Techniques Conventional single-port thoracoscopic surgery typically requires a 4-5 cm surgical incision. The novel “Ultra-minimal 2 cm Single-Port Thoracoscopic Surgery” technique described in this study successfully reduces the incision length for single-port thoracoscopic surgery to just 2 cm. Under conditions of reduced trauma, this surgical approach achieves comparable surgical quality to conventional single-port thoracoscopy. We have applied this technique to various standard thoracoscopic procedures, including wedge resections, bulla resections, segmentectomies, and lobectomies. Results We illustrate this approach with a relatively complex lung lobectomy case. The patient was a 72-year-old male who presented with a mixed ground-glass nodule measuring approximately 24 × 19 mm in the right upper lobe, discovered during a health examination. According to the preoperative plan, a 2-cm incision was made at the 5th intercostal space along the right anterior axillary line as the surgical port. An initial wedge resection of the right upper lobe was performed. Intraoperative frozen section analysis confirmed lung invasive adenocarcinoma, prompting a subsequent right upper lobectomy with systematic mediastinal lymph node dissection. The total operative time was 136 min, with an estimated blood loss of 30 ml. The chest tube was successfully removed on the third postoperative day, and no postoperative complications occurred. Conclusions Ultra-minimal 2-cm Single-Port Thoracoscopic Surgery shows promising prospects. It combines the advantages of minimized surgical trauma, maintained or simplified operative manipulation, and preserved high-quality 3D visualization.

Background: Early-stage invasive lung adenocarcinoma (ADC) characterized by a predominant micropapillary or solid pattern exhibit an elevated risk of recurrence following sub-lobar resection, thus determining histological subtype of early-stage invasive ADC prior surgery is important for formulating lobectomy or sub-lobar resection. This study aims to develop a deep learning algorithm and assess its clinical capability in distinguishing high-risk or low-risk histologic patterns in early-stage invasive ADC based on preoperative computed tomography (CT) scans. Methods: Two retrospective cohorts were included: development cohort 1 and external test cohort 2, comprising patients diagnosed with T1 stage invasive ADC. Electronic medical records and CT scans of all patients were documented. Patients were stratified into two risk groups. High-risk group: comprising cases with a micropapillary component >= 5% or a predominant solid pattern. Low-risk group: encompassing cases with a micropapillary component <5% and an absence of a predominant solid pattern. The overall segmentation model was modified based on Mask Region-based Convolutional Neural Network (MaskRCNN), and Residual Network 50 (ResNet50)_3D was employed for image classification. Results: A total of 432 patients participated in this study, with 385 cases in cohort 1 and 47 cases in cohort 2. The fine-outline results produced by the auto-segmentation model exhibited a high level of agreement with manual segmentation by human experts, yielding a mean dice coefficient of 0.86 [95% confidence interval (CI): 0.85-0.87] in cohort 1 and 0.84 (95% CI: 0.82-0.85) in cohort 2. Furthermore, the deep learning model effectively differentiated the high-risk group from the low-risk group, achieving an area under the curve (AUC) of 0.89 (95% CI: 0.88-0.90) in cohort 1. In the external validation conducted in cohort 2, the deep learning model displayed an AUC of 0.87 (95% CI: 0.84-0.88) in distinguishing the high-risk group from the low-risk group. The average diagnostic time was 16.00 +/- 3.2 seconds, with an accuracy of 0.82 (95% CI: 0.81-0.83). Conclusions: We have developed a deep learning algorithm, LungPath, , for the automated segmentation of pulmonary nodules and prediction of high-risk histological patterns in early-stage lung ADC based on CT scans.

