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With the development of laparoscopic technology and the accumulation of experience, total laparoscopic total gastrectomy has been gradually popularized and applied. Among them, laparoscopic esophagojejunostomy is the biggest challenge in this surgery because of its high difficulty. More and more surgeons have been trying to find a more feasible anastomosis method. So far, there have been many kinds of esophagojejunostomy, and they are constantly being improved. The purpose of this article is to review the technical tips and pitfalls of common laparoscopic esophagojejunostomy.
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Objective:To investigate the efficacy of total laparoscopic radical gastrectomy for locally advanced esophagogastric junction carcinoma and its effect on patient's immune function and levels of tumor markers.Methods:A total of 106 patients who underwent total laparoscopic radical gastrectomy (total endoscopic group) in the Affiliated Cancer Hospital of Shanxi Medical University from January 2016 to April 2020 were collected, and 98 patients who underwent open radical gastrectomy (open group) in the same period were selected. The short-term efficacy, preoperative and postoperative immune function and tumor markers were compared between the two groups.Results:The operative time of the total endoscopic group was longer than that of the open group [(214±49) min vs. (165±32) min, t = 8.87, P < 0.01], the intraoperative blood loss was less than that of the open group [(86±50) ml vs. (113±53) ml, t = 3.59, P < 0.01], the postoperative first exhaust time was shorter than that of the open group [3.0 d (3.0 d, 4.0 d) vs. 3.5 d (3.0 d, 4.5 d), Z = 2.89, P < 0.01], and the incision length was shorter than that of the open group [(4.6±0.6) cm vs. (17.6±2.0) cm, t = 68.63, P < 0.01]. The postoperative proportion of CD4 + T cells, CD4 +/CD8 + and proportion of NK cells in the total endoscopic group were higher than those in the open group [(41±8)% vs.(36±8)%, t = 4.710, P < 0.01; 1.63 (1.19, 2.30) vs. 1.15 (0.87, 1.63), Z = 4.165, P < 0.01; 24.60 % (17.77 %, 32.50 %) vs. 19.25 % (13.35 %, 25.80 %), Z = 3.440, P < 0.01], while the postoperative proportions of CD8 + T cells and regulatory T cells in the total endoscopic group were lower than those in the open group [(26±11)% vs. (30±10)%, t = 2.375, P = 0.018; 3.37% (5.00%, 6.70%) vs. 4.48% (5.70%, 7.20%), Z = 3.057, P = 0.002]. Postoperative carcinoembryonic antigen (CEA) and carbohydrate antigen 199 (CA199) in the total endoscopy were lower than those in the open group group [0.96 μg/L (0.54 μg/L, 1.50 μg/L) vs. 1.27 μg/L (0.70 μg/L, 2.98 μg/L), Z = 2.745, P = 0.036; 8.07 U/ml (5.48 U/ml, 13.07 U/ml) vs. 10.80 U/ml (6.54 U/ml, 19.93 U/ml), Z = 2.690, P = 0.043]. Conclusion:Compared with open surgery, total laparoscopic radical gastrectomy has less trauma and stress response, and has less impact on the gastrointestinal and immune function of patients, and the levels of tumor markers CEA and CA199 are low.
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Objective To explore the short-term effect of totally laparoscopic radical total gastrectomy with D2 lymph node dissection for treatment of local advanced upper gastric cancer. Methods Clinical data of 112 patients with local advanced upper gastric cancer who underwent totally laparoscopic or open radical total gastrectomy with D2 lymph node dissection in Affiliated Cancer Hospital of Shanxi Medical University from June 2016 to June 2018 were analyzed. The patients were divided into totally laparoscopic radical total gastrectomy with D2 lymph node dissection group (totally laparoscopic gastrectomy group, 54 cases) and open surgery radical total gastrectomy with D2 lymph node dissection group (opening gastrectomy group, 58 cases). The perioperative conditions and postoperative pathological conditions between the two groups were compared. Results All the 112 operations were technically successful. Compared with the opening gastrectomy group, the operating time of the totally laparoscopic gastrectomy group was longer [(240 ±47) min vs. (203 ±30) min], and the estimated blood loss was reduced [(103±21) ml vs. (260±34) ml], and the length of operative incision on body surface was shorter [(4.3±0.8) cm vs. (17.0±1.3) cm], and the differences between the two groups were statistically significant (all P< 0.05). There were no significant differences in the distance between the upper incision edge and tumor and the number of excised lymph node between the two groups (both P> 0.05). Compared with the opening gastrectomy group, the pain degree in 3-5 d after operation was slighter in the totally laparoscopic gastrectomy group, and the ratio of postoperative complications was lower, and the time of intestinal recovery and postoperative hospital stay was shorter, and the differences between the two groups were statistically significant (all P<0.05). Conclusion Totally laparoscopic radical total gastrectomy with D2 lymph node dissection for local advanced upper gastric cancer has advantages in operation safety, the time of postoperative recovery and the number of postoperative complications, and the effect of lymph node dissection can reach the level of open surgery.
