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@#A 54-year-old asymptomatic man underwent a video-assisted thoracoscopic left pneumonectomy for squamous-cell carcinoma. During the surgery, a complete left pericardial defect was unexpectedly discovered, but no special intervention was made. The preoperative chest CT was reciewed, which showed the heart extended unusually to the left, but the left pericardial defect was not evident. The operation time was 204 min and the patient was discharged from hospital upon recovery 9 days after the surgery. The pathological result indicated moderately differentiated squamous-cell carcinoma (T2N1M0, stage ⅡB), and metastasis was found in the parabronchial lymph nodes (3/5). The patient did not receive chemotherapy after the surgery, and there was no signs of recurrence 6 months after the surgery. Complete pericardial defects usually do not endanger the lives of patients, and if the patient is asymptomatic, pneumonectomy is feasible.
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China is one of the countries with the highest incidence of esophageal cancer, which is still increasing year by year in recent years. Surgical treatment is the first choice for early and middle esophageal cancer. Surgeons have been exploring how to remove the tumor as completely as possible and reduce the trauma as far as possible. In recent years, with the rapid development of minimally invasive surgery and endoscopic technology, minimally invasive esophagectomy(MIE)has led the trend of radical surgery for esophageal cancer. At present, the mainstream minimally invasive surgery is thoracoscopic thoracoscopic(VATS)resection of esophageal cancer, which requires thoracotomy and anesthesia, resulting in large surgical trauma and more complications of postoperative circulatory respiratory system. Mediastinose-assisted esophagectomy(MAE), which eliminates a thoracotomy, is also an important part of MIE. Overseas MAE application started early, but the domestic development is relatively slow. This article summarizes the experience of different MAE surgical methods in China, and provides the basis for its promotion in China.
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Objective:This article explores the treatment of stage I thoracoscopic segmentectomy and lobectomy. The clinical efficacy of non-small cell lung cancer is to provide relevant evidence for clinical decision-making.Method:Computer searches were conducted on PubMed, the Cochrane Library, Embase, Web of Science, Science Direct, Ovid Medline, Scopus database, and Google Scholar. The search time was from the establishment of the library to March 2019. A comparative study of thoracic segmental resection and lobectomy for clinical stage I NSCLC was performed and meta-analysis was performed using Revman 5.3 software.Restlus:A total of 16 retrospective clinical controlled studies were included in the study, with a total of 2 090 patients, including 696 in the thoracoscopic segmental resection group and 1 394 in the thoracoscopic lobectomy group. Meta-analysis showed that for clinical stage Ⅰ NSCLC, the incidence of complications after laparoscopic resection and lobectomy( RR=0.78, 95% CI: 0.59-1.02, P=0.07), postoperative recurrence rate( RR=0.78, 95% CI: 0.52-1.17, P=0.23), postoperative hospital stay( MD=-0.27, 95% CI: -0.58 to -0.05, P=0.10) and 5-year survival rate( RR=0.94, 95% CI: 0.87-1.03, P=0.17), tumor-free survival time( RR=0.95, 95% CI: 0.92-1.09, P=0.34), operation time( MD=-0.43, 95% CI: -10.10-9.25, P=0.93) The difference was not statistically significant, but laparoscopic lung segmentectomy can reduce intraoperative blood loss( MD=-23.81, 95% CI: -42.00 to -5.63, P=0.01), shortening Posterior chest tube drainage time( MD=-0.31, 95% CI: -0.51 to -0.12, P=0.002), but in the lymph node dissection, the segmentectomy was less than the lobectomy, the number of lymph node dissection( MD=-4.89, 95% CI: -7.57 to -2.20, P=0.0004). Percentage of postoperative/preoperative FVC%( MD=7.50, 95% CI: 5.81-9.18, P<0.00001) and 1-year postoperative/preoperative FEV1%( MD=8.26, 95% CI: 6.43-10.09, P<0.00001). The difference was statistically significant. Conclusion:In The course of clinical stage I NSCLC treatment, the two procedures were similar in terms of postoperative complications, operation time, recurrence rate, 5-year survival rate, tumor-free survival time and hospital stay, and fewer lung segments in lymph node dissection. In lobectomy, thoracoscopic segmental resection is better in terms of intraoperative blood loss and postoperative chest drainage time. Thoracoscopic segmentectomy may be more suitable for early stage non-small cell lung cancer. treatment method.
