Objective To evaluate the diagnostic role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the smear and culture negative tuberculosis.Methods The tuberculosis suspected patients with spu-tum-negative for three times and with hilar or mediastinal lymphadenopathy were randomly divided into 2 groups,study group received EBUS-TBNA and bronchoalveolar lavage group(BAL) examination,control group received BAL examination only.Chi-square test was used to compare their diagnostic sensitivity and negative predictive value.Results Totally 82 patients were included this study,40 patients were in control group and 42 in the study group.In the control group,tuberculosis was confumed in only 8 cases by means of bacteriological examination in the BAL fluid,27 were confirmed by the following surgery ordiagnostic treatment of anti-Tuberculosis,and the other 5 cases were diagnosis as other diseases; In the study group,tuberculosis was confirmed in 28 patients through bacteriological and pathological examination,8 were false negative and the other 6 were diagnosis as non-tuberculosis diseases.The diagnostic sensitivity in the study group was significantly higher than that in control group (77.8％ verus 22.9％,x2 =21.4,P ＜ 0.01 ) ; and the negative predictive value in the EBUS-TBNA group was also significantly higher than that in the BAL group (42.9％ VS 15.6％,x2 =3.97,P =0.046).Complications were similar inthese 2 groups,only 1 case of intervention required puncture site bleeding happened in the study group.Conclusion EBUSTBNA has a higher sensitivity and negative predictive value in the diagnosis of smear and culture negative pulmorary tuberculosis patients with hilar or mediastinal lymph nodes.This technique is a safe method with few complications than the traditional BAL examination.It may play an important role in the diagnosis of smear and culture negative tuberculosis patients.

Objective The aim of the present study was to assess the frequency of depression and quality of life(QoL)in lung cancer patients before and after diagnosis , and to investigate the potential related factors. Methods The subjects consisted of 115 consecutive adult patients newly diagnosed for lung cancer in Shanghai Pulmonary Hospital between April 2008 and October 2008. Depression and QoL were evaluated before the diagnosis for baseline; the same evaluation was repeated after surgery. The median interval was 34.6 days (ranged 28-44 days). Patients' biomedical characteristics were noted from patients' medical records, while the demographic factors were obtained during the interview at the out-patients department. Statistical analysis was used to identify the significant predictors. Results The overall incidence of depression before final diagnosis and after surgery was 22.6% and 17.4 %, respectively. No significant change in the prevalence of depression was found in our study. Education, cost of hospitalization, and smoking status were associated with an increased risk of depression before final diagnosis. Age, having confidant, performance status, and type of surgery were found related with postoperative depression. Patients' QoL had a decrease in every subscale after surgery. Changes in role, social functioning scales and fatigue, pain symptom scales were found significantly. In QoL subsc ales, preoperative dyspnea, postoperative role functioning, fatigue , and pain were associated with changes of depression. Conclusion Depression may be present prior to final diagnosis in lung cancer patients and it does not seem to decrease significantly after surgery, indicating the need for psychological screening and appropriate intervention during theperioperative period. A poorer QoL was detected after surgery, which maybe partly contributed to depression symptoms.

Objective To evaluate the application effect of pneumatic arm assisted single surgeon uniportal thoracoscopic surgery.Methods A total of 40 patients were admitted to our treatment group in Shanghai Pulmonary hospital in October who accepted pneumatic arm assisted single surgeon uniportal thoracoscopic surgery.All the clinic statistics of patients were collected including operative time,the volume of blood intra-operation,postoperative complications and hospitalization time.23 of 40 patients who accepted lobectomy/segmentectomy with pneumatic arm assisted single surgeon uniportal thoracoscopic surgery were assigned to the observation group,while another 30 concurrent patients who accepted lobectomy/segrnentectomy with conventional uniportal thoracoscopic surgery were assigned to the control group.Both groups were compared.Results The average postoperative hospitalization time of observation group was(4.6 ± 1.3) days.The average time for postoperative drainage tube retention was(46.7 ± 18.6) hours.The average operation time of patients in observation and control groups was(121.74 ± 25.16) min and (119.7 ± 14.26) min separately.The volume of blood intra-operation in observation group was(91.74 ± 32.88)ml and(89.00 ± 41.22) ml in control group.There is no significant difference between two groups(P ＞ 0.05).Conclusion The field of view and adjustment of camera in uniportal thoracoscopic surgery by single surgeon with pneumatic arm assistance are more accurate and steady,in which human resource can be saved.It is safe and reliable and does not prolong operative time or increase bleeding during operation,and can be applied to different kinds of diseases in thoracic surgery.It is worth promotion and application in eligible hospitals and medical institutions.

