目的 研究敲减miR-9对肺非小细胞癌(NSCLC)细胞侵袭和迁移的影响及其机制.方法 收集46例NSCLC患者(包含15例T1期、15例T2期和16例T3+T4期),用RT-qPCR法检测NSCLC组织和和癌旁组织中miR-9的表达水平.用RT-qPCR法检测人正常肺上皮细胞(BEAS-2B)以及NSCLC细胞株A549和NCI-H1299中miR-9的表达水平.将miR-9-inhibitor转染入A549和NCI-H1299细胞,用CCK-8法检测细胞增殖,用Transwell法检测细胞迁移与侵袭.用生物信息法、双荧光素酶法和功能法研究miR-9的靶基因.结果 与癌旁组织比较,miR-9在NSCLC组织中表达明显升高(P<0.001),且其表达随T分期递增(P<0.01).与BEAS-2B比较,miR-9在A549和NCI-H1299细胞中表达明显升高(P<0.001).敲减miR-9可显著降低A549和NCI-H1299细胞的增殖、侵袭和迁移(P<0.01或P<0.001).TET2是miR-9的靶基因.转染si-TET2可逆转miR-9敲减对A549细胞迁移与侵袭的抑制作用(P<0.01).结论 敲减miR-9通过TET2抑制NSCLC细胞增殖、迁移与侵袭.

具有血管周上皮细胞分化的肿瘤(neoplasms with perivascular epithelioid cell differention，PEComas)是一种罕见疾病，目前文献报道较少，本文报道1例肺PEComa自发破裂出血患者因突发胸痛入院，检查提示右中肺占位伴大量血胸，经急诊手术治疗后顺利出院，病理提示肺部良性PEComas。

目的 探究肺癌术后乳糜胸保守治疗与手术治疗的临床疗效.方法 入选2014年4月至2018年10月肺癌术后乳糜胸患者60例,依据治疗方式的不同分为保守组30例,手术组30例.保守组以保守的方法治疗,手术组采取手术方式治疗,比较两组治疗方法的临床疗效.结果 在治愈率方面,手术组的治愈率为100%,保守组的治愈率为93.33%,两组比较差异无统计学意义(P＞0.05).经过治疗后,保守组的乳糜胸再次发生时间平均为(20.3±3.4)个月,手术组的乳糜胸再次发生时间平均为(17.5±2.1)个月,两组比较差异有统计学意义(P＜0.05).保守组的引流液甘油三酯变化程度较手术组低,两组比较差异有统计学意义(P＜0.05).结论 肺癌术后乳糜胸采用保守治疗的治愈率较高,同时根据患者引流液中甘油三酯的水平选择合理的选择手术治疗方法.

目的 总结单操作孔胸腔镜手术治疗肺隔离症的临床经验,评价其安全性、有效性.方法 回顾性分析2015年1月至2019年5月共21例单操作孔胸腔镜手术治疗的肺隔离症患者临床资料,其中男性10例,女性11例,年龄21～57(39.5±9.2)岁,21名患者均为下肺病变,包括左下肺13例,右下肺8例;叶外型1例,叶内型20例,术前均行增强CT扫描和三维重建;双腔气管插管全麻下单操作孔胸腔镜行肺叶或肺段切除20例,中转开胸1例.结果 胸腔严重粘连者8例,行下肺叶切除术20例,下肺后基底段切除1例;手术均顺利完成,手术时间(167.3±61.5)min,术中出血量(157.3±30.2)mL,术后带管时间(5.3±1.6)天,术后住院时间(6.2±1.5)天,围手术期无死亡及严重并发症发生;随访21例无失访,随访时间7～59个月,21例患者复查胸片或CT无复发.结论 单操作孔胸腔镜手术治疗肺隔离症安全可行,术前合理的检查评估和术中对隔离肺异常血管的合理处理是手术成功的关键.

