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@#Objective To explore the safety and feasibility of uni-portal video-assisted thoracic surgery (VATS) for the treatment of bronchopulmonary sequestration (BPS). Methods The clinical data of BPS patients with surgical resection in Shanghai Pulmonary Hospital from February 2010 to June 2021 were reviewed. The patients were divided into a VATS group and a thoracotomy group according to the operation method. The operation time, intraoperative blood loss, hospital stay and postoperative complication rate were compared between the two groups. The VATS group was subdivided into a uni-portal VATS group and a multi-portal VATS group for subgroup analysis. Results Finally 131 patients were enrolled, including 62 males and 69 females with an average age of 39.3±13.2 years. There were 103 patients in the VATS group and 28 patients in the thoracotomy group. A total of 104 patients were diagnosed with left lower BPS, 26 with right lower BPS and 1 with bilateral lower BPS. The main symptom was cough (88 patients, 67.2%). There were 119 patients diagnosed by thoracic enhanced CT before operation. Compared with the thoracotomy group, the operation time was not statistically different (P=0.717), but the blood loss was less, the rate of postoperative complication was lower and hospital stay was shorter in the VATS group (P<0.05). The rate of conversion to open surgery in the uni-portal VATS group and multi-portal VATS group was 11.8% and 13.5%, respectively. Meanwhile, patients in the uni-portal VATS group had shorter operation time and postoperative hospital stay, less blood loss and lower postoperative complication rate than those in the multi-portal VATS group (P<0.05). Conclusion In order to improve the rate of diagnosis, the lung enhanced CT scan should be selected as an optimal noninvasive method in adult suspected patients (especially those with solid cystic and solid lesions in the lower lobe). Uni-portal VATS is a safe and feasible method for BPS which can be widely promoted.
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@#Objective To explore the clinical efficacy and learning curve of robot-assisted thymectomy via subxiphoid approach. Methods The clinical data of patients with robot-assisted thymectomy surgery via subxiphoid approach performed by the same surgical team in the Department of Thoracic Surgery of Shanghai Pulmonary Hospital from February 2021 to August 2022 were retrospectively analyzed. The cumulative sum (CUSUM) analysis and best fit curve were used to analyze the learning curve of this surgery. The general information and perioperative indicators of patients at different learning stages were compared to explore the impact of different learning stages on clinical efficacy of patients. Results A total of 67 patients were enrolled, including 31 males and 36 females, aged 57.10 (54.60, 59.60) years. The operation time was 117.00 (87.00, 150.00) min. The best fitting equation of CUSUM learning curve was y=0.021 2x3–3.192 5x2 +120.17x–84.444 (x was the number of surgical cases), which had a high R2 value of 0.977 8, and the fitting curve reached the top at the 25th case. Based on this, the learning curve was divided into a learning period and a proficiency period. The operation time and intraoperative blood loss in the proficiency stage were significantly shorter or less than those in the learning stage (P<0.001), and there was no statistical difference in thoracic drainage time and volume between the two stages (P>0.05). Conclusion The learning process of robot-assisted thymectomy via subxiphoid approach is safe, and this technique can be skillfully mastered after 25 cases.
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Malignant pleural mesothelioma(MPM) is a kind of rare and aggressive malignant neoplasm. Surgery plays one of the most important roles in the treatment of MPM. However, due to the high morbidity and mortality reported, the survival benefit and indication of surgery are still controversial. This article will review the surgical indications, discuss and compare the roles of extrapleural pneumonectomy(EPP) and pleurectomy / decortication(P/D) which aim to achieve macroscopic complete resection(MCR) in the treatment of MPM. Finally, we summarized the progress of other treatment methods including targeted therapy and immunotherapy.
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@#Lung cancer is the most common cancer and the leading cause of cancer-related death in China. Early screening of lung cancer proves to be effective in improving its prognosis. The National Comprehensive Cancer Network (NCCN) has updated and released version 2, 2022 NCCN clinical practice guidelines for lung cancer screening in July, 2022. Based on high-quality clinical evidence and the latest research progress, the guidelines have developed and updated criteria for lung cancer screening which have been widely recognized by clinicians around the world. Compared with Chinese lung cancer screening guidelines, this article will interpret the updated content of the brand new 2022 NCCN screening guidelines, providing some reference for the current lung cancer screening practice in our country.
