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電視胸腔鏡肺癌根治術5年臨床療效

目的 探討電視胸腔鏡輔助小切口肺癌根治術的5年療效. 方法 應用胸腔鏡輔助小切口對肺癌患者行肺葉或全肺切除、肺癌根治術2 200例,取其中1995年完成的130例作5年生存率統計,術式包括單肺葉切除術110例,雙肺葉切除術11例,全肺切除術9例.所有數據作Cox回歸生存分析. 結果 術后住院時間3～15天,平均住院時間8天,恢復生活自理時間7～13天;Ⅰ期肺癌5年生存率87.8%,Ⅱ期5年生存率42.8%;Ⅲa期5年生存率27.3%. 結論 胸腔鏡輔助小切口行肺葉或全肺切除、肺癌根治術具有創傷小,恢復快,出血、輸血少,對心肺功能損傷小,開、關胸時間短的優點,5年生存率與傳統開胸術差別無顯著性意義.但這種切口要求胸外科醫師有開胸和胸腔鏡的全面技術.

肺曲霉菌病的外科治療

目的探討肺曲霉菌病的臨床特點與外科治療原則。方法回顧分析32例肺曲霉菌病患者的臨床資料和手術治療結果，手術施行采用標準后外側切口肺葉切除術6例，楔形切除術3例，胸腔鏡或胸腔鏡輔助改良后外側微創小切口楔形切除術15例，肺葉切除術6例，肺段切除術2例。結果21例無肺原發疾病，11例有肺原發疾病。痰菌檢查陽性率為13．3％（2／15），術前診斷符合率為28．1％（9／32）；術后并發癥發生率為15．6％（5／32），其中切口皮下積液、肺膨脹不良各2例，氣胸1例；隨訪32例，隨訪10～160個月，無咯血或血痰、肺曲霉菌病復發或播散。結論肺曲霉菌病多數無肺原發疾病和癥狀，無論有否癥狀均應手術治療，而微創外科手術治療并發癥少且較輕，是首選的治療方法。

多學科協作促進共識更新——中國胸外科氣道管理協作組籌備會議亮點

電視胸腔鏡下胸腺切除術治療重癥肌無力

目的探討電視胸腔鏡手術（VATS）下行胸腺切除治療重癥肌無力的可行性和治療效果。方法19例重癥肌無力患者，按照Osserman臨床分型標準，Ⅰ型10例，Ⅱa型5例，Ⅱb型3例，Ⅲ型1例，均在VATS下行胸腺擴大切除術。結果19例患者均順利完成手術，無手術死亡，平均手術時間120min，術中出血量均小于100ml，術后發生重癥肌無力危象3例，經及時治療治愈。術后對所有患者均進行了隨訪，隨訪時間〉6個月，重癥肌無力病情完全緩解9例，好轉6例，無變化4例，總有效率79％（15／19）。結論在VATS下行胸腺擴大切除術治療重癥肌無力是可行的，且創傷小、疼痛輕，以期望減少術后并發癥。

Lung transplantation for interstitial lung disease : benefits and prognostic factors

ObjectiveTo analyze the benefits of lung transplantation in the treatment of interstitial lung disease (ILD) and investigate its prognostic factors.MethodsThe clinical data of patients diagnosed with ILD and meet the lung transplantation criteria were retrospectively analyzed from January 2012 to December 2017 in the First Affiliated Hospital of Guangzhou Medical University. A total of 111 patients, 88 males and 23 females, aged (58.3±11.4) years old, were divided into lung transplantation group and non-lung transplantation group. Clinical data and prognosis of the two groups were compared and the factors affecting the prognosis of lung transplantation were analyzed with relevant literatures. Results There were 56 patients in lung transplantation group and 55 patients in non-lung transplantation group. The mainly underlying disease of both groups were idiopathic pulmonary fibrosis (IPF). There was no significant difference in age, body mass index, arterial partial pressure of oxygen, percentage of forced vital capacity in the estimated value, percentage of diffusing capacity of the lung for carbon monoxide in the estimated value, six-minute walk distance between the two groups (P>0.05). The pulmonary arterial hypertension and arterial partial pressure of carbondioxide were higher in lung transplantation group than non-transplantation group (P<0.05). The 1-year survival rate in the lung transplantation group was significantly higher than that in the non-lung transplantation group: 77.4% vs. 32.7% (P<0.01). COX regression analysis showed that preoperative ventilator dependence, serum creatinine, bilirubin, pulmonary artery pressure, and procedures (single lung vs. double lung) had no significant effect on the prognosis of lung transplantation; age and preoperative diabetes mellitus were risk factors for the prognosis of lung transplantation.ConclusionsLung transplantation can significantly improve the prognosis of patients with ILD who are refractory to medicine therapy. IPF patients should be advised to consider lung transplantation as soon as possible. Age and preoperative diabetes mellitus are risk factors for the prognosis of lung transplantation.

Chinese thoracic surgery experts consensus on postoperative follow-up plans for non-small cell lung cancer patients

Resection is crucial for treating non-small cell lung cancer. Routine follow-up after surgery is an effective method for early detection and treatment of tumor recurrence and metastasis or the second primary tumor, which can improve the quality of life of patients and their prognosis. This consensus aims to provide a reference for colleagues responsible for postoperative follow-up of non-small cell lung cancer patients in China, and further improve the standardization of lung cancer diagnosis and treatment.

