ABSTRACT
BACKGROUND@#With the extensive application of segmental lung resection in the treatment of early-stage lung cancer, how to complete segmentectomy more accurately and minimally invasively has become a research hotspot. The aim of this study is to explore the application of three-dimensional computed tomography bronchography and angiography (3D-CTBA) combined with perfusion area recognition technique in single-hole thoracoscopic complex segmentectomy.@*METHODS@#From January 2021 to January 2022, the clinical data of 112 consecutive patients undergoing single-port thoracoscopic complex segmentectomy in the Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University were retrospectively analyzed. The three-dimensional reconstruction combined with perfusion area identification technique was used to perform the operation and the clinical data were analyzed.@*RESULTS@#The average operation time was (141.1±35.4) min; the initial time of intersegmental plane display was (12.5±1.7) s; the maintenance time of intersegmental plane was (114.3±10.9) s; the intersegmental plane was clearly displayed (100%); the amount of bleeding was [10 (10, 20)] mL; the total postoperative drainage volume was (380.5±139.7) mL; the postoperative extubation time was (3.9±1.2) d; and the postoperative hospitalization time was (5.2±1.6) d. Postoperative complications occurred in 8 cases.@*CONCLUSIONS@#The advantages of 3D-CTBA combined with perfusion area recognition technique are fast, accurate and safe in identifying intersegmental boundary in single-port thoracoscopic complex segmentectomy, which could provide guidances for accuratding resection of tumors, shortening operation time and reducing surgical complications.
Subject(s)
Humans , Lung Neoplasms/pathology , Bronchography , Pneumonectomy/methods , Retrospective Studies , Thoracic Surgery, Video-Assisted/methods , Tomography, X-Ray Computed , Angiography/methods , PerfusionABSTRACT
@#Objective To assess the clinical value of preoperative localization coupled with computed tomography (CT) three-dimensional reconstruction in pulmonary nodule-centered uniportal thoracoscopic combined subsegmental/segmental resection. Methods The clinical data of 30 patients of combined subsegmental/segmental resection in our hospital from December 2019 to October 2021 were retrospectively collected. There were 19 males and 11 females with the mean age of 56.4 (32.0-71.0) years. The pulmonary nodules were located by CT-guided injection of glue before operation. The three-dimensional reconstruction image and operation planning were carried out by Mimics 21.0 software. Results The operations were all successfully performed, and there was no conversion to open thoracotomy or lobectomy. The mean tumor diameter was 11.6±3.5 mm, the mean distance between the nodule and the visceral pleura was 13.6±5.6 mm, the mean width of the actual cutting edge was 25.0±6.5 mm, the mean operation time was 110.2±23.8 min, the mean number of lymph node dissection stations was 6.5±2.4, the mean amount of intraoperative bleeding was 50.8±20.3 mL, the mean retention time of thoracic catheter was 3.2±1.1 d, and the mean postoperative hospital stay was 4.5± 1.7 d. There was 1 patient of subcutaneous emphysema, 1 patient of atrial fibrillation and 1 patient of blood in sputum. Conclusion Preoperative CT-guided injection of medical glue combined with CT three-dimensional reconstruction of pulmonary bronchus and blood vessels is safe and feasible in pulmonary nodule-centered uniportal thoracoscopic combined subsegmental/segmental resection, which ensures the surgical margin and reserves lung tissues.
ABSTRACT
@#Objective To evaluate the learning curve of CT-guided medical glue localization for pulmonary nodule before video-assisted thoracic surgery (VATS). Methods The clinical data of the patients with pulmonary nodules who underwent CT-guided medical glue localization before VATS in our hospital from July 2018 to March 2021 were retrospectively analyzed. The patients were divided into 3 groups: a group A (from July 2018 to August 2019), a group B (from September 2019 to June 2020) and a group C (from July 2020 to March 2021). The localization time, morbidity, complete resection rate and other indexes were compared among the three groups. Results A total of 77 patients were enrolled, including 24 males and 53 females aged 57.4±10.1 years. There were 25 patients in the group A, 21 patients in the group B, and 31 patients in the group C. 77 pulmonary nodules were localized. There was no significant difference among the groups in the basic data (P>0.05). The localization time in the group C was 10.6±2.0 min, which was statistically shorter than that in the group A (15.4±4.4 min) and group B (12.9±4.3 min) (P<0.01). The incidence of complications in the group C was lower than that in the group A and group B (25.8% vs. 52.0% vs. 47.6%, P=0.04). The success rate of localization of the three groups was not statistically different (P=0.12). Conclusion There is a learning curve in CT-guided medical glue localization for single pulmonary nodule before VATS. After the first 46 cases, the operation time can be shortened, and the incidence of complications can be decreased.
