Lung transplantation is the only effective method to treat some lung diseases, which can greatly improve the quality of life after operation and significantly prolong the survival. However, compared with liver and kidney transplantation, the numbers of lung transplantation are smaller in most transplant centers, and the operation technique is less mature, which largely restricted the development of lung transplantation. By years of efforts, the clinical practice of lung transplantation has experienced dramatic development in China, but countermeasures are required to deal with current enormous problems.

观察双腔气管插管、支气管封堵器和单腔气管插管三种插管方式在胸腹腔镜食管癌切除术中对呼吸、循环的影响，评价其安全性及可行性。

2013年10月至2014年9月上海交通大学附属胸科医院对收治的60例ASAⅡ～Ⅲ级拟行胸腹腔镜联合食管癌根治术的患者，按气管插管方式分3组，分别采用双腔气管插管(30例)、支气管阻塞器(20例)和单腔气管插管(10例)；用气腹机在胸腔内CO₂中速充气，初始胸内压5～10mmHg(1mmHg＝0.133kPa)，调节胸内压力，选择对血压影响最小，视野暴露满意的压力；监测记录心率、平均动脉压(MAP)、中心静脉压(CVP)、脉搏血氧饱和度(SpO₂)、气道压(Paw)及呼气末CO₂分压(P_ETCO₂)等呼吸、循环和血气指标，观察其在CO₂充气前后的变化，采集4个时间节点的参数，分别为气管插管后20min(T₁)、人工气胸后20min(T₂)、人工气胸后60min(T₃)以及人工气胸结束后10min(T₄)，同时采集动脉血气标本检测。

CO₂吹入造成人工气胸后，CVP、Paw、P_ET CO₂及PaCO₂明显升高，动脉氧分压(PaO₂)和血气pH值明显下降，MAP、HR和SpO₂无明显变化。手术结束停止充气后，大多数指标恢复至基础值水平。所有病例均顺利完成胸腔镜手术医师和无严重并发症发生。

三种插管方式均可用于食管癌腹腔镜微创外科手术，但各有优缺点，相比传统的双腔气管插管和支气管阻塞导管，单腔气管插管加CO₂吹入人工气胸的方法能维持血流动力学稳定，生理指标在可接受的范围内，但可能有高碳酸血症、皮下气肿等并发症。插管选择上应根据患者、手术医师和麻醉医师的经验等多方面情况综合权衡，个体化选择。

To summarize the conditions of reflux after esophagectomy for esophageal cancer using stomach tube, and investigate the influence of stomach tube width on reflux after esophagectomy for esophageal cancer.

According to the order of admission, 60 patientsundergoing esophagectomy for esophageal cancer using stomach tube were randomly divided into group A (stomach tube width ≥ 3 cm, 30 cases) and group B (stomach tube width <3 cm, 30 cases). Eleven to fourteen days after recovery of intestinal function, 24 h esophageal pH monitoring was conducted.

The times of reflux, times of reflux >5 min, time of pH<4.00 and longest reflux time in group A were significantly larger or longer than those in group B(t=2.735, P=0.012; t=4.502, P=0.001; t=3.435, P=0.023; t=4.286, P=0.002).

Stomach tube width may influence the occurrence of reflux, and thin stomachtube can reduce the reflux after esophagectomy for esophageal cancer.

To investigate the clinical characteristics of esophageal foreign bodies, and summarize the reasonable algorithm of the management.

The clinical records of 199 consecutive patients with esophageal foreign bodies ingestion treated in Shanghai Chest Hospital between January 2008 and December 2013 were retrospectively collected. According to the findings of clinical signs, radiological images and other examinations, the patients were classified into two types, and were treated following a settled algorithm. Type 1 was defined as no or restricted esophageal perforation, and was sent to esophagoscopy first. Type 2 was defined as non-restricted esophageal perforation, and was sent to surgery first. The clinical outcomes of these two types were collected. The age, gender, duration of impaction, sharpness of esophageal foreign bodies and localization of entrapment were compared between endoscopy group and surgery group.

