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电视纵隔镜手术诊治胸部疾病36例

目的 探讨电视纵隔镜检查术( videomediastinoscopy, VM)在肺癌术前分期、纵隔疾病诊断中的价值。方法 自2006年2月至2007年4月，我们采用电视纵隔镜对36例拟诊为肺癌、纵隔肿物患者进行检查，33例经颈部行纵隔镜术，采用全身麻醉单腔气管内插管；3例经肋间行纵隔镜术，采用全身麻醉双腔气管内插管。 结果 除术前纤维支气管镜检查确诊4例外，余30例均经电视纵隔镜术检查后确诊；2例诊断不明或可能误诊，其中1例转院失访，另1例经开胸活检证实为肺大B细胞淋巴瘤。平均手术时间55min，平均出血量40ml，术后无死亡患者，无切口感染；发生并发症2例，1例出血，经止血纱布填压止血；1例喉返神经麻痹，经中医针灸治疗后好转。 结论 电视纵隔镜术是肺癌术前病理分期、纵隔疾病的重要检查方法，具有诊断准确率高、安全可靠等优点。

左肺上叶支气管脂肪瘤一例

右肺移植同期行左肺减容术一例

目的 探讨单肺移植术后对患者长期生存的影响因素，可能的干预措施。 方法 2004年7月我院对1例慢性阻塞性肺病（COPD）患者施行右肺移植，并同期行左肺减容术；随访观察3年来的肺功能、肝功能、免疫抑制剂血浓度、胸部CT以及治疗情况等。 结果 患者行肺移植术后肺功能第1秒用力呼气容积（FEV1.0)实测值占预计值的59.0%(1.97/3.34)，最大通气量(MVV)实测值占预计值的642%(79.24/123.36），较术前明显改善（Plt;0.05）［FEV1.0实测值占预计值的14.2%(0.47/3.30)，MVV实测值占预计值的11.4%(13.98/122.23）］；因使用免疫抑制剂而反复出现肺结核菌等感染，抗结核等治疗加重肝损害；血液环孢素浓度波动不大；CT检查示移植肺情况较稳定而左肺气肿呈现加重趋势。 结论 单肺移植是治疗终末期肺部疾病的有效方法，但术后并发症较多，积极有效地预防和治疗有助于其长期生存。

Application of indocyanine green fluorescence dual-visualization technique in evaluating intraoperative tumor margins during the thoracoscopic segmentectomy

ObjectiveTo analyze the effect of indocyanine green (ICG) fluorescence dual-visualization technique on evaluating tumor margins during the thoracoscopic segmentectomy. MethodsA total of 36 patients who underwent thoracoscopic anatomical segmentectomy using ICG fluorescence dual-visualization technique in our hospital from December 2020 to June 2021 were retrospectively included. There were 15 males and 21 females aged from 20 to 69 years. The clinical data of the patients were retrospectively analyzed. ResultsThe ICG fluorescence dual-visualization technique clearly showed the position of lung nodules and the plane boundary line between segments during the operation. There was no ICG-related complication. The average operation time was 98.6±21.3 min, and the average intraoperative bleeding amount was 47.1±35.3 mL, the average postoperative drainage tube placement time was 3.3±2.8 d, the average postoperative hospital stay was 5.4±1.8 d, and the average tumor resection distance was 2.6±0.7 cm. There was no perioperative period death, and one patient suffered a persistent postoperative air leak. ConclusionThe ICG fluorescence dual-visualization technique is safe and feasible for evaluating the tumor margins during thoracoscopic segmentectomy. It simplifies the surgical procedure, shortens the operation time, ensures sufficient tumor margins, and reserves healthy pulmonary parenchyma to the utmost extent, providing reliable technical support for thoracoscopic anatomical segmentectomy.

Application of Body Tom® mobile CT combined with basic anesthesia in preoperative painless localization of small pulmonary nodules: A retrospective cohort study

Objective To explore the application of Body Tom® mobile CT combined with basic anesthesia in preoperative painless positioning of small pulmonary nodules, and evaluate its safety and effectiveness. Methods Patients using mobile Body Tom® CT to accurately locate pulmonary nodules in the Department of Thoracic Surgery of Affiliated Nanjing Brain Hospital, Nanjing Medical University from August to October 2022 were retrospectively included. Clinical data of the whole patient group were analyzed. ResultsWe finally included 30 patients with 12 males and 18 females at age of 23-71 years. The position success rate of 30 patients with small pulmonary nodules was 100.0%. Location time was 14.20±4.07 min. There was one patient of intrapulmonary hemorrhage, with no other complications such as pneumothorax, positioning needle shedding, or pleural reaction. The time from the end of positioning to the start of surgery was 12.63±5.68 min. There was no needle migration or indocyanine green overflow. All patients completed resection of small pulmonary nodules under single-port thoracoscopy, no transit to opening chest. The average operation time was 85.32±12.60 min. There was no postoperative complications, and the average postoperative chest tube retention time was 2.12±1.34 days. And the average length of hospital stay was 3.52±1.45 days. The postoperative pathological results showed that the distance from the nodules was greater than 2 cm. Conclusion Body Tom® mobile CT combined with basic anesthesia can achieve the preoperative painless, precise positioning of pulmonary nodules, effectively reduce the incidence of preoperative positioning complications, shorten the operation waiting time, ensure the safety and effectiveness of patients with preoperative pulmonary nodules positioning, and further improve the surgical comfort of patients, which has certain clinical application value.

