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Objective:To explore the advantages of the novel individualized 3D printing artificial vertebral body in spine reconstruction and to evaluate its clinical effect.Methods:From January 2017 to December 2018, the 15 patients who underwent total vertebrectomy and spine reconstruction with individualized 3D printing artificial vertebral body were analyzed retrospectively. There were 8 males and 7 females, with the mean age 39.5 years (range: 20-57), including 12 primary tumors and 3 metastatic tumors. According to tumor location and surrounding soft tissue invasion range, simple posterior or combined anterior and posterior approach were used for total vertebral resection, and the defection was reconstructed by 3D printing artificial vertebral body. The operation time, intraoperative bleeding volume, postoperative stability of artificial vertebral body and bone ingrowth of adjacent vertebral body, preoperative and postoperative neurological changes, preoperative and postoperative VAS score, local control and survival of patients were analyzed.Results:The mean operation time was 412.0 min (range: 135-740 min), and the mean blood loss was 4 140.0ml (range: 100-14 000 ml). The mean follow-up time was 23.2 months (range: 12-35 months), and no one loss to follow-up. One case had pleural rupture, one case had cerebrospinal fluid leakage and one case had L5 nerve root palsy. All patients recovered after active symptomatic treatment. Compare with the preoperative VAS score (4.7±1.1), the differences of VAS score at 7 d postoperative and last follow-up (1.6±0.6 and 1.0±0.5) were significantly reduced ( P<0.001). Three patients with Frankel grade C gradually recovered to grade D, and no change were found in grade D and Grade E patients, there was no significant improved at last follow-up. Preliminary bone growth was found between the artificial vertebral body and the adjacent vertebral body 3 months after operation. The bone growth was more obvious at 12 months post-operation, and the artificial vertebral body fused with the adjacent vertebral bodies to form bone integration. At 24 months post-operation, the integration of the artificial vertebral body was more accurate. During the follow-up period, there was no loosening or displacement of the artificial vertebral body and no failure of internal fixation. A case of hemangioendothelioma and a case of epithelioid angiosarcoma died at 33 months and 35 months postoperatively. One patient with chondrosarcoma had local recurrence at16 months post-operation. After treated with arotinib, the tumor did not progress. The other 12 patients had no tumor recurrence or distant metastasis. Conclusion:After spinal tumor resection, individualized 3D printing artificial vertebral body can be used to accurate restoration of spinal continuity, and provide nice interface matching and bone growth between artificial vertebral body and the adjacent vertebral endplates. Moreover, the immediate and long-term stability of the artificial vertebral body can meet the needs of spinal reconstruction.
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Objective To analyze the influence of thoracoscopy combined with laparoscopy for radical operation of esophageal carcinoma and open ones on the perioperative effects and postoperative quality of life.Methods The data in 74 esophagus cancer patients in the thoracic surgery department of our hospital from October 2012 to June 2015 were collected and divided into the endo-scopic group and open group according to different operative ways.The perioperative effects and complications in the two operation ways were analyzed.The EORTC QLQ-C30 and QLQ-OES18 were used to conduct the questionnaire investigation and comparative analysis.Results The mean intraoperative blood loss,postoperative catheter drainage,hospitalization time,occurrence rates of post-operative complications such as pneumonia,hydrothorax and gastric emptying disorder in the endoscopic group were lower than those in the open group,while the operative time was longer than that in the open group,the differences were statistically significant (P <0.05).The total healthy status and function scores at postoperative 1,12 weeks in the two groups were decreased and symp-tom scores were increased,which at postoperative 24 weeks were back to close to preoperative level.The scores in the aspects of to-tal healthy status,physical functioning,role functioning,social functioning,fatigue,pain,dyspnea and difficultly coughing at postop-erative 1,12 weeks in the endoscopic group were superior to those in the open group,in which the scores of total healthy status, physical functioning and fatigue symptom at postoperative 24 week were still superior to those in the open group,the differences were statistically significant(P <0.05).Conclusion Thoracoscopy combined with laparoscopy for radical operation of esophageal carcinoma has the advantages in the aspects of intraoperative blood loss,catheter drainage,hospitalization time,some postoperative complications and QOL scores,but the operative time is longer.
