ObjectiveSummarize 500 cases of non-small cell lung cancer (NSCLC) that has accepted complete videoassisted thoracoscopic (VATs) lobectomy procedure in People's Hospital of Peking University,to report the mid-term follow-up results,and to evaluate the safety and effectiveness of VATs lobectomy.MethodsBetween September 2006 and September 2011,500 cases of non-small cell lung cancer that has accepted complete thoracoscopic lobectomy in the People's Hospital of Peking University were reviewed (267 male,233 female).Median patient age was 62.3 years.The average maximal diameter of solid tumors was 2.65cm.There are 496 cases of initial treat patients and 4 cases of operation after radiation and chemotherapy.This group consisted of lobectomies of left upper lobe ( n =129),left lower lobe ( n =73 ),right upper lobe ( n =163 ),right middle lobe x( n =47 ),right lower lobe( n =89 ).The operation procedure was complete VATs lobectomy combined with systematic lymph node resection ( at least 3 groups of lymph nodes in the mediastinum area),including 480 cases of purely lobectomy,13 cases of compound lobectomy (pulmonary lobe + pulmonary lobe,or pulmonary lobe + pulmonary segment),3 cases of segmentomy,2 cases of pneumonectomy,1 case of sleeve lobectomy and 1 case of bilateral lobectomy.ResultsAll procedures were carried out smoothly without serious complication,except 1 case of death of an advanced age patient due to multi-organ failure after the operation period.The average surgical duration was 198.1 min,and average blood loss was 214.6ml.There are 5 cases of postoperative hemorrhage,identified as pulmonary artery residual ooze blood,in which 4 cases of bleeding were stopped through re-operation,and 1 case was improved through conservative treatment.The median lymph nodes dissection was 5.7 group and median number of resected lymph nodes was 16.9.The median postoperative chest tube drainage duration was 7.8 day,and median postoperative hospital stay was 10.2 day.There were 45 cases (9.0％) of conversion to open thoracotomy and 87 cases ( 17.4％ ) of slight complications,including 32 cases of cardiac abnormalities,such as continuous arrhythmia,28 cases of air leakage beyond seven days,9 cases of pulmonary infections or atelectasis,6 cases of chylothorax,and 16 cases of other complications.The results of pathology show 363 cases of adenocarcinoma,85 cases of squamous carcinoma,12 cases of adenosquamous carcinoma,28 broncho-alveolar cell carcinoma,6 cases of large cell lung cancer and 6 cases of other lung cancer.The 1-year disease free survival (DFS) was 90.2％ and 1-year overall survival (OS) was 94.3％.The 3-year DFS was 76.4％ and 3-year OS was 81.3％.ConclusionCompletely video-assisted Thoracoscopic lobectomy procedure was a safe and effctive procedure for patients with non-small cell lung cancer.

Objective To study the effect of endoscopic treatment for acute appendicitis (AA)without perforation or gangrene.Methods A total of 94 patients with AA were randomly divided into operation group (n =45 ) to receive appendectomy,control group (n =15 ) to accept conventional medicine of metronidazole and Cefoxitin and colonoscopy group (n =34) to undergo conventional medicine plus endoscopic treatment.The time for alleviation of abdominal pain,duration and mean cost of the hospitalization,and the recurrence rate in one year were compared.Results Compared to operation group,colonoscopy group was superior in the duration [ (2.77 ± 0.27) d vs.(6.65 ± 1.68) d ] and mean cost of hospitalization [ ( 1011.35 ± 22.12) yuan vs.(4023.37 ± 32.02 ) yuan ] ( P ＜ 0.05 and P ＜ 0.01,respectively).There were no significant differences in the time for alleviation of abdominal pain or the recurrence rate in one year between 2 groups.Colonoscopy group was superior to control group in all the indices (P ＜ 0.05 ).Conclusion Endoscopic treatment for AA without perforation and gangrene is effective and safe,which can be considered as the first-line treatment.

Objective The aim of this study is to evaluate the efficacy and safety of preoperative Computed Tomography (CT)-guided microcoil localization for pulmonary ground-glass opacity.Methods We performed CT-guided Microcoil localization in 30 patients with 32 pure ground glass opacities between December 2012 and September 2013.All 30 patients underwent CT-guided micmcoil localization under local anesthesia with a 21G needle percutaneous lung biopsy.All patients accepted video-assisted thoracic surgery after the localization the same day or the next day.Results We located 32 pure ground glass opacitiesin 30 patients.The mean lesion diameter was 0.94 cm,the average depth from the visceral pleura was 0.71 cm,all leisons were successfully located by microcoil,asymptomatic pneumothorax was observed in seven patients,pulmonary hematoma was observed in two patients,pain was observed in one patient,dislodgement was found in one patient during the operation.None of these cases needed surgical treatment.Pathologic diagnoses of the target leisions were as follows:adenocarcinoma in situ (n =17),adenocarcinoma(n =9),atypical hyperplasia(n =4),inflammation (n =2).After the placement of preoperative CT-guided microcoil localization for pulmonary ground-glass opacity,all the 32 pulmonary pure ground-glass opacities resection success rate was 100％.Conclusion Preoperative CT-guided microcoil localization for pulmonary pure ground-glass opacity is a safe and effective way to improve the accuracy of surgical resection.

