目的 浅析胸腔镜下肺叶切除手术的扶镜配合技术。 方法 回顾性分析2014年3～8月上海胸科医院行胸腔镜下肺叶切除术150例患者的临床资料，其中女66例、男84例，患者年龄43～78岁，中位年龄62岁。所有患者均在全电视胸腔镜下行肺叶切除术，手术切口为通过3个胸部微创切口不撑开肋骨完成解剖性肺叶切除，同时恶性肿瘤患者行系统性淋巴结清扫。观察临床早期结果及预后。 结果 中转开胸2例，其余患者手术均在全胸腔镜下顺利施行解剖性肺叶切除术。中转开胸原因包括良性淋巴结肿大与血管致密黏连、无法在镜下顺利处理出血等。围术期无患者死亡，术后平均住院时间为4～14 d，导致延长住院时间的并发症包括肺漏气、淋巴瘘、心律失常和肺不张等，均经相应处理治愈。 结论 扶镜手需要良好的胸腔解剖空间结构知识，熟知手术步骤，了解胸腔镜的特性及掌握好扶镜的基本原则和技巧,了解术者的操作习惯,才能默契配合使手术顺利进行。
ObjectiveTo investigate expressions of ALCAM/CD166, Bcl-2, and Ki-67 in breast infiltrative ductal cancer tissues, so as to assess the role of ALCAM/CD166 protein in the carcinogenesis and progression of breast infiltrative ductal cancer. MethodsThe expressions of ALCAM/CD166, Bcl-2, and Ki-67 proteins were examined by immunohistochemistry(ElivisionTM Plus) in 96 breast infiltrative ductal cancer specimens and 30 adjacent normal tissues of breast cancer specimens(control group). The relation between ALCAM/CD166 protein expression and patient's age, tumor diameter, histopathologic grade, axillary lymph node metastasis, or TNM stage of breast infiltrative ductal cancer was analyzed, and the correlation between ALCAM/CD166 expression and Bcl-2 or Ki-67 was analyzed too. Results①In 96 cases of breast infiltrative ductal cancer, the positive rate of ALCAM/CD166 protein expression was 79.2%(76/96), which was significantly higher than that in the control group〔10.0%(3/30), P < 0.01〕.②In the breast infiltrative ductal cancer tissues, the expression of ALCAM/CD166 was related to axillary lymph node metastasis(P < 0.05), but was not related to patient's age, tumor diameter, histopathologic grade, and TNM stage(P > 0.05).③The ALCAM/CD166 protein expression was positively related to Bcl-2(rs=0.307, P=0.001) and not related to Ki-67(rs=0.064, P=0.475). ConclusionALCAM/CD166 protein expression might be related to the apoptosis and metastasis of breast infiltrative ductal cancer cells and it could serve as an important marker for predicting biological behavior and prognosis of tumor.