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Objective@#To observe the clinical effect of surgical resection after conversion therapy for patients with advanced gastric cancer.@*Methods@#The clinical data of 23 patients with advanced gastric cancer who were admitted to Shanxi Provincial Cancer Hospital from January 2015 to October 2017 were retrospectively analyzed. All patients underwent multi-disciplinary treatment(MDT)-directed conversion therapy, and D2 radical gastrectomy was performed after the disappearance of non-healing factors. The remission of patients after conversion therapy and the related intraoperative and postoperative indicators were analyzed.@*Results@#After the conversion therapy, there were 2 cases (8.7%) of complete remission, 13 cases (56.5%) of partial remission and 8 cases (34.8%) of stable disease. The remission rate of the conversion therapy was 65.2% (15/23). In all 23 cases, the surgical time was (135.5±32.1) min, the intraoperative blood loss was (356.7±101.3) ml, the number of lymph nodes resected was 35.5±10.3. The time of gastric tube indwelling was (70.5±29.6) h, the time to first liquid intake was (85.0±21.5) h, the time of drainage tube placement was (196.2±36.2) h and the postoperative hospital stay was (10.7±3.2) d. After surgery, two cases had grade ⅢA post-operative complications and 2 had gradeⅡ. All patients were followed up, the median progression-free survival time was 13.5 months and the median overall survival time was 21.9 months.@*Conclusion@#The survival time of patients with advanced gastric cancer can be prolonged by D2 radical gastrectomy after the MDT-guided conversion therapy.
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Objective To explore the effects and regulation mechanism of miR-489 on the stem cell phenotype and epithelial-mesenchymal transition of colon cancer cells in vitro.Methods The miR-489 expression of colon cancer cell lines ( HT29, SW480 and SW620, HCT116) and normal intestinal epithelial cells HIEC were detec-ted by RT-qPCR, the miR-489 expression in colon cancer cells was raised by gene transfection technology, the colon cancer stem cell markers CD133, CD44, EpCAM, ALDH1 and epithelial marker E-cadherin, mesenchy-mal cells markers vimentin and N-cadherin were detected by Western blot.The expression of TWIST1 mRNA and protein were detected by RT-qPCR and Western blot.Results The miR-489 relative expression in four kinds of colon cancer cells ( HT29, SW480 and SW620, HCT116) were significantly lower than that of normal HIEC in-testinal epithelial cells, the difference was statistically significant ( P<0.05) .Up-regulation of miR-489 expres-sion in HT29 and HCT116 cells leaded to lower expression of colon cancer stem cell marker CD133, CD44, EpCAM ALDH1 and mesenchymal cells markers Vimentin , N-cadherin, higher expression of epithelial markers ;E-cadherin (P<0.05).Also, up-regulation of miR-489 expression in HT29 and HCT116 cells leaded to lower ex-pression of TWIST 1 mRNA and protein ( P<0.05 ) .Conclusions miR-489 is down-regulated in colon cancer cells and up-regulation of miR-489 expression inhibits stem cell phenotype and epithelial-mesenchymal transition through targeting TWIST1 in colon cancer .