Objective The purpose of the present study was to analyses video-assisted thoracic surgery (VATS) lobectomy for early lung cancer and to provide evidence in guiding clinical practice.Methods From May 1997 to October 2009,VATS lobectomy for early lung cancer was performed in 518 patients.All patient data was reviewed retrospectively.Results The data group consisted of 297 male patients and 221 female patients with a mean age of (58.9 ± 10.6) years ( 19 - 89 years).Morbidity was 10.8％ and mortality was 0.4％.Multivariate analysis identified patient’ s age ( P =0.0300,OR =2.0148,95％ CI 1.0700-3.7940) and operation duration (P=0.0007,OR =1.0086,95％ CI 1.0036-1.0136) as the statistically significant predictors of postoperative complications.Overall 1,3 and 5-year survival rates were 98％,81％ and 66％.And postoperative patbological staging ( P =0.0036,OR =1.6071,95 ％ CI 1.1677 -2.2118 ) is a prognostic determinant.Conclusion VATS lobectomy is a safe and effective therapeutic method for early lung cancer.However,patient selection plays key role in VATS.Operation duration should be shortened as possible,otherwise,it may result in increased postoperative morbidity.It is important to deal with the accident situation rationally and converse to thoracotomy decidedly if necessary.

Objective Introduce the experience of open window thoracostomy in the treatment of bronchopleural fistula after pulmonary resection.To explore which patients are currently suitable for open window thoracostomy , how to deal with them after open window thoracostomy, and how to treat patients without window drainage.Methods In 2017, the thoracic surgery department of Shanghai Pulmonary Hospital completed 13,341 thoracic surgeries, including 10 cases of open window thoracos-tomy, and patients with BPF after other pulmonary resection were treated with conservative thoracic closed drainage .Thoracic closed drainage therapy is often accompanied by thoracic irrigation.From January 2004 to December 2017, 21 cases of chronic refractory abscess treated with autologous musculocutaneous flap implantation after pulmonary resection and open window drain-age were summarized.The treatment of chronic refractory abscess after 14 years of diagnosis was divided into three stages.The first stage is opening the abscess cavity stage, namely opening the window drainage.The second stage is elimination of abscess cavity and closure of bronchial pleural fistula.The third stage is autologous musculocutaneous flap transplantation or displace-ment to fill the abscess cavity stage.Results Compared with before open window, the 10 patients with open window thoracos-tomy showed obvious improvement in thoracic and pulmonary infection, without perioperative death.Other patients with BPF af-ter pulmonary resection without open window thoracostomy died in 2 of conservative thoracic closed drainage .From January 2004 to December 2017, 19 patients(19/21) were successfully treated with autologous musculocutaneous flap implantation af-ter pulmonary resection and open window thoracostomy, without recurrence of empyema and necrosis of skin flap, and 2 cases (2/21) were not cured due to large bronchial fistula, and local recurrence of empyema, without perioperative death.Conclu-sion Most patients with BPF after pulmonary resection are treated with closed thoracic drainage , especially those with lower lo-bectomy and with pleural irrigation.Most patients can be cured.If patients with upper lobe, middle and upper lobectomy or pneumonectomy, accompanied by BPF, chest infection and poor drainage, it is easy to develop intrapulmonary infection sprea-ding.We should do open window thoracostomy as soon as possible.The removal of the residual cavity by filling musculocutane-ous flap after open window thoracostomy is a great improvement compared with the transthoracic reconstruction .

