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Objective To investigate the results and effects of freezing phrenic nerves for the patients of pulmonary lobectomy.To optimize the best freezing time by studying the effects of different time at-65 ℃.Methods 50 patients of pulmonary lobectomy were randomly entered into 5 groups,including control group,30 seconds group,60 seconds group,90 seconds group,120 seconds group.After operation,the patients' cardiotach,blood pressure,SaO2,breath rate,time period of pulling out drainage tube and VAS about referred pain of scapular region were noted.After pulling out the intrathoracic drain tube,the routine chest normal X ray film and chest ultrasonic inspection were processed and the post-operation remnant cavity were observed.The chest normal fluoroscopy was inspected in 90 days after operation in order to observe the motion information of trouble side diaphragmatic muscle.Results The chest fluid [first day (329±178) ml,(345±150)ml,(268±51) ml,(227±36) ml,second day (251±131) ml,(269±112) ml,(208±61) ml,(158±110) ml,time of pulling out intrathoracic drain tube (5.8±1.75) days,(4.6±1.77) days,(3.9±0.74) days,(3.6±1.07) days] and VAS [(3.6±2.9) scores,(2.2±2.4) scores,(1.0±1.3) scores,(0.7±1.2) scores] about referred pain of scapular region of freezing groups were obviously lower than those in the control group [(375±136) ml,(309±132) ml,(5.7±2.36) days,(4.0±3.3) scores].90 s and 120 s freezing groups were lower than that of 30 s and 60 s groups,andthe 90 s freezing group did not significantly different from the 120 s group.The heart rate,blood pressure,saturation of blood oxygen and breathing rate of each group also had no difference.The remnant cavity sizes were larger in the control group (＞200 ml),they also had more fluidity (＞200 ml),and one case had been taken punctuation.The remnant cavity sizes of freezing groups were small and didn' t need special treatment.The diaphragmatic muscle' s movement of each group were fine after 3 months of operation.Conclusion The freezing phrenic nerves can effectively reduce the chest fluid,the post-operation remnant cavity and the time of pulling out intrathoracic drain tube.The freezing phrenic nerves can reduce the pain of referred pain of scapular region.The best freezing time should be 90 s.The freezing phrenic nerves do not influence the respiration function,and should be advantages of for the clinic researches and applications.
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Objective To analyze the different risks of cardia neoplasms in the immediate relatives of the cardia cancer patients,through a case-control study.Methods A case-control study was adopted on 772 cases and 772 controls,and relative risk (RR) were measured to compare the results from patemal or matrilineal groups.Results (1)Risk of the 1st grade kinship to the male cardia-cancer-patient group was obviously higher than that of the control group with RR=2.61 (95％CI:1.44-4.73,P＜0.01).(2) The risks of both paternal (P＜0.05) and matrilineal (P＜0.05) in the male cardia-cancer-patients were obviously higher than that of the control groups while the risk of those male cardia-cancer-patients in the paternal was higher than that of the control group (P＜0.05),so as the case for female patients in the matrilineal group (P＜0.05).(3) Data from the 1st grade kinship of cardia-cancer-patient group showed that parents and siblings had a higher risk than the control group (P＜0.05).(4) No significant genetic differences were found between the patemal of either the cancer group or the control group (P＞ 0.05),but statistical difference was observed that the risk of someone being the matrilineal of the cancer group was higher than that of the control group (P＜0.05).Conclusion The risks of cardia-cancer were higher in the 1st grade kinship,which including parents,brothers,sisters,maternal grandmother,mother,and maternal aunt.It was suggested that prevention programs should be focused on both earlier detection and treatment of the patients.New strategy for cancer prevention also need to be further developed.
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Objective To explore the relationship between esophagus cancer patients and both environmental and genetic factors,through analyzing the data on birth orders from esophagus cancer patients of Shanxi province.Methods Both Greenwood and Haldane methods on birth order were used to study the 1101 cases with esophagus cancer from Shanxi province.All the patients had received surgery and were diagnosed,by pathological evidence.First certificates of the patients were confirmed through the standard genetic epidemiologic investigation.Birth order was investigated on probands of the 1101 cases with esophagus cancer and their 44 siblings.Results Results form the Greenwood method showed that there was a tendency for cases with esophagus cancer in birth orders First to Third.However,the Haldane method showed that the results were quite different between actual value and the average theory value of 6A (6A(actual value)=17 118,(X)6A(average theory value) =19 290,X=∣6A-(X)6A∣/√V6A =7.63,X ＞ 2) which suggested that the birth order had some effects on the occurrence of esophagus cancer.In addition,the actual value of 6A was lower than the theoretic average value,and the parents at younger productive age or baby at the first birth was easy to develop esophagus cancer.Conclusion Esophagus cancer was related with the birth order,especially at early order,which was not consistent with the national reports on esophagus cancer.Results from this study suggested that there were certain effects of environmental risk factors on esophagus cancer patients.
