BACKGROUND Pulmonary mucoepidermoid carcinoma(PMEC)is a rare malignancy that arises from minor salivary glands within the tracheobronchial tree.The clear cell variant of PMEC is exceptionally uncommon and presents not...BACKGROUND Pulmonary mucoepidermoid carcinoma(PMEC)is a rare malignancy that arises from minor salivary glands within the tracheobronchial tree.The clear cell variant of PMEC is exceptionally uncommon and presents notable diagnostic challenges,primarily attributable to its morphological similarity to other tumors containing clear cells.CASE SUMMARY A 22-year-old male,formerly in good health,came in with a two-month duration of persistent cough and production of sputum.Subsequent imaging and bronchoscopy examinations revealed a 2 cm tumor in the distal left main bronchus,which resulted in complete atelectasis of the left lung.Further assessment via positron emission tomography/computed tomography scans and endoscopic biopsy confirmed the primary malignant nature of the tumor,charac-terized by clear cell morphology in most of the tumor cells.The patient underwent a left lower lobe sleeve resection accompanied by systematic mediastinal lymph node dissection.Molecular pathology analysis subsequently revealed a CRTC3-MAML2 gene fusion,leading to a definitive pathological diagnosis of the clear cell variant of PMEC,staged as T2N0M0.After surgery,the patient experienced a smooth recovery and exhibited no signs of recurrence during the one-and-a-half-year follow-up period.CONCLUSION This article describes an unusual case of a clear cell variant of PMEC characterized by the presence of a CRTC3-MAML2 gene fusion in a 22-year-old male.The patient underwent successful left lower lobe sleeve resection.This case underscores the distinctive challenges associated with diagnosing and treating this uncommon malignancy,underscoring the importance of precise diagnosis and personalized treatment strategies.展开更多
背景与目的:随着胸腔镜(V ideo-assisted thoracoscop ic surgery,VATS)技术的迅速发展,现在大多数肺癌的外科治疗可以安全地在胸腔镜下手术完成,一些胸外科医生很关注胸腔镜手术的安全性和彻底性。胸腔镜辅助小切口(V ideo-assisted m ...背景与目的:随着胸腔镜(V ideo-assisted thoracoscop ic surgery,VATS)技术的迅速发展,现在大多数肺癌的外科治疗可以安全地在胸腔镜下手术完成,一些胸外科医生很关注胸腔镜手术的安全性和彻底性。胸腔镜辅助小切口(V ideo-assisted m in i-thoracotomy,VAMT)扩展了手术的适应范围,使解剖上彻底的肺叶切除术及淋巴结清扫更容易。本文旨在探讨和总结胸腔镜辅助小切口肺叶切除术的临床价值。方法:总结102例胸腔镜辅助小切口下肺叶切除的手术方法及临床效果。结果:全组无手术死亡及严重并发症。平均手术时间与术后胸腔引流管时间分别为126分钟和3.5天,术中出血平均165m。l术后疼痛轻、恢复快,3年生存率87.8%和传统开胸手术组无差异。结论:胸腔镜辅助小切口肺叶切除及淋巴结清扫安全、彻底,效果确切。只要严格掌握手术适应证,运用合理的手术方法和技巧,一般可以达到与常规开胸同样的治疗效果,扩展了胸腔镜手术的适应范围。展开更多
