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Progress of Lung Preservation Solution in Lung Transplantation

Abstract: Although lung transplantation has been established as the only valid therapeutic approach for endstage pulmonary disease, several related problems remain to be solved. In addition to the serious problem in donor lung shortage, primary graft dysfunction caused by lung ischemia-reperfusion injury is one of the most common reason of early mortality. Optimal preservation of lung is essential to reduce ischemic organ dysfunction after lung transplantation. The development of a highly reliable lung preservation solution that reduces ischemia-reperfusion injury will improve the functioning of transplanted lungs. The progress of the type, perfusing technique or strategies and modified methods of lung preservation solution are reviewed in this article.

参附注射液对兔移植肺缺血再灌注损伤的保护作用

目的 观察参附注射液对供肺缺血再灌注损伤的保护作用。 方法 将20只新西兰白兔随机分为实验组和对照组，每组各10只，建立兔左肺自体原位移植模型，分别用参附注射液和生理盐水对兔肺进行预处理和供肺灌注。于主动脉阻断前、再灌注后15 min、30 min和60 min各时点检测左肺静脉血中丙二醛（MDA）含量、总超氧化物歧化酶（SOD）的活力，于再灌注60 min后称左肺组织的干湿比重（D/W），并观察其病理变化。 结果 主动脉阻断前两组MDA含量差异无统计学意义（Pgt;0.05）；再灌注15 min后实验组MDA含量较主动脉阻断前下降；再灌注30 min和60 min时，两组MDA含量均呈上升趋势，但实验组明显低于对照组（Plt;0.05）。主动脉阻断前实验组SOD活力明显高于对照组（Plt;0.05），再灌注后两组SOD活力均呈下降趋势，以对照组下降幅度明显（Plt;0.05）。实验组的D/W显著高于对照组（0.23±0.01 vs. 0.19±0.02，Plt;0.05）。对照组肺组织水肿明显，大量的炎性细胞浸润，肺泡腔内有片状渗出；而实验组表现为肺泡间隔水肿轻微，少量炎细胞浸润，渗出不明显。 结论 参附注射液对供肺的缺血再灌注损伤有较好的保护作用。

Influence of Tumor Associated Macrophages Distribution on Prognosis of Nonsmall Cell Lung Cancer

Objectives To investigate the effects of the distribution of tumor associated macrophages (TAMs) on prognosis in the patients with non-small cell lung cancer. Methods The number of CD68+ macrophages in 136 lung cancer nest and stroma was counted simultaneously by labelled streptavidin biotin method(LSAB）,and its correlation with patient postoperation prognosis was analyzed. Results CD68 macrophas were observed in both inside and around the cancer tissue,The mean TAMs in cancer stroma (36.00/HFP) was higher than that in cancer nest (23.80/HFP,Plt;0.05). Mean TAMs in nest of stage Ⅰ＋Ⅱ cancer was significantly higher than that of stageⅢ＋Ⅳ cancer（32.60/HFP vs. 14.80/HFP,Plt;0.05）,and mean TAMs in stroma of stage Ⅰ＋Ⅱ cancer was significantly lower than that of stage Ⅲ＋Ⅳ cancer（24.30/HFP vs. 47.60/HFP,Plt;0.05）.The number of TAMs in cancer nest and the ratio of nest TAMs /stoma TAMs were both positively correlated with the patient survival time (rs=0.510, 0.633, respectively). Otherwise the number of TAMs in cancer stroma was negatively correlated with the patient survival time (rs=-0.187). Five-year survival rate in patients with high density TAMs in cancer nest was significantly higher than that in patients with low density TAMs (51.4% vs. 11.1%, Plt;0.05), while reverse correlation between TAMs in cancer stroma and patient 5-year survival rate was observed (18.9% vs. 44.4%,Plt;0.05). And 5 year suvival rate in patients with high ratio of nest/stroma TAMs was higher than that with low ratio (58.1% vs.4.2%,Plt;0.01). Conclusion Cox regressive prognostic analysis showed that the higher the nest/stroma TAMs ratio, the higher probability of the patients survival time. While the higher number of TAMs in the cancer stroma, the lower probability of the patients survival time. Our results showed that distribution pattern of TAMs in cancer nest and cancer stroma could possibly be used to estimate the prognosis of patients with non-small cell lung cancer.

