Abstract Background Lung cancers arising in never smokers have been suggested to be substantially different from lung cancers in smokers at an epidemiological, genetic and molecular level. Focusing on non-small cell lung cancer (NSCLC), we characterized lung cancer patients in China looking for demographic and clinical differences between the smoking and never-smoking subgroups. Methods In total, 891 patients with NSCLC, including 841 with adenocarcinoma and 50 with squamous cell carcinoma, were recruited in this study. Association of smoking status with demographic and clinical features of NSCLC was determined, and risk factors for lymph node metastasis and TNM stage were evaluated using Multivariate logistic regression analysis. Results In patients with adenocarcinoma, never smokers showed a younger age at diagnosis (54.2 ± 12.7vs. 59.3 ± 9.4, p adjusted <0.001), a lower risk for lymph node metastasis than smokers (7,6% vs. 19.5%, p adjusted <0.001) and less severe disease as indicated by lower percentages of patients with TNM stage of III or IV (5.5% vs. 14.7%, p adjusted <0.001 ). By contrast, these associations were not observed in 50 patients with squamous cell carcinoma. Multivariate logistic regression analysis showed that smoking status was a risk factor for lymph node metastasis (OR = 2.70, 95% CI: 1.39–5.31, p = 0.004) but not for TNM stage (OR = 1.18, 95% CI: 0.09–14.43, p = 0.896) in adenocarcinoma. Conclusion This study demonstrates that lung adenocarcinoma in never smokers significantly differ from those in smokers regarding both age at diagnosis and risk of lymph node metastasis, supporting the notion that they are distinct entries with different etiology and pathogenesis.

目的:研究Ⅰ、Ⅱ期非小细胞肺癌患者胸腔镜术后并发症发生的影响因素.方法:选取2017年3月-2018年9月厦门大学附属第一医院进行Ⅰ、Ⅱ期非小细胞肺癌治疗患者195例进行临床研究.所有患者均给予VATS肺叶切除术+系统淋巴结清扫术.按照术后患者是否出现并发症将患者分为并发症组和无并发症组.观察两组一般情况、病理情况、围手术期情况.统计分组情况,比较两组一般情况、病理情况、围手术期情况.对Ⅰ、Ⅱ期非小细胞肺癌患者胸腔镜术后并发症发生进行Logistic多因素回归分析.结果:195例患者中有42例出现术后并发症(并发症组),发生率为21.54％,153例未出现术后并发症(无并发症组).并发症组年龄≥60岁、有吸烟史、合并COPD、冠心病占比均高于无并发症组(P<0.05).并发症组Ⅱ期占比高于无并发症组(P<0.05).并发症组手术时间长于无并发症组,术中失血量、术后第1天引流量均多于无并发症组,术后抗生素使用时间长于无并发症组(P<0.05).Logistic结果提示有吸烟史、合并COPD、冠心病、病理分期、手术时间、术后第1天引流量均是Ⅰ、Ⅱ期非小细胞癌患者胸腔镜术后并发症发生的危险因素(P<0.05).结论:对于有吸烟史、合并COPD、冠心病、分期为Ⅱ期、手术时间长、术后第1天引流量大的Ⅰ、Ⅱ期非小细胞癌患者,应注意胸腔镜术后并发症发生的风险.

目的:评价肺磨玻璃结节患者行胸腔镜局限性肺切除术中支气管封堵器(bron-chial blocker,BB)肺隔离的可行性和安全性.方法:选取厦门大学附属第一医院2018年1月-2019年12月拟行胸腔镜下局限性肺切除术肺磨玻璃结节患者122例作为研究对象.采用数字表随机法分为双腔支气管导管(double lumen tube,DLT)组和BB组,各61例.DLT组采用DLT辅助单肺通气行胸腔镜局限性肺切除术,BB组采用BB辅助单肺通气行胸腔镜局限性肺切除术.比较两组患者支气管镜定位用时、手术时长、一次插管成功率、肺萎缩质量、术后咽痛发生率,单肺通气前,单肺通气10、30 min的动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、气道峰压、平均动脉压(MAP).结果:BB组支气管镜定位用时长于DLT组,差异有统计学意义(P<0.05).两组手术时间比较差异无统计学意义(P>0.05).BB组一次性插管成功率为83.61％,高于DLT组的55.74％,BB组术后咽痛发生率为14.75％,明显低于DLT组的45.90％,差异均有统计学意义(P<0.05).两组肺萎缩质量比较差异无统计学意义(P>0.05).两组单肺通气10、30 min的PaO2均低于单肺通气前,气道峰压均高于单肺通气前,差异有统计学意义(P<0.05).两组单肺通气10、30 min的PaCO2、MAP与单肺通气前比较差异均无统计学意义(P>0.05).BB组单肺通气10、30 min的PaO2均高于DLT组,气道峰压均低于DLT组,差异有统计学意义(P<0.05).两组单肺通气10、30 min的PaCO2、MAP比较差异均无统计学意义(P>0.05).结论:肺磨玻璃结节胸腔镜下局限性肺切除术中应用支气管封堵器一次性插管成功率高,是安全可行的肺隔离、单肺通气方法,建议推广应用.