目的 探讨胸导管夹闭术后血脂的变化.方法 将2012年12月～2014年1月65例病理分期为Ⅰ期的非小细胞肺癌合并高脂血症患者,随机分为胸导管夹闭组34例,未夹闭组31例.分析术前、术后1个月、3个月、6个月、1年、2年、3年、4年、5年血总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C).结果 夹闭组术后TC明显低于术前和同时点未夹闭组,术后4年仍有统计学意义(P<0.05),术后5年与术前和未夹闭组差异无统计学意义(P>0.05);夹闭组术后1年内TG明显低于术前和同时点未夹闭组(P<0.05),1年之后2组差异无统计学意义(P>0.05);2组间及手术前后HDL-C差异无统计学意义(P>0.05);夹闭组术后LDL-C明显低于术前和同时点未夹闭组,至术后3年差异仍有统计学意义(P<0.05),术后4、5年与术前和未夹闭组差异无统计学意义(P>0.05).结论 胸导管夹闭术可降低TC、LDL-C,部分降低TG,对HDL-C无明显影响.TC和LDL-C分别在术后5年和4年逐渐代偿.

目的 探讨围术期应用甲强龙对减少胸腔镜肺癌术后呼吸系统并发症的作用.方法 200例接受胸腔镜肺癌手术的患者,随机分为治疗组和对照组,各100例.对照组围术期给予常规治疗,治疗组围术期在对照组基础上给予甲强龙治疗.比较两组患者临床资料、手术前后血清C反应蛋白(CRP)水平变化及呼吸系统并发症发生情况.结果 治疗组术后呼吸系统并发症发生率为2.00％,显著低于对照组的10.00％,差异有统计学意义(P<0.05).两组患者术前CRP水平比较差异无统计学意义(P>0.05);术后1、2、3、7 d,治疗组患者CRP水平均低于对照组,差异具有统计学意义(P<0.05).两组患者术后1～2 d CRP水平到达峰值后下降.结论 胸腔镜肺癌手术围术期应用甲强龙,可减少术后应激性炎症反应,进而降低术后呼吸系统并发症发生率.

目的 探讨双孔胸腔镜肺段切除术的安全性及可行性.方法 回顾性分析2015年1月～2017年12月我院56例双孔胸腔镜肺段切除术资料,术前检查示病变位于右上肺后段12例、尖前段3例,右下肺背段10例、基底段4例,左上肺舌段9例、尖后段4例,左下肺背段11例、基底段3例,直径0.9 ～2.0 cm,平均1.5 cm.结果 56例均获成功,无中转开胸,无中转肺叶切除,术后无严重并发症发生.术后病理结果显示肺良性疾病34例,原发性非小细胞肺癌15例,肺转移瘤7例.手术时间130～265 min,平均142 min;术中出血量30 ～510 ml,平均135 ml;术后胸腔引流时间3～10d,平均5.8d;术后住院时间4～12 d,平均7.6d.34例良性病变随访5～24个月,平均12个月,无并发症发生.15例肺癌随访3～ 34个月,平均23个月,均无复发、转移.结论 对于局限靠近肺门的良性病变、孤立性肺转移瘤和部分Ⅰ a期非小细胞肺癌,双孔胸腔镜肺段切除术是一种安全可靠的手术方式.

目的 探讨术前CT定位、术中染料结扎夹标记肺结节表面胸膜的方法在电视胸腔镜下肺小结节切除术中的应用价值.方法 选取2015年8月至2018年5月在本院胸外科治疗的89例患者,98枚肺小结节,术前CT在体表定位肺部小结节,术中在胸腔镜辅助下,以亚甲蓝结扎夹标记肺结节表面胸膜,完成镜下楔形切除术.结果 98枚结节按此方法成功定位85枚(87％),13枚结节因其位于纵隔面无法按此方法完成定位,术中无并发症发生,定位成功后行VATS肺楔形切除术,无中转开胸手术,术中均取得明确病理诊断.结论 术前CT定位,染料结扎夹标记肺结节表面胸膜的定位方法,简单有效,准确率高,安全性好,是肺部小结节微创术前理想的定位方法.

