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Diagnosis and treatment pathway of neoadjuvant immunotherapy for esophageal cancer in Henan province

Esophageal cancer is a highly prevalent tumor species in Henan province, which brings heavy medical burden to families and society. Surgical treatment plays a dominant role in the treatment of non-advanced esophageal cancer. However, cancer cells in esophageal cancer lesions are highly invasive, postoperative recurrence and metastasis rates are pretty high. More effective systemic and comprehensive treatment is urgently needed to improve the prognosis. We invited 52 doctors in esophageal surgery, oncology, pathology, imaging, and radiation therapy of 32 hospitals at all levels in Henan province, to repeatedly negotiate and fully discuss in combination with evidence and clinical practice experience. Finally, “diagnosis and treatment pathway of neoadjuvant immunotherapy for esophageal cancer in Henan province” was formulated. In this treatment pathway, seven recommendations were proposed from seven perspectives including target population, patient evaluation, protocol selection, surgical timing, postoperative management, organ preservation, and general principles to offer reference for medical personnel related to esophageal cancer surgery.

肺結核復治患者的外科治療

胸腔鏡下空洞清除術治療空洞型肺結核

目的　探討采用胸腔鏡下空洞清除術治療空洞型肺結核的臨床效果。　方法　對 72例空洞型肺結核患者行胸腔鏡下結核空洞清除術。　結果　 72例中失訪 1例 ,治愈 6 9例 ,治愈率 97.2 %。6 0～ 78歲的 5 2例老年患者全部治愈 ;4 2例痰涂片陽性患者隨訪 1年以上 ,有 4 1例陰轉 ,痰菌仍為陽性 1例 ,陰轉率 97.6 %。　結論　胸腔鏡下空洞清除術治療空洞型肺結核為一種較好的治療方法。從流行病學角度看 ,對消除老齡患者這部分傳染源 ,該手術方法更有價值。

非小細胞肺癌患者圍術期細胞免疫功能的變化及免疫治療

目的 觀察圍術期非小細胞肺癌患者細胞免疫功能的變化及應用胸腺肽α1后對機體免疫功能的影響，為臨床應用免疫增強劑聯合手術治療非小細胞肺癌患者提供依據。 方法 將97例行肺葉或右全肺切除術的非小細胞肺癌患者分為兩組，組1：圍術期給予胸腺肽α1治療；組2：圍術期未給予胸腺肽α1治療；對照組：另選擇19例同期非肺癌而采取手術治療的肺部疾病患者作為對照。 采用間接免疫熒光法(IFCA)測定3組圍術期T細胞亞群的百分率變化。 結果 術后第1 d組1 CD4+T、CD4+T/CD8+T高于組2（CD4+T 36.92%±2.10% vs. 31.18%±7.64%; CD4+T/CD8+T 1.31±0.36 vs. 1.09±0.32;Plt;0.05），術后第3 d組1 CD4+T和CD4+T/CD8+T高于組2（CD4+T 45.66%±3.77% vs. 34.70%±8.42%; CD4+T/CD8+T 1.42±0.11 vs. 1.14±0.20; Plt;0.05）；術后第9 d CD4+T、CD4+T/CD8+T高于組2（CD4+T 47.28%±1.96% vs. 39.12%±3.10%; CD4+T/CD8+T 1.46±0.14 vs. 1.22±0.36；Plt;0.05）；術后第16 d組1 CD4+T、CD4+T/CD8+T與組2和對照組比較差異無統計學意義（Pgt;0.05）。 結論 非小細胞肺癌患者的免疫功能低下，應用胸腺肽α1后細胞免疫功能較快恢復至正常狀態，對非小細胞肺癌患者早期采用手術、化療/放療的綜合治療有助于提高治療效果。

胸腔引流方法的改進

胸腹腔鏡聯合切除局部晚期食管癌手術視頻要點

A new classification of left apicoposterior segmental bronchus and its clinical significance

ObjectiveTo analyze a new classification of the left apicoposterior segmental bronchus and summarize its clinical significance. Methods We accessed the computed tomography imaging data of the inpatients treated in the Department of Thoracic Surgery, Henan Provincial People's Hospital between January and November 2021. We observed and classified the branching pattern of the left apicoposterior segmental bronchus (B1+2) using three-dimensional computed tomography bronchography and angiography (3D-CTBA) technique. And we filtered out the patients who underwent thoracoscopic left apicoposterior segmentectomy and analyzed their clinical data retrospectively to summarize the instructing significance of different bronchial classification in the accurate and safe operation of left apicoposterior segmentectomy. Results Finally 240 patients were collected, including 131 males and 109 females with a median age of 51.0 (19.0-77.0) years. The anatomical pattern of the left apicoposterior segmental bronchus was divided into four main types based on the branching pattern of the outer subsegmental bronchi (B1+2c): type Ⅰ 10% (24 patients), type Ⅱ 54% (130 patients) , type Ⅲ 17% (40 patients) , type Ⅳ 18% (43 patients) and other variations 1% (3 patients). Thirty-two patients smoothly underwent thoracoscopic left apicoposterior segmentectomy, including 23 patients of type Ⅰ and type Ⅱ receiving LS1+2 resection, the other 9 patients of type Ⅲ and type Ⅳ receiving LS1+2 resection (3 patients), LS1+2c resection (4 patients) and LS1+2(a+b) resection (2 patients). Conclusion This new classification systematically and concisely elucidates the branching characteristics of the left apicoposterior bronchus. Different branching types are instructive to the left apicoposterior segmentectomy.