Lung transplantation has been the only valid method in treating end-stage lung diseases, airway complications are the main cause to the failure of surgery and common postoperative complications. With the development on patient selection, organ preservation, surgical technique, immunosuppressive therapy and postoperative surveillance, the successful ratio of surgery has become most satisfactory. However, airway complications are still common after lung transplantation. Among these, the airway anastomosis stenosis is more predominant than others. The living quality and long-dated survival rate are highly improved by paying enough attention to the formation,corresponding management for tracheal stenosis. The progress of the cause, prevention and treatment of airway anastomosis stenosis after lung transplantation is reviewed in this article.
With widespread utilization of multi-slice helical computed tomography (CT) and low-dose CT in lung cancer screening, significantly greater incidence of patients with solitary pulmonary nodules (SPN) has been found. Once SPN is discovered, it is very difficult to immediately determine whether it is benign or malignant in clinical practice. In this review, SPN etiology, epidemiological characteristics of SPN patients, nodule size, morphology, location and growth rate, mathematical models for predicting malignancy of SPN, and diagnostic value of positron emission tomography (PET) and positron emission tomography-computed tomography (PET/CT) are summarized to provide reference for differential diagnosis of SPN. Current management strategies for SPN are also discussed in this review. According to whether SPN diameter is greater than 8 mm, whether SPN patients are advanced aged, have smoking or malignancy history, different follow-up and treatment strategies can be chosen. The diagnostic and treatment value of video-assisted thoracoscopic surgery for SPN is also discussed.
The classification of thymoma has always been controversial topil in recent years. It hasn’t been unified because of the morphological diversity of thymoma, the heterogeneity of tumour cells and the lack of simple and effective observation index. With the development of diagnostic technique and oncobiology research, several classification methods have been drawn off, including its World Health Organization(WHO) lassification. We reviewed the main classification and discussed the problems of each classification method and their clinical guiding significamce, summarized the development tendency, methods assist the classification and clinical research of thymoma.
Quality control of general thoracic surgery contains many links including the qualification and technical conditions of medical institutions, preoperative diagnostic system, surgery, postoperative management, pathological diagnosis and follow-up. Standards of quality control should be based on evidence-based medicine, and general rules with detailed criteria. As one of the core concepts of quality control, fine management is ought to strictly follow clinical practice guideline of thoracic surgery, to be clear with quality standards of each key link in clinical pathway, and to improve the clinical quality control system that combines self-evaluation and supervision and inspection.
With the development of thin section axial computed tomography scan, the detection rate of pulmonary ground-glass nodules (GGN) continues increasing. GGN has a special natural growth history: pure ground-glass nodules (PGGN) smaller than 10 mm can hold steady for a long term, surgery resection is unnecessary, patients need regular follow up. Larger part solid ground-glass nodules (PSN) with a solid component can be malignant early stage lung cancer, which requires early surgery intervention. Establishment of a standard definition of GGN growth, investments in the long term natural growth history of GGN, validation of the clinical, radiology and genetic risk factors would be beneficial for the management of GGN patients.
Tracheoesophageal fistula (TEF) is a disease characterized by an abnormal connection between the trachea and esophagus. Benign TEF often results from damage induced by tracheal intubation, primarily presenting as exacerbated cough during swallowing, which can be life-threatening in severe cases. However, there is no unified standard for the surgical treatment of TEF. Currently, the choice of surgical method mainly depends on the location, size, and condition of the surrounding trachea. For small to moderate TEFs, tracheal segmental resection and reconstruction is a classic surgical approach. For larger, complex, and refractory TEFs, musculocutaneous flap repair is an ideal option. This article reviews the application of several common musculocutaneous flaps, including the sternocleidomastoid, pectoralis major, and latissimus dorsi, in the repair of benign TEFs, aiming to provide a reference for the clinical diagnosis and treatment of this disease.
The postpericardiotomy syndrome (PPS) is an inflammation of the pericardium or pleura following a variety of pericardial injuries. The potential pathogenic factors of the PPS are autoimmune, special virus and latent virus infection. PPS is self-limited, but may lead to prolonged hospital stay, readmissions, and need for invasive interventions. The therapy for PSS is mainly empiric anti-inflammatory therapy. The perioperative use of colchicine could reduce the incidence of PPS but is not effective for postoperative atrial fibrillation or postoperative pericardial/pleural effusion. This article mainly analyzes the incidence, risk factors, clinical features, diagnosis and treatment standards, preventive measures and prognosis of PPS.