AIM To analyze pancreatic cancer patients who developed metachronous pulmonary metastases(MPM) as a first site of recurrence after the curative-intent surgery.METHODS One-hundred-fifty-nine consecutive pancreatic duct...AIM To analyze pancreatic cancer patients who developed metachronous pulmonary metastases(MPM) as a first site of recurrence after the curative-intent surgery.METHODS One-hundred-fifty-nine consecutive pancreatic ductal adenocarcinoma(PDAC) patients who underwent radical pancreatic surgery between 2006 and 2013 were included in this retrospective analysis. The clinical data including age, sex, grade, primary tumor location, p TNM stage, lymph node infiltration, microangioinvasion, perineural invasion, lymphovascular invasion, the therapy administered, and follow-up were all obtained from medical records. Further analysis covered only patients with metachronous metastases. Clinical and histopathological data(age, sex, grade, primary tumor location, p TNM stage, lymph node infiltration, microangioinvasion, perineural invasion, lymphovascular invasion, the therapy administered and follow-up) of patients with metachronous non-pulmonary metastases and patients with metachronous pulmonary metastases were statistically assessed. Disease-free survival(DFS) from pancreas resection until metastases onset and overall survival(OS) were calculated. Wilcoxon test, χ~2 test and survival functions computed by the KaplanMeier method were used. Statistical significance was evaluated by the log-rank test using SPSS. A P-value of less than 0.05 was considered statistically significant.RESULTS Metachronous pulmonary metastases were observed in 20(16.9%) and were operable in 3(2.5%) of PDAC patients after a prior curative-intent surgery. Patients with isolated pulmonary metastases(oligometastases and multiple metastases) had estimated prior DFS and OS of 35.4 and 81.4 mo, respectively, and those with metachronous pulmonary metastases accompanied by other metastases had prior DFS and OS of 17.3 and 23.4 mo, respectively. Patients with non-pulmonary metastases had prior DFS and OS of 9.4 and 15.8 mo, respectively. Different clinical scenarios according to the presentation of MPM were observed and patients could be divided to three subgroups with different prognosis which could be used for the selection of treatment strategy: isolated pulmonary oligometastases, isolated multiple pulmonary metastases and pulmonary metastases accompanied by other metastases.CONCLUSION Surgery should be considered for all patients with isolated pulmonary oligometastases, but the risk of intervention has to be individually weighted for each patient.展开更多
Actinomycosis is an uncommon disease, which is usually manifested as cervicofacial infection; related to poor oral hygiene or compromised immune function. Pulmonary actinomycosis is rare, but its diagnosis is changing...Actinomycosis is an uncommon disease, which is usually manifested as cervicofacial infection; related to poor oral hygiene or compromised immune function. Pulmonary actinomycosis is rare, but its diagnosis is changing due to its variable presentation; the similarity in appearance to other intrapulmonary diseases. Here we report an 80-year-old man with a solitary pulmonary nodule over the left upper lobe. Pulmonary neoplasm was highly suspected in this patient; thus resection of the mass was undertaken through video-assisted thoracic surgery (VATS). Histopathological examination demonstrated this patient had an Actinomyeces infection. While the application of VATS in patients with pulmonary actinomycosis has rarely been reported in literature, we conclude that VATS is valuable for the diagnosis; treatment of patients with undetermined pulmonary nodule(s).展开更多
AIM: To evaluate the outcomes of surgery for lung cancer after induction therapy.METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program(ACSNSQIP) database(2005-2012), we identifi...AIM: To evaluate the outcomes of surgery for lung cancer after induction therapy.METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program(ACSNSQIP) database(2005-2012), we identified 4063 patients who underwent a pulmonary resection for lung cancer. Two hundred and thirty-six(5.8%) received neo-adjuvant therapy prior to surgery(64 chemo-radiation, 103 radiation alone, 69 chemotherapy alone). The outcomes were compared to 3827 patients(94.2%) treated with surgery alone. Primary outcome was 30-d mortality, and secondary outcomes included length of stay, operative time and NSQIP measured postoperative complications.RESULTS: Lung cancer