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Objective To investigate the accuracy of liver volume measurement in patients with primary hepatocellular carcinoma by using the 3D + medical imaging visualization processing system. Methods Thirty patients who were clinically diagnosed as primary hepatocellular carcinoma and underwent surgical resection before preoperative assessment were selected from January 2016 to November 2016. Preoperative thin-slice CT images were transferred into the 3D + medical imaging visualization processing system for hepatic volume measurement, the predictive resection volume were measured and statistically analyzed with that of intraoperative specimen according to water measurement method. Results All patients had complete resection of tumor, the average volume of predictive resection calculated by the 3D software was (408.84 ± 177.07) ml, the average volume of intraoperative specimen measured by the water test was (399.95 ± 176.15) ml, the difference was not statistically significant (t=1.502, P=0.144), and the average percentage error was (6.21 ± 4.73) %. Pearson correlation analysis showed that there was significant correlation between them (r=0.983, P<0.05). Conclusion 3D+medical image visualization processing system is a simple, intuitive and accurate method for liver volume measurement, which can provide the basis for the accurate measurement of liver volume and the implementation of complex hepatectomy, and guide the precise hepatectomy.
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Objective To determine the expression of serum proteins in pancreatic cancer patients based on mass spectrometry to screen differential proteins and to find potential molecular biomarkers to prediagnosis of pancreatic cancer. Methods The technique of isobaric tags for relative and absolute quantitation (iTRAQ) and two-dimensional liquid chromatography-tandem mass spectrometry (2D-LC-MS/MS) were used to analyze the serum proteins in 15 pancreatic cancer patients and 10 healthy controls. Screening for serum differential proteins was performed via retrieving Panther, Mascot and Scaffold databases. Ingenuity Pathway Analysis was used to detect the correlation between proteins. Results The expression level of 442 proteins was quantified, and 76 proteins were found to be differentially expressed which changed corresponding biological process. The up-regulation of DNA repair protein 50 (RAD50) and down-regulation of transforming growth factor β1 (TGFβ1) and apoptosis protease-activating factor 1 (APAF1) which were correlated with cell growth and apoptosis were found in pancreatic cancer. A closely interacted network was formed between these three differential proteins and other molecules, which could effect metabolism in pancreatic cancer patients. Conclusion Differential expression of serum proteins screened by iTRAQ in pancreatic cancer patients may be the potential markers of pancreatic cancer, which can provide molecular basis for early diagnosis of pancreatic cancer.
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Objective To investigate the pollution status of volatile organic compounds (VOCs) in water supply systems of Minhang District of Shanghai taking Huangpu River and Qingcaosha reservoir as water source.Methods A total of 126 water samples were collected from water supply system for residents in Minhang District in Feb.(dry season) and Aug.(wet season) of 2016,including source water from Huangpu River and Qingcaosha reservoir,the factory finished water and tap water.Purge and trap gas chromatography mass spectrometry was used for the qualitative and quantitative determination of 86 kinds of VOCs.Results Totally,32 and 28 kinds of VOCs were detected in the water supply systems from the Huangpu River and Qingcaosha reservoir,among which 19 and 21 pollutants were priority-controlled by the US EPA,and 18 and 14 species have the national standard in China separately.The concentration of detected pollutants ranged from 0.04 μg/L to 213μg/L and from 0.04μg/L to 728μg/L,respectively.The pollutants in the supply system of the Huangpu river were at the lower level except for methyl tert-butyl ether (MTBE).The pollutants in the supply system of Qingcaosha reservoir were lower than the national standards in addition to dichloromethane and 1,2-dichloroethane,and with the higher level of Methyl chloride and MTBE.In both water supply systems,halogenated aliphatic hydrocarbons and aromatic compounds were mainly types of VOCs,but there were varied types and quantities of compounds in each water supply system.The halogenated aliphatic hydrocarbons accounted for 37.5％ and 56.2％ of the detected VOCs respectively,while aromatic compounds accounted for 64.3％ and 28.6％.A total of 5 disinfection by-products (DBP) were detected in both water supply systems,but the concentrations of dichloromethane,chloroform,bromodichloromethane and dibromochloromethane in the Qingcaosha reservoir water supply system were significantly higher than those in the Huangpu River water supply system,except for bromoform.The concentration of the disinfection by-products in order from large to small were in the tap water,factory finished water and source water,while dichloromethane was an exception.Conclusions There were VOC pollutions in both water supply system in Minhang District,including source water,factory finished water and tap water,with different pollution characteristics.Adequate attention should be paid to the pollutants without national standards in the future water quality monitoring work.
