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氣管鏡下覆膜內支架置入治療胸腔胃-氣道瘺

目的 探討氣管鏡下覆膜內支架置入治療胸腔胃-氣道瘺的可行性與療效。 方法 根據胸腔胃-氣道瘺口的位置、大小、數目選擇內支架,氣管鏡直視下，對5例患者6處瘺在氣管內置入6枚氣管覆膜內支架封堵瘺口。結果 5例內支架均置入成功，瘺口完全封閉，即刻消除嗆咳癥狀；5例均被有效控制肺部感染，生活質量提高；1例支架置入2個月后呼吸衰竭死亡。隨訪5~15個月，3例死于惡病質，1例死于呼吸衰竭，1例正常生活至今。 結論 氣管覆膜內支架能有效封堵胸腔胃-氣道瘺，操作簡單、安全、近期療效可靠。

Chest Drainage Management after Pulmonary Lobectomy

Proper management of chest drainage after pulmonary lobectomy is a topic that every thoracic surgeon must face up to. Reasonable chest drainage plays a critical role in postoperative normal physiological recovery. However， there are still controversies and discrepancies in many aspects of chest drainage management after pulmonary lobectomy. In this review，we focus on five aspects of chest drainage management after pulmonary lobectomy，including the choice of chest drainage system，single or double chest tubes，suction or not，treatment of persistent air leak，and removal of chest tube.

Single Utility Port Complete Video-assisted Thoracoscopic Surgery Lobectomy for Patients with Early-stage Lung Cancer

Abstract：?Objective?To evaluate clinical outcomes of single utility port complete video-assisted thoracoscopic surgery （VATS） lobectomy for patients with early-stage lung cancer.?Methods?We retrospectively analyzed the clinical data of 162 consecutive patients with early-stage lung cancer who underwent single utility port complete VATS lobectomy from September 2009 to October 2011 in Chinese PLA General Hospital （single utility port group），and compared them with 221 patients with early-stage lung cancer who underwent video-assisted mini-thoracotomy （VAMT） lobectomy in the same period （VAMT group）. The clinical outcomes including operation time, intraoperative blood loss, lymph node dissection number, time to first activity out of bed, chest drainage duration and postoperative complications, were compared between the two groups.?Results?No perioperative death was observed in both groups. There were statistical differences in the intraoperative blood loss （162.8±75.6 ml vs. 231.4±62.8 ml）, time to first activity out of bed （2.2±0.3 d vs. 3.7±0.5 d） , and chest drainage duration （3.5±0.2 d vs. 4.6±0.4 d） between the two groups （P＜0.05）. There was no statistical difference in operation time （133.7±22.0 min vs. 124.9±25.7 min） , lymph node dissection number （11.7±1.9 vs. 12.5±2.7）， and incidence of serious postoperative complications （7.4% vs. 8.1%）between the two groups.?Conclusion?Single utility port complete VATS lobectomy and lymph node dissection are safe and reliable for patients with early-stage lung cancer with less injury and better postoperative recovery compared with VAMT.

后縱隔神經源性腫瘤的外科治療

目的 探討后縱隔神經源性腫瘤的臨床特點和外科治療策略，提高手術療效。 方法 回顧性分析2003年8月至2008年8月收治的26例后縱隔神經源性腫瘤患者的臨床資料，男16例，女10例；年齡12～68歲，平均年齡41.8歲。其中9例患者行常規開胸手術， 17例在胸腔鏡輔助下完成手術。累及椎管的啞鈴型腫瘤5例，4例經后路椎管和側胸兩切口完成切除手術，1例直接經后胸徑路手術。 結果 腫瘤位于縱隔右側15例，左側11例。腫瘤平均直徑4.9 cm。神經鞘瘤19例（73%），其中包括1例神經纖維瘤病，節細胞神經瘤6例（23%），原始神經外胚層腫瘤1例（4%）。無手術死亡，其中2例啞鈴型腫瘤患者因有輕微腦脊液漏，出現不同程度的頭痛，2例患者因損傷一側T4以上交感神經干，出現一側上肢無汗。隨訪26例，隨訪時間2個月~5年，所有患者隨訪期間影像學檢查未見腫瘤復發，無不適，恢復正常工作、生活。 結論 多數后縱隔神經源性腫瘤可經胸腔鏡輔助完整切除，但對累及椎管內和胸廓出口處腫瘤應注意術前仔細評估，并進行有針對性的手術設計。

電視胸腔鏡手術治療食管憩室

目的　探討電視胸腔鏡在食管中段憩室切除術中的可行性及安全性。　方法　 1999年 1月～ 2 0 0 3年 2月共施行電視胸腔鏡食管中段憩室切除術 6例 ,術前均經食管 X線鋇餐造影及胃鏡檢查確診為食管中段憩室。結果　 6例患者均完全在胸腔鏡下完成手術 ,無中轉開胸患者 ,無死亡患者及嚴重并發癥發生 ;術后隨訪無復發。結論　胸腔鏡下行食管中段憩室切除術是一種安全可行的微創術式。

