目的：运用多层螺旋CT（MSCT）后处理技术显示周围性肺癌与支气管关系，分析其影像表现及诊断价值。方法：采用MSCT对77例周围性肺癌行层厚为0.5 mm的容积靶扫描，通过多平面或曲面重建（MPR或CMRP）以及表面遮盖（SSD）法显示支气管与周围肿块的关系,CT影像表现与手术、病理对照。结果：（1）全部3～7级支气管均全程、较完整显示。42例腺癌中与支气管有关系者为39例（92.9％），20例鳞癌中为15例（75.0％）。（2）肿瘤—支气管关系可分为4型：Ⅰ型，支气管被肿块截断；Ⅱ型，支气管进入肿块内后被截断；Ⅲ型，支气管在肿块内保持通畅；Ⅳ型，支气管紧贴肿块边缘走行，形态正常或受压移位。（3）发生率：Ⅰ型为48.1％（37/77），其中鳞癌略多于腺癌；Ⅱ型为13.0%（10/77），其中鳞癌略多于腺癌；Ⅲ型为16.9％（13/77），仅见腺癌；Ⅳ型为15.6％（12/77），腺癌略多于鳞癌。（4）与第四级支气管相关的肿块，鳞癌多于腺癌；与第六级支气管相关的肿块，腺癌多于鳞癌。结论：采用MSCT超薄层靶扫描后行MPR、CMPR和SSD重建，能准确显示肿块与支气管关系，并反映一定的病理改变关系，对良恶性鉴别或长期预后等相关性研究有着重要意义。
Objective To investigate the clinicopathological characteristics and factors influencing the prognosis of rectal carcinoid. Methods Clinical data of 31 cases with rectal careinoid, which identified diagnosis through operation and pathologic examination from January 2003 to March 2010 were retrospectively reviewed. Primary tumors were classified by size （≤1.0 cm， 1.0-2.0 cm， and ＞2.0 cm）and muscularis invasion respectively, compared therapeutic effect of different groups. Results Median age of 31 cases was 49 years (22-83 years). Median follow-up time was 36 months (15-86 months), follow-up rate was 80.6% （25 /31）. During the follow-up period, there were no cases with recurrence among the 15 patients with tumor size≤l.0 cm, 1 case recurred in the 7 patients with turmor size between 1.0 cm to 2.0 cm, and 2 cases died from postoperative liver metastasis among the 3 patients with tumor size＞2.0 cm.There were relations between the tumor size, invasion depth, and metastasis （P＜0.05）. Metastasis and invasion depth of tumor were possibility increment to follow the aggrandizement of the diameter of rectal carcinoid. Conclusion The diameter of rectal carcinoid and muscularis invasion may be important factors affecting survival, which may be an important basis for the choice of operative mode.
Objective Both stapled transanal rectal resection (STARR) and vaginal bridge repair are new operative techniques for treatment of rectocele transanal and transvaginal, respectively. In this study we observe the clinical outcomes for STARR as compared with vaginal bridge repair procedure. Methods The clinical data of 31 patients with obstructive defecation syndrome from January 2007 to May 2009 were retrospectively analyzed. The patients were divided into 2 groups according to different operative approach: STARR group (n=18) and bridge repair suture group (n=13). The clinical outcomes observed were operative time, blood loss, length of stay, cost of hospitalization, complication and the improvement of obstructed defecation syndrome. Results There was no difference in the age and severity in the patients of two groups. Evaluation of the clinical outcomes showed 16 (88.9%) patients in the STARR group and 6 (46.2%) in the bridge repair suture group reported improvement in symptoms (P=0.017). STARR had a shorter operative time (24.6 min vs. 33.2 min， Plt;0.01), less estimated blood loss (3.9 ml vs. 16.2 ml， Plt;0.01), more costly (10 743 yuan vs. 3 543 yuan, Plt;0.01) and a higher anal incontinenc rate but reversible. The length of stay was similar (average 6 d). Conclusion The stapled transanal rectal resection procedure is more superior to the vaginal bridge repair suture for improvement of obstructed defecation syndrome from rectocele, however, it has a higher cost and some patient with reversible slight anal incontinence after surgery.
