Combined Double Sleeve Lobectomy and Superior Vena Cava Resection for Non-small Cell Lung Cancer with Persistent Left Superior Vena Cava

A 65-year-old man with right central type of lung squamous carcinoma was admitted to our department.Bronchoscopy displayed complete obstruction of right upper lobe bronchus and infiltration of the bronchus intermedius with tumor.Chest contrast computed tomography revealed the tumor invaded right pulmonary artery,superior vena cava,and the persistant left superior vena cava flowed into the coronary sinus.The tumor was successfully removed by means of bronchial and pulmonary artery sleeve resection of the right upper and middle lobes combined with resection and reconstruction of superior vena cava(SVC)utilizing ringed polytetrafluoroethylene graft.To the best of our knowledge,this was the first report of complete resection of locally advanced lung cancer involving superior vena cava,right pulmonary artery trunk and main bronchus with persistant left superior vena cava.

Clinical experience of double sleeve lobectomy of the bronchus and the pulmonary artery in patients with central lung cancer

Objective： The aim of our study was to introduce the surgical method and evaluate the efficacy of double sleeve Iobectomy of the bronchus and the pulmonary artery in treatment for the central lung cancer. Method： From March 1995 to October 2010, double sleeve Iobectomy of the bronchus and the pulmonary artery was performed in 45 cases with central lung cancer that involved the bronchial opening of an upper lobe of the lungs or the main bronchus and＇pulmonary artery but didn＇t involve any lower lobes. Among them, left upper Iobectomy was performed in 37 cases, right medium-upper Iobectomy was performed in 6 cases and right upper Iobectomy was performed in 2 cases. Results： Postoperative complications were found in 12 cases. Among them, 3 cases were arrhythmia, 1 case was acute heart failure, 6 cases were obstructive pneumo-nia and pulmonary atelectasis, 2 cases were bronchial anastomotic fistula. Two cases died of cerebral infarction and massive hemoptysis respectively. Thirty-one cases were squamous carcinoma, 7 cases were adenocarcinoma, 4 cases were small cell lung cancer, 1 case was adenosquamous carcinoma, 1 case was sarcomatoid carcinomas, 1 case was mucinous adeno- carcinoma. Ten cases were T3NOM0, 11 cases were T3N 1M0, 17 cases were T3N2M0, 2 cases were T4N 1M0, 5 cases were T4N2M0. The 1-year, 3-year, 5-year survival rates were 84.4% （38/45）, 51.7% （15/29）, 53.8% （7/13） respectively. Conclu-sion： The double sleeve Iobectomy of the bronchus and the pulmonary artery can maximumly reserve the normal lung tissues while removing tumors, and avoid pneumonectomy. The surgery was safe and effective, while it required a high technique.

Sleeve gastrectomy ameliorates endothelial function and prevents lung cancer by normalizing endothelin-1 axis in obese and diabetic rats

BACKGROUND Previous evidence has implied that obesity is an independent risk factor for developing cancer.Being closely related to obesity,type 2 diabetes mellitus provides a suitable environment for the formation and metastasis of tumors through multiple pathways.Although bariatric surgeries are effective in preventing and lowering the risk of various types of cancer,the underlying mechanisms of this effect are not clearly elucidated.AIM To uncover the role and effect of sleeve gastrectomy(SG)in preventing lung cancer in obese and diabetic rats.METHODS SG was performed on obese and diabetic Wistar rats,and the postoperative transcriptional and translational alterations of the endothelin-1(ET-1)axis in the lungs were compared to sham-operated obese and diabetic rats and age-matched healthy controls to assess the improvements in endothelial function and risk of developing lung cancer at the postoperative 4 th,8 th,and 12 th weeks.The risk wasalso evaluated using nuclear phosphorylation of H2 A histone family member X as a marker of DNA damage(double-strand break).RESULTS Compared to obese and diabetic sham-operated rats,SG brought a significant reduction to body weight,food intake,and fasting blood glucose while improving oral glucose tolerance and insulin sensitivity.In addition,ameliorated levels of gene and protein expression in the ET-1 axis as well as reduced DNA damage indicated improved endothelial function and a lower risk of developing lung cancer after the surgery.CONCLUSION Apart from eliminating metabolic disorders,SG improves endothelial function and plays a protective role in preventing lung cancer via normalized ET-1 axis and reduced DNA damage.