0bjective Evaluate the clinical factors affecting the definite pathological diagnosis of solitary pulmonary odules(SPN).Methods From Jan 2000 to July 2009,390 patients(212 men,178 women,median age 57.1 years,range from 17 to 86 years)got definite pathological diagnosis of solitary pulmonary nodules in our Institute were investigated.All following clinical data were collected:age,gender,course of disease,symptoms,history and quantity of smoking,history of tumor,family history of tumor,site,diameter,calcification,spicular sign,border,lobulated,traction of pleural,vascular convergence sign,lymph nodes of mediastinum,adhesion,depression of pleural,pleural effusion.Results The surgical procedures included 20 tumor enucleation,153 wedge resection,and 217 lobectomy.There were 130 benign lesions,including hamartoma(n=33),arteriovenous istula(n=1),cyst(n=2),interstitial pneumonia(n=1),tuberculoma(n=49),lymphoproliferative(n=2),fungal ball(n=3),neurofibroma(n=1),inflammatory pseudotumor(n=27),sclerosing hemangioma(n=9),bronchiectasis(n=2).260 were malignant lesions,including Alveolar cell carcinoma(n=23),Metastatic carcinoma(n=20),Carcinoid(n=4),Squamous cell carcinoma(n=40),adenecarcinoma(n=164),Small cell carcinoma(n=9).Single factor analysis and Logistic regression analysis show that there were significant differences in age, diameter,border,calcification and depression of pleural in judgement character of SPN.In addition,there were no differences in gender,course of disease,symptoms,history and quantity of smoking,history of tumor,family history of tumor,site,spicu lar sign,lobulated,traction of pleural,vascular convergence sign,lymph nodes of mediastinum,adhesion and pleural effusion.Conclusion Age of patient,and diameter,border,calcification,pleural depression of the tumor were significant risk factors in judgment character of SPN.

Objective To evaluate the value of autofluorescence bronchoscope (AFB) in airway examination in central type lung cancer. Methods From Sep 2009 to Mar 2010 ,29 patients ( 23 men , 6 women , median age 62.2 years , range from 34 to 81 years) underwent AFB procedure. There were 3 lesions located at trachea, 1 at right main bronchus, 9 at right upper lobe, 1 at right median bronchus, 1 at right middle lobe, 4 at right lower lobe, 1 at left main bronchus, 9 at left upper lobe.There were 21 preliminary diagnostic cases and 8 postoperative surveillance cases. All procedure was performed under combination of local anaesthesia and general anaesthesia. All patients underwent white light bronchoscopy followed by AFB procedure.All of the suspicious abnormal sites were recorded and biopsied for pathological examination. Results All procedures were safely performed without death or serious complications. 100 specimens were obtained for pathologic examination. Malignant lesion was diagnosed in 39 and non-malignancy in61. All malignant sites were detected by AFB, however WLB missed 12 sites.The sensitivity of AFB and WLB for malignancy were 100% and 69.2%, respectively. In 21 preliminary diagnostic cases,AFB detected all malignancy sites, but WLB missed 23 sites, in which 9 were malignant sites. In 8 rechecked patients, AFB detected all malignancy sites, but WLB missed 7 sites, in which 3 were malignant sites. Conclusion Autofluorescence bronchoscopy could be more accurate in judging the extent of the tumor invasion, more sensitive in finding multiple lesions in airway, more sensitive in detecting early cancer recurrence in postoperative surveillance patients.

Objective To optimize operative techniques of completely video-assisted thoracoscopic lobectomy by reviewing the experience of Peking University People's Hospital. Methods From September 2006 to August 2010, 408 patients (214 males,194 females) with median age of 58.6 years (range from 15 to 86 years) underwent completely thoracoscopic lobectomy. All procedures were conducted under general anesthesia with double lumen intubation. The thoracoscope was introduced through 7th or 8th intercostals space on the mid-axillaries line. The 4 cm long utility incision was made on the 4th or 5th intercostals space anterior axillary's line without rib-spreading. A third retraction incision located on the 7th or 8th intercostals space sub-scapular line. The surgeon stands on the ventral side of patient using an electrocautery hook and a suction device through the utility incision. Anatomic lobectomy was performed with systemic mediastinal lymph node dissection for lung cancer patients. Results All procedures were carried out smoothly with no case of serious complication. There was 1 case death because of respiratory failure of pulmonary fungal infection during the operative period. The average surgical duration was 195 minutes, and average blood loss was 249 ml with no blood transfusion required. There were 35 cases (8.6%) of conversion to open thoracotomy, including interference by lymph nodes, bleeding, inflammatory adhesion of Artery and large size tumors.The results of pathology show 322 cases of malignant disease and 86 cases of benign disease. Conclusion To grasp the core technique of completely thoracoscopic lobotomy may make the procedure undergone smoothly, and may shorten the learning curve.