Current status of totally thoracoscopic surgery in cardiac surgery in China

Totally thoracoscopic surgery is a branch of minimally invasive cardiac surgeries, and its operational indicators are expanding with the development of the medical and imaging devices compared with median sternotomy and other minimally invasive cardiac surgeries (such as thoracoscope-assisted small incision surgery and robotic surgery). The learning curve is significantly shortened through the professional technique training. Totally thoracoscopic cardiac surgery has many advantages, such as minor trauma, few serious complications, fast recovery, high patient acceptance and being suitable to our country's current situation. Therefore it will be one main direction of minimally invasive cardiac surgery. This article mainly introduced the current status of totally thoracoscopic technology in the field of cardiac surgery in China.

全腔鏡下 Ivor-Lewis 食管癌根治術視頻要點

Treatment of Non-small Cell Lung Cancer by Single-direction Four-hole Complete Video-assisted Thoracoscopic Lobectomy

Treatment of Non-small Cell Lung Cancer by Single-direction Four-hole Complete Video-assisted Thoracoscopic Lobectomy HUANG Jia, ZHAO Xiao-jing, LIN Hao, TAN Qiang, DING Zheng-ping, LUO Qing-quan. (Shanghai Lung Tumor Clinical Medical Center, Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai 200030, P. R. China) Corresponding author：LUO Qing-quan, Email：luoqingquan@hotmail. com Abstract： Objective To explore the feasibility and safety of single-direction four-hole video-assisted thoracoscopic lobectomy in the treatment of non-small cell lung cancer (NSCLC). Methods Between January 2007 and December 2010, 428 patients with NSCLC were surgically treated by single-direction complete video-assisted thoracoscopic lobectomy in Shanghai Chest Hospital. There were 186 males and 242 females; aged 33 to 78 years. All the patients were diagnosed as primary NSCLC at early clinical stage. Among the 428 patients, 134 patients underwent right upper lobectomy, 48 patients underwent right middle lobectomy, 98 patients underwent right lower lobectomy, 4 patients underwent right middle and lower lobectomy, 72 patients underwent left upper lobectomy, and 72 patients underwent left lower lobectomy. All the 428 patients were divided into two groups according to their surgical approach：a three-hole group (300 patients) and a four-hole group (128 patients).The clinical results of the two groups were analyzed. Results A total of 412 patients underwent complete video-assisted thoracoscopic lobectomy, and 16 patients (3.7%) underwent conversion to open surgery. The average operation time was 132.1 (120-180) min, average length of incision was 3.7 (3-5) cm, and average blood loss was 150.0 (50-800) ml. There was no statistical difference in extubation time, intraoperative blood loss, and postoperative hospital stay between the two groups. But the operation time of the four-hole group is significantly shorter than that of the three-hole group （P＜0.05）. The 16 patients who underwent conversion to open surgery received intraoperative blood transfusion. Five patients died of severe pulmonary infection, pulmonary embolism, and acute cerebral infarction. Fifty two patients had squamous cancer, 340 patients had adenocarcinoma, 20 patients had adenosquamous carcinoma, 8 patients had poorly differentiated carcinoma, 6 patients had big cell lung cancer, and 2 patients had carcinoid. Postoperative persistent lung air leak occurred in 4 patients, thoracic empyema in 2 patients, pulmonary infection in 4 patients, arrhythmia in 26 patients, pulmonary embolism in 2 patients, chylothorax in 2 patients, and acute cerebral infarction in 2 patients. The overall 3-year survival rate was 83.6%（358/428）. Conclusion Single-direction four-hole complete video-assisted thoracoscopic lobectomy is feasible, safe and consistent with the operation standard in the surgical treatment for NSCLC patient. It is also helpful to reduce the operation time and facilitate lymph node dissection. Key words： Video-assisted thoracoscopic surgery； Lobectomy； Single-direction； Four-hole； Non-small cell lung cancer

胸腔鏡手術后對側張力性氣胸一例

電視縱隔鏡在惡性胸腔積液診治中的應用

目的探討電視縱隔鏡在診治惡性胸腔積液中的應用價值。方法回顧分析自2003年10月至2004年4月12例惡性胸腔積液患者行電視縱隔鏡胸膜活檢＋滑石粉胸膜固定術治療的臨床資料。結果術后病理診斷腺癌8例，鱗癌4例；肺癌胸膜轉移11例，食管癌肺、胸膜轉移1例；手術診斷率100％，有效率91．7％（11／12），全組無手術死亡。術后發生低熱3例，經處理后退熱；胸痛3例，經止痛后緩解。結論電視縱隔鏡對惡性胸腔積液的診斷和治療有良好的臨床效果。