Radionuclide Colloid ^(32)P Used for the Treatment of Stage II Lung Cancer by Video Enhanced Minimal Access Muscle Sparing Thoracotomy

Objective: To study the feasibility of radionuclide colloid 32P used for the treatment of stage II lung cancer by video enhanced minimal access muscle sparing thoracotomy (VEMAST). Methods: Video assisted thoracoscopic surgery (VATS) was carried out under general anesthesia. A double lumen endobronchial tube was intubated into trachea. One lung ventilation of the healthy side was done during operation. An incision of 8–10 cm long was made along the 4th or 5th intercostals. The lobectomy could be performed under VATS. Radionuclide colloid 32P was injected locally into the area where surgical cleaning of lymph node around was considered to be unsatisfactory or desection of the tumor was not completed. Results: The operation with VEMAST was successful in 29 patients. A conventional lobectomy by thoracotomy had to be done due to unusual bleeding from the pulmonary artery involved during VEMAST in one case and the procedure was interrupted because the pulmonary artery cloud not be separated from the tumor in another patient. There was no dead case or the patient who had any severe complication or adverse response to the radiant. Conclusion: Radionuclide therapy was performed to the treatment of stage II lung cancer with VEMAST in case that surgical resection was considered not to be satisfactory. Minithoractomy assisted with VATS lobectomy and radionuclide colloid 32P therapy is a safe and e?ective technique for some selected stage II lung cancer.

Resectable left lower lobe non-small cell lung cancer with lymph node metastasis is related to unfavorable outcomes

Background:Despite numerous previous studies,the consideration of tumor location as a prognostic factor in resectable non-small cell lung cancer(NSCLC)remains controversial.The present study analyzed the association between tumor location and clinical outcome in patients with resectable NSCLC who had undergone lobectomy with systematic lymphadenectomy and who had presented with varying nodal statuses.Methods:The data from a cohort of 627 eligible patients treated in Sun Yat-sen University Cancer Center between January 2000 and December 2008 were retrospectively collected,and the nodal statuses of patients with different tumor locations were compared.Cox proportional hazards regression model was used to determine the independent factors related to cancer-specific survival(CSS).Results:Multivariate analysis demonstrated that left lower lobe(LLL)tumors[hazard ratio(HR):1.465,95%confidence interval(CI)1.090-1.969,P=0.011],lymph node metastasis(HR:2.742,95%CI 2.145-3.507,P<0.001),and a tumor size of>4 cm(HR:1.474,95%CI 1.151-1.888,P=0.002)were three independent prognosticators in patients with resectable NSCLC.However,LLL tumors were associated only with CSS in node-positive patients(HR:1.528,95%CI 1.015-2.301,P=0.042),and a tumor size of>4 cm was the only independent risk predictor in the node-negative subgroup(HR:1.889,95%CI 1.324-2.696,P<0.001).Conclusions:Tumor location is related to the long-term CSS of NSCLC patients with lymph node metastasis.LLL tumors may be upstaged in node-positive patients to facilitate an optimal treatment strategy.