食管巨大神经鞘瘤十分少见.2017年4月我科收治一例食管上段长7. 5 cm肿块,不规则隆起,明显压迫气管,行胸、腹腔镜联合经颈、右胸、腹食管肿物切除+胃食管颈部吻合术,免疫组化染色确诊为食管神经鞘瘤,报道如下.

Objective To investigate the feasibility and clinical effect of two-port video-assisted thoracoscopic surgery (VATS) for the treatment of esophageal carcinoma. Methods From January 2015 to June 2017, 43 patients with esophageal carcinoma were treated with radical esophagectomy by two-port VATS, including 4 cases in the upper thoracic esophagus, 25 cases in the middle thoracic esophagus, and 14 cases in the lower thoracic esophagus. Their pathological diagnoses were squamous cell carcinoma before operation. The thoracic esophagus was mobilized and the thoracic lymph nodes were dissected by two-port VATS. And the stomach was mobilized and the abdominal lymph nodes were dissected by laparotomy. The cervical esophagogastrostomy was completed. Results All the operations were successful. There were 2 cases converted to open surgery because of tight pleural adhesions. The thoracoscopic operative time ranged from 90 min to 120 min (mean, 96 min). The blood loss ranged from 50 ml to 200 ml (mean, 90 ml). The thoracic drainage flow ranged from 110 ml to 300 ml (mean, 156 ml). The thoracic drainage time ranged from 5 d to 8 d (mean, 6. 2 d). The postoperative hospital stay ranged from 13 d to 20 d (mean, 14. 2 d). All the patients recovered and were discharged from hospital without severe operative and postoperative complications. There was no death. Postoperative pathological staging showed pT1N0M0 in 1 case, pT1N1M0 in 5 cases, pT1N2M0 in 1 case, pT2N0M0 in 13 cases, pT2N1M0 in 5 cases, pT2N2M0 in 2 cases, pT3N0M0 in 13 cases, pT3N1M0 in 2 cases, and pT3N2M0 in 1 case. All the 43 cases were followed up for 2 -30 months ( median, 20 months) without recurrence and metastasis. Conclusion Two-port VATS for the treatment of esophageal carcinoma is technically safe and feasible with minimal trauma and less complications.

淋巴管瘤是发生在淋巴系统的较为少见的肿瘤,它可以发生在包含有淋巴管道的任何部位,其中颈部为好发区域,出现在纵隔内更为罕见.2017年3月,广东省佛山市第一人民医院胸外科收治了1例纵隔巨大囊性淋巴管瘤病例,经手术治疗后痊愈,属罕见病例,报道如下.临床资料:男,51岁,因“体检发现纵隔肿物2年余”于2017年3月收入胸外科住院治疗.患者于2年余前曾来佛山市第一人民医院常规体检,行胸部CT示:右前纵隔囊性病灶,直径8cm,考虑囊肿可能(图1).当时无不适,未予治疗.门诊一直随诊,未见肿块增大.

[Summary] In April 2015, a patient suffering from breast cancer with contralateral axillary lymph node metastasis received ipsilateral modified radical mastectomy and contralateral mastectomy and axillary lymph node dissection after 6 courses of neoadjuvant chemotherapy , which made breast and axillary masses significantly reduced ( the maximum diameters were 53 and 41 mm respectively before treatment , while 18 and 17 mm after treatment ) .Then postoperative adjuvant radiotherapy and endocrine therapy were carried out.One year postoperative follow-up found no recurrence .

