目的探討食管多源癌的診斷及治療方法。 方法回顧性分析2008年3月至2009年11月在四川大學華西醫院行手術治療的15例食管多源癌患者的臨床資料，其中男14例，女1例，中位年齡62.5（48～75）歲。15例行手術治療食管多源癌的患者中，行Sweet術式8例，左胸-左頸兩切口4例，胸腹腔鏡聯合McKeown術式2例，開胸探查而未能切除腫瘤1例。 結果術前確診11例，術前確診率為73.3%（11/15）。術后1例發生肺部并發癥，3例發生吻合口瘺，圍術期無死亡。除腫瘤未能切除的患者外，隨訪13例，隨訪5年，1年生存率61.5%（8/13）、3年生存率30.8%（4/13）、5年生存率15.4%（2/13）。第一病灶位置與預后關系密切，第一病灶位于胸上段的食管多源癌患者，其中5例順利完成手術，吻合部位均在頸部，2例食管殘端存在癌殘留（R1），1年內死亡3例，無1例獲得3年生存。第一病灶位于胸中、下段的9例食管多源癌患者均完成根治性切除，食管及胃殘端均無癌殘留（R0），1年生存率75.0%，3年生存率50.0%，2例獲得5年長期生存。 結論對于食管多源癌，如第一病灶位于胸中、下段，首選手術治療。如第一病灶位于胸上段，不宜首選手術治療，這類患者采用新輔助放化療后再手術或直接采用其他治療模式，這需要以后進一步研究比較。
ObjectiveTo evaluate clinical outcomes of single utility port video-assisted thoracoscopic surgery (VATS) lobectomy for patients with early-stage peripheral non-small cell lung cancer. MethodsWe retrospectively analyzed the clinical data of 46 consecutive patients with early-stage peripheral non-small cell lung cancer who underwent single utility port complete VATS lobectomy in the First Affiliated Hospital of Hebei north University from December 2012 through November 2014. There were 39 male patients and 7 female patients with their age of 42-76 (60.26±4.38) years (VATS group). There were 58 patients with early-stage peripheral non-small cell lung cancer who underwent lobectomy via traditional thoracotomy including 47 male and 11 female patients with their age of 44-73 (61.42±3.67) years for the same period (conventional thoracotomy group). Clinical outcomes were compared between the two groups. ResultsAll the operations were successful. There was no conversions during single utility port VATS lobectomy, and no periopera-tive death in both groups. The VATS group had significantly less blood loss (126.10±48.56 ml vs. 260.84±69.70 ml), and amount of thoracic drainage (230.52±50.22 ml vs. 380.16±96.24 ml, P<0.05). Hospital stay was significantly shorter in the VATS group than the conventional thoracotomy group (6.42±1.40 days vs. 9.64±2.08 days, P<0.05). However, there was no significant difference between the VATS group and the conventional thoracotomy group with regard to the opera-ting time (146.25±19.68 minutes vs. 139.26±25.39 minutes), number of lymph nodes procured (13.56±2.31 vs. 14.12±3.06), and postoperative complications (13.0% vs. 19.0%, P>0.05). ConclusionSingle utility port VATS lobectomy for patients with early-stage peripheral non-small cell lung cancer is technically feasible, with less blood loss and shorter hospital stays for achieving acceptable standards of lymph node dissection. It is a promising surgical procedures for patients with early-stage peripheral non-small cell lung cancer.