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Objective To investigate the pollution status of volatile organic compounds (VOCs) in water supply systems of Minhang District of Shanghai taking Huangpu River and Qingcaosha reservoir as water source.Methods A total of 126 water samples were collected from water supply system for residents in Minhang District in Feb.(dry season) and Aug.(wet season) of 2016,including source water from Huangpu River and Qingcaosha reservoir,the factory finished water and tap water.Purge and trap gas chromatography mass spectrometry was used for the qualitative and quantitative determination of 86 kinds of VOCs.Results Totally,32 and 28 kinds of VOCs were detected in the water supply systems from the Huangpu River and Qingcaosha reservoir,among which 19 and 21 pollutants were priority-controlled by the US EPA,and 18 and 14 species have the national standard in China separately.The concentration of detected pollutants ranged from 0.04 μg/L to 213μg/L and from 0.04μg/L to 728μg/L,respectively.The pollutants in the supply system of the Huangpu river were at the lower level except for methyl tert-butyl ether (MTBE).The pollutants in the supply system of Qingcaosha reservoir were lower than the national standards in addition to dichloromethane and 1,2-dichloroethane,and with the higher level of Methyl chloride and MTBE.In both water supply systems,halogenated aliphatic hydrocarbons and aromatic compounds were mainly types of VOCs,but there were varied types and quantities of compounds in each water supply system.The halogenated aliphatic hydrocarbons accounted for 37.5％ and 56.2％ of the detected VOCs respectively,while aromatic compounds accounted for 64.3％ and 28.6％.A total of 5 disinfection by-products (DBP) were detected in both water supply systems,but the concentrations of dichloromethane,chloroform,bromodichloromethane and dibromochloromethane in the Qingcaosha reservoir water supply system were significantly higher than those in the Huangpu River water supply system,except for bromoform.The concentration of the disinfection by-products in order from large to small were in the tap water,factory finished water and source water,while dichloromethane was an exception.Conclusions There were VOC pollutions in both water supply system in Minhang District,including source water,factory finished water and tap water,with different pollution characteristics.Adequate attention should be paid to the pollutants without national standards in the future water quality monitoring work.
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Objective To analyze the basic clinical characteristics,auxiliary diagnostic indexes,bacterial infection spectrum and drug resistance of child urinary tract infection to provide the basis for the prevention,diagnosis and treatment of child UTI.Methods The clinical data in the inpatients with UTI or complicating UTI in our hospital from January 2012 to March 2014 were collected. The repeated strains were excluded.The differences in the pathogens between the patients with complicated UTI and the patients with non-complicated UTI were comprehensively analyzed.Results The onset peak of child UTI for the first time was 0 -0.5 years old.Escherichia coli ,Klebsiella and Pseudomonas aeruginosa are the major pathogens of child UTI,in which 110 strains were Escherichia coli,accounting for 52.9%.The enterobacteriaceae pathogens of UTI had higher sensitivity to carbapenems antibacterial drugs,with the resistance rate of less than 10%;the resistance rate of others detected antibacterial drugs was more than 20%.Con-clusion UTI in the children inpatients of this area has higher drug resistance rate,in the treatment of child UTI,the antibacterial drugs should be rationally used by combining the bacterial drug resistance situation in the local place and the disease severity in or-der to avoid the aggravation of bacterial drug resistance.
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Objective: To evaluate the diagnosis, treatment and prognosis of patients with synchronous primary endometrial and fallopian tube cancers. Methods: The clinical records of four cases of synchronous primary endometrial and fallopian tube cancers from Jiangxi Maternal and Child Health Hospital between October 2008 and October 2013 were reviewed. The follow-up was performed in all patients. The date of last contact was June 30, 2014. Results: The preoperative diagnosis for four cases was endometrial cancer. Two of them underwent extensive abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy and para-aortic lymph node biopsy, and the other two cases underwent extrafascial abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy and para-aortic lymph node biopsy. The postoperative diagnosis for four cases was stage IA endometrioid adenocarcinoma and stage IA/IB fallopian tube adenocarcinoma. Three patients received 1-3 cycles of chemotherapy of docetaxel plus platinum, and one patient didn't receive any chemotherapy. The follow-up time was 38-71 months. All patinets remained tumor-free survival by June 30, 2014. Conclusion: The patients with synchronous primary stage I endometrial cancer and stage I fallopian tube cancer has a good prognosis, and the extensive/extrafascial abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy and para-aortic lymph node biopsy are appropriate surgical procedures for these patients. The necessity of postoperative chemotherapy should be further explored.
