Lymph node metastasis is the main and frequent metastatic way of lung cancer, it is also the reason of postoperative carcinoma residue which results in relapse and metastasis. It is vital to clean mediastinal lymph nodes and hilar lymph nodes in lung cancer operation. However, the patterns of lymphadenectomy are not yet uniform. There are complete mediastinal lymph node dissection(CMLND), radical lymph node dissection(RLND), lymph node sampling(LS), systematic lymph node sampling(SS) and sentinel lymph node navigation(SLN). And with the development of minimal invasive surgery, the thoracoscopic lymphadenectomy gets mature day by day. It is very necessary to find a more standardized and perfect patten of lymphadenectomy. This paper reviews the clinical significance, the pattens and the extent of mediastinal lymph node dissection and hilar lymph node dissection, and also reviews the current status and prospect of thoracoscopic lymphadenectomy
Objective To evaluate the effectiveness and safety of single-incision video-assisted thoracic surgery versus conventional multiple ports video-assisted thoracic surgery in the treatment of lung cancer as well as providing reference for clinical decision-making. Methods We searched the Cochrane Library, PubMed, EMbase, CBM, CNKI, VIP, Wanfang ect until March 2017 to collect randomized controlled trials (RCTs), cohort studies, and case-control studies comparing single-incision with conventional multiple ports video-assisted thoracic surgery for lung cancer.Two reviewers independently screened and selected literatures according to inclusion and exclusion criteria. Then data extraction and quality assessment of included studies were conducted. RevMan 5.3 software was used for meta-analysis. Results Twenty-six cohort studies (3 053 patients) were included. The quality of the included studies was high with score more than five.Meta-analysis showed that single-incision video-assisted thoracic surgery had shorter thoracic drainage time (MD=–0.71, 95% CI –1.03 to –0.39), shorter hospitalization time (MD=–0.92, 95% CI –1.66 to –0.19), lower pain scores 1 day after surgery (MD=–0.65, 95% CI –0.90 to –0.40), lower pain scores 3 days after surgery (MD=–0.90, 95% CI –1.16 to –0.64), lower pain scores 7 days after surgery (MD=–1.24, 95% CI –1.90 to –0.57), less number of lymph node dissection (MD=–0.72, 95% CI –1.35 to –0.10), less total drainage fluid (MD=–108.60, 95% CI –180.42 to –36.79) and shorter length of surgical incision (MD=–2.74, 95% CI –3.57 to –1.90) than conventional multiple ports video-assisted thoracic surgery. But the differences between the two groups in operation time, intraoperative blood loss, postoperative complications were not statistically significant. Conclusion Single-incision video-assisted thoracic surgery is safer and better in patient's compliance than conventional multiple ports video-assisted thoracic surgery in the treatment of lung cancer. But there is no significant difference in operation time, intraoperative blood loss, or postoperative complications. It still needs large-scale, high-quality studies to demonstrate its effectiveness and safety.
Foreign body ingestion is common in emergency. The vast majority of foreign body ingestion occurs in the pediatric population as well as mentally impaired and edentulous adults. The typical clinical manifestation of foreign body ingestion includes acute onset of dysphagia and chest pain. Most of the ingested foreign bodies pass without the need of intervention; however, about 20% of esophageal foreign body ingestion requires endoscopic removal. While less than 1% will need surgery for foreign body extraction. Timely diagnosis and proper treatment are associated with low mortality and morbidity rate, while delayed diagnosis and improper treatment always lead to severe complications such as esophageal perforation and death. This article reviews the diagnosis and treatment of adult esophageal foreign body ingestion.
A new independent subtype CD4+ T cell which massively secreted interleukin-17 (IL-17) was found at the beginning of the 21st century, and thus it was named as T helper cell 17 (Th17 cell). With the progress of the research in recent years, Th17 cells were found to be widely involved in a variety of the human diseases such as autoimmune diseases, infections and tumors through secretion of IL-17. The relationship between Th17 cells, IL-17 and the occurrence, development and prognosis of lung cancer was reviewed.
Abstract: Objective To investigate the feasibility of videoassisted thoracoscopic surgery (VATS) ronchial sleeve lobectomy for lung cancer, and to describe this treatment method. Methods Between December 2010 and April 2011, three patients in our hospital underwent VATS bronchial sleeve lobectomy as treatment for right upper lobe nonsmall cell lung cancer. The patients were one female and two males, aged 61, 65, and 62 years. Surgical incisions were the same as for singledirection VATS right upper lobectomy. The right superior pulmonary vein was firstly transected, followed by the first branch of the pulmonary artery. Then, the lung fissure was transected and the mediastinal lymph nodes, including the subcarinal nodes, were also dissected to achieve sufficient exposure of the right main bronchus. The bronchus was transected via the utility incision, and the anastomosis was accomplished by continuous suture with 30 Prolene stitches. Another 0.5 cm port in the 7th intercostal space at the posterior axillary line was added in the third operation for handling of a pair of forceps to help hold the needle during anastomosis. A sealing test was performed to confirm that there was no leakage after completion of the anastomosis, and the stoma was covered with biological material. Bronchoscopy was performed to clear airway secretions and to confirm that there was no stenosis on postoperative day (POD) 1. Results The lobectomy and lymph node dissection was finished in 5158 minutes (averaging 54.7), and the time needed foranastomosis was 4055 minutes (averaging 45.7). Total blood loss was 55230 ml (averaging 155.0 ml). Number of dissected lymph nodes was 1821 (averaging 19.3). One patient was diagnosed with adenocarcinoma of the right upper lobe with metastatic hilar lymph node invasive to the right upper lobar bronchus. The other two patients were both diagnosed with centrally located squamous cell carcinoma of the right upper lobe, and all the patients achieved microscopically negative margins. There was no stenosis of the anastomosis stoma, and the postoperative course was uneventful. These patients were discharged on POD 810 (averaging 8.7 days), and they recovered well during the followup period, which lasted 2 to 6 months. [WTHZ]Conclusion [WTBZ]For experienced skillful thoracoscopic surgeons, VATS bronchial sleeve lobectomy is safe and feasible. Making the incisions of a singledirection VATS lobectomy with an additional miniport may be an ideal approach for this procedure.