Objective To summarize experience in the treatment of chronic refractory empyema with autologous myocutaneous flap implantation.Methods From January 2004 to December 2017,26 patients had been treated with autologous myocutaneous flap implantation in Shanghai Pulmonary Hospital for chronic refractory empyema.Among them,24 were men and 2 were women.The mediam age was 50.1 years(14-74 years).21 of them had medical histories of lung resection because of basic diseases(most of which accepted surgeries in other hospitals).Complications appeared after surgeries.15 of them had bronchopleural fistula while windowing,which could not be cured by conservative treatments such as drainage.Then we performed open-window thoracostomy and long-time dressing.6 of 21 had experienced pneumonectomy.Other 5 patients did not have primary operational histories.They experienced dressing by windowing because of chronic refractory empyema after the in effective conservative treatments like drainage without pulmonary re-expansion.Results No respiratory complications occurred in these patients.The catheters were successfully removed within 5 days and the patients were discharged within 3-6 weeks after the operations.The median follow-up period was 9 months.24 cases were successful with no recurrence of empyema or flap necrosis,the other 2 cases underwent recurrence of empyema.Conclusion The application of autologous myocutaneous flaps for the treatment of chronic refractory empyema is an effective and continuously improving method.

Objective:To evaluate the inpatient PE incidence and thromboprophylaxis after thoracic surgery according to adjusted Caprini VTE risk assessment model.Methods:The study selected consecutively 500 patients who received thoracic surgery from first of June in consecutive three years of 2015, 2016 and 2017. We retrospectively assessed these 1 500 patients using Caprini VTE risk model and recorded baseline characteristics, postoperative prophylaxis, and PE incidence.Results:Only 19.4% of 2015-year patients received pharmacologic prophylaxis, while the rate reached up to 65.2% in 2016 and 77.2% in 2017. PE occurred on 4 cases in 2015, 1 case in 2016, and 0 case in 2017. The overall incidence of PE was 0.3%(5/1 500). The PE incidence negatively correlated with the implementation of prophylaxis( r=-0.04, P=0.07). The PE risk(odds ratio) increased 4.68 times(95% CI: 0.525-41.800) when patients did not receive prophylaxis in PE cohort. Postoperative pharmacologic prophylaxis with current dosing did not affect the drainage of chest tube after surgery. Conclusion:Implementation of an adjusted Caprini risk assessment protocol can be useful for the thoracic postoperative patients to receive appropriate thromboprophylaxis. Current pharmacologic prophylaxis protocol should be safe and enough to prevent PE after thoracic surgery.

Objective To investigate the safety and efficacy of total thoracoscopic pneumonectomy for malignant lesion from a single-center pneumonectomy database.Methods A retrospectively analysis of 43 cases of malignant lesions in patients underwent total thoracoscopic pneumonectomy from surgical database of Shanghai Pulmonary Hospital from December 2013 to August 2017 was conducted,and then the mortality,complications,and disease recurrence were summarized.Results All lesions in 43 patients were pathologically comfirmed malignant,including 39 non-small cell lung cancers and 3 small cell lung cancers and 1 pulmonary metastasis.Complete thoracoscopic pneumonectomy was pedormed in 43 patients.The average operation time was (181.1 ± 68.0) min,blood loss was (146.5 t 113.6) ml,mean tube length was (8.4 ± 3.4) days.Perioperative mortality was 2.3％ (1/43).The complication rate of grade 3 or above was 16.3％.Median follow-up was 18 months,with 9 cases occuning local recurrence or distant metastasis;6 cases suffered from cancer-related death while non-cancer related death happened in 1 patient.Conclusion For selected locally advanced pulmonary malignant lesion,total thoracoscopic pneumonectomy is an alternative to open thoracic surgery with a better perioperative safety and satisfied mid-term oncologic survival.

Objective Evaluation of self-control suspension under the double hook system used to xiphoid thoracoscope fully the effect of thymectomy.Methods There were 17 cases of thymic adenoma diagnosed before surgery in November to December 2016,including 7 males and 10 females,aged(57 ± 10).The total thymomectomy was performed with a double hook method with a double hook procedure.Results All the 17 patients had smooth operation,and no clear hook related complications were observed after the operation.The operation was convenient and the thymus was completely removed.Conclusion It is worth populating that the double pull hook method is convenient and safe to remove the whole thymus gland.