Objective To evaluated the role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of thoracic sarcoidosis.Methods The study was retrospective,from September 2009 to June 2011,35 patients with suspected sarcoidosis,with enlarged hilar or mediastinal lymph nodes on computed tomography ( ≥1.0 cm),underwent EBUS-TBNA.Patients in whom EBUS-TBNA was nondiagnostic subsequently underwent surgical biopsy or a minimum of 6 months clinical and radiologic follow-up.Results EBUS-TBNA was performed on a total of 87 lymph node stations in 35 patients.Of the enlarged lymph nodes,64 (73.6％) were located in the mediastinal region and the remaining 23 ( 26.4％ ) around the hilar or interlobar area.A final diagnosis of sarcoidosis was made for 28 (80％) of the patients.In patients with a final diagnosis of sarcoidosis,EBUS-TBNA demonstrated noncaseating epithelioid cell granulomas in 25 ( 89.3％ ) of the patients.EBUS was well tolerated by all of the patients with no complications.Conclusion EBUS-TBNA is a safe procedure with a high yield for the diagnoses of thoracic sarcoidosis of stage Ⅰ or Ⅱ.

Objective To determine the long-term impacts of major pulmonary complications ( MPCs) and identify the in-dependent risk factors in those non-small cell lung cancer(NSCLC)patients who underwent VATS lobectomy.Methods A ret-rospective study was developed to analyze the pulmonary complications of 574 non-small cell lung cancer patients who under-went VATS lobectomy in Peking University Hospital , the complications were graded according to TMM classification criteria . The effects of PCs on the long-term prognosis were analyzed by using the Kaplan-Meier method.Multivariate logistic regression analysis was used to determine the risk factors of MPCs.Results Of 574 patients, 106 had PCs, including 50(8.7％) MPCs, Postoperative pulmonary complications were associated with significantly longer drainage time (P<0.001) and hospital stays(P<0.001).Perioperative mortality was significantly increased in patients with PCs (4.0％ vs 0.6％; P =0.021). Those who develop a MPC had a reduced 3-year DFS and 5-year DFS(61.3％ vs.77.4％、42.2％ vs.69.3％;P=0.003), as well as the reduced 3-year OS and 5-year OS(78.5％vs.88.2％、62.4％ vs.79.2％;P=0.047).MPCs were independ-ent prognostic factors of patients with lung cancer .Multivariate logistic regression analysis showed that the independent risk fac-tors for MPCs were age, male, ASA grade.Conclusion Major pulmonary complications after VATS lobectomy are associated with a poorer long-time outcome.The independent risk factors for MPCs are age, male, and ASA grade.

Objective:To investigate the safety and effectiveness of multi-stent overlapping assisted coil embolization for ruptured intracranial blood blister-like aneurysms (BBA).Methods:Patients with intracranial BBA admitted to the Affiliated Quanzhou First Hospital of Fujian Medical University and treated with multi-stent overlapping assisted coil embolization from January 2013 to January 2019 were enrolled retrospectively. The embolization rate immediately after procedure, modified Rankin Scale (mRS) score at discharge, aneurysm embolization rate, recurrence rate and mRS scores at 3 months after procedure were collected.Results:A total of 38 patients with BBA were enrolled, including 21 females (55.3%) and 17 males (44.7%); their age was 54±9.3 years (range, 29-71 years); the maximum diameter of aneurysm was 5.1±1.0 mm, and the diameter of aneurysm neck was 4.9±0.7 mm. Raymond grading showed that the complete embolization rate immediate after procedure was 71.1%, the residual rate of aneurysmal neck was 18.4%, and the residual rate of aneurysmal body was 10.5%. During the perioperative period, 2 patients had stent thrombosis and 2 had intraoperative aneurysm hemorrhage. Imaging follow-up at 3 months after procedure showed that the aneurysms of 31 cases (83.8%) disappeared completely, 4 (10.8%) improved, and 2 (5.4%) recanalized. The good clinical outcome rate (mRS score ≤ 2) was 81.1%, 1 patient (2.6%) died, and no postoperative rebleeding occurred.Conclusion:Multi-stent overlapping assisted coil embolization is a safe and effective surgical method for the treatment of ruptured intracranial BBA.