Intraoperative tracheobronchial injury is a rare but serious complication of lung surgery. With the increasing number of segmentectomies, surgeons need to locate finer and less easily identified segmental bronchi or even subsegmental bronchi. However, there is no simple or feasible method for visualizing the bronchus during surgery. Herein, we report a case in which indocyanine green (ICG) inhalation was used to visualize the pulmonary bronchus during video-assisted thoracoscopic surgery. The patient was a woman with a GGO located in the anterior segment of the right upper lobe, and thoracoscopic segmentectomy was scheduled. ICG (3.75 mg/ml) was inhaled into the lung on the operative side after single-lung ventilation for 5 min. During surgery, the anterior segmental bronchus was difficult to locate accurately. Under the overlay imaging window of the NIF imaging system, the bronchus was shown in green, indicating the bronchi in contrast to the surrounding lung tissue. We dissected the bronchi with the assistance of fluorescence imaging and were surprised to find that the bifurcation of the anterior and apical bronchi could be clearly identified by navigation via the inhaled ICG and NIF system. Segmentectomy was successfully performed, and no adverse events were recorded. This case showed that ICG nebulization is feasible and safe for visualizing the pulmonary bronchus during thoracoscopic surgery. This method has great application potential for reducing intraoperative tracheobronchial injury.

Circular RNA is an important regulator for non-small cell lung cancer (NSCLC). Circ_0000735 has been found to be significantly overexpressed in NSCLC tissues. Therefore, its role and mechanism in NSCLC progression need to be further explored. The expression levels of circ_0000735, miR-345-5p and A disintegrin and metalloprotease 19 (ADAM19) were determined using quantitative real-time PCR. EdU staining, wound healing and transwell assays were utilized to detect cell proliferation and metastasis. The protein levels of metastasis markers, exosome markers and ADAM19 were determined using western blot. Animal experiments were performed to confirm the role of circ_0000735 in NSCLC tumorigenesis. The exosomes from cells and serum were identified using transmission electron microscopy and nanoparticle tracking analysis. We found that circ_0000735 was upregulated in NSCLC, and its knockdown repressed NSCLC cell proliferation and metastasis. In terms of mechanism, circ_0000735 targeted miR-345-5p to regulate ADAM19. MiR-345-5p inhibitor reversed the suppressive effect of circ_0000735 knockdown on NSCLC progression, and ADAM19 overexpression abolished the inhibition effect of miR-345-5p on NSCLC progression. Also, animal experiments showed that silencing of circ_0000735 reduced NSCLC tumorigenesis. In addition, exosomes mediated the intercellular transmission of circ_0000735, and serum exosomal circ_0000735 might be an important indicator for the diagnosis of NSCLC. In conclusion, circ_0000735 facilitated NSCLC progression via miR-345-5p/ADAM19 pathway, and serum exosomal circ_0000735 might be a potential biomarker for NSCLC diagnosis.

ObjectivesThe purpose of this study was to assess the association between preoperative neutrophil-to-lymphocyte ratio (NLR) and the survival outcomes of esophageal cancer patients who underwent esophagectomy, the latest and comprehensive systematic review performed.MethodsRelated literature retrieved from PubMed, Web of Science, Embase, and Cochrane before January 2024, according to the inclusion criteria. Outcomes measured were overall survival (OS), disease-free survival (DFS), relapse-free survival (RFS), and cancer-specific survival (CSS).ResultsEighteen studies with 6,119 esophageal cancer patients were retained for analysis. Meta-analysis demonstrated that OS (HR: 1.47; 95% CI: 1.29, 1.67; P < 0.00001), DFS (HR: 1.62; 95% CI: 1.29, 2.05; P < 0.0001), and CSS (HR: 1.62; 95% CI: 1.29, 2.05; P < 0.0001) were significantly shorter in the high NLR group compared with the low NLR group. In addition, meta-analysis revealed a similar RFS (HR: 1.47; 95% CI: 0.92, 2.35; P = 0.10) among the two groups. Subgroup analysis of OS and DFS based on mean/median age, NLR cutoff, and region found that all subgroups remained significant difference between two groups.ConclusionAmong esophageal cancer patients who underwent esophagectomy, preoperative NLR can be used as prognostic factor independently. High-preoperative NLR is associated with poor prognosis. More large-scale, multicenter prospective clinical studies are needed to further validate the relationship between preoperative NLR and prognosis of esophageal cancer.