A hundred and seventy-six patients came to hospital within 48 h after impaction, while 23 patients did after 48 h. Esophageal foreign bodies were confirmed in 196 patients through esophagoscopy or surgery. The most frequent type of esophageal foreign bodies was the bones of fish, domestic fowls and animals (116 cases, 59.1%), and the secondary type was the dentures (31 cases, 15.8%). The frequency of location of entrapment was 61.2%(120 cases) at the first esophageal physiological narrow, 32.2%(63 cases) at the second and 6.6%(13 cases) in the lower esophagus. A hundred and seventy-nine patients were classified as type 1, among whom 175(97.8%) were successfully treated only with esophagofiberoscopy, 3 were sent to surgery later after failed retrieval of esophageal foreign bodies or complications after retrieval, and the other 1 died of septic shock following severe mediastinitis. Twenty patients with non-restricted esophageal perforation were treated by surgery first. As for the surgery group, the percentages of impaction duration longer than 48h and sharp type of esophageal foreign bodies were 30.4%(7/23) and 100%, respectively, both of which were significantly higher than the endocopy group(9.1%, 16/176) (χ²=9.066, P=0.003; χ²=4.799, P=0.028).

Impaction duration longer than 48 h and sharp esophageal foreign bodies are significant risk factors for surgical interference. With rational anesthesia, esophagofiberoscopy can safely retrieve most esophageal foreign bodies. The therapeutic ending of esophageal foreign bodies ingestion is not the retrieval of the esophageal foreign bodies but more importantly is the quick assessment and cure of the esophageal injury after esophageal foreign bodies ingestion by following a reasonable algorithm.

The aim of this study is to investigate the related factors indicating necessarily second esophagectomy after the treatment of endoscopic resection (ER) in early stage of esophageal cancer.

From June 2011 to March 2014, the data of patients with early stage esophageal cancer treated with ER were prospectively collected from the Department of Thoracic Surgery of Shanghai Cancer Hospital. Patients with or without further esophagectomy were followed up, and statistical analysis was carried out based on the factors including the depth of invasion(T grade), the depth of invasion of ER lesion(T0-1a or beyond T1a), the length of lesion(<3cm or ≥3cm), the location of tumor(upper, middle or lower), the degree of differentiation, and with or without lymph vascular invasion among patients without tumor residual after esophagectomy.

Eighty-eight patients with early stage esophageal cancer indicated by preoperative examination and staging underwent ER surgery, and 22(25.0%) of them received further esophagectomy, among whom 7(31.8%) had no tumor residual according to the final pathological reports. Statistical analysis showed that the invasive depth of ER lesion (T0-1a or above T1b) was a predicting factor which could indicate whether the patient need further radical surgery or not(χ²=8.56, P=0.005), while that had no significant effect on the length of lesion, location of lesion, differentiation degree and lymphatic vessel invasion(χ²=1.89, P=0.361; χ²=3.01, P=0.165; χ²=3.85, P=0.121; χ²=1.02, P=1.000).

Patients with lesions at stage T0-1a and negative surgical margin based on the pathological results can probably avoid esophagectomy after ER. While those beyond T1a stage, especially those with dissatisfaction about ESD mucosal protrusion after submucous injection with Methylene blue or endoscopic mucosal resection(EMR) mucosal trap, were recommended for esophagectomy. As for early stage cardia cancer, it should be very cautious when choosing to perform ER surgery.

The cancer which originates from esophageal mucosal epithelial cells and submucosal gland tissue, is called primary esophageal cancer; and the cancer which is caused by any other tissue or organ’s primary malignant tumors, either through direct infiltration of tumor cells or by lymphatic spread and hematogenous metastasis, is known as secondary esophageal cancer, which includes secondary invasive carcinoma and secondary metastatic cancer. This article reviewed the literature, and the current occurrence of secondary esophageal cancer, the mechanism of occurrence, the clinical features, the status and progress for diagnosis and treatment were summarized.