Partial removal of the pulmonary artery in video-assisted thoracic surgery for non-small cell lung cancer

Lobectomy with partial removal of the pulmonary artery in video-assisted thoracic surgery （VATS） currently remains a challenge for thoracic surgeons. We were interested in introducing pulmonary vessel blocking techniques in open thoracic surgery into video-assisted thoracic surgery （VATS） procedures. In this study, we reported a surgical technique simultaneously blocking the pulmonary artery and the pulmonary vein for partial removal of the pulmonary artery under VATS. Seven patients with non-small-cell lung cancer （NSCLC） received lobectomy with partial removal of the pulmonary artery using the technique between December 2007 and March 2012. Briefly, rather than using a small clamp on the distal pulmonary artery to the area of invading cancer, we replaced a vascular clamp with a ribbon and Hem-o-lock clip to block the preserved pulmonary veins so as to prevent back bleeding and yield a better view for surgeons. The mean occlusion time of the pulmonary artery and pulmonary veins were 44.0±10.0 and 41.3±9.7 minutes, respectively. The mean repair time of the pulmonary artery was 25.3±13.7 minutes. No complications occurred. No patients showed abnormal blood flow through the reconstructed vessel. There were no local recurrences on the pulmonary artery. In conclusion, the technique for blocking the pulmonary artery and veins is feasible and safe in VATS and reduces the risk of abrupt intraoperative bleeding and the chance of converting to open thoracotomy, and extends the indications of VATS lobectomy.

Randomized Control Trial on the Efficacy of Dual Bronchodilator of Glycopyrronium/Indacaterol for Lung Cancer Surgery: Improvement of Postoperative Pulmonary Function in Both Patients with Chronic Obstructive Pulmonary Disease and Normal Pulmonary Function

Background: A dual bronchodilator, long-acting anticholine drugs (glycopyrronium, LAMA) and the long running β-2 stimulant (indacaterol, LABA), are effective for the treatment of chronic obstructive pulmonary disease (COPD). To evaluate the effectiveness of the perioperative intervention of LAMA/LABA, a randomized prospective trial was performed for the lung cancer patients receiving a lobectomy with normal pulmonary function and COPD. Methods: Based on the results of the preoperative pulmonary function test, 25 patients were diagnosed with COPD [% forced expiratory volume in 1 second (%FEV1) < 70%]. Thirty-seven patients were enrolled as non-obstructive patients (70% ≤ %FEV1), who were randomized into two groups, the LAMA/LABA (n = 19) and the Control group (n = 18). The LAMA/LABA and the COPD groups daily received inhaled LAMA (50 μg) and LABA (110 μg) for 1 week before surgery and for least 4 weeks after surgery. The Control group had no treatment of the dual bronchodilator. The actual values were measured during the perioperative pulmonary function at three points of the preoperative baseline, the postoperative 1 week and the postoperative 4 weeks;these changes and changed ratios were then calculated. The patient-reported outcomes of the quality of life (PRO-QOL) were evaluated by the Cancer Dyspnea Scale (CDS), the COPD assessment test, and the St. George’s Respiratory Questionnaire. Results: Regarding the value of FEV1 at the baseline, that in the LAMA/LABA group was 79.2% ± 6.4% and that in the Control group was 80.9% ± 6.4%, but that in the COPD groups was 57.9% ± 8.7%;there was a significant difference between the COPD and the Control group (p < 0.0001). At the postoperative 1 week point, the FEV1 value in the Control group was 1.3 ± 0.5 L and that in the LAMA/LABA group was 1.7 ± 0.5 L. On the other hand, that in the COPD group was 1.7 ± 0.5 L, which was significantly higher compared to that in the Control group (p = 0.0251 and p = 0.0369). The intervention of LAMA/LABA for the COPD and non-obstructive patients resulted in the less decreased degree of the pulmonary function in FEV1 compared to that in the Control group. Based on the PRO-QOL by the CDS, the intervention of LAMA/LABA significantly reduced the total dyspnea in the LAMA/LABA group compared to that in the Control group (p = 0.0348). Conclusion: The perioperative intervention of LAMA/LABA should lead to maintaining the postoperative pulmonary function of the FEV1 during the lobectomy with COPD and non-obstructive patients and the improvement of PRO-QOL.

