Technical aspects of uniportal VATS lung major resections with bronchovascular reconstruction

Lung major resections involving bronchovascular reconstruction pose a surgical challenge due to their technical complexity and frequency.The traditional techniques to perform vascular or bronchial reconstructions through multiportal video-assisted thoracoscopic surgery(VATS)approach can be applied also by uniportal VATS approach.Nevertheless,specific tools have already been developed in order to facilitate these procedures through uniportal VATS approach increasing comfort and workspace through the single port utility.These procedures must be performed just in very highly uniportal VATS trained teams and it is recommended that teams who perform these techniques previously have completed the advanced learning curve for lung major resections through uniportal VATS approach.The aim of this paper is to describe the major key points for performing most frequent bronchovascular reconstructions through uniportal VATS approach in a safe and feasible way.Operative technique is step by step described in order to safely perform most common uniportal VATS left/right side lung major bronchovascular resections and reconstructions.Specific tip and tricks are detailed in order to facilitate vascular control,bronchovascular reconstructions and unexpected bleeding control through uniportal VATS approach.

肺内球形灶血管支气管平行CT征与病理对照研究

目的 :探讨肺内球形灶血管支气管平行CT征的病理基础及诊断价值。方法 :选择 1 2例肺内球形灶血管支气管平行CT征进行病理对照研究。所有病灶大小为 3 .0～ 6 .0cm。机型为ElscientCTTwin和GEProspeedCT机 ,1 2例均经肝静脉注射对比剂后 ,从肺尖至肺底扫描 ,层厚 1 0 .0mm ,依病灶大小 ,加扫薄层 3 .0～ 5 .0mm ,手术标本按Heitzman法制标本。根据CT横断面扫描特点 ,将标本病灶部分进行横断 ,作 0 .5～ 1 .0cm厚组织切片 ,然后 ,对“兴趣区”取材作石腊切片 ,HE染色 ,光镜观察 ,进行病理对照。结果 :在 1 2例肺球形灶血管支气管平行CT征中 ,除 1例肺炎性假瘤外 ,其余均为肺恶性肿瘤。结论

肺癌术后支气管胸膜瘘致死性大咯血经验(附7例报告)

背景与目的大咯血是肺癌术后少见但严重的并发症。本研究旨在探讨致死性大咯血的发生机制、危险因素、先兆症状及预防和治疗措施。方法 2007年4月-2011年5月四川大学华西医院共行肺癌手术1,737例,围手术期死亡20例,其中死于大咯血7例,复习7例患者的临床资料并结合文献进行分析。结果大咯血是肺癌术后第2位死亡原因。7例中6例直接死于大咯血,1例因大咯血行二次手术,最终死于肺部感染、呼吸衰竭。4例发生过先兆出血症状。4年大咯血发生率为0.4%(7/1,737)。结论支气管胸膜瘘引起的支气管血管瘘是大咯血发生的机制,糖尿病为高危因素,早期诊断、早期外科治疗支气管胸膜瘘或支气管血管瘘可避免大咯血死亡的发生。

Spreading pattern and CT findings of very early-stage peripheral small-cell lung cancer

Chest CT frequently reveals small pulmonary lesions. If there is no associated hilar or mediastinal lymphadenopathy, small-cell lung cancer (SCLC) is considered to be very early-stage. Few studies, however, have described the characteristic CT findings of very early-stage SCLC. Clarifying these findings would reduce diagnostic delay. The purpose of this study was to determine the characteristic CT findings of very earlystage SCLC. Computed tomography images obtained from 547 consecutive patients with lung cancer between 2003 and 2012 at Tokyo Dental College Ichikawa General Hospital were reviewed retrospectively. One hundred of these patients had SCLC and 447 had non-SCLC (NSCLC). These CT images, along with any that had also been obtained prior to the one on which the final diagnosis was based, were reviewed. In 5 of the cases reviewed, specific findings and a characteristic spreading pattern were identified on CT images that might have allowed a diagnosis of SCLC to have been made sooner. The findings included a sub-pleural, small nodule accompanied by daughter nodules spreading longitudinally along the bronchovascular bundle, no air bronchogram or cavitation, and background emphysematous change. These were not identified on CT images of very earlystage NCSLC, however (n = 22). Awareness of the relevance of these findings would help physicians and radiologists arrive at a differential diagnosis of small pulmonary nodules.

