2015沙龙sci那些事儿

SCI那些事儿

－经验交流与技术分享复旦大学附属中山医院

沈亚星

1937年中国人创办第一所西医医院黄家驷教授1906-1984石美鑫教授1918-20141948年

国内率先开展了肺转移瘤切除术1950年

首创食管烧灼伤食管切除1953年

脓胸全肺切除1957年

国内首例先天性食管闭锁1957年

食管气管瘘根治手术1994年

电视纵隔镜辅助食管癌切除术1999年

胸腔镜游离膈神经修复臂丛神经损伤2009年

俯卧位胸腔镜食管癌切除术2010年

达芬奇机器人辅助食管癌根治术历史

沿革

传承

创新临床vs

科研临床工作者不可缺少的一部分主要矛盾在于临床与科研脱节造成对临床及科研的双重危害台大附院2013年数据BiereSS,vanBergeHenegouwenMI,MaasKW,etal.Minimallyinvasiveversusopenoesophagectomyforpatientswithoesophagealcancer:amulticentre,open-label,randomisedcontrolledtrial.Lancet.2012;379(9829):1887-1892.RCT:115pts56ptsinopen59ptsinMIE9%vs29%3fold(p=0.005)优秀的临床研究最好的研究立足于临床解决临床问题与基础研究重归于好方向方向(三刊四会)AATS,AmericanAssociationforThoracicSurgeryESTS,EuropeanSocietyofThoracicSurgeonsEACTS,EuropeanAssociationforCardio-ThoracicSurgerySTS,SocietyofThoracicSurgeonsJTCVTSATSEJCVTS/ICVTS临床研究在中国数据问题设计问题写作问题ZhuC,JinK.MinimallyinvasiveesophagectomyforesophagealcancerinthePeople'sRepublicofChina:anoverview.OncoTargetsTher.2013;6:119-24.食管癌特点手术自身的复杂性

食管肿瘤切除

淋巴结清扫

消化道重建技术难度大

要求术者具有丰富的常规手术经验

同时掌握各类胸、腹腔镜操作

学习曲线较其他手术也相对更长中国特色

我国虽为“食管肿瘤大国”

昂贵的腔镜设备限制了新技术德开展历史回顾SongSY,NaKJ,OhSG,AhnBH.Learningcurvesofminimallyinvasiveesophagealcancersurgery.EurJCardiothoracSurg2009;35:689-693.临床研究：大样本长周期随访随访立足于说明临床问题不见得样本要大立足于解决临床问题不见得追访终身BiereSS,vanBergeHenegouwenMI,MaasKW,etal.Minimallyinvasiveversusopenoesophagectomyforpatientswithoesophagealcancer:amulticentre,open-label,randomisedcontrolledtrial.Lancet.2012;379(9829):1887-1892.微创vs开放食管癌手术对于术后QOL的影响研究方法：病例对照研究比较内容：胸腔镜手术（n=27）vs开放手术（n=29）量表：EORTCQLQ量表.

WangH,FengM,TanL,WangQ.Comparisonoftheshort-termqualityoflifeinpatientswithesophagealcanceraftersubtotalesophagectomyviavideo-assistedthoracoscopicoropensurgery.DisEsophagus.2010Jul;23(5):408-14.MIE初步优势：疲劳、疼痛、呼吸困难的症状评分更低WangH,TanL,FengM,ZhangY,WangQ.Comparisonoftheshort-termhealth-relatedqualityoflifeinpatientswithesophagealcancerwithdifferentroutesofgastrictubereconstructionafterminimallyinvasiveesophagectomy.QualLifeRes.2011Mar;20(2):179-89.曾经的我们主要靠祈祷！更重要的是要走出去！投稿大业AATSESTSSTS1项1项3项ChestXray1daypost-opTheoperativesideBackgroundChestXray1daypost-opTheventilativesideObjective:TheroleofSLVinPCLowtidalvolumeanditseffectonPC

Studydesign:Registered:C(No.NCT01194895)TheEthicsCommitteeofZhongshanHospital(No.2009156)Aprospective,randomized,controlledtrialTimeperiods:June2011andJuly2012MethodsRandomization:MIEpatientsassignedtoPVorCVMethodsThoracicstageAbdominalandcervicalstagePulmonarycomplicationsOver-allincidence:17.82%9.43%versus27.08%inPVandCV6ptsinrightside12ptsinleftsideShenY,ZhongM,WuW,WangH,TanL,WangQ.Theimpactoftidalvolumeonpulmonarycomplicationsfollowingminimallyinvasiveesophagectomy:Arandomizedandcontrolledstudy.JThoracCardiovascSurg.2013,146:1267-1274.轻学术IntroductionSurgeryisademandingworkWorkloadThoracoscopically+LaparoscopicallyTireddoctorVincentWillemvanGogh.PortraitofDr.Gachet,1890ObjectiveProneDecubitusLessWorkloadErgonomicallybetterUncertainFlowchart:RandomizationPatientseligibleforMIE(n=68)Randomized(n=67)AllocatedtoPP(n=35)AllocatedtoDP(n=32)Refusedtoparticipate(n=1)PatientsunderwentMIE(n=68)CervicalThoracicAbdominal轻学术:ErgonomicsinMIE