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Objective:To prospectively follow up the patients with ileocecal inflammatory lesions, to explore the characteristics of Crohn′s disease(CD) at early stage, and to provide references for early diagnosis of CD.Methods:From January 2013 to December 2018, at Department of Gastroenterology, The Seventh Medical Center of PLA General Hospital, 232 patients with unexplained ileocecal inflammatory lesions under colonoscopy examination were enrolled, which were followed up for more than one year. Chi-square test and Fisher exact probability text were used to compare the patients with early CD, with non-specific enteritis and intestinal tuberculosis in abdominal symptoms (abdominal pain, diarrhea, abdominal distension, constipation, hematochezia, changes in bowel habits), accompanying symptoms (oral ulcer, arthralgia), the proportion of patients with elevated erythrocyte sedimentation rate (ESR) or elevated C-reactive protein (CRP) level, serum antineutrophilic cytoplasmic antibody (ANCA), anti-saccharomyces cerevisiae antibody (ASCA), tuberculosis infection of T cells spot test, positive rate of fecal occult blood, lesion size, morphology, involvement site under endoscopy and histopathological results. Multivariate binary logistic regression was used to analyze the related factors of early CD.Results:Among 232 patients, 155 were males and 77 were females, and the age of first diagnosis was (43.9±13.8) years old. The follow-up period (range) was 27 months (12 to 79 months). Twenty-nine cases (12.5%) were diagnosed as early CD, 45 cases (19.4%) were intestinal tuberculosis, 105 cases (45.3%) were non-specific enteritis, and 53 cases (22.8%) as undetermined. All of 29 patients with early CD had abdominal symptoms, which accounted for 16.9% (29/172) of 172 patients with ileoceccal inflammatory lesion as well as abdominal symptoms. In early CD patients, the proportions of patients with abdominal pain, elevated CRP level and ESR level, positive rate of ASCA, positive rate of tuberculosis infection T cells and percentage of patients with thickened intestinal wall were all higher than those in patients with non-specific enteritis (62.1%, 18/29 vs. 33.3%, 35/105; 13.8%, 4/29 vs. 0; 13.8%, 4/29 vs. 1.0%, 1/105; 24.1%, 7/29 vs. 1.0%, 1/105; 20.7%, 6/29 vs. 3.8%, 4/105; 95.7%, 22/23 vs. 0), and the proportion of patients without abdominal symptoms was lower than that of patients with non-specific enteritis (0 vs. 31.4%, 33/105). And the differences were statistically significant ( χ2=6.692, Fisher exact probability text, χ2=7.162, χ2=17.826, χ2=7.497, Fisher exact probability text, and Fisher exact probability text, all P<0.05). Early CD patients were more likely to have multiple lesion sites (55.2%, 16/29), and mainly deep ulcers (55.2%, 16/29) and ulcers with a long diameter of 5 to 10 mm (39.3%, 11/28). The lesions of non-specific enteritis were mostly confined to the end of ileum (75.2%, 79/105), which were mainly superficial ulcers (41.0%, 43/105) and ulcers with a long diameter less than 5 mm (69.0%, 49/71). The proportion of patients without abdominal symptoms and the positive rate of tuberculosis infection of T cells spot test of early CD patients were both lower than those of intestinal tuberculosis group (0 vs. 15.6%, 7/45 and 20.7%, 6/29 vs. 68.9%, 31/45). The positive rate of ASCA and the proportion of patients with thickened intestinal wall were higher than those of intestinal tuberculosis group (24.1%, 7/29 vs. 0 and 95.7%, 22/23 vs. 11/19), and the differences were statistically significant (Fisher exact probability text, χ2=13.713, Fisher exact probability text and χ2=6.710, all P<0.05). The results of multivariate binary logistic regression analysis showed that abdominal pain and positive ASCA were independent risk factors for early CD (odds ratio ( OR)=2.855, 95% confidence interval ( CI) 1.014 to 8.037, P=0.047; OR=10.033, 95% CI 2.274 to 44.250, P=0.002). Conclusions:Prospective follow-up for more than one year in patients with unexplained ileocecal inflammatory lesions can effectively identify and diagnose early CD. Ileocecal inflammatory lesions with abdominal symptoms are one of the early manifestations of CD. Abdominal pain and positive serum ASCA at the initial diagnosis are independent risk factors for early diagnosis of CD.