Tumor cells tend to utilize glycolysis rather than aerobic respiration even under aerobic conditions. OVOL2, an inhibitory C2H2 zinc finger transcription factor, is a potential tumor suppressor in cancers. However, the association between OVOL2 and tumor energy metabolism is unknown. Western blotting was used to determine the expression of OVOL2 in different non-small cell lung cancer (NSCLC) cell lines and mouse models. The metabolic parameters in NSCLC cells following overexpression or knockdown OVOL2 were examined. To define the mechanism by which OVOL2 regulates aerobic glycolysis, interacting protein of OVOl2 and downstream molecular events were identified by luciferase assay and co-immunoprecipitation. We documented the regulatory mechanism in mouse xenograft models. Finally, clinical relevance of OVOL2, NF-κB signaling and GLUT1 was measured by immunostaining. OVOL2 is downregulated in NSCLC and overexpression of OVOL2 inhibits the survival of cancer cells. Moreover, OVOL2 directly binds to P65 and inhibits the recruitment of P300 but facilitates the binding of HDAC1 to P65, which in turn negatively regulates NF-κB signaling to suppress GLUT1 translocation and glucose import. In contrast, OVOL2 expression is negatively regulated by NF-κB signaling in NSCLC cells via the ubiquitin–proteasome pathway. Re-expression of OVOL2 significantly compromise NF-κB signaling-induced GLUT1 translocation, aerobic glycolysis in NSCLC cells and mouse models. Immunostaining revealed inverse correlations between the OVOL2 and phosphorylated P65 levels and between the OVOL2 and membrane GLUT1 levels, and a strong correlation between the phosphorylated P65 and membrane GLUT1 levels. These results suggest a regulatory circuit linking NF-κB and OVOL2, which highlights the role of NF-κB signaling and OVOL2 in the modulation of glucose metabolism in NSCLC.

目的:比较支气管前方隆突下淋巴结清扫与后方隆突下淋巴清扫在单孔胸腔镜肺上叶癌根治术中的效果与安全性.方法:选取2018年7月-2020年6月厦门大学附属第一医院胸外科收治的102例拟行根治性手术的肺上叶癌患者,采用隐匿数字随机法将患者分为前方清扫组和后方清扫组,每组51例.前方清扫组采用单孔胸腔镜肺上叶癌根治术+支气管前方隆突下淋巴结清扫,后方清扫组采用单孔胸腔镜肺上叶癌根治术+支气管后方隆突下淋巴结清扫.比较两组手术相关指标、隆突下淋巴结清扫数、视觉模拟评分法(VAS)评分和并发症发生情况.结果:两组手术时间、引流管留置时间、术后住院时间、术中出血量、术后引流量、隆突下淋巴结清扫数比较,差异均无统计学意义(P>0.05).两组术后VAS评分呈下降趋势(P<0.05).术后24、48、72 h,前方清扫组VAS评分均低于后方清扫组,差异均有统计学意义(P<0.05).前方清扫组并发症发生率为9.80％,低于后方清扫组的11.76％,但差异无统计学意义(P>0.05).结论:支气管前方隆突下淋巴结清扫与后方隆突下淋巴清扫数、并发症发生率相同,但前者可减轻肺部损伤降低术后疼痛,是优于后者的手术方案.

