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Meinoshin Okumura教授:T1和T2肺癌手术治疗和立体定向放疗的选择

Published at: 2015年第1卷第S1期

周丽桃
关键词:

编者按:2017年11月17-18日,由同济大学附属上海市肺科医院主办的第20届全国胸外科新进展论坛暨第9届胸腔镜学习班在上海隆重举行。第一天手术演示,电磁导航+17台胸腔镜手术,涵盖微创外科各种术式;第二天会议,近50场主题发言囊括近年胸外科新进展。国内国外专家齐聚沪上,砥砺学术,碰撞思想。借此机会,我们很荣幸邀请到本次参会嘉宾——日本胸外科协会(JACS)主席、日本大阪大学医学研究生学院Meinoshi Okumura教授分享他对于T1和T2肺癌手术治疗和立体定向放疗的选择、电磁导航支气管镜在肺外周结节的应用、剑突下胸腺切除术等的看法(图1)。

图1. Okumura教授和AME编辑合影

人物聚焦:Meinoshin Okumura

Meinoshin Okumura, MD, PhD,Professor, Department of General Thoracic Surgery, Osaka University, Graduate School of Medicine, Osaka University Hospital ,Osaka, Japan

Dr. Okumura received his medical degree from Osaka University School of Medicine after which he completed his resident at Department of Surgery, Osaka University Hospital. He was a Research Fellow at the Department of Surgery, Osaka University Hospital from 1990-1992. Dr. Okumura was a Post-Doctoral Fellow at Howard Hughes Medical Institute, and Department of Pathology, Washington University, St. Louis, MO, USA from 1993-1996. From 1996-2002, Dr. Okumura is an Assistant Professor at the Department of Surgery, Osaka University Hospital and then he was appointed as the Chief Surgeon at Department of Surgery, National Kinki Chuo Hospital from 2002-2004. And the he was promoted to Associate Professor at Department of Surgery, Osaka University Hospital in 2004. And since 2007, he has been the Professor at Department of General Thoracic Surgery, Osaka University, Graduate School of Medicine, Osaka University Hospital.

Dr. Okumura has joined the Board of surgery in Japan and the Board of general thoracic surgery in Japan. He has also taken an active part in academic activities. He is the President of Japanese Association for Chest Surgery (JACS) and the President of Japanese Association for Research on the Thymus (JART), as well as the member of European Society of Thoracic Surgeons (ESTS), Regent of Japan, European Association of Cardiothoracic Surgery (EACTS) and International Thymic Malignancy Interest Group (ITMIG).

Dr. Okumura specializes in surgery for lung cancer, thymic tumors, myasthenia gravis, and lung transplantation. He also focuses on basic research for oncology, immunology, and regenerative medicine.

采访提要

目前一些临床研究表明,T1和T2肺癌手术治疗和立体定向放疗的生存率相近。立体定向放疗(stereotactic body radiationtherapy, SBRT)技术是一种特殊的放疗技术,指在精确的图像引导技术下给予局部肿瘤以高剂量、低分割的放射治疗,可获得较高的肿瘤局部控制率。作为一名外科医生,Okumura教授表示,尽管立体定向放疗对肿瘤有一定的治疗效果,但如果通过肺段切除或者肺叶切除可使患者获得5年生存率,因此他不建议采用立体定向放疗。立体定向放疗可以针对年龄高于85岁,且手术耐受性差的患者。80-85岁的患者,且心脏功能良好,Okumura教授一般建议采用手术治疗,其他情况一般会跟其家属沟通,让他们自己做选择。

对于电磁导航支气管镜在肺外周结节应用的意义,Okumura教授指出,通过电磁导航支气管镜技术,可以更加精准地到达结节的位置,但整体上,电磁导航支气管镜在术中的使用比较费时,特别是在小型的医院,实现的难度更大。

胸腺是人体重要的免疫器官,会随着生长发育逐渐退化,胸腺瘤便是起源于此。剑突下胸腺切除术是微创胸腺手术中的一种。Okumura教授指出,剑突下的位置有很多静脉,需要小心处理,不然可能引起严重的出血问题。如果肿瘤离上腔静脉很近,就不适合进行剑突下胸腺切除术。肿瘤的大小也是手术中需要注意的一个重点,如肿瘤大于5cm,而肿瘤后面区域的血管等情况难以估计,容易出现意外情况。此外,肿瘤的位置也需要予以重视。

免疫治疗在肺癌患者中取得良好的效果,而在胸腺瘤患者中是否也可以起到同样的效果?面对这个问题,Okumura教授表示,PD-1可能在胸腺瘤治疗中有一定的效果,期待未来胸腺瘤的免疫治疗能取得一些成效。

更多详细的内容,欢迎观看采访视频。

采访问题

1. In recent years, some studies demonstrate that the survival rate of stereotactic body radiotherapy in patients with lung cancer at T1 and T2 is similar to surgery, how do you think about the prospect of stereotactic body radiotherapy?

2. Is it possible that the surgical treatment of early stage lung cancer may be replaced by stereotactic body radiotherapy?

3. For peripheral solid nodules of pulmonary, how do you think about the advantage and deficiency of electromagnetic navigation bronchoscopy (ENB)?

4. Nowadays many clinical centers carried out subxiphoid approach thymectomy, how do you think about the safety and outcome?

5. In view of the good effect of lung cancer immunotherapy, which studies on the immunotherapy of thymic carcinoma are worth to looking forward to?


采写编辑:周丽桃,AME Publishing Company

视频编辑:麦雪芳,AME Publishing Company

责任编辑:许梦杨,AME Publishing Company

学术审核:贾卓奇,西安交通大学第一附属医院胸外科一科

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