Non-invasive closed placement of nasojejunal feeding tube during Ivor-Lewis esophagectomy for esophageal carcinoma / 中国肿瘤临床

Objectives:To improve the surgical procedures and investigate the feasibility of the closed placement of nasojejunal tube during Ivor-Lewis esophagectomy. Methods:From January 2010 to December 2013, 85 patients (72 males and 13 females) with esophageal or gastric cardiac carcinoma underwent Ivor-Lewis esophagectomy in our department. Briefly, the general surgical proce-dures were performed as follows:1) stomach mobilization and enlargement of esophageal hiatus and pyloric sphincter digital fracture via laparotomy; 2) tubular stomach reconstruction, esophageal carcinoma resection, and intra-thoracic esophagogatrostomy via right posterolateral thoracotomy;and 3) forward closed placement of feeding tube through the nostrils and jejunum of patients under the guid-ance of a surgeon, who palpates the pylorus through the hiatus with the use of fingers. Results:No operative death or feeding tube-asso-ciated adverse event was observed. Among the 85 patients who have undergone Ivor-Lewis esophagectomy, feeding tube placement in-to the jejunum during surgery failed in 33 cases. The success rate of nasojejunal feeding tube placement was 61.2%(52/85). Twelve pa-tients with successful tube placement did not receive enteral feeding for several reasons and were thereby transferred to parenteral group. Significant differences were observed in terms of the nutritional cost and proportion between enteral feeding and parenteral groups (?1,469 ± 741 vs.?3,223 ± 917, P0.05). Conclusion:The novel forward closed placement of nasojejunal feeding tube dur-ing Ivor-Lewis esophagectomy provides a non-invasive, feasible, simple, and economical method for postoperative nutritional support. Surgeons could perform this novel technique successfully in practice.

Experience on the diagnosis and treatment of intrathoracic gastro-airway fistulae after esophagectomy for esophageal carcinoma / 中华胸心血管外科杂志

Objective To summarize our results and experience in dealing with the postoperative intrathoracic gastro-air-way fistulae after esophagectomy for esophageal carcinoma.Methods From January 2010 through February 2012,1490 patients with esophageal carcinoma underwent esophagectomy in our department.The postoperative intrathoracic gastro-airway fistulae were documented in 10 patients,with a frequency of 0.67％.Five of them died.The possible etiology,clinical characters,treatment and prevention of this complication were reviewed.Results The location of the fistulate were 7 at left main bronchus,1 at right main bronchus,and 2 at distal trachea.After 2-3 weeks conservative treatment,1 patient underwent primary surgical repair and cured,1 refused any further intervention and sacrified,8 patients underwent endoscopic insertion of covered stent and only 3 healed.For the remaining 5 cases with failed stent therapy,2 died of severe aspiration and lung infection,3 had surgical repair,one of them successed and 2 died of aspiration and aortic rupture,respecively.Conclusion The development of intrathoracic gastro-airway fistulae was associated with the iatrogenic injuries and suturing material irritation of the gastric tube to the tracheal/bronchial wall.Therefore,a meticulous closure and wapping of gastroplasty and appropriate isolation using artifical patch or great omentum between airway and esophageal substitution could effectively reduce the fistulae.The stent therapy usually fails in treating this entity and surgical repair remains the final and ratical therapeutic option.Primary repaire is suggested and careful preoperative assessment is crucial.

Detection of mRNA expression of CK-19 and MUC1 gene for diagnosis of lymph node micrometastasis in NSCLC patients by reverse transcriptase-polymerase chain reaction / 中国肺癌杂志

<p><b>BACKGROUND</b>To investigate gene diagnosis of micrometastasis in lymph nodes in patients with non-small cell lung cancer (NSCLC) and the feasibility of mucin 1 (MUC1) mRNA and cytokeratin 19 (CK19) mRNA as molecular marker to detect micrometastasis of lung cancer.</p><p><b>METHODS</b>Expression of MUC1 mRNA and CK19 mRNA was detected in 119 lymph nodes taken from 31 patients with NSCLC, 35 lymph nodes from 10 patients with pulmonary benign diseases as controls by nested reverse transcriptase-polymerase chain reaction (RT-PCR).</p><p><b>RESULTS</b>In the 119 lymph nodes from lung cancer patients, CK19 mRNA expression was detected in 66 lymph nodes (55.5%) and MUC1 mRNA expression was detected in 65 lymph nodes (54.5%) by RT-PCR. Neither CK19 mRNA nor MUC1 mRNA expression was observed in all the 35 lymph nodes in the benign pulmonary lesion group.</p><p><b>CONCLUSIONS</b>The results suggest that the detection of both MUC1 and CK19 mRNA might be helpful to diagnose NSCLC micrometastasis in lymph nodes. The establishment of this method may lead to an earlier diagnosis of metastasis for lung cancer.</p>

A study on the pericancerous tissue and vascular changes in non-small cell lung cancer with high-resolution CT / 中国肺癌杂志

<p><b>BACKGROUND</b>To investigate the CT changes of pericancerous tissues with high-resolution CT (HRCT) and to explore the specific signs of CT in non-small cell lung cancer.</p><p><b>METHODS</b>Thirty-one patients with non-small cell lung cancer and 12 patients with benign pulmonary nodules were analysed. An attention was paid on bronchovascular bundles, vessels and interlobular septa. HRCT films were read independently by two radiologists and results were statistically Chi-square tested.</p><p><b>RESULTS</b>In the cancer group, 20 cases (64.5%) had thickening of bronchovascular bundles, 15 cases (48.4%) angiectasis of superior lobular arteries, 13 cases (41.9%) angiectasis of superior lobular veins, 16 cases (51.6%) thickening of interlobular septa, and 5 cases (16.1%) ground-glass opacity. In benign pulmonary lesion group, the values were 2 (16.7%) , 1 (8.3%), 2 (16.7%), 6 (50.0%) and 5 (41.7%) cases respectively. Significant differences were found between the two groups in the thickening of bronchovascular bundles and the angiectasis of superior lobular arteries.</p><p><b>CONCLUSIONS</b>Thickening of bronchovascular bundles and angiectasis of superior lobular arteries are the specific signs of non-small cell lung cancer.</p>

Gene diagnosis and clinical significance of micrometastases in lymph nodes, peri pheral blood and bone marrow in non-small-cell lung cancer patients / 中国癌症杂志

Purpose:To explore the clinical significance of gene diagnosis in detecting micrometastases in lymph node,peripheral blood and bone marrow from non-small-cell lung cancer patients and the correlation to e ach other. Methods:The MUC1 mRNA expression was detected in lymph nodes, p eripheral blood and bone marrow from 31 lung cancer putients and 10 benign p?lm onary lesion patients by nested RT-PCR. Results:The sensitivity of the the RT-PCR technique was 10 -6 in this study. The positive rates of MUC1 mRNA were 54.6%, 32.3% and 22.6% in lymph nodes , peripheral blood and bone marrow from lung cancer patients resp ectively , and highly correlation existed among the three groups(P