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Objective:To investigate the clinical application of Grunenwald incision in cervicothoracic junction surgery.Methods:The clinical data of 25 patients with cervicothoracic junction tumor and 1 patient with cervicothoracic junction trauma in the single treatment group of Department of Thoracic Surgery, the Fourth Hospital of Hebei Medical University from December 2011 to September 2021 were analyzed retrospectively, including 19 males and 7 females, aged 9-73 years old. Among the 26 patients, there were 9 cases of upper mediastinal tumor, 6 cases of superior sulcus tumor, 4 cases of thyroid tumor invading the upper mediastinal, 4 cases of chest wall tumor, 2 cases of esophageal cancer combined with supraclavicular lymph node metastasis, and 1 case of foreign body penetrating injury at the cervicothoracic junction. Grunenwald incision or additional posterolateral thoracic incision, median sternal incision, neck collar incision were used in all patients. The degree of tumor resection was evaluated. The operation time, intraoperative blood loss, length of hospital stay were observed, and the postoperative follow-up was analyzed.Results:There was no perioperative death in the whole group. 14 cases were treated with Grunenwald incision alone, 6 cases with additional posterolateral chest incision, 4 cases with additional neck collar incision, and 2 cases with additional median sternal incision. The tumors were completely resection in 22 cases, palliative tumor resection in 3 cases, and complete foreign body removal in 1 case. Postoperative pathology included 4 cases of schwannoma; 3 cases of lung adenocarcinoma, thyroid cancer and myofibroblastoma, respectively; 2 cases of supraclavicular lymph node metastasis of esophageal cancer and lung squamous carcinoma, respectively; 1 case of large cell neuroendocrine carcinoma, metastatic carcinoma of the first rib after lung squamous cell carcinoma, ganglioneuroma, nodular goiter, hemangioma, well differentiated liposarcoma, vascular endothelial tumor and cavernous angioma, respectively. The operation time was 120-430 min, with a mean of(226.92±88.40)min. The intraoperative blood loss was 100-1 000 ml, with a mean of(273.46±196.34)ml. The length of hospital stay was 6-26 days, with a mean of(12.73±4.46 )days. 26 patients were followed up for 6-130 months, with a mean of(57.88±43.64) months. During the follow-up period, 6 patients died.Conclusion:Grunenwald incision can provide good exposure of the structures near the cervicothoracic junction, preserve the integrity of sternoclavicular joint, reduce shoulder deformity, and has advantages for patients with cervicothoracic junction tumors, high rib resection, and cervicothoracic junction trauma.
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Objective To analysis the short-term quality of life and clinical outcome of early enteral immunonutrition(EIN)used after operation in patients with totally endoscopic esophagectomy.Methods This randomized controlled trial enrolled 110 patients receiving totally endoscopic esophagectomy in department of thoracic surgery of the fourth hospital of Hebei medical university between May 2015 and November 2016.The patients were randomly divided into enteral immunonutrition group (EIN group,n =56) and parenteral nutrition group (PN group,n=54).The scale scores of quality of life,the time of first postoperative anal exhaust,the time of removal of drainage tube,the number of postoperative infections and the length of hospitalization were compared between the two groups before operation and after operation.Results (1) There were no significant differences in age,gender,education,marital status,tumor location,clinical stage,intraoperative bleeding between the two groups (P＞0.05).(2) There were no significant differences in the quality of life before operation (P＞0.05);All functional scale scores of EIN group were significantly higher than PN group (P＜0.05),while the symptom scale score were significantly lower than PN group(P＜0.05).(3) There were significant differences in the time of first postoperative anal exhaust,the time of removal of drainage tube,the number of postoperative pneumonia compliCations and the length ofhospitalization in the two groups (P＜ 0.05).There was no significant difference in the incidence of anastomotic fistula between the two groups(x2=0.621,P=0.431 4) The scale scores of quality of life (the overall health status as the representative) had a negatively linear relationship with the clinical outcome(P =0.000),the absolute value of correlation coefficient in EIN group was higher than that in PN group.The higher score of the quality of life,the shorter time of the postoperative anal exhaust,removal of drainage tube and the length of hospitalization.Conclusion Enteral immunonutrition can improve the quality of life,improve the prognosis and promote the rapid recovery of patients with totally endoscopic esophagectomy.
