Obstractive To observe the clinical effects and safety of endobronchial electrocautery treatment for tracheobronchial obstructive lesions in inoperable tracheobronchial squamous cell carcinoma.Methods Ninety-five patients with advanced and inoperable tracheobronchial squamous cell carcinoma were included. Thirty-four patients with central airway obstruction were treated with endobronchial electrocautery plus chemotherapy ( group A) and 61 patients without central airway obstruction were treated with chemotherapy alone ( group B) . The chemotherapy consisted of cisplatin or carboplatin, plus another thirdgeneration chemotherapy agent. Results In groug A, there were mean improvements in FEV1 of 41. 1% and in peak expiratory flow( PEF) of 65. 6% . There was no significant difference in the survival rates of the patients with and without central airway obstruction. Median survival time of group A was 11. 3 months and those of group B was 11. 6 months. 3, 6, and 12-month survival rates in group A were 87% , 68% and 39% respectively, and those in group B were 93% , 76% , and 45% respectively. Conclusion Endobronchial electrocautery is an effective and safe approach for inoperable tracheobronchial obstructive malignancies with few complications.
Abstract: Objective To investigate the feasibility of videoassisted thoracoscopic surgery (VATS) ronchial sleeve lobectomy for lung cancer, and to describe this treatment method. Methods Between December 2010 and April 2011, three patients in our hospital underwent VATS bronchial sleeve lobectomy as treatment for right upper lobe nonsmall cell lung cancer. The patients were one female and two males, aged 61, 65, and 62 years. Surgical incisions were the same as for singledirection VATS right upper lobectomy. The right superior pulmonary vein was firstly transected, followed by the first branch of the pulmonary artery. Then, the lung fissure was transected and the mediastinal lymph nodes, including the subcarinal nodes, were also dissected to achieve sufficient exposure of the right main bronchus. The bronchus was transected via the utility incision, and the anastomosis was accomplished by continuous suture with 30 Prolene stitches. Another 0.5 cm port in the 7th intercostal space at the posterior axillary line was added in the third operation for handling of a pair of forceps to help hold the needle during anastomosis. A sealing test was performed to confirm that there was no leakage after completion of the anastomosis, and the stoma was covered with biological material. Bronchoscopy was performed to clear airway secretions and to confirm that there was no stenosis on postoperative day (POD) 1. Results The lobectomy and lymph node dissection was finished in 5158 minutes (averaging 54.7), and the time needed foranastomosis was 4055 minutes (averaging 45.7). Total blood loss was 55230 ml (averaging 155.0 ml). Number of dissected lymph nodes was 1821 (averaging 19.3). One patient was diagnosed with adenocarcinoma of the right upper lobe with metastatic hilar lymph node invasive to the right upper lobar bronchus. The other two patients were both diagnosed with centrally located squamous cell carcinoma of the right upper lobe, and all the patients achieved microscopically negative margins. There was no stenosis of the anastomosis stoma, and the postoperative course was uneventful. These patients were discharged on POD 810 (averaging 8.7 days), and they recovered well during the followup period, which lasted 2 to 6 months. [WTHZ]Conclusion [WTBZ]For experienced skillful thoracoscopic surgeons, VATS bronchial sleeve lobectomy is safe and feasible. Making the incisions of a singledirection VATS lobectomy with an additional miniport may be an ideal approach for this procedure.
