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One hundred and thirty patients with esophageal carcinoma were randomly asigned into two groups:62 cases received thoracoscopic esophagectomy (TE group) and 68 cases received open thoracic esophagectomy group (OE group).All patients underwent lymph nodes dissection along bilateral recurrent laryngeal nerve.Compared with OE group,TE group had a less blood loss during the lymph nodes dissection (P ＜ 0.05) and a lower incidence of pulmonary infection (P ＜ 0.05).There were no significant differences in the number of dissected lymph nodes,dissection time,incidence of temporary hoarseness,permanent hoarseness and mechanical ventilation for respiratory failure between two groups (P ＞ 0.05).The study suggests that lymph nodes dissection along bilateral recurrent laryngeal nerve can be succesfully completed by thoracoscopic esophagestomy,and it has the advantage of less intraoperative blood loss and lower incidence of pulmonary infection,compared to open thoracic surgery.
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Objective To explore the clinical characteristics of IgG4-related disease (IgG4-RD) in Chinese by detailed clinicopathological and laboratory assessments.Methods The baseline features of 36 patients with biopsy-proven disease were reviewed.The diagnosis was confirmed by pathology review according to consensus diagnostic criteria and clinicopathologic correlation.Disease activity and damage were assessed by the IgG4-RD responder index (RI).Results Thirty (83.3％) of the patients were male,while six were female,and the average age of onset was 65.1 years.All of the 36 patients had active disease,in which submandibular gland,lymph nodes,retroperitoneal tissue were the most common affected organs in this group of patients.Among 36 patients,77.7％ had elevated serum IgG4 concentrations and 44.4％ had hypocomplementemia.Patients with elevated serum IgG4 had a higher RI,a greater number of organs involved (P ＜ 0.01 for all comparisons).The correlation between serum IgG4 level and RI (r=0.737,P ＜ 0.01) was stronger than IgG,ESR,CRP and serum complement levels.The incidence of hypocomplementemia in IgG4-RD patients with renal involvement was higher than that in IgG4-RD patients with other organs involvement (P ＜ 0.01).Twenty-eight patients received glucocorticoids therapy,and had lower RI and serum IgG4 concentration after therapy (P ＜ 0.05).Conclusions Both IgG4-RD RI and IgG4 concentration may be regarded as assessment markers of disease activity and therapeutic effect of IgG4-RD.The diagnosis of IgG4-RD should be supported by histopathology and clinical features.
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Objective To evaluate the application of preoperative CT-guided Hook-wire localization of pulmonary nodules in thoracoscopic lobectomy of lung.Method Twenty eight patients with 31 pulmonary nodules of ground-glass opacity (GGO) detected by CT scan were admitted in our hospital from December 2008 to December 2013,including 17 males and 11 females with an average age of 55.The lesions were located by CT-guided Hook-wire technique,and lobectomy plus lymphadenectomy or pulmonary wedge resection were performed according to the results of fast frozen pathology.The characteristics of pulmonary nodules and general condition of the patients were analyzed.Results Among 31 nodules,19 were malignant and 12 benign with an average size of (1.8 ± 0.6) cm and thickness of (1.2-± 0.4) cm.The vertical distance from pleural to nodules was (1.5 ± 0.7) cm and the insert depth of needle was (2.5 ± 0.9) cm.The time for CT-guided Hook-wire localization was (16.5 ± 5.2) min.The operation time for pulmonary wedge resection and pulmonary lobectomy was (18.5 ± 5.5) min and (54.7 ± 12.5) min,respectively.Intraoperative frozen section showed malignant tumors in 18 patients (19 GGO nodules),lobectomy plus lymphadenectomy were performed in 16 cases; 2 patients did not undergo pulmonary lobectomy because of poor physical condition or 2 GGO nodules in different lobes.There were no operation complications in this series.Postoperative pathologic findings of 31 nodules showed 9 cases of adenocarcinoma,10 bronchioloalveolar carcinoma,5 atypical adenomatous hyperplasia,2 epithelioid hemangioendothelioma,2 chronic inflammation,1 hamartoma,1 inflammatory pseudotumor and 1 sarcoidosis.The average postoperative hospital stay was (6.6 ± 1.9) days.Conclusions Endoscopic resection of pulmonary GGO nodules with CT-guided Hook-wire localization technique is feasible and safe,with less complications and less time consuming.