目的 比较传统2D胸腔镜和Flex-3D胸腔镜在非小细胞肺癌(NSCLC)患者肺叶切除术中的应用效果。方法 回顾性选取2021年11月—2023年7月在徐州市贾汪区人民医院行肺叶切除术的NSCLC患者83例为研究对象。根据术中胸腔镜使用类型将患者分为Fle...目的 比较传统2D胸腔镜和Flex-3D胸腔镜在非小细胞肺癌(NSCLC)患者肺叶切除术中的应用效果。方法 回顾性选取2021年11月—2023年7月在徐州市贾汪区人民医院行肺叶切除术的NSCLC患者83例为研究对象。根据术中胸腔镜使用类型将患者分为Flex-3D组46例和2D组37例。2D组患者接受传统2D胸腔镜肺叶切除术,Flex-3D组患者接受Flex-3D胸腔镜肺叶切除术。术后15、30 d采用门诊复诊方式进行随访。比较两组围术期指标(手术时间、术中出血量、24 h引流量、引流管留置时间和住院时间)、pTNM分期、淋巴结清扫数量,术后3、15、30 d数字评定量表(NRS)评分,术前及术后15、30 d肺功能指标[用力肺活量(FVC)、第1秒用力呼气容积占预计值的百分比(FEV_(1)%)],术后并发症(肺不张、肺部感染、肺栓塞、心律失常)发生率。结果 Flex-3D组手术时间、引流管留置时间、住院时间短于2D组,术中出血量、24 h引流量少于2D组(P<0.05)。两组pTNM分期、淋巴结清扫数量比较,差异无统计学意义(P>0.05)。手术方法和时间在NRS评分上存在交互作用(P<0.05);手术方法、时间在NRS评分上主效应显著(P<0.05)。Flex-3D组术后15 d NRS评分高于2D组,术后30 d NRS评分低于2D组(P<0.05);两组术后15、30 d NRS评分分别低于本组术后3 d,术后30 d NRS评分分别低于本组术后15 d(P<0.05)。手术方法和时间在FVC、FEV_(1)%上不存在交互作用(P>0.05);手术方法、时间在FVC、FEV_(1)%上主效应显著(P<0.05)。Flex-3D组术后15、30 d FVC、FEV_(1)%高于2D组(P<0.05);两组术后15、30 d FVC、FEV_(1)%分别低于本组术前,术后30 d FVC、FEV_(1)%分别高于本组术后15 d(P<0.05)。两组术后肺不张、肺部感染、肺栓塞、心律失常发生率比较,差异无统计学意义(P>0.05)。结论 与传统2D胸腔镜肺叶切除术相比,Flex-3D胸腔镜肺叶切除术能更有效地缩短NSCLC患者手术时间,减少出血量,进而缩短术后恢复时间,其还能更有效地减轻患者术后30 d疼痛,促进术后肺功能的恢复,且二者的安全性相当。展开更多
基金Hunan Provincial Natural Science Foundation of China,No.2022JJ40246The Hunan Cancer Hospital Climb Plan,No.2021NSFC-B005.
文摘BACKGROUND Pulmonary mucoepidermoid carcinoma(PMEC)is a rare malignancy that arises from minor salivary glands within the tracheobronchial tree.The clear cell variant of PMEC is exceptionally uncommon and presents notable diagnostic challenges,primarily attributable to its morphological similarity to other tumors containing clear cells.CASE SUMMARY A 22-year-old male,formerly in good health,came in with a two-month duration of persistent cough and production of sputum.Subsequent imaging and bronchoscopy examinations revealed a 2 cm tumor in the distal left main bronchus,which resulted in complete atelectasis of the left lung.Further assessment via positron emission tomography/computed tomography scans and endoscopic biopsy confirmed the primary malignant nature of the tumor,charac-terized by clear cell morphology in most of the tumor cells.The patient underwent a left lower lobe sleeve resection accompanied by systematic mediastinal lymph node dissection.Molecular pathology analysis subsequently revealed a CRTC3-MAML2 gene fusion,leading to a definitive pathological diagnosis of the clear cell variant of PMEC,staged as T2N0M0.After surgery,the patient experienced a smooth recovery and exhibited no signs of recurrence during the one-and-a-half-year follow-up period.CONCLUSION This article describes an unusual case of a clear cell variant of PMEC characterized by the presence of a CRTC3-MAML2 gene fusion in a 22-year-old male.The patient underwent successful left lower lobe sleeve resection.This case underscores the distinctive challenges associated with diagnosing and treating this uncommon malignancy,underscoring the importance of precise diagnosis and personalized treatment strategies.