背景与目的 我们的研究团队设计了一种可吸收先端半倒刺缝线,用于肺内小结节定位.本研究旨在评估可吸收先端半倒线用于电子计算机断层扫描(computed tomography,CT)引导下肺内小结节定位的可行性.方法 对10条成年杂种犬进行肺结节建模;然后,在CT引导下,采用可吸收先端半倒线对10条成年杂种犬肺结节进行定位;最后,对其中6条犬进行胸腔镜下楔形切除.定位操作采用"预充式定位操作定位法"完成.结果 10条犬全部定位成功,平均操作时间为12.0±5.8 min.以半倒刺线为标记进行楔形切除6例,成功5例,楔形切除平均用时10.0±5.9 min.出现定位相关轻微并发症7例,包括轻微血肿4例,少量气胸3例.结论 在实验动物犬中采用可吸收先端半倒线进行CT引导下肺内小结节定位,是一种便捷、有效、安全可行的定位方法.

Objective:The purpose of this study was to investigate the clinical value of CT-guided localization of pulmonary nodules with soft wire hook-wire by trailing technique.Methods:The clinical data of 211 pulmonary nodules of 185 patients from November 2020 to March 2022 in Beijing Aerospace General Hospital were retrospectively analyzed. The pulmonary nodules were localized with soft wire hook-wire by trailing technique before video-assisted thoracic surgery (VATS). The success rate, complications, pathological results and localization operations related data were statistically analyzed.Results:The success rate of localization was 97.63% (206/211), and the success rate of VATS removal was 99.53% (210/211). The average operation time was (7.19 ± 2.62) min, and the average time required for resection of lesions was 27 min (10 to 126 min). During the surgery, the soft wire hook-wire of two patient was found to be dislocated and retracted into the chest wall. The pulmonary nodules were successfully located and removed according traces left by puncture points on the lung surface. It was found that the hook-wire was located in the interlobar fissure in 3 patients. The pulmonary nodules were successfully removed by the hook-wire position and appropriately expanding the resection range. A minor pneumothorax occurred in 49 patients, but no closed drainage was needed; 12 patients developed intrapulmonary hematoma; 15 patients with chest pain were treated with analgesia.Conclusions:For small pulmonary nodules requiring thoracoscopic surgery, the computed tomography-guided pulmonary nodule localization with soft wire hook-wire by trailing technique is more convenient, safe and effective, and is worthy of promotion to use.

背景与目的 射频消融术(radiofrequency ablation,RFA)被越来越多地应用于肺癌治疗,本文将探讨针孔胸腔镜下R FA在肺癌局部治疗中的临床价值,评价其安全性、可行性和有效性,并探讨其适应证.方法 对2018年2月至2020年2月就诊于北京航天总医院胸外科,接受RFA治疗的21例肺癌患者的临床资料、治疗过程和治疗结果进行描述和比较.结果 根据手术方式将21例患者分为胸腔镜下RFA组(8例患者共17个病灶)和CT引导下RFA组(13例患者共18个病灶),两组患者的临床病理资料无显著差异.胸腔镜下RFA组17个病灶均达到完全消融;CT引导下RFA组16个病灶达到完全消融,另外2个病灶因术中严重胸痛和气胸而中止了治疗.与CT引导下RFA组相比,胸腔镜下RFA组所需的平均手术时间更短(39.2±18.4 min vs.49.3±25.6 min,P=0.041);进行的穿刺消融次数更多(3.3±1.2 vs.1.7±0.5),但差异无统计学意义.胸腔镜下RFA组的并发症发生率为25.0％(2/8),低于CT下RFA组的69.2％(9/13)(P=0.049).两组患者均未发生严重并发症和围手术期死亡,术后均顺利出院.两组均达到100％的局部控制率.在III–IV期的患者亚组分析中,胸腔镜下RFA组的中位无进展生存时间(progression-free survival,PFS)为8.5个月,CT引导下RFA组为8.0个月.结论 针孔胸腔镜下RFA的安全性和疗效与CT引导下RFA的疗效接近,具有手术时间更短和术中并发症更少的优势,是晚期肺癌治疗的一个可行和有益的补充.

