RESUMO
@#Objective To analyze the feasibility, advantages and disadvantages of the fluorescence method and the inflation-deflation method in defining the intersegmental plane during thoracoscopic lung segmental resection. Methods From February to October 2018, 60 patients underwent thoracoscopic anatomical segmentectomy in Thoracic Surgery Department of Nanjing Chest Hospital, with 28 males and 32 females, aged from 25 to 82 years. Three-dimension computed tomography bronchography and angiography was used to reconstruct pulmonary vessels, bronchus and virtual intersegmental plane. Among them, 20 patients used the fluorescence method to define the intersegmental plane, and the other 40 patients used the traditional inflation-deflation method to define the intersegmental plane. Results Fluorescent injection of indocyanine green (ICG) showed a clear intersegmental line with a duration sufficient to complete the label. With the fluorescence method, the intersegmental plane occurrence time was significantly shortened (10.75±3.78 s vs. 988.00±314.24 s, P<0.001) and had satisfactory repeatability. The lungs did not need to be inflated, which was convenient for the operation. And the operation time was shortened (108.75±31.28 min vs 138.00±32.47 min, P=0.002). No obvious ICG injection-related concurrency symptoms was found. Conclusion Compared with the traditional inflation-deflation method, the fluorescence method can display the intersegmental line quickly, accurately and clearly, reduce the difficulty of surgery, shorten the operation time, and provide reliable technical support for thoracoscopic anatomical segmentectomy. The fluorescence is a safe and effective method that is worthy of clinical application.
RESUMO
Objective: To observe the changes of T, B and NK lymphocyte subsets in peripheral blood of the patients with lung adenocarcinoma in the early stage after single-port thoracoscopic lobectomy, and to explore their relationships with the clinicopathological parameters of the patients and the possible clinical significances. Methods: A total of 66 patients with lung adenocarcinoma who underwent single-port thoracoscopic lobectomy were selected and the peripheral blood was respectively collected on the day of admission (DO), the 1st day (Dl) and the 5th day (D5) after operation. The blood cell counter and flow cytometry were used to detect the percentages of CD4+T, CD8 + T, CD19+B and CD56 + NK lymphocytes. At the same time, the variations of cell percentages of T, B and NK lymphocytes (ADO-1, ADO-5 and AD1-5) before and after operation were calculated, respectively. The correlations between the changes of cell percentages (ADO-1, ADO-5 and AD1-5) of the patients in the early stage after operation and the clinicopathological parameters were analyzed. Results: Compared with DO, the percentages of CD4 + T, CD8 + T, CD19 + B, and CD56 + NK lymphocytes in peripheral blood of the patients on Dl and D5 were significantly decreased (P0. 05). The percentage of CD8+ T cells in smokers was lower than that in non-smokers on DO and D5 (t=2. 162, P<0. 05; t= 1.974, P<0. 05). The percentage of CD19 + B lymphocytes in smokers was higher than that in the nonsmokers on DO ({= -1. 137, P<0. 05). The percentage of CD8+ T lymphocytes in stage Tl was higher than that in stage T2-3 on DO (t=l. 684, P<0. 05). The percentage of CD19+ B lymphocytes in stage Tl was higher than that in stage T2-3 (t=l. 431, P<0. 05), which was in stage I higher than that in stage II -IE on D5 (t=2. 134, P<0. 05). The variation in CD4 + T lymphocyte percentage of the male patients (AD1-5) was higher than that of the female patients (t=l. 707, P<0. 05). The variations in CD8+ T lymphocyte percentage (ADO-1 and ADO-5) had negative relationship with T stage (r= -0.366, P<0. 01; r= -0.252, P<0. 05). The variations in CD19+ B lymphocyte percentages (ADO-5 and AD1-5) of the patients in stage II -IE were higher than those in stage I (t=2. 075, P<0. 05; t=2. 140, P<0. 05). The variation of cell percentages of CD56 + NK lymphocytes (ADO-5) had significantly relationships with the age and smoking status of the patients. The ADO-5 in the older patients (≥60 years) was lower than that in the younger patients (< 60 years) and the ADO-5 in the smokers was lower than those in the non-smokers (t=l. 557, P<0. 05). The variation of lymphocyte percentage of CD56+ NK (AD1-5) had negative relationship with T stage (r= -0.592, P<0. 05). Conclusion: The change degrees of percentages of lymphocyte subsets are correlated with the patients" age, gender, smoking status, and T stage.