Search

Video-assisted Thoracoscopic Surgery versus Thoracotomy in Lymph Node Dissection for Lung Cancer: A Systematic Review and Meta-analysis

ObjectiveTo compare effectiveness and safety of video-assisted thoracic surgery (VATS) and thoracotomy in lymph node (LN) dissection for lung cancer. MethodsA comprehensive search of PubMed, Ovid Medline, EMbase, Web of Science, ScienceDirect, the Cochrane Library, Scopus and Google Scholar was performed to identify studies (from January 1990 to July 2015) comparing VATS with thoracotomy in LN dissection. The data were analyzed by RevMan 5.3 software. Quality of literature was evaluated by Newcastle-Ottawa scale or Jadad scale. ResultsFifty-one articles met the inclusion criteria involved 7 127 patients in the VATS group and 9 217 patients in the thoracotomy group. Thirty-eight articles were of good quality and the remaining thirteen were medium. Meta-analysis showed that fewer N1 LN stations in the VATS group (95% CI -0.23 to -0.04, P=0.005), although VATS harvested more left-side LNs (95% CI 0.51 to 3.22, P=0.007). The number of total LNs (95% CI -1.81 to 0.28, P=0.15), total LN stations (95% CI -0.34 to 0.15, P=0.44), N2 LNs (95%CI -1.77 to 0.79, P=0.45), N2 LN stations (95% CI -0.22 to 0.16, P=0.78), N1 LNs (95% CI -0.95 to 0.11, P=0.12), and right-side LNs (95% CI -1.52 to 2.23, P=0.71) harvested in the two groups were not significantly different. ConclusionIn the surgical treatment of lung cancer, VATS can achieve the same efficacy of LN dissection as thoracotomy. This conclusion still needs to be further proved by more high-quality and large-scale RCTs.

胸食管異物損傷的臨床診斷與治療

目的　探討提高胸食管異物損傷診斷及治療效果的方法。　方法　回顧性分析九江學院附屬醫院2004年5月至2011年10月26例胸食管異物損傷患者的臨床資料，其中男18例，女8例；年齡41.2 （18～70）歲。通過多層螺旋CT （MSCT）成像結合臨床特征判斷其病理類型，采用胃鏡異物取出11例，全身麻醉下胃鏡異物取出5例，行開胸手術8例，主動脈覆膜支架腔內隔絕2例。　結果　Ⅰ類損傷10例，Ⅱ類損傷5例，Ⅲ類損傷6例，Ⅳ類損傷5例。20例有異物，6例無異物；24例治愈，2例死亡， 分別因血管置換術中出血及血管修補術后再出血死亡。　結論　依據MSCT成像結合臨床特征及病史，明確胸食管異物損傷的診斷及病理類型，采取多學科合作的合理治療方法，能明顯提高胸食管異物損傷的診療效果。

降主動脈置換治療局部晚期食管癌一例

經腹腔鏡治療胸腹交界處支氣管源性囊腫一例

Upper left lung cancer with congenital complete left pericardial defect: A case report

A 54-year-old asymptomatic man underwent a video-assisted thoracoscopic left pneumonectomy for squamous-cell carcinoma. During the surgery, a complete left pericardial defect was unexpectedly discovered, but no special intervention was made. The preoperative chest CT was reciewed, which showed the heart extended unusually to the left, but the left pericardial defect was not evident. The operation time was 204 min and the patient was discharged from hospital upon recovery 9 days after the surgery. The pathological result indicated moderately differentiated squamous-cell carcinoma (T2N1M0, stage ⅡB), and metastasis was found in the parabronchial lymph nodes (3/5). The patient did not receive chemotherapy after the surgery, and there was no signs of recurrence 6 months after the surgery. Complete pericardial defects usually do not endanger the lives of patients, and if the patient is asymptomatic, pneumonectomy is feasible.

食管異物及合并主動脈食管瘺的診斷與治療

目的探討食管異物所致主動脈食管瘺的診斷及治療方法。 方法回顧性分析2004年1月至2012年12月南昌大學第二附屬醫院32例異物性食管損傷患者的診斷和治療經驗。其中男21例、女11例，年齡18～78歲。采用多層螺旋CT（MSCT）及其影像后處理對食管異物病理變化進行準確分級；對主動脈食管瘺的患者采用包括雜交技術（覆膜支架腔內隔絕術＋胸腔鏡縱隔引流術）為主的治療方案，總結MSCT和雜交技術在異物性主動脈食管瘺診療中的應用價值。 結果平掃影像診斷與臨床診斷符合率為75%（24/32），影像后處理診斷與臨床診斷符合率為100%（17/17）。MSCT分級所有Ⅰ級、Ⅱ級和Ⅲ級患者均治愈出院，4例Ⅳ級患者采用雜交技術治療；7例Ⅳ級主動脈食管瘺患者中有5例痊愈出院，2例死亡，因開胸行主動脈修補術中死亡1例，開胸行主動脈置換術后24 h內死亡1例。30例痊愈出院患者隨訪6個月，除1例Ⅳ級患者有輕微背痛以外，其他患者無不適。 結論MSCT對食管異物性損傷的準確分級和治療方式選擇均有重要的價值，雜交技術治療異物性主動脈食管瘺具有重要的臨床意義。