ABSTRACT
@# Objective To explore and analyze the related influencing factors for common intraoperative complications during CT-guided percutaneous radiofrequency ablation of pulmonary tumor. Methods We retrospectively analyzed the clinical data of the patients who underwent CT-guided percutaneous radiofrequency ablation of pulmonary tumor in our hospital from December 2018 to December 2019, and analyzed the influencing factors for complications. Results A total of 106 patients were enrolled. There were 58 (54.7%) males and 48 (45.3%) females aged 46-81 (68.05±8.05) years. All patients successfully completed the operation. The operation time was 47.67±16.47 min, and the hospital stay time was 2.45±1.35 d. The main intraoperative complications were pneumothorax (16.0%, 17/106) and intrapulmonary hemorrhage (22.6%, 24/106). Univariate analysis showed that the number of pleural punctures had an impact on the occurrence of pneumothorax (P=0.00). The length of the puncture path (P=0.00), ablation range (P=0.03) and ablation time (P=0.00) had an impact on the occurrence of intrapulmonary hemorrhage. Multivariate logistic regression analysis showed that the size of the lesion (OR=17.85, 95%CI 3.41-93.28, P=0.00) and the number of pleural punctures (OR=0.02, 95%CI 0.00-0.11, P=0.00) were independent influencing factors for the occurrence of pneumothorax. The length of the puncture path (OR=15.76, 95%CI 5.34-46.57, P=0.00) was the independent influencing factor for the occurrence of intrapulmonary hemorrhage. Conclusion Percutaneous radiofrequency ablation of pulmonary tumor is safe and with a high success rate, but intraoperative complications are affected by many factors, so the surgeons should be proficient in operating skills to avoid complications.
ABSTRACT
@#With the widespread application of high-resolution and low-dose computed tomography (CT), especially the increasing number of people participating in lung cancer screening projects or health examinations, the detection of pulmonary nodules is increasing. At present, the relevant guidelines for pulmonary nodules focus on how to follow up and diagnose, but the treatment is vague. And the guidelines of European and American countries are not suitable for East Asia. In order to standardize the diagnosis and treatment of pulmonary nodules and address the issue of disconnection between existing guidelines and clinical practice, the Lung Cancer Medical Education Committee of the Chinese Medicine Education Association has organized domestic multidisciplinary experts, based on literature published by experts from East Asia, and referring to international guidelines or consensus, the "Chinese expert consensus on multi-disciplinary minimally invasive diagnosis and treatment of plmonary nodules" has been formed through repeated consultations and thorough discussions. The main content includes epidemiology, natural course, malignancy probability, follow-up strategies, imaging diagnosis, pathological biopsy, surgical resection, thermal ablation, and postoperative management of pulmonary nodules.
ABSTRACT
@#Myasthenia gravis (MG) is an autoimmune disease with indefinite pathogenesis. MG is closely related to thymic diseases, and thymectomy is an important way for MG treatment. However, there are some controversies regarding thymectomy, including indications, operation opportunities, operative procedures, surgical approaches, perioperative managements, and efficacy evaluations, etc. Therefore, based on the literature and the experience of Chinese experts, this consensus has been written after careful discussion and inquiry and 29 recommendations have been made, aiming to guide surgical treatment of MG and improve the clinical outcomes.
ABSTRACT
@#In recent years, with the improvement of CT resolution, the reduction of radiation dose, the popularization of lung cancer screening and the enhancement of people's health awareness, the detection rate of lung nodules is higher and higher. Due to the close relationship between lung nodules and lung cancer, more and more attention has been paid to them. Although patients with early and middle stage lung cancer receive complete resection, all postoperative patients are at risk of recurrence and metastasis. Adjuvant or neoadjuvant therapy can improve the survival and reduce the recurrence and metastasis. Therefore, the multidisciplinary team, as the best model, provides a standardized and individualized plan for the diagnosis and treatment of lung nodules and lung cancer patients. However, in the clinical practice, the work efficiency of the multidisciplinary team is not high, and the participation rate of patients is low; therefore the multidisciplinary doctor model with thoracic surgeons as the mainstay is a reasonable alternative.