Successful TNM classification is the key factor for the diagnosis, treatment and prognosis prediction of lung cancer. The 7^th edition of the TNM Classification for Non-small-cell Lung Cancer, which was proposed in 2009 by the Union for International Cancer Control (UICC), has been widely used in clinical practice. With the advancement of therapeutic model and emerge of novel diagnostic techniques and treatment methods for lung cancer, the therapeutic effects and prognosis have been significantly improved, and the classification criteria are ready to be updated. Therefore, The International Association for the Study of Lung Cancer(IASLC) renewed the TNM classification of lung cancer in September 2015, and the forthcoming 8^th edition of the TNM Classification for Lung Cancer will be formally adopted in January 2017. The new classification criteria have enrolled a new database of 94, 708 cases of lung cancer between 1999 and 2010 obtained from 35 sources in 16 countries around the globe. The new edition of TNM classificationof lung cancer is interpreted in this paper.

To investigate the outcomes of fast track video-assisted thoracoscopic surgery for non-smallcell lung cancer, and summarize the treatment experience.

The clinical data of 240 patients with non-smallcell lung cancer treated in the Affiliated Hospital of Hainan Medical College between October 2011and October 2013 were retrospectively analyzed. Among these 240 patients, 170 were treated by video-assisted thoracoscopic surgery (thoracoscopic surgery group), and the other 70 were managed with conventional thoracotomy(conventional thoracotomy group). The operation time, volume of blood loss during operation, volume of postoperative chest drainage, chest tube intubation time, postoperative hospital stay and incidence of complications were compared between two groups, and the related indicators of immune stress before anesthesia(T0), 1h after skin incision(T1), at the end of operation(T2), 24 h after operation(T3) and 48 h after operation(T4) were observed.

There was no case ofperioperative death in two groups. The operation time, volume of blood loss during operation, volume of postoperative chest drainage, chest tube intubation time and postoperative hospital stay in thoracoscopic surgery group were significantly better than those in conventional thoracotomy group(t=-11.0, P=0.00; t=-3.2, P=0.00; t=-12.7, P=0.00; t=-9.4, P=0.00; t=-6.0, P=0.00). However, there was no significant difference in the incidence of postoperative complications between two groups (χ²=1.48, P=0.22). The related indicators of immune stress 24 h after operation (T3) and 48 h after operation (T4) in thoracoscopic surgery group were significantly higher than those in conventional thoracotomy group (P<0.01). The concentration of norepinephrine (NE) in the peripheral blood 24 h after operation (T3) and 48 h after operation (T4) in thoracoscopic surgery group was lower than that in conventional thoracotomy group (t=-11.81, P=0.00; t=-20.06, P=0.00).

Thoracoscopic surgery has the advantages of shorter operation time and hospitalization time, smaller volumes of blood loss during operation and postoperative drainage, less postoperative stress and immune response, and is worthy of application.

To analyse the clinical outcomes of selective three-field lymphadenectomy for thoracic esophageal squamous carcinoma.

From June 2009 to September 2012, 127 patients with esophageal squamous cell carcinoma received selective three-field lymphadenectomy according to tumor location, invasion degree and the results of preoperative cervical ultrasonography. Of the 127 cases of esophageal squamous cell carcinoma, 49 cases of tumor located in the upper third, 67 in the middle third, and the rest 11 in the lower third. According to the TNM staging, there were 2 patients in stage Ⅰ, 26 in stage Ⅱ and 99 in stage Ⅲ.

A total of 4963 lymphatic nodes were detected, and the average number of resected lymphatic nodes was 39.3 for one case. The mean duration of operation was (325.6±9.3)min, and the mean volume of bleeding was (316.0±18.7)ml. The incidence of postoperative complications and motality were 59.8%(76/127) and 1.6%(2/127), respectively. The metastasis rate of laryngeal recurrent nerve lymph node was 40.2% (51/127), and the metastasis rate of cervical lymph node was 55.9%(71/127). In patients with middle or lower esophageal cancer, the incidence of cervical lymph node metastasis was significantly related to that of laryngeal recurrent nerve lymph node metastasis(χ²=0.005, P=0.006). The overall median survival time was (35.0±1.9) months, and the 3-year survival rate was 51.8%. The median survival time and 3-year survival rate of patients in stage Ⅱ were (42.1±3.4) months and 74.5%, respectively, those of patients in stage Ⅲ were (32.3±2.0) months and 44.8%, respectively, and there were significant differences between these two groups of patients(χ²=3.940, P=0.047). The median survival time and 3-year survival rate of cervical lymph node-positive patients were (26.2±2.1) months and 34.9%, respectively, those of cervical lymph node-negative patients were (41.5±2.3) months and 67.6%, respectively, and there were significant differences between these two groups of patients(χ²=15.283, P<0.001).

