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非小细胞肺癌患者围术期细胞免疫功能的变化及免疫治疗

目的 观察围术期非小细胞肺癌患者细胞免疫功能的变化及应用胸腺肽α1后对机体免疫功能的影响，为临床应用免疫增强剂联合手术治疗非小细胞肺癌患者提供依据。 方法 将97例行肺叶或右全肺切除术的非小细胞肺癌患者分为两组，组1：围术期给予胸腺肽α1治疗；组2：围术期未给予胸腺肽α1治疗；对照组：另选择19例同期非肺癌而采取手术治疗的肺部疾病患者作为对照。 采用间接免疫荧光法(IFCA)测定3组围术期T细胞亚群的百分率变化。 结果 术后第1 d组1 CD4+T、CD4+T/CD8+T高于组2（CD4+T 36.92%±2.10% vs. 31.18%±7.64%; CD4+T/CD8+T 1.31±0.36 vs. 1.09±0.32;Plt;0.05），术后第3 d组1 CD4+T和CD4+T/CD8+T高于组2（CD4+T 45.66%±3.77% vs. 34.70%±8.42%; CD4+T/CD8+T 1.42±0.11 vs. 1.14±0.20; Plt;0.05）；术后第9 d CD4+T、CD4+T/CD8+T高于组2（CD4+T 47.28%±1.96% vs. 39.12%±3.10%; CD4+T/CD8+T 1.46±0.14 vs. 1.22±0.36；Plt;0.05）；术后第16 d组1 CD4+T、CD4+T/CD8+T与组2和对照组比较差异无统计学意义（Pgt;0.05）。 结论 非小细胞肺癌患者的免疫功能低下，应用胸腺肽α1后细胞免疫功能较快恢复至正常状态，对非小细胞肺癌患者早期采用手术、化疗/放疗的综合治疗有助于提高治疗效果。

胸腔镜下空洞清除术治疗空洞型肺结核

目的　探讨采用胸腔镜下空洞清除术治疗空洞型肺结核的临床效果。　方法　对 72例空洞型肺结核患者行胸腔镜下结核空洞清除术。　结果　 72例中失访 1例 ,治愈 6 9例 ,治愈率 97.2 %。6 0～ 78岁的 5 2例老年患者全部治愈 ;4 2例痰涂片阳性患者随访 1年以上 ,有 4 1例阴转 ,痰菌仍为阳性 1例 ,阴转率 97.6 %。　结论　胸腔镜下空洞清除术治疗空洞型肺结核为一种较好的治疗方法。从流行病学角度看 ,对消除老龄患者这部分传染源 ,该手术方法更有价值。

胸腔引流方法的改进

肺结核复治患者的外科治疗

Diagnosis and treatment pathway of neoadjuvant immunotherapy for esophageal cancer in Henan province

Esophageal cancer is a highly prevalent tumor species in Henan province, which brings heavy medical burden to families and society. Surgical treatment plays a dominant role in the treatment of non-advanced esophageal cancer. However, cancer cells in esophageal cancer lesions are highly invasive, postoperative recurrence and metastasis rates are pretty high. More effective systemic and comprehensive treatment is urgently needed to improve the prognosis. We invited 52 doctors in esophageal surgery, oncology, pathology, imaging, and radiation therapy of 32 hospitals at all levels in Henan province, to repeatedly negotiate and fully discuss in combination with evidence and clinical practice experience. Finally, “diagnosis and treatment pathway of neoadjuvant immunotherapy for esophageal cancer in Henan province” was formulated. In this treatment pathway, seven recommendations were proposed from seven perspectives including target population, patient evaluation, protocol selection, surgical timing, postoperative management, organ preservation, and general principles to offer reference for medical personnel related to esophageal cancer surgery.

胸腹腔镜联合切除局部晚期食管癌手术视频要点

A new classification of left apicoposterior segmental bronchus and its clinical significance

ObjectiveTo analyze a new classification of the left apicoposterior segmental bronchus and summarize its clinical significance. Methods We accessed the computed tomography imaging data of the inpatients treated in the Department of Thoracic Surgery, Henan Provincial People's Hospital between January and November 2021. We observed and classified the branching pattern of the left apicoposterior segmental bronchus (B1+2) using three-dimensional computed tomography bronchography and angiography (3D-CTBA) technique. And we filtered out the patients who underwent thoracoscopic left apicoposterior segmentectomy and analyzed their clinical data retrospectively to summarize the instructing significance of different bronchial classification in the accurate and safe operation of left apicoposterior segmentectomy. Results Finally 240 patients were collected, including 131 males and 109 females with a median age of 51.0 (19.0-77.0) years. The anatomical pattern of the left apicoposterior segmental bronchus was divided into four main types based on the branching pattern of the outer subsegmental bronchi (B1+2c): type Ⅰ 10% (24 patients), type Ⅱ 54% (130 patients) , type Ⅲ 17% (40 patients) , type Ⅳ 18% (43 patients) and other variations 1% (3 patients). Thirty-two patients smoothly underwent thoracoscopic left apicoposterior segmentectomy, including 23 patients of type Ⅰ and type Ⅱ receiving LS1+2 resection, the other 9 patients of type Ⅲ and type Ⅳ receiving LS1+2 resection (3 patients), LS1+2c resection (4 patients) and LS1+2(a+b) resection (2 patients). Conclusion This new classification systematically and concisely elucidates the branching characteristics of the left apicoposterior bronchus. Different branching types are instructive to the left apicoposterior segmentectomy.