目的 探讨原发性肺印戒细胞腺癌（PSRCACL）的临床病理学特点、诊断与鉴别诊断及其预后因素等。 方法 收集2000年1月－2012年6月间50例PSRCACL患者的临床资料，进行组织学及免疫组织化学检测观察，并进行随访和结合文献复习分析。 结果 PSRCACL的临床症状及影像学表现与非小细胞肺癌无明显差异，其诊断与鉴别诊断依据其特殊的细胞形态学及免疫组织化学检测。PSRCACL的发病率约占肺腺癌的1.20%，平均发病年龄为53.3岁，中位年龄为54.5岁，男女比例为1.17︰1。患者的中位生存时间约为56个月，1年生存率约为85.4%，3年生存率约为67.4%，5年生存率约为40.9%。患者的生存率与患者的性别、年龄无关（P＞0.05），与肿瘤的大小、是否伴有癌转移及TNM分期有关（P＜0.05）。 结论 PSRCACL是一种比较罕见的、好发于中青年人、恶性程度较高、易发生侵袭和转移、预后较差的恶性上皮性肿瘤，除手术治疗外，目前尚无标准化疗方案。
ObjectiveTo compare clinical results between single and double chest tube applications after lung cancer resection, and explore the role of single chest tube in postoperative fast track recovery. MethodNinety-three patients with lung cancer who underwent lobectomy between March and December of 2009 in West China Hospital of Sichuan University were included in this study. All the patients were divided into a single-tube group including 46 patients (39 males and 7 females) with their age of 58.4±9.5 years, and a double-tube group including 47 patients (32 males and 15 females) with their age of 58.2±9.0 years. Drainage amount, duration, postoperative hospital stay, and incidences of pneumothorax and pleural effusion after removal of chest tubes were compared between the 2 groups. ResultsThe percentage of patients undergoing complete video-assisted thoracic surgery (VATS) of the double-tube group was significantly higher than that of the single-tube group, and the percentage of patients undergoing thoracotomy of the double-tube group was significantly lower than that of the single-tube group (P < 0.05). Drainage amount of the double-tube group was significantly larger than that of the single-tube group (824.4±612.5 ml vs. 510.7±406.7 ml, P < 0.05). There was no statistical difference in drainage duration, postoperative hospital stay, the incidences of subcutaneous emphysema, pneumothorax, pleural effusion or re-insertion of chest drain between the 2 groups (P > 0.05). ConclusionClinical results of single chest tube is better than or equivalent to those of double chest tubes after lung cancer resection, and drainage duration of single chest tube application might be shorter.
Lung cancer is the most common cancer worldwide. The outcome and management of lung cancer patients could be improved by early diagnosis and prognosis. MicroRNAs (miRNAs) have been implicated in signaling pathways regulating a variety of biological processes and play important roles in the development of carcinoma. Moreover, miRNAs can exist in the circulation in a remarkably stable form. All of these suggest miRNAs as new potentially clinical biomarkers for diagnosis and prognosis of lung cancer. In this review, we aim to discuss diagnostic and prognostic value and potential clinical utility of miRNAs in serum.
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.
ObjectiveTo compare the cost and efficacy of ambulatory versus hospitalized surgery for lung tumor patients. MethodsTwo researchers independently conducted a computer search on February 14, 2025, in databases including CNKI (China National Knowledge Infrastructure), PubMed, Web of Science, Ovid Medline, Cochrane Library, and Wanfang Database, with the search period covering from the inception of these databases to February 2025. The outcome indicators were postoperative complication rate, length of hospital stay, and hospitalization costs. For the included randomized controlled trials and non-randomized controlled trials, we used the Cochrane risk of bias assessment tool and the Newcastle Ottawa Scale (NOS) respectively to evaluate the quality of the literature, and extracted data from the included studies for meta-analysis using RevMan 5.4 and Stata 18.0 software. ResultsA total of 12 articles were ultimately included, all of which were evaluated as high-quality, consisting of 2 randomized controlled trials, 2 prospective cohort studies, and 8 retrospective cohort studies, involving a total of 76 403 patients. Meta-analysis showed that the ambulatory surgery group had advantages over the hospitalized surgery group in terms of operation time [MD=−21.07, 95%CI (−30.55, −11.58), P<0.001], length of hospital stay [MD=−2.17, 95%CI (−3.25, −1.09), P<0.001], hospitalization costs [SMD=−1.22, 95%CI (−2.18, −0.26), P=0.01], and overall postoperative complications [OR=0.48, 95%CI (0.32, 0.74), P<0.001]. There was no statistically significant difference between the two groups in terms of postoperative hoarseness [OR=0.62, 95%CI (0.24, 1.61), P=0.33] and postoperative chylothorax [OR=0.27, 95%CI (0.07, 1.07), P=0.06]. ConclusionCompared to conventional hospitalized lung tumor resection, ambulatory lung tumor resection can significantly reduce the patient’s surgery and hospital stay time, decrease hospitalization costs, and reduce the incidence of postoperative complications. While improving hospital efficiency and reducing the economic burden on patients, it is worthy of further promotion and application.
