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@#Objective To compare the clinical effects of segmentectomy and lobectomy for ≤2 cm lung adenocarcinoma with micropapillary and solid subtype negative by intraoperative frozen sections. Methods The patients with adenocarcinoma who received segmentectomy or lobectomy in multicenter from June 2020 to March 2021 were included. They were divided into two groups according to a random number table, including a segmentectomy group (n=119, 44 males and 75 females with an average age of 56.6±8.9 years) and a lobectomy group (n=115, 43 males and 72 females with an average of 56.2±9.5 years). The clinical data of the patients were analyzed. Results There was no significant difference in the baseline data between the two groups (P>0.05). No perioperative death was found. There was no statistical difference in the operation time (111.2±30.0 min vs. 107.3±34.3 min), blood loss (54.2±83.5 mL vs. 40.0±16.4 mL), drainage duration (2.8±0.6 d vs. 2.6±0.6 d), hospital stay time (3.9±2.3 d vs. 3.7±1.1 d) or pathology staging (P>0.05) between the two groups. The postoperative pulmonary function analysis revealed that the mean decreased values of forced vital capacity and forced expiratory volume in one second percent predicted in the segmentectomy group were significantly better than those in the lobectomy group (0.2±0.3 L vs. 0.4±0.3 L, P=0.005; 0.3%±8.1% vs. 2.9%±7.4%, P=0.041). Conclusion Segmentectomy is effective in protecting lungs function, which is expected to improve life quality of patients.
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Objective Introduce the experience of open window thoracostomy in the treatment of bronchopleural fistula after pulmonary resection.To explore which patients are currently suitable for open window thoracostomy , how to deal with them after open window thoracostomy, and how to treat patients without window drainage.Methods In 2017, the thoracic surgery department of Shanghai Pulmonary Hospital completed 13,341 thoracic surgeries, including 10 cases of open window thoracos-tomy, and patients with BPF after other pulmonary resection were treated with conservative thoracic closed drainage .Thoracic closed drainage therapy is often accompanied by thoracic irrigation.From January 2004 to December 2017, 21 cases of chronic refractory abscess treated with autologous musculocutaneous flap implantation after pulmonary resection and open window drain-age were summarized.The treatment of chronic refractory abscess after 14 years of diagnosis was divided into three stages.The first stage is opening the abscess cavity stage, namely opening the window drainage.The second stage is elimination of abscess cavity and closure of bronchial pleural fistula.The third stage is autologous musculocutaneous flap transplantation or displace-ment to fill the abscess cavity stage.Results Compared with before open window, the 10 patients with open window thoracos-tomy showed obvious improvement in thoracic and pulmonary infection, without perioperative death.Other patients with BPF af-ter pulmonary resection without open window thoracostomy died in 2 of conservative thoracic closed drainage .From January 2004 to December 2017, 19 patients(19/21) were successfully treated with autologous musculocutaneous flap implantation af-ter pulmonary resection and open window thoracostomy, without recurrence of empyema and necrosis of skin flap, and 2 cases (2/21) were not cured due to large bronchial fistula, and local recurrence of empyema, without perioperative death.Conclu-sion Most patients with BPF after pulmonary resection are treated with closed thoracic drainage , especially those with lower lo-bectomy and with pleural irrigation.Most patients can be cured.If patients with upper lobe, middle and upper lobectomy or pneumonectomy, accompanied by BPF, chest infection and poor drainage, it is easy to develop intrapulmonary infection sprea-ding.We should do open window thoracostomy as soon as possible.The removal of the residual cavity by filling musculocutane-ous flap after open window thoracostomy is a great improvement compared with the transthoracic reconstruction .
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Background and objective As computed tomography (CT) screening for lung cancer becomes more common in China, so too does detection of pulmonary ground-glass nodules (GGNs). Although anumber of national or international guidelines about pulmonary GGNs have been published,most of these guidelines are produced by respiratory, oncology or radiology physicians, who might not fully understand the progress of modern minimal invasive thoracic surgery, and these current guidelines may overlook or underestimate the value of thoracic surgery in the management of pulmonary GGNs. In addition, the management for pre-invasive adenocarcinoma is still controversial. Based onthe available literature and experience from Shanghai Pulmonary Hospital, we composed this consensus about diagnosis and treatment of pulmonary GGNs. For lesions which are considered as adenocarcinoma in situ, chest thin layer CT scan follow-up is recommended and resection can only be adopt in some specific cases and excision should not exceed single segment resection. For lesions which are considered as minimal invasive adenocarcinoma, limited pulmonary resection or lobectomy is recommended. For lesions which are considered as early stage invasive adenocarcinoma, pulmonary resection is recommend and optimal surgical methods depend on whether ground glass component exist, location, volume and number of the lesions and physical status of patients. Principle of management of multiple pulmonary nodules is that primary lesions should be handled with priority, with secondary lesions taking into account. .
