Application of total mesoesophageal excision combined with sanye lymph node dissection in radical resection of esophageal carcinoma under thoracoscopy and laparoscopy / 中国综合临床

Objective To evaluate the clinical efficacy of total mesoesophageal excision and sanye lymph node dissection in the radical resection of esophageal carcinoma under thoracoscopy and laparoscopy,and to investigate its safety and feasibility, and to find a more reasonable and effective surgical treatment of esophageal carcinoma. Methods One hundred and twenty-six cases of esophageal cancer who underwent the minimally invasive surgery under thoracoscopy and laparoscopy for esophageal cancer in Central Hospital of Hengyang from October 2015 to September 2017 were retrospectively analyzed. Among them,Sixty-four patients accepted total mesoesophageal excision and sanye lymph node dissection under thoracoscopy and laparoscopy (observation group ), Sixty-two cases accepted with conventional esophagectomy under thoracoscopy and laparoscopy ( control group) . The operation time, blood loss, indwelling time of thoracic drainage tube, postoperative drainage volume,postoperative hospitalization time,number of lymph node dissection,lymph node metastasis degree,perioperative complications of the two groups were analyzed and compared. The number of lymph node dissection and lymph node metastasis degree in different regions were compared between the two groups. The number of recurrence and death were recorded in the two groups. Results Compared with the control group,the operation time was longer in the observation group((264. 9±32. 9) min vs. (233. 5±30. 4) min,t= -5. 56,P<0. 001),but blood loss was less((152. 7±26. 4) ml vs. (235. 5± 30. 6) ml,t = 16. 27,P<0. 001). There was no significant difference in the indwelling time of thoracic drainage tube, postoperative drainage volume or postoperative hospitalization time between the two groups (P>0. 05). The number of lymph nodes in the observation group was significantly higher than that in the control group ((32. 7±15. 5) pieces vs. (20. 9±11. 2) pieces,t = - 4. 93,P< 0. 001),and lymph node metastasis degree in the observation group was smaller than that of the control group ( 6. 7% vs. 9. 3%, χ2 = 7. 22, P < 0. 01) . There were no significant differences in perioperative complications such as pulmonary complications, arrhythmia, anastomotic fistula, chylothorax,hemorrhage,recurrent laryngeal nerve injury,tracheal injury and perioperative death (P>0. 05). Left and right recurrent laryngeal nerve,thoracic esophagus,celiac artery lymph node dissection of the number of observation group was higher than that of the control group ((4. 7 ± 3. 2) pieces vs. (1. 5 ± 1. 4) pieces, t= -7. 25;(6. 0±2. 7) pieces vs. (3. 1±1. 7) pieces,t = -7. 12;(5. 7± 2. 4) pieces vs. (3. 2± 1. 9) pieces,t= -6. 48;P<0. 001). Left and right recurrent laryngeal nerve,thoracic esophagus lymph node metastasis degree in the observation group was smaller than that in the control group (8. 7%(26/ 300) vs. 18. 1%(17/ 94),χ2= 6. 53;8. 9%(34/ 382) vs. 17. 9%(35/ 195),χ2 = 10. 04;P<0. 05) . There were no significant differences in the recurrence rate of tumor recurrence at 1 and 24 months after operation in the observation group and the control group(3 cases(4. 7%) vs. 4 cases(6. 5%),χ2 = 0. 92,P > 0. 05) . There were no deaths in the two groups. Conclusion Total mesoesophageal excision and three-field lymph node dissection in radical resection of esophageal carcinoma under thoracoscopy and laparoscopy is safe and feasible,the recent effect does not increase the surgical complications, but its long-term effect need a lot of long-term follow-up. A relatively thorough cleaning of the esophageal mesentery and its lymph nodes can minimize the tumor in the subendothelial micrometastasis,and is beneficial for the prognosis of patients with esophageal cancer.