patients who received preoperative treatment were younger(66 vs 69, P < 0.001), were more likely to have experienced recent weight loss(6.8% vs 3.5%; P = 0.011), to be active smokers(48.3 vs 34.9, P < 0.001), and had lower preoperative hematological cell counts(abnormal white blood cell: 25.6 vs 13.4; P < 0.001; low hematocrit 53% vs 17.3%, P < 0.001). On unadjusted analysis, neo-adjuvant patients had significantly higher 30-d mortality, overall and serious morbidity(all P < 0.001). Adjusted analysis showed similar findings, while matched cohorts comparison confirmed higher morbidity, but not higher early mortality.CONCLUSION: Our data suggest that patients who receive neo-adjuvant therapy for lung cancer have worse early surgical outcomes. Although NSQIP does not provide stage information, this analysis shows important findings that should be considered when selecting patients for induction treatment.展开更多
Introduction: Prolonged air leak (PAL) is a common complication following pulmonary resection. It is associated with pneumonia, empyema, increased length of hospital stay and health-care costs. Intraoperative techniqu...Introduction: Prolonged air leak (PAL) is a common complication following pulmonary resection. It is associated with pneumonia, empyema, increased length of hospital stay and health-care costs. Intraoperative techniques have been developed to mitigate the risk of developing a PAL, but for their use to be efficient, identification of patients at risk for PAL is necessary. Aim: To determine the incidence of PAL following lobectomy and lesser pulmonary resections, risk factors for development of PALs, and the impact of PAL on hospital stay and readmission rates. Methods: The following variables were analyzed as PAL risk factors: patient characteristics of age, sex, body mass index (BMI), forced minute expiratory volume and capacity ratio (FEV1 and FEV1/FVC), diffusion capacity (DCLO), and transplant recipient status. Validated scoring systems included the Charlson Comorbidity Index (CCI), Medical Research Council (MRC) dyspnea score, and Eastern Cooperative Oncology Group (EGOC) score. Surgical factors included surgical technique, unplanned conversion from video-assisted thoracoscopic surgery (VATS) to thoracotomy, location and extent of resection, presence of adhesions, completeness of fissures, and method of fissure completion. Length of hospital stay and readmission rates were analyzed. Statistical tests performed on the data include univariate and multivariate logistic regression analyses. Results: Over the 9-month study duration there were 269 lung resections, of which 31 (11.52%) had an air leak lasting longer than 5 days. Mean length of stay in hospital was significantly longer in patients with PAL compared to the control group (13 vs 5 days, P P = 0.009), right upper lobectomy (P = 0.001), and unplanned conversion from video-assisted thoracoscopic surgery (VATS) to thoracotomy (P = 0.023). Conclusion: The incidence of PAL in our study population is similar to that found in previous studies. PAL prolongs hospital length of stay. Normal BMI, right upper lobectomy, and unplanned conversion from VATS to thoracotomy are risk factors for PAL.展开更多
Objective This study is to analyse the clinical feature and risk factors of morbidity after pulmonary resection for lung cancer in patients older than 70 years. Methods The clinical records of 222 patients older than ...Objective This study is to analyse the clinical feature and risk factors of morbidity after pulmonary resection for lung cancer in patients older than 70 years. Methods The clinical records of 222 patients older than 70 years who had undergone pulmonary resection for their lung cancer were reviewed. The patients were divided into 3 groups,group I including the patients who had展开更多
BACKGROUND Pulmonary mucormycosis is a rare but life-threatening invasive fungal infection that mostly affects immunocompromised patients.This disease usually develops acutely and progresses rapidly,often leading to a...BACKGROUND Pulmonary mucormycosis is a rare but life-threatening invasive fungal infection that mostly affects immunocompromised patients.This disease usually develops acutely and progresses rapidly,often leading to a poor clinical prognosis.Chronic pulmonary mucormycosis is highly unusual in immunocompetent patients.CASE SUMMARY A 43-year-old man,who was a house improvement worker with a long history of occupational dust exposure,presented with an irritating cough that had lasted for two months.The patient was previously in good health,without