ABSTRACT
Recent studies have shown that tumor immune microenvironment is closely related to tumor progression, metastasis, recurrence and response to treatment. Some immunotherapies also offer hope for cancer patients. However, the efficacy of tumor immunotherapy is uncertain and has some side effects. In order to enhance its efficacy, tumor immunotherapy combined with tumor thermal ablation has been studied. Thermal ablation has the advantages of minimally invasive, rapid recovery, safety, fewer complications, conformation, reliable effect, repeatable, low cost, and has become the fourth tumor treatment measure after surgery, radiotherapy, and drug therapy. It can directly kill tumor cells and modulate the immune system through a variety of mechanisms, although the corresponding mechanisms are not well understood, but combined tumor immunotherapy has been proposed to treat several solid malignancies. In this review, the current status and progress of thermal ablation combined with immunotherapy for lung tumor were reviewed, and further studies on the efficacy and safety of thermal ablation combined with immunotherapy were expected. .
Subject(s)
Humans , Combined Modality Therapy , Hyperthermia, Induced , Immunotherapy , Lung Neoplasms/surgery , Tumor MicroenvironmentABSTRACT
BACKGROUND@#The localization of pulmonary nodules is related to whether the lesions can be found and removed accurately and quickly. It is an important link for the success of minimally invasive video-assisted thoracic surgery (VATS). This study investigated the feasibility of medical glue localization under VATS video-assisted thoracoscopic computed tomography (CT) guidance for single pulmonary nodule and more than two pulmonary nodules, and compared with the accuracy and safety of single nodule localization.@*METHODS@#A retrospective analysis of the clinical data of patients who underwent unilateral CT-guided medical glue localization before VATS from November 2018 to March 2021 were performed, the patients was divided into multiple pulmonary nodules group (localized nodules ≥2) and single pulmonary nodule group according to the number of localized nodules. The localization time, success rate and complication rate of the two groups were compared.@*RESULTS@#There were 126 nodules in the two groups, including 62 in single pulmonary nodule group and 64 in multiple pulmonary nodules group. The average single nodule localization time was (13.23±4.5) min in single pulmonary nodule group and (10.52±2.8) min in multiple pulmonary nodules group, the difference between the two groups is statistically significant (P<0.05). The localization success rate of single pulmonary nodule group and multiple pulmonary nodules group were 100% and 98.4% separately, the difference between the two groups was not statistically significant (P>0.05). All VATS were successfully completed after localization. The incidence of pneumothorax was higher in multiple pulmonary nodules group than in single pulmonary nodule group (P=0.07).@*CONCLUSIONS@#Compared with localization of single lung nodule, unilateral CT-guided medical glue localization for multiple pulmonary nodules before VATS is also feasible and accuracy, it is worthy of clinical application. But the higher rate of pneumothorax should be paid attention to.
Subject(s)
Humans , Lung Neoplasms/surgery , Multiple Pulmonary Nodules/surgery , Pneumothorax , Retrospective Studies , Solitary Pulmonary Nodule/surgery , Thoracic Surgery, Video-Assisted , Tomography, X-Ray ComputedABSTRACT
BACKGROUND@#With the wide application of computed tomography (CT) in the screening of early lung cancer, more and more ground glass nodules (GGNs) have been found. Early intervention is helpful to improve the survival rate of lung cancer patients. Radiofrequency ablation (RFA) is an alternative option to manage primary or metastatic lung malignancies. The purpose of this study is to review the safety and clinical efficacy for lung GGN treated by RFA.@*METHODS@#From June 2016 to March 2021, 24 patients with a total of 28 lung GGNs in our hospital underwent 28 sessions of RFA. There were 13 males and 11 females with an average age of (69.4±11.1) years. The size of GGN receiving RFA was (1.30±0.56) cm; The ablation range was (2.50±0.63) cm and ablation time was (15.00±8.68) min.@*RESULTS@#The procedure of all RFAs went smoothly, no perioperative deaths occurred and no serious complications during the operation. The median follow-up was 25 months. One case died of myocardial infarction 2 months after operation. All 28 GGNs showed no evidence of local progression and the local control rate was 100.0%. Kaplan-Meier analysis showed that the 1-year and 2-year overall survival rates were 95.8% and 95.8%; the tumor specific survival rates were 100.0% and 100.0%, respectively.@*CONCLUSIONS@#RFA is a safe, effective and minimally invasive technique for the treatment of lung GGNs.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Lung , Lung Neoplasms/surgery , Radiofrequency Ablation/adverse effects , Tomography, X-Ray ComputedABSTRACT
"The Expert Group on Tumor Ablation Therapy of Chinese Medical Doctor Association, The Tumor Ablation Committee of Chinese College of Interventionalists, The Society of Tumor Ablation Therapy of Chinese Anti-Cancer Association and The Ablation Expert Committee of the Chinese Society of Clinical Oncology" have organized multidisciplinary experts to formulate the consensus for thermal ablation of pulmonary subsolid nodules or ground-glass nodule (GGN). The expert consensus reviews current literatures and provides clinical practices for thermal ablation of GGN. The main contents include: (1) clinical evaluation of GGN, (2) procedures, indications, contraindications, outcomes evaluation and related complications of thermal ablation for GGN and (3) future development directions. .