Clinical analysis of minimally invasive surgery under thoracoscopy and laparoscopy in the treatment of esophageal cancer / 中国综合临床

Objective To analyze the feasibility and clinical effect of thoracoscopy and laparoscopy minimally invasive surgery in the treatment of esophageal cancer.Methods Eighty-six cases patients with esophageal cancer who were underwent the minimally invasive surgery under thoracoscopy and laparoscopy for esophageal cancer in the Central Hospital of Hengyang from August 2014 to February 2016 were retrospectively analyzed.Operation time,bleeding volume,indwelling time of thoracic drainage tube,length of stay,number of lymph node dissection,postoperative complications and so on were recorded.Results All patients were successfully completed surgery,no intraoperative death and intraoperative massive hemorrhage.Operation time was 270-380 min,the amount of bleeding during the operation was 50-550 ml.Chest drainage tube was removed from 3 to 10 d after operation.The number of lymph node dissected was 10-19.Lymph node metastasis was found in 13 cases.Postoperative cervical anastomotic fistula in 6(7.0%) cases,hoarseness in 8(9.3%) cases,7(8.1%) cases of pulmonary infection,and 1(1.2%) case of chylothorax,all were cured after conservative treatment.Postoperative hospital stay was 9-20 d.The patients were followed up for 3 to 21 months,1 case had lymph node metastasis in 10 months after surgery,and the other patients had no recurrence,metastasis or death.Conclusion Minimally invasive surgery under thoracoscopy and laparoscopy for esophageal cancer is safe and feasible,clinical effect is satisfied,it is worthy of further clinical application.

Culture of dendritic cells in vitro and its anti-tumor immunotherapy / 中国肺癌杂志

<p><b>BACKGROUND AND OBJECTIVE</b>Immunocompromised patients with malignant tumor always lack of strong anti-tumor immune response, because the antigenicity of tumor cells is weak, and antigen-presenting cell function is low, so that can not be effectively presenting tumor antigens to the lymphocytes. Therefore, how to effectively induce anti-tumor immune response is the key issue. Through the study on establishing a method to culture dendritic cells (DC) in vitro and to observe the anti-lung cancer immunological effect induced by DC, we provided definite experiment basis for the clinic application of vaccine based on DC.</p><p><b>METHODS</b>Through the experiment we get the soluble antigen polypeptide from lung cancer cells GLC-82 by 3 mol/L potassium chloride. DCs are cultured and obtained from peripheral blood mononuclear cell by GM-CSF, IL-4 and TNF-a. DCs are identified by flow cytometer (FCM) and immunostaining. DCs modified by lung cancer tumor soluble antigen (TSA) and staphylococcal enterotox in A (SEA), DCs modified by TSA or DCs modified by SEA or DCs modified by nothing were cultivated together with T lymphocyte, and the obtained cells are named TSA-SEA-DCL or TSA-DCL or SEA-DCL or DCL as effector cells. The anti-tumor activity of every effector cells against target cells was assayed with MT method. Shape of DCs and effector cells, and the process of killing target cells were observed in microscope.</p><p><b>RESULTS</b>Induced DCs expressed more CD1a, CD80 and HLA-DR, which had typical cell traits such as tree branch. The killing ratio of the TSA-SEA-DCL in vitro to GLC-82 is larger than TSA-DCL, SEA-DCL and DCL, also larger than to K562. When the effector cells cultivate with target cells, we can observe the CTL approach and gather to the cancer cell, induce it necrosis and apoptosis.</p><p><b>CONCLUSION</b>Ripe DCs that have typical characteristic and phenotype could be induced successfully. High potency and relatively specific antilung caner effect can be prepared in virtue ofDC Bacterin Induced by lung caner TSA and SEA.</p>

Treatment of Lung Cancer by Regulating Dendrite Cells / 国际中医中药杂志

The dendrite cells are important in treating lung cancer.Through the integrated treatment of traditional Chinese medicine and chemotherapy and radiotherapy,good results have been achieved in increasing the function of dendrite cells and enhancing immunity.The integrated Traditional Chinese and Western Medicine has good prospects in improving dendrite cells and so thus treating lung cancer.