PPDPpValue(n=35)(n=32)EyeblinksrateR1

10.6±2.311.3±3.50.333R2

9.1±2.66.0±2.2<0.001R1-R21.2±0.93.0±1.4<0.001MusculoskeletalComplaints3.13±2.826.29±1.54<0.001R1R2R2TimeBlinksBeginningEndEndShenY,FengM,WangH,TanL,LiJ，WangQ.Thoracoscopicesophagectomyinproneversusdecubitusposition:Ergonomicevaluationfromarandomizedandcontrolledstudy.AnnThoracSurg2014(Accepted).21stEUROPEANCONFERENCEONGENERALTHORACICSURGERY,BIRMINGHAM,UK26–29May2013THEEFFECTOFNARROWEDGASTRICCONDUITONANASTOMOTICLEAKAGEFOLLOWINGMINIMALLYINVASIVEESOPHAGECTOMY/Oesophagus/MediastinumSessionLijieTan/LijieTanInCompliancewithUEMS/EACCMEGuidelines,potentialconflictsofinterestorsupportrelevanttotheabovepresentationthatmightcauseabiasaredeclaredasfollows:√NopotentialconflictsofinteresttoreportConflictsofinteresttoreport:(companyname,typeofrelationship)21stEUROPEANCONFERENCEONGENERALTHORACICSURGERY,BIRMINGHAM,UK26–29May2013LEARNINGCURVESFORTHORACOSCOPICESOPHAGECTOMY:FROMDECUBITUSTOPRONEPOSITION/MixedThoracicSessionWeiJiang/LijieTanInCompliancewithUEMS/EACCMEGuidelines,potentialconflictsofinterestorsupportrelevanttotheabovepresentationthatmightcauseabiasaredeclaredasfollows:√NopotentialconflictsofinteresttoreportConflictsofinteresttoreport:(companyname,typeofrelationship)21stEUROPEANCONFERENCEONGENERALTHORACICSURGERY,BIRMINGHAM,UK26–29May2013EXTENSIVEMEDIASTINALLYMPHADENECTOMYDURINGMINIMALLYINVASIVEESOPHAGECTOMY:ONCOLOGICALOUTCOMESFROMSINGLECENTER/MixedThoracicSessionYaxingShen/LijieTanInCompliancewithUEMS/EACCMEGuidelines,potentialconflictsofinterestorsupportrelevanttotheabovepresentationthatmightcauseabiasaredeclaredasfollows:√NopotentialconflictsofinteresttoreportConflictsofinteresttoreport:(companyname,typeofrelationship)历史回顾限制原因：术后并发症AtkinsBZ,ShahAS,HutchesonKA,MangumJH,PappasTN,HarpoleDHJr,D'AmicoTA.Reducinghospitalmorbidityandmortalityfollowingesophagectomy.AnnThoracSurg,2004;78:1170-1176.

微创食管切除术:窄型管状胃的应用

窄型管状胃对术后吻合口漏的影响NdoyeJM,DiaA,NdiayeA,FallB,DiopM,NdiayeA,SowML.Arteriographyofthreemodelsofgastricoesophagoplasty:thewholestomach,awidegastrictubeandanarrowgastrictube.SurgRadiolAnat.2006;28(5):429-437.传统管状胃宽度：5cm窄型管状胃宽度：3cm

微创食管切除术:窄型管状胃的应用

ShenY,WangH,etal.ESTS2013,Interactivecardiovascularthoracicsurgery2014.

GroupNGroupWpValue

(n=126)(n=133)Mortalitya0(0.0%)1(0.7%)0.978Morbidity41(32.5%)48(36.1%)0.548Anastomoticleakage11(8.7%)23(17.3%)0.041Respiratorycomplications10(7.9%)10(7.5%)0.899Cardiaccomplications7(5.6%)5(9.8%)0.492Hoarsenessb11(8.7%)9(6.7%)0.554Chylothorax1(0.8%)0(0.0%)0.978Delayedemptying1(0.8%)0(0.0%)0.978Woundinfection0(0.0%)1(0.7%)0.978吻合口瘘发生率降低一半:17%-8%

三角吻合

JingpeiLi,YaxingShen,LijieTan.Triangulatingstapledanastomosisforminimallyinvasiveesophagectomy,.JThoracDis,2014吻合口瘘发生率降低一半8%-4%Characteristicsee-TSA(n=33)es-CSA(n=51)pTimeforEGA,min18±3.417±2.70.139Lengthofstay(range),days10（7-28）10（7-62）0.799Complications,n(%)5（15.2%）18（35.3%）0.043Mortality,n(%)0(0.0%)1(2.0%)0.825Gastrointestinalcomplication1(3.0%)13(25.5%)0.006Anastomoticleakage1(3.0%)6(11.8%)0.312Anastomoticstricture0(0.0%)7(13.7%)0.069Pulmonarycomplication3(9.1%)8(15.7%)0.586方向-规划-调整AATSEACTSESTSSTSJTCVTSATSEJCVTS/ICVTS目标Yes!Yes!Yes!小学术:在学术游击中累积胜利短周期:避免长期随访精密设计：科学、一目了然新颖观