Selective three-field lymphadenectomy is a safe and feasible method which could improve the efficiency of metastatic cervical lymph node dissection, screen out potential patients who can benefit from the procedure, and prolong the survival time.

To evaluate the feasibility and safety of anatomic segmentectomy with video-assisted thoracoscopic surgery(VATS).

The clinical data of 36 patients with lung diseases undergoing anatomic segmentectomy with VATS in the First Affiliated Hospital of Nanyang Medical College between January 2012 and December 2014 were retrospectively analyzed. Left lung apex posterior segmental resection(natural section) was done in 5 cases, and tongue resection in 7 cases; left lung lobe resection in 4 cases, and basal segment resection in 4 cases; right lung apex segmental resection in 3 cases, anterior resection in 2 cases, and posterior resection in 3 cases; right lung dorsal segment of lower lobe resection in 5 cases, and basal segment resection in 3 cases.

All patients completed anatomic segmentectomy, and there was no transfer to open chest surgery. The operation time ranged from 105 to 310 min, with an average of 175 min. The volume of bleeding was 30 to 210 ml, wih an average of 125 ml. The drainage volume was 160 to 1 250 ml, with an average of 350 ml. The time of drainage tube was 2 to 9 d, with an average of 4 d. The length of hospital stay was 4 to 15 d, with an average of 7 d. There was one case of thoracic cavity bleeding, one case of atrial fibrillation, one case of persistent pulmonary leak and two cases of pulmonary infection in one week after operation, and all were properly treated and discharged. The incidence of postoperative complications was 13.8% (5/36). The follow-up time ranged from 1 to 32 months, with an average of 12 months. Chest CT was reviewed 2 months after operation, and the adjacent lung segments to the resected expanded well. There was no recurrence or metastasis in 17 patients with primary lung cancer (excluding 4 cases of metastastic cancer).

Anatomic segmentectomy with VATS is safe and feasible, and can achieve a most precise and minimally invasive lesion resection.

To evaluate the efficacy of oral administration of Huoxiangzhengqi pill and moxibustion therapy in postoperative esophageal cancer patients with functional diarrhea, so as to provide a theoretical basis for clinical treatment and nursing care.

A total of 135 patients with postoperative functional diarrhea were enrolled in this study from October 2014 to April 2016. Patients were randomly divided into three groups: the Huoxiangzhengqi pill group, the moxibustion care group and the combination therapy group (at the same time to give oral Huoxiangzhengqi pills and moxibustion care operation), each group of 45 cases, the clinical efficacy and body mass index (BMI) of the three groups were compared.

The total effective rate was 68.9% in the Huoxiangzhengqi pill group and 71.1% in the moxibustion care group. The total effective rate was 91.1% in the combination therapy group. The total effective rate of treatment in the combination therapy group was significantly higher than the Huoxiangzhengqi pill group and the moxibustion care group (P<0.05). After treatment, the body mass index (BMI) of the patients in the combination therapy group was significantly higher than the Huoxiangzhengqi pill group and the moxibustion care group (t=-8.38, P<0.01).

Combined use of oral administration of Huoxiangzhengqi pill and moxibustion nursing operation has synergistic effect on patients with functional diarrhea after esophageal cancer surgery. It is worthy of recommendation.

To investigate the effect of early minimally invasive Judet fixation on the respiratory function of patients with traumatic flail chest.