Robot-assisted lobectomy in a patient with poor lung function:Another advantage of robot-assisted thoracoscopic surgery

Patients with poor lung function have a high-risk for pulmonary complications following lobectomy.The development of minimally invasive thoracic surgical techniques allows sicker patients to safely undergo lung resection.Robotic lobectomy could benefit these higher risk patients.Here we present a case of a 58-year-old female patient with poor lung function presented with a 3-cm mass in her lower left pulmonary lobe,who successfully underwent lobectomy via robot-assisted thoracoscopic surgery.Her forced expiratory volume in one second was slightly improved compared to the preoperative value.Her forced vital capacity continued to improve in the follow-up period.There was no recorded recurrence during the three years follow-up period.

Effect of Inhaled Tiotropium as the Perioperative Management of Patients Undergoing Pulmonary Resection for Primary Lung Cancer

Background: The purpose of this study was to evaluate the effectiveness of perioperative tiotropium therapy for patients undergoing pulmonary resection for primary lung cancer. The short-term tiotropium effect was investigated by perioperative pulmonary function and “lung age”. Methods: The fifty-five patients who underwent a lobectomy and had tiotropium treatment available from October 2007 through May 2009 were the subjects. The patients were divided into 3 groups according to their airway limitation such as Chronic Obstructive Pulmonary Disease (COPD) or a history of smoking;those with COPD (%FEV1 ≤70%, C-group, n = 22), smokers (%FEV1 > 70%, S-group, n = 10) and non-smokers (%FEV1 > 70%, N-group, n = 23). As the bronchodilator groups, the C- and S-groups received inhaled tiotropium bromide (18 μg once daily) for 1 week before surgery until at least 3 weeks after surgery without interruption, and as a control, the N-group had no treatment. The preoperative baselines, the predicted postoperative values, and the actual postoperative ones were measured by the pulmonary function test. The changed rates were calculated and denoted as ΔVC, ΔFEV1, ΔVC%, and ΔFEV1/FVC, from the baseline of the predicted postoperative values. The mean “real age” and “lung age” were calculated. Results: In the S-group, the parameters of ΔVC, ΔFEV1, ΔVC%, and ΔFEV1/FVC significantly increased compared to those of the N-group. In the C-group, the increased extents of ΔFEV1 and ΔFEV1/FVC were lower compared to those in the S-group (not significant). In the N-group, the parameters of ΔVC, ΔFEV1, and ΔVC% decreased. The postoperative “lung age” and “real age” were increased to 29.5 ± 18.0 year-old in the C-group, 25.8 ± 18.0 in the S-group, and 24.7 ± 17.0 in the N-group. Lung resection affected the “lung age”;the aging was a 28.9 ± 12.7 year-old increase in the N-group. In the C- and S-group, the “lung age” was a 14-year-old increase. The effect of tiotropium treatment affected the “lung age” as a 15-year-old increase. Conclusion: Perioperative interventional tiotropium contributed to the lobectomy patients with COPD and for smokers with a non-obstructive airway and played a role of preserving the postoperative lung function.

Unexpected Intraoperative Resecting of Common Trunk of Pulmonary Vein Resulted in an Incidental Pneumonectomy from Left Upper Lobectomy

There is a wide range of anatomical variations in the pulmonary vessels. Some of these variations may cause surgical morbidity during general thoracic surgery. We intended to perform a left upper lobectomy for a 73-year-old male with suspected left lung cancer (lt.U, S3, 20 × 20 mm, P0, E0, D0, PM0, N0, T1aN0M0, c-stage IA). Preoperatively, we did not recognize the existence of the common trunk of the left pulmonary vein. After the open thoracotomy, due to a severe intrathoracic adhesion, we omitted releasing the adhesion of the lower lobe. We did not exactly confirm the location of the inferior pulmonary vein (IPV). After cutting the interlobular pulmonary arterial branchies, we resected the superior pulmonary vein (SPV) using auto sutures. After division of the lung parenchyma and incomplete fissures using auto sutures, we intended to resect the upper bronchus. However, we could not find an IPV at the normal IPV site. A thin IPV was found to be returned to the peripheral site of the resected SPV. The SPV and IPV formed a common trunk at the normal site of the SPV. Although we considered reconstructing the resected common trunk, we finally made a decision of performing an incidental pneumonectomy in order to prevent any postoperative complications on the reconstruction of the IPV such as thrombus occlusion at the anastomosis site and venous return congestion. Retrospectively, we confirmed the preoperative images of the computed tomographic scanning, which showed a narrow IPV that returned to the peripheral site of the SPV. It is important to confirm both accurate locations of the SPV and IPV when performing a lobectomy.