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<p><b>OBJECTIVE</b>To evaluate the feasibility of right neck anastomosis in thoracoscopic and laparoscopic esophagectomy.</p><p><b>METHODS</b>This study used a retrospective cohort study method. Clinical data of 169 patients with stage I-III esophageal squamous cell carcinoma undergoing neck anastomosis in thoracoscopic and laparoscopic esophagectomy at the Department 5 of Thoracic Surgery, the Fourth Hospital of Hebei Medical University from November 2013 to October 2016 were retrospectively analyzed. Eighty-two cases underwent right neck anastomosis (right neck anastomosis group) and 87 cases underwent left neck anastomosis(left neck anastomosis group). Both groups underwent routine thoracoscopic and laparoscopic radical resection of esophageal cancer. The entry of right and left neck anastomosis group was at the anterior edge of the right and left sternocleidomastoid muscle respectively. Anastomosis of the esophagogastric junction was performed and the drainage tube was placed in the neck incision. The operation time, intraoperative blood loss, lymph node dissection and morbidity of postoperative complications were compared between the two groups.</p><p><b>RESULTS</b>There were 101 males and 68 females among 169 patients with esophageal cancer. There were no significant differences in age, gender, tumor location, clinical stage between two groups(all P>0.05). The total operation time of left and right neck anastomosis groups was (278.3±39.4) minutes and (287.8±39.4) minutes, respectively (t=1.563, P=0.120). The intraoperative blood loss was (134.9±71.5) ml and(147.9±85.5) ml, respectively (t=1.074, P=0.284). The number of lymph node dissections was (17.45±5.68) and (16.47±4.98), respectively (t=1.190, P=0.236). Seventeen cases(20.7%) in the right neck anastomosis group developed postoperative complications, while 31 cases (35.6%) in the left neck anastomosis group developed postoperative complications (χ²=4.609,P=0.032). Compared with left neck anastomosis group, right neck anastomosis group had lower rate of gastric emptying disorder (0% vs. 6.9%, P=0.029), anastomotic fistula (7.3% vs. 18.4%, χ²=4.572, P=0.033), pneumonia (18.3% vs. 32.2%, χ²=4.294, P=0.038) and ICU management (4.9% vs. 16.1%, χ²=4.726, P=0.030).</p><p><b>CONCLUSION</b>Thoracoscopic and laparoscopic esophagectomy with right neck anastomosis is safe and effective, can completely remove the tumor, at the same time, has less complications than left neck anastomosis, and improve the quality of life.</p>
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Female , Humans , Male , Anastomosis, Surgical , Esophageal Neoplasms , General Surgery , Esophagectomy , Laparoscopy , Lymph Node Excision , Postoperative Complications , Quality of Life , Retrospective Studies , ThoracoscopyABSTRACT
OBJECTIVE:To observe the clinical efficacy of taxol combined with cisplatin neoadjuvant chemotherapy in the treatment of esophageal cancer and effects on serum tumor markers in patients with esophageal cancer. METHODS:100 patients with esophageal cancer were randomly divided into control group(50 cases) and observation group(50 cases). Observation group was given taxol+Cisplatin injection(TP)neoadjuvant chemotherapy,given 175 mg/m2 taxol by intravenous infusion,d1-5. And ev-ery 5 d was a treatment course,the regimen was adjusted based on patients’efficacy;control group was given conventional sur-gery and TP after surgery,the same usage and dosage as observation group,it lasted for 4 courses. Clinical efficacy,high mobility protein B1(HMGB1),carcinoembryonic antigen (CEA) and squamous cell carcinoma antigen (SCC-Ag) level in 2 groups before and after treatment were observed,objective response rate,disease control rate,the incidence of toxicity and severe toxicity,inci-dence of postoperative complications and survival rate of postoperative 1,3 and 5 years were recorded. RESULTS:After treatment, objective response rate in observation group was significantly higher than control group,HMGB1,CEA and SCC-Ag levels were significantly lower than before and control group,HMGB1 and CEA levels in control group were significantly lower than before, the differences were statistically significant(P0.05). CONCLUSIONS:Taxol combined with cisplatin neoadjuvant chemotherapy can significantly improve the efficacy of patients with esophageal cancer and reduce the levels of cancer-related indicators,with good safety.
