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Objective To analyze the cosmetic effects and postoperative complications of patients with early breast cancer who underwent oncoplastic breast-conserving reconstruction and traditional breast-conserving surgery.Methods From January 201 2 to October 201 5,we collected a total of 67 patients with early-stage breast cancer who underwent breast-conserving surgery in Affiliated Mindong Hospital of Fujian Medical Univer-sity.Thirty patients who underwent oncoplastic breast-conserving reconstruction were in observation group,and 37 patients who underwent traditional breast-conserving surgery were in the control group.The postoperative complications,cosmetic effects and survival situations in the two groups were compared.Results In the aes-thetic effects evaluation,22 patients (73.33%)and 1 6 patients (43.24%)had good or excellent cosmetic effects,6 patients (20.00%)and 1 4 patients (37.84%)had general cosmetic effects,2 patients (6.67%) and 7 patients (1 8.92%)had poor cosmetic effects in the observation group and control group,with a signifi-cant difference (Z =-2.51 3,P =0.01 2).Four patients (1 3.33%)in the observation group had postopera-tive complications,including that 1 patients had incisional dehiscence followed by incisional wound infection and skin necrosis,and 3 patients had subcutaneous exudates.However,2 patients (5.41 %)in the control group had postoperative complications,including 1 patients with incisional dehiscence,and 1 patients with inci-sional wound infection.There were no significant difference in the occurrence rates of postoperative complica-tions in the two groups (χ2 =0.490,P =0.484).The mean follow-up period was 28 months.We found 1 patients of local recurrence,and 2 patients of metastases in the control group.However,all patients were free of recurrence and metastases in the observation group,with no significant difference (P =0.1 40).Conclusion Oncoplastic surgical technique in the breast-conserving surgery for patients with early-stage breast cancer is a safe and effective procedure,with highly satisfactory cosmetic effects for the majority of patients,which is worth to recommend.
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<p><b>OBJECTIVE</b>To evaluate the effect of early enteral nutrition(EEN) on immune response and clinical outcomes after esophageal cancer operation.</p><p><b>METHODS</b>Sixty patients with esophageal cancer undergoing radical operation between March 2010 and July 2011 were randomly divided into two groups using envelope method: EEN group(n=30, administration of water and enteral nutrition early after operation) and TPN group(n=30, administration of total parenteral nutrition). Two groups both received 7-day nutrition support. Immune indexes(CD3(+), CD4(+), CD8(+), CD4(+)/CD8(+)) and serum nutritional indexes(albumin, pre-albumin, transferrin) were measured before operation and 1-, 3-, and 7-day after operation. The time to first flatus, length of postoperative hospital stay, total hospitalization cost, and postoperative complication were recorded.</p><p><b>RESULTS</b>As compared to TPN group, the time to first flatus was significantly shorter in EEN group[(66.5±7.3) h vs. (75.1±6.8) h, P<0.01], as was hospital stay[(7.8±1.1) d vs. (9.3±1.3) d, P<0.01]. Total hospitalization cost[(36 210±3810) yuan vs. (39 731±4013) yuan, P<0.01] was lower in EEN group as compared to TPN group. There was no significant difference in postoperative complication rate between the two groups[13.3%(3/30) vs. 20.0%(6/30), P>0.05]. The levels of CD3(+), CD4(+), CD4(+)/CD8(+), albumin, prealbumin and transferrin were significantly higher in EEN group as compared to TPN group on postoperative day 3 and 7(all P<0.05), while CD8(+) was significantly lower in EEN group(P<0.05).</p><p><b>CONCLUSION</b>EEN can promote early recovery of gastrointestinal function, improve nutritional and immune function, and therefore lead to fast postoperative recovery in esophageal cancer patients.</p>
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Humans , Enteral Nutrition , Esophageal Neoplasms , General Surgery , Length of Stay , Nutrition Assessment , Postoperative Complications , Postoperative PeriodABSTRACT
ObjectiveTo investigate the influence of fast track surgery (FTS) on insulin resistance indexes in esophageal cancer patients.MethodsA total of 68 esophageal cancer patients receiving radical operation in our hospital from November 2009 to March 2011 were randomly divided into 2 groups by envelope method:FTS group ( n =34) and control group ( n =34 ).The postoperative first passage of gas by annus and defecation,postoperative hospital stay,hospitalization expenditure,and postoperative complications were recorded.Insulin resistance indexes were measured before operation as well as on the 1st,3rd,and 7th postoperative days,including fasting blood-glucose (FBG),fasting insulin (FINS),serum level of interleukin-6 (IL-6),and C-reactive protein (CRP).The insulin resistance index (HOMA-IR) was calculated at the same time points.ResultsThe postoperative time of first passage of gas [ ( 1.91 ± 1.13 ) d vs.(2.95 ± 1.25 ) d,P =0.000 ] and defecation [ ( 3.75 ± 1.54 ) d vs.(4.84 ± 1.76) d,P =0.007] in FTS group were significantly shorter compared with control group,and the total hospitalization expenditure was significantly lower in FTS group [ (3.19±0.42) ten-thousand yuan vs.(3.98 ±0.36) ten-thousand yuan,P =0.000 ].The preoperative insulin resistance indexes showed no signifcant differences between the two groups ( all P ＞ 0.05 ).One day after operation,the levels of log-HOMA-IR (0.97 ± 0.52vs.1.54±0.57,P=0.000),FINS [ (11.87±4.55) μU/ml vs.(17.16±6.90) μU/ml,P=0.000],IL-6[ (124.15±21.39) ng/Lvs.(138.78±23.60) ng/L,P.=0.009],and CRP [ (62.92±14.78) mg/L vs.(71.07 ± 14.51 ) mg/L,P =0.025 ] in FTS group were significantly lower than those in control group.Three days after operation,the levels of log-HOMA-IR (0.86 ± 0.47 vs.1.27 ± 0.58,P =0.002),FINS [ ( 9.56 ± 4.37 )μU/mlvs.(14.91±6.54) μU/ml,P=0.000],IL-6 [ (140.94±25.12) ng/Lvs.(153.89±24.06) ng/L,P=0.035],and CRP [ (138.59 ±21.61) mg/L vs.(153.17 ±25.20) mg/L,P=0.019] in FTS group were significantly lower than those in control group.Seven days after operation,the level of CRP in FTS group was significantly lower than that in control group [ (53.07 ± 15.84 ) mg/L vs.( 61.59 ± 16.28 ) mg/L,P =0.032 ].ConclusionFTS may promote the early recovery of gastrointestinal function,reduce stress reaction and postoperative insulin,thus being conducive to fast rehabilitation of esophageal cancer patients.
