%,Ⅱ期5年生存率42.8%;Ⅲa期5年生存率27.3%. 结论 胸腔镜辅助小切口行肺叶或全肺切除、肺癌根治术具有创伤小,恢复快,出血、输血少,对心肺功能损伤小,开、关胸时间短的优点,5年生存率与传统开胸术差别无显著性意义.但这种切口要求胸外科医师有开胸和胸腔镜的全面技术.

多学科协作促进共识更新——中国胸外科气道管理协作组筹备会议亮点

Lung transplantation for interstitial lung disease : benefits and prognostic factors

ObjectiveTo analyze the benefits of lung transplantation in the treatment of interstitial lung disease (ILD) and investigate its prognostic factors.MethodsThe clinical data of patients diagnosed with ILD and meet the lung transplantation criteria were retrospectively analyzed from January 2012 to December 2017 in the First Affiliated Hospital of Guangzhou Medical University. A total of 111 patients, 88 males and 23 females, aged (58.3±11.4) years old, were divided into lung transplantation group and non-lung transplantation group. Clinical data and prognosis of the two groups were compared and the factors affecting the prognosis of lung transplantation were analyzed with relevant literatures. Results There were 56 patients in lung transplantation group and 55 patients in non-lung transplantation group. The mainly underlying disease of both groups were idiopathic pulmonary fibrosis (IPF). There was no significant difference in age, body mass index, arterial partial pressure of oxygen, percentage of forced vital capacity in the estimated value, percentage of diffusing capacity of the lung for carbon monoxide in the estimated value, six-minute walk distance between the two groups (P>0.05). The pulmonary arterial hypertension and arterial partial pressure of carbondioxide were higher in lung transplantation group than non-transplantation group (P<0.05). The 1-year survival rate in the lung transplantation group was significantly higher than that in the non-lung transplantation group: 77.4% vs. 32.7% (P<0.01). COX regression analysis showed that preoperative ventilator dependence, serum creatinine, bilirubin, pulmonary artery pressure, and procedures (single lung vs. double lung) had no significant effect on the prognosis of lung transplantation; age and preoperative diabetes mellitus were risk factors for the prognosis of lung transplantation.ConclusionsLung transplantation can significantly improve the prognosis of patients with ILD who are refractory to medicine therapy. IPF patients should be advised to consider lung transplantation as soon as possible. Age and preoperative diabetes mellitus are risk factors for the prognosis of lung transplantation.

Chinese thoracic surgery experts consensus on postoperative follow-up plans for non-small cell lung cancer patients

Resection is crucial for treating non-small cell lung cancer. Routine follow-up after surgery is an effective method for early detection and treatment of tumor recurrence and metastasis or the second primary tumor, which can improve the quality of life of patients and their prognosis. This consensus aims to provide a reference for colleagues responsible for postoperative follow-up of non-small cell lung cancer patients in China, and further improve the standardization of lung cancer diagnosis and treatment.

Comparison of short-term efficacy of neoadjuvant immunotherapy combined with chemotherapy and neoadjuvant chemoradiation for locally advanced resectable esophageal squamous cell carcinoma

ObjectiveTo investigate the short-term therapeutic effect of neoadjuvant immunotherapy combined with chemotherapy in the locally advanced esophageal squamous cell carcinoma. MethodsThe clinical data of patients with esophageal squamous cell carcinoma treated with neoadjuvant treatment in Gaozhou People's Hospital from August 2019 to October 2020 were retrospectively analyzed. According to the different treatments, the patients were divided into two groups: a neoadjuvant immunotherapy combined with chemotherapy group (NIC group) and a neoadjuvant chemoradiotherapy group (NC group). The baseline data, incidence of adverse events during treatment, perioperative indicators, postoperative pathological remission rate and incidence of postoperative complications were compared between the two groups. ResultsTotally 33 patients were enrolled, including 15 males and 18 females, with an average age of 62.37±7.99 years. There were 17 patients in the NIC group and 16 patients in the NC group. In the NIC group, the carcinoma was mainly located in the middle and lower esophagus, with 5 paitents in stage Ⅱ, 9 patients in stage Ⅲ, and 3 patients in stage Ⅳa. In the NC group, the carcinoma was mainly located in the upper-middle esophagus, with 1 patient in stage Ⅱ and 15 patients in stage Ⅲ. During the neoadjuvant treatment, there was no significant difference in the occurrence of bone marrow suppression or gastrointestinal reactions between the two groups (P>0.05). There were 4 immune-related rashes in the NIC group and 1 esophageal perforation in the NC group. Fourteen (82.35%) patients in the NIC group and 12 (75.00%) patients in the NC group completed the operation on schedule. The postoperative ICU stay time and chest tube indwelling time in the NIC group were shorter than those in the NC group (P<0.05). There were 5 patients of complete remission in the NIC group, and 6 patients in the NC group. There was no significant difference in the pathological regression grade or residual tumor cells between the two groups (P>0.05). There was no significant difference in the incidence of anastomotic fistula, thoracic gastric fistula, bronchial mediastinal fistula, abdominal distension, pulmonary infection, stroke, or hoarseness during the perioperative period between the two groups of patients who completed the operation (P>0.05). In the NC group, 2 patients died during the perioperative period because of thoracic gastric fistula complicated by severe infection. ConclusionNeoadjuvant immunotherapy combined with chemotherapy dose not significantly increase the occurrence of adverse events and shows a good rate of pathological remission, which indicates that the neoadjuvant immunotherapy combined with chemotherapy is a safe, feasible and potential new treatment model.

The 5-year survival rate of 11 958 postoperative non-small cell lung cancer patients in stage Ⅰ-ⅢA by two different follow-up patterns: A multi-center, real-world study

ObjectiveTo compare the 5-year survival rates between two different follow-up patterns of postoperative stage Ⅰ-ⅢA non-small cell lung cancer (NSCLC) patients.MethodsPathological stage Ⅰ-ⅢA NSCLC 11 958 patients who underwent surgical resection and received follow-up within 6 months after initial diagnosis through telephone follow-up system were included in nine hospitals from July 2014 to July 2020. The patients were divided into two groups including a proactive follow-up group (n=3 825) and a passive follow-up group (n=8133) according to the way of following-up. There were 6 939 males and 5 019 females aged 59.8±9.5 years. The Kaplan-Meier and Cox proportional hazards regression model were used.ResultsThe median follow-up frequency was 8.0 times in the proactive follow-up group and 7.0 times in the passive follow-up group. The median call duration was 3.77 minutes in the proactive follow-up group and 3.58 minutes in the passive follow-up group. The 5-year survival rate was 81.8% and 74.2% (HR=0.60, 95CI 0.53-0.67, P<0.001) in the proactive follow-up group and the passive follow-up group, respectively. Multivariate analysis showed that follow-up pattern, age, gender and operation mode were independent prognostic factors, and the results were consistent in all subgroups stratified by clinical stages.ConclusionThe proactive follow-up leads to better overall survival for resected stage Ⅰ-ⅢA NSCLC patients, especially in the stage ⅢA.