Objective:To investigate the difference of HRCT imaging features between COVID-19 and the ground-glass opacity(GGO) lesion of early-stage lung carcinoma, standardize the diagnosis and treatment process of ground-glass opacity(GGO) degeneration during the epidemic.Methods:A total of 34 patients with diagnosed COVID-19 who confirmed by positive results of the new coronavirus nucleic acid test were collected as observation group 40 patients with pathologically diagnosed early-stage lung carcinoma whose preoperative HRCT examination showed pure ground glass lesions and received surgical intervention were recruited from the Department of Thoracic Surgery (The First Affiliated Hospital of Xiamen University) from January 2018 to December 2019 as the control group. The HRCT imaging features of these two groups of patients were compared and statistically analyzed.Results:The HRCT imaging features of the new type of COVID-19 showed significant difference by characteristics of multiple lesions, lesion rapid variation within 3 days, reticular pattern, vacuolar sign and clear boundary compared to the GGO lesion of early-stage lung carcinoma( P<0.05). The chinical and imaging characteristic the sex, age, with pleural effusion or not and the lesion location showed no significant difference between these 2 groups ( P>0.05). Conclusion:Contrast with inert early lung carcinoma lesions, COVID-19 disease developed rapidly. Imaging dynamic examination can provide evidences to distinguish Novel Coronavirus Pneumonia and early-stage lung carcinoma.

目的 研究腔镜食管癌切除术前口服橄榄油,术中胸导管暴露的优势.方法 回顾性分析2013年6月至2015年6月厦门大学附属第一医院胸外科136例腔镜食管癌切除术患者的临床资料,其中男83例、女53例,年龄(58.3±7.6)岁.所有患者术前12h口服橄榄油100 ml,术后观察乳糜胸发生的情况.结果 全组患者均成功实施手术,无中转开胸.术中胸导管充盈透明,呈乳白色,暴露清晰.131例患者成功保留胸导管,5例因肿瘤外侵分离胸导管时损伤,术中发现并用钛夹夹闭.所有患者术后留置胸腔引流管3～5d,术后24 h平均引流量(150±35)ml,术后总引流量(500±130)ml,术后均未出现乳糜胸,术后平均住院时间(9±2)d.结论 腔镜食管癌切除术患者术前口服橄榄油,简单、安全、有效、无损伤,术中胸导管暴露清晰,减少了胸导管的损伤,保存了胸导管的完整性,保留了正常的糖脂代谢,是食管癌术前准备中一个良好选择,值得推广应用.

Objective To discuss the safety and efficacy of the 3D mode video-assisted thoracoscopic surgery (3D-VATS)for mediastinal tumor. Methods Data were collected from 62 patients with mediastinal tumor treated with 3D-VATS from July 2013 to July 2015 in our department.The observation port and the operation port were determined according to the tumor location,which could be swapped during the operation based on surgical situation.If the tumor diameter was greater than 5 cm,or close to great blood vessel,or with the surrounding adhesion difficult to expose,small incision video-assisted minithoracotomy (VAMT)was employed. Results The 3D-VATS was successfully completed in 58 cases.VAMT was conducted in 3 cases because of tumor diameter of 6 cm. Conversion to open surgery was required in 1 case due to tumor invasion to the left unknown vein.Intraoperative injury to the phrenic nerve leading to diaphragm elevation happened in 2 cases,which recovered 3 months after operation.Pulmonary atelectasis was seen in 2 cases, which were given anti-inflammatory, atomization, and expectoration until relief. No death occurred intraoperatively, postoperatively or 30 days after surgery.Postoperative pathology showed 31 cases of thymoma,16 cases of thymic hyperplasia,5 cases of thymic carcinoma,1 case of bronchogenic cyst,1 case of thymic cyst,2 cases of proliferation of lymphocytes,3 cases of teratoma, 2 cases of neurogenic tumor,and 1 case of pleural lipoma.All the 62 cases were followed up for 1 -24 months,with a median follow-up time of 12 months.No recurrence was seen in all the benign cases,while 1 case of thymic carcinoma recurred. Conclusion Treatment of mediastinal tumor with 3D-VATS is a new choice,bearing safe and feasible clinical effects.

Objective To evaluate the effects of surgical treatment for solitary pulmonary nodules under thoracoscopic 3D mode(3D-VATS). Methods A total of 50 cases of solitary pulmonary nodules from March 2013 to March 2014 were retrospectively analyzed.Intraoperative wedge pulmonary resection with 3D-VATS was utilized.According to intraoperative pathological findings , lobectomy plus lymph node dissection was given or not .Intraoperative time (minus fast freezing time), drainage volume for 24 h, total drainage volume , drainage tube removal time , number of lymph node dissected , and postoperative complications were recorded . Results Under 3D-VATS mode, 50 cases of solitary pulmonary nodules were treated with wedge resection , including 23 cases of malignant pathology receiving radical resection , which was smoothly . The radical resection time ( lung lobectomy plus lymphadenectomy) was (62 ±12) min, the bleeding volume was (35 ±5) ml, the lymphadenectomy number was 19 ±3, the drainage volume for 24 h was (120 ±20) ml, the postoperative chest tube removal time was (4 ±1) days, and the postoperative hospital stay was (7 ±2) days.Postoperative complications occurred in 3 cases, including 2 cases of pneumonia and 1 case of paroxysmal atrial fibrillation.No perioperative deaths were observed .All the cases were followed up for 2-12 months, with an average of 6.3 months. Brain metastases was found in 1 case at the third postoperative month and recurrence of lung cancer was noted in 1 case at the fifth postoperative month . Conclusion Thoracoscopic 3D mode treatment for solitary pulmonary nodules is a new , safe, and feasible alternative and should be widely applied .

