ObjectiveTo analyze the surgical techniques and perioperative patient management of bronchial sleeve resection and plasty, carinal resection and reconstruction, and angioplasty in the treatment of locally advanced central type of lung cancer and summarize the experiences. MethodsWe retrospectively analyzed the clinical data of 21 locally advanced central type of lung cancer patients with bronchial sleeve resection and plasty, carinal resection and reconstruction, and angioplast in our hospital from December 2011 through November 2014. There were 17 males and 3 females with a mean age of 63.2±6.2 years. All operations were successful. The time of operation was 3.29±0.75 h. The hospitalization time was 25.48±22.31 days. No death ocurred during perioperative period. Postoperative complications were found in 3 patients, including 2 patients with atelectasis and 1 patient with bronchopleural fistula. ConclusionBronchial sleeve resection and plasty, carinal resection and reconstruction, and angioplasty apply to treat locally advanced central type of lung cancer not only maximally remove the lung cancer tissue, but also maximally reserve the healthy lung tissue.
Objective To investigate the feasibility and therapeutic efficacy of inverted Y-shaped self-expandable metal airway stent for complex airway diseases ( stenosis or fistula) .Methods According to the particular anatomic structure and the pathological changes of complex airway diseases, the inverted Y-shaped self-expandable metal airway stent was designed. 10 stents were implanted in 10 cases of airway complex diseases under the guidance of interventional fibroscopy and fluoroscopy. Results The inverted Y-shaped stents were placed successfully with immediate relief of the symptoms. 100% of the patients were able to be weaned fromoxygen therapy completely. Dyspnea grade improved significantly fromⅢ-Ⅳ to 0-Ⅱ,and oxygen saturation elevated from ( 85 ±5) % in inspiring high concentration oxygen to ( 95 ±3) % in breathing ambient air ( t = - 7. 352, P lt;0. 05) . Breathlessness in 2 cases with tracheoesophageal fistula was relieved after inserting covered airway stent without bucking while foodintaking after fasting 24 hours.Conclusion The placement of inverted Y-shaped self-expandable metal airway stent is a feasible and safetreatment for complex airway disease such as stenosis or fistula.
Objective To investigate the indication of carina reconstruction surgery for locally advanced non-small cell lung cancer through analyzing the clinicopathological characteristics and prognosis of these patients.Methods Fifteen patients were involved in this retrospective analysis. One patient underwent carina resection and reconstruction, 6 patients underwent right pneumonectomy plus carina resection and reconstruction, 3 patients underwent right upper lobe and carina resection plus carina reconstruction, and 5 patients underwent left pneumonectomy plus carina resection and carina reconstruction. Kaplan-Meier method was used to calculate the survival rate, and Logrank test was used to compare the survival difference between groups. Results The mean duration time for operation was 410 min(261.3±81.6min). The number of resected mediastinal lymph nodes was 10.8±3.7. No perioperative death occurred. Two patients complicated with pneumonitis after surgery, both of them recovered through machine supported respiratory combined with antibiotics administering; 1 patient complicated with chylothorax and recovered through noninvasive procedure; 1 patient underwent thoracotomy exploration due to the persistant air leak and cured by suturing the air leaking lung tissue.The median survival time for whole group was 39 months, 3-year and 5-year survival rate were 52.5%，22.5%, respectively. The median survival time for the patients underwent right pneumonectomy was 12 months, compared 40 months with that of other patients. Conclusion Carina reconstruction is necessary for some patients with locally advanced nonsmall cell lung cancer with main bronchus or carina invasion, despite the sophisticated operation procedure and high morbidity rate. While the right pneumonectomy plus carinal reconstruction should be avoided due to the poor prognosis.
ObjectiveTo evaluate tip location of peripherally inserted central catheter (PICC) by using the carina as evaluation mark, so as to provide clinical references for blinding manipulation of PICC. MethodsA retrospective analysis about the effects of tip location of PICC by using the carina as evaluation mark on inpatients with malignant tumour was conducted in tumour centre of the West China Hospital from March 2013 to April 2014. Chest X radiography was applied to evaluate the tip location of PICC. Statistical analysis was performed using SPSS software (version 19.0) and the outcomes were presented by frequency and percentage. ResultsA total of 612 cases of blinding manipulation of PICC were evaluated, of which, 502 (82%) were located in the central venous and 110 (18%) were located in the noncentral venous. The numbers of those with the catheter tips located in the non-central venous were 38 in the right atrium, 33 in the internal jugular vein, 24 in the innominate vein, 8 in the axillary vein, and 7 in the subclavian vein, respectively. ConclusionThe effects of blinding manipulation of peripherally-inserted central catheter by using the carina as evaluation mark are relatively good. But it still needs to be improved.
This patient was a 47-year female who underwent carinal resection and reconstruction because of left main bronchial mucoepidermoid carcinoma. She underwent four cycles chemotherapy when recovering from surgery because of subcarinal lymph node metastasis. However, the patient suffered from recurred productive cough and dyspnea during chemotherapy. Bronchoscopic assessment revealed stenosis at the reconstructed carina and left main bronchus five months after surgery. The granulation tissues of the left main bronchus showed no evidence of cancer recurrence. After repeated bronchoscopic resection of granulation tissue combined with bronchial stent placement, the left main bronchial stenosis gradually worsened with granulation tissue growth. Three acid-fast bacilli were found in the granulation tissue harvested ten months after surgery. The reason of postoperative bronchostenosis was confirmed as endobronchial tuberculosis, and antitubercular agents were added. Unfortunately, she had persistent left main bronchostenosis due to irreversible destruction and left pulmonary atelectasis thereafter. Therefore, for the recurring anastomotic granulomas after tracheobronchial reconstruction, the possibility of tuberculosis infection should be considered.