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Objective To investigate the effect of synchronous chemotherapy combined with spleen polypeptide on immune function in patients with esophageal cancer and cardiac cancer after operation. Methods Sixty postoperative patients of esophageal and esophagogastric junction carcinoma were collected in the Fourth Hospital of Hebei Medical Universitythe from March 2013 to January 2014,and were randomly divided into two groups,including 30 cases were treated with simple chemotherapy as control group,and the other 30 cases were treated with chemotherapy combined with lineal polypeptides as experimental group. Results There were no significant differences in terms of CD3,CD4 and CD4/CD8 between the two groups before operation( P>0. 05) . After two cycles of chemotherapy,the CD3,CD4,CD4/CD8 of experimental group were all significantly higher than the control group((76. 08±8. 04)% vs. (38. 58±6. 40)%,(42. 91±7. 73)% vs. (42. 91±7. 73)%,1. 31 ±0. 21 vs. 1. 16±0. 22),and the differences were significant(P=0. 037,0. 022,0. 008). The survival quality of the experimental group was better than that of the control group ( P=0. 038 ) . The proportion of patients with WBC in the normal range of the experimental group was significantly higher than that in the control group (80. 0% vs. 53. 3%,P=0. 028). The adverse reactions of the digestive system in the experimental group were lower than those in the control group, the difference was statistically significant between the two groups ( acid reflux and heartburn:26. 7% vs. 63. 3%,P=0. 004;nausea and vomiting:33. 3% vs. 73. 3%,P=0. 002;loss of appetite:46. 7% vs. 80. 0%,P=0. 007) . Conclusion The treatment of the patients with esophageal cancer and cardiac cancer after chemotherapy with spleen peptides can improve immunity,and improve the quality of life of patients after chemotherapy and chemotherapy.
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Objective To explore the dynamic changes of serum HMGB1, CEA and SCC as well as the value in the evaluation of prognosis of patients with esophageal squamous cell carcinoma resection. Methods The dynamic changes in serum levels of HMGB1, CEA and SCC were measured respectively in 100 patients preopera-tively as well as a month after esophagectomy. The relationships between the changes of serum tumor markers and the clinical efficacy were analyzed. Results The 5-years survival rate of the CEA, SCC and HMGB1 negative peo-ple before operation was significantly higher than that of the positive patients (P < 0.05). The 5-years survival rate of those patients with all three markers negative before operation was significantly higher than that of those patients with the three markers positive (P < 0.01). The Median Survive Time of the patients with the levels of all three markers decreased after operation was longer than those with the levels of all the three markers increased (χ2 =6.584, P=0.01). The Median Survive Time of the patients with levels of the three markers decreased by more than 50%was longer than those with the levels decreased by less than 50% (χ2=5.418, P = 0.02). Conclusions The dynamic and combined detections of serum HMGB1, CEA, SCC in patients with esophageal squamous cell carcino-ma resection can effectively evaluate the therapeutic effect and prognosis.
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Objective To investigate the efficacy of heart value replacement on elderly patients and summarize the experience of surgical treatment.Methods The clinical data and follow-up status of 76 elderly patients were analyzed retrospectively in our hospital from January 2008 to December 2011.The operative method,general effect,postoperative death,postoperative complications,survival rate and life quality followed-up were analyzed.Results No intraoperative death appeared and there were 4 early operative deaths with a mortality rate of 5.3％.There were 31 cases occurred postoperative complication with a complication rate of 40.8％ which including respiratory insufficiency,lung infection,arrhythmia,incision infection,pleural effusion,low cardiac output syndrome and renal insufficiency.The follow-up time was 18-52 months and the mean follow-up time was (24.7± 3.6)months.There were 5 cases lost of follow up and the follow-up rate was 93.4％.There were 6 patients died after a month postoperative with a mortality rate of 7.9％.The heart function of the survivors achieved differed degree improvements and the result at the end of follow-up were grade Ⅰ-Ⅱ 47 cases,grade Ⅲ 13 cases and grade Ⅳ 6 cases.Conclusions To correctly determine the surgery indications,do all the preoperative preparation,intraoperative rigorous operating with a good myocardial protection and to strengthen the postoperative care will be help to reduce the mortality and complications of the elderly patients with heart value replacement.