Subject(s)
Humans , Adenocarcinoma , Diagnosis , Diagnostic Imaging , General Surgery , Adenocarcinoma of Lung , China , Consensus , Hospitals , Lung Neoplasms , Diagnosis , Diagnostic Imaging , General Surgery , Physicians , Psychology , Positron Emission Tomography Computed Tomography , Practice Guidelines as Topic , Retrospective Studies , Solitary Pulmonary Nodule , Diagnosis , Diagnostic Imaging , General Surgery , Tomography, X-Ray ComputedABSTRACT
Objective To summarize experience in the treatment of chronic refractory empyema with autologous myocutaneous flap implantation.Methods From January 2004 to December 2017,26 patients had been treated with autologous myocutaneous flap implantation in Shanghai Pulmonary Hospital for chronic refractory empyema.Among them,24 were men and 2 were women.The mediam age was 50.1 years(14-74 years).21 of them had medical histories of lung resection because of basic diseases(most of which accepted surgeries in other hospitals).Complications appeared after surgeries.15 of them had bronchopleural fistula while windowing,which could not be cured by conservative treatments such as drainage.Then we performed open-window thoracostomy and long-time dressing.6 of 21 had experienced pneumonectomy.Other 5 patients did not have primary operational histories.They experienced dressing by windowing because of chronic refractory empyema after the in effective conservative treatments like drainage without pulmonary re-expansion.Results No respiratory complications occurred in these patients.The catheters were successfully removed within 5 days and the patients were discharged within 3-6 weeks after the operations.The median follow-up period was 9 months.24 cases were successful with no recurrence of empyema or flap necrosis,the other 2 cases underwent recurrence of empyema.Conclusion The application of autologous myocutaneous flaps for the treatment of chronic refractory empyema is an effective and continuously improving method.
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OBJECTIVE:To investigate the association of Cytochrome P4503A family polypeptide 5 [(CYP)3A5] and IL-10 poly-morphisms with the concentration/dose(C/D) ratio of tacrolimus in lung transplantation recipients. METHODS:CYP3A5 polymor-phisms at rs774746 and IL-10 polymorphisms at rs1800896 from peripheral blood cell of 51 lung transplant recipients was detected by Se-quenom MassArray iPLEX GOLD system. The relationship between gene polymorphism and tacrolimus C/D ratio was analyzed. RE-SULTS:The tacrolimus C/D ratio of the recipients who carried CYP3A5 rs776746 GG genotype were higher than those with AA+GG genotype,with statistical significance(P<0.01). The tacrolimus C/D ratio of the recipients who carried IL-10 rs1800896 AA genotype were higher than those with AG genotype during 1 week and 2 weeks after transplantation,with statistical significance(P<0.05). Com-bined analysis of these two genes,the tacrolimus C/D ratio of the recipients who carried more fast metabolic alleles were higher than those who didn't carry fast metabolic alleles,with statistical significance(P<0.01). CONCLUSIONS:Determination of recipients CYP3A5 at rs 776746and IL-10 at rs800896 genotype may be performed prospectively to help individualizing tacrolimus dose regimen.
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Objective The purpose of the present study was to analyses video-assisted thoracic surgery (VATS) lobectomy for early lung cancer and to provide evidence in guiding clinical practice.Methods From May 1997 to October 2009,VATS lobectomy for early lung cancer was performed in 518 patients.All patient data was reviewed retrospectively.Results The data group consisted of 297 male patients and 221 female patients with a mean age of (58.9 ± 10.6) years ( 19 - 89 years).Morbidity was 10.8％ and mortality was 0.4％.Multivariate analysis identified patient’ s age ( P =0.0300,OR =2.0148,95％ CI 1.0700-3.7940) and operation duration (P=0.0007,OR =1.0086,95％ CI 1.0036-1.0136) as the statistically significant predictors of postoperative complications.Overall 1,3 and 5-year survival rates were 98％,81％ and 66％.And postoperative patbological staging ( P =0.0036,OR =1.6071,95 ％ CI 1.1677 -2.2118 ) is a prognostic determinant.Conclusion VATS lobectomy is a safe and effective therapeutic method for early lung cancer.However,patient selection plays key role in VATS.Operation duration should be shortened as possible,otherwise,it may result in increased postoperative morbidity.It is important to deal with the accident situation rationally and converse to thoracotomy decidedly if necessary.
