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@#Extracorporeal membrane oxygenation (ECMO), as an extracorporeal life support technology, can provide respiratory support and hemodynamic support according to different modes. The significant advantages of ECMO in the treatment of acute respiratory distress syndrome and the development of its oxygenator, pump, and heparin-coated circuits have promoted its application and exploration in thoracic surgery. ECMO can be used during the perioperative period of lung transplantation and can be applied for patients who cannot maintain one-lung ventilation, or have a high risk of anesthesia, or undergo complex thoracic surgery involving trachea, carina, mediastinum and esophagus. This article will review the application and progress of ECMO in general thoracic surgery.
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Objective To study l-arginine aerosolized inhalation's protective effect on pulmonary ventilation of the pulmonary-arterial-hypertension patients during the early stage after pulmonary lobectomy,and its preventive effect on reducing postoperative complications.Methods 54 cases of pulmonary lobectomy patients with preoperative plumonary arterial hypertension were divided into two groups randomly-Group A was given L-arginine aerosolized inhalation within 4 h after the operation;Group B was given the same dose of aerosolized inhalation of physiological saline as contrast(other postoperative medication being the same with Group A).Compare the two groups of patients in terms of oxygenation index(PaO2/FiO2),alveolararterial oxygen difference(PA-aO2),nitric oxide(NO) concentration,ultrasonic cardiogram,mechanical ventilation duration,ICU duration,occurances of hemodvnamic disturbance and arrhythmia,and differences in postoperative hospital stay.Results The oxgenation index and the content of NO in plasma of Group A were higher than that of Group B(P ＜0.001);the alveolar-arterial oxygen difference and the postoperative pulmonary arterial pressure detected by UCG of Group A were lower than that of Group B(P ＜ 0.001);the postoperative mechanical ventilation duration,ICU duration,occurances of hemodynamic disturbance and arrhythmia of Group A were all lower than that of Croup B(P ＜ 0.05).Conclusion The postoperative l-arginine aerosolized inhalation during the early stage after pulmonary lobectomy has positive effect on the lung protection of the pulmonary-arterial-hypertension patients and it can reduce the perioperative complications and postoperative hospital stay of such patients.
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The lung is the second most common site of neuroendocrine tumors (NETs). Typical and atypical carcinoids are low-grade NETs of the lung. These rare tumors have received little attention and education is needed for treating physicians. The article describes the classifcation of lung NETs, the epidemiology and pathological characteristics. When lung NETs are diagnosed at an early stage, surgical intervention is often curative. For advanced lung NETs patients, different treatment methods including chemotherapy, somatostatin analogs, m-TOR inhibition, peptide receptor radioligand therapy, and biologic systemic therapy are discussed. The conclusions are generally extrapolated from the outcome of extra-pulmonary carcinoids. Prospective randomized well-designed trials are urgently needed to inform current recommendations on systemic treatment. .
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Humans , Disease-Free Survival , Drug Therapy , Methods , Lung , Radiation Effects , General Surgery , Lung Neoplasms , Pathology , General Surgery , Therapeutics , Neoplasm Grading , Neuroendocrine Tumors , Pathology , General Surgery , Therapeutics , Outcome Assessment, Health Care , Radiotherapy , MethodsABSTRACT
Objective The mechanism of the lymph node metastasis in lung adenocarcinoma is unknown.The characteristic of the N1 and N2 lymph nodes metastasis are different.We explore the relationship between the N1 lymph node metastasis and clinicopathological factors in lung adenocarcinoma patients.Methods Data of 126 patients who had received lobectomy and systematic lymph node dissection were retrospectively analyzed.Chi-square test and Fisher exact method was used in univariate analysis,logistic regression was performed to analyze the multivariate analysis.Critical value was calculate in ROC.All the methods executed in software SPSS 19.0.Results After analyzed the N1 lymph node metastasis and clinicopathological factors,sex (P =0.016),diameter of tumor (P =0.001),pleural invasion (P =0.008),micropapillary pattern (P =0.028),solid pattern (P =0.047) has statistical significance in univariate analysis.Logistic regression analysis reveal diameter of tumor,micropapillary pattern and solid pattern were independent risk factors for N1 lymph nodes.CEA level (P =0.004),cancer embolus (P =0.029),micropapillary pattern (P =0.018),affect the groups (number of metastasis station) of the metastasis lymph nodes.Logistic regression analysis find CEA and micropapillary pattern were independent risk factors,which might lead multiple groups lymph nodes metastasis.There is only one factor could impact the location of the N1 lymph node metastasis,which is micropapillary pattern (P =0.027).Conclusion Via ROC results,there are three factors affect the N1 lymph nodes metastasis:purity of micropapillary pattern more than 27.5％,purity of solid pattern more than 15％,diameter of tumor larger than 3.0 cm.If a lung adenocarcinoma patient who was in early stage has one or more than one factors,we suggest chemotherapy followed the surgery.Higher CEA level or higher content of micropapillary pattern much more groups lymph nodes metastasis might appear,so radiotherapy and other method should be considered to added on.High content of micropapillary pattern maybe imply cancer cell has already invaded extra pulmonary lymph nodes.
