目的探讨食管多源癌的诊断及治疗方法。 方法回顾性分析2008年3月至2009年11月在四川大学华西医院行手术治疗的15例食管多源癌患者的临床资料，其中男14例，女1例，中位年龄62.5（48～75）岁。15例行手术治疗食管多源癌的患者中，行Sweet术式8例，左胸-左颈两切口4例，胸腹腔镜联合McKeown术式2例，开胸探查而未能切除肿瘤1例。 结果术前确诊11例，术前确诊率为73.3%（11/15）。术后1例发生肺部并发症，3例发生吻合口瘘，围术期无死亡。除肿瘤未能切除的患者外，随访13例，随访5年，1年生存率61.5%（8/13）、3年生存率30.8%（4/13）、5年生存率15.4%（2/13）。第一病灶位置与预后关系密切，第一病灶位于胸上段的食管多源癌患者，其中5例顺利完成手术，吻合部位均在颈部，2例食管残端存在癌残留（R1），1年内死亡3例，无1例获得3年生存。第一病灶位于胸中、下段的9例食管多源癌患者均完成根治性切除，食管及胃残端均无癌残留（R0），1年生存率75.0%，3年生存率50.0%，2例获得5年长期生存。 结论对于食管多源癌，如第一病灶位于胸中、下段，首选手术治疗。如第一病灶位于胸上段，不宜首选手术治疗，这类患者采用新辅助放化疗后再手术或直接采用其他治疗模式，这需要以后进一步研究比较。
ObjectiveTo evaluate clinical outcomes of single utility port video-assisted thoracoscopic surgery (VATS) lobectomy for patients with early-stage peripheral non-small cell lung cancer. MethodsWe retrospectively analyzed the clinical data of 46 consecutive patients with early-stage peripheral non-small cell lung cancer who underwent single utility port complete VATS lobectomy in the First Affiliated Hospital of Hebei north University from December 2012 through November 2014. There were 39 male patients and 7 female patients with their age of 42-76 (60.26±4.38) years (VATS group). There were 58 patients with early-stage peripheral non-small cell lung cancer who underwent lobectomy via traditional thoracotomy including 47 male and 11 female patients with their age of 44-73 (61.42±3.67) years for the same period (conventional thoracotomy group). Clinical outcomes were compared between the two groups. ResultsAll the operations were successful. There was no conversions during single utility port VATS lobectomy, and no periopera-tive death in both groups. The VATS group had significantly less blood loss (126.10±48.56 ml vs. 260.84±69.70 ml), and amount of thoracic drainage (230.52±50.22 ml vs. 380.16±96.24 ml, P<0.05). Hospital stay was significantly shorter in the VATS group than the conventional thoracotomy group (6.42±1.40 days vs. 9.64±2.08 days, P<0.05). However, there was no significant difference between the VATS group and the conventional thoracotomy group with regard to the opera-ting time (146.25±19.68 minutes vs. 139.26±25.39 minutes), number of lymph nodes procured (13.56±2.31 vs. 14.12±3.06), and postoperative complications (13.0% vs. 19.0%, P>0.05). ConclusionSingle utility port VATS lobectomy for patients with early-stage peripheral non-small cell lung cancer is technically feasible, with less blood loss and shorter hospital stays for achieving acceptable standards of lymph node dissection. It is a promising surgical procedures for patients with early-stage peripheral non-small cell lung cancer.