Clinical application of basic anesthesia combined with local anesthesia in preoperative localization of multiple pulmonary nodules: A retrospective cohort study

Objective To evaluate the safety and efficacy of basic anesthesia combined with local anesthesia in the preoperative localization of multiple pulmonary nodules. Methods The clinical data of 200 patients who underwent preoperative localization for multiple pulmonary nodules resection under single-port thoracoscopy in Nanjing Brain Hospital from July 2023 to September 2023 were extracted. They were divided into a group A and a group B, according to the localization method. The group A consisted of 100 patients who were localized under local anesthesia, and the group B consisted of 100 patients who were localized with basic anesthesia combined with local anesthesia. The basic clinical characteristics, localization success rate, incidence of localization complications, localization time, and pain score of the two groups were compared and analyzed. Results The incidence of localization complications (4% vs. 13%), localization time [(19.9±8.66) min vs. (15.23± 5.98) min], and pain score (2.01±2.09 vs. 3.29± 2.54, P≤0.05) in the group B were significantly lower than those in the group A, and the differences were statistically significant. The localization success rate of the group B was significantly higher than that of the group A (98% vs. 92%, P≤0.05), and the difference was statistically significant. Conclusion Basic anesthesia combined with local anesthesia for preoperative localization of multiple pulmonary nodules under mobile CT has the advantages of short localization time, fewer localization complications, high safety, high success rate, and high patient comfort, and has certain clinical promotion value.

Long-term prognosis after sublobar resection for T1a-bN0M0 non-small cell lung cancer: A propensity-score matching study

ObjectiveTo evaluate the long-term survival of patients with T1a-bN0M0 non-small cell lung cancer (NSCLC) after sublobar resection. MethodsPatients with T1a-bN0M0 NSCLC who underwent sublobar resection from 2004 to 2015 were selected from the Surveillance, Epidemiology, and End Results (SEER) database, and divided into a segmentectomy group and a wedge resection group according to the resection method. After propensity-score matching (PSM) at a ratio of 1:1, the overall survival (OS) and disease-specific survival (DSS) of patients were analyzed using Cox regression model, log-rank test, and restricted mean survival time (RMST). ResultsA total of 3262 patients were included in the study, including 1321 males and 1941 females, with a median age of 69.0 years. Among them, 2419 patients were in the wedge resection group and 843 patients were in the segmentectomy group. After matching, 843 pairs of patients were obtained. The results showed that the DSS death risk of the segmentectomy group was lower than that of the wedge resection group [HR=0.82, 95%CI (0.68, 0.98), P=0.030], but there was no statistical difference in the OS death risk [HR=0.90, 95%CI (0.79, 1.02), P=0.107]. The 10-year DSS rate (68.0% vs. 60.6%, P=0.011) and 10-year OS rate (40.8% vs. 37.0%, P=0.049) of the segmentectomy group were better than those of the wedge resection group, while there was no statistical difference in the 5-year DSS rate (82.9% vs. 79.5%, P=0.112) or 5-year OS rate (68.9% vs. 64.9%, P=0.096). Subgroup analysis showed that segmentectomy had a better 10-year OS-RMST in patients with adenocarcinoma (P=0.045), right lower lobe tumor (P=0.014), and tumor diameter≤1.6 cm (P=0.006). ConclusionIncreasing lymph node dissection during sublobar resection may improve prognosis. Compared with wedge resection, segmentectomy may improve the long-term DSS rate of patients with T1a-bN0M0 NSCLC.