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Objective:To summarize our experience in diagnosis and treatment of patients with pulmonary mucosa-associated lymphoid tissue-derived(MALT) lymphoma and to explore the role of surgery.Methods:We retrospectively analyzed the clinical and follow-up data of 86 patients with pulmonary MALT lymphoma in Shanghai Pulmonary Hospital from January 2000 to December 2018. 86 cases were identified with 44 males and 42 females. The mean age was(56.7±10.6) years old. 38(44.2%) cases had symptoms mainly presenting as cough and sputum at diagnosis. The chest CT scan of the patients showed pulmonary consolidation in 39 cases, nodule/mass shadow in 37 cases, usually with air bronchogram. Only 8(9.3%) cases could be diagnosed by non-surgical approach. 58 cases received complete resection, 10 of which followed chemotherapy. 8 of 17 cases who received incomplete resection accepted chemotherapy. The rest 11 cases who experienced surgical biopsy because of uncertain diagnosis were treated by chemotherapy or radio-chemotherapy or just watch-to-wait.Results:The median follow-up of 83 cases was 64 months, ranged from 24 to 219 months. The estimated 5-year and 10-year OS rates were 95.0% and 76.8%, while 5-year and 10-year PFS were 75.7% and 35.1% respectively. Patients who received complete resectionhad better PFS( P<0.001)but similar OS( P=0.395), compared with those received incomplete resection. There were no significant difference in OS and PFS between patients who received complete resection accepted chemotherapy or not( P>0.05). Conclusion:Pulmonary MALT lymphoma has an indolent nature with an excellent long-term survival. Diagnosis is difficult to be made by non-surgical approach. Surgery plays an important role of treatment of pulmonary MALT lymphoma, due to significant improvement of diagnosis rate and radical treatment of localized disease by complete resection.
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Objective:To explore the sex-based heterogeneity in demographic and pathological trends of lung cancer during the past 30 years.Methods:Patients with primary lung cancer who received surgical treatment in the Department of thoracic surgery, Shanghai Pulmonary Hospital Tongji University from 1989 to 2018 were retrospectively analyzed. The differences between male and female patients in age, smoking history, pathological stage and type were compared. Mann- Kendall trend test was performed for trend analysis. Results:A total of 58 433 patients were included in this study, encompassing 30 729(52.6%) men and 27 , 704(47.4%) women. Compared with male patients, female patients were younger(56.0 years old vs. 59.7 years old), and had a higher proportion of non-smokers(98.3% vs. 52.3%), stage Ⅰ lung cancers(60.6% vs. 49.3%), and adenocarcinoma(93.7% vs. 56.1%, all P-values <0.001). Trend analyses revealed that the proportion of female patients increased year by year, and surpassed males in 2015, with the current ratio of male to female being 1∶1.5. After 2013, the age of onset in females was getting younger, and the average age decreased from 58.7 years old to 54.7 years old( P=0.02). The decrease in the proportion of smoking patients was mainly reflected by male patients(from 68.5% to 31.1%, P<0.01). Stage Ⅰ lung cancers in male and females outnumbered advanced stage in 2012 and 2010, respectively, with a much higher proportion in female patients. Among male patients, adenocarcinoma has replaced squamous cell carcinoma as the most common pathological type since 2012, while in female patients adenocarcinoma remained the most common pathological type of lung cancer, and its proportion continued to increase reaching over 98%. Conclusion:A dramatic change in gender distribution was noticed during the past 30 years. Female patients became the primary population in surgically-treated lung cancers, with a trend of getting younger. The proportion of smokers and squamous cell carcinoma decreased significantly in male patients, and adenocarcinoma has become the most common pathological type of lung cancer. The proportion of stage Ⅰ lung cancers was on a dramatic rise, with the popularization of CT screening for lung cancer.