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ObjectiveTo investigate the expression and the clinical significance of diacylglycerol kinase α (DGKα) and protein kinase C (PKC) in human hepatocellular carcinoma (HCC).MethodsDGKα and PKC expressions in the samples from 60 pathologically confirmed HCC patients were analyzed by immunohistochemistry. The relationship between DGKo expression and clinical pathology factors was analyzed.ResultsThe expression positive rates of DGKo and PKC were highest in normal liver tissues [90.0％ (9/10) and 100.0％ (10/10)].The positive rates were 81.7 ％ (49/60) and 71.7 ％ (43/60) in HCC tissues,respectively,and were 58.3 ％ (35/60) and 61.7 ％ (37/60) in carcinoma adjacent tissues,respectively.In three liver tissues,the positive rates of DGKα and PKC were significantly different (P ＜0.05).The location of both kinases in hepatocytes translocated from cytoplasm/nucleus to membrane.The expressions of DGKα and PKC were positively correlation(r =0.495, P ＜ 0.05), The DGKα expression was correlated to differentiation type,portal venous tumor thrombus and TNM staging(all P ＜ 0.05).ConclusionDGKa is expressed with high activity in advanced stage and poorly differentiated HCC. It may be promote the pathological process of HCC.
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OBJECTIVE@#To investigate the effect of overexpression of glycosylphosphatidyl-inositol-specific phospholipase D (GPI-PLD) on the biological character of hepatocellular carcinoma cell line HepG2.@*METHODS@#The GPI-PLD gene eukaryon expression vector pcDNA3.1(+)/ GPI-PLD was transiently transfected into HepG2 cell by lipid-media transfection. The untransfected HepG2 and HepG2 transfected with pcDNA3.1(+) were used as controls. After screening with G418, the single clone was obtained. The expression level of GPI-PLD mRNA in HepG2 was identified by reverse transcription polymerase chain reaction (RT-PCR). GPI-PLD activities were analyzed quantitatively by triton-X-114 partition with GPI anchored placental alkaline phosphatase (PLAP) as a substrate. Cell count was used to detect the proliferation of the 3 groups, and complement dependent cytotoxicity (CDC) effects were observed by the staining of trypan blue. Apoptosis cells were analyzed by flow cytometry. Carcinoembryonic antigen (CEA)was detected by enzyme linked immunosorbent assay (ELISA).@*RESULTS@#Compared with HepG2 and pcDNA3.1(+)/HepG2 cell, the levels of GPI-PLD activities and its mRNA from pcDNA3.1(+)/GPI-PLD/HepG2 were increased with almost 2 to 5 times,respectively. The GPI anchored PLAP and CEA released into the medium by GPI-PLD, and the rate of CDC killing on the cells were significantly increased. However, the proliferative capacity was obviously decreased, and the typical apoptosis cells were presented in positive clones and its apoptosis rates were increased significantly.@*CONCLUSION@#The stable cell line with overexpression of GPI-PLD has been constructed. The overexpression of GPI-PLD in these cells increases the sensitivity of these cells to CDC killing and impairs the proliferative capacity of cells, and promotes the apoptosis.
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Humans , Apoptosis , Genetics , Carcinoma, Hepatocellular , Genetics , Pathology , Complement Activation , Genetics , Cytotoxicity, Immunologic , Genetics , Eukaryotic Cells , Metabolism , Genetic Vectors , Genetics , Metabolism , Liver Neoplasms , Genetics , Pathology , Phospholipase D , Genetics , RNA, Messenger , Genetics , Transfection , Tumor Cells, Cultured , Up-RegulationABSTRACT
Objective To compare the efficacy of liver preservation in SX-1 solution,HC-A solution and UW solution in the two-cuff technique orthotopic liver transplantation model in rats.Methods We confected SX-1 solution using of aseptic technique and built up two-cuff technique orthotopie liver transplantation model in rats.The SX-1 solution,UW solution and HC-A solution preserved rats livers in 2 h,8 h and 24 h,then went orthotopic liver transplantation.The various hepatic indices were determined when the rats survived for 6 hours after the operation.Results For the ALT,AST,the SX-1 solution group(2 h,8 h,24 h)and UW solution group went up synchronously,there was no statistical significance,(P＞0.05).Compared with HC-A solution group the SX-1 solution group (2 h,8 h,24 h)has already shown the statistical signifcance(P＜0.05).For the LDH,the SX-1 solution group (2 h,8 h,24 h)and HC-A solution group went up synchronously,there was no statistical significance(P＞0.05).Compared with UW solution group the SX-1 solution group(2 h,8 h,24 h)has already shown the statistical significance(P＜0.05).For the number of liver with bile production,each group didn1 show the statistical significance (P＜0.05).The time of preserving liver increased with the number of liver with bile production reducing.Conclusions Confirmed by the orthotopie liver transplantation model in rat,the SX-1 solution is the same as the UW solution in the indices of hepatic enzymologists.exceeding the HC-A solution.The SX-1 solution is the same as HC-A solution and UW solution in the number of liver with bile production.
