目的 淺析胸腔鏡下肺葉切除手術的扶鏡配合技術。 方法 回顧性分析2014年3～8月上海胸科醫院行胸腔鏡下肺葉切除術150例患者的臨床資料，其中女66例、男84例，患者年齡43～78歲，中位年齡62歲。所有患者均在全電視胸腔鏡下行肺葉切除術，手術切口為通過3個胸部微創切口不撐開肋骨完成解剖性肺葉切除，同時惡性腫瘤患者行系統性淋巴結清掃。觀察臨床早期結果及預后。 結果 中轉開胸2例，其余患者手術均在全胸腔鏡下順利施行解剖性肺葉切除術。中轉開胸原因包括良性淋巴結腫大與血管致密黏連、無法在鏡下順利處理出血等。圍術期無患者死亡，術后平均住院時間為4～14 d，導致延長住院時間的并發癥包括肺漏氣、淋巴瘺、心律失常和肺不張等，均經相應處理治愈。 結論 扶鏡手需要良好的胸腔解剖空間結構知識，熟知手術步驟，了解胸腔鏡的特性及掌握好扶鏡的基本原則和技巧,了解術者的操作習慣,才能默契配合使手術順利進行。
ObjectiveTo investigate expressions of ALCAM/CD166, Bcl-2, and Ki-67 in breast infiltrative ductal cancer tissues, so as to assess the role of ALCAM/CD166 protein in the carcinogenesis and progression of breast infiltrative ductal cancer. MethodsThe expressions of ALCAM/CD166, Bcl-2, and Ki-67 proteins were examined by immunohistochemistry(ElivisionTM Plus) in 96 breast infiltrative ductal cancer specimens and 30 adjacent normal tissues of breast cancer specimens(control group). The relation between ALCAM/CD166 protein expression and patient's age, tumor diameter, histopathologic grade, axillary lymph node metastasis, or TNM stage of breast infiltrative ductal cancer was analyzed, and the correlation between ALCAM/CD166 expression and Bcl-2 or Ki-67 was analyzed too. Results①In 96 cases of breast infiltrative ductal cancer, the positive rate of ALCAM/CD166 protein expression was 79.2%(76/96), which was significantly higher than that in the control group〔10.0%(3/30), P < 0.01〕.②In the breast infiltrative ductal cancer tissues, the expression of ALCAM/CD166 was related to axillary lymph node metastasis(P < 0.05), but was not related to patient's age, tumor diameter, histopathologic grade, and TNM stage(P > 0.05).③The ALCAM/CD166 protein expression was positively related to Bcl-2(rs=0.307, P=0.001) and not related to Ki-67(rs=0.064, P=0.475). ConclusionALCAM/CD166 protein expression might be related to the apoptosis and metastasis of breast infiltrative ductal cancer cells and it could serve as an important marker for predicting biological behavior and prognosis of tumor.