目的 探索先端可吸收半倒线装置用于肺内小结节穿刺定位的可行性.方法 将21个猪肺平均分为3组,分别采用先端半倒刺线、微弹簧圈、带钩钢丝对其进行穿刺定位,判断是否成功,然后通过手摇式拉力架测量定位物的锚定力.所有定位操作均采用"预充式"定位法完成.6名专家独立评估先端半倒刺线、微弹簧圈、带钩钢丝的柔韧性.结果 3组全部21次定位均成功.先端半倒刺线组的锚定力明显优于微弹簧圈[(1.089±0.288)N VS(0.066±0.015)N,P=0.000],与带钩钢丝锚定力相似[(1.089±0.288)N VS(1.190±0.279)N,P=0.519].6名专家均认为先端半倒刺线柔韧度与微弹簧圈相似明显优于带钩钢丝.结论 离体实验显示,采用先端可吸收半倒刺线装置穿刺定位肺内小结节具有先端锚定力强、不易脱落、柔韧性好的优点,且无金属异物残留风险,具有临床应用前景,值得进一步研究评估.

Objective To investigate the effect of the amputation order of pulmonary artery and pulmonary artery on pulmonary residual blood volume in total thoracoscopic lobectomy.Methods Sixtyeight patients who were scheduled to underwent total thoracoscopic lobectomy from June 2015 to April 2019 in Beijing Aerospace General Hospital were selected.The patients were divided into first amputation pulmonary artery group and first amputation pulmonary vein group by random envelope method with 34 cases in each group.Five cases in first amputation pulmonary artery group and 4 cases in first amputation pulmonary vein group were excluded because of the procedure modification or the fragmentation of the specimen during the course of operation.In the end,29 cases were enrolled in first amputation pulmonary artery group and 30 cases in first amputation pulmonary vein group.In first amputation pulmonary vein group,all arteries were ligated before interruption of the veins;and in first amputation pulmonary artery group had a reverse sequence.The perioperative period status were recorded,and the crude pulmonary quality,dry pulmonary quality,pulmonary residual blood volume and adjusted pulmonary residual blood ratio were measured or calculated.Results All 59 patients were operated successfully.No serious complications occurred,no perioperative death occurred,and no patients needed blood transfusion.There was no statistical difference in the incidence of minor complications between first amputation pulmonary artery group and first amputation pulmonary vein group:27.6％ (8/29) vs.33.3％ (10/30),P＞0.05.There were no statistical differences in operative time,transoperative bleeding volume,pulmonary residual blood volume,crude pulmonary quality,dry pulmonary quality,adjusted pulmonary residual blood ratio,hemoglobin difference before and after surgery,postoperative drainage time and postoperative hospitalization time between 2 groups (P＞0.05).Conclusions The amputation order of pulmonary artery and pulmonary vein sequence of vessel interruption during total thoracoscopic lobectomy has no effect on the pulmonary residual blood volume,can be reasonably selected according to the intraoperative situation.

肺叶扭转是指肺实质沿支气管血管蒂不同程度旋转,进而产生肺动脉血供障碍、静脉回流受阻和支气管狭窄闭塞,临床罕见,多发生于肺叶切除术后.目前多数学者认为肺叶扭转一经诊断应立即切除扭转肺组织[1-2].保守治疗尚未见报道,现将本研究所涉及2例右肺上叶切除术后中叶扭转患者保守治疗长期效果报道如下.

BACKGROUND:Preoperative computed tomography (CT) guided microcoil localization is a common method for small lung nodules before video-assisted thoracoscopic surgery (VATS). However, this method still has some limitation such as complicated operation and slight complications. We have optimized the original method. The purpose of this study was to investigate the clinical value of this optimized method.METHODS:35 pulmonary nodules from 31 patients between September 2018 and January 2019 were localized by the optimized method before VATS. The success rate, complications, pathological results and localization operations related data were statistically analyzed.RESULTS:The success rate of localization was 97.1%, and the success rate of VATS removal was 100%. The average operation time was 10.1 min (5 min-31 min), and the average time required for resection of lesions was 38.2 min (10 min-100 min). During the surgery, the microcoil of one patient was found to be dislocated and retracted into the chest wall. A puncture needle was inserted intolung tissue from the chest wall puncture point after the lung was inflated, and then the pulmonary nodule were successfully located and removed. A minor pneumothorax occurred in 3 patients, but no closed drainage was needed. Three patients developed intrapulmonary hematoma. The pathological results of 35 pulmonary nodules included 15 well-differentiated adenocarcinoma, 7 carcinoma in situ, 5 microinvasive adenocarcinoma, 4 atypical adenomatoid hyperplasia, 2 intrapulmonary lymph node hyperplasia, 2 inflammatory nodules.CONCLUSIONS:For small pulmonary nodules requiring thoracoscopic surgery, the optimized computed tomography-guided pulmonary nodule microcoil localization technique is convenient, safe and effective, and worthy of promotion to use.

