Search

23例創傷性支氣管斷裂的外科治療

Surgical Treatment of ⅢA-N2 Stage Non-small Cell Lung Cancer：Controversies and Consensus

The optimal treatment of stage ⅢA-N2 non-small cell lung cancer （NSCLC） remains controversial. Resultsof primary surgery alone are not satisfied. Surgery after induction chemotherapy yields better outcomes compared to resectiononly which has been widely accepted. Randomized studies show induction chemotherapy followed by either radiotherapy or surgery have approximately equivalent survival outcomes，significant improved survival can be achieved by combined surgery in selected patients. Low-grade N2，effective response and mediastinal downstaging after induction therapy，and successful complete resection by lobectomy，are good indications of surgery. Ideal treatments are approached base on theheterogeneity of N2 . Patients with bulky or fixed N2 disease should be considered for radical chemo-radiotherapy，and surgeryshould be a part of multi-modality management for patients with non-fixed，non-bulky，single-zone N2 disease. Further randomized trials of surgery added to multi-modality management in patients with multi-zone N2 disease should be taken in order to establish possible subgroups of patients might be benefitted more from the addition of surgery.

閉合性胸部外傷致食管胃連接部斷裂一例

Video-assisted thoracic surgery for 22 patients with stab wound to the chest

目的 探討電視胸腔鏡手術（VATS）在胸部刀刺傷中的應用價值。 方法 回顧性分析我院 2012～2015 年 22 例胸部刀刺傷行 VATS 診治的臨床資料。其中男 20 例、女 2 例，年齡 26.5（17～48）歲。 結果 行 VATS 18 例，肺破裂修補 12 例，出血血管鈦夾、電凝止血 4 例，肺破裂及膈肌破裂修補 2 例；輔助小切口手術 2 例，肋間動脈縫扎止血 1 例，膈肌修補 1 例；中轉開胸行心室壁修補術 1 例，胸腔鏡下膈肌破裂修補合并開腹行肝破裂修補術 1 例。全組無手術死亡，無術后嚴重并發癥。 結論 VATS 安全、有效、創傷小，早期應用有助于降低胸部刀刺傷患者的死亡風險。