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Objective:To evaluate the effect of prolonged graft cold ischemia time(CIT)on outcomes of lung transplantation(LTx).Methods:Clinical data are retrospectively reviewed for 111 patients undergoing LTx at Affiliated Shanghai Pulmonary Hospital of Tongji University between January 2019 and January 2022. They are divided into two groups of prolonged CIT(8~12 h, 41 cases)and control(<8 h, 70 cases)according to CIT. Kaplan-Meier method is employed for estimating 1-year cumulative survival rate and multivariable Cox proportional hazard regression model for identifying independent risk factors of 1-year mortality.Results:No significant inter-group difference existed in the incidence of primary graft dysfunction grade Ⅲ within the first 72 h post-LTx(21.2% vs. 16.3%). The 30-day(90.2% vs. 94.3%)and 90-day(82.9% vs. 82.9%)survival rates are comparable between two groups. Similarly 1-year cumulative survival is also comparable between two groups (74.6% vs. 60.4%, Log-rank P=0.279). Multivariate Cox regression analysis indicated that prolonged CIT was not associated with an elevated risk of 1-year mortality( HR 0.691; 95% CI: 0.317~1.506). However, an absence of ECMO support during surgery( HR 3.562; 95% CI: 1.061~11.959)and postoperative mechanical ventilation for >3 days(HR 2.892; 95% CI: 1.387~6.031)elevate 1-year risk of mortality. Conclusions:Prolongation of CIT to 8~12 h has no adverse effect on the prognosis of recipients. Given a great scarcity of donor lungs and a growing number of LTx candidates, it is reasonable to accept prolonged CIT donor lungs for clinical LTx.
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Objective:To explore the airway pathogen characteristics and examine the correlation between donor-derived pathogens and post-transplant outcomes in patients after lung transplantation (LT).Methods:Between January 1, 2015 and December 31, 2019, retrospective review was conducted for clinical and microbiological data of 88 LT recipients.Airway pathogen percentage of different microorganisms and evolution of drug-resistance were examined.Drug-resistant pathogen positive group (n=71) and negative group (n=17) were assigned according to whether or not drug-resistant pathogens were detected.Survival analysis was conducted by Log-rank with 3-year follow-ups.Between April 11, 2020 and September 5, 2020, prospective study was conducted in 14LT recipients.The potential pathogenic bacteria from donor lungs were detected by metagenomic next generation sequencing and the impact of those bacteria was examined on 1-year post-transplantation outcome in 2020.Microbial diversity and richness were shown with Shannon index.The outcome variables included heart rate, neutrophil count, lymphocyte count, immunoglobulin level and pulmonary spirometry.ANOVA and Pearson's correlation analysis were performed for elucidating the relationship between airway microbiota and post-LT outcomes.Results:From 2015 to 2019, 88 recipients were recruited and 992 strains of airway pathogens were isolated, including bacteria 796 strains and fungi 196 strains.Gram-negative bacteria (704 strains) accounted for 88.4% of all bacteria.The detection rates of Gram-positive bacteria, Klebsiella pneumonia (Kp), Acinetobacter baumannii (Ab), Stenotrophomonas maltophilia and Candida increased in 2019 than that in 2015 (8.2% vs. 5.3%, 13.6% vs. 13.2%, 33.2% vs. 17.5%, 6.5% vs. 5.3%, 26.6% vs. 20.2%). Drug resistance rate of Kp to imipenem was 68.18% in 2019 and drug resistance rate of Ab to imipenem 98.44%.The 3-year survival rate was 46.3% and 35.3% in drug-resistance positive and negative groups and the difference was insignificant ( P=0.410). Fourteen recipients were enrolled in 2020.Potential pathogenic bacteria could be detected in all donor samples.Five recipients carried the same bacteria and two died during 1-year follow-up.Nine recipients did not carry the donor-derived pathogens and two died during 1-year follow-up.The diversity of donor/recipient-derived airway microbiota (Shannon index) showed no correlation with the outcomes of 1-year follow-up by Pearson's correlation test. Conclusions:Gram-negative bacteria predominated in airway pathogens of recipients post-LT.The drug resistance rate to imipenem remained high.The donor/recipient-derived pathogen isolates showed no correlation with immediate outcomes post-LT.
