Innovative attempt to explore the feasibility and accuracy of using indocyanine green fluorescence (ICGF) to identify the intersegmental plane by the target segmental veins preferential ligation during thoracoscopic segmentectomy. A retrospective analysis was conducted on clinical data of 32 consecutive patients who underwent thoracoscopic segmentectomy with intersegmental plane identification using both ICGF and inflation-deflation method after target segmental veins prioritized blocking at Nanjing Chest Hospital from December 2022 to June 2023. Preoperative three-dimensional reconstruction was used to identify the target segment and the anatomical structure of the arteries, veins, and bronchi. After ligating the target segmental veins during surgery, the first intersegmental plane was immediately identified and marked with an electrocoagulation device using an inflation-deflation method. Subsequently, the second intersegmental plane was determined using the ICGF method. Finally, the consistency of the two intersegmental planes was evaluated. All the 32 patients successfully completed thoracoscopic segmentectomy without ICG-related complications and perioperative death. The average operation time was (98.59 ± 20.72) min, the average intraoperative blood loss was (45.31 ± 35.65) ml, and the average postoperative chest tube removal time was (3.5 ± 1.16) days. The average postoperative hospital stay was (4.66 ± 1.29) days, and the average tumor margin width was (26.96 ± 5.86) mm. The intersegmental plane determined by ICGF method was basically consistent with inflation-deflation method in all patients. The ICGF can safely and accurately identify the intersegmental plane by target segmental veins preferential ligation during thoracoscopic segmentectomy, which is a beneficial exploration and important supplement to the simplified thoracoscopic anatomical segmentectomy.

To evaluate the safety and efficacy of mobile CT combined with procedural sedation and analgesia for the preoperative localization of multiple nodules. The clinical data of 200 patients who underwent CT-guided localization before single-port thoracoscopic pulmonary lobe surgery at our hospital from July 2023 to September 2023 were retrospectively analyzed. The patients were divided into two groups according to the localization method: Group A consisted of 100 patients who were localized under local anesthesia, and Group B consisted of 100 patients who were localized under procedural sedation and analgesia combined with local anesthesia. The general clinical data and localization data of the two groups were compared and analyzed. The incidence of localization complications in Group B was significantly lower than that in Group A (4

Objective To evaluate the safety and efficacy of mobile CT combined with basic anesthesia for the preoperative localization of multiple nodules. Methods The clinical data of 200 patients who underwent CT-guided localization before single-port thoracoscopic pulmonary lobe surgery at our hospital from July 2023 to September 2023 were retrospectively analyzed. The patients were divided into two groups according to the localization method: Group A consisted of 100 patients who were localized under local anesthesia, and Group B consisted of 100 patients who were localized under basic anesthesia combined with local anesthesia. The general clinical data and localization data of the two groups were compared and analyzed. Results The incidence of localization complications in Group B was significantly lower than that in Group A (4% vs. 13%). The localization success rate in Group B was significantly greater than that in Group A (98% vs. 92%). The localization time in Group B was significantly shorter than that in Group A (15.23 ± 5.96 min vs. 19.90 ± 8.66 min), and the pain score in Group B was significantly lower than that in Group A (2.01 ± 2.09 min vs. 3.29 ± 2.54 min). Conclusion Compared with traditional local anesthesia, mobile CT combined with basic anesthesia for preoperative puncture localization of multiple pulmonary nodules results in a shorter localization time, fewer complications, greater safety, a greater success rate, and greater patient comfort, indicating that this method is safe and effective and has significant clinical value.

ObjectiveTo evaluate the operability and safety of mobile CT combined with basic anesthesia in locating pulmonary nodules before uniportal thoracoscopic lung surgery. Methods The clinical data of 72 patients who underwent CT-guided localization before thoracoscopic lung surgery in The Affiliated Brain Hospital of Nanjing Medical University from October 2022 to November 2022 were analyzed. They were divided into group A and group B according to the positioning method. Patients located under local anesthesia were classified as group A （n=36）, patients located under basic anesthesia were classified as group B （n=36）. The clinical data of the two groups were compared. ResultsCompared with group A, in group B, the positioning time was shorter ［（12.75±3.45）min vs（15.00±5.62）min, t=2.047, P=0.045］, the success rate of positioning was higher （100.0%vs83.3%, χ2=4.545, P=0.033）, the number of needle adjustments was less ［0 （0, 0）vs0 （0, 1）］, and the pain score during the positioning process was lower ［1 （0, 2）vs3 （1, 5）］, with statistically significant differences （P＜0.05）. ConclusionCompared with previous local anesthesia, mobile CT combined with basic anesthesia for pulmonary nodules puncture positioning has shorter positioning time, higher success rate and reduced pain sensation of patients, indicating that this method is safe and reliable and worthy of further clinical application.