Mini-invasive video-assisted thoracoscopic surgery (VATS) has been employed in diagnosis and treatment of esophageal diseases for about 10 years. The potential advantages of VATS over thoracotomy are reduction of chest pain just after the operation and in the long run, lower incidence of postoperative respiratory complications, and reduction of aesthetic sequelae. Thoracoscopic staging of esophageal cancer is to evaluate the invasion and metastasis of cancer, which is helpful for better selection of patients for appropriate treatment .Operation of esophageal cancer with VATS is prescribed mainly in the early stage of carcinoma, but it’s application is restricted due to the multiple sites of operation and complexity of procedures. VATS for benign esophageal diseases such as esophageal leiomyoma and achalasia is becoming the preferable choice of operation in qualified medical centers.
Objective To observe an early result after the repair of the large upper thoracic wall defect by a combined use of the titaniumnet, reconstruction nickelclad, and latissimus dorsi myocutaneous flap in a patient who underwent a breast sarcomatoid caricinoma resection on the upper thoracic wall. Methods A breast sarcomatoid carcinoma in the upper thoracic wall was removed in 1 56yearold female patient in February 2006. After the tumorectomy, a large thoracic wall defect was left, which was 20cm×15cm in size. The defect was covered by the titanium net, the bilateral stumps of the clavicles were connected by the reconstruction nickelclad, and the soft tissue defect was repaired with the right latissimus dorsi myocutaneous flap(20cm×15cm). Results The patient depended on the breathing machine for 3 days after operation. When the breathing machine was discontinued, the patient developed a severe paradoxical breathing. Two weeks after operation when theblood circulation of the flap was stabilized, the paradoxical breathing disappeared with the help of the chest bandage for fixation of the chest cavity, and the blood supply of the flap was improved. The chest X-ray film showed that the titanium net and the reconstruction nickelclad were well positioned. The patient received chemotherapy 1 month after operation, The follow-up for 3 months revealed that the patient’s local condition and physical condition were good, and ROMof both the shoulders was improved, with AF 90° and ABD 90°. No recurrence ofthe tumor was found. Conclusion A large thoracic wall defect should be repaired with solid materials. The normal anatomic locations of the clavicles should be maintained with fixation by the reconstruction nickelclad for a good function of the shoulders. The latissimus dorsi myocutaneous flap can be properly enlarged.
ObjectiveThe clinical trial evidence and expert consensus in the airway management were systematically summarized in this guideline to provide clinical guidance for healthcare professionals.MethodsA total of 40 clinical questions were proposed by 32 experts, and 12 clinical questions were finally identified through the Delphi method and the PICO (patient, intervention, control, outcome) principle from 2019 to 2020. PubMed, Web of Science, Wanfang database and CNKI were searched from establishment of each database up to November, 2020. The evidence of 160 articles was graded according to GRADE method, including 18 in class A, 36 in class B, 69 in class C, and 37 in class D. Four symposiums were organized for discussion of the recommendations. Finally, 23 recommendations were made for these 12 clinical questions, among which 10 were strongly recommended and 13 were weakly recommended.ResultsSmoking cessation for at least 4 weeks, pulmonary function assessment and pulmonary rehabilitation exercise were recommended in the perioperative period, especially at least 1 week of pulmonary rehabilitation exercise for the patients with high risk factors. Anesthesia was maintained by inhalation or intravenous anesthesia. It was recommended to choose short acting drugs, monitor the depth of anesthesia and muscle relaxation during operation, and use protective ventilation strategy. Postoperative use of drugs and mechanical measures to prevent venous thromboembolism, the appropriate application of drainage tube, preemptive analgesia and multimodal analgesia for pain management were recommended. Inhaled corticosteroids with bronchodilators could be used in perioperative period to reduce airway hyperresponsiveness and postoperative cough.ConclusionFor perioperative airway management, smoking cessation, pulmonary function assessment and pulmonary rehabilitation exercise are recommended in the perioperative period. The rational use of anesthetic drugs and protective ventilation strategy are emphasized during the operations. Postoperative pain management and cough treatment should be strengthened, and drainage tube should be used properly.
Apoptosis is an important means to regulate cell proliferation and maintain homeostasis. Recent researches have shown that the B-cell lymphoma-2 (BCL-2) family not only plays a dominant role in the regulation of normal cell apoptosis, but also plays a crucial role in the formation of tumor genesis, progression and subsequent drug resistance mediated by the escape mode of apoptosis. The phenomenon that BCL-2 family antagonized the apoptosis induced by antitumor drugs and then acquired drug resistance has been reported in the clinical treatment of hematologic lymphatic system tumors, breast cancer, lung cancer, gastric cancer and other diseases. Thus, specific inhibitors targeting anti-apoptotic members of the BCL-2 family have emerged with the development of research. In this paper, we systematically reviewed the regulation of apoptosis mediated by BCL-2 family and the drug resistance mediated by BCL-2 family. Meanwhile, we summarized the research advances of BCL-2 family specific inhibitors to provide new strategy for solving the problems on tumor therapeutic resistance and for finding new therapeutic targets in the future.