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@#Objective To evaluate the safety and application value of three-dimensional reconstruction for localization of pulmonary nodules in thoracoscopic lung wedge resection. Methods The clinical data of 96 patients undergoing thoracoscopic lung wedge resection in our hospital from January 2019 to August 2020 were retrospectively reviewed and analyzed, including 30 males and 66 females with an average age of 57.62±12.13 years. The patients were divided into two groups, including a three-dimensional reconstruction guided group (n=45) and a CT guided Hook-wire group (n=51). The perioperative data of the two groups were compared. Results All operations were performed successfully. There was no statistically significant difference between the two groups in the failure rate of localization (4.44% vs. 5.88%, P=0.633), operation time [15 (12, 19) min vs. 15 (13, 17) min, P=0.956], blood loss [16 (10, 20) mL vs. 15 (10, 19) mL, P=0.348], chest tube placement time [2 (2, 2) d vs. 2 (2, 2) d, P=0.841], resection margin width [2 (2, 2) cm vs. 2 (2, 2) cm, P=0.272] or TNM stage (P=0.158). The complications of CT guided Hook-wire group included pneumothorax in 2 patients, hemothorax in 2 patients and dislodgement in 4 patients. There was no complication related to puncture localization in the three-dimensional reconstruction guided group. Conclusion Based on three-dimensional reconstruction, the pulmonary nodule is accurately located. The complication rate is low, and it has good clinical application value.
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@#（正）食管癌是我国高发的消化道恶性肿瘤，目前食管癌的治疗仍然以手术方式为主，化疗、放疗等方法为辅[1]。食管癌手术切除术式经过多年的演变，从开放左胸一切口、二切口，发展到开放右侧进胸二切口、三切口。随着高清晰度胸腔镜、高科技内镜手术器械和先进麻醉技术的应用，微创食管切除手术技术得到迅猛的发展并趋于成熟。胸腔镜手术具有创伤小、恢复快等优势，已经在胸外科手术中得到了充分肯定[2-3]。本视频旨在展示胸腹腔镜联合食管癌手术的手术入路和操作要点。
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Objective to investigate the clinical effect of negative pressure suction by double caping pipe on cervical esophagus fistula after esophageal carcinoma surgery,and search for the effective treatment of cervical anastomotic fistula after esophageal carcinoma surgery.Methods The clinical data of 140 patients with cervical esophagus fistula after esophageal carcinoma surgery in Nanjing General Hospital of Nanjing Command from September 2004 to September 2015 were retrospective analyzed.Among them,85 cases were treated with low negative pressure suction by double caping pipe as experimental group,55 cases were treated with conventional drainage and dressing as the control group.The length of hospital stay,healing time,dressing frequency,neck bleeding risk,anastomotic stenosis and mortality rate between two groups were analyzed and compared.Results The length of hospital stay,the time of wound healing,the frequency of wound change dressing,the rate of neck bleeding in experimental group were (15.94± 1.57)d,(8.00± 1.55)d,(6.22± 1.52)times,1.18％ respectively,significantly lower than that of control group ((23.64 ± 2.36) d,(15.64 ± 2.08) d,(27.56±3.58) times,12.24％;P=0.000,0.000,0.000,0.029).While the rate of anastomotic stenosis after half a year in experimental group was 17.65％,lower than that of the control group (23.64％),the difference was no significant(P=0.387).Conclusion The treatment on cervical esophagus fistula with low negative pressure suction by double caping pipe has superiorities on hospitalization and healing time,dressing frequency,neck bleeding risk,mortality,and does not increase the incidence of anastomotic stenosis,and it can achieve a better therapeutic effect compare with the conventional drainage and dressing.
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Objective Thoracic cavity fistula following esophagus carcinoma resection is a serious complication with a high mortality.This study aims at a better therapy for thoracic cavity fistula following esophagus carcinoma resection by summarizing the ex-perience with the four-tube strategy ( jejunal fistula tube, stomach tube, chest drainage tube, and nasal fistula tube) in the treatment of the complication. Methods We retrospectively analyzed the clinical data about 62 cases of thoracic cavity fistula following esopha-gus carcinoma resection, 35 treated with the four-tube strategy ( treatment group) and the other 27 with the three-tube ( stomach tube, chest drainage tube, and nasal fistula tube) method ( control group) .We compared the hospital days, wound healing time, mortality, and incidence of anastomotic stenosis at 6 months after operation between the two groups of patients. Results Compared with the controls, the treatment group showed remarkable decreases in the hospital days (P0.05 ) . Conclusion Compared with the three-tube method, the four-tube strategy has the advantages of shorter healing time and lower mortali-ty, and therefore is preferable for the treatment of thoracic cavity fis-tula following esophagus carcinoma resection.
