Comparison of the Effects of Propofol and Sevoflurane on the Plasma TXB2,ET-1 and D-D Levels of Patients Underwent Posterior Retroperitoneal Laparoscopic Surgery / 现代生物医学进展

Objective:To compare the effects ofpropofol and sevoflurane on the plasma thromboxane B2 (TXB2),endothelin-1 (ET-1) and D-dimer (D-D) levels of patients underwent posterior retroperitoneal laparoscopic surgery.Methods:84 cases of patients underwent post retroperitoneal laparoscopic surgery in our hospital from May 2015 to December 2016 were selected as research objectives and randomly divided into two groups with 42 cases in each group.The same anesthesia induction were provided for two groups,the observation group was given 2％～3％ sevoflurane for continuous inhalation,while the control group was given 4～12 mg/(kg·h) of propofol for continuous injection by pump.Both groups received remifentanil 10 μg/ (kg ·h) target-controlled infusion simultaneously.The levels of plasma TXB2,ET-1 and D-D in the two groups were measured after anesthesia induction (T0),at 0.5 h (T1),1 h (T2),1.5 h (T3) after pneumoperitoneum.Meanwhile,the anesthetic effects and adverse reactions were compared between two groups.Results:The time of consciousness disappearence,time of tracheal intubation,spontaneous breathing recovery time,eye opening time,verbal response time,orientation recovery time and extubation time of observation group were significantly shorter than those of the control group (P＜0.01).No significant difference was found in the occurrence of adverse reactions between two groups (P＞0.05).The plasma TXB2,ET-1 and D-D levels of both groups were gradually increased at T1,T2 and T3,and all were significantly higher than that at T0 (P＜0.01).The plsma TXB2,ET-1 and D-D levels at T1,T2 and T3 of observation group were significantly lower than those of the control group at same time (P＜0.01).Conclusion:Posterior laparoscopic surgery could cause different degrees of hypercoagulability of blood.Compared with propofol,sevoflurane could effectively inhibit the release of TXB2,ET-1 and D-D in anesthesia after retroperitoneal laparoscopic anesthesia,and play a better role of anticoagulation.

Clinical features and risk factors of anastomotic leakage after radical esophagectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the clinical features and risk factors of anastomotic leakage after radical esophagectomy of esophageal carcinoma.</p><p><b>METHODS</b>The clinical data of 547 esophageal cancer patients underwent radical esophagectomy in Tianjin Medical University Cancer Hospital from January 2012 to December 2013 was analyzed retrospectively. There were 421 male and 126 female patients, with a median age of 65 years (ranging from 29 to 82 years). There were 155 cases of upper esophageal carcinoma, 340 cases of middle esophageal carcinoma and 52 cases of lower esophageal carcinoma. The surgical procedures included 41 cases completed through Sweet, 145 cases completed through McKeown, 279 cases completed through Ivor Lewis, 82 cases completed through minimally invasive esophagectomy. Moreover, 24 of 547 cases underwent preoperative neoadjuvant radiochemotherapy. χ² test and Cox's proportional hazards regression model were used for univariate analysis and multivariate analysis of the risk factors of postoperative anastomotic leakage.</p><p><b>RESULTS</b>Twenty-seven of 547 cases with esophagectomy occurred anastomotic leakage and the incidence rate was 4.94% (27/547). One of 27 cases died and the mortality rate was 3.70% (1/27). The time of anastomotic leakage found was 4 to 45 days, with a median time of 10 days. There were 0 case of early leakage, 20 cases of mid-term leakage, 7 cases of late leakage. Three of 27 cases with anastomotic leakage had tracheoesophageal fistula, while 3 cases had contralateral pleural fistula. As to the incidence rate of anastomotic leakage, there was statistically significant difference between cervical anastomotic leakage (8.14%, 18/221) and intrathoracic anastomotic leakage (2.76%, 9/326) (χ² =7.41, P=0.000), among Sweet (4.88%, 2/41), McKeown (9.66%, 14/145), Ivor Lewis (2.51%, 7/279) and MIE (4.88%, 4/82) (χ² =21.48, P=0.000), and between with (16.67%, 4/24) and without (4.40%, 23/523) neoadjuvant radiochemotherapy (χ² =9.20, P=0.000). The multivariate analysis showed that anastomotic site (HR=2.594, P=0.048), surgical approach (HR=5.689, P=0.003) and preoperative neoadjuvant radiochemotherapy (HR=3.604, P=0.027) are independent risk factors for anastomotic leakage after esophagectomy.</p><p><b>CONCLUSIONS</b>The mid-term anastomotic leakage after esophagectomy occurs higher. McKeown is a main surgical procedure and neoadjuvant radiochemotherapy is an important factor for the anastomotic leakage.</p>