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Objective To evaluate the clinical value of epithelial vessel branch detected by non-magnifying narrow-band imaging ( NM-NBI ) in diagnosis of early esophageal cancer. Methods A retrospective analysis was performed on data of 59 patients, who underwent endoscopy with NM-NBI and iodine staining to screen early esophageal cancer in PLA General Hospital from January 2013 to May 2015. The final diagnosis for all lesions were determined by pathology. The diagnostic accuracy, sensitivity and specificity of NM-NBI and iodine staining for early esophageal cancer were compared. Results The accuracy, sensitivity and specificity of NM-NBI on the epithelial vessel branch in diagnosis of early esophageal cancer were 83. 1％ (49/59), 91. 3％ (21/23) and 77. 8％ (28/36), respectively, and the corresponding statistical values of iodine staining were 55. 9％ ( 33/59) , 95. 7％ ( 22/23) and 30. 6％ ( 11/36), respectively. The accuracy (χ2=1. 45, P=0. 028) and specificity (χ2=21. 4, P=0. 000) of epithelial vessel branch by NM-NBI were significantly higher than those of iodine staining, and there was no significant difference in the sensitivity between the two methods (χ2=22. 3, P=1. 000) . Conclusion The observation of epithelial vessel branch using NM-NBI was useful and reliable in diagnosis of early esophageal cancer with high accuracy and specificity, and can be possible for application in the clinic.
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Objective To evaluate the clinical efficacy of pre-procedure simethicone on detection of pharynx by upper gastrointestinal endoscopy. Methods A total of 100 patients with esophageal squamous cell carcinomas ( ESCCs) were enrolled in this prospective controlled trial and randomly assigned into two groups. The study group was given gargle with 5 mL simethicone plus 5 mL water combined with conventional procedure before gastroscopy. The control group was prepared according to the conventional procedure. The age, gender, tumor stage, lesion size, doctor＇s satisfaction and examination time between two groups were analyzed. Results The basic conditions between the two groups, including age, gender, and tumor stage were not significantly different (all P＞0. 05). The detection rate of superficial lesion in pharynx was higher in the study group than that in the control group, with no significant difference [8. 16%(4/49) VS 2. 04%( 1/49), P＝0. 362]. The median time of pharyngeal observation in the study group was less than that in the control group (21. 7 s VS 33. 9 s, P＝0. 000). The doctor was more satisfied in the study group than the control group (P＝0. 001). Conclusion Pre-procedure with simethicone improves the endoscopic visibility and detection rate of superficial squamous cell carcinoma with less observation time.
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Objective To evaluate the efficacy of premedication of pronase and simethicone before upper gastrointestinal endoscopy. Methods A total of 4 690 patients undergoing upper gastrointestinal en?doscopy from January 2014 to November 2014 were recruited at gastrointestinal endoscopy center in Beijing Military General Hospital. All patients were randomized into 3 groups. The pronase plus simethicone group( n=1 602) took 40 ml mixed solution of pronase, sodium bicarbonate and simethicone orally 20 minutes before endoscopy. The simethicone group( n=1 548) took 40 ml simethicone orally 20 minutes before endoscopy. And the control group( n=1 540) took 10 ml lidocaine hydrochloride mucilage orally 5 minutes before endos?copy. The visibility during gastroscopy was observed. Results Each patient underwent gastroscopy, and no severe adverse event occurred during the procedure. The visibility of 82?3%( n=1 318) of the pronase plus simethicone group, 67?7%( n=1 048) of the simethicone group and 28?1% patients( n=432) of the control group respectively reached grade A or B. The visibility during gastroscopy in the pronase plus simethicone group was higher than that in the simethicone group(χ2=89?42, P=0?000) , while that in the simethicone group was higher than that of the control group(χ2=486?30, P=0?000). Conclusion Premedication of pronase and simethicone can improve the visibility during gastroscopy.
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Objective To evaluate the efficacy of L?Arabinose for bowel preparation before colonos?copy. Methods A total of 170 patients who underwent colonoscopy were randomized into 2 groups. The ex?perimental group (n=85) used L?Arabinose for bowel preparation, while the control group (n=85) used polyethylene glycol electrolyte solution ( PEG?ELS ) . The degree of comfort, adverse effects, and the visibility during colonoscopy were observed. Results Premedication of L?Arabinose for bowel preparation yielded to more comfort ( U=-4?349,P=0?000) , less adverse effects (χ2=29?27,P=0?000) , and similar visibility during colonoscopy ( U=-0?875,P=0?381) compared with PEG?ELS. Conclusion L?Arabinose is safe, comfortable, and effective for bowel preparation before colonoscopy.