Objective To observe the clinical and pathological characteristics of choroidal metastatic carcinoma from lung carcinoma.Methods The clinical and pathological data of 6 patients with choroidal metastatic carcinoma from lung carcinima were analysed retrospectively.Results All the 6 patients had severe visual impairment, including 3 with severe ophthalmalgia. Flat neoplasm were seen in the posterior pole of the eyes in all the 6 patients and retinal detachment were found in 5 patients. Fundus fluorescein angiography (FFA) examination had been performed on 1 patient and blocked fluorescence and hyperfluorescence were seen in the lesion with pinpoint fluorescein leakage loop around it. CT examination had been performed on 3 patients and the shadow of flat homogenous tumor was seen. MRI examination had been performed on 1 patient and high signal intensit ies on T1W and low signal intensities on T2W were found. In all the 6 patients with primary lung carcinoma, 5 were diagnosed with adenocarcinoma and 1 with cellule carcinoma through pathological examination, and 5 patients were diagnosed with choroidal metastatic carcinoma from adenocarcinoma and 1 with choroidal metastatic carcinoma from cellule carcinoma through pathological examination.Conclusion Rapid visual acuity decrease, severe ophthalmalgia, flat neoplasm in ocular fundus and secondary retinal detachment are the main clinical characteristics of the choroidal metastatic carcinoma from lung carcinoma. Most histopathologica l manifestations of the metastatic carcinoma like that of the primary focus, and adenocarninoma is the most common histoclassification. (Chin J Ocul Fundus Dis，2003，19：333-404)
Objective To explore the efficacy and safety of bronchoscopy-guided radioactive 125I seeds implantation combination with chemotherapy for advanced central type lung cancer. Methods Sixty-six patients with central type lung cancer in stage Ⅲb or Ⅳ were enrolled in this study from May 2014 to July 2016. The patients were randomly divided into two groups, ie. bronchoscopy-guided seeds implantation combined with chemotherapy group (experimental group, n=30) and chemotherapy group (control group, n=36). All patients accepted GP regimen (gemcitabine plus cisplatin) chemotherapy and were followed up by CT and electric bronchoscopy (EB) examination 1, 3, 5 months later. According to WHO unified standard, the efficacy and adverse effects were evaluated . Results In the experimental group and the control group, the response rate (complete response plus partial response) was 80.00% and 50.00%, respectively. There was significant difference between two groups (P<0.05). The incidence rate of hemoptysis in the experimental group was significantly higher than that in the control group (P<0.05), but there was no significant difference between the two groups in the incidence rate of pneumothorax, fever or bone marrow suppression (allP>0.05). All adverse reactions were light and could be controlled. Conclusions The short-term clinical efficacy is better in the bronchoscopy-guided seeds implantation combined with chemotherapy group. The bronchoscopy-guided seeds implantation combined with chemotherapy is a safe and minimally invasive treatment for advanced central type lung cancer.
ObjectiveTo summarize the clinical features of pulmonary mucoepidermoid carcinoma (PMEC) and improve the level of the diagnosis and therapy.MethodsA case of PMEC was reported and related literatures were reviewed in PubMed, WanFang data and China National Knowledge Infrastructure.ResultsA 21-year-old female patient, complaining of cough and expectoration for 5 months, intermittent hemoptysis for 3 months and repeated fever more than 4 days, was hospitalized in March 2017. After admission, the patient was diagnosed as low-grade PMEC and received anti-infection, fibrobronchoscope sputum aspiration and alveolar lavage therapy. During the hospitalization, the anti-infection of the patients was not much effective, and the chest CT examination suggested space-occupying lesions in the middle lobe of the right lung. After the surgical removal of the right lung, the syndrome of the patient was improved. A total of 13 patients were reviewed, there was no obvious gender difference, and the median age was about 40 years old (most frequently occurred in younger adults with an average age less than 50 years). Frequent clinical manifestations were cough, fever and hemoptysis, which were often accompanied with atelectasis. Most of the patients could be improved after surgical resection, and a few need comprehensive treatment including radiotherapy, chemotherapy and targeted treatment, etc.ConclusionsPMEC is rare and the etiology is still unclear. The pathology is mainly low-grade. Majority of patients with PMEC could be cured after surgical resection.