Objective To investigate clinical feasibility and efficacy of combined use of thoracoscopy and laparoscopy in total laryngectomy for cervical esophageal carcinoma . Methods Clinical data of 33 patients with cervical esophageal carcinoma undergoing surgical treatment in our department from January 2009 to July 2014 were analyzed retrospectively .The esophagus was separated under thoracoscopy .And laparoscopic gastroplasty , total laryngectomy , tracheal permanent colostomy , and gastric pharyngeal anastomosis were performed. Results The thoracoscopic operation time was 40 -66 min ( mean, 53 min), the laparoscopic operation time was 35-51 min (mean, 44 min), and the cervical operation time was 128-150 min (mean, 139 min).The blood loss was 130 -270 ml (mean, 150 ml).The postoperative hospital stay was 8 -14 d (mean, 12 d).Pathological examinations showed squamous cell carcinoma in all the cases , including 2 cases of highly differentiated carcinoma , 19 cases of moderately differentiated carcinoma , 7 cases of moderately or lowly differentiated carcinoma , and 5 cases of lowly differentiated carcinoma .No residual cancer was found at cutting edges pathologically .Among the 33 cases, lymph node metastasis was found in 31 cases. Complications included 2 cases of anastomotic fistula , 3 cases of recurrent laryngeal nerve injury , 6 cases of pulmonary infection , 2 cases of delayed gastric emptying , and 1 case of anastomotic stenosis .There was no death .All the patients were followed up for 1 months to 5 years.The survival rates at 1, 3, and 5 postoperative year were 87.9%, 54.5%, and 45.5%, respectively. Conclusions Cervical esophageal carcinoma should be surgically treated actively .Gastric pharyngeal anastomosis is an ideal option for the repair of cervical esophageal cancer resection .

Objective To investigate the feasibility of Storz three dimensional video-assisted thoracoscopic surgery (3D-VATS) for the treatment of pulmonary disease. Methods In July 2013, under 3D video-assisted thoracoscope (Storz), lobectomy plus systematic lymphadenectomy was performed on 2 cases and local resection was performed on 2 cases respectively .The seventh intercostal space along the midaxillary line was selected as observation port of the thoracoscope ; an incision of 2-3 cm in length made at the third or fourth intercostal space along the anterior axillary line was used for main operating port and a 2 cm incision at the eighth or ninth intercostal space along the posterior axillary line was used for the first assisted operating port .Wearing 3D polarization glasses , we performed local excision or lobectomy combined with systematic lymphadenectomy on the 3D effect operation screen. Results Four operations were accomplished successfully , without conversion to open surgery .No complications or death occurred.The operative time was 36, 38, 72 and 90 min, respectively; the blood loss was 5, 10, 35 and 80 ml, respectively and postoperative hospital stay was 3, 3, 5 and 7 d, respectively.No complications were observed during the follow-up of 2 months. Conclusion Compared with VATS, 3D-VATS is safe and feasible for pulmonary disease with a lifelike view and improved flexibility .

目的:探讨高龄食管癌患者术后并发心律失常的相关因素,总结在临床上食管癌患者术后心律失常预防和治疗方法。方法:选取2004年6月至2009年11月来我院就诊的95例高龄食管癌术后并发心律失常患者9,5例患者手术后都进行72h心电监测。结果:年龄大于70岁,吸烟指数,手术的方式和手术时间,术中出血量及吻合口位置等是导致术后心律失常发生的危险因素。结论:高龄食管癌患者手术前应该做好各方面充分的准备,选择好手术方式,把握好手术时间及术中出血量。

目的 探讨胸腔手术后乳糜胸的诊断与治疗.方法 回顾性分析我院2005年至2009年胸腔术后并发乳糜胸15例患者的临床资料.结果 本组食管肿瘤9例,纵隔肿瘤3例,中心型肺癌3例.再次开胸结扎胸导管13例,均获成功,保守治疗2例死亡.结论 乳糜胸的发生与肿瘤部位及外侵有一定关系,因此术后胸水量的观察在乳糜胸的诊断中具有重要地位.乳糜胸一旦确诊,应积极采取手术治疗,其效果明显优于非手术治疗.

目的:胸腔镜手术与腋下小切口手术治疗自发性气胸的效果对比对胸腔镜手术效果进行分析。方法:选取医院患者44例,其中VATS28例患者与同期行SAMT16例患者进行比较。结果:VATS组术后住院天数、术后胸管放置时间和术后疼痛时间均较SAMT组明显缩短,无中转开胸。两组均无并发症、死亡。结论:电视胸腔镜手术创伤小,对心肺功能影响小,术后恢复快。

2000年7月～2006年6月,笔者共收治3名建筑钢筋、茅竹由胸、腹 、头面部穿透伤的患者,报道如下.

食管癌是我国常见的恶性肿瘤之一,严重危害我国人民身体健康.近年来随着外科麻醉技术以及围手术期监护手段的进步,老年食管癌手术已很常见,并取得一定的效果.我院1990～2001年行食管癌手术1 257例,其中65岁以上93例,占7.4%.现将临床资料总结如下.