The clinical data of 60 patients with flail chest complicated by pulmonary contusion treated between January 2008 and December 2014 were retrospectively analyzed. Patients were randomly divided into two groups according to the admission time. Patients in surgical treatment group(n=30) were managed with Judet fixation (minimally invasive fixation of embedded Judet) within 72 h after admission, and patients in conservative treatment group(n=30) received chest compression bandaging, butterfly-shaped adhesive external fixation or ventilator-assisted ventilation. The recovery of respiratory function and incidences of postoperative complications were compared between two groups.

The forced expiratory volume in one second(FEV₁), maximum minute ventilation(MMV) and forced vital capacity(FVC) 24 h after operation in surgical treatment group were significantly better than those in conservative treatment group (t=1.923, P=0.026; t=4.981, P=0.037; t=1.892, P=0.024). Besides, the prevalence of pulmonary infection in surgical treatment group was significantly lower than that in conservative treatment group(χ²=4.286, P=0.049).

Early surgical comprehensive treatment for flail chest complicated by pulmonary contusion is necessary and feasible, which can promote the recovery from chest deformity and recovery of respiratory function, and reduce the incidences of complications.

The detection rate of pulmonary nodules in modern medical conditions is increasing year by year, and the diagnosis and treatment of pulmonary nodules is another challenge for thoracic surgeons. It is still challenging to identify and treat small lung lesions in surgery, and the difficulty is how to integrate surgical and oncology principles with lung preservation surgery which should be more minimally-invasive and appropriate. In order to meet the increasing demand for pulmonary nodules and the transformation of surgical treatment modes, there have been many developments and innovations in the field of video-assisted thoracoscopic surgery (VATS). In recent years, the emergence of single-hole VATS and non-intubated VATS has significantly reduced the invasive injury of VATS. The emergence of glass-free 3D display system, image-guided VATS, hybrid operating theatre and fluorescence thoracoscopy have all contributed to improving the precision of VATS, and are becoming important auxiliary means to diagnose and treat pulmonary nodules. This article will discuss some key points of the recent developments of VATS technology and their important roles in the management of pulmonary nodules.

To investigate the effects of enteral nutrition(EN) support combined with early nasal liquid feeding and nursing intervention on postoperative nutritional status of patients with esophageal cancer surgery.

Ninety-six patients undergoing esophageal cancer surgery were divided into experiment group and control group using random number table method, with 48 patients in each group. Patients in experiment group were managed with nasal feeding of EN emulsion, and early nasal liquid feeding and nursing intervention were conducted. Patients in control group were only treated with nasogastric feeding of EN suspension and conventional care. The nutrition-related indicators(hemoglobin, urea, albumin, prealbumin and total cholesterol) before operation were compared with those on the seventh day after operation by PG-SAG scale.

There was no significant difference in age, gender constitution, time of EN commencement after operation, mean hospitalization days and incidence of perioperative complications between two groups(P>0.05). On the seventh day after operation, although the nutrition-related parameters decreased after operation in two groups, the concentrations of hemoglobin, urea, albumin, prealbumin and total cholesterol in experiment group were significantly higher than those in control group (t=6.836, P=0.009; t=6.503, P=0.012; t=4.492, P=0.028; t=5.073, P=0.020; t=6.082, P=0.018).

EN combined with nasal liquid feeding and nursing intervention can improve the perioperative nutritional status and promote postoperative rehabilitation in patients undergoing esophageal cancer surgery.

To investigate the lung protection and perioperative management in senior lung cancer patients with low pulmonary function.

The clinical data of 78 senior lung cancer patients aged ≥70 years undergoing surgical management in Huarun Wugang General Hospital between January 2009 and June 2014 were retrospectively analyzed, and the pulmonary function parameters before and after operation were retrieved. Patients were grouped according to the occurrence of postoperative cardiovascular and respiratory complications or based on the status of tracheal extubation. The prognostic factors of tracheal extubation after operation were explored by multivariate Logistic analysis.