Comparative study of fluorescence and inflation-deflation methods in defining the intersegmental plane in thoracoscopic anatomical lung segmentectomy

ObjectiveTo analyze the feasibility, advantages and disadvantages of the fluorescence method and the inflation-deflation method in defining the intersegmental plane during thoracoscopic lung segmental resection.MethodsFrom February to October 2018, 60 patients underwent thoracoscopic anatomical segmentectomy in Thoracic Surgery Department of Nanjing Chest Hospital, with 28 males and 32 females, aged from 25 to 82 years. Three-dimension computed tomography bronchography and angiography was used to reconstruct pulmonary vessels, bronchus and virtual intersegmental plane. Among them, 20 patients used the fluorescence method to define the intersegmental plane, and the other 40 patients used the traditional inflation-deflation method to define the intersegmental plane.ResultsFluorescent injection of indocyanine green (ICG) showed a clear intersegmental line with a duration sufficient to complete the label. With the fluorescence method, the intersegmental plane occurrence time was significantly shortened (10.75±3.78 s vs. 988.00±314.24 s, P<0.001) and had satisfactory repeatability. The lungs did not need to be inflated, which was convenient for the operation. And the operation time was shortened (108.75±31.28 min vs 138.00±32.47 min, P=0.002). No obvious ICG injection-related concurrency symptoms was found.ConclusionCompared with the traditional inflation-deflation method, the fluorescence method can display the intersegmental line quickly, accurately and clearly, reduce the difficulty of surgery, shorten the operation time, and provide reliable technical support for thoracoscopic anatomical segmentectomy. The fluorescence is a safe and effective method that is worthy of clinical application.

Indocyanine green fluorescence identification of the intersegmental plane by preferentially ligating the target pulmonary vein during thoracoscopic segmentectomy

Objective To explore the feasibility and accuracy of using indocyanine green fluorescence (ICGF) to identify the intersegmental plane after ligation of the target pulmonary vein during thoracoscopic segmentectomy. Methods From December 2022 to June 2023, the patients with pulmonary nodules undergoing video-assisted thoracoscopic anatomical segmentectomy with intersegmental plane displayed using ICGF after ligation of the target pulmonary vein by the same medical team in our hospital were collected. Preoperative three-dimensional reconstruction was used to identify the target segment where the pulmonary nodule was located and the anatomical structure of the arteries, veins, and bronchi in the target segment. The intersegmental plane was first determined by the inflation-deflation method after the target pulmonary vein was ligated during the operation. During the waiting period, the target artery and bronchus could be separated but not cut off. The inflation-deflation boundary was marked by electrocoagulation, and then ICGF was injected via peripheral vein to identify the intersegmental plane again, and the consistency of the two intersegmental planes was finally evaluated. Results Finally 32 patients were collected, including 14 males and 18 females, with an average age of 58.69±11.84 years, ranging from 25 to 76 years. The intersegmental plane determined by inflation-deflation method was basically consistent with ICGF method in all patients. All the 32 patients successfully completed uniportal thoracoscopic segmentectomy without ICGF-related complications or perioperative death. The average operation time was 98.59±20.72 min, the average intraoperative blood loss was 45.31±35.65 mL, and the average postoperative chest tube duration was 3.50±1.16 days. The average postoperative hospital stay was 4.66±1.29 days, and the average tumor margin width was 26.96±5.86 mm. Conclusion The ICGF can safely and accurately identify the intersegmental plane by target pulmonary venous preferential ligation in thoracoscopic segmentectomy, which is a useful exploration and important supplement to the simplified thoracoscopic anatomical segmentectomy.

电视纵隔镜在胸部疾病诊断与治疗中的应用

摘要: 　目的　探讨电视纵隔镜在胸部疾病诊断和治疗中的应用价值, 总结其临床经验。　方法　对2006 年3 月至2007 年5 月开展的47 例电视纵隔镜手术资料进行回顾性分析, 其中经颈部纵隔镜手术38 例, 左胸纵隔镜手术8 例,右胸纵隔镜手术1 例。　结果　本组手术时间10～ 100m in, 平均44. 2min; 术中出血5～ 200ml, 平均33. 5ml 。肺癌术前分期12 例, 纵隔淋巴结病理检查阴性4 例, 阳性8 例, 均与开胸手术后检查结果相符, 其敏感性、特异性、准确性均为100%。纵隔疑难疾病诊断31 例, 经过纵隔镜手术后30 例(96. 8%) 明确诊断, 其中恶性肿瘤16 例, 分别为纵隔转移性肿瘤8 例、纵隔淋巴瘤3 例, 恶性纤维组织细胞瘤、食管鳞状细胞癌、促纤维组织增生性小圆细胞肿瘤、胸腺类癌、淋巴上皮癌各1 例; 良性疾病14 例, 分别为结节病8 例、慢性淋巴结炎4 例、纵隔淋巴结结核2 例。纵隔镜辅助纵隔或肺部病变切除4 例, 均顺利完成手术。本组手术无死亡及严重并发症发生, 均治愈出院。　结论　电视纵隔镜手术安全、可靠,可作为纵隔疑难疾病诊断和鉴别诊断的有效方法以及肺癌术前分期的金标准。