文摘背景与目的:随着胸腔镜(V ideo-assisted thoracoscop ic surgery,VATS)技术的迅速发展,现在大多数肺癌的外科治疗可以安全地在胸腔镜下手术完成,一些胸外科医生很关注胸腔镜手术的安全性和彻底性。胸腔镜辅助小切口(V ideo-assisted m in i-thoracotomy,VAMT)扩展了手术的适应范围,使解剖上彻底的肺叶切除术及淋巴结清扫更容易。本文旨在探讨和总结胸腔镜辅助小切口肺叶切除术的临床价值。方法:总结102例胸腔镜辅助小切口下肺叶切除的手术方法及临床效果。结果:全组无手术死亡及严重并发症。平均手术时间与术后胸腔引流管时间分别为126分钟和3.5天,术中出血平均165m。l术后疼痛轻、恢复快,3年生存率87.8%和传统开胸手术组无差异。结论:胸腔镜辅助小切口肺叶切除及淋巴结清扫安全、彻底,效果确切。只要严格掌握手术适应证,运用合理的手术方法和技巧,一般可以达到与常规开胸同样的治疗效果,扩展了胸腔镜手术的适应范围。
文摘目的 比较传统2D胸腔镜和Flex-3D胸腔镜在非小细胞肺癌(NSCLC)患者肺叶切除术中的应用效果。方法 回顾性选取2021年11月—2023年7月在徐州市贾汪区人民医院行肺叶切除术的NSCLC患者83例为研究对象。根据术中胸腔镜使用类型将患者分为Flex-3D组46例和2D组37例。2D组患者接受传统2D胸腔镜肺叶切除术,Flex-3D组患者接受Flex-3D胸腔镜肺叶切除术。术后15、30 d采用门诊复诊方式进行随访。比较两组围术期指标(手术时间、术中出血量、24 h引流量、引流管留置时间和住院时间)、pTNM分期、淋巴结清扫数量,术后3、15、30 d数字评定量表(NRS)评分,术前及术后15、30 d肺功能指标[用力肺活量(FVC)、第1秒用力呼气容积占预计值的百分比(FEV_(1)%)],术后并发症(肺不张、肺部感染、肺栓塞、心律失常)发生率。结果 Flex-3D组手术时间、引流管留置时间、住院时间短于2D组,术中出血量、24 h引流量少于2D组(P<0.05)。两组pTNM分期、淋巴结清扫数量比较,差异无统计学意义(P>0.05)。手术方法和时间在NRS评分上存在交互作用(P<0.05);手术方法、时间在NRS评分上主效应显著(P<0.05)。Flex-3D组术后15 d NRS评分高于2D组,术后30 d NRS评分低于2D组(P<0.05);两组术后15、30 d NRS评分分别低于本组术后3 d,术后30 d NRS评分分别低于本组术后15 d(P<0.05)。手术方法和时间在FVC、FEV_(1)%上不存在交互作用(P>0.05);手术方法、时间在FVC、FEV_(1)%上主效应显著(P<0.05)。Flex-3D组术后15、30 d FVC、FEV_(1)%高于2D组(P<0.05);两组术后15、30 d FVC、FEV_(1)%分别低于本组术前,术后30 d FVC、FEV_(1)%分别高于本组术后15 d(P<0.05)。两组术后肺不张、肺部感染、肺栓塞、心律失常发生率比较,差异无统计学意义(P>0.05)。结论 与传统2D胸腔镜肺叶切除术相比,Flex-3D胸腔镜肺叶切除术能更有效地缩短NSCLC患者手术时间,减少出血量,进而缩短术后恢复时间,其还能更有效地减轻患者术后30 d疼痛,促进术后肺功能的恢复,且二者的安全性相当。