目的 评价人工智能肺部结节辅助诊疗系统鉴别肺结节良恶性及浸润程度的效能.方法 回顾性分析2019年1月至2020年8月厦门大学附属第一医院收治的87例肺结节患者的临床资料,其中男33例(37.9％),平均年龄(55.1±10.4)岁;女54例(62.1％),平均年龄(54.5±14.1)岁.共纳入90枚结节,将结节分为恶性肿瘤组(80枚)和良性病变组(10枚),其中恶性肿瘤组又分为浸润性腺癌组(60枚)和非浸润性腺癌组(20枚).比较各组的恶性概率和倍增时间等信息,分析其对结节的良恶性及浸润程度的预测能力.结果 恶性肿瘤组与良性病变组恶性概率差异有统计学意义,且恶性概率可以较好地区分出恶性结节与良性病变(87.2％±9.1％vs.28.8％±29.0％,P=0.000),受试者工作特征(ROC)曲线下面积(AUC)为0.949.良性病变组结节最大径显著大于恶性肿瘤组[(1.270±0.481)cm vs.(0.990±0.361)cm,P=0.026];良性病变的倍增时间明显长于恶性结节[(1 083.600±258.180)dvs.(527.025±173.176)d,P=0.000],AUC 为0.975.对比浸润性腺癌组与非浸润性腺癌组发现,浸润性腺癌组结节最大径大于非浸润性腺癌组的最大径,且差异有统计学意义[(1.350±0.355)cm vs.(0.863±0.271)cm,P=0.000];两组间恶性概率差异无统计学意义(89.7％±5.7％vs.86.4％±9.9％,P=0.082),AUC为0.630.浸润性腺癌组倍增时间明显较非浸润性腺癌组短[(392.200±138.050)d vs.(571.967±160.633)d,P=0.000],AUC为0.829.结论 基于人工智能的肺部结节辅助诊疗系统得出的肺结节恶性概率和倍增时间,可用于辅助鉴定术前肺结节的良恶性及评估浸润情况.

目的 探讨全胸腔镜肺叶切除术中应用超细胸腔引流管和常规粗引流管对引流效果,患者疼痛程度及引流相关并发症的影响.方法 选取2017年1月至2018年9月行全胸腔镜肺癌根治术的156例患者,随机分为A组(超细胸管组)和B组(常规粗胸管组)各78例,比较两组术后引流时间、总引流量、术后住院时间、术后疼痛评分及引流相关并发症发生率等情况.结果 A组术后引流时间、总引流量、引流相关并发症显著少于B组(P＜0.05),术后第3、4天疼痛评分A组显著低于B组(P＜0.05),两组住院时间、术后第1、3、5天疼痛评分差异无统计学意义(P＞0.05).结论 全胸腔镜肺叶切除术后应用超细胸腔引流管可缩短引流时间,减轻术后疼痛,降低引流相关并发症的发生,且切口愈合美观,是效果确切满意的引流方式.

目的:比较早期肺癌患者采用胸腔镜下肺叶切除术与胸腔镜下肺段切除术对其免疫功能及血清学指标的影响.方法:本次研究对象来源于笔者所在医院胸外科2015年2月-2017年2月收治的早期肺癌患者84例,双盲法随机分成两组,其中对照组(n=42)采用胸腔镜肺叶切除术,观察组(n=42)采用胸腔镜肺段切除术,比较两组术前术后血清肿瘤标志物与细胞免疫功能.结果:两组术前各项血清肿瘤标志物指标比较差异无统计学意义(P>0.05),术后观察组CatX、Cyfra21-1及SCC明显低于对照组,差异有统计学意义(P<0.05);两组术前各项细胞免疫功能指标比较差异无统计学意义(P>0.05),术后观察组Th1高于对照组,CD4CD25Treg、Th2及Th17明显低于对照组,差异有统计学意义(P<0.05).结论:胸腔镜肺段切除术相较于胸腔镜肺叶切除术治疗早期肺癌患者更有利改善患者免疫功能并降低血清标志物含量.