dysglycemia or any known immunodeficiencies.Chest computed tomography revealed a mass in the left lower lobe,measuring approximately 6 cm in diameter,which was suspected to be primary lung carcinoma complicated with obstructive pneumonia.Thoracoscopic-assisted left lower lobectomy was performed,and metagenomic next-generation sequencing detection,along with special pathological staining of surgical specimens,suggested Rhizopus microsporus infection.Postoperatively,the patient’s respiratory symptoms were relieved,and no signs of recurrence were found during the six-month follow-up.CONCLUSION This article reports a rare case of chronic pulmonary mucormycosis caused by Rhizopus microsporus in a middle-aged male without dysglycemia or immunodeficiency.The patient’s surgical outcome was excellent,reaffirming that surgery remains the cornerstone of pulmonary mucormycosis treatment.展开更多
Objective:To explore factors related to postoperative pulmonary infection in lung cancer patients after recovery from COVID-19 and to provide methods for preventing and reducing the incidence of postoperative lung inf...Objective:To explore factors related to postoperative pulmonary infection in lung cancer patients after recovery from COVID-19 and to provide methods for preventing and reducing the incidence of postoperative lung infection in patients with lung cancer.Methods:A total of 92 patients who underwent lung cancer surgery in the Department of Thoracic and Cardiac Surgery of Yichang Central People’s Hospital from January 28,2023,to March 3,2023,were selected.They were divided into a pulmonary infection group(47 cases)and a nonpulmonary infection group(45 cases)according to whether pulmonary infection occurred.General clinical data of patients were collected and collated to analyse the related influencing factors of pulmonary infection in lung cancer patients after recovery from COVID-19.Results:Univariate analysis showed that patient age(≥60 years),fever after COVID-19 infection,oral and laryngeal symptoms,digestive tract symptoms,neurological symptoms,long-term smoking history,hypertension history,and operation time(≥3 h)were correlated with pulmonary infection(all P<0.05).There was no significant correlation between postoperative pulmonary infection and sex,ocular,nasal and tongue symptoms,systemic symptoms,duration of COVID-19,COPD,lobectomy site,incision pain,mechanical ventilation time(≥6 h),drainage tube retention time(3 d),surgical method(P>0.05).Logistic multivariate analysis showed that age(≥60 years old),long operation time(≥3 h)and long-term smoking history were independent influencing factors for postoperative pulmonary infection in patients with radical resection of lung cancer(P>0.05).Conclusion:In this study,older age(≥60 years old),long-term smoking history,and long operation time(≥3 h)were risk factors for pulmonary infection after lung cancer surgery.In the future,active treatment measures can be taken to address these risk factors during the perioperative period to reduce the incidence of postoperative pulmonary infection.展开更多
Congenital pulmonary airway malformation(CPAM), previously known as congenital cystic adenomatoid malformation is a congenital disorder of the lung similar to bronchopulmonary sequestration. In CPAM, usually an entire...Congenital pulmonary airway malformation(CPAM), previously known as congenital cystic adenomatoid malformation is a congenital disorder of the lung similar to bronchopulmonary sequestration. In CPAM, usually an entire lobe of lung is replaced by a non-working cystic piece of abnormal lung tissue. This abnormal tissue will never function as normal lung tissue. The underlying cause for CPAM is not known. It occurs in approximately 1 in every 30000 pregnancies. The association between CPAM and malignancy has been well documented. There is a small risk(0.7%) of malignant transformation within the cyst. So early diagnosis and surgical resection is important to prevent the grave complications. Herein, we are reporting two interesting cases of CPAM and one belonged to Type Ⅱ and other belonged to Type Ⅲ of Stocker's classification.展开更多