All patients were cured during perioperation. There were significant differences in preoperative pulmonary function between complication group and non-complication group (χ²=25.807, P<0.01). There were also significant differences in preoperative pulmonary function and resection range between successful extubation group and delayed extubation group (χ²=10.953, P=0.027; χ²=7.033, P=0.031). The preoperative pulmonary function parameters of VC%, FEV_l% and MVV% in successful extubation group were significantly higher than those in delayed extubation group (P<0.01), and the postoperative predictive value of FEV_l%-ppo in successful extubation group was also significantly higher than that in delayed extubation group(P<0.01). Multivariate Logistic analysis demonstrated that low pulmonary function was closely related to the prognosis (P<0.05).

Preoperative improvement of pulmonary function, appropriate anesthesia management and individualized surgical approach during operation, and optimal postoperative mechanical ventilation are of vital importance to perioperative lung protection among senior lung cancer patients with low pulmonary function. Preoperative pulmonary function and resection range of the lung are associated with prognosis.

To summarize the 18-year experience in video-assisted McKeown esophagectomy for esophageal cancer.

The clinical data of 639patients with esophageal cancer undergoing McKeown esophagectomy between August 1997 and June 2015 in Department of Thoracic Surgery, Taizhou Hospital affiliated to Wenzhou Medical University were retrospectively analyzed. Among these 639 patients, 622(97.34%) completed the surgery with video-assisted procedures. A total of 7.98% of esophageal tumors located in the upper segment, 63.54% in the middle segment, and 28.48% in the lower segment.Preoperative neoadjuvant chemoradiotherapy was done in 8.92% of patients. For TNM staging, stage 0 accounted for 10.33%, stage Ⅰ29.26%, stage Ⅱ 42.10%, stage Ⅲ15.02% and stage Ⅳ 3.29%. Pathological examinations demonstrated that there were 92.02% of squamous cancer and 7.98% of adenocarcinoma and other histological types.Surgery were completed by thoracoscopy and laparotomy(44.60%), thoracoscopy and laparoscopy(47.26%), thoracotomy and laparoscopy(5.48%), and conversion to thoracotomy or laparotomy (2.66%).

The time of esophagus freeing and pleural lymph node dissection under thoracoscope was (78.6±36.9)min, and the time of stomach freeing and abdominal lymph node dissection under laparoscope was (55.4±19.5) min. The volumes of blood loss in thoracoscopic surgery and laparoscopic surgery were (99.5±79.2) ml and (40.5±23.4) ml respectively. The mean total number of lymph node dissection was(24.1±12.4) per case, and the number of thoracic lymph node dissection was (14.9±8.1) per case, abdominal lymph node dissection (9.1±5.5) per case, and neck lymph node dissection (1.5±1.3) per case. There was no death during operation. There were 4 cases of intraoperative bleeding due to the azygos vein or spleen injury, 4 cases of accidental tracheal injury caused by cautery hook or ultrasound knife, 13 cases of thoracic duct injury of non-focal cause, 11 cases of atrial fibrillation and 4 cases of esophageal resection margin-positive R₁ resection. The major complications in the early postoperative period which occurred in more than 10 cases were lung infection(11.42%), neck anastomosis leak(7.04%), arrhythmia(4.85%), pleural effusion catheterization(3.29%), recurrent laryngeal nerve injury(3.13%) and chylothorax(2.03%). Six cases(0.94%) died early after operation. Among them, 3 died of postoperative respiratory failure, 1 severe pulmonary infection after tracheoesophageal fistula, 1 recurrent hyperglycemia complicated with neck anastomotic fistula uncured and multiple organ failure, and the other aorta rupture and bleeding caused by chest gastric fistula or necrosis. Three hundred and seven patients (48.04%) received postoperative radiotherapy and chemotherapy. The follow-up rate was 90.8%, and the mean follow-up time was (44.5 ± 33.1) months.The 1, 2, 3, and 5-year overall survival rates were 83.9%, 69.7%, 57.1%and 45.5%, respectively.

Video-assisted McKeown esophagectomy for esophageal cancer is feasible and effective in tumor R₀ resection and short-term and long-term effects.