目的:探讨低剂量螺旋CT联合肺癌自身抗体、肿瘤标志物糖类抗原(CA)12-5、CA19-9在肺癌诊断中的临床应用价值.方法:选择2019年1月至2021年12月在我院经低剂量螺旋CT检查发现肺部病灶的患者86例,以病理诊断结果分为肺癌组49例、肺部良性病变组37例,另选取同期健康体检志愿者30例作为对照组.观察肺癌的低剂量螺旋CT影像学特征,检测比较各组血清肺癌自身抗体[p53、SOX区域Y相关HMG蛋白家族成员2(SOX2)、G抗原7(GAGE7)、RNA解旋酶自身抗体4-5(GBU4-5)]及CA12-5、CA19-9水平,并对比阳性表达情况,分析低剂量螺旋CT联合肺癌自身抗体、CA12-5、CA19-9对肺癌的诊断价值.结果:49例肺癌患者经低剂量螺旋CT检查共发现51个病灶,其中实性结节或部分实性结节30个,非实性结节21个;病灶平均直径(10.92±1.17)mm,＜5mm者9个,5～10mm者17个,≥10mm者25个;11个病灶伴有钙化,16个病灶有毛刺征,20个病灶有分叶征;有6例表现为空洞,空洞通常壁薄厚不均匀,呈中心性或偏心性.肺癌组血清p53、SOX2、GAGE7、GBU4-5及CA12-5、CA19-9水平均明显高于肺部良性病变组和对照组,肺部良性病变组上述指标水平均明显高于对照组(P＜0.05).肺癌组CA12-5、CA19-9、4项肺癌自身抗体单独及联合的阳性率均明显高于肺部良性病变组和对照组(P＜0.05),肺部良性病变组CA12-5、CA19-9及4项肺癌自身抗体联合的阳性率高于对照组(P＜0.05).低剂量螺旋CT联合4项肺癌自身抗体、CA12-5、CA19-9对肺癌诊断的灵敏度为91.84％,特异度为97.30％,准确度为94.19％.结论:低剂量螺旋CT联合肺癌自身抗体、肿瘤标志物CA12-5、CA19-9在肺癌诊断中有较好的临床应用价值.

目的 比较Del Nido心脏停搏液与冷含血停搏液在复杂心脏手术中的心肌保护效果.方法 回顾性分析2018年1月至2019年10月体外循环(CPB)下行复杂心脏手术(主动脉阻断时间＞120 min)75例患者的病例资料,按照使用的心肌保护液不同将其分为Del Nido停搏液组37例和冷含血停搏液组38例.收集两组患者身体质量指数(BMI)、术前及术后射血分数(EF)、体外循环时间、主动脉阻断时间、后并行时间、停搏液灌注次数及总量、两组心脏的自动复跳率、除颤率、术后24h和术后48 h血清肌钙蛋白(cTnT)和肌酸磷酸激酶同工酶(CKMB)浓度,术后机械通气时间、ICU滞留时间、术后住院时间、术后正性肌力药物使用天数、术后肝肾功能等临床资料.结果 两组患者均顺利完成手术.A组的后并行时间、停搏液灌注次数、除颤率明显低于B组,差异有统计学意义(P＜0.05,P＜0.01).A组术后24 h、48 h CKMB、cTnT水平较B组明显降低,差异有统计学意义(P ＜0.05,P＜0.01).结论 Del Nido心脏停搏液与冷含血停搏液相比,在复杂心脏手术中,前者灌注次数更少,除颤率更低,后并行时间更短,术后24 h、48 h CKMB、cTnT水平明显降低,心肌保护效果要优于冷含血停跳液.Del Nido心脏停搏液在复杂心脏手术中的临床应用是安全可行的.

目的 比较Del Nido停搏液、HTK停搏液与改良St.Thomas停搏液三种不同心肌保护液在心脏瓣膜置换术中的心肌保护效果.方法 回顾性分析2016年1月至2018年12月行体外循环(CPB)下瓣膜置换术的120例患者的临床资料,按照使用心肌保护液的不同分为三组:Del Nido停搏液组40例患者,HTK停搏液组40例患者,改良St.Thomas停搏液组40例患者.收集CPB时间、主动脉阻断时间、停搏液灌注次数、自动复跳率、除颤率、术后24h和术后72 h外周血肌钙蛋白Ⅰ(cTnⅠ)和肌酸磷酸激酶同工酶(CK-MB)浓度、术后正性肌力药使用天数、气管插管时间、人住重症监护室时间、术后住院天数、停跳液治疗费用、术后射血分数(EF)等临床资料.结果 三组患者性别、年龄、体重、术前射血分数等基本资料差异无统计学意义(P＞0.05);三组患者均顺利完成瓣膜置换手术.三组体外循环时间、自动复跳率、血液指标、气管插管时间、入住重症监护室时间、术后住院天数差异无统计学意义.与改良St.Thomas停搏液组相比,Del Nido停搏液组、HTK停搏液组灌注次数均明显减少,主动脉阻断时间缩短,除颤率降低,差异具有统计学意义.与HTK停搏液组相比,Del Nido停搏液组治疗费用明显降低.结论 DelNido停搏液具有与HTK停搏液同样的心肌保护效果,且治疗费用更低,易于配制,与改良St.Thomas停搏液相比,前两者阻断时间缩短,灌注次数减少,除颤率明显降低;Del Nido停搏液在成人心脏瓣膜手术中的临床应用是安全可行的.

目的:探索微创胸骨上段J型小切口行主动脉瓣置换术的安全可行性以及临床优势.方法:回顾性分析20例胸骨上段J型小切口行主动脉瓣置换和同期20例传统胸骨正中切口主动脉瓣置换术患者资料,对比两组术中升主动脉阻断时间,转机时间,手术时间、术后引流量、胸管拔除时间、术后拔出气管插管时间、术后出院时间以及住院费用.结果:两组均无手术死亡,两组术中升主动脉阻断时间、体外循环时间及手术时间无显著性差异.与传统正中切口相比,胸骨上段J型小切口术后第1天引流量及术后总引流量减少,胸管拔除时间更早,术后拔出气管插管时间更早,术后住院天数明显缩短,住院整体费用明显降低.结论:胸骨上段J型小切口主动脉瓣置换术是安全可行的手术方式.