Comparison of short-term efficacy of neoadjuvant immunotherapy combined with chemotherapy and neoadjuvant chemoradiation for locally advanced resectable esophageal squamous cell carcinoma

ObjectiveTo investigate the short-term therapeutic effect of neoadjuvant immunotherapy combined with chemotherapy in the locally advanced esophageal squamous cell carcinoma. MethodsThe clinical data of patients with esophageal squamous cell carcinoma treated with neoadjuvant treatment in Gaozhou People's Hospital from August 2019 to October 2020 were retrospectively analyzed. According to the different treatments, the patients were divided into two groups: a neoadjuvant immunotherapy combined with chemotherapy group (NIC group) and a neoadjuvant chemoradiotherapy group (NC group). The baseline data, incidence of adverse events during treatment, perioperative indicators, postoperative pathological remission rate and incidence of postoperative complications were compared between the two groups. ResultsTotally 33 patients were enrolled, including 15 males and 18 females, with an average age of 62.37±7.99 years. There were 17 patients in the NIC group and 16 patients in the NC group. In the NIC group, the carcinoma was mainly located in the middle and lower esophagus, with 5 paitents in stage Ⅱ, 9 patients in stage Ⅲ, and 3 patients in stage Ⅳa. In the NC group, the carcinoma was mainly located in the upper-middle esophagus, with 1 patient in stage Ⅱ and 15 patients in stage Ⅲ. During the neoadjuvant treatment, there was no significant difference in the occurrence of bone marrow suppression or gastrointestinal reactions between the two groups (P>0.05). There were 4 immune-related rashes in the NIC group and 1 esophageal perforation in the NC group. Fourteen (82.35%) patients in the NIC group and 12 (75.00%) patients in the NC group completed the operation on schedule. The postoperative ICU stay time and chest tube indwelling time in the NIC group were shorter than those in the NC group (P<0.05). There were 5 patients of complete remission in the NIC group, and 6 patients in the NC group. There was no significant difference in the pathological regression grade or residual tumor cells between the two groups (P>0.05). There was no significant difference in the incidence of anastomotic fistula, thoracic gastric fistula, bronchial mediastinal fistula, abdominal distension, pulmonary infection, stroke, or hoarseness during the perioperative period between the two groups of patients who completed the operation (P>0.05). In the NC group, 2 patients died during the perioperative period because of thoracic gastric fistula complicated by severe infection. ConclusionNeoadjuvant immunotherapy combined with chemotherapy dose not significantly increase the occurrence of adverse events and shows a good rate of pathological remission, which indicates that the neoadjuvant immunotherapy combined with chemotherapy is a safe, feasible and potential new treatment model.

Chinese expert consensus on postoperative follow-up for non-small cell lung cancer (version 2025)

Surgical treatment is one of the key approaches for non-small cell lung cancer (NSCLC). Regular postoperative follow-up is crucial for early detection and timely management of tumor recurrence, metastasis, or second primary tumors. A scientifically sound and reasonable follow-up strategy not only extends patient survival but also significantly improves quality of life, thereby enhancing overall prognosis. This consensus aims to build upon the previous version by incorporating the latest clinical research advancements and refining postoperative follow-up protocols for early-stage NSCLC patients based on different treatment modalities. It provides a scientific and practical reference for clinicians involved in the postoperative follow-up management of NSCLC. By optimizing follow-up strategies, this consensus seeks to promote the standardization and normalization of lung cancer diagnosis and treatment in China, helping more patients receive high-quality care and long-term management. Additionally, the release of this consensus is expected to provide insights for related research and clinical practice both domestically and internationally, driving continuous development and innovation in the field of postoperative management for NSCLC.

The 5-year survival rate of 11 958 postoperative non-small cell lung cancer patients in stage Ⅰ-ⅢA by two different follow-up patterns: A multi-center, real-world study

ObjectiveTo compare the 5-year survival rates between two different follow-up patterns of postoperative stage Ⅰ-ⅢA non-small cell lung cancer (NSCLC) patients.MethodsPathological stage Ⅰ-ⅢA NSCLC 11 958 patients who underwent surgical resection and received follow-up within 6 months after initial diagnosis through telephone follow-up system were included in nine hospitals from July 2014 to July 2020. The patients were divided into two groups including a proactive follow-up group (n=3 825) and a passive follow-up group (n=8133) according to the way of following-up. There were 6 939 males and 5 019 females aged 59.8±9.5 years. The Kaplan-Meier and Cox proportional hazards regression model were used.ResultsThe median follow-up frequency was 8.0 times in the proactive follow-up group and 7.0 times in the passive follow-up group. The median call duration was 3.77 minutes in the proactive follow-up group and 3.58 minutes in the passive follow-up group. The 5-year survival rate was 81.8% and 74.2% (HR=0.60, 95CI 0.53-0.67, P<0.001) in the proactive follow-up group and the passive follow-up group, respectively. Multivariate analysis showed that follow-up pattern, age, gender and operation mode were independent prognostic factors, and the results were consistent in all subgroups stratified by clinical stages.ConclusionThe proactive follow-up leads to better overall survival for resected stage Ⅰ-ⅢA NSCLC patients, especially in the stage ⅢA.