Résumé
Objective To discuss decision of the safety margin of esophagus in the radical gastrectomy of adenocarcionma of esophagogastric junction.Methods The length of esophageal resection margin of intraoperative,postoperative and pathological large slice under the microscope of 50 cases adenocarcionma of esophagogastric junction underwent radical gastrectomy were measured,and the proximal invasive length of esophagus in large pathological slice were also measured,and the relationship between it and pathological factors was analyzed.Determined the minimum safety cut edge distance.Results In 46 of 50 patients,proximal intramural spread of the tumor was observed.The invasive length of tumor from 0.1 cm to 3.5 cm.The invasive length of tumor was <1.0 cm with 11 patients,1.0-1.5 cm with 19 patients,1.5-3.0 cm with 15 patients,in only 1 patient was the distance of spread 3.5 cm.Invasive length of adenocarcionma of esophagogastric junction had a significant difference between the groups in different pathological factors(P<0.001).Conclusion The length of 3.5 cm is the safety margin of esophagus in the radical gastrectomy of adenocarcionma of esophagogastric junction(SiewertⅡ,Ⅲ type) by abdominal incision.
Résumé
Objective To evaluate the curative effect of neoadjuvant chemotherapy via arterial infusion on advanced colorectal carcinoma. Methods One hundred and twenty-eight advanced colorectal carcinoma patients in stage Ⅱ B or Ⅲ were randomly divided into 2 groups. Sixty-eight cases received preoperative arterial infusion chemotherapy( the treatment group),and chemotherapy regimen consist of Oxaliplatin(L-OHP) 130 mg/m2, Hydroxycamptothecin (HCPT) 20 mg/m2 and Dexifluridine (FUDR)600 mg/m2. Femoral arterial infusion chemotherapy administrated 8 ～ 14 days preoperative. Sixty cases received surgery directly(the control group). The adverse reaction and histology effect after arterial infusion chemotherapy were observed, and resection rate,complications,pathology stage,together with long term survival were compared. Results Adverse reaction were mostly grade Ⅰ -Ⅱ gastrointestinal discomfort and bone marrow depression with arterial infusion chemotherapy. Resection rate was 97. 1% (66/68) ,and 64 cases(96. 9%) underwent raclical (R0) resection in the treatment group, which were higher than those in the the control group(73. 3%(44/60) and 79. 5%,respectively) (x2 = 14. 848,8. 906, Ps ＜ 0. 05). Histology effect of the treatment group was 72. 7%, and the pathology stage downstaged compared to preopeartion. Percent of patients in stage Ⅱ in the treatment group was higher than that in the control group( P ＜ 0. 05). The median survival time of test group was 53. 0 months, 1- ,3-,and 5-year survival rates were 95.3%,85.9% and 44.6%, respectively. In the control group, the median survival time was 42.0 months, 1-, 3-, and 5-year survival rates were 92.6%, 75.9% and 22.0%,respectively. There was significant difference in 5-year survival rate(x2 = 6. 385, P ＜ 0. 05). No difference in postoperative complications between two groups(P ＞ 0. 05). Conclusion The neoadjuvant chemotherapy via arterial infusion is of great significance on downstnging the pathology of advanced colorectal carcinoma, raising the excision rate, especially radical resection, and long term survival rate.
Résumé
Objective To investigate the protective effects of ulinastatn on the lungs in patients with lung cancer undergoing lobectomy. Methods Forty ASA Ⅱ or Ⅲ patients with stage Ⅲ lung cancer, aged 50-64 yr weighing 53-70 kg undergoing lobectomy were randomly divided into 2 groups ( n = 20 each): control group (group C) and ulinastatin group (group U). In group U ulinastatin 10 000 U/kg in 20 ml normal saline was infused iv over 30 min immediately after induction of anesthesia. The patients were premedicated with diazepam 10 mg and scopolamine 0.3 mg im. Anesthesia was induced with midazolam 0.05 mg/kg, fentanyl 4 μg/kg, TCI of propofol (Cp 4 μg/ml) and vecuronium 0.12 mg/kg and maintained with TCI of propofol (Cp 2-3 μg/ml) and intermittent iv boluses of fentanyl and vecuronium. The patients were intubated with double-lumen tube. Correct position of the tube was checked with fiberoptic bronchoscope. One-lung ventilation (OLV) was performed (VT 6-8 ml/kg, RR 10-16 bpm, I:R 1:2, FiO2 100% ). PETCO2 was maintained at 35-45 mm Hg. Arterial blood samples were taken before anesthesia (T0, baseline), at 0.5 h and 1 h of OLV (T1, T2 ) and 4 h and 24 h after operation (T3, T4 )for blood gas analysis and determination of plasma TNF-α, IL-6 and IL-10 concentrations. Respiratory index (RI)was calculated. (RI= PA-a O2 /PaO2 ).Results Compared with the baseline values at To, plasma TNF-α and IL-6 concentrations and RI at T1-4 and plasma IL-10 concentrations at T1-3 were all significantly increased in group C,while in group U plasma TNF-α and IL-6 concentrations at T2,3 and plasma IL-10 concentrations and RI at T1-4 were all significantly increased ( P ＜ 0.05 ). Plasma TNF-α and IL-6 concentrations and RI were significantly lower while plasma IL-10 concentration was significantly higher in group U than in group C (P ＜ 0.05).Conclusion Ulinastatin 10 000 U/kg can effectively protect the lungs in patients with lung cancer undergoing lobectomy by attenuating systemic inflammatory response.