BACKGROUND:Mediastinal neoplasms are typical thoracic diseases with increasing incidence in the general global population and can lead to poor prognosis. In clinical practice, the mediastinum's complex anatomic structures and intertype confusion among different mediastinal neoplasm pathologies severely hinder accurate diagnosis. To solve these difficulties, we organised a multicentre national collaboration on the basis of privacy-secured federated learning and developed CAIMEN, an efficient chest CT-based artificial intelligence (AI) mediastinal neoplasm diagnosis system. METHODS:In this multicentre cohort study, 7825 mediastinal neoplasm cases and 796 normal controls were collected from 24 centres in China to develop CAIMEN. We further enhanced CAIMEN with several novel algorithms in a multiview, knowledge-transferred, multilevel decision-making pattern. CAIMEN was tested by internal (929 cases at 15 centres), external (1216 cases at five centres and a real-world cohort of 11 162 cases), and human-AI (60 positive cases from four centres and radiologists from 15 institutions) test sets to evaluate its detection, segmentation, and classification performance. FINDINGS:In the external test experiments, the area under the receiver operating characteristic curve for detecting mediastinal neoplasms of CAIMEN was 0·973 (95% CI 0·969-0·977). In the real-world cohort, CAIMEN detected 13 false-negative cases confirmed by radiologists. The dice score for segmenting mediastinal neoplasms of CAIMEN was 0·765 (0·738-0·792). The mediastinal neoplasm classification top-1 and top-3 accuracy of CAIMEN were 0·523 (0·497-0·554) and 0·799 (0·778-0·822), respectively. In the human-AI test experiments, CAIMEN outperformed clinicians with top-1 and top-3 accuracy of 0·500 (0·383-0·633) and 0·800 (0·700-0·900), respectively. Meanwhile, with assistance from the computer aided diagnosis software based on CAIMEN, the 46 clinicians improved their average top-1 accuracy by 19·1% (0·345-0·411) and top-3 accuracy by 13·0% (0·545-0·616). INTERPRETATION:For mediastinal neoplasms, CAIMEN can produce high diagnostic accuracy and assist the diagnosis of human experts, showing its potential for clinical practice. FUNDING:National Key R&D Program of China, National Natural Science Foundation of China, and Beijing Natural Science Foundation.

目的:探讨一次性使用肺结节定位针在肺小结节术前定位中的应用效果.方法:选取2021年10月—2023年6月揭阳市人民医院收治的60例符合标准的肺小结节患者,采用随机数字表法分为两组.其中试验组(n=30)使用一次性肺结节定位针进行定位,对照组(n=30)采用传统的生物胶+亚甲蓝进行定位.比较两组定位成功率、平均定位时间、并发症发生情况及患者手术满意度.结果:试验组定位成功率显著高于对照组,差异具有统计学意义(P<0.05);试验组的平均定位时间、手术时间均短于对照组,差异均具有统计学意义(P<0.05);

Optimal treatment for resectable esophageal squamous cell carcinoma (ESCC) is controversial, especially in the context of potential benefit of combining PD-1 blockade with neoadjuvant therapy. This phase 2 study aimed to assess neoadjuvant camrelizumab plus chemotherapy in this population. Patients (clinical stage II-IVA) received two cycles of neoadjuvant chemoimmunotherapy (NIC) with camrelizumab (200 mg on day 1) plus nab-paclitaxel (260 mg/m2 in total on day 1 and day 8) and cisplatin (75 mg/m2 in total on days 1-3) of each 21-day cycle. Surgery was performed approximately 6 weeks after completion of NIC. Primary endpoint was complete pathologic response (CPR) rate in primary tumor. Secondary endpoints were objective response rate (ORR) per RECIST v1.1, 2-year progression-free survival (PFS) rate after surgery, PFS, overall survival (OS) and safety during NIC and perioperative period. Between 17 January 2020 and 8 December 2020, 56 patients were enrolled, and 51 received esophagectomy. Data cutoff date was 25 August 2021. The CPR rate was 35.3% (95% CI, 21.7%-48.9%). NIC had an ORR of 66.7% (95% CI, 40.0%-70.4%) and treatment-related adverse events (TRAEs) of low severity (grade 1-2, 75.0%; grade 3, 10.7%; grade 4-5, no). No perioperative mortality occurred. Three (5.9%) patients had tumor recurrence and one (2.0%) patient died. The 2-year PFS rate, median PFS and median OS had not been reached yet. Camrelizumab plus neoadjuvant chemotherapy in resectable ESCC demonstrates promising efficacy with acceptable toxicity, providing a feasible and effective option. Study is ongoing for long-term survival analyses.