ObjectiveTo explore the clinical features, primary lesions and prognosis of optic nerve metastases.MethodsSeven patients (11 eyes) with optic nerve metastatic tumor diagnosed by the examinations of ophthalmology, laboratory and pathology in Chinese PLA General Hospital from April 2015 to September 2017 were included in this study. All patients underwent BCVA, flash VEP, OCT, orbital MRI, serum tumor marker, cerebral spinal fluid detection and PET-CT. Histopathological examination of primary or near superficial metastases was performed. The follow-up period was ranged from 16 to 44 months, with the mean of 23.0±10.9 months. The clinical characteristics, primary tumor, imaging features, treatment and clinical prognosis in the patients were analyzed.ResultsAmong 7 patients, there were 5 males and 2 females, with the mean age of 53.90±14.99 years; 3 patients with unilateral optic nerve involvement, 4 patients with bilateral optic nerve involvement; 5 patients (71.4%) first diagnosed in ophthalmology. Five patients (45.5%) were misdiagnosed as optic neuritis, optic disc edema in 6 eyes (54.5%). All of them appear loss of visual acuity, including 8 eyes (72.7%) with BCVA＜0.1, 2 eyes (18.2%) with BCVA 0.1-0.5, 1 eye (9.1%) with BCVA＞0.5. MRI results show that 1 patient with intraorbital segment, 1 patient with internal segment of optic canal, 4 patients with intracranial segment, 1 patient with intracranial segment and optic chiasma involved simultaneously, 4 patients involving surrounding tissue. There were 4 patients (57.1 %) with lung cancer, 2 patients (28.6%) with kidney cancer, 1 patient (14.3%) with gastric cance; 6 patients (85.7%) with metastasis from other sites, 2 patients with brain metastasis (1 patient with meningitis carcinomatosa). There were 2 patients (28.6%) with previous primary cancer surgery. After diagnosis, 1 patient received chemotherapy, 1 patient received radiotherapy, 5 patients gave up treatment. At the end of follow-up, 1 patient (1 eye) of chemotherapy with BCVA increased by 2 line; 1 patient (2 eyes) of radiotherapy with no change in BCVA; of the 5 patients who gave up treatment, 1 patient died of disease, 1 patient lost follow-up, and 3 patients (4 eyes) had no change in BCVA.ConclusionsWith atypically clinical manifestations, the optic nerve metastases easily misdiagnosed as optic neuritis, and with poor therapeutic effect. Primary lesions are mostly found in lung cancer.
ObjectiveTo explore the effects of rehabilitation therapy on postoperative pulmonary function and exercise capacity of patients with lung cancer during the hospitalization in the setting of enhanced recovery after surgery (ERAS) protocols.MethodsA total of 110 lung cancer patients undergoing thoracoscopic lobectomy in the Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from September 2017 to December 2018 were randomly divided into the rehabilitation treatment group (the trial group, n=54) and the non-rehabilitation treatment group (the control group, n=56). The trial group got out of bed within 24 hours after surgery and performed respiratory rehabilitation training. The control group did not receive rehabilitation after surgery. Pulmonary function and 6-minute walking distance (6MWD) were evaluated preoperatively and prior to discharge in both groups to compare the differences in pulmonary function and exercise capacity between the two groups.ResultsThe preoperative forced vital capacity (FVC) in the trial group and the control group were (2.45±0.57) and (2.47±0.61) L, respectively; the forced expiratory volume in the first second (FEV1) were (2.29±0.55) and (2.22±0.55) L, respectively; 6MWD were (592±51) and (576±57) m, respectively; the differences between the two groups were not statistically significant (P>0.05). Prior to discharge, the FVC in the trial group and the control group were (1.43±0.36) and (1.19±0.33) L, respectively; FEV1 were (1.28±0.32) and (1.06±0.61) L, respectively; 6MWD were (264±43) and (218±37) m, respectively. The results of pre-discharge evaluation were significantly lower than those of preoperative evaluation (P<0.01). The pre-discharge FVC, FEV1, and 6MWD in the trial group were significantly superior to those in the control group (P<0.01).ConclusionIn the setting of ERAS protocols, postoperative rehabilitation therapy during hospitalizations can improve pulmonary function and promote the recovery of exercise capacity in lung cancer patients more effectively.