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Objective The stentless full root aortic bioprosthesis has superior hemodynamics.Clinical data of Bio-Bentall procedure using stentless full root bioprosthesis of our center was retrospectively analyzed in this perspective for validation.Methods From November 2001 to March 2009,317 adult patients ( 196 male and 121 female) underwent modified Bio-Bentall procedure using the Medtronic Freestyle xenograft as a full root replacement.Two hundred and three patients received an isolated root replacement or a root and ascending aortic replacement (ARR).In 114 patients a variety of concomitant procedures including coronary artery bypass grafting ( n =32 ),mitral valve repair ( n =11 ) and aortic arch replacement ( n =36 ) were performed.(ARR + ).Results Mean patient age was (70.3 ± 10.2) years (range 17 -94 years),97 patients were 75 and older at time of procedure.Mean operative time for the ARR was ( 190 ± 57 ) min with a clamp time of 88 - 27 min.Mean operative time for ARR + group was (282 ±93) min with an average clamp time of (110 ±32) min.Overall operative mortality was 7.9％ (25/317),for ARR it was 5.4％ (11/203 ).Mean ICU stay was (4.9 ± 8.1 ) days,mean hospital stay being (9.8 ± 8.1 ) days.Necessity for bailout bypass surgery among patients with ARR was low at 1.5％ (3/203) comparable to stented xenograft implantations.Echocardiography demonstrated excellent clinical results with low transvalvular gradients especially when a single suture inflow anastomosis technique was used.Conclusion Full root stentless valve implantation preserving porcine root integrity is a valuable option in aortic valve/ascending aorta surgery.Though technically a more challenging operation,it does not lead to increased perioperative morbidity and mortality and can be beneficial mainly for elderly patients with small aortic roots with or without aortic root pathology.
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A total of 850 patients undergoing the 3-field esophagectomy were retrospectively recruited and divided into tubular stomach reconstruction group (n =453) and whole stomach reconstruction group (n =397).They underwent esophagectomy through right thorax,left cervical part,abdominal triple incisions and esophageal reconstruction by hand-sewn two-layer anastomosis.In comparison with whole stomach,esophageal reconstruction with tubular stomach had a lower incidence of anastomotic leakage,less manifestation of intrathoracic syndrome and less occurrence of reflux esophagitis (P ＜ 0.05).However,the incidence of anastomotic stricture showed no significant difference between two groups (P ＞ 0.05).It suggests that,for esophageal cancer patients undergoing the 3-field esophagectomy,tubular stomach is better than whole stomach for esophageal reconstruction as reflected by reduced occurrences of postoperative anastomotic leakage,intrathoracic syndrome and reflux esophagitis.
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Objective To summarize the experience in the diagnosis and surgical treatment of pulmonary sequestration. Method The clinical data from 15 patients with pulmonary sequestration underwent surgical operation from July 2000 to January 2009 were reviewed and analyzed retrospectively. Results Pulmonary sequestration was diagnosed in 14 patients before the operation with the diagnosis rate of 93.33% (14 /15).Preoperation plane and contrast chest CT scan were performed in all cases,and 9 patients performed angiography reconstruction. Twelve patients with intralobar sequestration underwent lobectomy and 3 patients with extralobular sequestration underwent local lesion resection. Abnormal supply arteries were intraoperatively found in 14 patients originating from the thoracic main artery, 1 patient from the eeliac artery. Smooth recovery was achieved in all patients. No perioperarive death occurred. Conclusions Pulmonary sequestration is a rare disease with high misdiagnosis rate in some patients. Contrast enhanced CT scan and angiography may improve the diagnosis of pulmonary sequestration. Operation is a safe and effective method for the treatment of pulmonary sequestration.
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This study retrospectively analyzed 7 patients with severe pectus excavatum who underwent thoracoscope-assistant Nuss procedure from July 2006 to June 2008.All the participants were followed up for 1 to 24 months(mean,15.7 months).No intraoperative or postoperative complications were found in any of the patients.The operating time was 40 to 55 minutes.Mean hospital stay was 5 days (range,4 to 7days).Our experience with the minimally invasive repair of pectus excavatum might be encouraging.thoracoscope-assistant Nuss could effectively treat pectus excavatum in children,associated with minimal invasion,lower morbidity,less hospital stay,and considerable improvement in physiologic and psychological function.