We explored clinicopathological features and treatment strategies for thoracic SMARCA4-deficient undifferentiated tumor (SMARCA4-UT). Thoracic SMARCA4-UT is a new entity recently acknowledged in the 2021 edition of World Health Organization Classification of Thoracic Tumors, and doctors are relatively unfamiliar with its diagnosis, treatment, and prognosis. Taking a case of SMARCA4-UT treated in Peking University First Hospital as an example, this multi-disciplinary discussion covered several hot issues on diagnosing and treating thoracic SMARCA4-UT, including histological features, immu- nohistochemical and molecular phenotype, immune checkpoint inhibitor (ICI) therapy, and pathological assessment of neoadjuvant therapy response. The patient was an older man with a long history of smoking and was admitted due to a rapidly progressing solid tumor in the lower lobe of the right lung. Histologically, tumor cells were epithelioid, undifferentiated, diffusely positive for CD34, and partially positive for SALL4.The expression of BRG1 protein encoded by SMARCA4 gene was lost in all of tumor cells, and next-generation sequencing(NGS)confirmed SMARCA4 gene mutation (c.2196T>G, p.Y732Ter). The pathological diagnosis reached as thoracic SMARCA4-UT, and the preoperative TNM stage was T1N2M0 (ⅢA). Tumor proportion score (TPS) detected by immunohistochemistry of programmed cell death 1-ligand 1 (PD-L1, clone SP263) was 2%. Tumor mutation burden (TMB) detected by NGS of 1 021 genes was 16. 3/Mb. Microsatellite detection showed the tumor was microsatellite stable (MSS). Neo-adjuvant therapy was implemented with the combined regimen of chemotherapy and ICI. Right lower lobectomy was performed through thoracoscopy after the two weeks' neoadjuvant. The pathologic assessment of lung tumor specimens after neoadjuvant therapy revealed a complete pathological response (CPR). The post-neoadjuvant tumor TNM stage was ypT0N0M0. Then, five cycles of adjuvant therapy were completed. Until October 2022, neither tumor recurrence nor metastasis was detected, and minimal residual disease (MRD) detection was negative. At present, it is believed that if BRG1 immunohistochemical staining is negative, regardless of whether SMARCA4 gene mutation is detected, it should be classified as SMARCA4-deficient tumors. SMARCA4-deficient tumors include a variety of carcinomas and sarcomas. The essential criteria for diagnosing SMARCA4-UT includes loss of BRG1 expression, speci-fic histological morphology, and exclude other common thoracic malignant tumors with SMARCA4-deficiency, such as squamous cell carcinoma, adenocarcinoma and large cell carcinoma. SMARCA4-UT is a very aggressive malignant tumor with a poor prognosis. It has almost no targeted therapy mutations, and little response to chemotherapy, but ICI is currently the only effective drug. The successful diagnosis and treatment for this case of SMARCA4-UT should enlighten significance for various kinds of SMARCA4-deficient tumors.

目的:探讨胸膜灼烧胸膜固定在单操作孔胸腔镜手术治疗原发性自发性气胸(primary spontaneous pneumothorax,PSP)患者中的可行性及效果.方法:回顾性研究2018年5月-2020年5月北京市顺义区医院收治的PSP患者60例,根据治疗方法不同分为胸膜灼烧组与胸膜机械摩擦组,每组30例.对所有患者行单操作孔胸腔镜肺大疱切除手术,胸膜灼烧组术中给予胸膜灼烧胸膜固定术治疗,胸膜机械摩擦组行胸膜机械摩擦胸膜固定.观察两组患者手术指标、术后临床指标及复发情况.结果:胸膜灼烧组手术时间短于胸膜机械摩擦组,术中出血量少于胸膜机械摩擦组,比较差异均有统计学意义(P<0.05).胸膜灼烧组术后体温>38℃、WBC>10×109/L的患者占比少于胸膜机械摩擦组,胸腔引流量少于胸膜机械摩擦组,置管时间、住院时间少于胸膜机械摩擦组,疼痛评分低于胸膜机械摩擦组,比较差异均有统计学意义(P<0.05).胸膜灼烧组并发症发生率及复发率均为0,低于胸膜机械摩擦组的6.7％、3.3％,但比较差异无统计学意义(P>0.05).结论:胸膜灼烧胸膜固定术在单操作孔胸腔镜手术治疗PSP能减少并发症,减轻术后疼痛,这种方法值得临床推广.