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Objective To explore the effect of surgical treatment of bronchioloalveolar carcinoma (BAC). Methods Data were collected from 94 patients with BAC (including 67 cases with pure bronchioloalveolar carcinoma, 16 cases with BAC by local infiltration and 11 cases with adenocarcinoma having BAC character). All patients were proved pathologically bronchioloalveolar carcinoma from January 1989 to December 2003. Clinical features, characteristics of radiology, methods of treatment and survival status were studied retrospectively. Surgical treatment and efficacy approaches according to different TNM stages and clinical patterns were also analyzed. Results Ninety-eight patients underwent complete resection and 4 underwent palliative operation and 2 underwent exploratory thoractomy. The 1-, 3-, 5-year survival rates were 75.5 %, 53.2 %, 41.5 %. According to international staging system of lung cancer, there were marked difference in stage Ⅰ group, stage Ⅱ group and stage Ⅲ group (P <0.01). According to pathological classification, there were marked difference in pure bronchioloalveolar carcinoma, BAC with local infiltration and adenocarcinoma having BAC character (P <0.01). Conclusion Bronchioalveoar carcinoma is a special form of lung cancer. It has its own characteristics on biology,radiology,clinic or pathology. Lobectomy is performed commonly in patients with bronchioloalveolar carcinoma. It may be concluded that the early diagnosis, early therapy are the key points for improving the survival rate of BAC.
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Objective Studies on cardia-cancer caused by hereditary factors. Methods Case-control method was adopted,with information including name,sex,date of birth,date of death of all the Ⅰ,Ⅱ,Ⅲ relatives of the patients,diagnosis and the treatment collected. The hereditary probability of cardia cancer and the separation degree were calculated by Falconer and Li-Mentel-Gart. Results (1) Prevalence rates of cardia-cancer on relative Ⅰ,relative Ⅱ,relative Ⅲ of cardia-cancer patients appeared to be 0.54%,0.04%,and 0.05% respectively. Prevalence rates of upper-digestive-tract-cancer of relative Ⅰ,relative Ⅱ,relative Ⅲ of cardia-cancer patients showed as: 2.50%,0.36% and 0.13% respectively. Data showed that relative Ⅰ> relative Ⅱ> relative Ⅲ and family cluster existed in both males and females. (2) Cardia-cancer hereditary probability of the relative Ⅰ cardia-cancer probands was 11.71%,with males as 14.01% and females as 14.72%. The upper-digestive-tract-cancer hereditary probability of the relative Ⅰ cardia-cancer probands was 13.87%,with males as 11.49% and females as 23.08%,both below 25%,indicating this was a low hereditary cancer. (3) The upper-digestive-tract-cancer separation of the blood compatriots of cardia-cancer patients was 0.0452,with males as 0.0441 and females as 0.0507,both below 0.25,indicating the nature of a multi-gene but not single-gene hereditary way. Conclusion Hereditary factor is recognized as one of the high risk cardia cancer,but not the most risky factor causing the high morbidity of cardia cancer in Shanxi province.
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Objective In order to provide new clues on the cause of esophagus-cancer through seeking for information among the relatives of esophagus-cancer-patients at high-risk,contrast analysis was carried out to compare the ORs between esophagus-cancer cases and the relatives of the patients.Methods Case-control study was adopted on 720 cases and 720 controls who were kin relatives of the patients.Results (1) Risk of the relatives to the esophagus-cancer-patient group ( 1.34%-2.24% ) was obviously higher than the control group (0.78%-1.21%) (P＜0.01).In 1st grade relatives,the risk of parent' s to the esophagus-cancer patients (6.11% ) was obviously higher than the control group (2.97%) (P＜0.01 ).(2) According to the cascade analysis to the cases of both paternal and matriarchal,lines,results showed that the risks of both the paternal line (0.87%-1.01%) and the matriarchal line (0.50%-0.79%) in the group of esophagus-cancer cases were all obviously higher than the lines in the control groups (0.53%-0.65%) and (0.38%-0.47%).Data also showed that the risk among the male relatives of paternal line (eg:grandfathers',father' s,uncles' etc.) in the group of cases was 2.68% while the matriarchal (eg:grandmother's,mother' s,aunts' etc.) was 1.91%.Both figures were obviously higher than that in the control group (1.50% and 0.92%,P＜0.01 ).Conclusion The risk factor of esophagus cancer of the next generation seemed higher if the father and his brothers or mother and her sisters having had esophagus-cancers.
