An analysis about early and long-term curative effect of 56 cases of completion pneumonectomy / 中华胸心血管外科杂志

Objective This study was to analyze the early and long-term effect of completion pneumonectomy.Methods Retrospective analysis was made on the patients who underwent completion pneummonectomy in Shanghai Chest Hospital.Results There were totally 56 cases patients underwent completion pneumonectomy during January 2003 to July 2013.Among them,45 patients received CCP,and other 11 patients received RCP.CCP refers to the complete removal of lung tissue remaining after an initial ipsilateral partial pulmonary resection.RCP refers to the complete removal of residual lung due to the severe complications after pneumonectomy.The mortality and morbidity rate of CCP were 4.4％ and 33.3％ respectively.In the case of CCP,the incidence of benign lesions is significantly higher than the incidence of malignant tumor(80.0％ vs 27.5％,P =0.04).The mortality and morbidity rate of RCP were 27.3％ and 90.9％ respectively.In the case of RCP,higher postoperative mortality often occurs in aged patients (P =0.046) and patients with preoperatie mechanical ventilation (P =0.03).Overall five-year survival rate for patients with benign lesions was 80％,and for malignant lung cancer patients,the number was 30％.Survival time differs according to the TNM staging(a median of 60.0 months,35.0 months,10.0 months,stage Ⅰ,stage Ⅱ,stage Ⅲ,P ＜0.01),and survival rate was higher when the time interval(between the initial pulmonary resection and the completion pneumonectomy) ＞ 2 years(a median of 60.0 months,18.0 months,P ＜ 0.01).Conclusion Completion pneumonectomy is a high-risk surgery,especially RCP.Advanced age and preoperative mechanical ventilation are associated with higher postoperative mortality rate for RCP.As for CCP,higher postoperative risk exists in patients with benign lesions,but the survival rate is also higher.In patients with malignant lung tumor,survival rate is higher when the time interval (between the initial pulmonary resection and the completion pneumonectomy) ＞2 year.

Application of lymphography in the location and treatment decision of chyle leakage: an analysis of 177 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To identify the value of lymphography in the location and treatment decision of chyle leakage.</p><p><b>METHODS</b>The clinic data of 177 patients suffered from chyle leakage admitted in 6 medical centers in Shanghai from February 1998 to December 2014 was analyzed retrospectively. There were 94 male and 83 female patients aging from 9 to 84 years with a mean of 49 years, including 128 cases of chyluria, 34 cases of primary chylothorax and 15 cases of other chyle leakage. All patients had failed to conservative treatment more than 2 weeks. Pedal lymphography was performed in every patient to investigate the site and range of chyle leakage. Effect of surgical or conservative management was compared according to the different results of lymphography.</p><p><b>RESULTS</b>No serious complication was noticed. For all 177 patients, lymphography showed localized lymphatic diseases in 148 cases (83.6%), including 125 cases of lymphatic renal pelvic leaks, 14 cases of unilateral identified leak within thorax and 9 cases of chyle leakage in neck, heart, abdomen or scrotum. Among these patients, surgical treatment cured 129 and improved 3 patients but failed in 2 patients, while the remaining 14 cases had their leaks decreased after lymphography and cured by conservative management. For those 15 patients having disseminated lymphatic diseases or 14 with no abnormality under lymphography, surgery only cured 2 and improved 1 patient but failed in 8 patients (with 3 death), whereas continuous conservative treatment cured 11 patients, improved 5 patients but only failed in 2 patients (with one death). For localized leakage, surgical treatment showed better efficacy (98.5% vs. 3/11), whereas conservative treatment had significantly higher successful rate than surgical interventions in patients with disseminated lymphatic diseases or no abnormality under lymphography (16/18 vs. 3/11).</p><p><b>CONCLUSIONS</b>Lymphography could identify the location and range of complicate chyle leakage failed to primary conservative management. Patients with disseminated lymphatic diseases or no abnormality under lymphography would be better managed by continuous non-operative treatment partly due to therapeutic effect of lymphography, while surgical intervention could be a good option for patients having localized lymphatic etiology.</p>

Effect of clinical cluster management during perioperative period on esophageal cancer in elderly patients aged 75 years and over / 中华老年医学杂志

