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Objective To evaluate the effect of treating achalasia of cardia by transabdominally HellerDor operation.Methods Thirty-five cases with achalasia of cardia who were treated by transabdominally Heller-Dor procedure were recruited in this study from January 2006 to December 2011.Twenty patients received preand post-operative manometry and 24-hour-pH monitoring.Recorded parameters included pre-and post-operative lower esophageal sphincter pressure (LESP),reflux frequency in 24 hours,the longest duration of reflux,the total time (min) of pH ＜ 4.0 and the percentage (％) of time of pH ＜ 4.0.Statistical analyses were conducted.Results Symptom was significantly improved in 34 patients after surgery,while 1 patient remained dysphasia.Recheck the manometry and 24-hour-pH post-operation at 1 month,the LESP was significantly lower than pre-operation ((10.22 ±8.91)mm Hg vs.(30.81 ±6.63) mm Hg,and the reflux frequency,the longest duration of reflux,the total time (min) of pH ＜ 4.0 and the percentage (％) of time of pH ＜ 4.0 significantly declined at one month after operations (t =2.740,2.335,2.829 and 2.139;P =0.022,0.019,0.036 and 0.040 respectively).Thirty-two patients (91.4％,32/35) were followed up,among whom 24 patients (75.0％,24/32) were cured and 8 patients(25.0％,8/32) improved.Reflux did not detected after surgery in the 4 cases (20.0％,4/20) with preoperative reflux.Conclusion Transabdomianlly Heller-Dor operation could dramatically alleviate the symptoms of patients with achalasia of cardia.Moreover,it could especially prevent pestoperative-reflux,with the advantages of simple operations,little traumas and few complications.
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Objective To investigate the regularity of thoraco-abdominal two-field lymphatic metastasis and methods of the nodal dissection in middle-third thoracic esophageal carcinoma,and to guide the scope of the lymph-node clearance.Methods Thoraco-abdominal two-field lymph-node dissection based on surgical incisions of the right chest and middle upper abdomen were conducted in 62 cases with middle-third thoracic esophageal cancer and the regularity of nodal metastasis was analyzed.Results Five hundred and five pieces of lymph node were cleaned in all 62 patients and among them 102 pieces were detected as metastasis lymph node,the nodal metastasis ratio was 20.2％ (102/505).The middle-third thoracic esophageal cancer not only includes the nodal metastases up to the trachea of the right neck,around the bilateral recurrent laryngeal nerve chains,near the esophagus and the tumor,and the lymph-node metastasis at the inferior tracheal protuberance,but also the nodal metastases down to the cardiac,around the left gastric artery and at the retina of the lesser curvature of the stomach etc,presenting a tendency of 2-way metastasis.The infiltration depth and differentiation of the tumor is of statistical significance on the nodal metastasis ratio.There was significant difference on the metastasis rate of lymph node from T1 to T4 (T1:10.0％ (1/10),T2:20.0％ (3/15),T3:43.3 ％ (13/30),T4:57.1％ (4/7),x2 =18.56,P ＜ 0.05).It indicated that metastasis rate was increased with the development of the infiltration depth.There was significant difference on the metastasis rate of high differentiation carcinoma,moderate differentiation carcinoma and low differentiation carcinoma (14.3％ (2/14) vs 39.5％ (15/38) vs 57.1％(4/7),x2 =17.75,P ＜ 0.05).Conclusion The lymph node metastasis of patients with middle-third thoracic esophageal carcinoma is significantly correlated with the depth of tumor invasion and the degree of differentiation,with the tendency of thoraco-abdominal 2-field nodal metastasis.The peritracheal lymph node at right neck and bilateral recurrent laryngeal nerve chains are important regions of the metastasis.The surgical incision of the right thorax and upper abdomen greatly facilitates the excision of the middle-third thoracic esophageal cancer and the 2-field lymph node dissection Thus on this basis,the lymph node clearance around the right trachea and at bilateral recurrent laryngeal nerve chains through the right thoracic apex is safe and feasible.
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Objective:To explore the functions of cytokines and TM in the pathogenesis of acute cerebral infarction.Methods:The levels of IL-1、IL-6 、TNF and TM were detected by ELISA in 55 patients with acute cerebral infarction.Results:The levels of IL-1、IL-6 、TNF and TM were increased significantly in the patients with acute cerebral infarction in comparision with the controls ( P