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@#Objective To compare the clinical effects of segmentectomy and lobectomy for ≤2 cm lung adenocarcinoma with micropapillary and solid subtype negative by intraoperative frozen sections. Methods The patients with adenocarcinoma who received segmentectomy or lobectomy in multicenter from June 2020 to March 2021 were included. They were divided into two groups according to a random number table, including a segmentectomy group (n=119, 44 males and 75 females with an average age of 56.6±8.9 years) and a lobectomy group (n=115, 43 males and 72 females with an average of 56.2±9.5 years). The clinical data of the patients were analyzed. Results There was no significant difference in the baseline data between the two groups (P>0.05). No perioperative death was found. There was no statistical difference in the operation time (111.2±30.0 min vs. 107.3±34.3 min), blood loss (54.2±83.5 mL vs. 40.0±16.4 mL), drainage duration (2.8±0.6 d vs. 2.6±0.6 d), hospital stay time (3.9±2.3 d vs. 3.7±1.1 d) or pathology staging (P>0.05) between the two groups. The postoperative pulmonary function analysis revealed that the mean decreased values of forced vital capacity and forced expiratory volume in one second percent predicted in the segmentectomy group were significantly better than those in the lobectomy group (0.2±0.3 L vs. 0.4±0.3 L, P=0.005; 0.3%±8.1% vs. 2.9%±7.4%, P=0.041). Conclusion Segmentectomy is effective in protecting lungs function, which is expected to improve life quality of patients.
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Objective:To explore the efficacy and safety of neoadjuvant chemoimmunotherapy combined with surgery for stage ⅢA NSCLC patients.Methods:Six patients with NSCLC who were diagnosed as ⅢA and received two cycles of neoadjuvant chemoimmunotherapy and surgery between September 2019 and January 2020 were described in this study.Results:Five of them experienced AEs during neoadjuvant therapy. All of them received surgery and achieved an MPR of 50%. No viable tumor cells were found in the tissues of one patient. One patient with a small bronchopleural fistula after lobectomy.Conclusion:Neoadjuvant chemoimmunotherapy combined with surgery for stage ⅢA NSCLC patients is safe and efficient. Long-term outcomes of neoadjuvant chemoimmunotherapy combined with surgery should be further validated.
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Objective:To investigate the influencing factors of thyroid volume in school-age children aged 8 - 10 years in Xinjiang Uygur Autonomous Region (Xinjiang for short).Methods:In 2020, counties (cities, districts) were taken as the units in the whole region of Xinjiang. Each county (city, district) was divided into 5 sampling areas according to the orientation of east, west, south, north, and middle, one township/street was selected from each area, and one primary school was selected from each township/street, 40 non-boarding children aged 8 - 10 years were selected from each primary school as the investigation subjects. Height and weight of children were measured, and body mass index (BMI) and body surface area were calculated; 24 h mixed urine samples of children and household edible salt samples were collected to detect the contents of urinary iodine and salt iodine; thyroid volume of children was measured by B-ultrasonography. Pearson correlation analysis was used to analyze the correlation between thyroid volume and age, height, weight, body surface area, BMI, urinary iodine content, and salt iodine content. Univariate and multiple linear regression analyses were used to evaluate the correlation variables affecting thyroid volume.Results:A total of 18 334 children aged 8 - 10 years were investigated. The median urinary iodine was 237.88 μg/L. There were 132 children with goiter, and the rate of goiter was 0.72%. Of these, 9 249 (50.45%) were girls and 9 085 (49.55%) were boys. Girls' thyroid volume was positively correlated with age, height, weight, body surface area, BMI, urinary iodine content, and salt iodine content ( r = 0.125, 0.135, 0.167, 0.167, 0.154, 0.031, 0.019, P < 0.05); boys' thyroid volume was positively correlated with age, height, weight, body surface area, and BMI ( r = 0.132, 0.326, 0.156, 0.149, 0.146, P < 0.05), and there was no correlation with urinary iodine content and salt iodine content ( r = 0.019, 0.017, P > 0.05). Univariate linear regression analysis showed that age, height, weight, BMI, body surface area and urinary iodine content were the influencing factors of thyroid volume ( t = 14.92, 12.54, 20.98, 17.98, 20.25, 4.28, P < 0.01). Further multiple linear regression analysis showed that age, BMI, body surface area and urinary iodine content had significant independent effects on thyroid volume ( t = 9.61, 8.57, 7.76, 4.89, P < 0.01), the coefficient of determination ( R2) of the model was 0.278 2. According to the regression coefficient (β), the body surface area (β = 0.522 6) had the greatest influence on thyroid volume. Conclusions:The iodine nutrition of children aged 8 - 10 years in Xinjiang is sufficient. Thyroid volume is affected by age, BMI, body surface area and urinary iodine content.