单孔与双孔电视胸腔镜肺叶切除术治疗肺癌的临床疗效比较

目的探讨单孔与双孔电视胸腔镜肺叶切除术治疗肺癌的临床疗效。方法随机选取2016年1月至2023年1月在武警北京总队医院接受胸腔镜肺叶切除术的患者,根据切除方案的不同分为双孔电视胸腔镜肺叶切除组(n=50,双孔组)和同期接受单孔电视胸腔镜肺叶切除组(n=50,单孔组)。对比手术指标、肺功能指标、并发症及相关检验指标。结果单孔组术中出血量、胸腔引流量,住院时间低于双孔组(P<0.05),手术操作时间高于双孔组;淋巴清扫个数、术前后肺功能差异无统计学意义(P>0.05)。单孔组并发症发生率低于双孔组(P<0.05);术前EGFR、TGF-α、IGA、IGM差异无统计学意义(P>0.05)。干预后双孔组EGFR、TGF-α高于单孔组,IGA、IGM低于单孔组(P<0.05)。结论2种方案对于淋巴清扫数量及术后肺功能恢复效果相近,但单孔手术操作的安全性更高,并发症发生率较低,降低炎性反应,利于术后恢复,具有积极临床使用价值。

全胸腔镜肺叶切除术对早期非小细胞肺癌患者miR-25、miR-29A、miR-126及T淋巴细胞亚群的影响

目的探讨对早期非小细胞肺癌(NSCLC)患者采用全胸腔镜肺叶切除术(VATS)治疗的效果。方法采用随机数字表法将NSCLC患者80例分为2组,各40例,对照组采用开胸手术,观察组采用VATS。比较两组围术期指标、微小核糖核(miR)相关指标及免疫功能指标,并随访1年,统计两组总生存期及无进展生存期。结果观察组住院时间短于对照组,术后引流量及术中出血量均少于对照组,有统计学差异(P<0.05);两组手术时间、淋巴结清扫数目比较,无统计学差异(P>0.05);两组术后miR-25、miR-29A、miR-126水平均较术前升高,且观察组高于对照组,有统计学差异(P<0.05);两组术后CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平均较术前降低,但观察组高于对照组,两组CD8^(+)水平均较术前升高,但观察组低于对照组,有统计学差异(P<0.05);随访1年,两组无进展生存期及总生存期比较,无统计学差异(P>0.05)。结论在早期NSCLC患者中采用VATS治疗创伤更小,可有效调节血浆miR-25、miR-29A、miR-126水平,对免疫功能影响小,有利于患者术后尽早恢复。

肺癌患者胸腔镜下肺叶切除术中转开胸风险列线图预测模型的构建

目的构建肺癌患者胸腔镜下肺叶切除术中转开胸风险列线图预测模型。方法选取2021年8月-2023年2月该院收治的肺癌胸腔镜下肺叶切除术患者160例,随机分为建模组(112例)和验证组(48例),根据是否中转开胸,将建模组分为开胸组和未开胸组;采用多因素Logistic回归模型,分析(Enter法)肺癌患者胸腔镜下肺叶切除术中转开胸的危险因素;采用R软件构建列线图模型,评估模型预测效能。结果建模组112例中,有39例发生中转开胸,中转开胸率为34.82%。开胸组和未开胸组年龄、肺结核、肿瘤位置(肺上叶)和胸膜粘连比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄≥65岁、肺结核、肿瘤位置(肺上叶)和胸膜粘连,是肺癌患者胸腔镜下肺叶切除术中转开胸的危险因素(P<0.05)。验证建模组结果,绘制受试者操作特征曲线(ROC curve),曲线下面积(AUC)为0.857,区分度较好,H-L检验提示一致性良好(χ^(2)=5.34,P=0.502)。外部验证的AUC为0.917,区分度较好,H-L检验提示一致性良好(χ^(2)=6.21,P=0.414)。结论年龄≥65岁、肺结核、肿瘤位置(肺上叶)和胸膜粘连,是肺癌患者胸腔镜下肺叶切除术中转开胸的危险因素,以此构建的列线图模型,具有良好的区分度和一致性,能直观地预测肺癌患者胸腔镜下肺叶切除术中转开胸的风险。