目的 观察非气管插管下单体位单孔胸腔镜双侧交感神经T3/T4切断术治疗手足多汗症的效果.方法 选取2016年1月至2019年12月入院治疗的70例手足多汗症患者作为研究对象,随机分为两组,各35例.所有患者均给予单体位单孔胸腔镜双侧交感神经T3/T4切断术治疗,其中A组给予喉罩复合全静脉非插管麻醉,B组给予单腔气管插管全身麻醉.比较两组患者手术过程中心率、血压、血氧饱和度指标变化及围手术期结果.结果 术后,两组患者双手、双足均变为干燥温暖,有效率100％,两组患者治疗效果、手术时间比较差异无统计学意义;A组麻醉起效时间、进食时间、术后下地活动时间、住院时间等均显著短于B组,术后24 h疼痛评分、术后舒适度评分、住院费用均低于B组(P<0.05).A组并发症发生率为5.71％(2/35),B组为25.71％(9/35),两组比较差异有统计学意义(P<0.05).T0时刻,两组HR、MBP、SpO2比较差异无统计学意义,T1～T3时刻,两组患者HR、MBP均高于T0时刻,差异有统计学意义(P<0.05),组间比较差异无统计学意义,两组不同时间点SpO2比较差异无统计学意义.结论 非气管插管下单体位单孔胸腔镜双侧交感神经T3/T4切断术有助于促进手足多汗症术后康复,并发症发生率较低,值得临床推广应用.

Background Diabetes mellitus is a recognized risk factor for esophageal squamous cell carcinomas (ESCC), and metformin is a recognized protective factor for some gastrointestinal tumors. But knowledge is limited regarding the effect of metformin on survival outcome of ESCC patients with type 2 diabetes mellitus (T2DM). We assessed the impact of post-diagnosis metformin use on overall survival (OS) and disease-free survival (DFS) in ESCC with T2DM undergoing surgical resection. Methods A retrospective analysis was performed on 3,523 patients with ESCC who met the study conditions after surgical resection. Log-rank and Cox regression models were used to evaluate the relationship between metformin and T2DM and ESCC survival rate, and adjusted according to age, gender, BMI, smoking, drinking and staging, et al. Results Among included ESCC patients, 619 were associated with type 2 diabetes, while the remaining 2,904 were not associated with type 2 diabetes. The 5-year OS (28.43%) of patients with T2DM was significantly lower than that of patients without T2DM (32.75%), P=0.037. DFS in 5 years were 27.30% (with T2DM) and 31.75% (without T2DM) (P=0.030), respectively. Compared with patients without T2DM, patients with T2DM presented worse OS [adjusted risk ratio (HRadj) =1.19] and DFS (HRadj =1.17; P<0.001). Among the 619 patients with type 2 diabetes, 485 were treated with metformin and 134 were not treated with metformin. Patients treated with metformin had significantly improved OS [adjusted risk ratio (HRadj) =0.89; P=0.031) and DFS (HRadj =0.90; P=0.013). Conclusions T2DM was again associated with poorer survival in ESCC patients, and metformin may improve the prognosis of these patients.

目的 探讨适用于揭阳市的肺癌高危人群低剂量螺旋CT筛查路径模式,向民众普及肺癌的预防及早期筛查知识.方法 通过揭阳市人民医院微信公众号、揭阳电视台爱健康栏目、揭阳日报等向揭阳市民宣传肺癌高危人群的特征及低剂量CT筛查的获益从而招募筛查人群,开放体检中心绿色通道为筛查人群提供便利.根据《低剂量螺旋CT肺癌筛查专家共识》的高危人群特征招募筛查人群.采用我院的西门子超高速SOMATOM Definition双源CT进行薄层扫描.对筛查出的肺部结节人数、肺部结节个数、恶性结节比例及人群资料等进行统计分析,同时研究生殖因素是否影响女性肺癌患者的发病率.结果 2017年7月至2018年6月期间,共招募肺癌高危人群3535例,其中男性2085例(58.98％),女性1450例(41.01％),共筛查出肺部结节人群631例,两个以上结节人群150例,高度怀疑恶性结节53例,20例取得病理诊断,19例为肺癌,1例为肺结核,男性与女性肺癌患者检出率差异无统计学意义(P=0.573),女性人群中无肺部结节组与确诊肺癌组的平均活产个数比较差异无统计学意义(P=0.97).结论 胸部低剂量螺旋CT是一种有效的早期肺癌筛查方法可考虑进一步地推广,在筛查过程中严格遵守筛查指南规范可以确切地避免过度诊断和过度治疗.本项目在一定程度上推动了民众肺癌防治意识的普及.