Clinical practice with respect to metastatic colorectal cancer differs from the other two most common cancers,breast and lung,in that routine surveillance is recommended with the specific intent of detecting liver and...Clinical practice with respect to metastatic colorectal cancer differs from the other two most common cancers,breast and lung,in that routine surveillance is recommended with the specific intent of detecting liver and lung metastases and undertaking liver and lung resections for their removal.We trace the history of this approach to colorectal cancer by reviewing evidence for effectiveness from the 1950s to the present day.Our sources included published citation network analyses,the documented proposal for randomised trials,large systematic reviews,and meta-analysis of observational studies.The present consensus position has been adopted on the basis of a large number of observational studies but the randomised trials proposed in the 1980s and 1990s were either not done,or having been done,were not reported.Clinical opinion is the mainstay of current practice but in the absence of randomised trials there remains a possibility of selection bias.Randomised controlled trials(RCTs)are now routine before adoption of a new practice but RCTs are harder to run in evaluation of already established practice.One such trial is recruiting and shows that controlled trial are possible.展开更多
背景与目的肺部切除术后慢性咳嗽是最常见的并发症之一,严重影响患者术后生活质量,目前国内尚无关于肺部切除术后慢性咳嗽预测模型。因此,本研究旨在探讨肺部切除术后慢性咳嗽相关危险因素,构建预测模型并进行验证。方法回顾性分析2021...背景与目的肺部切除术后慢性咳嗽是最常见的并发症之一,严重影响患者术后生活质量,目前国内尚无关于肺部切除术后慢性咳嗽预测模型。因此,本研究旨在探讨肺部切除术后慢性咳嗽相关危险因素,构建预测模型并进行验证。方法回顾性分析2021年1月至2023年6月于中国科学技术大学附属第一医院接受肺部切除术的499例患者的临床资料和术后咳嗽情况,按7:3随机分配原则分为训练集(n=348)和验证集(n=151),根据训练集患者术后是否慢性咳嗽分为咳嗽组和非咳嗽组。使用中文版莱斯特咳嗽问卷(The Mandarin-Chinese version of Leicester cough questionnare,LCQ-MC)评估术前、术后咳嗽的严重程度及其对患者生活质量的影响,采用咳嗽视觉模拟量表(visual analog scale,VAS)和自拟的数字评分法(numerical rating scale,NRS)评估术后慢性咳嗽,采用单因素和多因素Logistic回归分析独立危险因素和模型构建,受试者工作特征(receiver operator characteristic,ROC)曲线评估模型区分度,校准曲线评估模型的一致性,绘制决策曲线分析(decision curve analysis,DCA)评估模型的临床应用价值。结果多因素Logistic分析筛选出术前用力呼气第1秒呼气量与用力肺活量比(forced expiratory volume in the first second/forced vital capacity,FEV_(1)/FVC)、手术方式、行上纵隔淋巴结清扫、行隆突下淋巴结清扫、术后胸腔闭式引流时间是术后慢性咳嗽的独立危险因素,基于多因素分析结果构建列线图预测模型。ROC曲线下面积为0.954(95%CI:0.930-0.978),最大约登指数所对应的临界值为0.171,此时敏感度为94.7%,特异度为86.6%。Bootstrap法抽样1000次,校准曲线图预测的肺部切除术后慢性咳嗽与实际发生风险高度一致。DCA显示当预测模型概率的预概率为0.1-0.9之间,患者表现为正的净收益。结论肺部切除术后慢性咳嗽严重影响患者生活质量。列线图的可视化展现形式有助于准确预测肺部切除术后慢性咳嗽,为临床决策提供支持。展开更多
基金Supported by the Ministry of Health of the Czech Republic,no.16-28375A to Mohelnikova-Duchonova B
文摘AIM To analyze pancreatic cancer patients who developed metachronous pulmonary metastases(MPM) as a first site of recurrence after the curative-intent surgery.METHODS One-hundred-fifty-nine consecutive pancreatic ductal adenocarcinoma(PDAC) patients who underwent radical pancreatic surgery between 2006 and 2013 were included in this retrospective analysis. The clinical data including age, sex, grade, primary tumor location, p TNM stage, lymph node infiltration, microangioinvasion, perineural invasion, lymphovascular invasion, the therapy administered, and follow-up were all obtained from medical records. Further analysis covered only patients with metachronous metastases. Clinical and histopathological data(age, sex, grade, primary tumor location, p TNM stage, lymph node infiltration, microangioinvasion, perineural invasion, lymphovascular invasion, the therapy administered and follow-up) of patients with metachronous non-pulmonary metastases and patients with metachronous pulmonary metastases were statistically assessed. Disease-free survival(DFS) from pancreas resection until metastases onset and overall survival(OS) were calculated. Wilcoxon test, χ~2 test and survival functions computed by the KaplanMeier method were used. Statistical significance was evaluated by the log-rank test using SPSS. A P-value of less than 0.05 was considered statistically significant.RESULTS Metachronous pulmonary metastases were observed in 20(16.9%) and were operable in 3(2.5%) of PDAC patients after a prior curative-intent surgery. Patients with isolated pulmonary metastases(oligometastases and multiple metastases) had estimated prior DFS and OS of 35.4 and 81.4 mo, respectively, and those with metachronous pulmonary metastases accompanied by other metastases had prior DFS and OS of 17.3 and 23.4 mo, respectively. Patients with non-pulmonary metastases had prior DFS and OS of 9.4 and 15.8 mo, respectively. Different clinical scenarios according to the presentation of MPM were observed and patients could be divided to three subgroups with different prognosis which could be used for the selection of treatment strategy: isolated pulmonary oligometastases, isolated multiple pulmonary metastases and pulmonary metastases accompanied by other metastases.CONCLUSION Surgery should be considered for all patients with isolated pulmonary oligometastases, but the risk of intervention has to be individually weighted for each patient.
