Objective:To compare the effects of thoracoscopic anatomical segmentectomy and thoracoscopic lobectomy on patients' respiratory function.Methods:Retrospective analysis of 326 patients who underwent thoracoscopic surgery from July 2016 to July 2019(209 patients underwent anatomical segmentectomy, 117 patients underwent lobectomy). According to variables including gender, age, tumor location, smoking history and BMI, two propensity score-matched cohorts including 89 patients respectively were constructed. The patients’ baseline data and respiratory function date of the patients pre-operation and post-operation were analyzed. The measurement data that obey the normal distribution were described by mean±standard deviation, and the t-test was used for comparison between groups; the measurement data of non-normal distribution was described by the median value( P25, P75), and the Wilcoxon rank sum test was used for the comparison between groups; The data was described by frequency, and the chi-square test or Fisher's exact probability method was used for comparison between groups. Results:At the first-month follow-up after surgery, there was no significant difference in the variation of FVC[(0.48±0.40)L vs.(0.34±0.37)L, P=0.215)and FEV1[(0.52±0.46)L vs.(0.43±0.77)L, P=0.364), and in the change rate of FVC(%)[15.23(8.74, 21.25) vs. 14.58(7.75, 19.40), P=0.122], FEV1(%)[17.25(9.56, 22.78) vs. 16.42(9.15, 20.28), P=0.154]and DLCO(%)[18.54(10.88, 25.68)vs. 17.45(9.58, 23.75) P=0.245]. Between the segmentectomy group and lobectomy group, there was a significant difference in the alteration of FVC[(0.50±0.47)L vs. (0.29±0.31)L, P=0.031] and FEV1[(0.44±0.34)L vs.(0.24±0.23)L, P<0.001], the change rate of FVC(%)[14.27(7.87, 22.32) vs. 9.95(5.56, 17.24), P=0.008]、FEV1(%)[15.23(8.36, 22.17)vs. 10.05(5.15, 18.54), P<0.001]and DLCO(%)[13.74(6.24, 19.78) vs. 4.45(-2.32, 13.75), P=0.023]in the 6th month after surgery. The lobectomy group had a higher variation of FEV1[(0.34±0.49)L vs.(0.18±0.26)L, P=0.006] and change rate of FVC(%)[9.28(2.15, 18.94) vs. 5.24(0.52, 11.45), P=0.0032] and FEV1(%)[10.45(3.15, 21.32) vs. 6.50(1.55, 14.24), P<0.001] in the first year after surgery. However, the variation of FVC[(0.29±0.36)L vs.(0.21±0.24)L, P=0.176) and the change rate of DLCO(%)[8.35(2.15, 16.45) vs. 6.23(2.12, 14.54), P=0.143] didn't show a significant difference between the two groups. Conclusion:Whether in the short or the middle postoperative period, segmentectomy can preserve postoperative respiratory function than lobectomy.

目的 评估胸腺瘤WHO分型、Masaoka分期与其预后的相关性.方法 纳入2009～2019年在复旦大学附属华山医院接受手术治疗的胸腺瘤患者468例,其中男234例、女234例,年龄21～83 (49.6±18.7)岁.行胸腔镜手术132例,胸骨正中切口手术336例,平均随访时间(5.7±2.8)年.分析患者的临床资料.结果 胸骨正中切口组术中出血量(178.3±133.5)mL,胸腔镜手术组术中出血量(164.8±184.1)mL,差异无统计学意义(P=0.537).胸骨正中切口组手术时间(3.3±0.7)h,胸腔镜组手术时间(3.4±1.2)h,差异无统计学意义(P=0.376).术后活动性出血、膈神经损伤、乳糜胸并发症在胸腔镜组分别为8例、9例、1例,在胸骨正中切口组分别为37例、31例、7例,差异均无统计学意义(P=0.102,0.402,0.320).WHO病理分型A型、AB型、B1型、B2型、B3型和C型胸腺瘤患者5年累计无进展生存率分别为100.0％、100.0％、95.7％、81.4％、67.5％和50.0％ (P＜0.001).Masaoka Ⅰ～Ⅳ期胸腺瘤患者5年累计无进展生存率分别为96.1％、89.2％、68.6％和19.3％ (P＜0.001).伴重症肌无力患者5年累计无进展生存率为87.3％,无重症肌无力患者为78.2％ (P＜0.001).胸腔镜与胸骨正中切口患者5年累计无进展生存率分别为82.4％和83.8％ (P=0.904).结论 WHO病理分型与Masaoka分期对临床预后有提示意义.伴重症肌无力胸腺瘤患者预后较好,提示早诊断和早治疗对胸腺瘤具有重要意义.

目的 探讨影响非小细胞肺癌(NSCLC)临床无纵隔淋巴结转移证据,但术后病理意外证实转移(意外N2)患者预后的因素.方法 回顾性分析2006年1月至2010年12月复旦大学附属华山医院接受根治性手术的263例NSCLC意外N2患者的临床资料,并随访生存信息.随访时间截至2012年12月31日.采用Cox风险比例模型确立影响NSCLC意外N2患者预后的因素.结果 共有263例患者入组.随访率91.63％.术后1年、3年和5年生存率分别为94.6％、55.2％和26.3％.电视胸腔镜手术(VATS,P=0.017,RR=0.659,95％CI 0.469-0.927)、纵隔淋巴结转移站数(P=0.003,RR=1.605,95％CI 1.180-2.183)和未接受辅助化疗(P=0.012,RR=1.576,95％CI1.105-2.246)是影响NSCLC意外N2患者预后的独立因素.接受VATS的单站意外N2患者术后中位生存期优于开胸手术的单站意外N2患者(48.55个月vs.37.34个月,P=0.018).而未接受辅助化疗的多站意外N2患者术后中位生存期低于接受辅助化疗的多站意外N2患者(20.32个月vs.31.55个月,P=0.001).结论 NSCLC意外N2患者预后与手术方法、辅助化疗和N2站数有关.单站N2患者更能从微创VATS中获得生存受益,而多站N2患者更能从辅助化疗中获得生存受益.

Objective To analyze the clinical value of preoperative CT- guided Hook-wire puncturing or methylxanthine chloride staining in treatment of the small pulmonary nodules with video assistant thoracic surgery (VATS). Methods A retrospective review of 90 patients with 94 small pulmonary nodules undergoing VATS,using pre-operative CT-guided puncturing or methylxanthine chloride staining was performed. The puncturing achievement ratio, the complications and the conversion to thoracotomy ratio of preoperative localization were summarized and analyzed. Results The puncturing achievement ratio was 91.7%by Hook-wire puncturing and 86.4%by methylxanthine chloride staining,respectively. The complications included pneumothorax,hemothorax,puncturing failure,and Hookwire needle loss. In pathological results,benign lesions and malignant lesions accounted for 38.3% and 61.7%,respectively. Conclusions The application of preoperative CT-guided Hook-wire puncturing or methylxanthine chloride staining in treatment of the small pulmonary nodules with video assistant thoracic surgery increases the achievement ratio of VATS with few complications,and may be widely used in clinical diagnosis and treatment of small pulmonary nodules with VATS.