Objective To assess the value of lobectomy by video-assisted mini-thoracotomy(VAMT) for the treatment of peripheral pulmonary carcinoma.Methods From January 2004 to December 2007,56 cases of peripheral pulmonary carcinoma underwent VAMT lobectomy under general anaesthesia in our hospital.Of the patients,5 had the tumor in the upper lobe of the right lung,2 in the middle lobe of the right lung,19 in the superior lobe of the right lung,8 in the upper lobe of the left lung,and 22 in the superior lobe of the left lung.All the tumors were no more than 5 cm in diameter.All the cases were intubated with double-lumen tubes and then one-lung ventilation was performed.With the patients being placed in a lateral position,a mini-incision(6.0-8.0 cm in length) was made at the fourth or fifth intercostal space.And another 1.5-cm incision was made at the sixth intercostal space along the midaxillary line for introducing the video-thoracoscope.The resected pulmonary lobe was removed though the mini-incision.Afterwards,enlarged lymph nodes were dissected as routine.Results During the operation,no incision was prolonged in the cases.A mean of 14 lymph nodes were removed(ranged from 9 to 31).The mean operation time was(145?35) min(range,120 to 220 min),and the intraoperative hemorrhage was 100 to 450 ml [(210?48) ml].The patients were discharged from hospital in 5 to 11 days(mean,7 days).Seven of the patients developed complications including thoracic effusion in 5 and atelectasis in 2.The patients were followed up for 1 year,3 of them died during the period(1 year survival rate:94.6%).Conclusion VAMT lobectomy is feasible and safe for peripheral lung cancer.

Ojective To study the application and the effect of extrathoracic minimally invasive surgery on the patients with mediastinal mass. Methods The therapeutic result of 6 cases of mediastinal mass resected through minimal extrathoracic approach were retrospectively reviewed. Results 6 patients underwent successfully operation and recovered smoothly without any complication or operation death. A following up period lasting two years showed that no recurrence or metastasis occurred. Conclusions Extrathoracic minimally invasive surgery has the advantages of minimal invasion, quicker recovery and complete resected tumor. It may substitute the classical thoracotomy and could obtain the same therapeutic in the selective cases.

Objective:To investigate the necessity and measures about quality assurance (QA) and quality control (QC) in bedside photography based on digital radiography (DR). Methods: To do retrospective analysis on bedside photography in the same month of different years (2013.9 and 2014.9) by image storage and PACS system. Each has 200 cases. They were evaluated and analyzed of its causes in order to explore the QA improvement measures.Results:The application of DR and its quality control in bedside photography can improve image quality obviously, shorten the examination time greatly, reduce radiation dose, put an end to waste film.Conclusion: DR has obvious advantages in the bedside photography, can provide better image with more information for clinic work.

Objective To evaluate initial results of Ivor Lewis minimally invasive esophagectomy (MIE) for esophageal carcinoma using a diamond-shaped anastomosis with 45 mm linear-stapler.Methods Clinical data of 12 patients diagnosed middle to distal esophageal carcinoma and undergoing Ivor Lewis minimally invasive esophagetomy using a diamond-shaped anastomosis technique during Dec.2015 and Nov.2016 in Peking Union Medical College Hospital were collected and analyzed retrospectively.Results The mean operation time was (378 ± 56) min,the mean blood loss was (280 ± 120) ml,and the mean postoperative hospital stay was (12.2 ± 2.0) days.No positive margin,no peri-operative death occurred.Postoperative complication included atelectasis and pulmonary infection in 1 patient,paresis of left recurrent laryngeal nerve in 1 patient.No anastomotic leak or constriction occurred.Median follow up was 7 months,11 patients had no evidence of disease progress,1 patient had subcutanecous metastasis and was reoperated.Conclusion The diamond anastomosis technique utilizing in Ivor Lewis MIE for esophageal carcinoma is feasible,easy to manipulate,safe and reliable.

Exosomes are vesicle-like structures generated and secreted actively by all kinds of cells.They contain proteins, nucleic acids and also lipids from the original cells, functioning in interactions between cells by shuttling cellular cargoes, and regulation of immune response in the microenvironment.Besides, they play important roles in the oncogenesis and progression of lung neoplasms.Considerable studies have demonstrated great potentials of exosomal proteins and microRNAs as biomarkers for diagnosis, prognosis prediction and treatment of lung cancers, including immunotherapy and targeted delivering of anti-tumor drugs based on exosomes.

Amphiregulin is the ligand of epidermal growth factor receptor.It's widely expressed in many tissues and is involved in the oncogenesis,progression and metastasis of tumors.In the clinical study of lung caner,amphiregulin is a prognostic marker for NSCLC patients.Furthermore,amphiregulin is closely associated with the sensitivity and resistance of EGFRTKI treatment.Medicine target on amphiregulin can inhibit the activity of tumors.

