Comparison of the outcomes of monopolar and bipolar radiofrequency ablation in surgical treatment of atrial fibrillation / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To compare the therapeutic effects and safety of monopolar and bipolar radiofrequency (RF) ablation used during cardiac surgery to treat atrial fibrillation.</p><p><b>METHODS</b>We retrospectively studied a total of 81 patients with chronic atrial fibrillation who underwent open cardiac surgery with concomitant RF ablation between January 2007 and March 2011. Fifty-eight patients received bipolar RF ablation and 23 received monopolar RF ablation, respectively. The sinus rhythm restoration rate, the procedural duration, the frequency of severe perioperative complications, and mortality were compared between the two groups.</p><p><b>RESULTS</b>The sinus rhythm restoration rate did not differ significantly between the two groups after follow-up of 15.1 ± 12.6 months (P=0.199). The frequencies of severe perioperative complications and mortality were also similar in the two groups. The total procedural time using bipolar RF ablation was significantly shorter than that using monopolar ablation (19.7 ± 4.6 minutes vs. 28.1 ± 8.5 minutes, P< 0.001).</p><p><b>CONCLUSIONS</b>Both monopolar and bipolar RF ablation are safe and effective in treating chronic atrial fibrillation patients during open cardiac surgery, but bipolar RF ablation is more convenient in practice.</p>

Personalized management of anastomotic leak after surgery for esophageal carcinoma / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To summarize the management of anastomotic leak following surgery for esophageal carcinoma.</p><p><b>METHODS</b>The medical records of the patients developing digestive tract leak after surgery for esophageal carcinoma in our hospital from January 2003 to March 2011 were retrospectively analyzed.</p><p><b>RESULTS</b>A total of 36 patients were included, in whom 13 developed cervical anastomotic leak, 18 had intra-thoracic anastomotic leak, and 5 had intra-thoracic gastric necrosis. Of these patients, 7 were treated with resurgery, 6 with esophageal stent implantation, and 23 with conservative treatment. Treatment lasted for 5 to 181 days, averagely 47.0 +/- 31.9 days. After management, 9 patients died (25.0%). Among seven patients with resurgery, four had deceased, two were cured, and one developed leak again and was switched to conservative treatment until discharged. All the 6 patients treated with stent implantation were cured. Of the 24 patients receiving conservative treatment (including one switched from resurgery), 18 (75.0%) were cured and 1 was not cured but survived.</p><p><b>CONCLUSIONS</b>Anastomotic leak following surgery for esophageal carcinoma should be treated individually based on the onset time, location, size, and extent of the leakage. Conservative treatment is still a safe and effective method. The efficacy of stent implantation needs further investigation to confirm.</p>

Diagnostic value of endoscopic ultrasonography and CT in T, N stage of preoperative esophageal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the preoperative endoscopic ultrasonography (EUS) and CT in the diagnosis of TN stage of esophageal cancer.</p><p><b>METHODS</b>Fifty-one hospitalized patients with esophageal cancer in our center from July 2002 to January 2004 were enrolled in this study. According to UICC (1997) TNM clinical stage, the TN stage results of esophageal cancer by EUS and CT examination of above 51 cases were compared with the postoperative pathological TN stage.</p><p><b>RESULTS</b>(1)The accuracy rates of T and N stage by EUS were 82.4%(42/51) and 88.0%(45/51) respectively. The accuracy rates of T and N stage by CT were 52.9%(27/51) and 51.0%(26/51) respectively. The accuracy rates of T and N stage by combination of EUS and CT were 86.3%(44/51) and 90.0%(46/51). (2)The consistent condition among EUS, CT or combination of EUS and CT with pathology: The Kappa of EUS to T and N stage were 0.700(P<0.001) and 0.763(P<0.001). The Kappa of CT to T and N stage were 0.275(P=0.002) and 0.006(P=0.964). The Kappa of EUS+CT to T and N stage were 0.769(P<0.001) and 0.801(P<0.001). (3)Significant differences were found between EUS and CT:PT=0.001(chi(2)=10.079) and PN<0.001(chi(2)=16.730). No significant difference was found between EUS+CT and EUS.</p><p><b>CONCLUSIONS</b>EUS can be used as important and main preoperative examination because of presenting high accuracy rate in the diagnosis of T and N stage of esophageal cancer. EUS+CT does not improve accuracy rate significantly in TN stage diagnosis of esophageal cancer.</p>

Benign gastric strictures after transthoracic esophagectomy and esophagogastrostomy: an analysis of 9 cases / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the manifestations,etiology,diagnosis and treatment of benign gastric strictures after transthoracic esophagectomy and esophagogastrostomy.</p><p><b>METHODS</b>From January 1998 to December 2004, 9 cases with benign gastric strictures following esophagectomy were enrolled in the study. The manifestations,radiographic and endoscopic findings, treatment were analyzed retrospectively.</p><p><b>RESULTS</b>The patients included 8 males and 1 female. Benign gastric stricture is characterized by mucosa absence and proliferation of fibrous tissue in the stomach below the stoma. The age ranged from 49 to 71 years old (median age 62). The common symptom was postoperative dysphagia. The length of stricture ranged from 1.5 to 5.0 cm, and the width from 0.1 to 0.5 cm. Seven cases were treated ineffectively with simple dilation,while esophageal stent placement was performed in 8 cases successfully. After follow- up from 5 to 60 months, restenosis occurred for 11 times including stent fall-off for 6 times,stent migration for 1 times, overgrowth of granular tissues for 4 times. Other complications included cervical incision infection and massive hemorrhage in one case respectively. Restenoses were all solved with stent replacement.</p><p><b>CONCLUSIONS</b>Benign gastric stricture should be diagnosed through dysphagia, barium meal and endoscopy. Placement of non-self-expandable stent or whole covered self-expandable metallic stent is the primary treatment.</p>