ABSTRACT
BACKGROUND@#As a new technique developed in recent years, endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) has the advantages of simple operation, minimal invasive, high accuracy, safety and repeatability. It has become a new standard for lung cancer diagnosis and mediastinal staging. Because small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) have different biological characteristics and treatment methods, it is very important to diagnose and differentiate the types of lung cancer in the early stage of lung cancer for the staging, treatment and prognosis of lung cancer. This article evaluated the accuracy and sensitivity of EBUS-TBNA in the diagnosis of SCLC and NSCLC.@*METHODS@#From January 2012 to December 2018, the clinical data of 85 patients with SCLC and NSCLC who performed EBUS-TBNA in Xuan Wu Hospital CMU were retrospectively analyzed and the differences between the two groups were compared.@*RESULTS@#45 cases of SCLC were confirmed by immunohistochemistry and pathology. 42 cases of SCLC were diagnosed by EBUS-TBNA. The accuracy and sensitivity of diagnosis were 93.3% (42/45) and 100.0% (42/42), respectively. The positive rate of diagnosis was 48.9% (22/45) in 22 cases diagnosed by cytology, and 40 cases diagnosed by pathology, including 35 cases diagnosed by EBUS-TBNA. The accuracy and sensitivity of diagnosis were 87.5% (35/40) and 100.0% (35/35), respectively. The positive rate of diagnosis was 27.5% (11/40) in 11 cases diagnosed by cytology. The diagnostic sensitivity of EBUS-TBNA in SCLC group was significantly higher than that in NSCLC group (P<0.05).@*CONCLUSIONS@#EBUS-TBNA is more sensitive in the diagnosis of SCLC than NSCLC. As a minimally invasive technique, EBUS-TBNA can assist SCLC in early diagnosis and timely treatment.
ABSTRACT
In recent years, with the development of the high resolution computed tomography (HRCT) screening program for lung cancer, the multifocal ground-glass nodule (GGN) has been discovered more and more. Because there are still many uncertainties in the diagnosis and treatment of multifocal GGN in lung, this paper reviews the clinical concerns such as the follow-up interval and time, the relationship between main focus and other focuses, diagnosis, treatment and follow-up of residual nodules.
ABSTRACT
@#In December 2019, an outbreak of pneumonia associated with the coronavirus disease 2019 (COVID-19) occurred in Wuhan, China. The lung imaging finding is like that of the lung cancer immune checkpoint inhibitors (ICI) associated pneumonia. Therefore, we speculated that they may have similar pathogenesis and treatment strategies, which is reviewed in this article in order to provide some reference to timely and effectively reduce the fatality rate of COVID-19.
ABSTRACT
Recent widespread use of high resolution computed tomography (HRCT) for the screening of lung cancer have led to an increase in the detection rate of very faint and smaller lesions known as ground-glass nodule (GGN). However, it had been proved that GGN was well associated with lung cancer in previous studies. Therefore, the classification, imaging characteristics, pathological type, follow-up, suggested managements and other clinical concerns of GGN were reviewed in this paper. .
ABSTRACT
Objective To evaluate the therapeutic effects afer radiofrequency ablation(RFA) in 24 patients with pulmonary neoplasms through quantitative iodine-based and water-based material decomposition images with spectral computed tomography(CT) imaging.Methods 30 patients(19 male,11 female;age range,52-85 years;mean age,69 years;26 peripheral lung cancer,4 central lung cancer) underwent lung radiofrequency ablation on a GE Discovery CT750HD scanner from March 2012 to March 2013.We compared the volume,CT value,water-based value and iodine-based value of lung tumor before and after the RFA using spectral imaging mode.Results 22 of 30 tumors was bigger after the RFA,8 had no change.Through water-based material decomposition images,the water content in the tumors were increased from(1 014.76 ±6.83) mg/ml to (1 022.71 ± 10.16)mg/ml after RFA,and the difference was significant (t =-2.329,P ＜ 0.05).The iodine-based value in parenchyma of the tumor was 2.49 ± 0.74 mg/mL before the RFA.The tumor was most or completly necrosis after the RFA,the value of iodine in the area of necrosis was (0.45 ± 0.29) mg/mL,which was obviously reduced than before (t =11.072,P =0.000).Conclusion Through compared with the volume,CT value,water-based value and iodine-based value of the parenchyma of the tumors before and after the RFA with spectral computed tomography(CT) imaging,we can know the morphology and metabolism of the tumors to investigate the short term results.