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Objective:To investigate the effects of different levels of iodine intake on thyroid function in Wistar rats after pregnancy, and to provide experimental basis for scientific supplementation of iodine and thyroid function screening during pregnancy.Methods:One hundred and fifty female SPF Wistar rats weaned for 2 weeks were selected. Female Wistar rats were intervened with iodine nutrition by drinking deionized water containing potassium iodide (KI). According to the random number table, female Wistar rats were divided into 5 groups [severe iodine deficiency (SID) group, mild iodine deficiency (MID) group, control group (NI), mild iodine excess (MIE) group, and severe iodine excess (SIE) group, 30 rats per group]. The iodine doses of the five groups were 0.0, 1.5, 5.5, 70.0 and 350.0 μg/d, respectively. The animal model was established and intervened for 3 months to detect the 24 h urinary iodine content of rats, and compared with the NI group to determine the success of the model or not. After successful modeling, the tested female Wistar rats were mated with male Wistar rats (female : male=2-3 : 1). There were about 15 pregnant rats in each group, and continued to intervene the pregnant rats for 21 d with the same doses as the modeling conditions. The abdominal aortic blood of non-pregnant and pregnant rats was taken. After serum separation, 5 items [free thyroxine (FT 4), free triiodothyronine (FT 3), thyroid stimulating hormone (TSH), anti-thyroglobulin antibodies (TgAb), thyroid peroxidase antibody (TPOAb)] of serum thyroid function were detected in each group. Results:There was significant difference in urinary iodine content between the five groups (the medians urinary iodine were 3.540, 51.410, 286.801, 644.192 and 2 368.701, respectively, H = 94.791, P < 0.01). Rats with different iodine nutrition levels were successfully established. There were no significant differences in TSH level, TPOAb and double antibodies positive rates of non-pregnant rats among groups ( P > 0.05). There were statistically significant differences in the levels of FT 4, FT 3 and the positive rate of TgAb among groups ( P < 0.05). The level of FT 4 in SID group was lower than that in NI group ( P < 0.05). The level of FT 3 in SID group was higher than that in NI group ( P < 0.05). The positive rate of TgAb in SIE group was higher than that in NI group ( P < 0.05). There were no significant differences in TSH, FT 4 and FT 3 levels of pregnant rats among groups ( P > 0.05). There were significant differences in the positive rates of TgAb, TPOAb and double antibodies among the groups ( P < 0.05). The positive rates of TgAb, TPOAb and double antibodies in MIE and SIE groups were higher than those in NI group ( P < 0.05). The positive rate of TPOAb in MIE group was higher than that in NI group ( P < 0.05), and the positive rates of double antibodies in MID and MIE groups were higher than that in NI group ( P < 0.05). Conclusions:Iodine deficiency can lead to the change of thyroid hormone level in non pregnant rats, while iodine excess can increase the positive rate of related antibodies in non pregnant and pregnant rats.
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Objective:To understand the iodine nutritional status of pregnant women in the early, middle and late pregnancy in historical iodine deficiency areas (South Xinjiang) and non historical iodine deficiency areas (North Xinjiang) in Xinjiang, so as to provide scientific basis for the prevention and control of iodine deficiency disorders in pregnant women and the formulation of appropriate prevention and control measures.Methods:From March to June 2019, using cluster yandom sampling, each county (city, district, county for short) in the whole region was divided into five sampling areas according to the east, west, south, north and middle direction. Twenty pregnant women were selected from each area, and the iodine content was determined by taking household salt samples and random urine samples.Results:A total of 9 461 salt samples were collected from pregnant women's families in 96 counties, of which 9 099 were qualified iodized salts, 22 were non iodized salts, the rate of non iodized salt was 0.23%, the coverage rate of iodized salts was 99.77% (9 439/9 461), the consumption rate of qualified iodized salts was 96.17% (9 099/9 461), and the median of salt iodine was 27.42 mg/kg. A total of 9 456 urine samples of pregnant women were tested. The median of urinary iodine was 187.30 μg/L, ranging from 0.30 to 1 300.00 μg/L. The median of urinary iodine of pregnant women in 12 counties (North Xinjiang) was < 150 μg/L. The medians of urinary iodine of pregnant women in the early, middle and late pregnancy in historical iodine deficiency areas were 215.85, 208.10 and 196.60 μg/L, respectively, while that in the non historical iodine deficiency areas were 179.10, 180.70 and 179.15 μg/L, respectively, the differences were statistically significant ( P < 0.01). There was a significant difference in the urinary iodine content of pregnant women in the early, middle and late pregnancy in historical iodine deficiency areas ( H = 8.85, P < 0.05), but there was no significant difference in the non historical iodine deficiency areas ( H = 0.28, P > 0.05). Conclusions:Some pregnant women in North Xinjiang are in iodine deficiency. The contents of urinary iodine in the early, middle and late pregnancy in historical iodine deficiency areas are higher than those in non historical iodine deficiency areas. The distribution of urinary iodine in the early, middle and late pregnancy of pregnant women in the historical iodine deficiency areas is different.