文摘Actinomycosis is an uncommon disease, which is usually manifested as cervicofacial infection; related to poor oral hygiene or compromised immune function. Pulmonary actinomycosis is rare, but its diagnosis is changing due to its variable presentation; the similarity in appearance to other intrapulmonary diseases. Here we report an 80-year-old man with a solitary pulmonary nodule over the left upper lobe. Pulmonary neoplasm was highly suspected in this patient; thus resection of the mass was undertaken through video-assisted thoracic surgery (VATS). Histopathological examination demonstrated this patient had an Actinomyeces infection. While the application of VATS in patients with pulmonary actinomycosis has rarely been reported in literature, we conclude that VATS is valuable for the diagnosis; treatment of patients with undetermined pulmonary nodule(s).
文摘AIM: To evaluate the outcomes of surgery for lung cancer after induction therapy.METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program(ACSNSQIP) database(2005-2012), we identified 4063 patients who underwent a pulmonary resection for lung cancer. Two hundred and thirty-six(5.8%) received neo-adjuvant therapy prior to surgery(64 chemo-radiation, 103 radiation alone, 69 chemotherapy alone). The outcomes were compared to 3827 patients(94.2%) treated with surgery alone. Primary outcome was 30-d mortality, and secondary outcomes included length of stay, operative time and NSQIP measured postoperative complications.RESULTS: Lung cancer patients who received preoperative treatment were younger(66 vs 69, P < 0.001), were more likely to have experienced recent weight loss(6.8% vs 3.5%; P = 0.011), to be active smokers(48.3 vs 34.9, P < 0.001), and had lower preoperative hematological cell counts(abnormal white blood cell: 25.6 vs 13.4; P < 0.001; low hematocrit 53% vs 17.3%, P < 0.001). On unadjusted analysis, neo-adjuvant patients had significantly higher 30-d mortality, overall and serious morbidity(all P < 0.001). Adjusted analysis showed similar findings, while matched cohorts comparison confirmed higher morbidity, but not higher early mortality.CONCLUSION: Our data suggest that patients who receive neo-adjuvant therapy for lung cancer have worse early surgical outcomes. Although NSQIP does not provide stage information, this analysis shows important findings that should be considered when selecting patients for induction treatment.
文摘Introduction: Prolonged air leak (PAL) is a common complication following pulmonary resection. It is associated with pneumonia, empyema, increased length of hospital stay and health-care costs. Intraoperative techniques have been developed to mitigate the risk of developing a PAL, but for their use to be efficient, identification of patients at risk for PAL is necessary. Aim: To determine the incidence of PAL following lobectomy and lesser pulmonary resections, risk factors for development of PALs, and the impact of PAL on hospital stay and readmission rates. Methods: The following variables were analyzed as PAL risk factors: patient characteristics of age, sex, body mass index (BMI), forced minute expiratory volume and capacity ratio (FEV1 and FEV1/FVC), diffusion capacity (DCLO), and transplant recipient status. Validated scoring systems included the Charlson Comorbidity Index (CCI), Medical Research Council (MRC) dyspnea score, and Eastern Cooperative Oncology Group (EGOC) score. Surgical factors included surgical technique, unplanned conversion from video-assisted thoracoscopic surgery (VATS) to thoracotomy, location and extent of resection, presence of adhesions, completeness of fissures, and method of fissure completion. Length of hospital stay and readmission rates were analyzed. Statistical tests performed on the data include univariate and multivariate logistic regression analyses. Results: Over the 9-month study duration there were 269 lung resections, of which 31 (11.52%) had an air leak lasting longer than 5 days. Mean length of stay in hospital was significantly longer in patients with PAL compared to the control group (13 vs 5 days, P P = 0.009), right upper lobectomy (P = 0.001), and unplanned conversion from video-assisted thoracoscopic surgery (VATS) to thoracotomy (P = 0.023). Conclusion: The incidence of PAL in our study population is similar to that found in previous studies. PAL prolongs hospital length of stay. Normal BMI, right upper lobectomy, and unplanned conversion from VATS to thoracotomy are risk factors for PAL.