Objective To evaluate the safety and efficacy of dual-port complete video-assisted thoracoscopic surgery (cVATS) for lobectomy in the management of pulmonary benign diseases.Methods Between February 2011 and October 2015,a total of 192 patients with pulmonary benign disease underwent dual-port cVATS for lobectomy in our hospital.All the resections were carried out by pure thoracoscopic procedures using two ports,one working port and one observing port,which could replace each other.During the anatomical lobectomy operation,the double joint surgical instruments were used by double hands for cross performance,without distracting or pulling the ribs.Results Conversion to traditional tri-port cVATS occurred in 7 patients (3.6％) due to severe adhesion,poor differentiation of the fissure and the proliferation of tortuous vessels at the hilus.The mean time for dual-port cVATS was (115.6 ± 87.1) min (range,86-281 min),during which,a mean of (184.3 ± 71.8) ml blood loss (range,50-374 ml) was collected.The mean chest tube duration was (6.1 ± 4.8) days (range,2-15 days) and the mean postoperative hospital stay was (9.3 ± 4.6) days (range,5-16 days).No mortality or severe complications occurred perioperatively.However,complications occurred in 20 cases (morbidity rate:10.4％),including 12 cases of persistent air 1eak,5 cases of pneumonia and 3 cases of incision infection.Follow-up for an average of 22.3 months (range,3-40 months) found all patients recovered well.Conclusion Dual-port cVATS is safe and effective for lobectomy in patients with pulmonary benign diseases.

颗粒细胞瘤( granular cell tumor,GCT)是一种比较少见的软组织肿瘤,大部分为良性,可发生在身体的任何部位,发生于乳腺者较罕见,占此类肿瘤的5% ~8% [1] ,临床易误诊为乳腺癌. 我院2013年诊治1例GCT,现报道如下.

患者 女,27岁. 因反复咳嗽、咯血2月余. 入院查胸部CT提示左上肺近肺门处占位,疑恶性肿瘤,累及左主支气管,伴左上肺阻塞性肺炎(图1). 行支气管镜检提示左上叶舌段开口处类圆形肿物,取病理活检,镜下见支气管黏膜纤维组织增生,伴淋巴细胞、浆细胞浸润,局灶见多核巨细胞反应,未见肿瘤性病变.

目的 探讨单操作孔全胸腔镜纵隔肿物切除手术的优势及临床价值.方法 回顾性分析2006年6月～2014年6月收治的125例行电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)切除纵隔肿物的患者,其中单操作孔VATS组56例,常规三孔VATS组69例,比较两组患者的手术时间、术中出血量、术后ICU监护治疗时间、术后胸腔引流管放置时间、术后疼痛感、术后住院时间、术后并发症等临床资料.结果 125例患者均手术顺利,无中转开胸.两组患者手术时间、术后ICU监护治疗时间、术后胸腔引流管放置时间、术后住院时间差异均无统计学意义;单操作孔VATS组术中出血量、术后疼痛评分均低于三孔VATS组,差异有统计学意义(均P＜0.05).患者无围手术期死亡,三孔VATS组出现1例肺部感染、1例心率失常,单操作孔VATS组出现1例肺部感染,余患者术后恢复顺利.随访3个月～8年,15例胸腺瘤合并重症肌无力患者(单操作孔VATS组7例,常规三孔VATS组8例)中11例患者肌无力症状术后不同程度好转(单操作孔 VATS组6例,常规三孔VATS组5例),4例患者术后肌无力症状无明显改善(单操作孔VATS组1例,常规三孔VATS组3例),15例患者术后均门诊口服溴吡啶斯的明治疗.125例患者,除常规三孔VATS组1例伤口持续性疼痛半年,给予理疗止痛等治疗好转外,其他患者均恢复良好,未见复发及其他并发症.结论 单操作孔 VATS切除纵隔肿物在技术上是安全、可行的,与常规三孔VATS相比,具有创伤小、恢复快等优点.