目的 探讨胸腔肺癌根治手术中,应用无抓持整块纵隔淋巴结清扫技术的安全性、可行性及技术要点.方法 回顾性分析2017年6月—2019年6月在该院进行胸腔镜下肺叶切除术贯续无抓持整块纵隔淋巴结清扫的78例患者的临床资料.男性51例,女性27例,平均年龄(60.5±6.8)岁.无抓持整块清扫左侧纵隔淋巴结33例,右侧45例,对比两组患者的手术时间、淋巴结清扫数目、引流管留置时间、引流量及住院时间.结果 全组78例患者均完成胸腔镜肺叶切除术序贯无抓持整块纵隔淋巴结清扫.平均手术时间(125±17.4)min.清扫淋巴结的数目平均(16.5±6.7)个.手术后胸腔引流管留置的时间平均(4.5±2.5)d,术后平均胸液引流量为(524±108)mL.术后住院时间平均(6.7±1.5)d.结论 胸腔镜手术中使用无抓持淋巴结清扫技术是安全可行的,相较传统的抓持技术更适用于在胸腔镜下应用.

目的:探讨单孔与三孔胸腔镜肺癌根治术对患者T淋巴细胞亚群、应激反应及生活质量的影响.方法:选择2016年2月～2018年9月期间我院收治的肺癌根治术患者127例为研究对象,依据随机数字表法将其分成单孔组(n=63,采用单孔胸腔镜肺癌根治术治疗)和三孔组(n=64,采用三孔胸腔镜肺癌根治术治疗),比较两组患者手术及临床指标、T淋巴细胞亚群、应激反应指标及生活质量评分,并观察两组患者术后并发症发生情况.结果:单孔组术中出血量少于三孔组,住院时间短于三孔组,而手术时间长于三孔组(P＜0.05),而两组淋巴结清扫个数、术后引流时间、术后引流量比较差异无统计学意义(P＞0.05).术后ld、术后7d单孔组皮质醇、生长激素、PGE2均低于三孔组(P＜0.05).术后3d单孔组CD3+、CD4+以及CD4+/CD8+高于三孔组(P＜0.05).术后3个月单孔组躯体疼痛、社会功能、情感职能、平均分数高于三孔组(P＜0.05).两组患者术后并发症总发生率比较无差异(P＞0.05).结论:与三孔胸腔镜肺癌根治术相比,单孔胸腔镜肺癌根治术可减少患者术中出血量,缩短住院时间,减轻机体应激反应,对免疫功能损害较轻,且可有效改善患者生活质量.

With the development of minimally invasive thoracoscopic and anesthesia control techniques, intravenous anesthesia with spontaneous ventilation video-assisted thoracic surgery (SV-VATS) has been increasingly employed in management of pleural effusion, bullectomy for pneumothorax, mediastinal biopsy, thymectomy and thymomectomy, wedge lung resections, anatomical lung resections for radical treatment of lung cancer and even more complex surgical procedures including tracheal resection and sleeve lobectomy (1-7) This changes in surgical strategies have been applied in the believe that SV-VATS can avoid adverse effects of mechanical ventilation and the residual effects of muscle relaxants, can achieve a faster recovery of respiratory muscle function and lower operative morbidity (7,8).

目的:探讨亚甲蓝复合制剂对食管癌微创McKeown术后患者的镇痛效果.方法:选取本科室收治的112例行腔镜下McKeown术的食管癌患者,根据术后镇痛方式的不同,分为研究组和对照组.研究组45例,采用亚甲蓝复合制剂肋间神经阻滞镇痛治疗;对照组67例,采用硬膜外管接镇痛泵镇痛治疗.比较两组患者的视觉模拟评分(VAS评分)、镇痛药用量、并发症总发生率、血流动力系统及胃肠功能方面差异.结果:研究组患者术后第3、5、7天胸腹部VAS评分均低于对照组,且术后双氯芬酸钠及布桂嗪的用量均显著低于对照组(P＜0.05);术后研究组患者的并发症总发生率为8.8％,显著低于对照组的29.8％(P＜0.05);术后6、12h的平均动脉压(MAP)和心率(HR)研究组均显著低于对照组(P＜0.05),而术后24 h的MAP和HR两组差异均无统计学意义(P＞0.05);患者的胃肠动力相关指标研究组均较对照组明显改善(P＜0.05).结论:亚甲蓝复合制剂对食管癌微创McKeown术后患者的镇痛效果显著,对患者的血流动力系统及胃肠功能的影响较小,且并发症少,值得临床大力推广.