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@#In recent years, subxiphoid uniportal video-assisted thoracoscopic surgery is one of the most important innovations in the field of mini-invasive thoracic surgery. Because it avoids the injury of intercostal nerve, previous studies have shown that it can significantly reduce the perioperative and long-term incision pain. The operation is technically more difficult, so the selection of patients is more strict compared with the traditional intercostal surgery. Some special surgical techniques are needed during the operation, and special lengthening instruments should be used. We hope that the experience described in this paper will be continuously supplemented and improved with the further development of this technique, and will produce greater reference value.
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@#The quality control of lung transplantation involves many aspects, such as team building, selection of recipients, preoperative diagnosis and evaluation of recipients, maintenance of brain-dead donors, evaluation and acquisition of donors, surgical operation, postoperative management and postoperative follow-up. Precision management is the core concept of operation quality control. Only by normalizing the operation quality control of lung transplantation to provide basic guarantee for multi-team cooperation and development of lung transplantation management in the future, building a complete lung transplantation database to excavate data resources and improve the quality of transplanta-tion, and comprehensively building a Chinese lung transplantation quality control system with multi-team participation and cooperation, can we improve the overall level of surgical diagnosis and treatment of lung transplantation in China.
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@#The precise resection and suture of bronchia, vascular and pulmonary tissue are the key techniques in thoracic surgery. Mechanical suture technique has gradually become a routine operation in thoracic surgery. However, at present, there is still a lack of consensus and guidelines on the application of this technique in thoracic surgery, neither strong evidence-based medical support. In this study, we discuss the application standard of mechanical suture technique in thoracoscopic surgery, irregular treatment techniques, intraoperative complications, and management principles to promote the standardized application of mechanical suture technique. We also explain the shortcomings of the technique in order to promote the further improvement and perfection.
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Objective To investigate iodine nutritional status of key population in Puhui Town,Korla Xinjiang.Methods In 2018,totally 29 samples of factory water,peripheral water and self-prepared well water from centralized water supply in Puhui Town were collected,and urine samples,salt samples and blood samples were collected from 200 children aged 8 to 10 years old and 100 women of childbearing age (including pregnant women)in Puhui Town.Arsenic-cerium catalytic spectrophotometric method was used for determination of iodine in water and urine;the salt iodine was determined using direct titration and the thyroid was examined by ultrasound.The assessment was conducted according to the standard of "Delineation of Water-source Areas and Endemic Areas of High Iodine Goiter" (GB/T 19380-2016).Results In this survey,the median of water iodine in Puhui town (n =29)was 76.1 μg/L,and the median of salt iodine (n =175) was 27.76 mg/kg;the rate of iodized salt was 98.29％ (172/175);the consumption rate of qualified iodized salt was 96.00％ (168/175);the medians of urinary iodine of children aged 8 to 10 years old (n =208),women of childbearing age (n =73),and pregnant women (n =25) were 292.47,248.23,and 246.36 μg/L,respectively.The thyroid enlargement rate was 1.9％ (4/208) in children aged 8-10 years old,no swelling of women of childbearing age and pregnant women.Conclusions Iodine nutrition of pregnant women is in an appropriate state;both the children aged 8 to 10 years old and the women of childbearing aged are in excess of the appropriate level;goiter rate is lower in children.According to the national standards,Puhui Town does not belong to waterborne high iodine area.