Objective To explore the applicative effect of the clinical cluster management during perioperative period on esophageal cancer in elderly patients aged 75 years and over.Methods A total of 36 cases with esophageal cancer aged 75 years and over admitted into Thoracic Surgery Department in our hospital from January 2010 to February 2015 were divided into experimental and control group.Patients in experimental group received clinical cluster management including preoperative therapy for improvement of heart and lung function, selective protection during operation, strengthening support after operation and early nasal tube nutrition.Patients in control group received routine treatment for esophageal carcinoma during perioperative period.The postoperative complications, intensive care unit (ICU) stay, the incidence of anastomotic leakage,postoperative feeding time, postoperative hospitalization time and other indicators were observed.Results Among 20 patients in the experimental group, postoperative cardiopulmonary complications were found in 6 cases, postoperative cardiovascular complications in 3 cases and anastomotic leakage in 2 cases.Among 16 patients in the control group, postoperative cardiopulmonary complications were found in 12 cases, postoperative cardiovascular complications in 10 cases and anastomotic leakage in 5 cases.The incidences of postoperative cardiopulmonary and cardiovascular complications were lower in experimental group than in control group (x2 =7.200 and 8.693, P =0.007 and 0.003).The incidence of anastomotic leakage showed no significant difference between the two groups (x2 =2.562,P=0.109).The mean duration of ICU stay and postoperative hospitalization time were shorter in experimental group than in control group[(5.6±2.7) d vs.(9.8±4.9) d, (15.4±4.5) d vs.(20.6±5.5) d, t=3.208 and 3.125, P=0.003 and 0.004].There was no significant difference in postoperative feeding time between the two groups [(8.4±1.5)d vs.(9.1±1.1)d, t=1.569, P=0.126].Conclusions A tightly clustered clinical managements during perioperative period can minimize the incidences of postoperative complications and mortality rate in elderly patients with esophageal carcinoma.

An investigation of dyslipidemia and correlation analysis between dyslipidemia and hemoglobin of senior citizens over 65 in community / 国际检验医学杂志

Objective To understand the blood lipid levels and abnormal conditions of the senior citizens aged over 65 in Shenz-hen city and provide a scientific basis for prevention of dyslipidemia.Furthermore,to investigate the influence of dyslipidemia on the result of hemoglobin(Hb).Methods Through random investigation of 252 samples aged over 65 in Shenzhen on their fasting serum TC,TG,HDL-C,LDL-C and Hb in peripheral venous blood and analyze current situation of dyslipidemia.By comparing the groups with dyslipidemia (A,B,C,D group)and group with normal blood lipid (E group),investigation on the influence of dyslipidemia on Hb was conducted.Results The total prevalence of dyslipidemia was 48.02%,TG,TC,LDL-C,HDL-C prevalence was 26.19%, 32.14%,25.79%,17.86% respectively.The average value of TG,TC,LDL-C,HDL-C respectively was(1.53 ±0.66),(4.79 ± 0.90),(2.96±0.77),(1.28±0.26)mmol/L.The prevalence and the difference of average level on TG between male and female was significant in statistics(P <0.01).There had been statistical differences of Hb among groups A,B and group E(P <0.05 ). Conclusion The total prevalence of dyslipidemia of people over the age of 65 in Shenzhen is higher than average,especially in TC. There is interference on Hb when TG,TC is abnormal.Therefore,emphasis should be laid clinically and related rectification must be carried out to ensure the accuracy of Hb.

Clinical analysis of 41 cases with resected multiple primary lung cancers / 中国癌症杂志

