Objective:To explore the differential diagnosis and different treatment methods of chylothorax and pseudochylothorax after lung cancer surgery.Methods:Clinical data of 1 584 surgical patients with non-small cell lung cancer from January 2016 to December 2021 were analyzed, 21 cases of chylothorax and 8 cases of pseudochylothorax were identified and analyzed to compare the differences in pleural fluid chyle test, pleural effusion biochemical values, total cholesterol, triglycerides, total cholesterol/triglyceride ratio, leukocyte count, bacterial culture and treatment.Results:The incidence of chylothorax after lung cancer surgery was 1.3%, and the incidence of pseudochylothorax was 0.5%; 80.9%% of chylothorax on the right side was significantly higher than 19.1% of chylothorax on the left side, and the difference was statistically significant( P<0.05). Pseudochylothorax occurred on the right side(100%). The difference between chylothorax and pseudochylothorax in pleural fluid tests for cholesterol and triglyceride was statistically significant( P<0.05), the leukocyte count was significantly higher in pseudochylothorax than chylothorax, and the difference was statistically significant( P<0.05). The differences in drainage before treatment, postoperative drainage time and postoperative hospitalization time between the two groups were statistically significant( P<0.05). The success rate was 61.9% in 13 cases of chylothorax treated conservatively and 38.1% in 8 cases of thoracic duct clamping; all cases of pseudochylothorax were treated conservatively with a success rate of 100%. Conclusion:In naddition to pleural fluid chyle test and pleural effusion biochemical values, total cholesterol, triglyceride and total cholesterol to triglyceride ratio in pleural fluid should be tested to identify chylothorax and pseudochylothorax, high triglyceride in pleural fluid diagnosed as chylothorax; Pseudochylothorax is diagnosed with a cholesterol/triglyceride ratio >1 in the pleural fluid, pseudochylothorax is usually treated conservatively. Chylothorax is treated conservatively and surgically according to different conditions. If the drainage flow is greater than 800 ml/day for 3 consecutive days or if it causes serious electrolyte disorders, it is recommended to perform thoracoscopic-assisted thoracic duct clamping via right-sided approach.

乳糜胸是一种罕见且严重的胸外科手术并发症,导致患者严重的营养消耗、生理紊乱和免疫抑制,了解乳糜漏的病理生理学是治疗原则的基础.保守治疗旨在通过营养干预减少乳糜的产生,并通过乳糜液引流控制症状,终点是淋巴管的自发闭合.手术干预的时机仍然存在争议,胸腔镜胸导管夹闭以及栓塞已成为开放手术的替代方案.采取何种处理方法应根据患者自生情况判断和决定,过度强调手术及不适当的保守治疗都不是临床的最佳选择.本文对胸外科术后继发乳糜胸的治疗及预防现状和新的进展进行了综述.

目的 研究敲减miR-9对肺非小细胞癌(NSCLC)细胞侵袭和迁移的影响及其机制.方法 收集46例NSCLC患者(包含15例T1期、15例T2期和16例T3+T4期),用RT-qPCR法检测NSCLC组织和和癌旁组织中miR-9的表达水平.用RT-qPCR法检测人正常肺上皮细胞(BEAS-2B)以及NSCLC细胞株A549和NCI-H1299中miR-9的表达水平.将miR-9-inhibitor转染入A549和NCI-H1299细胞,用CCK-8法检测细胞增殖,用Transwell法检测细胞迁移与侵袭.用生物信息法、双荧光素酶法和功能法研究miR-9的靶基因.结果 与癌旁组织比较,miR-9在NSCLC组织中表达明显升高(P<0.001),且其表达随T分期递增(P<0.01).与BEAS-2B比较,miR-9在A549和NCI-H1299细胞中表达明显升高(P<0.001).敲减miR-9可显著降低A549和NCI-H1299细胞的增殖、侵袭和迁移(P<0.01或P<0.001).TET2是miR-9的靶基因.转染si-TET2可逆转miR-9敲减对A549细胞迁移与侵袭的抑制作用(P<0.01).结论 敲减miR-9通过TET2抑制NSCLC细胞增殖、迁移与侵袭.