目的 探讨支气管前方清扫隆突下淋巴结在单孔胸腔镜肺上叶癌根治手术中的应用效果及安全性.方法 回顾性分析北京大学第一医院胸外科2016年6月-2017年1月应用单孔胸腔镜技术行肺上叶癌根治手术的患者20例,对比该科室同期行单操作孔胸腔镜肺上叶癌根治手术的患者40例.比较两组患者术前、术中及术后的相关数据.结果 两组患者在术后住院天数、术中出血量、术后总引流量、术后引流管留置时间和第7组淋巴结清扫数目等方面无明显差异;单孔胸腔镜组(支气管前方清扫隆突下淋巴结)在疼痛评分方面较单操作孔胸腔镜组(支气管后方清扫隆突下淋巴结)低,在肿瘤大小方面较单操作孔胸腔镜组(支气管后方清扫隆突下淋巴结)小,在手术时间方面较单操作孔胸腔镜组(支气管后方清扫隆突下淋巴结)短.两组患者均无术后严重并发症,无围手术期死亡病例,顺利出院.术后随访12个月,期间均无出血、肺不张、胸腔包裹性积液和支气管胸膜瘘等并发症,患者影像学复查无复发、转移情况.结论 经支气管前方清扫隆突下淋巴结是一个可行的手术方案,在手术质量及安全性上得到了保证.

多原发肺癌(MPLC)是肺癌中的一种少见类型.目前MPLC主要依据肿瘤的病理类型、遗传学特点、影像学表现、出现的部位及临床症状等进行诊断,并采取以手术为主的多学科综合治疗.本文总结最新的文献进展,从MPLC的流行病学特征、病因、诊断、鉴别诊断、治疗及预后等方面作一综述.

Objective To evaluate the feasibility of 3D thoracoscopic system in uniportal video-assisted thoracoscopic surgery (uniportal VATS) for the treatment of thoracic diseases. Methods 7 cases of thoracic diseases were accomplished with 3D thoracoscope from Nov 2015 to Dec 2015, including 3 cases of lobectomy, 2 cases of wedge resection of pulmonary tumor, 2 cases of mediastinal mass. Results All the operations were completed successfully, without conversion to open surgery. All the patient recovery successfully. The data of operative time, bleeding volume, postoperative chest tube drainage and hospital time and postoperative complications were counted. No complications and tumor recurrence or metastasis were observed during the followed 3 months. Conclusion 3D thoracoscopic system can be used in uniportal video-assisted thoracoscopic surgery (uniportal VATS) safely and provide high-definition and better sense of depth which facilitate the operation more precise and safer.

目的：：观察不同术式对食管癌患者的临床疗效及其并发症的影响。方法：将86例食管癌患者随机分为观察组和对照组，每组各43例。对照组患者行开放式食管癌切除淋巴结清扫术治疗；观察组患者行胸腹腔镜联合治疗术。对比两组患者的术中出血量、淋巴结清扫数目、手术时间、胸管留置时间、住院时间，并发症发生率；术后随访12个月，对比两组患者有无复发、转移。结果：两组患者的术中淋巴结清扫数目接近，差异无统计学意义(P>0.05)，但观察组患者的术中出血量明显少于对照组，手术时间、胸管留置时间和住院时间均明显短于对照组；观察组患者术后并发症的发生率分别为2.3%(1/43)、2.3%(1/43)、0%(0/43)，对照组分别为9.3%(4/43)、11.6%(5/43)、7.0%(3/43)，观察组患者明显低于对照组，组间差异有统计学意义(P<0.05)；经过12个月随访，两组患者均未出现复发和远处转移。结论：实施胸腹腔镜联合治疗术在提高食管癌患者的疗效和减少其并发症方面优于开放式食管癌切除淋巴结清扫术。

Objective To study the value of video-assisted minithoracotomy (VAMT) in treatment of unsymmetrical severe emphysema with extensive pleural adhesion. Methods From January 2002 to November 2002,11 patients of unsymmetrical severe emphysema with extensive pleural adhesion underwent lung volume reduction surgery (LVRS) with video-assisted minithoracotomy. Result There was no perioperative death. Persistent air-leak occurred in 8 cases (72.7%). All the paitients left hospital in 7~67 days after operation. When leaving hospital,the respiratory difficulty index decreased from Ⅳ to 0~Ⅱ. Analysis showed that PaO2 increased and PaCO2 decreased (P 0.01). Conclusion LVRS with VAMT in treatment of severe emphysema with extensive pleural adhesion is effective and safe.

OBJECTIVE:To compare video-assisted thoracis surgery (VATS) and mini-incision thoracotomy for the treatment of benign esophageal diseases.METHODS:The clinical data of 52 patients with benign esophageal diseases underwent minimally invasive surgical treatment from January 1995 to January 2007 were analyzed retrospectively. VATS were performed in 25 cases and mini-incision thoracotomy were performed in 27 cases.RESULTS:There was no operative death or major perioperative complications in both groups. There were no significant difference between them according to operation time, postoperative thoracic drainage time, postoperative gastric drainage time and postoperative hospital stay time.CONCLUSIONS:For the treatment of benign esophageal diseases, both VATS and mini-incision thoracotomy are safe and effective. VATS can be performed in suitable cases with more minimal incision and decreased operative trauma, mini-incision thoracotomy can be performed in almost all cases, preferring the sophisticated cases.