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Objective The mechanism of the lymph node metastasis in lung adenocarcinoma is unknown.The characteristic of the N1 and N2 lymph nodes metastasis are different.We explore the relationship between the N1 lymph node metastasis and clinicopathological factors in lung adenocarcinoma patients.Methods Data of 126 patients who had received lobectomy and systematic lymph node dissection were retrospectively analyzed.Chi-square test and Fisher exact method was used in univariate analysis,logistic regression was performed to analyze the multivariate analysis.Critical value was calculate in ROC.All the methods executed in software SPSS 19.0.Results After analyzed the N1 lymph node metastasis and clinicopathological factors,sex (P =0.016),diameter of tumor (P =0.001),pleural invasion (P =0.008),micropapillary pattern (P =0.028),solid pattern (P =0.047) has statistical significance in univariate analysis.Logistic regression analysis reveal diameter of tumor,micropapillary pattern and solid pattern were independent risk factors for N1 lymph nodes.CEA level (P =0.004),cancer embolus (P =0.029),micropapillary pattern (P =0.018),affect the groups (number of metastasis station) of the metastasis lymph nodes.Logistic regression analysis find CEA and micropapillary pattern were independent risk factors,which might lead multiple groups lymph nodes metastasis.There is only one factor could impact the location of the N1 lymph node metastasis,which is micropapillary pattern (P =0.027).Conclusion Via ROC results,there are three factors affect the N1 lymph nodes metastasis:purity of micropapillary pattern more than 27.5％,purity of solid pattern more than 15％,diameter of tumor larger than 3.0 cm.If a lung adenocarcinoma patient who was in early stage has one or more than one factors,we suggest chemotherapy followed the surgery.Higher CEA level or higher content of micropapillary pattern much more groups lymph nodes metastasis might appear,so radiotherapy and other method should be considered to added on.High content of micropapillary pattern maybe imply cancer cell has already invaded extra pulmonary lymph nodes.
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Objective To compare the clinical effects between uniportal video-assisted thoracic surgery (VATS) and 3-portal VATS lobectomy for patients with lung cancer. Methods Patients were divided into uniportal VATS lobectomy group (n=45) and 3-portal VATS lobectomy group (n=53). The clinical data were compared between two groups, including the oper-ation time, intraoperative blood loss, number of lymph node dissection, length of incision, postoperative extubation time, post-operative pain score and postoperative hospitalization. Results There were no significant differences in intraoperative blood lose (128.75±18.32) mL vs (129.15±17.69) mL, lymph node dissection number (13.33±1.05) vs (13.12±1.38), duration of chest drainage (4.90±0.75)d vs (4.75±0.70)d, duration of hospital stay (7.52±1.16)d vs (7.55±1.10)d and incidence of seri-ous postoperative complications between two groups (P>0.05). The incision length (5.36±0.22)cm vs (7.44±0.35)cm, numeric pain intensity scale including first day(6.47±0.54) vs (6.86±0.52),third day(3.59±0.29) vs (4.05±0.25), and patient satisfac-tion scores (91.03 ± 2.62) vs (88.35 ± 2.97) were significantly better in uniportal VATS group than those of 3-portal VATS group (P<0.05). The operation time (143.81±17.97) min vs(130.11±15.03)min was longer in uniportal VATS group than that of 3-portal VATS group (P < 0.05). Conclusion Uniportal VATS lobectomy is safe and reliable for patients with early-stage lung cancer, which has less surgical injury, slighter pain, and higher satisfaction than 3-portal VATS lobectomy.
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Objective To investigate the expression levels and clinical significance of (forkhead box Q1) FOXQ1 and E-cadherin in esophageal squamous cell carcinoma (ESCC). Methods Expression levels of FOXQ1 and E-cadherin were in ESCC tissues (ESCC group, n=42) and adjacent normal esophageal tissues (control group, n=42) were detected using im?munohistochemistry. Correlations of FOXQ1 and E-cadherin expressions with clinical pathological parameters and progno?sis were analyzed between two groups. Results The expression level of FOXQ1 was significantly higher in ESCC group than that in control group(64.29% vs 28.57%,χ2=5.384,P<0.05). The expression level of E-cadherin was significantly lower in ESCC group than that incontrol group(52.38%vs 90.48%,χ2=7.691,P<0.05). There were significant differences in FOXQ1 expressions between different TNM stages and whether lymph node metastasis is involved within ESCC group. There were significant differences in expression of E-cadherin between different tumor differentiation, depth of invasion, TNM stage and whether lymph node metastasis is involved within ESCC group. The expression of FOXQ1 was negatively cor?related with E-cadherin in ESCC (r=-0.412, P<0.05). The 5-year survival rates were significantly lower with high expres?sion of FOXQ1 or with low expression of FOXQ1(18.52%vs 66.67%,χ2=9.737,P<0.05). The 5-year survival rates were significantly higher with high expression of E-cadherinor low expression of E-cadherin(59.09%vs 10.00%,χ2=10.996,P<0.05). A multivariate Cox's proportional hazard regression analysis indicated that high FOXQ1 expression, low E-cadherin expression and lymph node metastasis were independent prognostic factors for ESCC. Conclusion The expression of FOXQ1 and E-cadherin showed a good correlation with ESCC. And examining expressions of both FOXQ1 and E-cadherin in ESCC may have practical values in estimating the prognosis of ESCC and directing future treatment .