具有血管周上皮细胞分化的肿瘤(neoplasms with perivascular epithelioid cell differention，PEComas)是一种罕见疾病，目前文献报道较少，本文报道1例肺PEComa自发破裂出血患者因突发胸痛入院，检查提示右中肺占位伴大量血胸，经急诊手术治疗后顺利出院，病理提示肺部良性PEComas。

目的 总结手汗症术中特殊情况的处理经验.方法 2003年4月～2021年7月对2218例手汗症行腔镜R4胸交感神经链切断术,其中52例术中遇到特殊情况:①胸腔粘连26例,用电凝吸引器、超声刀或LigaSure血管闭合器分离.②术中出血11例,均用电凝吸引器电凝止血.③交感神经显露不清7例,用电凝吸引器从上往下触碰敲打胸椎旁2～5肋骨,在第4肋骨表面灼开脂肪组织,显露肋骨,再灼断交感神经.④小肺大疱5例,用7号丝线套扎或直接用切割缝合器切除.⑤手汗复发二次手术3例,术中见肺组织与第4肋骨交感神经灼断处广泛或部分融合粘连,灼断R3交感神经.结果 全组手术时间40～50 min,平均42 min,无并发症发生,术后多汗症状消失.术后随访3～12年,中位数6年,均无复发.结论 应重视手汗症术中出现的特殊情况,掌握处理方法,保证手术的安全性.

目的 总结单操作孔胸腔镜手术治疗肺隔离症的临床经验,评价其安全性、有效性.方法 回顾性分析2015年1月至2019年5月共21例单操作孔胸腔镜手术治疗的肺隔离症患者临床资料,其中男性10例,女性11例,年龄21～57(39.5±9.2)岁,21名患者均为下肺病变,包括左下肺13例,右下肺8例;叶外型1例,叶内型20例,术前均行增强CT扫描和三维重建;双腔气管插管全麻下单操作孔胸腔镜行肺叶或肺段切除20例,中转开胸1例.结果 胸腔严重粘连者8例,行下肺叶切除术20例,下肺后基底段切除1例;手术均顺利完成,手术时间(167.3±61.5)min,术中出血量(157.3±30.2)mL,术后带管时间(5.3±1.6)天,术后住院时间(6.2±1.5)天,围手术期无死亡及严重并发症发生;随访21例无失访,随访时间7～59个月,21例患者复查胸片或CT无复发.结论 单操作孔胸腔镜手术治疗肺隔离症安全可行,术前合理的检查评估和术中对隔离肺异常血管的合理处理是手术成功的关键.

目的 探讨纵隔良性肿瘤应用常规电视胸腔镜与单操作孔切除术治疗的效果.方法 选取230例纵隔良性肿瘤患者,随机分为常规组和单孔组各115例,常规组实施三孔操作电视胸腔镜手术,单孔组实施单操作孔操作电视胸腔镜手术.对比两组手术相关指标、术后疼痛程度及并发症发生率.结果 两组术后并发症发生率比较,无明显差异(P＞0.05);两组手术相关指标比较,无明显差异(P＞0.05);术后,单孔组比常规组疼痛评分更低(P＜0.05).结论 纵隔良性肿瘤行电视胸腔镜单操作孔切除术可达到与三孔胸腔镜同等治疗效果,且单操作孔操作可有效降低疼痛程度.临床效果较好.

目的 探讨胸导管夹闭术后血脂的变化.方法 将2012年12月～2014年1月65例病理分期为Ⅰ期的非小细胞肺癌合并高脂血症患者,随机分为胸导管夹闭组34例,未夹闭组31例.分析术前、术后1个月、3个月、6个月、1年、2年、3年、4年、5年血总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C).结果 夹闭组术后TC明显低于术前和同时点未夹闭组,术后4年仍有统计学意义(P<0.05),术后5年与术前和未夹闭组差异无统计学意义(P>0.05);夹闭组术后1年内TG明显低于术前和同时点未夹闭组(P<0.05),1年之后2组差异无统计学意义(P>0.05);2组间及手术前后HDL-C差异无统计学意义(P>0.05);夹闭组术后LDL-C明显低于术前和同时点未夹闭组,至术后3年差异仍有统计学意义(P<0.05),术后4、5年与术前和未夹闭组差异无统计学意义(P>0.05).结论 胸导管夹闭术可降低TC、LDL-C,部分降低TG,对HDL-C无明显影响.TC和LDL-C分别在术后5年和4年逐渐代偿.

目的 探讨围术期应用甲强龙对减少胸腔镜肺癌术后呼吸系统并发症的作用.方法 200例接受胸腔镜肺癌手术的患者,随机分为治疗组和对照组,各100例.对照组围术期给予常规治疗,治疗组围术期在对照组基础上给予甲强龙治疗.比较两组患者临床资料、手术前后血清C反应蛋白(CRP)水平变化及呼吸系统并发症发生情况.结果 治疗组术后呼吸系统并发症发生率为2.00％,显著低于对照组的10.00％,差异有统计学意义(P<0.05).两组患者术前CRP水平比较差异无统计学意义(P>0.05);术后1、2、3、7 d,治疗组患者CRP水平均低于对照组,差异具有统计学意义(P<0.05).两组患者术后1～2 d CRP水平到达峰值后下降.结论 胸腔镜肺癌手术围术期应用甲强龙,可减少术后应激性炎症反应,进而降低术后呼吸系统并发症发生率.

