ABSTRACT
Objective:To assess the long-term outcome and influencing factors of laparoscopic Heller myotomy plus Dor fundoplication(LHM+ Dor) for achalasia by a single operator.Methods:Fifty-four patients who underwent LHM+ Dor consecutively from January 2011 to December 2019 were retrospectively reviewed. Those who had already undergone surgical or endoscopic myotomy and who were complicated with cancer were ruled out. Symptom inquiry and esophagogram were conducted both before and after surgery for assessing surgical results. Esophagoscopy, esophageal manometry and 24 h pH monitoring were performed before surgery, and the effects of these preoperative factors on the long-term outcome were analyzed.Results:All patients had dysphagia for average 6.5 years, ranging from 0.5-30.0 years. Intra-operative mucosal perforation occurred in 4(7.4%) patients, and there were no postoperative morbidity and mortality. At a median follow-up of 5.2 years, the morbidity of dysphagia decreased from 100% before surgery to 5.5% after surgery( P<0.001), Eckardt scores from 4.85±1.64 to 0.71±1.08( P=0.000). After surgery, 94.4% of patients had excellent and good relief of symptoms and good control of gastroesophageal reflux, the morbidity of heartburn being 3.7%. At 5 years after surgery, the probability of being symptoms free(Eckardt score≤1) was 91.7% in patients without preoperative night cough, compared to 54.6% in those with preoperative night cough( P=0.047). The probability was 92.3% in patients with grade Ⅰ and Ⅱ dilation of the esophagus and 79.0% in patients with grade Ⅲ and Ⅳ dilation( P=0.027). At multivariate analysis, heavier esophageal dilation was the independent predicator for poor symptom control after surgery. Conclusion:LHM+ Dor can be safely performed and durably relieve achalasia symptoms. Severe esophageal dilation before surgery is an independent predictor of a poor response to surgery.
ABSTRACT
Objective To evaluate the feasibility and safety of thoracoscopic lung cancer surgery under non-tracheal intubation anesthesia. Methods Twenty patients with peripheral lung cancer were enrolled in experimental group and control group. Then monitored and recorded Systolic pressure (SBP), diastolic pressure (DBP), mean arterial pressure (MAP), heart rate (HR), electrocardiogram (ECG), heart rate (HR), Oxygen saturation (SpO2), Final moisture CO2 partial pressure (PETCO2), central venous pressure, invasive arterial blood pressure and blood glucose and the related complications like sore throat, hoarse voice, nausea and so onin such time points: before induction (T0), induction of intubation (T1), operation (T2), and sudden removal (T3) of the two groups. Results The laryngeal mask group was given a smaller stimulus to the cardiovascular system during anesthesia.The time of feeding, the exhaust, the time of getting out of bed, the average hospitalization day, the reduction of hospitalization expenses, pharynx, respiratory and cardiovascular complications were shorter and less than intubation group. Conclusion The laryngeal mask ventilation intravenous anesthesia with thoracic vagal nerve block in the thoracoscopic lobectomy is simple, safe, no intubation-related complications and single lung ventilation lung injury, in line with surgery -anesthesia overall minimally invasive development concept, worthy of clinical promotion.
ABSTRACT
Objective To evaluate the clinical application of thoracoscope mediastinal tumor resection with the laryngeal mask anesthesia. Methods 40 cases of mediastinal tumors were randomly divided into two groups from 2012 to 2015, 20 cases in each group. Laryngeal mask group performed thoracoscope mediastinal tumor resection with laryngeal mask anesthesia and the Intubation group performed thoracoscope mediastinal tumor resection dou-ble-lume nendo tracheal intubation anesthesia, then compare the overall effect. Results All the patients were suc-cessfully completed with the thoracoscope surgery, no transfer to open chest cases. The preoperative anesthesia time of laryngeal mask group was shorter, blood pressure and pulse range of wave was smaller in the process of anesthesia and surgery, move restlessly was less, postoperative recovery time was shorter, and lower incidence of postoperative pharynx ministry unwell and sore throat, so the laryngeal mask group shows statistically significance comparing with the intubation group (P 0.05). Conclusion The laryn-geal mask airway intravenous anesthesia in thoracoscope mediastinal tumor resection in practical good, in the preop-erative anesthesia and postoperative recovery time and postoperative sore throat was better than that of intubation group, so should be extended in clinical treatment.