高分辨率CT上非小细胞肺癌结节周围肺组织和血管改变的研究

目的 应用高分辨率CT(HRCT)对非小细胞肺癌 (NSCLC)结节周围组织、血管的改变进行研究 ,总结NSCLC的特征性改变 ,提高HRCT对NSCLC的诊断率。方法 应用HRCT观察 3 1例NSCLC和 12例肺部良性病变周围组织、血管的形态改变 ,由两位放射学家分别阅片 ,观察肺小叶血管支气管束、血管和叶间隔的改变。统计学处理应用 χ2 检验。结果 3 1例NSCLC患者中 ,2 0例 ( 64 .5 % )出现肺小叶支气管血管束增厚 ,15例 ( 4 8.4% )上级肺小叶动脉扩张 ,13例 ( 4 1.9% )上级肺小叶静脉扩张 ,16例 ( 5 1.6% )叶间隔增厚 ,5例 ( 16.1% )磨玻璃样变。对照组中肺小叶支气管血管束增厚者 2例 ( 16.7% ) ,上级肺小叶动脉扩张 1例 ( 8.3 % ) ,上级肺小叶静脉扩张 2例 ( 16.7% ) ,叶间隔增厚 6例 ( 5 0 .0 % ) ,5例 ( 4 1.7% )磨玻璃样变。NSCLC患者的肺小叶支气管血管束增厚和上级肺小叶动脉扩张的出现率均高于对照组 (P <0 .0 0 5和 0 .0 1<P <0 .0 2 5 )。结论 肺部结节伴肺小叶支气管血管束增厚或上级肺小叶动脉扩张时可高度怀疑NSCLC。

三维CT支气管血管重建技术在胸腔镜精准肺段切除术中的应用

人肺部的解剖结构复杂,其中支气管、动脉、静脉及动静脉分支的走行变化多样.肺癌是一种发病率较高的呼吸系统恶性肿瘤.与对早期肺癌患者进行传统的肺叶切除术相比,对其进行胸腔镜肺段切除术的难度更大,对手术精准度的要求更高.三维CT支气管血管重建(threedimensional-computed tomography bronchography and angiography,3D-CTBA)技术是一种先进的影像学技术.对早期肺癌患者进行胸腔镜精准肺段切除术前,对其病灶图像实施三维CT支气管血管重建,能清晰地显示其肺部的三维解剖结构及肺段支气管、动脉、静脉的走行及变异情况,明确其病灶的位置及归属的肺段,规划手术的安全切缘及手术路径,实现术前的规划、导航、模拟、推演及术中的对照解剖,进而可显著提高手术的精准度和安全性.本文主要是对三维CT支气管血管重建技术在胸腔镜精准肺段切除术中应用的情况及相关的研究进展进行介绍.

肺动脉支气管成形重建术治疗期非小细胞肺癌

目的 :为了提高 期非小细胞肺癌的手术切除率 ,减少全肺切除率并获得与全肺切除相同的手术彻底性。方法 :用肺动脉成形同时行支气管成形术治疗 期非小细胞肺癌 1 9例 ,其中鳞癌1 3例 ,腺癌 6例。左上叶袖状切除 1 1例 ,右上叶 6例 ,右中上叶 2例。结果 :本组无手术死亡 ,术后1例发生支气管胸膜瘘 ,余 1 8例无并发症 ,术后 1年及 3年生存率分别为 83%和 39%。结论 :肺动脉支气管成形重建术的应用最大限度地切除了肿瘤组织 。

支气管血管束异常在肺弥漫性病变诊断中的价值

目的：探讨支气管血管束异常对于肺弥漫性病变的鉴别诊断价值。材料与方法：７２例肺弥漫性病变中，经病理证实１５例，其余５７例均经临床证实。其中肺弥漫性间质性病变３３例，肺弥漫性实质性病变５例，支气管病变１４例，播散性病变２０例。全部病例均做了胸部ＣＴ常规扫描，少数病例同时做了ＨＲＣＴ扫描，每例均由两位主任医师共同观察。结果：支气管血管束异常征象：（１）支气管血管束变细，主要见于肺弥漫性间质性病变和慢性支气管炎。（２）支气管血管束增粗，主要见于肺间质性病变及播散性病变，结节病与癌性淋巴管炎多呈串珠状增粗。（３）支气管血管束显示率增加，主要见于毛细支气管炎及播散性病变。结论：支气管血管束异常是肺弥漫性病变的ＣＴ征象，占８０％，支气管血管束异常无特异性，但呈串珠状增粗多见于结节病及癌性淋巴管炎。特发性肺间质纤维化及慢性支气管炎伴弥漫性间质性病变时，参考横膈位置具有鉴别诊断价值，前者横膈位置正常或升高，后者横膈位置低平。支气管血管束从正常演变到异常，表示病变的发展。

三维肺支气管血管重建术与三孔胸腔镜根治术治疗早期NSCLC的安全性、有效性分析

目的:探究三维CT肺支气管血管重建术(3D-CTBA)与三孔胸腔镜根治术治疗早期非小细胞肺癌(NSCLC)的安全性、有效性。方法:选取早期NSCLC患者75例,随机分为三孔胸腔镜组(A组=37例)和3D-CTBA组(B组=38例),A组采用三孔胸腔镜根治术治疗,B组采用3D-CTBA治疗。对比两组患者手术指标及术后疼痛感,检测对比肿瘤标志物、氧化应激指标、炎症因子及T淋巴细胞亚群水平,对比两组并发症发生率。结果:与A组比较,B组患者术中出血量、术后引流量、术后胸管留置时间、术后住院时间均较低。B组患者术后12h、24h、48h VAS评分均低于A组。术后,B组患者CA724、CA125、CEA、AOPP、IL-1β和IL-12水平均低于A组,而CD8+、CD4+和CAT水平均高于A组。B组患者并发症发生率低于A组。结论:3D-CTBA应用于早期NSCLC患者的治疗,具有较好的疗效性和安全性,患者预后理想,并发症发生率较低。