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老年自发性气胸合并肺大泡患者术后并发症的预防及治疗

目的 总结预防和治疗老年自发性气胸合并肺大泡患者术后并发症的临床经验、治疗难点，探讨治疗对策，以降低术后并发症的发生率。 方法 回顾性分析117例老年自发性气胸合并肺大泡患者外科治疗的临床资料，117例患者中55例行胸腔镜手术，62例行开胸手术。 结果 住院死亡4例(3.4%），均死于呼吸衰竭、多器官功能衰竭。术后发生并发症45例（38.5%，45/117），主要并发症为心律失常、心功能不全、呼吸衰竭、肺部感染等。术后胸腔引流管漏气72例，其中16例漏气时间gt;7d，5例漏气时间gt;14d，再次开胸修补1例。术后留置胸腔引流管1~60d(5.2±8.2d)。随访113例,随访时间3～18个月，无气胸复发。 结论 老年自发性气胸合并肺大泡患者由于术前合并症多、肺组织质地和弹性差以及愈合能力差，导致围手术期并发症发生率增高。严格掌握手术指征、术中采取有效的肺修补方法减少漏气、减少手术时间和创伤是患者术后顺利康复的重要条件。同时应强化呼吸道祛痰、营养支持，尽早拔除胸腔引流管，早期活动。

可吸收止血膜在肺外科手术中的应用

Evaluation of the application of staplers in thoracoscopic lung surgery

Compared to traditional suturing, lung stapling using automatic staplers offers advantages such as smaller trauma, faster wound healing, ease of operation, and lower complication rates, making it widely used in clinical practice. However, there are significant differences in bronchial tissue thickness at different anatomical locations, and the market is flooded with various types of staplers. Currently, there is a lack of recommended stapling schemes for bronchial staplers at different anatomical locations. This article reviews the development and application of automatic staplers and summarizes some types of staplers that are currently used in clinical practice, with the aim of promoting the formation of individualized stapler selection protocols for minimally invasive thoracic surgery based on the Chinese population.

Interpretation of updated NCCN clinical practice guidelines for lung cancer screening (version 2. 2022)

Lung cancer is the most common cancer and the leading cause of cancer-related death in China. Early screening of lung cancer proves to be effective in improving its prognosis. The National Comprehensive Cancer Network (NCCN) has updated and released version 2, 2022 NCCN clinical practice guidelines for lung cancer screening in July, 2022. Based on high-quality clinical evidence and the latest research progress, the guidelines have developed and updated criteria for lung cancer screening which have been widely recognized by clinicians around the world. Compared with Chinese lung cancer screening guidelines, this article will interpret the updated content of the brand new 2022 NCCN screening guidelines, providing some reference for the current lung cancer screening practice in our country.

Comparison of segmentectomy versus lobectomy for ≤2 cm lung adenocarcinoma with micropapillary and solid subtype negative by intraoperative frozen sections: A multi-center randomized controlled trial

ObjectiveTo compare the clinical effects of segmentectomy and lobectomy for ≤2 cm lung adenocarcinoma with micropapillary and solid subtype negative by intraoperative frozen sections.MethodsThe patients with adenocarcinoma who received segmentectomy or lobectomy in multicenter from June 2020 to March 2021 were included. They were divided into two groups according to a random number table, including a segmentectomy group (n=119, 44 males and 75 females with an average age of 56.6±8.9 years) and a lobectomy group (n=115, 43 males and 72 females with an average of 56.2±9.5 years). The clinical data of the patients were analyzed.ResultsThere was no significant difference in the baseline data between the two groups (P>0.05). No perioperative death was found. There was no statistical difference in the operation time (111.2±30.0 min vs. 107.3±34.3 min), blood loss (54.2±83.5 mL vs. 40.0±16.4 mL), drainage duration (2.8±0.6 d vs. 2.6±0.6 d), hospital stay time (3.9±2.3 d vs. 3.7±1.1 d) or pathology staging (P>0.05) between the two groups. The postoperative pulmonary function analysis revealed that the mean decreased values of forced vital capacity and forced expiratory volume in one second percent predicted in the segmentectomy group were significantly better than those in the lobectomy group (0.2±0.3 L vs. 0.4±0.3 L, P=0.005; 0.3%±8.1% vs. 2.9%±7.4%, P=0.041).ConclusionSegmentectomy is effective in protecting lungs function, which is expected to improve life quality of patients.