目的 研究对肺癌手术的患者应用加速康复外科(ERAS)方法的效果和安全性.方法 选择2017年2月至2018年2月入住我院130例肺癌患者作为研究对象,根据数字法随机分为观察组及对照组,每组65例,观察组应用ERAS,对照组应用传统的治疗模式,分别比较两组患者手术后并发症发生率、疼痛程度、恢复速度快慢、手术后第一次下床活动以及进食的时间、胸管停留时间、平均住院时间、费用和抗生素使用时间.结果 观察组第一次下床活动及进食的时间、胸管停留时间、恢复时间和抗生素使用时间均低于对照组(P<0.05);住院时间以及住院使用的费用均低于对照组(P<0.05);术后6h,1天,数字评分法(NRS)评分均低于对照组,但差异无统计学的意义(P>0.05),术后2天,3天,4天,5天NRS评分低于对照组(P<0.05);术后出现不良反应概率低于对照组(P<0.05).结论 本研究通过加速康复外科在肺癌手术治疗中的应用,从术后并发症、疼痛程度、恢复速度、首次下床活动及进食时间、胸管停留时间、平均住院时间、费用及抗生素使用时间等方面,与传统模式作对比,显示出ERAS治疗的优越性,同时为胸外科围手术期管理提供新理念.

目的 探讨快速康复外科(FTS)对经剑突下单孔胸腔镜双侧肺大疱切除术的安全性及术后患者肺功能的影响.方法 选取拟行经剑突下单孔胸腔镜双侧肺大疱切除术治疗的双侧肺大疱60例患者为研究对象,分FTS组和常规组各30例.常规组按常规程序进行治疗,FTS组根据FTS理念制订围术期流程并实施手术方案.监测比较两组患者手术情况、围术期疼痛和肺功能指标及并发症发生率.结果 与常规组比较,FTS组术后胸腔引流管留置时间和术后住院时间均缩短,术后疼痛视觉模拟评分(VAS)降低,肺功能指标则提高,并发症总发生率低于常规组(P＜0.05).结论 FTS理念可有效促进患者疼痛症状的缓解、肺功能的改善及并发症的预防.

Primary spontaneous pneumothorax (PSP) has an estimated incidence ranging from 17–24/100,000 and 1–6/100,000 among males and females, respectively (1,2). It usually occurs in tall thin individuals between 10–30 years of age, especially smokers (3).