Objective To analyze the effects of different surgical methods on postoperative pulmonary function and exercise capacity in patients with non-small cell lung cancer (NSCLC), so as to explore whether it can effectively improve pulmonary function and promote the recovery of exercise capacity by reducing the number of trocars ports and the resection of normal lung tissues. Methods The clinical data of NSCLC patients who underwent surgery in the First Affiliated Hospital of Hebei North University from January 2016 to June 2019 were collected retrospectively. According to the surgical methods, they were divided into three groups: single utility port video-assisted thoracic surgery (SP-VATS) segmentectomy group, SP-VATS lobectomy group and three port video-assisted thoracic surgery (TP-VATS) lobectomy group. The changes of pulmonary function [forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), maximal voluntary ventilation (MVV)] and 6-minute walking distance (6MWD) at different time points [1st day before the operation (T0); 3rd day (T1), 7th day (T2), 1st month (T3), 3rd month (T4), 6th month (T5) and 1st year (T6) after the operation] were compared among the three groups. Results A total of 342 patients were included, including 102 in SP-VATS segmentectomy group, 116 in SP-VATS lobectomy group and 124 in TP-VATS lobectomy group. Except for pathological type and TNM stage (P<0.05), there was no significant difference in general information, preoperative pulmonary function or 6MWD among the three groups (P>0.05). The pulmonary function and 6MWD of the three groups before and after operation were not affected by pathological type or TNM stage (P>0.05). Except at T6 time point (P>0.05), there were significant differences in postoperative pulmonary function and 6MWD among the three groups at T1-T5 time points (P<0.05). Intra group comparison of pulmonary function and 6MWD in the three groups showed that the operation had the least impact on patients in SP-VATS segmentectomy group with the fastest recovery, followed by SP-VATS lobectomy group, and SP-VATS lobectomy group was the worst. Conclusions Video-assisted thoracoscopic for NSCLC can improve pulmonary function and promote the recovery of exercise capacity by reducing the number of trocars ports and the resection of normal lung tissues. However, this advantage is mainly reflected in the early postoperative stage.
ObjectiveTo evaluate the clinical effects of segmentectomy versus lobectomy under single utility port video-assisted thoracic surgery on inflammatory factors and immune cells in peripheral blood of non-small cell lung cancer patients, and to analyze the effect of changes of postoperative inflammatory factors and immune cells on the prognosis of the patients.MethodsThe clinical data of 256 patients who underwent segmentectomy or lobectomy under single utility port video-assisted thoracic surgery for non-small cell lung cancer in the First Affiliated Hospital of Hebei North University from January 2016 to October 2020 were retrospectively collected. According to the operation method, they were divided into a segmentectomy group (126 patients with 79 males and 47 females at an age of 63.4±6.2 years) and a lobectomy group (130 patients with 91 males and 39 females at an age of 62.9±5.6 years). The change of inflammatory factors (C reactive protein, interleukin-6, interleukin-8, tumor necrosis factor-α) and immune cells (CD4+T cells, CD8+T cells and natural killer cells) were recorded and analyzed before operation (T0) and 1 day (T1), 3 days (T2), 7 days (T3), 1 month (T4) after the operation between the two groups. According to postoperative recurrence situations, they were divided into a recurrence group and a non-recurrence group, multivariate logistic regression analysis was used to analyze the relationship between the change of postoperative inflammatory factors, immune cells, and the prognosis of patients with non-small cell lung cancer.Results(1) There was no statistical difference in sex ratio, underlying diseases, body mass index, levels of preoperative inflammatory factors or immune cells between the two groups (all P>0.05). (2) The changes of postoperative inflammatory factors in the segmentectomy group were significantly less than those in the lobectomy group at T1-T3 (all P<0.05), and the changes of postoperative immune cells in the segmentectomy group were significantly less than those in the lobectomy group at T1-T4 (all P<0.05). (3) The changes of postoperative inflammatory factors and immune cells on postoperative day 3 in the recurrence group were significantly more than those in the non-recurrence group (all P<0.05). (4) Multivariate logistic regression analysis showed that the changes of postoperative inflammatory factors and immune cells on postoperative day 3 may be the risk factors for postoperative recurrence and metastasis in patients with non-small cell lung cancer (all P<0.05).ConclusionSingle utility port video-assisted thoracic surgery segmentectomy for the treatment of non-small cell lung cancer can reduce the inflammatory response and protect body's immune function, and the change of postoperative inflammatory factors and immune cells in postoperative day 3 may be the risk factors for postoperative recurrence and metastasis in patients with non-small cell lung cancer.