Video-assisted Thoracoscopic 3D Mode Operation for Solitary Pulmonary Nodules

目的探讨三维胸腔镜手术(3d VIdEO-ASSISTEd THOrACIC SurgEry,3d-VATS治疗孤立性肺结节(SOlITAry PulMOnAry nOdulE,SPn)的效果。方法回顾性分析2013年3月~2014年3月50例SPn的资料,采用3d-VATS手术模式楔形切除结节,根据快速病理结果决定是否行肺叶切除加淋巴结清扫术。统计手术时间(去除快速冰冻时间)、术后24 H引流量、总引流量、引流管拔除时间、淋巴结清扫数及术后并发症等。结果 3d-VATS模式下,50例均行肺结节楔形切除,其中23例病理为恶性,继续行肺癌根治术,手术顺利。肺癌根治术手术时间(62±12)MIn,术中出血量(35±5)Ml,清扫淋巴结(19±3)个,术后24 H引流量(120±20)Ml,术后胸管引流时间(4±1)d,术后住院时间(7±2)d。并发症3例,其中术后肺炎2例,阵发性心房纤颤1例,均治愈。无围手术期死亡。随访2~12个月,平均6.3月。1例术后3个月脑转移,1例术后5个月肺癌复发。结论胸腔镜3d模式下治疗SPn是一种新的选择方式,安全可行,值得推广应用。Objective To evaluate the effects of surgical treatment for solitary pulmonary nodules under thoracoscopic 3D mode(3D-VATS).Methods A total of 50 cases of solitary pulmonary nodules from March 2013 to March 2014 were retrospectively analyzed.Intraoperative wedge pulmonary resection with 3D-VATS was utilized.According to intraoperative pathological findings,lobectomy plus lymph node dissection was given or not.Intraoperative time( minus fast freezing time),drainage volume for 24 h,total drainage volume,drainage tube removal time,number of lymph node dissected,and postoperative complications were recorded.Results Under 3D-VATS mode,50 cases of solitary pulmonary nodules were treated with wedge resection,including 23 cases of malignant pathology receiving radical resection, which was smoothly.The radical resection time( lung lobectomy plus lymphadenectomy) was(62 ± 12) min,the bleeding volume was(35 ± 5) ml,the lymphadenectomy number was 19 ± 3,the drainage volume for 24 h was(120 ± 20) ml,the postoperative chest tube removal time was(4 ± 1) days,and the postoperative hospital stay was(7 ± 2) days.Postoperative complications occurred in 3 cases,including 2 cases of pneumonia and 1 case of paroxysmal atrial fibrillation.No perioperative deaths were observed.All the cases were followed up for 2- 12 months,with an average of 6.3 months.Brain metastases was found in 1 case at the third postoperative month and recurrence of lung cancer was noted in 1 case at the fifth postoperative month.Conclusion Thoracoscopic 3D mode treatment for solitary pulmonary nodules is a new,safe,and feasible alternative and should be widely applied

Combined Use of Thoracoscopy and Laparoscopy in Total Laryngectomy for Cervical Esophageal Carcinoma

目的探讨胸、腹腔镜联合全喉切除治疗颈段食管的可行性和疗效。方法 2009年1月~2014年7月胸、腹腔镜联合全喉切除治疗33例颈段食管癌。胸腔镜下分离食管、腹腔镜下管胃成形、全喉切除、气管永久造口、胃咽吻合术。结果胸部手术时间40~66 MIn,平均53 MIn;腹部手术时间35~51 MIn,平均44 MIn;颈部手术时间128~150 MIn,平均139 MIn。术中出血量130~270 Ml,平均150 Ml。术后住院时间8~14 d,平均12 d。病理均为鳞状细胞癌,其中高分化2例,中分化19例,中-低分化7例,低分化5例。切缘病理学检查无癌组织残留。31例淋巴结转移。并发症:吻合口漏2例,喉返神经损伤3例,肺部感染6例,胃排空障碍2例,吻合口狭窄1例,无死亡病例。33例随访1个月~5年,术后1、3、5年生存率分别为87.9%、54.5%、45.5%。结论颈段食管癌应采取积极的手术治疗,胃咽吻合术是颈段食管癌切除后较为理想的修复手段。Objective To investigate clinical feasibility and efficacy of combined use of thoracoscopy and laparoscopy in total laryngectomy for cervical esophageal carcinoma.Methods Clinical data of 33 patients with cervical esophageal carcinoma undergoing surgical treatment in our department from January 2009 to July 2014 were analyzed retrospectively.The esophagus was separated under thoracoscopy.And laparoscopic gastroplasty,total laryngectomy,tracheal permanent colostomy,and gastric pharyngeal anastomosis were performed.Results The thoracoscopic operation time was 40- 66 min( mean,53 min),the laparoscopic operation time was 35- 51 min( mean,44 min),and the cervical operation time was 128- 150 min( mean,139 min).The blood loss was 130- 270 ml( mean,150 ml).The postoperative hospital stay was 8- 14 d( mean,12 d).Pathological examinations showed squamous cell carcinoma in all the cases,including 2 cases of highly differentiated carcinoma,19 cases of moderately differentiated carcinoma,7 cases of moderately or lowly differentiated carcinoma,and 5 cases of lowly differentiated carcinoma.No residual cancer was found at cutting edges pathologically.Among the 33 cases,lymph node metastasis was found in 31 cases.Complications included 2 cases of anastomotic fistula,3 cases of recurrent laryngeal nerve injury,6 cases of pulmonary infection,2cases of delayed gastric emptying,and 1 case of anastomotic stenosis.There was no death.All the patients were followed up for 1months to 5 years.The survival rates at 1,3,and 5 postoperative year were 87.9%,54.5%,and 45.5%,respectively.Conclusions Cervical esophageal carcinoma should be surgically treated actively.Gastric pharyngeal anastomosis is an ideal option for the repair of cervical esophageal cancer resection

古尔班通古特沙漠南部防护体系建成10a来的生境变化与植物自然定居[J]

于2000—2009年对古尔班通古特沙漠南部防护体系内的生境变化与自然定居植物进行了系统观测和研究。结果表明,草方格及人工植被相结合的综合防护体系可以有效固定重大工程扰动地表。防护体系建成初期,土壤水分条件好于原始地表,为人工林的生长和植物自然定居创造了良好条件。防护体系建成10a后,土壤理化性质得到有效改善,普遍形成了地衣结皮,但土壤水分出现了减少的趋势。在未经扰动的原始地表,总计有植物48种,其中短命植物30种。防护体系建成初期自然定居植物仅有8种,10a后多达33种,其中短命植物达到21种。定居植物多度由初期的1.4株.m-2增加到10a后的14株.m-2,其中短命植物占到自然定居植物总株数的85%,很少观测到自然定居的乔灌木。自然定居植物呈明显的差异性分布,与风向对种源的影响密切相关。随着草本植物的进入、生物结皮的形成和土壤水分的减少,人工植被的稳定性问题尚需进一步研究和探讨