目的 探讨双孔胸腔镜肺段切除术的安全性及可行性.方法 回顾性分析2015年1月～2017年12月我院56例双孔胸腔镜肺段切除术资料,术前检查示病变位于右上肺后段12例、尖前段3例,右下肺背段10例、基底段4例,左上肺舌段9例、尖后段4例,左下肺背段11例、基底段3例,直径0.9 ～2.0 cm,平均1.5 cm.结果 56例均获成功,无中转开胸,无中转肺叶切除,术后无严重并发症发生.术后病理结果显示肺良性疾病34例,原发性非小细胞肺癌15例,肺转移瘤7例.手术时间130～265 min,平均142 min;术中出血量30 ～510 ml,平均135 ml;术后胸腔引流时间3～10d,平均5.8d;术后住院时间4～12 d,平均7.6d.34例良性病变随访5～24个月,平均12个月,无并发症发生.15例肺癌随访3～ 34个月,平均23个月,均无复发、转移.结论 对于局限靠近肺门的良性病变、孤立性肺转移瘤和部分Ⅰ a期非小细胞肺癌,双孔胸腔镜肺段切除术是一种安全可靠的手术方式.

目的 探讨术前CT定位、术中染料结扎夹标记肺结节表面胸膜的方法在电视胸腔镜下肺小结节切除术中的应用价值.方法 选取2015年8月至2018年5月在本院胸外科治疗的89例患者,98枚肺小结节,术前CT在体表定位肺部小结节,术中在胸腔镜辅助下,以亚甲蓝结扎夹标记肺结节表面胸膜,完成镜下楔形切除术.结果 98枚结节按此方法成功定位85枚(87％),13枚结节因其位于纵隔面无法按此方法完成定位,术中无并发症发生,定位成功后行VATS肺楔形切除术,无中转开胸手术,术中均取得明确病理诊断.结论 术前CT定位,染料结扎夹标记肺结节表面胸膜的定位方法,简单有效,准确率高,安全性好,是肺部小结节微创术前理想的定位方法.

食管巨大神经鞘瘤十分少见.2017年4月我科收治一例食管上段长7. 5 cm肿块,不规则隆起,明显压迫气管,行胸、腹腔镜联合经颈、右胸、腹食管肿物切除+胃食管颈部吻合术,免疫组化染色确诊为食管神经鞘瘤,报道如下.

Objective To investigate the feasibility and clinical effect of two-port video-assisted thoracoscopic surgery (VATS) for the treatment of esophageal carcinoma. Methods From January 2015 to June 2017, 43 patients with esophageal carcinoma were treated with radical esophagectomy by two-port VATS, including 4 cases in the upper thoracic esophagus, 25 cases in the middle thoracic esophagus, and 14 cases in the lower thoracic esophagus. Their pathological diagnoses were squamous cell carcinoma before operation. The thoracic esophagus was mobilized and the thoracic lymph nodes were dissected by two-port VATS. And the stomach was mobilized and the abdominal lymph nodes were dissected by laparotomy. The cervical esophagogastrostomy was completed. Results All the operations were successful. There were 2 cases converted to open surgery because of tight pleural adhesions. The thoracoscopic operative time ranged from 90 min to 120 min (mean, 96 min). The blood loss ranged from 50 ml to 200 ml (mean, 90 ml). The thoracic drainage flow ranged from 110 ml to 300 ml (mean, 156 ml). The thoracic drainage time ranged from 5 d to 8 d (mean, 6. 2 d). The postoperative hospital stay ranged from 13 d to 20 d (mean, 14. 2 d). All the patients recovered and were discharged from hospital without severe operative and postoperative complications. There was no death. Postoperative pathological staging showed pT1N0M0 in 1 case, pT1N1M0 in 5 cases, pT1N2M0 in 1 case, pT2N0M0 in 13 cases, pT2N1M0 in 5 cases, pT2N2M0 in 2 cases, pT3N0M0 in 13 cases, pT3N1M0 in 2 cases, and pT3N2M0 in 1 case. All the 43 cases were followed up for 2 -30 months ( median, 20 months) without recurrence and metastasis. Conclusion Two-port VATS for the treatment of esophageal carcinoma is technically safe and feasible with minimal trauma and less complications.

