Purpose:Discuss the clinicat value of video-mediastinoscopy in the diagnosis and treatment of intrathoracic diseases. Methods:From Oct.2002 to Jun.2003, 58 cases were examined and treated by video-mediastinoscopy. Of these patients,48 case were examined(the examination group) and 10 cases were treated(the treatment group). In the examination group, standard mediastinoscopy was applied in 40 cases, extended mediastinoscopy was applied in 8 cases. In the treatment group,9 cases of palmar hyperhidrosis were treated by thoracic sympathectomy,1 case of pericardial liparomphalus was resected. Results:In the examination group, 47 cases obtained definite pathological diagnoses, and 5 cases had complications. In the treatment group,no complications occurred. Conclusions:Video-mediastinoscopy is a valuable procedure to clarify diagnosis and to stage lung cancer, or in the diagnosis of mediastinal mass. It can also be used in the treatment of palmar hyperhidrosis, pericardial liparomphalus and pericardial cyst.

Lung Neoplasms ; Periodicals as Topic

Education, Medical ; Humans ; Neoplasms ; therapy ; Rare Diseases ; therapy

Objective To explore the clinicopathological features of adult pulmonary sequestration and summarize the misdiagnosis experiences.Methods Data of 16 cases of adult pulmonary sequestration ( 18 years),who were confirmed by surgery and biopsy in our hospital were collected and reviewed.Results The median age of all the patients was 38.5 years.The female seemed to be more likely to suffer from adult pulmonary sequestration ( n =12) with cough to be the most frequent symptom ( n =9 ).CT scans revealed most of the lesions were located in the left lower lobes of the lungs ( n =9 ).Half of the lesions were characterized by pulmonary cyst-like changes and/or multiple cystic bronchiectasis ( n =8 ),followed by soft tissue mass in or out of the lung fields ( n =7).Enhanced CT scans showed abnormal arteries from the systemic circulation.Only two cases were diagnosed as pulmonary sequestration correctly in the primary diagnosis.The remaining were mostly misdiagnosed as pulmonary cyst-like changes with bronchiectasis ( n =6) or tumors (n =6).According to the findings during surgery,13 cases were intralobar pulmonary sequestrations; 3 cases were extralobars,whose tissues were all detected dysplasia and chronic inflammatory by histopathological examinations.Conclusions The misdiagnosis rate of pulmonary sequestration is high because of its non-specific clinical symptoms.Since it is characterized by abnormal arteries and pulmonary dysplasia,enhanced CT scans should be used as a preferred screening method for suspected cases,especially for those middleaged patients with cystic or mass-like lesions in the left lower lobes of the lungs.

Objective     To share the clinical experience of video-assisted thoracoscopic surgery (VATS) anatomic basal segmentectomy by single-direction method. Methods     The clinical data of 352 patients who underwent VATS anatomic basal segmentectomy in West China Hospital between April 2015 and April 2021 were retrospectively reviewed, including 96 males and 256 females with a median age of 50 (range, 26-81) years. All basal segmentectomies were performed under thoracoscopy, through the interlobar fissure or inferior pulmonary ligament approach, and following the strategy of single-direction and the method of "stem-branch". Results    All patients underwent basal segmentectomy successfully (49 patients of uniportal procedure, 3 patients of biportal procedure and 300 patients of triportal procedure) without addition of incisions or conversion to thoracotomy and lobectomy. The median operation time was 118 (range, 45-340) min, median intraoperative blood loss was 20 (range, 5-500) mL, median drainage time was 2 (range, 1-22) d and median postoperative hospital stay was 4 (range, 2-24) d. The postoperative complications included pneumonia in 6 patients, prolonged drainage (air leakage duration>5 d or drainage duration>7 d) in 18 patients, cerebral infarction in 1 patient and other complications in 2 patients. All patients were treated well and discharged without main complaints. No perioperative death happened. Conclusion    VATS anatomic basal segmentectomy is feasible and safe. It can be performed in a simple manner following the strategy of single-direction.

Micro-invasive thoracic surgery, especially represented by video-assisted thoracic surgery (VATS), has be-come the mainstream of lung cancer resection. Traditional multi-portal VATS techniques, including four-port, three-port, and two-port VATS, have been widely used to perform nearly all kinds of lung cancer resections. However, how to make lung cancer resection less invasive is always the subject that all thoracic surgeons never stop pursuing. Compared with multi-portal VATS, uniportal VATS causes less postoperative pain and paresthesia because only one small incision is made and one intercoastal space is involved. In recent years, good clinical results have been obtained from uniportal VATS in lung cancer resections. In this paper, we’d like to present a brief summary about the progresses made in the application of uniportal VATS in lung cancer resection. Uniportal VATS is a sublimation of micro-invasive lung cancer resection.

Enhanced recovery after surgery (ERAS) is a paradigm shift in perioperative care,resulting in substantial improvements in clinical outcomes,shorter length of hospital stay and cost savings.But the current ERAS either by application of breadth or depth is not enough,why? The main reason is the lack of "operability,evaluation,repetition" ERAS protocol and suitable for clinical extensive application protocol.How to form the clinical available protocol? Operational mainly refers to the clinical scheme is simple and feasible,and protocol compliance is good;Evaluate refers to the methods used before,during and after are the objective evaluation criteria and plan;Repeatable is clinical scheme repeatability in the process of single or multiple center.

The concept of enhanced recovery after surgery (EARS) has already been accepted by almost all the clinicians and nurses, the practice of which is based on interdisciplinary cooperation. The reason is still unclear why the effect of EARS varies a lot though the same EARS scheme is used. The main cause may be the same EARS scheme can not be suitable for different patients. In other words, does EARS also need to conform to Precision Medicine Theory? This study is focused on the necessity and clinical efficacy of "Precision EARS" performed in lung cancer patients. The conclusions are the following: first of all, an accurate judgment of patients who need EARS should be done properly before surgery, which means that the high risks assessment should be done accurately. Secondly, a specific EARS scheme should be carried out in each independent pa-tient who has obvious clinical symptoms in order to alleviate clinical symptoms and improve the ptients' quality of life (QOL). Thirdly, for the asymptomatic patitents who also don't have severe concomitant diseases, process-optimized EARS should be selected to make patients feel more comfortable and shorten the average length of stay (ALOS). To summary, "subtraction" in-stead of "addition" should be considered when performing EARS.

BACKGROUNDTo study the relationship between expression of endostatin and clinical and pathophysiological characteristics in the non-small cell lung cancer (NSCLC).

METHODSThe expression of endostatin was detected in 46 lung cancer tissues and paracancerous lung tissues, 14 benign pulmonary lesion tissues as control by immunohistochemical staining (LSAB method).

RESULTSThe expression of endostatin in lung cancer tissues (84.91%±7.65%) was significantly higher than that in paracancerous tissues (63.70%±12.45%) and benign pulmonary lesion tissues (40.29%±15.01%) (P < 0.01); The expression of endostatin was closely related to the size of primary tumor, distant metastasis of the cancer, P-TNM stages and cell differentiation of lung cancer (P < 0.05), but not to the histological classification, lymph node status, location of the tumor, smoking or not, age and sex of the patients with lung cancer (P > 0.05).

CONCLUSIONSThe expression of endostatin in NSCLC cancer tissues might be helpful to evaluate the biological behavior of lung cancer.