ABSTRACT
OBJECTIVE:To observe clinical efficacy and toxic reaction of bronchial artery infusion(BAI)chemotherapy com-bined with Cinobufacini capsule in the treatment of advanced non-small cell lung cancer(NSCLC). METHODS:A total of 126 cas-es of advanced NSCLC diagnosed in stage Ⅲb-Ⅳ were randomly divided into observation and control group,63 cases in each group. Both of them were treated by BAI with taxotere/cisplatin(TP regimen),once every three weeks for a cycle,a total of 5 cy-cles;observation group was additionally given Cinobufacini capsule 500 mg/time,three times a day,on the basis of BAI chemo-therapy,for 15 weeks. Clinical efficacy,KPS,survival rate and toxic reaction of 2 groups were observed. RESULTS:The total ef-fective rate(82.54%)of observation group was better than that(63.49%)of control group,with statistical significance(P<0.05). KPS score of observation group was significantly better than that of control group,with statistical significance (P<0.05). 1-year survival rate of observation group and control group were 65.08% and 30.15%,2-year survival rate of them were 19.05% and 4.76%,with statistical significance(P<0.05). Adverse reactions of two groups was mainly marrow suppression and gastrointesti-nal reaction,marrow suppression degree and the incidence of nausea and vomiting in observation group was lighter than control group,with statistical significance (P<0.05). CONCLUSIONS:BAI combined with Cinobufacini capsule in the treatment of ad-vanced NSCLC can improve short-term curative effect and long-term survival rate,and can improve the survival quality with little toxic effect.
ABSTRACT
Objective The sirolimus-eluting stent (SES) has dramatically reduced the rate ofrestenosis in comparison to that with the bare-metal stent (BMS).This study aimed to evaluate the short-term efficacy and safety of Firebird stent implantation for patients with coronary heart disease (CHD). Methods From Apri12006 through July 2007, 155 patients (mean age 58.93～10.27 years) with CHD were implanted with Firebird stent or Cypher select stent at Daxing Hospital. Patients were followed up for one year. All-cause mortality, major adverse cardiac events (MACE, including cardiac death, myocardial infarction, recurrence of angina pectoris, heart failure, revascularization, and adverse arrhythmia) and stent thrombosis were compared between the 2 groups. Results Of the 155 consecutive patients, 147 patients were revascularized completely. Of these patients, 48 (with 59 lesions) were treated with Firebird stent, 59 patients (with 75 lesions) with Cypher select stent. The demographic characteristics were similar in the 2 groups. All the angiographic and procedural results were not significantly different between the 2 groups. All-cause mortality, myocardial infarction, recurrence of angina pectoris, MACE and stent thrombosis were almost identical between the 2 groups before discharge, at 6 months and at one year .Conclusion The short-term efficacy and safety of Firebird stent are similar to that of the cypher select stent for the treatment of patients with CHD.
ABSTRACT
Objective To study the different therapeutic proportion of the patient populations undergone coronary angiography (CAG) in the era of development in multislice spiral computed tomography(MSCT).Methods Two hundred and fifty four consecutive patients(mean age 59.24±10.65),who underwent CAG at Daxing Hospital from February 2007 through October 2007,were enrolled,160 patients were male and 94 were female.By evaluating from the coronary angiogram,the patients were not diagnosed to have coronary heart disease(CHD) with less than 50% diameter stenosis of coronary artery;the patients to have CHD with more than or equal to 50% stenosis of coronary artery;the patients were performed the procedure of percutaneous coronary intervention(PCI) with more than or equal to 70% stenosis;the patients were proposed to have coronary aortic bypass graft(CABG) surgery with left main coronary artery lesions or diffuse triple coronary artery lesions.Results In the 254 consecutive patients,59 patients(23.2%) had not been diagnosed to have CHD;195(76.8%)to have CHD,of these patients with CHD,49 patients(19.3%)were not indicated for PCI (including the patients receiving follow-up coronary angiography after stenting),81(31.9%)had been performed the procedure of stent implantation,57(22.4%)proposed to have CABG,8(3.1%)the procedure of PCI had not been successful,or had not been performed because of patients opposing to this therapy.Conclusion Multislice spiral computed tomography can be applied as a non-invasive screening tool to exclude the presence of CHD,to increase the positive proportion of the populations with CHD in all patients receiving coronary angiograhpy,to avoid the use of CAG in a subset of patients.
