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

One stage surgical treatment of multiple primary carcinoma of hypopharynx and esophagus

目的探讨下咽、颈胸段食管多原发癌(multiple primary carcinoma,; MPC)在胸腔镜辅助下行全喉、下咽、食管切除并管状胃重建一期手术的应用及疗效。方法胸科组行胸腔镜辅助下分离食管及纵膈淋巴结清扫后开腹行管状胃成形; ,头颈组行颈部淋巴结清扫、全喉下咽切除、咽胃吻合术。术后常规补充放化疗。结果本组全部病例均一期完成手术,肺部感染3例,胸腔积液2例、气管撕裂1例; ;无吻合口瘘及围手术期死亡病例;3年生存率63.6%,5年生存率50.0%。结论下咽癌应常规行胃镜检查以免MPC的漏诊;胸腔镜辅助下全喉、下咽、; 食管切除并管状胃重建术可一期完成以往分次手术难以完成的手术治疗,有效提高下咽颈胸段食管多重癌的治疗效果。OBJECTIVE To discuss the therapeutic effect of one stage surgical; treatment in the multiple primary hypopharyngeal and cervical thoracic; esophageal carcinoma. METHODS The thoracoscopy group: dissecting the; esophagus and mediastinal lymph node assisted with thoracoscope, and; then opened abdominal cavity to make gastric tube. Head and neck group:; doing the cervical lymph node dissection, total laryngectomy, total; hypopharyngectomy and total esophagectomy, and then anastomosis of the; pharynx with gastric tube. All cases were received conventional; radiotherapy and chemotherapy after operation. RESULTS All the cases in; this group were successfully underwent the one stage operation. The; postoperative complications were pulmonary infection in 3 cases, pleural; effusion in 2 cases and tracheal tear in one case. No anastomotic; fistula or postoperative deaths occurred. The 3 and 5 year survival; rates were 63.6% and 50.0% respectively. CONCLUSION It should take; necessary examinations of cervical thoracic esophagus to prevent missing; the multiple primary carcinoma of the hypopharyngeal carcinoma. The; total laryngectomy, total hypopharyngectomy and total esophagectomy, and; anastomosis of the pharynx with gastric tube for multiple primary; hypopharyngeal and cervical thoracic esophageal carcinoma is a feasible; and active treatment method

Experimental study on inhibitory effects of Brucea javanica oil emulsion against lung cells

目的:探讨鸦胆子油乳在体外对肺腺癌细胞SPA-A1的抑制作用。方法:本研究通过鸦胆子油乳处理肺腺癌细胞(SPA-A1),采用MTT法观察其对细胞生长的抑制效应;DAPI染色观察肺腺癌细胞SPA-A1凋亡的形态学改变;流式细胞术测定细胞凋亡率及分析细胞周期变化。结果:鸦胆子油乳对肺腺癌细胞SPA-A1的抑制呈剂量和时间依赖性;鸦胆子油乳作用后SPA-A1细胞呈凋亡形态学改变;不同浓度的鸦胆子油乳作用SPA-A1细胞后,可以有效地引起细胞凋亡,且具有明显的剂量依赖性;并可阻滞SPA-A1细胞于G0/G1期。结论:鸦胆子油乳可抑制肺腺癌SPA-A1细胞增殖,诱导肺腺癌SPA-A1细胞凋亡,并使肺腺癌SPA-A1细胞阻滞于G0/G1期。OBJECTIVE To investigate effects of Brucea javanica oil emulsion against proliferation of lung adenocarcinoma SPA-A1 cells in vitro and its mechanisms.METHODS MTT assay was used to determined inhibitory rate of Brucea javanica oil emulsion against proliferation of SPA A1 cells.Apoptosis induced by Brucea javanica oil emulsion was detected by DAPI staining.Apoptotic rate and change in cell cycles were examined by flow cytometry(FCM).RESULTS Brucea javanica oil emulsion significantly inhibited proliferation of SPA-A1 cells in a dose and time dependent manner.Typical morphological changes of apoptosis were observed in SPA-A1 cells with DPAI staining after induced by Brucea javanica oil emulsion.Moreover,Brucea javanica oil emulsion arrested cell cycle at phase G0/G1 and induced apoptosis in a concentration dependent manner.CONCLUSION Brucea javanica oil emulsion can inhibit growth of SPA-A1 cells by reducing proliferation,inducing cell apoptosis and blocking cell cycle.福建省中医药科研项目(编号:Wst201214);; 福建省自然科学基金科技项目(编号:2015J01546);; 河南省卫计委项目(编号:201403087