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Objective To investigate the risk fairs and significance of late recurrence in non-small cell lung cancer (NSCLC)patients who had undergone complete resection and remained recurrence-free for5 years.Methods 496 individuals diagnosed and surgically treated for Stage Ⅰ and Ⅱ A NSCLC were included.We examined patients at 3-month intervals for the first 2 years after surgery and typically at 6-month intervals thereafter on an outpatient basis.The follow-up evaluation included physical examination,inaging examination and tumor narkers.Pathological examination had also been performed when needed.Of these,336 patients remained recurrence-free for 5 years were followed up continuously for 3 years.Clinicopathologic factors were collected including age,sex,smoking history,preoperative serum carcinoembryonic antigen (CEA) level,surgical apprach,maximum tumor dimension on resected specimen,histologic type,histologic differentiation,intratumoral lymphatic permeation,intratumoral vascular invasion,pleural invasion and pathologic stage.The primary end event was lung cancer recurrence.The data collection ended in January 2011.Kaplan-Meier method was used for survival rate.Survival difference wasevaluated bylog-rank test.Multivariate Cox regression was used to test the relationship of recurrence-free probability to various clinicopathologic factors.Results At 5 years after resection,109 patients had died of disease and 33 had died of other causes.18 patients were alive with disease.The remaining 3 - 36 patients were alive and recurrence-free for the first 5 years.The median follow-up period of these 5-year recurrence free survivors was 27 months (range,3-36 months).34 (10.1％)patients developed a late recurrence at 3 years among the 336 patients.Recurrence was locoregional in 13 (38.2％)patients:6 patients in mediastinal lymph nodes,3 patients in ipsilateral lung,2 patients with pleural dissemination and 2 patients in other locations.Recurrence was distant in 21 (61.8％) patients:8 patients with multiple-organ metastases,13 patients with single-organ metastasis,and the latter consisted of 5 patients in contralateral lung,3 patients in liver,2 patients in central nervous system and 3 patients in other locations.Smoking history,preoperative serum CEA level,histologic differentiation,intratumoral lymphatic invasion,intratumoral vascular invasion,pleural invasion and pathologic stage were risk factors for late recurrence in univariate analysis.Multivariate Cox analysis demonstrated that intratumoral vascular invasion and intratumoral lymphatic invasion were independent risk factors for late recurrence.Conclusion NSCLC patients have a significant risk of late recurrence after complete resection 5 years,especially for the patients with intratumoral vascular invasion and intralumoral lymphatic invasion.It is needed and significant for the patients to follow up continuously after 5 years of complete resection.
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Aim To detect the antitumor activities of five sesquiterpene lactones from the roots of Inula helenium.Method Using MTT assay to evaluate the antitumor activities of five sesquiterpene lactones to the cell lines of U251SP,T-98,HLE,MM1-CB,HMV-1 and KT,and to explore the relationship between structure and activities.Results Isoalantolactone exhibited significant anti-growth activities to U251SP,HLE and MM1-CB,while other compounds demonstrated weak or moderate anti-growth activities to cell lines even in the 50% inhibition concentration≤100 μmol·L~(-1).Conclusion Isoalantolactone exhibits significant anti-growth activities to three cell lines and its anti-tumor activitiesve close relationship with the structures,α,β-unsaturated five-membered lactone ring is necessary for the activities,and saturated lactone or 5,10-seco and A,B-ring become a ten-membered macro-ring leading to the loss or decrease of anti-growth activity.
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Objective To study the clinical characteristics of the surgical treatment of cardiac valve disease in elderly patients.Methods Between January 2004 and February 2009,43 patients aged ≥65 underwent cardiac valve operation were enrolled as elderly group,85 patients aged <65 underwent the same operation served as control group in the same period,analyzed the clinical characteristics and difference between the two groups.Results The mortality of elderly group was higher than that of control group [11.6%(5/43) vs 2.4% (2/85),P<0.05].In elderly group,the duration of staying in ICU [(73.8±15.9) h],mechanical ventilation [(40.4±10.1)h],postoperative hospitalization time [(23.7±6.3) d]and the morbidity of postoperative complications [23.3%(10/43)]were higher than those of control group [(43.1±8.6)h,(28.5±5.8) h,(15.6±3.8) d,5.9%(5/85)](P<0.05 or <0.01).Conclusions Although there are high risks in patients aged 65 years and elderly with cardiac valve disease,the treatment results would be satisfactory ff select the right operating time and do full preparation with reasonable surgery strategy,the mortality and morbidity of postoperative complications could be reduced.
