Surgical repair of early bronchopleural fistula after pulmonary resection / 中华胸心血管外科杂志

Objective Bronchopleural fistula (BPF) is a common but potentially lethal complication after pulmonary resection.Currently,there is still controversy over the appropriate management strategy for BPF,especially when pleural space contamination develops.The purpose of this study was to evaluate the efficacy and safety of surgical repair fistulas combined with pedicled muscle flaps coverage in patients with early BPF after pulmonary resection based on our experience with 23 cases.Methods The clinical data for 23 patients who underwent surgical repair of early BPF from January 1999 to December 2010 at our hospital were reviewed.Thirteen patients had undergone a prior pneumonectomy and 10 patients had undergone a prior lobectomy.BPF occurred from postoperative day 5 to40 (mean postoperative day 21 ).Nine patients had a contaminated pleural space.After BPF was clearly diagnosed,prompt closed pleural drainage was instituted,followed by surgical repair of BPF.Four patients underwent a direct suture repair of fistula,ten patients underwent stump revision and suture closure,seven patients underwent stump revision and bronchoplasty or carina plasty,and a pedicled muscle flap was sewn to the edges of the fistula in two patients.The stump was covered with various muscle flaps,including interostal muscle flap in five cases,latissimus dorsi muscle flap in ten cases,serratus anterior muscle flap in six cases,and erector spinae muscle flap in two cases.Postoperatively,the pleural space was routinely irrigated and drained.Results No intraoperative or early postoperative death occurred.Four patients developed severs complications,including respiratory failure in two cases,pulmonary embolism in one case,and empyema in one case.All four cases recovered well after treatment.The mean duration of hospitalization was 33 days (range 8 - 120 days ).Surgical repair of BPF was successful in 21 cases (91.3％) but failed for 2 patients..BPF recurrence developed in only one patient two years postoperatively due to stump recurrence.He died of extensive metastatic disease 2 years after BPF recurrence.Conclusion Excellent results can be achieved by early surgical repair combined with stump pedicled muscle flaps coverage in patients with BPF who can tolerate reoperation,even if they have a contaminaled pleural space.

Regulation of Acupuncture on Interferon-γ and Tumor Necrosis Factor of Lung Cancer-Operative Cases / 针灸推拿医学（英文版）

Objective:To investigate the regulation of acupuncture on γ-interferon (INF-γ) and tumor necrosis factor (TNF) of lung cancer-operative cases. Methods: to determine the INF-γ and TNF contents in the blood serum of lung cancer patients by double antibody sandwich immuno-enzymatic method (ELISA); to measure the INF-γ and TNF contents of 30 lung cancer patients in the acupuncture anesthesia group and 30 lung cancer patients in general anesthesia group before the operation and at the 8th days, the 12th day after the operation respectively and make comparison between the two groups. Results:The pre-operation INF-γ contents of the two groups showed no significant difference (P＞0.05); the post-operation INF-γ contents of the two groups showed significant difference at 8th day and 12th day after the operation (P＜0.05); the acupuncture anesthesia group was superior to the general anesthesia group; the self-comparison of the anesthesia group showed significant difference at the 12th day and 8th day after the operation (P＜0.05); the pre-operation TNF contents of the two groups showed no significant difference (P＞0.05) and the post-operation TNF contents of the two groups showed significant difference at the 8th day and 12th day after the operation (P＜0.05). Conclusion:Acupuncture can increase the serum INF-γ and TNF contents of lung cancer patients and therefore regulate the immunity of the patients.

Tracheal and carinal resection and reconstruction in the treatment of lung cancer / 中国肺癌杂志

<p><b>BACKGROUND</b>Tracheal and carinal resection and reconstruction is an important way in treatment of lung cancer invading trachea and carina. The aim of this study is to summarize the method and effect of tracheal and carinal resection and reconstruction in treatment of lung cancer.</p><p><b>METHODS</b>Seventy-three patients with lung cancer who underwent tracheal and carinal resection and reconstruction were retrospectively analyzed. There were 22 cases for right pneumonectomy and carinal resection, 14 cases for right pneumonectomy and tracheobronchoplastic procedure, 12 cases for right sleeve pneumonectomy, 15 cases for tracheobronchoplastic procedure plus right upper lobectomy, 2 cases for left sleeve pneumonectomy and 8 cases for left pneumonectomy and tracheobronchoplastic procedure.</p><p><b>RESULTS</b>Four cases received palliative operation. Four patients (5.48%) died in the perioperative period. The 1-, 3-and 5-year survival rate was 75.3%, 63.0% and 23.3% respectively.</p><p><b>CONCLUSIONS</b>Careful preoperative assessment, skillful operation and appropriate postoperative treatment are helpful to improve the outcome of tracheal and carinal resection and reconstruction for lung cancer.</p>

Bronchoplasty and pulmonary artery reconstruction in the treatment of central type lung cancer / 中国肺癌杂志

<p><b>BACKGROUND</b>To investigate the effectiveness and the surgical experience of bronchoplasty and pulmonary artery reconstruction in the treatment of central type lung cancer.</p><p><b>METHODS</b>From January, 1996 to May, 2000, 78 patients with central type lung cancer underwent bronchoplasty and pulmoanry artery reconstruction in the treatment of central type lung cancer. According to P-TNM classification, 5 patients were in stage IIB, 69 in stage IIIA and 4 in stage IIIB. The surgical procedures included bronchoplasty and pulmonary artery reconstruction in the left lung in 53 cases, bronchoplasty and pulmonary artery reconstruction in the right lung in 25 cases. A combination of comprehensive therapy including radiotherapy and chemotherapy was carried out postoperatively. The postoperative follow-up ranged from 24 months to 78 months.</p><p><b>RESULTS</b>There was one postoperative death resulting from respiratory infection and failure (1.3%, 1/78). The postoperative complication included pulmonary infection (6.4%) and atelectasis (7.7%). The overall 1, 3 and 5-year survival rates were 81.5%, 47.6% and 33.2% respectively.</p><p><b>CONCLUSIONS</b>The results suggest that bronchoplasty and pulmonary artery reconstruction for the patients with central type lung cancer is a safe and effective surgical technique, as alternative to pneumonectomy. This method ensures more radical resection of central type lung cancer, and extends the surgery indications to patients with poor lung function and senility by reducing the ratio of pneumonectomy and improving postoperative quality of life. Therefore, it is clinically valuable.</p>