文摘Objective This study is to analyse the clinical feature and risk factors of morbidity after pulmonary resection for lung cancer in patients older than 70 years. Methods The clinical records of 222 patients older than 70 years who had undergone pulmonary resection for their lung cancer were reviewed. The patients were divided into 3 groups,group I including the patients who had
基金Supported by Hunan Provincial Natural Science Foundation of China,No.2022JJ40247,No.2022JJ40256。
文摘BACKGROUND Pulmonary mucormycosis is a rare but life-threatening invasive fungal infection that mostly affects immunocompromised patients.This disease usually develops acutely and progresses rapidly,often leading to a poor clinical prognosis.Chronic pulmonary mucormycosis is highly unusual in immunocompetent patients.CASE SUMMARY A 43-year-old man,who was a house improvement worker with a long history of occupational dust exposure,presented with an irritating cough that had lasted for two months.The patient was previously in good health,without dysglycemia or any known immunodeficiencies.Chest computed tomography revealed a mass in the left lower lobe,measuring approximately 6 cm in diameter,which was suspected to be primary lung carcinoma complicated with obstructive pneumonia.Thoracoscopic-assisted left lower lobectomy was performed,and metagenomic next-generation sequencing detection,along with special pathological staining of surgical specimens,suggested Rhizopus microsporus infection.Postoperatively,the patient’s respiratory symptoms were relieved,and no signs of recurrence were found during the six-month follow-up.CONCLUSION This article reports a rare case of chronic pulmonary mucormycosis caused by Rhizopus microsporus in a middle-aged male without dysglycemia or immunodeficiency.The patient’s surgical outcome was excellent,reaffirming that surgery remains the cornerstone of pulmonary mucormycosis treatment.
基金supported by the Open Foundation of Hubei Key Laboratory(China Three Gorges University)of Tumor Microenvironment and Immunotherapy(No.2022KZL1-08).
文摘Objective:To explore factors related to postoperative pulmonary infection in lung cancer patients after recovery from COVID-19 and to provide methods for preventing and reducing the incidence of postoperative lung infection in patients with lung cancer.Methods:A total of 92 patients who underwent lung cancer surgery in the Department of Thoracic and Cardiac Surgery of Yichang Central People’s Hospital from January 28,2023,to March 3,2023,were selected.They were divided into a pulmonary infection group(47 cases)and a nonpulmonary infection group(45 cases)according to whether pulmonary infection occurred.General clinical data of patients were collected and collated to analyse the related influencing factors of pulmonary infection in lung cancer patients after recovery from COVID-19.Results:Univariate analysis showed that patient age(≥60 years),fever after COVID-19 infection,oral and laryngeal symptoms,digestive tract symptoms,neurological symptoms,long-term smoking history,hypertension history,and operation time(≥3 h)were correlated with pulmonary infection(all P<0.05).There was no significant correlation between postoperative pulmonary infection and sex,ocular,nasal and tongue symptoms,systemic symptoms,duration of COVID-19,COPD,lobectomy site,incision pain,mechanical ventilation time(≥6 h),drainage tube retention time(3 d),surgical method(P>0.05).Logistic multivariate analysis showed that age(≥60 years old),long operation time(≥3 h)and long-term smoking history were independent influencing factors for postoperative pulmonary infection in patients with radical resection of lung cancer(P>0.05).Conclusion:In this study,older age(≥60 years old),long-term smoking history,and long operation time(≥3 h)were risk factors for pulmonary infection after lung cancer surgery.In the future,active treatment measures can be taken to address these risk factors during the perioperative period to reduce the incidence of postoperative pulmonary infection.