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<p><b>BACKGROUND</b>Adenosquamous carcinoma of the lung is a rare pathologic type of lung cancer. The aim of this study is to explore the clinical features of adenosquamous carcinoma of the lung.</p><p><b>METHODS</b>A total of 115 patients with adenosquamous carcinoma of the lung were retrospectively analysed, who were diagnosed by operation and pathology.</p><p><b>RESULTS</b>Among the 36 female patients, 7 were under 49 years (19.44%). There were 14 patients (12.17%) without any symptom and 16 patients had residual carcinoma at the resection margin (14.04%). The degree of lymph node metastasis was 37.51%. The proportion of stage III patients was 54.78%.</p><p><b>CONCLUSIONS</b>The incidence of adenosquamous carcinoma of the lung in young women (under 49 years, especially under 39 years) is rather high. The residual carcinoma at the resection margin often occurs after routine operation. The degree of lymph node metastasis is rather high.</p>
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BACKGROUND: It is manifested in epidemiology and clinical observation that lipoprotein (a) is a new risk factor of cerebrovascular disease and is closely related to cerebral ischemic stroke.OBJECTIVE: To discuss the relationship between levels of high serum lipoprotein (a) and stroke.DESIGN: Case controlled analysis.SETTING: Neurological Institute of Xiangya Hospital of Central South University.METHODS: Totally 294 patients with stroke were selected from Neurological Department of Xiangya Hospital of Central So, uth University between September 1999 and March 2002. Of them, 159 cases were regarded as cerebral infarction group and other 135 cases as acute hypertensive cerebral hemorrhage group. In cerebral infarction group, 109 patients had atherosclerotic cerebral infarction and 50 patients had lacunar cerebral infarction, and 94patients with contimuous health examination were regarded as health examination group. Serum lipoprotein (a) in each group was assayed with "sandwich enzyme-linked immuno-sorbent assay". According to whether the value of lipid was normal or not, patients with atherosclerotic cerebral infarction and acute hypertensive cerebral hemorrhage were divided into two groups. Comparisons between the two groups were assayed with single sample t test, and multiple liner regression was used to assay whether sex, hypertension and value of lipid were related to the level of serum lipoprotein (a).MAIN OUTCOME MEASURES: ① Comparisons of serum lipoprotein (a)among atherosclerotic cerebral infarction group, lacunar cerebral infarction group, acute hypertensive cerebral hemorrhage group and health examination group. ② Correlated analysis between serum lipoprotein (a) and lipid.RESULTS: Among 294 patients, 94 cases in control group entered the final analysis. ① Comparisons of serum lipoprotein (a) among atherosclerotic cerebral infarction group, lacunar cerebral infarction group, acute hypertensive cerebral hemorrhage group and health examination group: Levels of serum lipoprotein (a) in atherosclerotic cerebral infarction group and cerebral hemorrhage group were higher than those in health control group (P ＜ 0.05), and concentration of lipoprotein (a) in atheroosclerotic cerebral infarction group was increased as compared with that in acute hypertensive cerebral hemorrhage group (P ＜ 0.05). Also, level of lipoprotein (a) in lacunar cerebral infarction group was a little higher than that in control group,but the difference was not significant (P ＞ 0.05). ② Correlated analysis between serum lipoprotein (a) and lipid: Levels of lipoprotein (a) in both normal lipid group and abnormal lipid group were assayed with single sample t test, and the results showed that levels in the two groups were similar (P ＞ 0.05). Multiple liner regression was used to assay whether sex,hypertension and value of lipid were related to level of serum lipoprotein (a).CONCLUSION: Levels of lipoprotein (a) may be an independent risk factor for cerebral hemorrhage and atherosclerotic cerebral infarction.