[Summary] A patient suffering from huge pulmonary arteriovenous malformation (PAVM) received video-assisted mini-incision thoracoscopic surgery after percutaneous coronary intervention ( PCI) was not successful in this department in December 2013.After 1-year of follow-up, the patient kept in stable condition and no relapse was observed.PAVM is a rare disease, which is lack of specificity.At present, computed tomography angiography (CTA) is the main diagnostic tool for PAVM.Improvement of understanding and vigilance of PAVM can help avoid misdiagnosis.Video-assisted thoracoscopic surgery is a safe and feasible method to treat PAVM.

目的 探讨电视辅助胸腔镜手术(VATS)在纵隔肿瘤临床诊治中的安全性和有效性.方法 回顾性分析2005年6月至2013年10月间收治的115例原发性纵隔肿瘤患者的临床资料,其中男性74例,女性41例,年龄17 ～75岁.肿瘤平均最大直径4.5 cm.前纵隔肿瘤78例,中纵隔肿瘤3例,后纵隔肿瘤34例.手术均采用气管插管静吸复合全麻.结果 115例患者中,有111例患者行肿物完整切除,4例仅行活检手术.102例患者行VATS切除,91例采用3个套管口,11例采用2个套管口,9例术中延长切口8 ～10 cm完成手术.手术时间45 ～ 240 min,平均90 min.术中出血50～1200 ml,平均100 ml.术后留置胸管引流2～6d,平均3.5d,术后住院7～16 d,平均8d.所有患者手术及恢复顺利,无围术期死亡.结论 VATS治疗纵隔肿瘤安全、微创、有效,在临床上值得推广.

OBJECTIVE:To assess the clinical value of single-port video-assisted thoracoscopic surgery (VATS) for treatment of pulmonary diseases.METHODS:From October, 2009 to December, 2013, 105 patients with pulmonary diseases were scheduled for single-pore VATS for pulmonary lobectomy (19 patients), wedge resection of the lung (34 patients), and bullae resection and pleurodesis for spontaneous pneumothorax or pulmonary bleb (52 patients).RESULTS:Of the 105 patients, 101 patients underwent single-port VATS; the procedure was converted to open thoracotomy in 1 patient and to conventional three-port VATS in 2 patients. The operative time was 50.6∓36.8 min (20-200 min) with intraoperative blood loss of 70∓56.9 ml (10-300 ml), thoracic drainage time of 4.2∓3.2 days (2-14 days), and postoperative hospital stay of 5.4∓3.8 days (3-16 days). Postoperative complications of the procedures included prolonged air leakage (6 cases) and atelectasis (2 cases). All the other patients recovered smoothly without serious complications.CONCLUSION:Single-port VATS is a safe and efficient procedure that allows rapid postoperative recovery and is a method of choice for selected patients with pulmonary diseases.

Objective To explore the feasibility and clinical effect of two-port video-assisted thoracoscopic surgery ( VATS) for the treatment of pulmonary diseases in elderly patients . Methods From October 2009 to December 2013, a total of 48 elderly patients with pulmonary diseases were treated by single working pore VATS , including 6 cases of pulmonary lobectomy , 22 cases of wedge resection of lung , 20 cases of bullae resection and pleurodesis . Results Of the 48 patients, 45 underwent two-port VATS, 1 patient was given a conversion to thoracotomy , and 2 patients were treated with conventional three-port VATS.The operative time was 20-180 min (mean, 52.6 ±33.8 min).The intraoperative blood loss was 10-250 ml (mean, 75.3 ±52.9 ml).The thoracic drainage time was 5-14 d (mean, 7.2 ±3.2 d).The postoperative hospital stay was 8-16 d (mean, 10.4 ±3.8 d).Postoperative complications included 6 cases of prolonged air leakage , 2 cases of atelectasis , 3 cases of pulmonary infection , and 5 cases of arrhythmia.All other patients recovered smoothly without severe complications . Conclusions Two-port VATS is a safe and efficient procedure for elderly patients , with good patient recovery .It is a method of choice for selected patients with pulmonary diseases .