Search

Video-assisted Thoracoscopic Surgery versus Thoracotomy in Lymph Node Dissection for Lung Cancer: A Systematic Review and Meta-analysis

ObjectiveTo compare effectiveness and safety of video-assisted thoracic surgery (VATS) and thoracotomy in lymph node (LN) dissection for lung cancer. MethodsA comprehensive search of PubMed, Ovid Medline, EMbase, Web of Science, ScienceDirect, the Cochrane Library, Scopus and Google Scholar was performed to identify studies (from January 1990 to July 2015) comparing VATS with thoracotomy in LN dissection. The data were analyzed by RevMan 5.3 software. Quality of literature was evaluated by Newcastle-Ottawa scale or Jadad scale. ResultsFifty-one articles met the inclusion criteria involved 7 127 patients in the VATS group and 9 217 patients in the thoracotomy group. Thirty-eight articles were of good quality and the remaining thirteen were medium. Meta-analysis showed that fewer N1 LN stations in the VATS group (95% CI -0.23 to -0.04, P=0.005), although VATS harvested more left-side LNs (95% CI 0.51 to 3.22, P=0.007). The number of total LNs (95% CI -1.81 to 0.28, P=0.15), total LN stations (95% CI -0.34 to 0.15, P=0.44), N2 LNs (95%CI -1.77 to 0.79, P=0.45), N2 LN stations (95% CI -0.22 to 0.16, P=0.78), N1 LNs (95% CI -0.95 to 0.11, P=0.12), and right-side LNs (95% CI -1.52 to 2.23, P=0.71) harvested in the two groups were not significantly different. ConclusionIn the surgical treatment of lung cancer, VATS can achieve the same efficacy of LN dissection as thoracotomy. This conclusion still needs to be further proved by more high-quality and large-scale RCTs.

胸食管异物损伤的临床诊断与治疗

目的　探讨提高胸食管异物损伤诊断及治疗效果的方法。　方法　回顾性分析九江学院附属医院2004年5月至2011年10月26例胸食管异物损伤患者的临床资料，其中男18例，女8例；年龄41.2 （18～70）岁。通过多层螺旋CT （MSCT）成像结合临床特征判断其病理类型，采用胃镜异物取出11例，全身麻醉下胃镜异物取出5例，行开胸手术8例，主动脉覆膜支架腔内隔绝2例。　结果　Ⅰ类损伤10例，Ⅱ类损伤5例，Ⅲ类损伤6例，Ⅳ类损伤5例。20例有异物，6例无异物；24例治愈，2例死亡， 分别因血管置换术中出血及血管修补术后再出血死亡。　结论　依据MSCT成像结合临床特征及病史，明确胸食管异物损伤的诊断及病理类型，采取多学科合作的合理治疗方法，能明显提高胸食管异物损伤的诊疗效果。

降主动脉置换治疗局部晚期食管癌一例

经腹腔镜治疗胸腹交界处支气管源性囊肿一例

Upper left lung cancer with congenital complete left pericardial defect: A case report

A 54-year-old asymptomatic man underwent a video-assisted thoracoscopic left pneumonectomy for squamous-cell carcinoma. During the surgery, a complete left pericardial defect was unexpectedly discovered, but no special intervention was made. The preoperative chest CT was reciewed, which showed the heart extended unusually to the left, but the left pericardial defect was not evident. The operation time was 204 min and the patient was discharged from hospital upon recovery 9 days after the surgery. The pathological result indicated moderately differentiated squamous-cell carcinoma (T2N1M0, stage ⅡB), and metastasis was found in the parabronchial lymph nodes (3/5). The patient did not receive chemotherapy after the surgery, and there was no signs of recurrence 6 months after the surgery. Complete pericardial defects usually do not endanger the lives of patients, and if the patient is asymptomatic, pneumonectomy is feasible.

食管异物及合并主动脉食管瘘的诊断与治疗

目的探讨食管异物所致主动脉食管瘘的诊断及治疗方法。 方法回顾性分析2004年1月至2012年12月南昌大学第二附属医院32例异物性食管损伤患者的诊断和治疗经验。其中男21例、女11例，年龄18～78岁。采用多层螺旋CT（MSCT）及其影像后处理对食管异物病理变化进行准确分级；对主动脉食管瘘的患者采用包括杂交技术（覆膜支架腔内隔绝术＋胸腔镜纵隔引流术）为主的治疗方案，总结MSCT和杂交技术在异物性主动脉食管瘘诊疗中的应用价值。 结果平扫影像诊断与临床诊断符合率为75%（24/32），影像后处理诊断与临床诊断符合率为100%（17/17）。MSCT分级所有Ⅰ级、Ⅱ级和Ⅲ级患者均治愈出院，4例Ⅳ级患者采用杂交技术治疗；7例Ⅳ级主动脉食管瘘患者中有5例痊愈出院，2例死亡，因开胸行主动脉修补术中死亡1例，开胸行主动脉置换术后24 h内死亡1例。30例痊愈出院患者随访6个月，除1例Ⅳ级患者有轻微背痛以外，其他患者无不适。 结论MSCT对食管异物性损伤的准确分级和治疗方式选择均有重要的价值，杂交技术治疗异物性主动脉食管瘘具有重要的临床意义。