Objective To observe the analgesic effect of compound coeruleum methylene blue preparation after thoracoscopic surgery,and to provide a new idea for the choice of analgesic drugs for thoracoscopic patients.Methods The clinical data of 116 patients who underwent selective thoracoscopic surgery in the Department of Cardiothoracic Surgery of Jieyang People's Hospital from January 2016 to May 2018 were analyzed.This study was a prospective study.Research subjects were divided into control group (n =57) and observation group (n =59) by random digital table.In the two groups,no analgesic measures were used in advance,of which the patients in the control group were given the routine injection of piperidine hydrochloride by intramuscular injection after operation.While patients in the observation group were given intercostal nerve block across the upper and lower fibs after operation,and the dosage of compound methylene blue was 1 ml in each rib.on the basis with pethidine hydrochloride.The visual analog score and Ramsay sedation score were compared between the two groups of patients at 4 h,12 h 24 h and 48 h after operation and compared the use of pethidine hydrochloride,adverse drug reactions,ambulation time and hospitalization time.The counting data was expressed in terms of frequency and percentage (％).The measurement data were represented by ((x) ± s).The comparison of different time points within the group was performed by single-factor analysis of variance,and the comparison between the two groups was performed by independent sample t test.Results Compared with the control group's patients [in resting state,12 h:(3.85 ± 1.97) points;24 h:(2.74 ± 1.91) points;48 h:(2.11 ± 1.70) points;in activity state,12 h:(5.02 ± 1.64) points;24 h:(4.89 ± 1.36) points;48 h:(3.83 ± 1.51) points],the VAS scores of the patients in the observation group in resting state [12 h:(2.68 ± 1.24) points;24 h:(1.35 ± 1.16) points;48 h:(0.74 ± 0.63) points] and activity state[12 h:(3.81 ±1.53) points;24 h:(3.25±1.71) points;48 h:(2.42± 1.33)points] were significantly lower at 12 h,24 h and 48h after operation.Compared with the control group's patients 12 h [(2.58 ± 0.41) points] and 24 h [(2.29 ± 0.34) points],the Ramsay scores were significantly higher at 12 h[(2.93 ±0.35)points] and 24 h [(2.79 ±0.30)points] after operation (P＜0.05).The observation group's amount of piperidine hydrochloride was less,and the ambulation and hospitalization time were shorter than the control group's (P ＜ 0.05).The incidence of analgesia-related adverse reactions in the control group and the observation group were 35.09％ and 27.12％,respectively,with no significant difference (P ＞ 0.05).Conclusions Compound coeruleum methylenum's analgesic effect after thoracoscopic surgery is accurate and maintains long time,and the side effects are less and the operation is convenient.It is worthy of clinical application.

Objective To compare the effect of thoracoscopy combined with laparoscopy Mckeown and tradi-tional three incision surgery in radical resection of esophageal carcinoma.Methods 300 patients with esophageal cancer who confirmed diagnosis by gastroscopy and pathology,were randomly divided into the observation group and the control group,150 patients in each group.The observation group was treated by thoracoscopy combined with lapa-roscopy Mckeown esophagectomy,and the control group was treated by traditional three incision surgery.The operation time,intraoperative blood loss,number of lymph node dissection,length of chest tube drainage,postoperative complica-tions,and length of postoperative hospital stay of the two groups were compared.Results There were no significant differences between the two groups in operating time[(282 ±62)min vs.(273 ±64)min,P >0.05],and number of lymph node dissection[(23.2 ±6.6)vs.(21.6 ±6.4),P >0.05],and there were significant differences in intraop-erative blood loss[(262.3 ±44.7)mL vs.(315.2 ±72.6)mL,P <0.05],length of chest tube drainage[(7.6 ± 1.6)d vs.(9.4 ±2.4)d,P <0.05],postoperative complications[16.7% vs.30.0%,P <0.05],and length of hos-pital stay[(10.5 ±2.5)d vs.(14.0 ±2.0)d,P <0.05].Conclusion Thoracoscopy combined with laparoscopy Mckeown esophagectomy can achieve the same efficacy compared with the traditional approach,and it is worth popu-larizing in clinic for reducing intraoperative blood loss,length of chest tube drainage,postoperative complications,and length of hospital stay.

Objective:To evaluate the clinical effect and prognosis of uniportal video-assisted thoracoscopic surgery (VATS) through the subxyphoid approach for bilateral bullae. Methods:70 patients with bilateral bullae treated in this hospital during January 2014 to December 2015 were randomly divided into two groups. Patients in observation group (n=35) and control group (n=35) who underwent bilateral bullae excision with uniportal VATS were individually through the subxyphoid approach and the intercostal approach. hTe clinical indexes were compared between the two groups, including the surgery related indicators, the incidence of postoperative complications and the degree of pain, etc. Results:All operations were successfully completed;the observation group had shorter operation time. At 48 h, 72 h, and the 5th day atfer operation, the pain was less than that in the control group (P<0.05). The incidence of incision pain or incision numbness in observation group was significantlylower than that in control group during the 6-month follow-up period. But there was no significant difference in intraoperative blood loss, duration of postoperative thoracic tube drainage, total drainage volume and the incidence of postoperative complications between two groups (P>0.05). Conclusion:Simultaneous subxyphoid approach uniportal video-assisted thoracoscopic surgery for bilateral bullae is safe and feasible, which has shorter operation time, relief of postoperative pain and satisfying prognosis.