50%葡萄糖溶液在肺手术后持续肺漏气治疗中的应用

Clinical analysis of the mediastinal tumor in patients with spontaneous breathing intravenous anesthesia

ObjectiveTo evaluate the safety and the clinical curative effect of mediastinal tumor resection by video-assisted thoracoscopic surgery(VATS） with spontaneous breathing under intravenous anesthesia, comparing with endotracheal tube anesthesia.MethodsThe data of 43 patients, aged 28–58 years, with mediastinal benign tumors which had been cofirmed by chest CT in our hospital were retrospectively analyzed. Among them, 18 patients underwent mediastinal tumor resection by VATS with spontaneous breathing under intravenous anesthesia, 25 patients by endotracheal tube anesthesia.The differences, including the time of anesthesia intubation and extubation, operation time and intraoperative blood loss, muscle strength at 4 hours and at 24 hours after operation, pain score at 24 hours after operation, hospitalization time, were be compared between the two groups.ResultsThe duration of intubation (17.8±4.8 min) in spontaneous breathing under intravenous anesthesia group was shorter than another group (28.6±8.17 min), the difference was statistically significant (P<0.05). Muscle strength at 4 hours after operation in spontaneous breathing under intravenous anesthesia group was significantly higher than another group (38.5±6.5 kg vs. 28.3±5.2 kg, P<0.05) as well. However, there was no significant difference between the two groups in extubation time, operation time and intraoperative blood loss, muscle strength and pain score at 24 hours after operation, hospitalization time.

电视胸腔镜手术中心性非小细胞肺癌支气管袖式切除的病例对照研究

目的 探讨胸腔镜下中心性非小细胞肺癌支气管袖式切除的临床疗效。 方法 回顾性分析我院 2014 年 6 月至 2018 年 3 月 44 例中心性非小细胞肺癌患者的临床资料，男 38 例、女 6 例，年龄 43～73 岁。其中 18 例患者采用胸腔镜下支气管袖式切除淋巴结清扫术，为腔镜组；26 例患者采用开胸支气管袖式切除淋巴结清扫术，为开胸组。比较两组临床效果。 结果 两组患者手术时间、手术出血量、拔管时间、术后住院时间差异均无统计学意义（P>0.05）。胸腔镜手术组较开胸手术组支气管吻合时间更长、术后 24 h 及术后 72 h 疼痛评分更低，差异有统计学意义（P<0.05）。 结论 胸腔镜下中心性肺癌支气管袖式切除患者术后疼痛更轻，拔管时间更短。

Video-ass isted Thoracoscopic Surgery of Ben ign Pulmonary D iseases: 128 Cases

Abstract: 　Objective　To investigate the role of video-assisted thoracoscopic surgery (VATS) in treatment of benign pulmonary disease, in order to promo te the mini-invasive way of operation. 　Methods　From May 2001 to M ay 2006, 128 patients with benign pulmonary diseases were treated by VATS. The diseases included 17 kinds of different lesions, such as tuberculosis, bronchiectasis, inflammatory pseudotumor, giant bullae of lung, hamartoma,lymphangiomyomatosis, etc. 53 cases had definite diagnosis before operation, the others had final diagnosis by pathology. Limited resection were performed in 66 cases, single lobectomy in 56 cases, bilobectomy in 2 cases, and concomitant bilateral lobectomy in 4 cases. Limited resections were carried out by pure thoracoscopic procedure with three ports, lobectomies were carried out by video-assisted minithoracotomy with 7-10cm incision. 　Results　For lim ited resect ion, the average operat ive durat ion w as 110m in (30-180m in) , blood loss was 60m l (10-300m l) , none had intraoperative blood transfusion needed. Conversion to minithoracotomy occurred in 2 patients. Postoperative bleeding happened in one case, which was controlled by medicine. Average length of stay was 6. 5 days. For lobectomy, the average operation time was 145 min (80-260min) , blood loss was 190ml (50-500m l) , no intraoperative blood tansfusion needed. Conversion to tranditional thoracotomy occurred in 3 patients, pneumonia occurred in 2 patients, delayed healing of mini-incision occurred in 2 patients. One diaphragmat ic hernia and one active bleeding after operat ion underwent second thoracotomy. Average length of postoperative stay was 7. 4 days (4-13d). For bilateral lobectomies, the average operative duration was 330min (270-415m in) , postoperative length of hospital stay was 10.7days (8-16d). No perioperative death occurred. 　Conclusion　VATS for benign pulmonary disease is miniinvasive and safe, the pat ients recover quickly. It could be the choice of operation for selected patients in equipped center.