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BACKGROUND: Alginic sodium diester (ASD) possesses neuroprotective function because of its selective calcium antagonist effects.OBJECTIVE: To compare the influences of ASD on intraneuronal Ca2+content and nerve cell apoptosis before and after reperfusion in focal cerebral ischemic rats.DESIGN: Randomized controlled observation.SETTING: Neurological Department of Xiangya Hospital Affiliated to South China University; Laser Orthopedic Surgery of the First Hospital Affiliated to Southern China University.MATERIALS: This experiment was carried out between November 2003and April 2004 at the Neurological Department of Xiangya Hospital Affiliated to South China University. A total of 65 male SD rats were recruited and randomized into 6 groups; 17 got lost during the experiment, and the other 48 rats completed the experiment with 8 rats in each group.METHODS: In sham operation group, an incision was made on rats' cervical skin and sutured. Right cerebral middle artery was occluded in rats of ischemic group, ASD 5 mg/kg preischemic group, ASD 5 mg/kg postischemic group, ASD 10 mg/kg preischemic group, and ASD 10 mg/kg postischemic group. After that, rats in all but ischemic group were subjected to intraperitoneal injection of various dosage of ASD or excipient 30minutes before reperfusion and 5 hours after reperfusion. FCM was used to determine intraneuronal Ca2+ content and rate of nerve cell apoptosis;meanwhile, neurological dysfunction was scored.MAIN OUTCOME MEASURES: [1] Influence of ASD on the score for neurological dysfunction, intraneuronal Ca2+ fluorescence intensity, and neuronal apoptosis in rats with right cerebral middle artery ischemia. [2]Correlation of behavioral obstacle score with intraneuronal Ca2+ fluorescence intensity and neuronal apoptosis in rats with right cerebral middle artery ischemia.RESULTS: Totally 65 rats were enrolled in this study, 17 of which got lost and the other 48 rats entered the result analysis. [1] Influence of ASD on the score for neurological dysfunction, intraneuronal Ca2+ fluorescence intensity, and neuronal apoptosis in rats with right cerebral middle artery ischemia: The score was obviously reduced in ASD 5 mg/kg preischemic group, ASD 5 mg/kg postischemic group, ASD 10 mg/kg preischemic group and ASD 10 mg/kg postischemic group as compared with ischemic group (1.80±0.21, 2.20±0.23, 1.20±0.11, 2.00±0.22, 3.40±0.65); moreover,functional improvement was more obvious due to pre-reperfusional administration than post-reperfusional administration. Intraneuronal Ca2+ concentration was reduced after ASD administration at different degrees and lower than that of ischemic group. Decrement of intraneuronal Ca2+ concentration was found most obvious due to 10 mg/kg ASD administration 30 minutes before reperfusion, approximately reduced by 70%; moreover, neuronal apoptosis rate on the ischemic side was obviously suppressed by ASD administration, displaying time-dependent manner, with apoptotic suppression effect more obvious in pre-reperfusional group than in post-reperfusional group (5.68%, 10.03%; 4.00%, 9.91%). [2] Correlation of behavioral obstacle score of right cerebral middle artery ischemic rats with intraneuronal Ca2+ fluorescence intensity and membrane associated protein/propidium iodide apoptosis: Obvious positive correlation was found between behavioral obstacle score and intraneuronal Ca2+ fluorescence intensity and detection rate of membrane associated protein/propidium iodide apoptosis (r=0.51,0.62, P ＜ 0.05); intraneuronal Ca2+ fluorescence intensity was also positively correlated with the detection rate of membrane associated protein/propidium iodide apoptosis (r=0.84, P ＜ 0.05).CONCLUSION: [1] ASD can exert anti-apoptosis effect by suppressing the increment of intraneuronal Ca2+ concentration, thus having neuroprotective function and ultimately improving neurological dysfunction. [2] Its effect displays time-dependent manner, and neurological functional improvement is more obvious by pre-reperfusional administration than by post-operational administration.
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OBJECTIVE:To evaluate the abnormality in hematological system induced by antituberculosis drugs so as to promote the rational use of drugs in the clinic.METHODS:The 441 case reports on abnormality in hematological system induced by antituberculosis drugs retrieved from Chinese medical science periodicals from Jan 1990 to Apr 2007 collected in CHKD periodicals knowledge base in China hospital digital library were analyzed statistically.RESULTS:A total of 15 antibuberculosis drugs were involved in the ADR cases,leading the list were rifampicin,ciprofloxacin and isoniazide,which resulted in a total of 211 ADR cases.Leukopenia was the chief clinical manifestation.CONCLUSIONS:It is essential for clinical practitioners master the distribution patterns of ADR in hematological system caused by antituberculosis drugs so as to promote medication safety.