ABSTRACT
[Objective] To observe the de-jaundice of severe jaundice hepatitis with TCM enema.[Method] 87 cases of chronic virus hepatitis with hyperbilirubinemia were randomly divided into 2 groups,the treatment group treated with TCM preserving enema and routine combination of TCM and western medicine which could protect liver and decrease enzyme and de-jaundice.The control one used only the later,observed for 6 weeks.[Result] The reduction of total bilirubin of the treatment group was larger than control group,P
ABSTRACT
OBJECTIVE The purpose of our study was to measure the glucocorticoid receptor(GR)protein level in the nuclei of nasal polyp cells and compare the results in nasal polyposis patients with chronic rhinosinusitis alone and with chronic rhinosinusitis accompanied with asthma, before and after glucocorticoid(Glu)therapy. METHODS We used enzyme-linked immunosorbentassay(ELISA) techniques to quantitatively measure the activated- GR protein level in the nuclei of the nasal polyp cells. Nasal polyp tissues were obtained from patients with chronic rhinosinusitis alone and with chronic rhinosinusitis accompanied with bronchial asthma. In the latter, polyp tissues were obtained before and after Glu therapy seperatively. RESULTS Our data showed no significant differences between the activated- GR protein level of the nasal polyposis patients with chronic rhinosinusitis alone and with chronic rhinosinusitis accompanied with bronchial asthma before Glu therapy. However, the activated-GR protein level was significantly upregulated after Glu therapy in the patients with chronic rhinosinusitis accompanied with bronchial asthma. CONCLUSION The result of our research clearly showed that Glus upregulated the activated-GR protein level in the nuclei of nasal polyp cells and that the upregulation is essential for Glus anti-inflammatory action.
ABSTRACT
0.05).Conclusion VAMT is as effective as VATS,whereas it can achieve a shorter operation time.
ABSTRACT
Objective To identify the association of HLA-DQA1 and-DQ B1 alleles with vitiligo in Chinese Hans in Anhui province.Methods Polymerase chain reaction sequence-specific primer (PCR-SSP) method was used to analyze the distribution of HLA-DQA1 and-DQB1 alleles among 187 patients with vitiligo and 273 healthy controls.Results The frequencies of HLA-DQA1*0302,-DQB1*0303,-DQB1*0503 alleles were significantly increased in the patients with vitiligo compared with those in the controls,and HLA-DQA1*0501 allele frequency was mark edly decreased.HLA-DQA1*0302,-DQA1*0601,-DQB1*0303,-DQB1*0503 alleles were p ositively associated,whereas HLA-DQA1*0501 allele was negatively associated wit h childhood vitiligo,and HLA-DQB1*0303 allele was positively associated with ad ult vitiligo,in comparison with those in the controls.The frequency of HLA-DQB 1*0303 allele was significantly increased in localized vitiligo patients compare d with that in the controls,whereas frequencies of HLA-DQA1*0302,-DQB1*0303,-DQB1*0503 alleles were significantly increased and the frequency of HLA-DQA1*050 1 allele was markedly decreased in generalized vitiligo patients.Conclusions HLA-DQA1*0302,-DQA1*0601,-DQB1*0303 and-DQB1*0503 alleles could be the suscep tible alleles of vitiligo,while HLA-DQA1*0501 allele could be the protective al lele in Chinese Hans in Anhui province.There may be different genetic backgroun ds between childhood and adult patients,and between localized and generalized vitiligo.