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Objective To compare the efficacy of lymph nodes(LNs) dissection between video-assisted thoracic surgery (VATS) and thoracotomy in the treatment of clinical stage Ⅰ lung cancer.Methods A comprehensive search of PubMed,Ovid Medline,EMBASE,Web of Science,ScienceDirect,the Cochrane Library,Scopus database and Google Scholar was performed to identify studies comparing VATS and thoracotomy in LNs dissection.The data was analyzed by RevMan 5.3 software and SPSS 18.0.Results After selection,23 articles met the inclusion criteria.2 316 patients were involved in VATS group and 3 346 patients were involved in Open group.Meta analysis showed that less total LNs(95％ CI:-1.64--0.60,P ＜ 0.0001),totalLNsstations(95％CI:-0.61--0.01,P=0.04) andN1 LNs(95％CI:-0.28--0.02,P=0.02)were dissected in VATS group.On the left side,more LNs were dissected in VATS group(95％ CI:0.51-3.22,P =0.007).The same number of mediastinal LNs (95％ CI:-0.74-0.15,P =0.20),mediastinal LNs stations (95％ CI:-0.20-0.14,P =0.76),right side LNs (95 ％ CI:-1.52-2.23,P =0.71) were harvested in both groups.Conclusion In the surgical treatment of clinical stage Ⅰ lung cancer,less total LNs,total LNs stations and N1 LNs were dissected in VATS group,while more left side LNs were harvested by VATS.The same number of mediastinal LNs,mediastinal LNs stations right side LNs were harvested in the two groups.This conclusion still needs to be further proved by more high-quality and large-scale RCTs.
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Objective To explore clinical value of the single-hale video-assisted thoracoscope surgery in lung surgery.Methods In our hospital from January 2015 to June 2015, a total of 60 patients was performed with lung partial resection line thoracoscope surgery, 28 routine puckering traditional video-assisted thoracoscope treatment, in the same period 32 underwent video-assisted thoracoscope surgery.Intraoperative blood loss, operating time, postoperative pain degree, and postoperative chest such as flow rate were compared between two groups.Results Two groups of patients had no perioperative death and severe complications.Intraoperative blood loss and operating time were no significant significance between single-and double-hole operation groups.The degree of postoperative pain score was (0.8 ± 0.5) in puckering thoracoscope group, and (1.2 ± 0.6) in traditional thoracoscope group, with significant difference (P =0.009).Conclusions Single-hole thoracoscope surgery in the treatment of lung diseases is feasible and reliable compared to traditional thoracoscope surgery, and patients can effectively reduce postoperative pain, and improve the quality of life.
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Objective To study the expression profile of microRNAs in the lung adenocarcinoma tissue and its expression in CD133+ lung cancer cells .Methods The specimens of adenocarcinoma tissue and pericarcinomatous tissue were collected for con-ducting the microRNA expression chip analysis .The flow cytometry(FCM ) was adopted to sort and culture CD133+ A549 cells in serum-free medium for 2 weeks .The positive rate of CD133+CD44+ in those cells was assayed .The expression of miRNA-892b and miRNA-4686 in CD133+ A549 cells were detected by real-time qPCR .Results Compared with the pericarcinomatous tissue ,27 miRNAs expressions in the lung adenocarcinoma tissue were up-regulated(P<0 .05) and 6 miRNAs expressions were down-regula-ted(P<0 .05) .The positive rate of cancer stem like cells CD 133+CD44+ was 75 .0% .The expression of miRNA-892b and miRNA-4686 in CD133+ A549 cells was higher than A549 cells(P<0 .01) .Conclusion Abnormal expression profile of miRNAs in lung ad-enocarcinoma tissue ,and miRNA-892b and miRNA-4686 may play a certain role to maintain the biological characteristics of CD133+ lung cancer cells .
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Objective To study the protective effect of sodium ferulate (SF) on CPB-induced lung ischemia reperfusion injury (IRI) and discuss its possible mechanism. Methods 40 patients undergoing CPB were randomly divided into contral group(CCG, n=20 ) and SF group(SFG, n=20). In SFG, SF was injected (0.2 g in NS 150 ml) intravenously Bid for one week preoperatively. In CCG, SF was replaced by same volume of NS. The changes of TNF-?、IL-6、IL-8、SOD level in the CCG and SFG would be examined before operation, at 15min、30 min after aortic cross clamp(ACC) and 1 hour after operation. By the time of before ACC、15 min and 30 min after ACC was opened, blood samples were taken from the right and left atrium to examine the amount of neutrophils. Lung tissues were cut for pathological studies in 5 patients in each group randomly. Results At 15 min、30 min after ACC and 1h after operation TNF-?、IL-6、IL-8、SOD levels of 2 groups were significantly higher than that before the operation (P