Lung cancer is one of the leading causes of cancer deaths worldwide. Many options including surgery, radiotherapy, chemotherapy, targeted therapy and immunotherapy have been applied in the treatment for lung cancer patients. However, how to develop individualized treatment plans for patients and accurately determine the prognosis of patients is still a very difficult clinical problem. In recent years, radiomics, as an emerging method for medical image analysis, has gradually received the attention from researchers. It is based on the assumption that medical images contain a vast amount of biological information about patients that is difficult to identify with naked eyes but can be accessed by computer. One of the most common uses of radiomics is the diagnosis and treatment of non-small cell lung cancer (NSCLC). In this review, we reviewed the current researches on chest CT-based radiomics in the diagnosis and treatment of NSCLC and provided a brief summary of the current state of research in this field, covering various aspects of qualitative diagnosis, efficacy prediction, and prognostic analysis of lung cancer. We also briefly described the main current technical limitations of this technology with the aim of gaining a broader understanding of its potential role in the diagnosis and treatment of NSCLC and advancing its development as a tool for individualized management of NSCLC patients.
ObjectiveTo propose a path planning method for precise robot-assisted bronchial intervention. MethodsIn the MuJoCo dynamic simulation environment, a simulation model and a simulated bronchus model which could accurately represent the motion process of the robot were built. Based on the Informed RRT* algorithm, the known spatial information was used to improve the path planning method and the motion characteristics of the robot were simulated to verify the ability of the robot algorithm to reach the target position. ResultsIn the dynamic simulation environment, the robot could move as required, and could explore the target point of the planning task in a short time, and the position accuracy was improved by more than 50% compared with the existing electromagnetic navigation and other methods. ConclusionThe established simulation model can restore the motion of the robot, and the robot has the ability to move in the bronchial environment. The proposed method can precisely control the simulated robot to enter the more peripheral airway position. It has the advantages of accuracy and faster speed than traditional manual interventional surgery, and can be used for the human-machine coordinated control task of robot-assisted bronchoscopy.
Objective To evaluate the feasibility, safety, radicality, and short-term and mid-term clinical outcomes of laparoscopic total mesorectal excision （TME） in comparison with open procedure for the middle-lower rectal cancer. Methods From October 2005 to October 2008， 52 patients with middle-lower rectal cancer received laparoscopic TME （Dixon’operation） without preventive stoma， while 46 patients underwent conventional open TME （Dixon’operation） without preventive stoma. The operative procedures, clinicopathological data， and short-term and mid-term outcomes were collected and compared between the two groups. Results The other patients were successful in both groups in addition to 2 （3.8%） patients were converted to open procedure in laparoscopic TME group. There was no perioperative death in both groups. The intraoperative blood loss, the time for bowel movement retrieval （first flatus）， and the incision healing in laparoscopic TME group were better than that in open TME group （P＜0.05）. No significant differences were observed between two groups in anastomotic leakage and pulmonary infection （P＞0.05）. Comparison of specimen, no significant differences were observed between two groups in negative distal margin and circumferential resection margin, number of lymph nodes resected, distance of distal resection margin to the tumor （P＞0.05）. No significant differences were observed between two groups in cancer-related death, local recurrence, distant metastasis, and 3-year survival rate （P＞0.05）. Conclusions Laparoscopic TME for middle-low rectal cancer is a safe, feasible, and minimally invasive technique, and can achieve satisfactory oncological outcome, which provides similar short-term and mid-term outcome compared with the traditional open procedure.