肺栓塞是肺癌患者常见的并发症,明显增加死亡风险.肺栓塞最常见的诊断方法为胸部增强CT肺动脉血管成像(CTPA)、肺灌注扫描以及肺动脉造影等,但限于CT场地、造影剂以及射线的原因,难以应用于病情危重无法转运至CT室的患者、造影剂过敏患者、肾功能障碍患者以及处于妊娠期无法暴露于射线的患者,超声支气管镜可作为上述患者的备选诊断方法.

Objective To assess the choice between direct operation and followed- up observation for subclinical esophageal submucosal mass. Methods The clinical data of 133 patients with subclinical esophageal submucosal mass from February 1996 to October 2013 were retrospectively analyzed. The patients were divided into 2 groups according to the modes of intervention: direct operation group (82 cases) and followed-up group (51 cases). Their clinical data, imaging, endoscopy information, modes of intervention and final outcome were compared. Results All of the 133 patients were considered as esophageal leiomyoma. The age and body examination detection rate in direct operation group were significantly lower than those in followed-up group: (47.7 ± 13.1) years vs. (52.2 ± 10.1) years and 15.9% (13/82) vs. 37.3% (19/51), the tumor diameter, case history and incidence of chest and abdominal pain were significantly higher than those in followed-up group: (2.2 ± 1.4) cm vs. (1.7 ± 1.0) cm, 51 (44, 60) months vs. 47 (40, 55) months and 28.0% (23/82) vs. 9.8% (5/51), and there were statistical differences (P＜0.05 or ＜0.01). There was no operative mortality in direct operation group, and the incidence of mild surgical complication was 8.5% (7/82); the pathological result showed that esophageal leiomyoma and other benign diseases were in 70 cases, and malignant disease in 12 cases (12 cases of malignant diseases who missed diagnosis before operation were mostly caused by incomplete examination.). In followed-up group, the mean observation time was 35.5 (3 to 240) months, disease progression was in 23 cases (45.1%, 23/51), 3 cases developed new-onset symptoms, 20 cases increased in diameter, and the average doubling time was 856 (126 to 2 891) d. Twenty-seven patients eventually underwent surgery (52.9%, 27/51, post-observation intervention group), without perioperative death, and the incidence of surgical complication was 7.4% (2/27). The pathological result showed that esophageal leiomyoma and other benign diseases were in 23 cases, and malignant disease in 4 cases. Compared with direct operation group, post-observation intervention group had no delayed treatment due to the observation and did not increase the surgery risk and difficulty, and no malignant transformation occurred. Conclusions Subclinical esophageal submucosal mass could be followed up, but endoscopic ultrasonography, CT and gastrointestinal angiography must be performed and must be followed up closely.

目的 回顾性对比研究单操作孔与传统三孔法在电视胸腔镜肺叶切除术中的效果.方法 选取2016年1月 ～2018年1月因肺部良恶性疾病于我院接受电视胸腔镜肺叶切除术患者90例,根据操作方式的不同分为两组,其中单孔组45例,采取单操作孔法完成手术,多孔组45例,采取传统三孔法完成手术,对比分析两组手术效果.结果 两组患者在手术时间、淋巴结清扫组数、术后并发症发生率方面无统计学差异(P>0.05).单孔组患者在术中出血量、术后住院天数以及术后疼痛评分方面显著优于多孔组,差异具有统计学意义(P<0.05).结论 胸腔镜肺叶切除术时,单操作孔法能实现与传统三孔法相同的手术效果和安全性,且能减轻术后疼痛程度,减少术中出血量和术后住院天数,促进患者康复,是一种较为理想的胸腔镜肺叶切除方式,具有较高的临床应用价值.

