Great progress has been made in immunotherapy for esophageal squamous cell carcinoma in recent years. However, for thoracic surgeons, immunotherapy is still a new thing and they lack enough experience. Therefore, this paper attempts to discuss some hot issues of immunotherapy, including the indications, side effects, clinical efficacy and evaluation of efficacy. The author hopes that this article will help and attract the attention of thoracic surgeons.
Some complex surgical procedures allow for day surgery benefited from the advancement of the concept of enhanced recovery after surgery and minimally invasive surgical techniques. Shanghai Chest Hospital has set up thoracic day surgery ward incorporating some lung tumor surgeries into day surgery. Through process innovation, model innovation and management innovation, relying on the full-process closed-loop day surgery management system, the day surgery ward runs efficiently. It can help effectively alleviate the difficulty of admission and operation, and improve hospital operation efficiency as well as reduce the economic burden of disease. At the same time, we hope to explore an innovative development path for the possibility of day surgery in complex thoracic surgery, and create a new mode of day surgery that can be replicated and promoted.
ObjectiveTo explore the clinical applications of 3D-CT reconstruction combined with 3D printing in the analysis of anatomical types and variations of bilateral pulmonary arteries. MethodsFrom January 2019 to February 2022, the clinical data of 547 patients who underwent anatomical lung lesion resection in our hospital were retrospectively collected. They were divided into a 3D-CT reconstruction plus printing technology group (n=298, 87 males and 211 females aged 53.84±12.94 years), a 3D-CT reconstruction group (n=148, 55 males and 93 females aged 54.21±11.39 years), and a non-3D group (n=101, 28 males and 73 females aged 53.17±10.60 years). ResultsIn the 3D-CT reconstruction plus printing technology group, the operation time of patients (right: 125.61±20.99 min, left: 119.26±28.44 min) was shorter than that in the 3D-CT reconstruction group (right: 130.48±11.28 min, left: 125.51±10.59 min) and non-3D group (right: 134.45±10.20 min, left: 130.44±9.53 min), which was not associated with the site of surgery; intraoperative blood loss (right: 20.92±8.22 mL, left: 16.85±10.43 mL) was not statistically different compared with the 3D-CT reconstruction group (right: 21.13±8.97 mL, left: 19.09±7.01 mL), but was less than that of the non-3D group (right: 24.44±10.72 mL, left: 23.72±11.45 mL). Variation was found in the right pulmonary artery of 7 (3.91%) patients and in the left pulmonary artery of 21 (17.65%) patients. We first found four-branched lingual pulmonary artery in 2 patients.ConclusionPreoperative CT image computer-assisted 3D reconstruction combined with 3D printing technology can help surgeons to formulate accurate surgical plans, shorten operation time and reduce intraoperative blood loss.
In order to further regulate the application of 3D reconstruction in thoracic surgery, the Chinese Expert Consensus Group on the Application of Integrated 3D Reconstruction with Artificial Intelligence in Thoracic Surgery conducted discussions and developed this consensus. This consensus is based on the clinical experience and existing prospective or retrospective studies of 3D reconstruction technology in various scenarios of thoracic surgery and summarizes recommendations, and also appends a list of 3D reconstruction technology application scenarios that are currently controversial, not fully studied, or still in the exploratory stage, to provide direction and evidence for future clinical research and disease diagnosis and treatment, and to reach a consensus.
With the popularization of CT technology, more and more multiple primary lung cancer, that is, the simultaneous presence of more than one primary cancer in the lungs, has been detected. Imaging can make a rough judgment, histopathology is still the diagnostic gold standard, and molecular genetics examination can better distinguish it from intrapulmonary metastatic cancer when necessary. At present, there is no unified treatment standard for multiple primary lung cancer. Surgery is the most important and effective means, and the surgical method needs to be personalized according to the size and distribution of the patient's lesions, one-sided lobectomy and the other side sublobar resection is considered safe and feasible. At the same time, local nonsurgical treatment is also an option or a supplement to surgical treatment. This article reviews the diagnosis and treatment of multiple primary lung cancer in recent years.
目的:分析與研究“5·12”汶川大地震所致成批胸外傷患者的特點及護理措施,為災難性胸外傷護理方法提供有益的經驗與措施。方法:回顧性分析“5·12”汶川大地震發生后10天內四川大學華西醫院胸心外科普胸病區收治的75例住院患者資料,總結護理方法與效果。結果:75 例患者均有不同程度的皮膚挫裂傷和擦傷(100％),血胸75例(100 ％),血氣胸24例(32％),肋骨骨折75例(100％),鎖骨骨折6例(8％),肩胛骨骨折11例(14.7％),肺穿刺傷3例(4％),右主支氣管斷裂1例(1.33％),左側膈肌破裂2例(2.7％),肺不張29例(38.7％)。同時伴有其它部位損傷:四肢骨折10 例(13.3％),脊柱損傷2 例(2.7％),腦損傷2例(2.7％),脾破裂2例(2.7％),胃破裂1例(1.33 ％)。住院期間死亡1例,其余患者均康復。結論:“5·12”地震胸外傷以血、氣胸和肋骨骨折為主,合并嚴重的臟器損傷和復合傷是其主要特征,通過精心護理,可以降低死亡率和并發癥的產生,促進患者康復。