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Objective To evaluate the effect of curing achalasia by transabdominally Heller-Dor operation. Methods To summarize 33 cases of achalasia treated by transabdominally Heller-Dor procedure and visit them postoperatvely. 18 patients receive pre- and post-operativemanometry and 24-hour-pH monitoring. The parameters including reflux frequency 、the longest lasting-time of reflux 、the total time(min) of pH ＜4.0 and the percentage( % ) of time of pH ＜4.0 were recorded and compared using statistical mothods. Results Symptom was significantly improved in 32 patients after surgery, while 1 patient remained dysphasia as pre-operative. The LESP, the reflux frequency、the longest lasting-time of reflux 、the total time(min) of pH ＜ 4.0 and the percentage ( % ) of time of pH ＜ 4.0 also declined after operations ( P ＜ 0. 05 ). 30 patients were followed up,22 (73.3% ,22/30) were cured and 8 had mild sypmtom. Reflux did not detected in 3 cases( 16.7% ,3/18 ) with preoperative reflux. Conclusion Transabdominally Heller-Dor operation could dramadically alleviate the symptoms of patients with achalasia, moreover, it could especially prevent the postoperative-reflux, and with the advantages of simple operations, little traumas.
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<p><b>BACKGROUND</b>To explore the perioperative changes of T subsets and NK cell and analyze the related factors in patients with lung cancer.</p><p><b>METHODS</b>The T subsets and NK cell from peripheral blood of 60 patients with lung cancer, 15 patients with lung benign tumor and 15 healthy people were detected by immunofluorescence. These indexes of the patients with lung cancer were detected also at postoperative 2nd, 7th, 14th and 28th days.</p><p><b>RESULTS</b>1.There were significant differences in the indexes between the lung cancer group and the groups of lung benign tumor and normal people except for CD8+ (P < 0.05). 2.At postoperative 2nd day CD3+, CD4+, CD4+/CD8+ and NK cell of the patients with lung cancer were decreased and CD8+ was increased significantly than those before operation (P < 0.05). During postoperative 1 to 2 weeks, all indexes had recovered basically to the preoperative level. At postoperative 28th day, CD3+, CD4+ , CD4+/CD8+ and NK cell were increased and CD8+ was decreased than those before operation (P < 0.05). 3. There was significant difference in the indexes among preoperative stage IIIA, IIIB and IB, and between preoperative N2 diseases and N0 group (P < 0.05). There was significant difference between the groups of radical and palliative operation and the group of thoracic exploration at postoperative 28th day (P < 0.05). There was significant difference in T subsets between the groups of blood transfusion and non-transfusion at postoperative 14th day (P < 0.05).</p><p><b>CONCLUSIONS</b>The cellular immune function of the patients with lung cancer was lower than that of the patients with lung benign tumor and normal people. The perioperative immunity of patients with lung cancer decreases after operation and increases later. TNM stage and lymph node metastasis are relative to preoperative but not postoperative immunity. There is no significant correlation between cellular immune function and pathological type of the tumor. Radical and palliative operations can both significantly increase the patients' cellular immune function. Therefore the palliative operation is better than thoracic exploration. Blood transfusion can depress the immune function of the patients, so it is better to avoid perioperative blood transfusion.</p>
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<p><b>OBJECTIVE</b>To investigate the value of mediastinoscopy in diagnosis of the thoracic diseases and the determination of the operative indication.</p><p><b>METHODS</b>From 1979 to 2000, 165 patients were given mediastinoscopy by local infiltration anesthesia (rare cases with additional vein bacic anesthesia). The exploration and biopsy were given to the neoplasms and lymph nodes around the trachea through the pretracheal interstice.</p><p><b>RESULTS</b>The diagnosis of 125 patients by mediastinoscopy accorded with the pathological diagnosis and that of 21 patients was not accorded with the pathology. The rate of definitive diagnosis was 85.6% (125/146). The other 19 cases were not included into the ground because 11 cases were not given definitive diagnosis and 8 cases with lung cancer were not be performed operation although the results of mediastinoscopy were negative. Twenty patients with lung cancer which had metastasis in the mediastium and 7 patients with malignant lymphadenoma avoided exploratory thoracotomy.</p><p><b>CONCLUSION</b>The mediastinoscopy is a effective examinative method to the disease involving the lymph nodes in the mediastinum and the thoracic disease closing on the mediastinum. The mediastinoscopy in appropriate especially to the simple enlargement of lymph node in the mediastinum that is not given definitive diagnosis. The cases with lung cancer accompanied enlargement of lymph node in the mediastinum and that with tumors in the mediastinum may choose the mediastinoscopy.</p>