单孔胸腔镜支气管袖状切除术与开胸支气管袖状切除术治疗中央型肺癌的疗效对比研究

目的对比单孔胸腔镜支气管袖状切除术和开胸支气管袖状切除术治疗中央型肺癌的可行性和安全性。方法回顾性分析2020年5月-2024年3月新疆医科大学附属肿瘤医院胸外科开展支气管袖状切除术的68例中央型肺癌患者,按照手术方式分为观察组(进行单孔胸腔镜支气管袖状切除术)32例,对照组(实施传统开胸支气管袖状切除术)36例。比较两组一般资料,包括:淋巴结清扫数目、手术时间、术中出血量、术后引流量、术后疼痛评分、术后拔管时间、术后住院时间、术后并发症情况。结果所有患者手术均顺利结束,均无支气管断端残留和围术期死亡。与对照组比较,观察组患者术中出血量、术后引流量减少;术后拔管时间、术后并发症发生率及术后住院天数缩短、术后疼痛评分降低,两组之间比较有统计学意义(P<0.05)。两组之间手术时间和术中淋巴结清扫情况比较,差异无统计学意义(P>0.05)。结论与传统开胸支气管袖状切除术相比,单孔胸腔镜支气管袖状切除术治疗中央型肺癌具有术中创伤小,术后恢复快,近期疗效可靠等优点,具有临床推广意义。

早期分阶段肺康复在肺叶切除术重症肺癌患者中的应用

目的分析早期分阶段肺康复方案对肺叶切除术重症肺癌患者肺功能、癌因性疲乏及身体活动量的影响。方法随机抽样选取2019年6月至2020年5月于新疆医科大学附属肿瘤医院行肺叶切除术的112例重症肺癌患者为研究对象。按照入组先后顺序将其分为对照组和观察组,每组56例,2组患者基线资料比较差异无统计学意义(P>0.05),具有可比性。对照组给予常规康复护理,观察组在对照组基础上添加早期分阶段肺康复方案干预,对2组患者进行为期18个月的随访研究,比较2组患者干预前或术前3 d以及干预后1、6、18个月肺功能指标[第1秒用力呼气容积(FEV1)、第1秒用力呼气容积/用力肺活量(FEV1/FVC)]、癌因性疲乏发生率、每日身体活动时间、焦虑自评量表(SAS)评分和抑郁自评量表(SDS)评分。结果观察组癌因性疲乏发生率(44.64%)低于对照组(64.29%),差异有统计学意义(P=0.037)。重复测量方差分析显示,FEV1、FEV1/FVC、每日身体活动时间、SAS评分、SDS评分主体内效应及主体间效应有统计学意义(P<0.05),FEV1、FEV1/FVC、每日身体活动时间、SAS评分、SDS评分随时间发生变化,且因组别不同而存在差异。干预后1、6、18个月,观察组FEV1、FEV1/FVC、每日身体活动时间高于对照组,SAS评分、SDS评分低于对照组,差异有统计学意义(P<0.05)。结论在常规康复护理基础上添加早期分阶段肺康复干预,能够改善肺叶切除术重症肺癌患者远期肺功能与负性情绪,降低癌因性疲乏发生率,提高身体活动量。

