1. Brief medical history: Male, 59 years old, was admitted to the hospital with dry cough and chest tightness for one month. Chest CT showed: bronchial stenosis in the upper lobe of the left lung with peripheral soft tissue shadow, upper lobe dysplasia, and enlarged lymph nodes in groups 7 and 10. Bronchoscopy suggested: neoplastic obstruction of the lower segment of the left main bronchus. Preoperative diagnosis: left upper lobe lung cancer with non-tenderness Proposed surgery: left upper lung bronchial sleeve resection + mediastinal lymph node dissection or left total pneumonectomy + mediastinal lymph node dissection. 2. Brief description of the operation: On exploration, we saw: left upper lobe of the lung with opacification, no pleural metastasis, a small amount of yellowish pleural fluid, about 200 ml, and well-developed lung fissures. The ligament of the lower lung was cut, 9 groups of lymph nodes were removed, and the lower pulmonary veins were freed. The mediastinal pleura around the pulmonary hilum was dissected, and 7 groups of lymph nodes (lymph nodes under the bullae) were removed. The tumor was close to the pulmonary hilum, and the extrapericardial portion of the left upper pulmonary vein could not reach the safe resection length, so the pericardium was cut to free the upper pulmonary vein, which was left untreated for the time being. The interlobular pulmonary artery was dissected, and the anterior and posterior parts of the pulmonary fissure were cut and sutured with a 6-cm green staple, and the anterior and posterior segments of the apical artery were freed, ligated and sutured, and the root of the lingual segment artery was found to be invaded by continued exploration and could not be freed and cut. The left pulmonary artery trunk was freed and 5 groups of lymph nodes (main pulmonary window lymph nodes) were removed at the same time. The left upper pulmonary vein was cut and sutured with a 3-cm white staple, the left pulmonary artery root was blocked with potts forceps, the interlobular pulmonary artery was blocked with romel, and part of the wall of the main pulmonary artery trunk was cut along the root of the lingual segment artery, and the cut was about 0.5 cm from the tumor. Since the resected part did not exceed 25% of the circumference of the left pulmonary artery, direct suturing was feasible: the cut vessel lumen was flushed with heparin saline, and continuous sutures were made with 5-0 Prilling thread. After suturing the last stitch, the distal romel was first released to allow the regurgitated blood to occupy the vessel lumen in order to expel the air in the canal, and the potts clamp was released after tying the knot, but not removed for the time being, and the potts clamp was removed after making sure that the suture was secure. At this point, the treatment of the left upper lung vessels was completed. The left main bronchus and lower lobe bronchus were cut off 1 cm above and below the opening of the left upper lobe bronchus, and the airway was opened. Exploration revealed that the opening of the left upper lobe bronchus was affected by the tumor wave, and part of the cut edge was taken and sent to fast freezing stump negative, and the left main bronchus was made to do continuous end-to-end anastomosis with the left lower lobe bronchus with a 3-0 Prilling line, and after testing water without air leakage, the nearest fiber pericardium was freed The anastomosis was wrapped and the mediastinal lymph nodes were cleared to end the operation. 3. Experience: The patient was in TNM stage-IIIb, which is locally advanced and a difficult operation in general thoracic surgery, and there are many things that we young doctors should learn: ① When encountering a locally advanced patient, we should learn to give the patient an individualized and appropriate treatment plan according to the principle of maximum tumor resection and maximum preservation of lung function. ②When blocking the blood vessels, the veins should be blocked first and then the arteries to prevent the spread of cancer emboli along the blood channels. ③Sleeve resection should be performed when the wall of pulmonary artery is resected more than 25% of its circumference, instead of direct suturing to prevent postoperative stenosis. Care should be taken to expel the air in the lumen of the vessel before tying the last stitch of the anastomosed vessel to prevent embolism. When loosening the blocking device, the distal end should be sent first before loosening the proximal end, and low-molecular heparin anticoagulation should be given for one week after surgery to prevent thrombus formation at the anastomosis. ④In fact, there are also many small details worth noting when sleeve resection of bronchus: how to cut and how to sew have many skills worth learning. Due to the limited space, we will learn slowly later.