Objective:To evaluate the treatment strategy of primary shortening plus secondary lengthening for Gustilo ⅢC open fractures in the lower limb.Methods:From January 2010 to January 2018, 12 patients (8 males and 4 females) with complex Gustilo ⅢC open fracture in the lower limb received emergency treatment at Department of Orthopaedic Surgery, Wuhan Fourth Hospital. Their ages ranged from 22 to 67 years (average, 41.2 years). All patients were complicated with bone and soft tissue defects associated with nerve and vascular injury in the lower limb. The sizes of soft tissue defects ranged from 4 cm × 2 cm to 17 cm × 12 cm; the main arteries were shortened after debridement by an average of 4.2 cm (from 1.2 cm to 8.3 cm); the broken nerves were shortened after debridement by an average of 4.0 cm (from 1.0 cm to 8.1 cm); the tibial shaft defects averaged 6.3 cm in length (from 2.0 to 9.6 cm). All cases were treated at the first stage by emergency debridement and shortening at the fracture site to directly repair the damaged bone, blood vessels and nerves before the wound was covered. After the limb survived and the wound completely healed, an Ilizarov external fixator was installed to lengthen the limb by bone transport. Recorded were speed of bone lengthening, time with external fixation and complications. The lower limb functions were evaluated at the last follow-up by Paley criteria.Results:The 12 patients were followed up for 14 to 32 months (average, 19.1 months). All the limbs survived with no serious infection. The shortening ranged from 2.0 to 8.2 cm (average, 3.6 cm); the mean speed of bone transport was 0.87 mm/day; the time with external fixation ranged from 11 to 16 months (average, 13.2 months); the bony union was achieved after 10 to 14 months (average, 11.2 months). Postoperative horseshoe inversion was reported in 7 patients, and needle tract infection below Dahl grade 3 in 2 cases. According to Paley criteria, the function of lower limb was rated as excellent in 8 cases, as good in 3 cases, and as fair in one.Conclusion:The treatment strategy of primary shortening plus secondary lengthening using Ilizarov technique has lowered the risk for limb salvage and the surgical difficulty, leading to fine clinical outcomes.

Objective Placental transmogrification of the lung(PTL) is rare;summarizes the reported cases and add our two cases, to explore the best diagnosis and treatment strategy.Methods Review of the cases reported in the literature, combined with the 2 cases described in this article, summarizes the characteristics of PTL and analyzed the best diagnosis and treatment strategy.Results We reported two cases of placental transmogrification of the lung, both presented in the right lower lobe, imaging performance as a giant bulla with a cystic nodule.VATS lobectomy was performed in both cases, no complication after operation.Combined with literature review of 34 cases of patients to analyze the best diagnosis and treatment strategy.Conclusion Grossly and microscopically, the lesion resembles placental tissue, with formation of placental villus-like papillary structures covered by epithelial cells.The most common imaging manifestation of PTL is a bullous emphysema pattern or with a mixed pattern of thin-walled cystic lesions and nodules.Early diagnosis and surgical operation should be performed as soon as possible, these lesions are best treated by minimally invasive surgery, leaving as much normal lung tissue and avoiding pneumonectomy if possible.Surgical treatment is usually curable and leads to successful improvement of symptoms and quality of life.

BACKGROUNDLung cancer is still the most common cause of cancer death. Although it is reported that the 5-year survival rate for lung cancer has been greatly increased, surgical results are controversial. The aim of this study is to investigate and evaluate the improvement of survival of lung cancer surgically intervened in PUMC hospital during the last 15 years.

METHODSFrom January 1989 to December 2003, 1574 cases of lung cancer underwent surgical treatment and obtained follow-up. The results were retrospectively a- nalysed . All cases in this series were divided into two groups according to time, group A (1999-2003) and group B (1989-1998), and the differences of survival rate between group A and group B were compared.

RESULTSThe morbidity and mortality of group A decreased significantly when compared to group B (11.2% vs 19.2%, 1.06% vs 1.93%, respectively, P < 0.01). However, the 3- and 5-year survival rates had been obviously raised from 42.35% to 56.07%, and from 28.46% to 38.99%, respectively (P < 0.05 ). A significant improvement in survival was observed in patients with stageI, stage II and stage IIIA, but not in stage IIIB and stage IV. Also, the patients with lobectomy had better results but those with exploratory thoracotomy, limited resection, pneumonectomy and sleeve resection did not show better results.

CONCLUSIONSLobectomy associated with systematic dissection of mediastinal lymph nodes has become the standard mode for the resectable lung cancer. Combination of complete resection and lymph nodes dissection, with postoperative adjuvant chemotherapy based on platinum/3rd generation medicine, have preliminarily been justified and proved an important approach for effective improvement of long-term survival of lung cancer.

OBJECTIVETo understand the clinical manifestations, diagnostic methods, surgical management and prognosis of retrosternal thyroid masses in various pathological types.

METHODSSixty-four cases of retrosternal thyroid masses with surgical intervention were analyzed retrospectively.

RESULTSTrachea-compressed symptoms (65%) and shadows beside the trachea at thoracic inlet (94%) were the most common clinical findings, chest X-ray (70%) and CT scan (96%) had higher diagnostic rate. No death occurred during operation or hospitalization among these patients. Total complications occurred in 15.7% cases (11/70) (including 3 preoperative cases with hoarseness) and postoperative pathological results were mainly multinodular goiter (54.7%), thyroid adenoma (21.9%) and thyroid carcinoma (15.6%) (including local carcinomatous change).

CONCLUSIONSDiagnosis of retrosternal thyroid mass can be correctly made by chest X-ray and CT scan. Most operations on retrosternal thyroid masses can be performed safely through cervical incision with minimal morbidity and low recurrence rate. Retrosternal thyroid carcinoma was potentially invasive and could hardly be resected completely, hence with poor prognosis.

Adenoma ; diagnosis ; surgery ; Adult ; Aged ; Carcinoma ; diagnosis ; surgery ; Female ; Goiter, Nodular ; diagnosis ; surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Thoracotomy ; Thyroid Gland ; diagnostic imaging ; surgery ; Thyroid Neoplasms ; diagnosis ; surgery ; Thyroidectomy ; Tomography, X-Ray Computed