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Objective To evaluate the application of tubular stomach gastroesophagostomy on the life quality after esophagectomy surgery.Methods From March 2011 to September 2011,66 cases of esophageal cancer patients were divided in two groups in randomized principles.Tirty-four cases in group of tubiform gastro surgery whose the stomach was cut into tubiform stomach in width of 4 cm.And 32 cases of conventional group and whose surgery method was adopted to maintain whole stomach but cut the cardia.And then,using statistical methods,life quality after esophagectomy (treatment related symptoms,general symptoms,daily life,social life,emotional activities) and the perioperative complications were evaluated in 3,6,12,24 months in comparison and analysis.Results Sixty-six surgeries of both group patients were successfully performed,tumor resection rate was 100％,and there was no intraoperative accident also no perioperative death.There was no statistical significance of perioperative complications of 2 groups (P ＞ 0.05).Life quality of tubiform gastro group had improved apparently more than conventional group at the 3rd,6th,12th and 24th month after surgery(78.68 ±2.23 vs 65.94± 4.13,83.79 ± 2.40 vs 66.84 ± 5.86,86.41 ± 1.94 vs 67.09 ± 4.43,89.02 ± 1.71 vs 68.88 ±3.53,P＜0.05).At each time point,there were statistically significant differences between tubiform gastro group and conventional group on treatment related symptoms,general symptoms,daily life,emotion activities (P ＜0.05).At the 3rd,6th month after surgery,tubiform gastro group and the conventional group had no statistically significant difference in the aspect of social life (P＞0.05).In the conventional group,the evaluation of quality of life at each time point after surgery and before a point in time in the same group showed no statistical significance (P＞0.05).Conclusion Tubiform gastro esophagectomy has a positive influence on life quality of patients of esophageal cancer after surgery prospectively.
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other trauma.The diagnosis of blunt cardiac rupture is difficult and the mortality rate is high .The experience of rapid and accurate di-agnosis and operation on 16 cases of blunt cardiac rupture was summarized in this article . Methods The clinical data of 16 cases of blunt cardiac rupture in Nanjing General Hospital of Nanjing Military Region from July 2006 to June 2013 were retrospectively re-viewed.All of the 16 patients were diagnosed by physical examination , chest CT and cardiac ultrasound accurately in the emergency room.The treatment of emergency chest operation was conducted to repair the broken sites of heart .One case with left ventricular rup-ture was treated with emergency repair through cardiopulmonary bypass .The remaining 15 cases were repaired without cardiopulmonary bypass.Nine cases suffered rupture of right ventricle were treated with interrupted mattress sutures , 1 case suffered accompanying inju-ry of the right coronary artery was treated with emergency right coronary artery bypass grafting , 4 cases suffered rupture of right atrium were treated with direct sutures , 2 cases suffered rupture of the opening of pulmonary vein were treated with interrupted mattress su -tures.Two cases combining rupture of mitral chordae tendineae did not receive any special treatmen simultaneously and two cases combining with splenic rupture received laparotomy and splenectomy after cardiosurgery .Thoracic drainage tube , ECG monitoring , ventila-tor assisted breathing and so on were used in all patients . Results One case with left ventricular rupture died of low cardiac output after operation , the rest 15 cases recovered successfully .Two cases combining with mitral chordae tendineae received mitral valve replacement because of mitral severe insufficiency after 1 year. Conclusion Rapid and accurate diagnosis and timely and reasonable operation were the key treatments of blunt cardiac rupture .
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Objective The onset and progression of lung cancer correlate closely to individual genetic background .This study evaluated the correlation between the onset risk of lung cancer and short tandem repeat (STR) polymorphisms in order to find a new pathway for investigating the pathogenesis of lung cancer . Methods Using PCR and electrophoresis on 15 STR loci , we studied the gene and genotype frequencies of peripheral vein blood specimens from 120 lung cancer patients and 156 healthy individuals in Nan-jing area.According to the differences in the allele distribution of the 15 STR loci, we evaluated the susceptive and/or resistant factors relevant to lung cancer . Results There were statistically significant differences between the lung cancer patients and healthy controls at alleles 10, 15.2, and 16 of the loci CSF1PO, D19S433, and D3S1358 (P1), as well as at alleles 14 and 14.2 of the loci CSF1PO and D19S433 (P<0.05, OR<1). Conclusion It is possible that alleles 10, 15.2 and 16 of the loci CSF1PO, D19S433, and D3S1358 are susceptive factors and alleles 14 and 14.2 of the loci CSF1PO and D19S433 are resistant factors relevant to lung cancer .
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Objective To summary the experience of T4 esophageal carcinoma surgery and to explore the methods and operating skills on descending thoracic aortic resection with prosthetic vascular graft replacement in patients with T4 locally advanced esophageal carcinoma invading descending thoracic aorta.Methods From Jan.2001 to Dec.2010,36 patients with esophageal carcinoma underwent esophagectomy and descending aortic replacement simultaneously in our hospital.The clinical data were retrospectively reviewed.All patients had a left posterior lateral incision via the 6th intercostal space.The vascular adventitia of the descending thoracic aorta in the left side was incised,and the aorta was clamped in the proximal and distal side of the invaded segment.Then the invaded segment was resected and replaced with artificial vessels.Esophageal carcinoma was radically resceted,and left cervical esophageal-gastro anastomosis was performed in all patients.Results Radical resection of esophageal carcinoma was achieved in all patients.There was no perioperative death,or severe complications such as paraplegina,acute renal failure and intestinal dysfunction occurred.Two patients had chylous hydrothorax,and one had late stage anastomotic stoma fistula.The post-operative hospital stay was 10-42 d,mean (15.5 ± 7.2 )d.The pathological examination revealed that all the patients had squamous cell carcinoma.The aortic tunica adventitia was invaded in all the patients,9(25％ ) had tunica media invasion,and there was no tunica intima invasion observed.The 1-,3-,and 5-year survival rate was 80.6％,46.2％ and 20.0％ respectively.Conclusion Combined esophagectomy and descending aortic replacement for locally advanced T4 esophageal carcinoma invading aorta can be considered as radical operation for selected patients,and it can improve the survival rate and life quality of the patients.