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Objective To determine the length of warm ischemic (WI) tolerance in bronchial graft from non-heart-beating donors. Methods Forty-eight rats were randomly divided into 4 groups (each group having 12 rats) according to different WI durations including WI-0 min (group A), WI-30 min (group B), WI-45 min (group C) and WI-60 min (group D). In each group, the tracheae from 6 rats were respectively imbedded in greater omentum of other 6 rats, and 14 days later, the transplanted tracheae were taken from recipients to evaluate epithelial thickness and regeneration. Results Epithelial thickness and the degree of epithelial regeneration had no significant difference (P >0. 05) between the syngeneic control group and the WI-30 minutes group. All of the grafts with WI duration of 45 min were viable, but the epithelium was significantly thinner than that in the syngeneic control group (P<0. 05). However all of the grafts with WI duration of 60 min showed lower viability rate. Conclusion The time limits of tolerance to WI of tracheal grafts from NHBDs may be 45 min.
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Objective To investigate the efficacy of video-assisted thoracic small incision in diagnosis and treatment of small pulmonary nodules.Methods From February 2007 to February 2008,53 patients(aged over 40 years) with small solitary pulmonary nodule(≤3 cm in diameter) were treated by video-assisted thoracoscopy via a small incision.The nodules were removed during the operation,and then based on the results of quick pathological examination,malignant cases received further surgeries.Results Totally 39 patients were diagnosed with malignant disease,34 of them received small-incision radical lobectomy for primary lung cancer,small-incision resection of the lesions were performed on 5 patients who had bilateral(2 cases) or metastatic lung cancer(3 cases).Benign lesions were confirmed in 14 patients during the operation,and were removed by local resection.All of the patients with primary lung cancer,except one,achieved an mean of 7 months follow-up(ranged 2 to 12 months),31 of the patients survived without tumor during the period;2 patients showed recurrent cancer in 6 months after the operation,and thus received lobectomy.The 2 patients who had bilateral lung cancer and the 3 cases of metastatic lung cancer died in 2 to 6 months(mean,4 months) after the surgery.The 14 benign cases were followed up for 3 to 12 months(mean,7.5 months),none of them had recurrence.Conclusion Video-assisted thoracic small incision is effective in the diagnose and treatment of small pulmonary nodules.
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Objective To discuss the value of video-assisted thoracoscope in the treatment of esophageal leiomyoma. Methods Clinical data of 19 patients with esophageal leiomyoma treated by video-assisted thoracoscopy from July 2000 to October 2007 were reviewed retrospectively.Under general anaesthesia with the patients at the lateral position according to the location of esophageal leiomyoma,3 incisions were made on the chest wall for insertion of the trocars.Gastroscope was applied for intraoperative auxiliary operation.Results Under a video-assisted thoracoscope,enucleation of the leiomyoma was performed on 18 of the patients,the other one,who were diagnosed with esophageal leiomyoma(3 cm ? 2 cm) was converted to thoracotomy because of the tumor was confirmed huge during the thoracoscopy.No postoperative death or severe complications occurred.Pathological examination confirmed the diagnosis of leiomyoma in all of the cases.The patients were followed up for a mean of 24.5 months(5-35 months),no recurrence was found during the period. Conclusions Video-assisted thoracoscopy can be the first choice for the treatment of esophageal leiomyoma.Open surgery should be considered if the tumor is huge.
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Objective: To review the efficacy of nutrition support and operation in management of chylothorax.Methods: 6 patients underwent conservative way(fat-free enteral nutrition+PN+ somatostatin) and 3 patients then received the operation.Results: 3 patients were cured with only conservative way,but 3 others were cured under operation.Conclusion:The conservative way(fat-free enteral nutrition+PN+ somatostatin) is a effective method in patients with chylothoral,and the operation is needed in some patients.