ObjectiveTo explore the clinical pattern of intrapulmonary lymph node metastasis and the significance of No.13 and No.14 lymph nodes biopsy in patients with non-small cell lung cancer (NSCLC).MethodsThe clinical data of 234 patients with primary peripheral NSCLC who underwent systemic dissection of intrathoracic lymph nodes and intrapulmonary lymph nodes in the First Affiliated Hospital of Chongqing Medical University between 2013 and 2015 were retrospectively analyzed. There were 159 males and 75 females, aged 36-89 (61.35±8.57) years. Statistical analysis was performed accordingly on hilar (No.10), interlobar (No.11), lobar (No.12) and segmental (No.13 and 14) sites of the samples of N1 lymph nodes after surgery.ResultsA total of 3 019 lymph nodes of No.10-14 were dissected in 234 patients (12.9 per patient). The 263 lymph nodes were positive with a rate of 8.71% (263/3 019) and lymph node metastasisa occured in 99 patients with a rate of 42.31% (99/234), among whom there were 40 patients of N1 metastasis, 48 of N1+N2 metastasis and 11 of N2 skipping metastasis. Routine pathological examination demonstrated No.13 and No.14 lymph nodes metastasis in 16 patients with a rate of 6.84% (16/234). In 886 dissected lymph nodes of No.13 and No.14, 86 lymph nodes showed metastasis with a rate of 9.71% (86/886). Of the patients with swelling hilar and mediastinal lymph nodes reported by preoperative CT scan, only 56.32% of them were confirmed with lymph node metastasis by postoperative histopathology; while 34.01% of the patients with normal size lymph nodes had lymph node metastasis.ConclusionIn the surgical treatment of NSCLC, it is necessary to detect the metastasis of No. 13 and 14 lymph nodes and non-tumor parabronchial lymph nodes, which is helpful to obtain accurate postoperative TNM staging and is of great significance for guiding postoperative treatment. Preoperative CT is not a reliable method to judge lymph node metastasis, particularly for intrapulmonary lymph node metastasis.
ObjectiveTo observe the clinical features of uveal metastases from lung carcinoma.MethodsA retrospective case study. From 1983 to 2014, 14 patients with uveal metastases of lung cancer confirmed by ocular examination in Peking Union Medical College Hospital were included in the study. Among them, 7 were male, 7 were female; 11 were monocular and 3 were binocular. The mean age was 54.5±9.6 years. Pathologic examination showed primary bronchial lung cancer, including 13 patients of non-small cell lung cancer (10, 2 and 1 patients of lung adenocarcinoma, squamous cell carcinoma and adenosquamous cell carcinoma, respectively) and 1 patient of small cell lung cancer. Four patients (28.6%) were diagnosed with lung cancer before ophthalmology consultation, and 10 patients (71.4%) were first diagnosed with ophthalmology due to ocular symptoms. The duration from ocular symptoms to lung cancer diagnosis was 1 week to 6 months. The course from diagnosis of lung cancer to ophthalmological consultation was ranged from 10 to 60 months, and the average course was 29.5±19.0 months. There were 7, 4 and 3 patients with impaired vision, occlusion of visual objects and deformation of visual objects, respectively. All patients underwent visual acuity, slit lamp microscope, B-mode ultrasound and UBM examinations. FFA was performed in 8 eyes, and 2 eyes were examined for ICGA. Orbital MRI was performed in 5 patients. Vitreoretinal surgery was performed on 1 eye. The clinical characteristics of the patients were analyzed and observed.ResultsIn 17 eyes, there were 2 eyes with visual acuity of light perception, 3 eyes of hand movement to counting finger before the eyes, 5 eyes of 0.1-0.3, 4 eyes of 0.4-0.6, 3 eyes of greater than 0.8. Metastatic cancer was located in iris in 1 eye, it presents as a red mass with irregular shape on the surface, which is full of small nourishing blood vessels. Metastatic cancer were located in choroid in 16 eyes, they presented yellowish-white or grayish-yellow lumps under the posterior pole or equatorial retina, including 14 eyes with a single lesion and 2 eyes with 2 lesions, with retinal detachment in 8 eyes and increased intraocular pressure in 5 eyes. B-mode ultrasonography showed posterior polar flat or surface irregular wavy intraocular space occupying lesions with localized or extensive retinal detachment. FFA and ICGA showed the focal, apical and patchy fluorescence of the tumor. MRI showed that T1WI medium and high signal consistent with the vitreous body, while T2WI showed low signal.ConclusionsUveal metastatic may be the first manifestation of lung cancer, and visual impairment, part of solid mass lesions with fundus flattening may be accompanied by secondary glaucoma and retinal detachment as the main clinical manifestations. Most of the metastatic sites are located in choroid, which is more common in single eye and single lesion. Adenocarcinoma is the most common type of uveal metastasis in non-small cell lung cancer.