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Objective To investigate the effectiveness and safety of simultaneous lung volume reduction surgery in the treatment of lung volume mismatch after single lung transplantation. Methods Twenty-four single lung transplantations were performed on 20 male and 4 female patients, with a mean age of 54. 6 ± 12. 2 years (ranging from 28 to 75 years). Indications for transplantation included end-stage chronic obstructive lung disease (COPD) in 14 cases, COPD combined with upper lobe lung destruction in 1 case, COPD combined with pneumoconiosis in 1 case, end-stage interstitial pulmonary fibrosis in 6 cases, lymphangioleiomyomatosis (LAM) in 1 case, and post-transplantation bronchiolitis obliterans syndrom (BOS) in 1 case. Sixteen cases had right-side and 8 cases had left-side lung transplantation. Lung volume reduction surgeries were performed through open thoracotomy. Graft lung volume reduction was carried out through the same incision as transplantation, and native lung volume reduction through a small anterior lateral incision contralaterally. Patients were divided into lung volume reduction group (group Ⅰ) and control group (group Ⅱ). There were 8 cases in group Ⅰ,including 5 graft lung, 2 native lung, and 1 graft and native lung volume reduction surgeries. In group Ⅱ, there were 16 cases that had no further treatment for lung volume mismatch. Differences in various clinical parameters between the two groups were compared. Results Two out of 14 (14.3%) patients with COPD accepted lung volume reduction, which was significantly lower than that in patients with other diseases (6 out of 10, 60%, P＜0. 05). Post-transplantation chest X-ray showed that 50.0% and 25% of patients had an undeflected mediastinum in group Ⅰ and group Ⅱ, respectively (P＜0. 05).None of the other clinical parameters had significant difference between the two groups (P＞0.05).But a tendency of increase in mechanical ventilation, chest tube drainage time, air leak time, volume of chest drainage, and a tendency of decrease in times and volume of thoracentesis could be observed in group Ⅰ. Lung function test was not performed on 8 cases after transplantation. Sixteen cases (4 in group Ⅰ, 12 in group Ⅱ) had complete lung function data. There was no significant difference in FEV1 improvement after lung transplantation between the two groups (P＞0. 05). Conclusion Simultaneous graft or native lung volume reduction surgery is a safe and effective way of ameliorating lung volume mismatch after single lung transplantation, probably by improving ventilation-perfusion ratio.
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Objective To discuss the prophylaxis, surveillance, and therapy on the aspergillus colonization and infection in lung transplant recipients. Methods From Jan 2003 to Sep 2004, single lung transplantation was performed in 6 patients. In 4 patients there was presence of positive aspergillus cultures from sputum after operation. Results Of these, two patients were symptomless, though treated by Itraconazole for two months. The third one has symptomatic bronchial stenosis, bronchomalacia and saprophytic colonization in the first postopearative month, which was proved by bronchoscopic biopsy and cured by stenting. The last one with invasive, disseminated pneumonia duo to aspergillus was cured after six weeks by itraconazole and aerosolized amphotericin B. Conclusion Antifungal prophylaxis with itraconazole and aerosolized amphotericin B prevent fungal infection during the early postoperative period of lung transplantation.
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Objective To discuss the causes, prophylaxis, and treatment of the complications of mediastinoscopy. Methods Mediastinoscopy was performed in 262 consecutive patients from September 1981 to November 2005 in this hospital. Of them, 12 patients experienced preoperative or postoperative complications. Results During the operation, massive hemorrhage from branches of the innominate artery occurred in 1 patient. After the extension of cervical incision, the bleeding was stopped by pressure tamponade for 2 hours. Wound infection happened in 5 patients. One patient was clarified as having pulmonary tuberculosis, with enlargement and necrosis of mediastinal lymph nodes that led to the diabrosis of biopsy passage. The wound infection was cured by cut-open, drainage, and dressing changes. Wound infection in another 4 patients healed after dressing changes. Hoarseness of voice developed in 2 patients and spontaneously subsided at 1 and 3 postoperative months respectively. Two patients with abnormal electrocardiogram were treated with cedilanid. Pneumothorax was found in 2 patients and spontaneously healed at 4~6 days after operation. Conclusions Complications of mediastinoscopy can be avoided in experienced hands, on the basis of proficiency of mediastinal anatomy and careful surgical manipulation.