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Objective To investigate the expression of RGC32 gene in pulmonary adenocarcinoma tissue and to explore the influence on proliferation and apoptosis of A549 cells.Methods Real-time PCR was applied to detect the expression of RGC32 gene in 36 cases of pulmonary adenocarcinoma and pericancerous tissues.RNA interference was used to inhibit the expression of RGC32 gene.After RNA interference,the expression of RGC32 gene was detected by real-time PCR,the apoptosis of the transfected cells was detected by flow cytometry and the inhibition ratio of cell proliferation was detected by methyl thiazolyl tetrazolium (MTT).Results The expression of RGC32 gene was upgraded in pulmonary adenocarcinomas tissues(1:2.2736,t=-29.185,P=0.01).After RNA interference,the expression of RGC32 gene transfected A549 cells was down-regulated significantly[(2.47±0.17)％ vs(4.65±0.26)％,t=-202.868,P=0.000].Comparing to the control cells,the apoptosis of experimental group cells increased significantly (2.9 ％ vs 45.4 ％,t=-37.915,P=0.01),and the inhibition ratio of cell proliferation increased significantly.Conclusion The expression of RGC32 gene shows an obvious upgraded in pulmonary adenocarcinoma.The low expression of RGC32 gene can induce apoptosis and inhibit proliferation of A549 cells.
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BACKGROUND: Esophageal replacement or reconstruction should be performed after esophageal resection. There are still no suitable substitutes for esophagus if the conventional esophageal substitutes cannot be used.OBJECTIVE : To investigate the feasibility of applying a pulmonary tissue with vascular pedicle to repair the intrathoracic esophageal defect.DESIGN: A prospective animal investigation.SETTING: Department of Thoracic Surgery, Second Hospital Affiliated to China Medical University.MATERIALS: This trial was carried out in the laboratory of Department of Thoracic Surgery, Second Hospital Affiliated to China Medical University during January 2003 to June 2004. Fourteen adult mongrel dogs of either gender, with body mass of 12 to 18 kg, were provided by Animal Room, Second Hospital Affiliated to China Medical University (License No.SYXK (Liao) 2003-0019).METHODS: Of 14 anesthetized dogs, the middle lobe of right lung was dissected and its right middle lobar bronchus was ligated without damaging pulmonary and bronchial vessels in order to make pulmonary flap. A part of full-layer intrathoracic esophageal wall was resected, which was 4 cm long and 1/2 to 2/3 circled esophageal wall. The defect was patched by pulmonary tissue with vascular pedicle which was inosculated with esophageal cross section. On the 3rd day after operation, intravenous transfusion was performed to maintain nutrition. Qn the 7th day after operation, the dogs were given oral liquid soft food gradually 2 weeks after the operation. The access to the food and the survival of dogs were observed. Every 2 dogs were sacrificed respectively at the 2nd, 4th, 6th, 8th and 10th postoperative weeks. To observe the healing of esophageal defect, light microscope, transmission electron microscope, esophagography and endoscope were used in this study.MArN OUTCOME MEASURES: ①Survival situation and access to food of dogs after operation. ② The healing of esophageal defect of dogs.RESULTS: Three of fourteen dogs died within one week after operation. Eleven dogs survived. ① The survival and access to food of experimental dogs after operation: One dog was alive without problems for more than 170 weeks. The living dogs could be fed orally on the 7th day after operation. ② The healing at esophageal defect of experimental dogs:At the 2nd week after operation, the esophageal defect was covered with collagen layer and inflammatory exudation. A little epithelization was observered at free edge of the anastomosis, which was 1 to 2 layers of stratified squamous epithelium cells. At the 4th to 6th weeks after operation, the internal surface of the defect was covered with 3 to 5 layers of stratified epithelium cells. At the 8th to 10th weeks after operation, the luminal surface of the defect was covered with 6 to 8 layers of stratified epithelium cells. The pathological changs of pulmonary flap mainly included pulmonary alveoli atelectasis and pulmonary fibrosis, and some inflammatory cells without infective focus were observed. In the transmission electron microscope examination, newborn stratified squamous epithelium cells were. found on the surface of pulmonary tissue flap at esophageal defect.CONCLUSION: It is feasible to repair the partial irregular intrathoracic esophageal defect with the autologous pulmonary flap in dogs.
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Objective: The purpose of our experiment is to use new type esophageal prosthesis, which is pulmonary tissue with vascular pedicle, to repair the partial esophageal defect. Methods: Twelve adult mongrel dogs were used for the study. Middle lobar bronchus of right lung was ligated and incised, so the pulmonary tissue with vascular pedicle was made. A 4 cm long and 1/2～2/3 circled esophageal wall, and full-thickness defect was created. The defect was patched by pulmonary tissue with vascular pedicle. Results: Seven dogs were put to death at planned times after the reconstructive operation. One dog is still alive without any problems for more than 12 months. One dog survived 38 days and then died of chronic empyema. The other three dogs died of anastomotic leak at 5～7 days after operation. The living dogs could be fed orally at seventh day after operation. Epithelization was found in the luminal surface of the defect. Conclusion: It was feasible that the partial esophageal defect was replaced by pulmonary tissue with vascular pedicle.