Comparative analysis of sleeve resection and pneumonectomy for lung cancer / 中国肺癌杂志

<p><b>BACKGROUND</b>Sleeve recestion for lung cancer can get similar tumor and lymph node resection rate as pneumonectomy, with less influence on pulmonary function and much improvement of quality of life. The aim of this study is to compare the 5-year survival and complications of sleeve resection and pneumonectomy for lung cancer.</p><p><b>METHODS</b>Survival analysis was used to investigate the 5-year survival of 173 patients undergoing sleeve resection and 435 patients undergoing pneumonectomy from January 1990 to December 2000. Their complication and perioperative motality were also analyzed.</p><p><b>RESULTS</b>The overall 5-year survival for sleeve resection and pneumonectomy was 42.3% and 30.9%, respectively (P=0.007). 5-year survival of right lung sleeve resection was better than that of left lung [P=0.004 (N0), 0.025 (N1), 0.042 (N2)]. In left lung cancer patients without nodal involvement, the survival after sleeve resection was better than that after pneumonectomy. There was no survival difference between N1 and N2 lung cancer patients. Survival was not significantly different for bronchoplasty and pulmonary arterioplasty and pneumonectomy. The incidence rate of pneumonia and arrhythmia for sleeve resection was less than those for pneumonectomy (P=0.0019), and no significant difference of mortality was observed between the two groups.</p><p><b>CONCLUSIONS</b>In lung cancer patients suitable for sleeve resection or pneumonectomy, sleeve resection should be performed for right lung cancer and left lung cancer of stage I. Bronchoplasty and pulmonary arterioplasty don't prolong the survival of lung cancer patients compared with pneumonectomy.</p>

Guideline of surgical practice for non-small cell lung cancer based staging / 中国肺癌杂志

The clinical evidences of the guideline came from clinical trials based evidence-based medicine. Applied principle of the evidence was: systematic reviews, RCTs, the results from multiple factors ana-lysis, consensus, especially combined with Chinese experience and some lung cancer guidelines used in USA or Europe. All doctors who use the guideline in making therapeutic strategy must combine patients' conditions with the knowledge of biological behavior, dynamic change and response to treatment of lung cancer.

Clinical analysis of the characteristics of thoracic lymph node metastasis in lung cancer: A report of 318 cases / 中国肺癌杂志

<p><b>BACKGROUND</b>To investigate the clinical characteristics of thoracic lymph node metastasis in lung cancer.</p><p><b>METHODS</b>Three hundred and eighteen patients with lung cancer underwent pneumonectomy or lobectomy and lymphadenectomy from Jan 2000 to Jan 2002.</p><p><b>RESULTS</b>A total of 1534 groups of lymph nodes were removed. Metastatic frequency of thoracic lymph nodes was 58.5% (186/318), in which N1 was 27.0% (86/318), N2 was 31.4% (100/318). There were higher frequencies of lymph node metastasis in 4, 7, 10, 11 regions around the root of lung. Among the skipping N2 metastasis (14.5%, 46/318), upper lobe cancer led to only upper mediastinal lymph node metastasis, however, lower or right middle lobe cancer caused both upper and lower mediastinal lymph node metastasis. Of the patients with swelling hilar and mediastinal lymph nodes reported by preoperative CT scan, only 48.2% were confirmed with lymph node metastasis by postoperative histopathology; while 22.4% of the patients with normal size lymph nodes had lymph node metastasis.</p><p><b>CONCLUSIONS</b>If there is no hilar and inferior carinal metastatic lymph node in patients with upper lobe cancer, the lower mediastinal lymph node dissection might not be necessary. But systematic mediastinal lymph node dissection should be performed in patients with lower lobe or right middle lobe cancer whether there is hilar or inferior carinal metastatic lymph node or not. The extent of lymph node dissection should not depend on the results of preoperative chest CT scan.</p>