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Recently, uniportal video-assisted thoracic surgery (VATS) has developed rapidly and has become the main theme of global surgical development. The specific, standardized and systematic training of this technology has become an important topic. Specific training in the uniportal VATS approach is crucial to ensure safety and radical treatment. Such training approach, including a direct interaction with experienced surgeons in high-volume centers, is crucial and represents an indispensable step. Another form of training that usually occurs after preceptorship is proctorship: an experienced mentor can be invited to a trainee's own center to provide specific on-site tutelage. Videos published online are commonly used as training material. Technology has allowed the use of different models of simulators for training. The most common model is the use of animal wet laboratory training. Other models, however, have been used mostrecently, such as the use of 3D and VR Technology, virtual reality simulators, and completely artificial models of the human thorax with synthetic lung, vessel, airway, and nodal tissues. A short-duration, high-volume, clinical immersion training, and a long term systematic training in high-volume centers are getting more and more attention. According to the evaluation of students' grading, a diversified training mode is adopted and the targeted training in accordance with different students helps to improve the training effect. We have done some work in systematic and standardized training of uniportal VATS in single center. We believe such training is feasible and absolutely necessary.
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Humans , Lung Neoplasms , General Surgery , Surgeons , Education , Teaching , Thoracic Surgery, Video-Assisted , Education , MethodsABSTRACT
Background and objective As computed tomography (CT) screening for lung cancer becomes more common in China, so too does detection of pulmonary ground-glass nodules (GGNs). Although anumber of national or international guidelines about pulmonary GGNs have been published,most of these guidelines are produced by respiratory, oncology or radiology physicians, who might not fully understand the progress of modern minimal invasive thoracic surgery, and these current guidelines may overlook or underestimate the value of thoracic surgery in the management of pulmonary GGNs. In addition, the management for pre-invasive adenocarcinoma is still controversial. Based onthe available literature and experience from Shanghai Pulmonary Hospital, we composed this consensus about diagnosis and treatment of pulmonary GGNs. For lesions which are considered as adenocarcinoma in situ, chest thin layer CT scan follow-up is recommended and resection can only be adopt in some specific cases and excision should not exceed single segment resection. For lesions which are considered as minimal invasive adenocarcinoma, limited pulmonary resection or lobectomy is recommended. For lesions which are considered as early stage invasive adenocarcinoma, pulmonary resection is recommend and optimal surgical methods depend on whether ground glass component exist, location, volume and number of the lesions and physical status of patients. Principle of management of multiple pulmonary nodules is that primary lesions should be handled with priority, with secondary lesions taking into account. .
Subject(s)
Humans , Adenocarcinoma , Diagnosis , Diagnostic Imaging , General Surgery , Adenocarcinoma of Lung , China , Consensus , Hospitals , Lung Neoplasms , Diagnosis , Diagnostic Imaging , General Surgery , Physicians , Psychology , Positron Emission Tomography Computed Tomography , Practice Guidelines as Topic , Retrospective Studies , Solitary Pulmonary Nodule , Diagnosis , Diagnostic Imaging , General Surgery , Tomography, X-Ray ComputedABSTRACT
Objective To discuss the treatment methods of early adenocarcinoma.Methods Analyzed all the lung adenocarcinoma patients who received the surgical treatment in our hospital from January 2013 to December 2015 and compare the surgical treatment for the very early stage lung adenocarcinoma.Results There are totally 8 908 lung adenocarcinomas cases enrolled.Among all the cases,there are 1 143 cases of AIS and 674 cases of MIA.VATS surgery was performed on all these very early stage of adenocarcinoma cases.The proportion of lobectomy in AIS decreased year by year,the proportion of surgery type for MIA is relatively stable.Lymph node metastasis was not found in all patients.Conclusion Both AIS and MIA are re presented as ground glass opacity(GGO) in CT scan.If the lesion is larger than 8mm and has been followed up for a period can be considered for VATS.For AIS,sub-lobectomy is recommended.But for MIA,both lobectomy and sub-lobectomy are ac ceptable and lymph node sampling is enough.