文摘Congenital pulmonary airway malformation(CPAM), previously known as congenital cystic adenomatoid malformation is a congenital disorder of the lung similar to bronchopulmonary sequestration. In CPAM, usually an entire lobe of lung is replaced by a non-working cystic piece of abnormal lung tissue. This abnormal tissue will never function as normal lung tissue. The underlying cause for CPAM is not known. It occurs in approximately 1 in every 30000 pregnancies. The association between CPAM and malignancy has been well documented. There is a small risk(0.7%) of malignant transformation within the cyst. So early diagnosis and surgical resection is important to prevent the grave complications. Herein, we are reporting two interesting cases of CPAM and one belonged to Type Ⅱ and other belonged to Type Ⅲ of Stocker's classification.
基金Supported by The British Heart Foundation(to Fiorentino F)
文摘Clinical practice with respect to metastatic colorectal cancer differs from the other two most common cancers,breast and lung,in that routine surveillance is recommended with the specific intent of detecting liver and lung metastases and undertaking liver and lung resections for their removal.We trace the history of this approach to colorectal cancer by reviewing evidence for effectiveness from the 1950s to the present day.Our sources included published citation network analyses,the documented proposal for randomised trials,large systematic reviews,and meta-analysis of observational studies.The present consensus position has been adopted on the basis of a large number of observational studies but the randomised trials proposed in the 1980s and 1990s were either not done,or having been done,were not reported.Clinical opinion is the mainstay of current practice but in the absence of randomised trials there remains a possibility of selection bias.Randomised controlled trials(RCTs)are now routine before adoption of a new practice but RCTs are harder to run in evaluation of already established practice.One such trial is recruiting and shows that controlled trial are possible.
文摘背景与目的肺部切除术后慢性咳嗽是最常见的并发症之一,严重影响患者术后生活质量,目前国内尚无关于肺部切除术后慢性咳嗽预测模型。因此,本研究旨在探讨肺部切除术后慢性咳嗽相关危险因素,构建预测模型并进行验证。方法回顾性分析2021年1月至2023年6月于中国科学技术大学附属第一医院接受肺部切除术的499例患者的临床资料和术后咳嗽情况,按7:3随机分配原则分为训练集(n=348)和验证集(n=151),根据训练集患者术后是否慢性咳嗽分为咳嗽组和非咳嗽组。使用中文版莱斯特咳嗽问卷(The Mandarin-Chinese version of Leicester cough questionnare,LCQ-MC)评估术前、术后咳嗽的严重程度及其对患者生活质量的影响,采用咳嗽视觉模拟量表(visual analog scale,VAS)和自拟的数字评分法(numerical rating scale,NRS)评估术后慢性咳嗽,采用单因素和多因素Logistic回归分析独立危险因素和模型构建,受试者工作特征(receiver operator characteristic,ROC)曲线评估模型区分度,校准曲线评估模型的一致性,绘制决策曲线分析(decision curve analysis,DCA)评估模型的临床应用价值。结果多因素Logistic分析筛选出术前用力呼气第1秒呼气量与用力肺活量比(forced expiratory volume in the first second/forced vital capacity,FEV_(1)/FVC)、手术方式、行上纵隔淋巴结清扫、行隆突下淋巴结清扫、术后胸腔闭式引流时间是术后慢性咳嗽的独立危险因素,基于多因素分析结果构建列线图预测模型。ROC曲线下面积为0.954(95%CI:0.930-0.978),最大约登指数所对应的临界值为0.171,此时敏感度为94.7%,特异度为86.6%。Bootstrap法抽样1000次,校准曲线图预测的肺部切除术后慢性咳嗽与实际发生风险高度一致。DCA显示当预测模型概率的预概率为0.1-0.9之间,患者表现为正的净收益。结论肺部切除术后慢性咳嗽严重影响患者生活质量。列线图的可视化展现形式有助于准确预测肺部切除术后慢性咳嗽,为临床决策提供支持。