淋巴管瘤是发生在淋巴系统的较为少见的肿瘤,它可以发生在包含有淋巴管道的任何部位,其中颈部为好发区域,出现在纵隔内更为罕见.2017年3月,广东省佛山市第一人民医院胸外科收治了1例纵隔巨大囊性淋巴管瘤病例,经手术治疗后痊愈,属罕见病例,报道如下.临床资料:男,51岁,因“体检发现纵隔肿物2年余”于2017年3月收入胸外科住院治疗.患者于2年余前曾来佛山市第一人民医院常规体检,行胸部CT示:右前纵隔囊性病灶,直径8cm,考虑囊肿可能(图1).当时无不适,未予治疗.门诊一直随诊,未见肿块增大.

[Summary] In April 2015, a patient suffering from breast cancer with contralateral axillary lymph node metastasis received ipsilateral modified radical mastectomy and contralateral mastectomy and axillary lymph node dissection after 6 courses of neoadjuvant chemotherapy , which made breast and axillary masses significantly reduced ( the maximum diameters were 53 and 41 mm respectively before treatment , while 18 and 17 mm after treatment ) .Then postoperative adjuvant radiotherapy and endocrine therapy were carried out.One year postoperative follow-up found no recurrence .

Objective To evaluate the safety and efficacy of dual-port complete video-assisted thoracoscopic surgery (cVATS) for lobectomy in the management of pulmonary benign diseases.Methods Between February 2011 and October 2015,a total of 192 patients with pulmonary benign disease underwent dual-port cVATS for lobectomy in our hospital.All the resections were carried out by pure thoracoscopic procedures using two ports,one working port and one observing port,which could replace each other.During the anatomical lobectomy operation,the double joint surgical instruments were used by double hands for cross performance,without distracting or pulling the ribs.Results Conversion to traditional tri-port cVATS occurred in 7 patients (3.6％) due to severe adhesion,poor differentiation of the fissure and the proliferation of tortuous vessels at the hilus.The mean time for dual-port cVATS was (115.6 ± 87.1) min (range,86-281 min),during which,a mean of (184.3 ± 71.8) ml blood loss (range,50-374 ml) was collected.The mean chest tube duration was (6.1 ± 4.8) days (range,2-15 days) and the mean postoperative hospital stay was (9.3 ± 4.6) days (range,5-16 days).No mortality or severe complications occurred perioperatively.However,complications occurred in 20 cases (morbidity rate:10.4％),including 12 cases of persistent air 1eak,5 cases of pneumonia and 3 cases of incision infection.Follow-up for an average of 22.3 months (range,3-40 months) found all patients recovered well.Conclusion Dual-port cVATS is safe and effective for lobectomy in patients with pulmonary benign diseases.

目的:总结单操作孔全胸腔镜联合腹腔镜食管癌根治术的安全性、可行性和有效性.方法:回顾性分析2015年9月至2016年9月于我院行单操作孔胸腔镜联合腹腔镜治疗的食管癌患者13例的临床资料.结果:所有患者均未出现围术期死亡;平均手术时间(271±35.6)min、术中出血量(203±95.7)ml、淋巴结清扫数目(11.8±3.2)个、住院时间(12.1±6.3)d、引流管留置时间(8.3±2.1)d、引流量(810±78)ml.在术后的1-2周内出现颈部吻合口瘘、肺部感染各1例,经治疗后痊愈.结论:单操作孔全胸腔镜联合腹腔镜食管癌根治术安全有效.

目的 探讨自发性气胸采用单孔胸腔镜手术联合中心静脉导管引流与单操作孔胸腔镜手术治疗的效果.方法 回顾性分析66例于2016年1月至2016年8月期间我院施行单孔胸腔镜联合中心静脉导管引流或单操作孔胸腔镜手术治疗原发性自发性气胸的患者,分为单孔导引组(n=21)和单操作孔组(n=45),观察两组治疗效果.结果 单孔导引组术后胸管留置时间、术后疼痛与单操作孔组比较有明显差异性(P<0.05);两组术中出血量、手术时间和术后复发率比较无明显差异(P>0.05).结论 两种手术方式均安全、有效.单孔胸腔镜手术联合中心静脉导管引流治疗自发性气胸法创伤小、疼痛轻.

颗粒细胞瘤( granular cell tumor,GCT)是一种比较少见的软组织肿瘤,大部分为良性,可发生在身体的任何部位,发生于乳腺者较罕见,占此类肿瘤的5% ~8% [1] ,临床易误诊为乳腺癌. 我院2013年诊治1例GCT,现报道如下.

患者 女,27岁. 因反复咳嗽、咯血2月余. 入院查胸部CT提示左上肺近肺门处占位,疑恶性肿瘤,累及左主支气管,伴左上肺阻塞性肺炎(图1). 行支气管镜检提示左上叶舌段开口处类圆形肿物,取病理活检,镜下见支气管黏膜纤维组织增生,伴淋巴细胞、浆细胞浸润,局灶见多核巨细胞反应,未见肿瘤性病变.