目的：探讨复方苦参注射液灌注联合深部热疗方案治疗癌性胸腹腔积液的有效性与安全性。方法将68例癌性胸腹腔积液患者随机分为2组，治疗组34例给予复方苦参注射液灌注联合深部热疗治疗，对照组34例给予常规药物灌注联合深部热疗治疗，7 d为1个周期。观察2组治疗2个周期后临床疗效及治疗前后KPS评分、中医症状积分和胸腹腔积液中乳酸脱氢酶（ LDH）、腺苷脱氢酶（ ADA）、癌胚抗原（ CEA）水平变化情况，统计2组不良反应发生情况。结果治疗2个周期后治疗组疾病控制率以及治疗总有效率均明显高于对照组（P均＜0．05）；治疗后2组KPS评分均明显提高（P均＜0．05），中医症状积分均明显降低（P均＜0．05），且治疗组改善程度较对照组更明显（P均＜0．05）；治疗后2组LDH水平均明显升高（P均＜0．05），CEA水平明显降低（P均＜0．05），且治疗组改善程度较对照组更明显（P均＜0．05）；治疗后2组ADA水平均无明显变化（P＞0．05）。2组不良反应发生率比较差异无统计学意义（P＞0．05）。结论复方苦参注射液灌注联合深部热疗治疗癌性胸腹腔积液可明显提高疗效，改善患者生存质量、临床症状及胸腹腔积液生化指标，且使用安全。

Objective To investigate the indication,techniques,safety and efficacy of medical suture versus traditional suturein thoracoscopic surgery incision closure.Methods From October 2014 to January 2016,121 patients undergoing thoracoscopic surgery were divided into two groups according to the method of incision closure:53 cases of traditional suture group and 68 cases of medical suture hasp group.The time of closure,healing time,wound healing scores and patient's satisfaction were recorded and statistically analyzed.Results All patients were successfully operated without perioperative death.One patient underwent postoperative bleeding in the medical suture hasp group.The medical suture hasp was found to be reliable and easy to remove in secondary operation.The postoperative incision was changed to traditional suture.Two patients in each group had delayed healing.Two patients of medical suture hasp group were caused by incision bleeding,of whom one case switched to traditional suture,and one patient was treated with pressure bandage and healed.The wound closure time of the medical suture hasp group was significantly shorter than that of the traditional suture group:(110.0 ± 12.7) s vs.(305.0 ± 31.6) s,P ＜ 0.01.The wound healing scores of medical suture hasp group were higher than those of traditional suture group 2 weeks and 1 month after surgery (P ＜ 0.01).There was no significant difference in healing rate between two groups (P ＞ 0.05).The satisfaction scores of the patients in medical suture hasp group were higher than those in traditional suture group (P ＜ 0.01).Conclusions The use of medical suture hasp in the thoracoscopic surgical incision closure process is safe and reliable.It can accelerate the early repair of incision,and improve patient's satisfaction.

目的:探讨卡培他滨联合参芪扶正注射液对食管癌术后患者VEGF表达及不良反应发生率和生活质量的影响.方法:选取我院收治的食管癌术后患者90例,根据治疗方案不同分为对照组及实验组,对照组以常规化疗,实验组化疗联合参芪扶正注射液治疗.比较各组患者治疗前后生活质量及血管内皮生长因子VEGF表达水平,治疗后副反应发生率、肝肾功损害变化情况.结果:与治疗前比较,治疗后两组躯体、社会及QOL评分、疲乏评分及睡眠水平均降低(P＜0.05),QOL评分、尿素氮及肌酐均升高(P＜0.05),治疗后与对照组比较,实验组躯体、社会、睡眠及疲乏评分、生活质量、血象较高(P＜0.05),实验组消化道反应、脱发时间较短,肌酐及尿素氮水平及VEGF水平较低(P＜0.05).结论:卡培他滨联合参芪扶正注射液可减轻化疗对患者体质、睡眠、社会功能、生活质量等水平的影响,保护肝肾功能,减轻脱发、恶心呕吐等副反应症状,降低VEGF水平,临床疗效优于传统方案,可作为临床有效治疗方案.

自发性气胸是最常见的胸外科急症，好发于青年患者，通常症状严重，难以预防，反复发作，更可导致学习、劳动能力的丧失，对于具有确切手术指征的患者应积极进行手术治疗。目前电视胸腔镜手术（video-assisted thoracoscopic surgery，VATS）治疗自发性气胸已被临床广泛接受，且自发性气胸已成为VATS的最佳适应证之一[1]。传统VATS手术治疗气胸多采用“三孔法”或切口长度在3~4cm 的单操作孔法[2]。作者近年来结合自身胸部微创手术的临床经验对上述术式进行了改良，采用1.5cm单操作切口，结合“王氏手法”及低能量电凝固处理肺大疱等新方法，对不同病变类型的自发性气胸患者进行精准治疗。改良后的术式疗效满意，且较传统VATS更为微创、精准、实用、切口美观，现报道如下。