ObjectiveTo analyse epidermal growth factor receptor (EGFR) gene mutations in pathologically confirmed lung adenocarcinoma (LAC) samples obtained by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). MethodsClinical data of 964 consecutive patients who underwent EBUS-TBNA in Department of Thoracic Surgery, Fudan University Shanghai Cancer Center from April 2009 to September 2013 were retrospectively reviewed. EGFR gene mutations in 77 LAC patients who were comfirmed by cell morphology and immunohistochemistry were analyzed. There were 48 males and 29 females with their median age of 61 (range 33-78) years, and 43 patients were smokers. ResultsAll the 77 LAC patients were confirmed by immunohistochemistry. Among them, 31 patients (40.26%) were found to have EGFR gene mutations. There was no statistical difference in EGFR gene mutations between male and female patients (P=0.088). Mutation rate of EGFR genes of non-smokers was significantly higher than that of smokers (P=0.032). ConclusionSamples obtained by EBUS-TBNA can be used for EGFR gene mutations analysis. The mutation rate of EGFR genes of non-smokers is higher than that of smokers.
目的：运用多层螺旋CT（MSCT）后处理技术显示周围性肺癌与支气管关系，分析其影像表现及诊断价值。方法：采用MSCT对77例周围性肺癌行层厚为0.5 mm的容积靶扫描，通过多平面或曲面重建（MPR或CMRP）以及表面遮盖（SSD）法显示支气管与周围肿块的关系,CT影像表现与手术、病理对照。结果：（1）全部3～7级支气管均全程、较完整显示。42例腺癌中与支气管有关系者为39例（92.9％），20例鳞癌中为15例（75.0％）。（2）肿瘤—支气管关系可分为4型：Ⅰ型，支气管被肿块截断；Ⅱ型，支气管进入肿块内后被截断；Ⅲ型，支气管在肿块内保持通畅；Ⅳ型，支气管紧贴肿块边缘走行，形态正常或受压移位。（3）发生率：Ⅰ型为48.1％（37/77），其中鳞癌略多于腺癌；Ⅱ型为13.0%（10/77），其中鳞癌略多于腺癌；Ⅲ型为16.9％（13/77），仅见腺癌；Ⅳ型为15.6％（12/77），腺癌略多于鳞癌。（4）与第四级支气管相关的肿块，鳞癌多于腺癌；与第六级支气管相关的肿块，腺癌多于鳞癌。结论：采用MSCT超薄层靶扫描后行MPR、CMPR和SSD重建，能准确显示肿块与支气管关系，并反映一定的病理改变关系，对良恶性鉴别或长期预后等相关性研究有着重要意义。
Objective To evaluate the validity of video-assisted thoracoscopic surgery (VATS) pneumonectomy in thoracic diseases treatment. Methods We retrospectively analyzed the clinical data of 34 consecutive patients who underwent VATS pneumonectomy in Xiangya Hospital Central South University between January 2013 and October 2015. There were 26 males and 8 females at age of 35–69 (53.8±7.7) years. Results VATS pneumonectomy was completed successfully in 32 patients (5.8% conversion rate). The average operation time was 182.5±52.4 min. The average blood loss was 217.1±1 834.8 ml. Chest tube drainage flow was 3–11 (6.0±1.7) days and postoperative hospital stay was 5–12 (7.6±1.8) days. Eleven patients got postoperative complications (34.3%), mainly pulmonary infections. The 32 patients were followed up for 10 (1–21) months. Two patients died of lung metastasis 16 or 17 months after the operation. One patient died of sudden cardiac arrest 3 months after operation. Bronchopleural fistula (BPF) happened in one patient after hospital discharge in 2 months. Conclusion VATS is feasible for pneumonectomy. However, further studies and follow-up are needed to verify the benefits of VATS pneumonectomy for lung cancer.
ObjectiveTo investigate the feasibility and safety of DynaCT microwave ablation (MWA) guided by 3D iGuide puncture technology for lung cancer.MethodsThe clinical data of 19 patients with primary or metastatic lung cancer who underwent DynaCT MWA from June 2019 to December 2020 in our hospital were retrospectively analyzed, including 15 males and 4 females with an average age of 64.9±11.7 years. The technical success rates, adverse reactions and complications, postoperative hospital stay, and local therapeutic efficacy were recorded.ResultsTechnical success rate was 100.0%. The mean time required to target and place the needle was 15.7±3.7 min and the mean ablation time was 5.7±1.6 min. Thirteen patients underwent biopsy synchronously before the ablation, and 10 (76.9%) patients had positive pathological results. The main adverse reactions were pain (7/19, 36.8%), post-ablation syndrome (4/19, 21.1%) and cough (2/19, 10.5%). The minor complications were pneumothorax (6/19, 31.6%), hemorrhage (5/19, 26.3%), pleural effusion (2/19, 10.5%) and cavity (1/19, 5.3%). Three patients had moderate pneumothorax and received closed thoracic drainage. The median hospitalization time after ablation was 2.0 (2.0, 3.0) d, and no patient died during the perioperative period. The initial complete ablation rate was 89.5% (17 patients) and the incomplete ablation rate was 10.5% (2 patients) at 1-month follow-up, and no local progression was observed.ConclusionDynaCT MWA of lung cancer under the guidance of 3D iGuide system is safe and feasible with a high short-term local control rate, but the long-term efficacy remains to be further observed.