Background and purpose:Multiple primary lung cancers (MPLC) is a rare entity, but recently there has been a gradual increase in the number of patients diagnosed with MPLC. The aim of this study is to investigate the diagnosis, treatment and prognosis of MPLC through analyzing the clinical data.Methods:Forty-one patients were diagnosed MPLC by Martini-Melamed criteria. Their clinicopathological data were retrospectively reviewed. Results:There were 3 patients with triple primary lung cancer and 38 patients with double primary lung cancer. There were 13 patients with synchronous MPLC, 26 patients with metachronous MPLC, 2 patients with synchronous and metachronous MPLC. Of 85 lesions, the surgical procedures were mainly lobectomy (78.8%, 67/85). Lesions (41.2%, 35/85) were frequently in right upper lobe. Pathological type was mainly adenocarcinoma (70.6%, 60/85),followed by squamous cell carcinoma (17.6%, 15/85). Of 60 adenocarcinoma specimens, the papillary predominant subtype was more common (50%, 30/60). Eighty percent (68/85) of the lesions were stage I. As to the initial cancer and repeated cancer, patients who shared the same pathological type (68.3%, 28/41) were more than the different (31.7%, 13/41), of which adenocarcinoma-adenocarcinoma was most common(82.1%, 23/28). Lesions located in contralateral lobes were in 37 patients (90.2%), and located in ipsilateral different lobes were in 4 patients (9.8%). The 2-year overall survival (OS) of them was 87.8%. Survival analysis showed that the prognosis of patients with same pathological type was better than patients with different pathological type (P=0.037), the prognosis of patients with no lymph node metastasis was better than patients with N1,N2 metastasis (P=0.02).Conclusion:Lesions in patients with multiple primary lung cancers are more frequently in the right upper lobes. The pathology type is mainly adenocarcinoma, of which the papillary predominant subtype was most common. Early diagnosis improves continuously, active treatment with operation can achieve better prognosis.

PDS Ⅱ absorbable suture netting for chest wall reconstruction: report of 23 cases / 中华胸心血管外科杂志

Objective Explore a new method which application absorbable suture netting for chest wall reconstruction and observe the clinical effect.Methods For 23 cases of part of the rib resection,support the soft tissue using absorbable suture netting and observe the postoperative results.Results 23 patients have the postoperative respiratory stability and no abnormal breathing and chest wall collapse happened.And this method has a good effect to support the Chest wall.Conclusion Chest wall reconstruction using absorbable suture netting has the following advantages:easily obtained,easy to learn to promote,low prices and postoperative respiratory stability.We believe this method is a new technology deserved to be promoted in our country.

Diagnosis and treatment of invasive pulmonary aspergillosis following lung transplantation: one case (report) / 中华器官移植杂志

Objective To study the curative effectiveness of Itraconazole in the treatment of invasive pulmonary aspergillosis following bilateral lung transplantation.Methods One patients undergoing bilateral lung transplantation was readmitted at 8-month postoperatively due to cough, sputum, and fever. Sputum culture reported positive Aspergillus flavus. Chest X-ray manifested bilateral lung infiltration. Chest CT scan showed multiple small cavities. Itraconazole (Sporanox) therapy was performed.Results Sputum smear and culture reported negative aspergillus at sixth of Itraconazole therapy. Patient’s symptoms after Itraconazole treatment for 10 days were improved obviously. Chest CT scan showed the lung lesion still existed. After treatment by Itraconazole, FK506 dosage was decreased from 3 mg, twice a day to 0.5 mg, once a day.Conclusion Pulmonary aspergillosis is an important complication following lung transplantation. Itraconazole therapy can effectively treat invasive pulmonary aspergillosis following bilateral lung transplantation. Blood drug concentration monitoring indicated the dosage of FK506 was significantly decreased after Itraconazole therapy.

Clinical practice of 9 cases of bilateral sequential lung transplantations / 中华器官移植杂志

Objective To explore the surgical indications and safety of bilateral sequential lung transplantation in 9 cases.Methods Between Jan.2003 to June 2005,9 bilateral sequential lung transplantations were performed in Shanghai Chest Hospital.In 2 cases,the resection and re-transplantation of the second lung was done after ventilation and perfusion in the first lung transplantation.In 6 cases,after the first lung was transplanted,ECMO was established with heparin-bonded circuitry and centrifugal pump and the second lung was transplanted.In 1 case,CPB was used during the transplantation of the second lung.Meanwhile,inhaled nitric oxide(INO) therapy(40 ppm) was performed in 7 cases.Results Severe lung edema occurred in 2 cases,and the patients survived only 12 and 36 h respectively.Six cases with ECMO thereafter rided out the operation successfully.Postoperative days ventilated were 36 to 72 h(mean 48 h).Four patients of them discharged in good conditions and have survived 16,14,11,9 months respectively.One patient died of pulmonary infection and emptysis one month after operation.Another patient died of acute renal failure 3 weeks after operation.The operation performed under the support of CPB was unsuccessful because of heavy hemorrhage and severe acidosis.Conclusions Bilateral sequential lung transplantation is a high risk procedure.ECMO can reduce the risk significantly. Inhaled nitric oxide during and after operation is of benefit to stabilization of hemodynamics and reduce ischemic reperfusion injury.