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Objective To explore the influence of some factors on long-term survival of postoperative stage Ⅰ NSCLC patients. Methods 91 patients of NSCLC who underwent radical surgery of the primary tumor with dissection of the hilar and mediastinal lymph nodes were diagnosed as stage Ⅰ NSCLC postoperatively by pathology and followed up for 5 years. Its hilar and subcarinal lymph nodes were detected occult micrometastastic tumor cells by immunohistochemistry (SP method) by using the binoclonal antibody multicytokeratin (AE1/AE3) as a micrometastatic marker. To analyse the influence of micrometastasis and the clinicopathologic characteristics on long-term survivals. Results The rate of micromatastasis of stage Ⅰ NSCLC was 49 %. The five-year overall survival rate was 70.3 %. The median of survival time was 48.5months. The rate of metastasis was 32 % and the meantime of relapse and metastasis was 36.6months. Tumor size, differentiation, stage, and micrometastasis were significantly associated with relapse and metastasis (P <0.05). The tumor differentiation, stage, and micrometastasis were found to be significant independent factor on survival in multivariate analysis (P<0.05). Conclusion There was nodal micrometastasis in completely resected stage Ⅰ NSCLC, and the tumor differentiation, stage, and micrometastasis were found to be significant independent factor on survival.
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Objective To detect the nodal occult micrometastasis in stage Ⅰ non-small-cell lung cancer(NSCLC),and further investigate the main factor of affecting the nodal occult micrometastasis and the rule of micrometastasis in stage Ⅰ NSCLC. Methods Occult micrometastatic tumor cells by in hilar and subcarinal lymph nodes(LN)were detected immunohistochemistry (SP method),which were removed from 91patients with completely resected stage Ⅰ NSCLC.The monoclonal antibody muhicytokeratin(MCK)was used as a micrometastatic marker.Another 45 hilar LN removed from benign pulmonary lesion patients and 45 hilar LN removed from Ⅱ and Ⅲ stage NSCLC were detected, respectively by conventional histopathologic examination as negative and positive control.Results Micrometastasis was detected in all lymph nodes that were removed from stageⅡand Ⅲ NSCLC.but no one was detected in lymph nodes that were removed from benign pulmonary lesion patients.There were 45 positive cases in 91 patients.The rate of micrometastasis in stage Ⅰ NSCLC was 49%(45/91).among them 39 subcarinal lymph nodes and 11 hilar lymph nodes were detected as positive,5 cases were detected as positive both in subcrinal and hilar lymph nodes.Logistic regression analysis indicated that tumor size,stage and differentiation affected micrometastasis significantly,odd ratios(OR) were 8.444,6.946 and 14.566 respectively.The multivariate analysis indicated that cell difierentiation and T stage may be the adverse factors for nodal micrometastasis,odd ratios(OR)were 7.028and 14.509 respectively.Conclusion There is nodal micrometastasis in completely resected stage Ⅰ NSCLC patients.The micrometastasis frequency of stage ⅠB is significantly higher than stage ⅠA;It is necessary for stage ⅠB NSCLC to be given chemotherapy after operation;cell differentiation and T stage may be the adverse factors for nodal micrometastasis.The method of lymph node micrometastasis is from hilum to mediastinum.The skip micrometastasis may be taken place in adenocarcinoma.
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Objective To analyze the clinical diagnosis and therapeutic effect of primary middle lobe lung cancer,in order to provide evidence for clinical diagnosis and treatment.Methods The clinical data of 45 cases of primary middle lobe lung cancer treated by surgery from January 2002 to January 2007 were ana- lyzed retrospectively.The operation style includes:simple middle lobectomy 12 cases(26.7 %),middle or up- per lobectomy 10 cases(22.2 %),right lung total resection 5 cases(11.1%).Chest exploration was done on 2 cases(4.44 %),palliative resection or vedged resection 2 cases(4.44 %).Results 1 case died from lung in- fection and respiratory failure(2.22 %).15 cases with arrhythmia (33.3 %), 1 case with chylothorax were cured after conservative treatment.The survival rate of 1,3,5 year were 82.1%,64.3 %,32.1% respectively. Conclusion The treatment of primary middle lobe lung cancer is dominated by regular lobectomy. It is difficult to perform middle lobectomy,so double or total lobectomy is done generally.Owing to the more postoperative complications, it should be cautious to perform sleeve resection.It should be avoided to do vedged resection for primary middle lobe lung cancer in order to lessen local recurrence.
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Objective To review the surgical experience of intrapericardial pneumonectomy for Ⅲ stage lung cancer. Methods 35 patients with Ⅲ stage lung cancer received intrapericardial pneumonectomy from January 1990 to December 2000. Results None of the patients was operative death. The side effect rate was 34.3 %. 1, 3, and 5 years survival rate were 75.2 %, 35.8 %, 21.3 % respectively. Conclusion Intrapericardial pneumonectomy can increase obiousiy resect rate of Ⅲ stage lung cancer which is a kind of safe and dependable surgical operation. It can prolong the life and improve the quality of life. [