ObjectiveTo analyze the research hotspots and progress of surgical treatment of myasthenia gravis. MethodsThe top 100 most cited articles on surgical treatment of myasthenia gravis were identified by searching the Web of Science database, and a bibliometric analysis was conducted. ResultsThe publication year of the top 100 most cited articles ranged from 1939 to 2021, and the number of citations ranged from 55 to 850 per article. Most of the included articles were original research articles (75/100), which were mainly retrospective studies (64/75). The United States was the country with the most published articles and most citations, and Annals of Thoracic Surgery was the most sourced journal (n=20). Through VOSviewer analysis, high-density keywords were thymectomy, maximal thymectomy, extended thymectomy, transcervical thymectomy, thymoma, and autoantibodies. ConclusionThe scope of surgical resection, surgical approach and pathogenesis are the current hotspots in the field of surgical treatment of myasthenia gravis. It is hoped that this paper can provide references for future researches in this field.
Objective To investigate the feasibility of laparoscopic-assisted transanal everted pull-through resection and anastomosis in the treatment for ultra-low rectal cancer （the inferior margin of the tumor from the anal margin of less than 5cm）. Methods From December 2006 to December 2009，46 patients with ultra-low rectal cancer had been undergone laparoscopic-assisted transanal everted pull-through resection and anastomosis. The intraoperative condition，postoperative complications，and the result of follow-up were analyzed retrospectively. Results The operation was successfully performed on all the patients. The intraoperative blood loss was （202±56） ml （100-290m1）. The time of recovery of gastrointestinal function was （60±16） h （36-82 h）. No anastomotic bleeding or stomal leak was observed. All the patients were followed-up for （31±5） months （21-45months），15 patients developed mild to moderate anastomotic stricture，1 local recurrence， and 2 liver metastasis. All the patients had no anal incontinence 10months after stoma closure operation， the defecation of all the patients became normal （4.5±1.2） months（2-10months） later. Conclusions Laparoscopic-assisted transanal everted pull-through resection and anastomosis for ultra-low rectal cancer is safe and feasible， and the effect is satisfactory.
Objective To assess the safety and clinical outcomes of segmentectomy in one- or two-staged video-assisted thoracoscopic surgery (VATS) for bilateral lung cancer. MethodsWe retrospectively enrolled 100 patients who underwent VATS segmentectomy for bilateral lung cancer at the Department of Thoracic Surgery of Peking Union Medical College Hospital from December 2013 to May 2022. We divided the patients into two groups: a one-stage group (52 patients), including 17 males and 35 females with a mean age of 55.17±11.09 years, and a two-stage group (48 patients), including 16 males and 32 females with a mean age of 59.88±11.48 years. We analyzed multiple intraoperative variables and postoperative outcomes. Results All 100 patients successfully completed bilateral VATS, and at least unilateral lung received anatomical segmentectomy. Patients in the one-stage group were younger (P=0.040), had lower rate of comorbidities (P=0.030), were less likely to have a family history of lung cancer (P=0.018), and had a shorter interval between diagnosis and surgery (P=0.000) compared with patients in the two-stage group. Wedge resection on the opposite side was more common in the one-stage group (P=0.000), while lobectomy was more common in the two-stage group. The time to emerge from anesthesia in the one-stage group was longer than that in the first and second operations of the two-stage group (P=0.000, P=0.002). Duration of surgery and anesthesia were similar between two groups (P>0.05). Total number of lymph node stations for sampling and dissection (P=0.041) and lymph nodes involved (P=0.026) were less in the one-stage group. Intraoperative airway management was similar between two groups (P>0.05). The one-stage group was associated with lower activities of daily living (ADL) scores. Conclusion Segmentectomy is safe in one- or two-staged VATS for bilateral lung cancer, including contralateral sublobectomy and lobectomy. Duration of surgery and perioperative complications are similar between two groups, but the one-stage group is associated with lower ADL scores. On the basis of comprehensive consideration in psychological factors, physical conditions and personal wishes of patients, one-staged sequential bilateral VATS can be the first choice.