目的 研究腔镜食管癌切除术前口服橄榄油,术中胸导管暴露的优势.方法 回顾性分析2013年6月至2015年6月厦门大学附属第一医院胸外科136例腔镜食管癌切除术患者的临床资料,其中男83例、女53例,年龄(58.3±7.6)岁.所有患者术前12h口服橄榄油100 ml,术后观察乳糜胸发生的情况.结果 全组患者均成功实施手术,无中转开胸.术中胸导管充盈透明,呈乳白色,暴露清晰.131例患者成功保留胸导管,5例因肿瘤外侵分离胸导管时损伤,术中发现并用钛夹夹闭.所有患者术后留置胸腔引流管3～5d,术后24 h平均引流量(150±35)ml,术后总引流量(500±130)ml,术后均未出现乳糜胸,术后平均住院时间(9±2)d.结论 腔镜食管癌切除术患者术前口服橄榄油,简单、安全、有效、无损伤,术中胸导管暴露清晰,减少了胸导管的损伤,保存了胸导管的完整性,保留了正常的糖脂代谢,是食管癌术前准备中一个良好选择,值得推广应用.

Objective To discuss the safety and efficacy of the 3D mode video-assisted thoracoscopic surgery (3D-VATS)for mediastinal tumor. Methods Data were collected from 62 patients with mediastinal tumor treated with 3D-VATS from July 2013 to July 2015 in our department.The observation port and the operation port were determined according to the tumor location,which could be swapped during the operation based on surgical situation.If the tumor diameter was greater than 5 cm,or close to great blood vessel,or with the surrounding adhesion difficult to expose,small incision video-assisted minithoracotomy (VAMT)was employed. Results The 3D-VATS was successfully completed in 58 cases.VAMT was conducted in 3 cases because of tumor diameter of 6 cm. Conversion to open surgery was required in 1 case due to tumor invasion to the left unknown vein.Intraoperative injury to the phrenic nerve leading to diaphragm elevation happened in 2 cases,which recovered 3 months after operation.Pulmonary atelectasis was seen in 2 cases, which were given anti-inflammatory, atomization, and expectoration until relief. No death occurred intraoperatively, postoperatively or 30 days after surgery.Postoperative pathology showed 31 cases of thymoma,16 cases of thymic hyperplasia,5 cases of thymic carcinoma,1 case of bronchogenic cyst,1 case of thymic cyst,2 cases of proliferation of lymphocytes,3 cases of teratoma, 2 cases of neurogenic tumor,and 1 case of pleural lipoma.All the 62 cases were followed up for 1 -24 months,with a median follow-up time of 12 months.No recurrence was seen in all the benign cases,while 1 case of thymic carcinoma recurred. Conclusion Treatment of mediastinal tumor with 3D-VATS is a new choice,bearing safe and feasible clinical effects.

Objective To evaluate the effects of surgical treatment for solitary pulmonary nodules under thoracoscopic 3D mode(3D-VATS). Methods A total of 50 cases of solitary pulmonary nodules from March 2013 to March 2014 were retrospectively analyzed.Intraoperative wedge pulmonary resection with 3D-VATS was utilized.According to intraoperative pathological findings , lobectomy plus lymph node dissection was given or not .Intraoperative time (minus fast freezing time), drainage volume for 24 h, total drainage volume , drainage tube removal time , number of lymph node dissected , and postoperative complications were recorded . Results Under 3D-VATS mode, 50 cases of solitary pulmonary nodules were treated with wedge resection , including 23 cases of malignant pathology receiving radical resection , which was smoothly . The radical resection time ( lung lobectomy plus lymphadenectomy) was (62 ±12) min, the bleeding volume was (35 ±5) ml, the lymphadenectomy number was 19 ±3, the drainage volume for 24 h was (120 ±20) ml, the postoperative chest tube removal time was (4 ±1) days, and the postoperative hospital stay was (7 ±2) days.Postoperative complications occurred in 3 cases, including 2 cases of pneumonia and 1 case of paroxysmal atrial fibrillation.No perioperative deaths were observed .All the cases were followed up for 2-12 months, with an average of 6.3 months. Brain metastases was found in 1 case at the third postoperative month and recurrence of lung cancer was noted in 1 case at the fifth postoperative month . Conclusion Thoracoscopic 3D mode treatment for solitary pulmonary nodules is a new , safe, and feasible alternative and should be widely applied .

