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.

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.

The technique of thoracoscopic lung surgery has gradually matured. Nowadays, thoracoscope is recommended as the most preferred approach for surgical treatment of early stage non-small cell lung cancer in different guidelines. However, there are still some cases of accidential major bleeding due to vascular injury during thoracoscopic lung surgery. The wall of the hilum vessels is relatively thin. These vessels often involve a great portion of the cardiac output blood flow. Once the injury happened, the emergent condition may be life-threatening due to massive blood loss. Therefore, this became an important factor which hindered the development of thoracoscopic lung surgery. In this review, details of the vascular injury in thoracoscopic lung surgery were summarized, including the incidence of vascular injury, commonly injured sites and reasons of the injuries. Among all the cases of thoracoscopic major pulmonary resection, 2.9% to 9.2% may suffer from vascular injury during the operation. The most commonly injuried sites are pulmonary artery and the branches, and this is also the most critical situation during thoracoscopic lung surgery. Hilum adhesion is the most important risk factor for vascular injury. On the one hand, the suction-compressing angiorrhaphy technique was developed for bleeding control and angioplasty. On the other hand, the strategies like pre-control of the pulmonary, cut the bronchus in advance, and fire the bronchus and pulmonary artery together may decrease the incidence of vascular injury in patients with risk factors.

BACKGROUNDTo investigate the roles of E-cadherin and β-catenin genes in metastasis and prognosis of non-small cell lung cancer.

METHODSThe expression of E-cadherin and β-catenin were detected in 112 non-small cell lung cancer tissues and 30 benign pulmonary lesion tissues by immunohistochemical method (LSAB method).

RESULTSThe expression of E-cadherin and β-catenin in lung cancer tissues was significantly lower than that in adjacent non-cancerous lung tissues and benign pulmonary tissues (P < 0.01); The expression of E-cadherin and β-catenin in lung cancer tissues with lymph node and/or distant metastasis was significantly lower than that in those without lymph node and distant metastasis (P < 0.01); The 5-year survival rate in patients with low E-cadherin expression and low β-catenin expression (6.78%) was remarkably lower than that in cases with high expression (6.78% vs 35.85% and 3.78% vs 37.29%) (P < 0.01).

CONCLUSIONSUnderexpressions of E-cadherin and β-catenin are very common in non-small cell lung cancer, and it may play an important role in the progression and metastasis of lung cancer. Detection of expression of E-cadherin and β-catenin in lung cancer might be helpful to predict prognosis.

BACKGROUNDTo analyze the perioperative respiratory and circulatory features of overweighted patients with lung cancer.

METHODSThe perioperative respiratory and circulatory features of 221 overweighted lung cancer patients were compared with those of 715 normal-weighted patients, by means of Chi-square analysis and t analysis.

RESULTSThe abnormal incidence of MBB, Raw, SGaw, PEF, FEV₁, V₇₅ , and EEG, blood presure, serum cholesterol and glucose, was significantly higher in overweighted group than that in the normal weighted group ( P < 0.05), and FRC was significantly lower than that of the normal weighted group (3.46±0.87 vs 3.63±1.17, P < 0.01). There was no difference in D LCO, MMEF, V₅₀ , V₂₅ between the two groups. The odds of postoperative complication in respiratory or circulatory system was significantly increased in overweighted group than that in the normal weighted group.

CONCLUSIONSThe obstruction of main airway, partial alveolar collapse and impotency of respiratory muscle may result in respiratory complication in overweighted patients, and increased cardiac burden and some pre-existing diseases in overweighted patients might be the cause of increased incidence of circulatory complication.