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电视胸腔镜手术治疗后纵隔良性神经源性肿瘤

目的　探讨电视胸腔镜手术切除后纵隔良性神经源性肿瘤的临床疗效和价值。 方法　回顾性分析德阳市人民医院2008年3月至2012年4月运用电视胸腔镜手术切除后纵隔良性神经源性肿瘤24例的临床资料，其中男17例、女7例，年龄17～71 （41.25±14.78）岁；分析其安全性、有效性和危险性。 结果　全组24例均顺利完成手术，手术时间（114.25±52.30） min，手术出血量（214.45±123.12） ml，术中、术后输血2例，术后胸腔闭式引流时间（2.75±1.42） d，术后住院时间（7.25±3.26） d。全组24例中，19例在全胸腔镜下完成，3例哑铃型神经源性肿瘤采用胸腔镜联合背部小切口切除，2例中转开胸，中转开胸手术率8.33%。术后轻微并发症3例，无围手术期死亡。术后病理检查示神经鞘瘤10例，神经纤维瘤9例，神经节细胞瘤5例。术后24例均进行了随访，随访时间（21.23±18.56） 个月，全组均生存，无复发。 结论　利用电视胸腔镜手术治疗后纵隔良性神经源性肿瘤安全、有效，但应严格掌握手术适应证及合理的手术方式，熟练掌握电视胸腔镜手术治疗后纵隔良性神经源性肿瘤的手术技巧，能有效地降低手术风险。

电视胸腔镜手术同期治疗双侧原发性自发性气胸的临床分析

目地　探讨应用电视胸腔镜手术同期治疗双侧原发性自发性气胸的可行性、效果及术中、术后注意事项。 方法　回顾分析四川省德阳市人民医院2005年9月至2012年3月应用电视胸腔镜手术同期治疗13例双侧自发性原发性气胸的临床资料及术中、术后处理经验的临床资料，均为男性，年龄15～36 （21.5±3.2） 岁。 结果　全组患者均顺利完成手术，手术时间（102.6±21.4） min，术中出血量（65.2±18.6） ml，术后住院时间（8.6±2.3） d，全组无术中、术后死亡，无严重并发症发生。术后随访3～36个月，其中随访12例，失访1例，无气胸复发。 结论　应用电视胸腔镜手术同期治疗双侧原发性自发性气胸安全、有效，值得临床推广。

Clinical analysis on the combination of low molecular weight heparin and warfarin for acute pulmonary thromboembolism after thoracotomy

Objective To investigate the diagnosis and treatment of pulmonary thromboembolism (PTE) after thoracotomy. Methods We analyzed the clinical data of 10 patients with PTE after thoracotomy treated from January 2011 to March 2015. Among them were 8 males and 2 females, with their age ranging from 51 to 73 years old, averaging 61. Six patients had lung cancer lobectomy, and 4 had esophagus carcinoma resection. All the 10 patients suffered sudden shortness of breath, chest pain and palpitation within the first 40 hours to 128 hours after surgery, and the physical examinations revealed tachypnea, drop of blood pressure and tachycardia. The PTE diagnosis was confirmed after using echocardiography, three-dimensional imaging of CT pulmonary angiography. All the patients accepted the treatment combination of low molecular weight heparin and warfarin. Results All the patients were cured without complications like chest or wound bleeding. Follow-up checks 3 months after the surgery showed no relapses. Conclusions Thoracotomy patients are of high risks of PTE. The diagnosis should be based on imaging examinations. Treatment combination of low molecular weight heparin and warfarin has a remarkable effect in treating PTE patients after thoracotomy, which also has a low rate of bleeding complications.

胸腔镜手术治疗胸膜脂肪瘤一例

Knockdown of estrogen receptor alpha inhibits the proliferation and migration of A549 cells and the formation of transplanted tumors in nude mice

Objective To explore the effect of interfering RNA (shRNA) on biological activity of A549 cells and tumor growth in nude mice after knockdown of estrogen receptor α (ERα) gene. Methods The ERα gene in A549 cells was knocked down by shRNA. RT-PCR and Western blot were used to detect the gene expression and protein expression after knockdown; colony formation experiment was used to detect the proliferation of cells, and RT-PCR was used to detect the expression of Ki-67 and PCNA; flow cytometry was used to detect apoptosis rate; transwell assay was used to detect cell invasion ability; Western blot was used to detect the expression of epithelial cadherin (E-cad) and neuropathic cadherin (N-cad) protein. The control group and A549 cells transfected with ERα-shRNA1 were injected subcutaneously in nude mice to construct transplanted tumors. Immunohistochemistry was used to detect the expression of Ki-67 and N-cad in tumor tissues. Results Compared with the control group, after transfection of ERα-shRNA1 and ERα-shRNA2, the mRNA and protein expressions of ERα were reduced significantly (P<0.05), and shRNA1 with high interference efficiency was used for subsequent experiments. Compared with the control group, the A549 cells were transfected with ERα-shRNA1, the colony formation rate was down-regulated significantly (P<0.05), the apoptosis rate was increased significantly (P<0.05), the expression of Ki-67 and PCNA were down-regulated significantly (P<0.05), the number of invasive cells was reduced significantly, the expression of E-cad was increased, and the expression of N-cad was decreased (P<0.05). The results of tumor formation in nude mice showed that interfering with ERα expression can significantly inhibit tumor growth (P<0.05), and down-regulate the rate of Ki-67 and N-cad positive cells (P<0.05). Conclusion Knockdown of ERα inhibits the proliferation and migration ability of NSCLC cells and the occurrence and development of transplanted tumors in nude mice.

Uniportal Video-assisted Toracoscopic Surgery for 186 Patients with Benign Toracic Diseases

目的探索单操作孔电视胸腔镜手术治疗胸部良性疾病的有效性和安全性。 方法回顾性分析2008年3月至2013年4月德阳市人民医院单操作孔电视胸腔镜手术治疗胸部良性疾病186例患者的临床资料，其中男101例、女85例，年龄15～65（30.1±5.3）岁。 结果全组患者无围手术期死亡。手术时间18～88（47.2±7.6）min，术中出血量5.0～110.0（49.8±9.4）ml，患者术后住院时间7～16（9.2±2.1）d。2例因致密粘连转为辅助小切口手术。自发性气胸肺大泡切除术后当日及术后1～2 d出现持续肺漏气3例，1例肺漏气持续9 d，1例肺漏气持续10 d，1例肺漏气持续11 d，均经保守治疗治愈。切口脂肪液化4例，换药后治愈。术后肺部感染3例，经加强抗感染后治愈。随访3～24（6.8±3.2）个月，失访18例，总体随访率90.3%（168/186）。随访期间气胸复发4例，气胸压缩肺组织10%～20%，观察5～8 d自行吸收，未再次手术；肺及纵隔良性病变无复发；结核患者术后抗痨治疗12～18个月治愈。 结论单操作孔电视胸腔镜手术治疗胸部良性疾病创伤小，切口美观，患者恢复快，手术安全，对适应证患者可作为手术方式。