Objective To investigate clinical feasibility and efficacy of combined use of thoracoscopy and laparoscopy in total laryngectomy for cervical esophageal carcinoma . Methods Clinical data of 33 patients with cervical esophageal carcinoma undergoing surgical treatment in our department from January 2009 to July 2014 were analyzed retrospectively .The esophagus was separated under thoracoscopy .And laparoscopic gastroplasty , total laryngectomy , tracheal permanent colostomy , and gastric pharyngeal anastomosis were performed. Results The thoracoscopic operation time was 40 -66 min ( mean, 53 min), the laparoscopic operation time was 35-51 min (mean, 44 min), and the cervical operation time was 128-150 min (mean, 139 min).The blood loss was 130 -270 ml (mean, 150 ml).The postoperative hospital stay was 8 -14 d (mean, 12 d).Pathological examinations showed squamous cell carcinoma in all the cases , including 2 cases of highly differentiated carcinoma , 19 cases of moderately differentiated carcinoma , 7 cases of moderately or lowly differentiated carcinoma , and 5 cases of lowly differentiated carcinoma .No residual cancer was found at cutting edges pathologically .Among the 33 cases, lymph node metastasis was found in 31 cases. Complications included 2 cases of anastomotic fistula , 3 cases of recurrent laryngeal nerve injury , 6 cases of pulmonary infection , 2 cases of delayed gastric emptying , and 1 case of anastomotic stenosis .There was no death .All the patients were followed up for 1 months to 5 years.The survival rates at 1, 3, and 5 postoperative year were 87.9%, 54.5%, and 45.5%, respectively. Conclusions Cervical esophageal carcinoma should be surgically treated actively .Gastric pharyngeal anastomosis is an ideal option for the repair of cervical esophageal cancer resection .

Objective To investigate the feasibility of Storz three dimensional video-assisted thoracoscopic surgery (3D-VATS) for the treatment of pulmonary disease. Methods In July 2013, under 3D video-assisted thoracoscope (Storz), lobectomy plus systematic lymphadenectomy was performed on 2 cases and local resection was performed on 2 cases respectively .The seventh intercostal space along the midaxillary line was selected as observation port of the thoracoscope ; an incision of 2-3 cm in length made at the third or fourth intercostal space along the anterior axillary line was used for main operating port and a 2 cm incision at the eighth or ninth intercostal space along the posterior axillary line was used for the first assisted operating port .Wearing 3D polarization glasses , we performed local excision or lobectomy combined with systematic lymphadenectomy on the 3D effect operation screen. Results Four operations were accomplished successfully , without conversion to open surgery .No complications or death occurred.The operative time was 36, 38, 72 and 90 min, respectively; the blood loss was 5, 10, 35 and 80 ml, respectively and postoperative hospital stay was 3, 3, 5 and 7 d, respectively.No complications were observed during the follow-up of 2 months. Conclusion Compared with VATS, 3D-VATS is safe and feasible for pulmonary disease with a lifelike view and improved flexibility .

目的探讨食管癌贲门癌患者的临床治疗效果。方法分析90名食管癌贲门癌患者的病例资料。结果本组患者都清扫术野淋巴结,切除90名,其中经左胸后外侧切口80名,右胸前外侧及上腹正中切口2名,右胸前外侧、上腹正中及左颈部三切口7名,左颈部及上腹正中非开胸食管内剥脱1例。患者术后发生并发症5名,其中2名肺部并发症,3名吻合口瘘,均无死亡。结论严格掌握手术适应证,做好充分的术前准备,准确的选择手术路径切口,慎重把握术中操作过程,改善吻合方法,有利于提高切除率、降低并发症的发生率,延长患者寿命。

目的探讨老年患者心脏手术除外的胸部手术的危险因素和围术期处理。方法回顾性分析总结我院2000～2007年134例65岁以上老年患者胸部非心脏手术的临床诊治资料。结果术后出现并发症48例(35.82%),早期死亡8例(5.97%)。结论衰老性合并症是老年患者围术期并发症及早期死亡的危险因素(P<0.05)。若重视加强围术期处理,仍可使大部分老年患者安全度过围术期。

Objective To study the risk factors of noncardiac chest surgery in senile cases and their perioperative management.Methods A total of 134 cases with noncardiac chest surgery were retrospcctively analyzed.Results Complications appeared in 48 cases (35.82%) after operation.The early mortality was 5.97%.Conclusions Complication in senile cases is risk factors of perioperative complications and early death of senile cases(P0.05).The majority of elderly cases can survive the perioperation by strengthening the perioperative management.