胸腔镜下肺段切除与肺叶切除对早期肺癌患者疗效及生活质量的影响

目的对比胸腔镜下肺段切除与肺叶切除在早期肺癌患者治疗中的应用价值,以及对患者生活质量的影响。方法选取皖北煤电集团总医院2021年1月~2023年11月收治的103例早期肺癌患者,随机数表法分为观察组和对照组,观察组(n=51)患者接受胸腔镜下肺段切除术治疗,对照组(n=52)患者则接受胸腔镜下肺叶切除术治疗。比较两组患者围术期指标;比较两组患者术前、术后1月肺功能指标[用力肺活量(FVC)、第1 s用力呼气容积(FEV1)]变化;比较两组患者生活质量指标[肺癌治疗功能性量表(FACT-L)评分]的变化;记录随访半年时复发及死亡情况。结果观察组手术时间及引流管留置时间分别为(127.32±20.38)min,(4.39±1.63)d,明显短于对照组的(153.15±32.61)min,(5.54±2.89)d;引流量为(645.82±122.51)ml,显著少于对照组的(947.53±180.87)ml,差异均有统计意义(t=4.810、9.893、2.485,P<0.05)。两组患者术中出血量、淋巴结清扫数量比较,差异无统计学意义(P>0.05);术后住院时间、并发症发生率差异亦无统计学意义(P>0.05)。与术前比较,术后两组患者肺功能指标FVC、FEV1均有所降低,但是与对照组比较,观察组降低程度较小,差异有统计学意义(P<0.05)。术后,观察组患者FACT-L量表中情感及功能状态、总分分别为(17.21±3.94)分、(19.08±3.61)分、(104.39±9.64)分,明显高于对照组的(14.15±2.49)分、(17.17±2.24)分、(97.97±8.22)分,差异均有统计意义(t=4.561、3.233、3.639,P<0.05)。术后随访6月,两组均无死亡与复发病例。结论对于早期肺癌的治疗,胸腔镜下肺段切除与肺叶切除术均具有较好的疗效,但是肺段切除术患者的术后恢复快,更有利于肺功能的保护及生活质量的改善。

六字诀对快速康复外科非小细胞肺癌胸腔镜肺叶切除术后病人肺癌术后症状及并发症的影响

目的:观察六字诀对快速康复外科(ERAS)非小细胞肺癌(NSCLC)胸腔镜肺叶切除术后病人肺癌术后症状及并发症发生情况的影响。方法:选取2021年6月—2022年4月入院诊断为NSCLC并行快速康复外科胸腔镜肺叶切除术后病人101例作为研究对象,采用随机数字表法随机分成对照组(n=50)和六字诀组(n=51)。对照组采用快速康复外科常规治疗与护理,六字诀组在对照组的基础上进行12周六字诀训练,于干预前后评估病人肺癌术后症状、中性粒细胞与淋巴细胞比以及血小板与淋巴细胞比(NLR、PLR)和并发症发生情况。结果:干预后六字诀组肺癌术后咳嗽症状改善较对照组显著,差异有统计学意义(P<0.05)。六字诀组肺癌术后并发症发生率与对照组比较差异无统计学意义(P>0.05)。结论:六字诀可有效改善ERAS非小细胞肺癌胸腔镜肺叶切除术后病人的咳嗽症状。