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<p><b>OBJECTIVE</b>To develop a questionnaire to evaluate the cooperation of adolescent orthodontic patients.</p><p><b>METHODS</b>182 orthodontic patients (9 - 15 years old, 78 boys and 104 girls) with fixed appliance were selected in Dalian. A questionnaire was developed according to the past research and 4 hypotheses.</p><p><b>RESULTS</b>The scale is made up of 25 items and 4 factors. The reliability of this scale was confirmed (the reliability coefficient > 0.9 and Cronbach alpha coefficient > 0.7).</p><p><b>CONCLUSION</b>The questionnaire may be used to evaluate the cooperation of orthodontic patients.</p>
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Adolescent , Child , Female , Humans , Male , Factor Analysis, Statistical , Malocclusion , Therapeutics , Orthodontics, Corrective , Psychology , Surveys and QuestionnairesABSTRACT
Objective To evaluate the influential factors of iron acquisition during Francisella tularensis LVS infection of mouse macrophages.Methods F.tularensis LVS expressing green fluorescent protein was used to infect murine macrophage J774A.1 cells.Transferrin receptor 1(Tfr1)was detected with mono-antibody and visualized with a goat-anti mouse IgG conjugated to Alexa 594.The expression profile of 5 iron metabolism related genes of J774A.1 murine macrophages uninfected or infected with F.tularensis LVS was determined with real-time PCR.Immunoblot analysis was used to compare the Tfr1 expression of live Francisella infected macrophage with dead bacteria.Tfr1 knock-off in J774A.1 cells was performed with siRNA.The transfected cells were infected with Francisella for immunoblotting and microscopy and infection assay.Results It was revealed that the live vaccine strain of F.tularensis induced the expression of Tfr1 in host macrophages.Gene expression analysis indicated that F.tularensis LVS drove an active iron acquisition program with induction of Tfr1 and iron regulatory proteins(Irp1 and Irp2).It was shown by Western-blotting that the siRNA-Tfrc-1 could knock off about 75% of Tfr1 in J774A.1 cells.It was determined by infection assay that,Tfr1 was knocked off,the bacteria number at 1h infection with Francisella was not different from that of control(F=1.06,P=0.326 5),while it was decreased significantly after 24h of infection(F=24.12,P=0.000 6).Conclusions It is demonstrated that upregulation of the Tfr1 may be mediated by post-transcriptional regulation during early infection,but sustained later through increased expression of Irp 1 and Irp 2.Increased expression of Tfr1 expands the intracellular iron pool through transferrin-mediated delivery and may thus be readily available for uptaking by Francisella.Knocking off the expression of Tfr1 does not affect bacterial invasion.Francisella,however,may fail to proliferate in macrophages in which the expression of transferrin receptor has been suppressed.
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Objective To evaluate the safety of a surgical appwach for transabdominal cardial carci- noma.Methods We retrospectively analyzed 326 patients undergoing transabdominal esophagastrostomy or esophagojejunostomy from 1998 to 2006 via the EEA(end-to-end anastomosis)stapler.Results By the surgi- cal approach for transabdominal cardial carcinoma,the average length of reseete esophagus above the carci- noma was about 6～8 cm realized the low average of remnant carcinoma at the margin and operation mortality and anastomotic leakage,which was lower than those in the thoraeotomy appmaeh significantly.Conclusion The transabdominal approach makes a clear operative field in posterio-inferior mediastinum,it is beneficial for radical resection of eardial carcinoma and intramediastinal esophagogastric or esophagojejunal mechanical anastomosis,and it fits to the old,the weakening and with the disease of heart and lung.