ABSTRACT
Objective:To explore the relationship between carotid atherosclerosis (CAS)detected by ultrasonography and ECG abnormality and correlation between CAS and blood pressure in patients with coronary heart disease (CHD).Methods:A total of 389 CHD patients were divided into CAS group (n=213)and no CAS group (n=176).ECG abnormalities were compared between two groups,and ECG and blood pressure were compared among patients with different degrees of CAS in CAS group.Results:Compared with no CAS group,there were significant rise in constituent ratios of atrial fibrillation,Ⅱ~Ⅲ°atrioventricular block,total lead number of ST segment de-pression,and of abnormal T wave,ST segment deviation complicated abnormal T wave and angina pectoris compli-cated ST segment depression in CAS group (P <0.05~<0.01).Along with CAS grade increased (grade I~ grade IV),there were gradual rise in percentages of atrial fibrillation (8.33% vs.21.33% vs.31.03% vs.45.00%),to-tal lead number of ST segment depression (17.64% vs.27.22% vs.37.07% vs.52.08%),total lead number of ab-normal T wave (5.00% vs.6.56% vs.10.34% vs.22.08%)and ST segment deviation complicated abnormal T wave (26.67% vs.37.33% vs.50.00% vs.60.00%),P <0.05 or <0.01. There were no significant difference in diastolic blood pressure (DBP)between no CAS group and CAS group,but systolic blood pressure (SBP)and pulse pressure (PP)of CAS patients were significantly higher than those of no CAS patients,and they gradually elevated along with CAS severity increased (P <0.05~<0.01).Pearson correlation analysis indicated that CAS was signifi-cant positively correlated with SBP and PP (r =2.064,1.348,P <0.01 both).Conclusion:The incidence rate of abnormal ECG in CHD patients complicated CAS is higher than that of CHD patients without CAS;and CAS is pos-itively correlated with blood pressure.Therefore,carotid ultrasonography can better reflect CHD patients′condition.
ABSTRACT
Objective To explore the clinical characteristics of bronchial carcinoma in elder patients and determine the operative indication, surgical technique, and management in the perioperative period. Methods 16 patients with bronchial carcinoma aged 80 and over received major pulmonary resection through muscle sparing mini-thoracotomy. The operative procedures were lobectomy(8 cases), bilobectomy (3 cases), sleeve lobectomy (2 cases), pneumonectomy (1 case), and lobectomy plus wedge resection (2 cases). Clinical data were analyzed retrospectively. Results Of the 16 patients, 6 with stage Ⅰ disease, 3 with stage Ⅱ and 7 with stage Ⅲdisease. There were no perioperative death occurred. The most popular postoperative complications were cardiac arrhythmia, pulmonary infection and hypoxemia. Conclusion Major pulmonary resection is a rational choice for part of the octogenarian patients with lung cancer.
ABSTRACT
Objective Under the guidance of CT and three dimensional reconstruction, we made therapeutic plan for lung cancer by radiofrequency ablation (RFA) and observed its effect. Methods From February 2007 to January 2009, we used RITA radiofrequency therapeutic equipment to treat lung cancer under the guidance of 64-slice spiral CT (Siemens) and three dimensional reconstruction of the image. The target temperature is 90℃. Results We performed 29 RFA on 25 patients. In the follow-up, 10 of them showed tumor shrinkage by CT scan. 23 showed lack of tumor-uptake value by SPECT scan and 2 showed lower tumor-uptake value. Conclusion CT-guided percutaneous RFA is safe and practical for lung cancer. It has satisfactory short-term effect to reduce tumor burden.
ABSTRACT
Surgical resection remains the cornerstone of therapy for early stage lung cancer. Five-year survival rates are reported as high as 92% for stage Ⅰ non-small cell lung cancer (NSCLC). However, many patients presenting with resectable early stage disease are unable to tolerate pulmonary resection, even sublobular resection, because of compromised cardiopulmonary functions or other comorbidities. Traditionally,patients deemed medically inoperable have been treated by external-beam radiation. But the results were poor with a mean survival of 20 months and a 5-years survival rate of 12%. In this scenario, we need to develop other non-surgical local therapies. One of these was image-guided percutaneous radiofrequency ablation(RFA).Many clinical trials show that RFA for lung tumors is a minimally invasive, feasible and safe technique with minor mortality and morbidity. Moreover, its efficacy seems to be promising, even in the long-term follow-up.Further experiences and comparison with other emerging minimally invasive local treatments are required to determine its rote in the treatment of medically inoperable early stage NSCLC.