基于预康复理念的肺康复训练在肺癌肺叶切除患者围术期的护理应用

目的探讨基于预康复理念的肺康复训练在肺癌肺叶切除患者围术期的护理效果,旨在提高患者干预前的肺功能及自我管理水平,为术后康复奠定基础。方法选择2022年5月—2023年8月吉安市中心人民医院行肺癌肺叶切除患者80例作为研究对象,按照组间基线资料均衡可比原则分为对照组和观察组,各40例。对照组给予常规护理,观察组给予基于预康复理念的肺康复训练。对比两组患者围术期自我水平能力、肺功能指标[用力肺活量(FVC)、第1秒用力呼气量(FEV_(1))、FEV_(1)/用力肺活量(FEV_(1)/FVC)]、并发症、6 min步行试验(6MWD)。结果观察组自主咳嗽依从率87.50%、早期下床活动依从率82.50%,均高于对照组57.50%、50.00%,差异有统计学意义(P<0.05)。术后1个月,观察组患者FVC、FEV_(1)、FEV_(1)/FVC均高于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率7.50%低于对照组27.50%,差异有统计学意义(P<0.05)。术后1个月,观察组的6 min步行距离长于对照组,差异有统计学意义(P<0.05)。结论基于预康复理念的肺康复训练在肺癌肺叶切除患者围术期的护理应用,提高自我管理水平,有利于减少并发症,促进术后康复,改善肺功能及运动耐力。

肺叶切除术、肺楔形切除术与肺段切除术治疗老年Ⅰ期非小细胞肺癌患者的疗效及对预后的影响

目的 对比肺叶切除术、肺楔形切除术与肺段切除术治疗老年Ⅰ期非小细胞肺癌(NSCLC)患者的疗效及对预后的影响。方法 将105例老年Ⅰ期NSCLC患者按手术方式的不同分为A组(肺叶切除术,n=36)、B组(肺楔形切除术,n=32)、C组(肺段切除术,n=37)。比较3组患者围手术期指标、围手术期并发症发生情况、肺功能指标[用力肺活量(FVC)、肺一氧化碳弥散量(DLCO)、最大通气量(MVV)]、术后随访情况(复发、远处转移和死亡)。结果 B组患者手术时间、术后引流时间、术后住院时间均短于A组、C组,C组患者手术时间短于A组,差异均有统计学意义(P﹤0.05)。3组患者围手术期并发症总发生率比较,差异无统计学意义(P﹥0.05)。术后6个月,A组患者FVC、DLCO均较术前降低,B组、C组患者FVC、DLCO、MVV均高于A组,差异均有统计学意义(P﹤0.05)。术后随访1年,3组患者复发、远处转移情况比较,差异均无统计学意义(P﹥0.05),3组患者均未出现死亡。结论 亚肺叶切除术可促进老年Ⅰ期NSCLC患者术后恢复和肺功能改善,建议临床根据患者实际情况选择术式。

微创解剖性肺段切除术在早期非小细胞肺癌患者中的应用效果

目的探讨微创解剖性肺段切除术在早期非小细胞肺癌患者中的应用效果。方法选取2020年1—12月晋江市医院收治的80例早期非小细胞肺癌患者作为研究对象,采用随机数字表法分为常规组与观察组,每组40例。常规组行常规微创肺叶切除术治疗,观察组行微创解剖性肺段切除术治疗。比较两组临床疗效、手术指标、术后并发症发生率、镇痛药物使用率及手术前后血清疼痛应激指标。结果两组治疗总有效率比较差异无统计学意义。两组手术时间、术中出血量、术后引流量比较差异无统计学意义;观察组淋巴结清扫个数多于常规组,胸腔引流管留置时间及住院时间均短于常规组,差异有统计学意义(P<0.05)。观察组术后并发症发生率及镇痛药物使用率均低于常规组,差异有统计学意义(P<0.05)。术后,观察组β-内啡肽(β-endorphin,β-EP)、神经肽Y(neuropeptide Y,NPY)、前列腺素E_(2)(prostaglandin E2,PGE2)及皮质醇(cortisol,Cor)水平均低于常规组,差异有统计学意义(P<0.05)。术后,观察组用力肺活量(forced vital capacity,FVC)、第1秒用力呼气容积(forced expiratory volume in one second,FEV_(1))、FEV_(1)%预计值、最大肺活量(maximal vital capacity,VC_(max))、最大通气量(maxi-mal voluntary ventilation,MVV)均高于常规组,差异有统计学意义(P<0.05)。结论微创解剖性肺段切除术在早期非小细胞肺癌患者中的手术效果显著,具有较高的安全性,可改善患者肺功能并减轻疼痛应激反应。