To investigate the long-term clinical efficacy of patients with non-small cell lung cancer(NSCLC) between video-assisted minithoracotomy(VAMT) and open lobectomy.

The clinical data of 120 patients with NSCLC treated in Department of Cardiothoracic Surgery, the First Affiliated Hospital, Zhejiang University between January 2006 and June 2008 were retrospectively analyzed. Among these patients, 40 underwent VAMT(VAMT group), and conventional open lobectomy was carried out in the other 80(open lobectomy group). Patients were followed up for 5 years, and the 5-year overall survival(OS) and disease-free survival(DFS) were compared between groups. The quality of life was assessed by the 36-item short form health survey(SF-36) in Chinese version, and the causes of death were analyzed.

There was no significant difference in the sex constitution ratio, mean age and clinical stage constitution ratio between two groups before operation(P>0.05). There was no significant difference in the 5-year OS and DFS between two groups(χ²=2.165, P=0.856; t=0.151, P=0.732). In the evaluation of SF-36 5 years after operation, the scores of physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional and mental health in VAMT group were significantly higher than those in open lobectomy group(t=5.298, P=0.035; t=4.508, P=0.021; t=2.085, P=0.036; t=6.316, P=0.019; t=3.584, P=0.024; t=4.903, P=0.023; t=5.354, P=0.020; t=2.772, P=0.022).

Though there is no significant difference in long-term survival between VAMT and open lobectomy, while the survival patients in VAMT group have a higher quality of life than open lobectomy group 5 years after surgery. VAMT has a better long-term efficacy than open pulmonary lobectomy, and is worthy of clinical application.

With the change of disease spectrum and technology advancement, especially with the screening of early lung cancer, tremendous changes in clinical manifestations have taken place for non-small cell lung cancer (NSCLC), which are characterized by the transformation from central type disease to peripheral type disease, from squamous carcinoma to adenocarcinoma, from massive type to small nodule, and from single lesion to multiple lesions. Multiple-lesion lung cancers may be multiple primary lung cancers or lung metastasis of lung cancer, and the differential diagnosis and prognosis are important factors for management strategies. Through recent literature review, in combination with research findings of these kinds of diseases in this hospital, the diagnosis and surgical management of multiple primary lung cancers are introduced in this paper.

Closed drainage for thoracic cavity is the most basic thoracic surgical treatment, which is commonly used after thoracotomy of lung, esophagus, mediastinum and heart disease. Therefore, to ensure smooth and adequate thoracic drainage, it’s very important to design and manage closed thoracic drainage devices scientifically and rationally. This paper summarizes the principle and structure of all kinds of closed thoracic drainage bottles in China, and the four-cavity drainage bottle and dry drainage bottle produced by a medical company in Shanghai were introduced emphatically, and their advantages and disadvantages were compared.

探讨胸腹腔镜联合食管癌切除术围手术期并发症的防治。

从2012年6月至2015年5月山东大学齐鲁医院胸外科采用胸腹腔镜联合食管癌切除术治疗食管癌患者256例，其中男性203例，女性53例；年龄45～78岁，平均62岁。病变位于胸上段41例，胸中段143例，胸下段72例。在人工气胸胸腔镜下游离食管及清扫淋巴结，在腹腔镜下游离胃并行空肠造瘘置营养管，颈部左胸锁乳突肌前缘切口行器械吻合。

平均手术时间(240±30)min，其中胸腔手术时间(60±20)min，腹腔镜手术时间(60±10)min；术中估计失血量20～80 ml，术中无明显并发症。256例患者术后病理检查为鳞状细胞癌251例，腺癌3例，神经内分泌癌2例；平均清扫淋巴结24枚；术后第1～2天能下床活动。术后主要并发症包括吻合口瘘21例、声音嘶哑15例、肺部感染10例、胃排空障碍6例、乳糜胸2例、膈疝1例、空肠瘘1例、胸胃瘘1例。

胸腹腔镜联合食管癌切除术操作简单易行、创伤小、淋巴结清扫更彻底。术后并发症主要发生在手术开展的初期阶段，技术成熟后并发症明显减少。