The influence of different method of mediastinal lymph node excision on perioperative immune function of lung cancer patients / 肿瘤研究与临床

Objective To explore the influence of different method of mediastinal lymph node excision on the immune function of non-small cell lung cancer patients.Metbods Clinical data was collected continuously from 415 cases of inhospital patients with non-small cell lung cancer from March 2009 to March 2012,who were divided into system lymph node dissection group (SLND,216 cases) and lymph node sampling group (LNS,199 cases).The total lymphocytes,NK cells,CD4+ T cells and CD8+ T cells in blood samples taken preoperatively and at 3rd and 7th day postoperation were analyzed.Results Total lymphocytes,NK cells and CD8+ T cells were reduced significantly in the SLND group compared with those in LNS group at 3rd day and 7th day postoperation (3rd day:LC (0.95±0.57) × 109/L vs (1.10±0.65) × 109/L,CD8+ T cells (19.53± 6.48) ％ vs (20.93±6.70) ％,NK (17.36±6.06) ％ vs (18.57±5.97) ％,P ＜ 0.05; 7th day:LC (0.86±0.53) × 109/L vs (1.00±0.60) × 109/L,CD8+ T cells (17.27±5.64) ％ vs (18.40±5.26) ％,NK (13.11±4.84) ％ vs (14.20± 5.30) ％; P ＜ 0.05).CD4+ T cells in the SLND group were reduced significantly at 3rd day postoperation compared with LNS group ((29.59±6.53) ％ vs (31.19±6.32) ％,P ＜ 0.05).Conclusion LNS can reduce immunosuppression compared with SLND for postoperative patients.

Effect of early coronary artery bypass grafting to the left ventricular wall motion state in dogs with acute myocardial infarction / 国际外科学杂志

Objective To investigate the effect of early coronary artery bypass grafting (CABG)to the left ventricular wall motion state and the significance of CABG to awake hibernating myocardial in dogs with acute myocardial infarction.Methods The anterior descending coronary of all thirty dogs were ligated into MI model.According to the operation date,the experimental groups included the 1 st week (n =6),the 2nd week (n =4),the 4th week (n =6) and the 6th week (n =6) CABG,and established control group (n =2) for every experimental group.Operators marked hibernate myocardial and determined the room wall motion score by means of dobutamine ultrasound load test (DSE) combining with tissue doppler imaging (DTI)technology before CABG and after eight weeks CABG through thoracotomy surgery for the experimental group and the control group.Every dog was executed and detected the area of MI.Results Four dogs of experimental group and all dogs of control group survived to the end of the study.The change of ventricular room wall motion score in the 1st and the 2nd week CABG was smaller than that in the 4th and the 6th week CABG and MI group(0.03 ±0.06,0.05 ±0.09,0.23 ±0.08,0.27 ±40.06,0.32 ±0.05,P ＜0.05).The change of room wall motion score in all CABG groups was smaller than that in MI group(1.195 ±0.09,1.25 ±0.18,1.30 ±0.18,1.36 ±0.11,1.65 ±0.17,P＜0.05).The hibernate myocardial were more awaken in all CABG groups than that in MI group (0.27 ± 0.12,0.22 ± 0.04,0.31 ± 0.09,0.23 ± 0.03,0.03 ± 0.04,P ＜ 0.05).The area of MI became smaller in 1 and 2 weeks CABG than that in 4 and 6 weeks CABG and MI group(20.75 ± 2.63,21.25 ± 2.5,27.25 ± 1.71,27.75 ± 2.22,P ＜ 0.05).Conclusions Early CABG surgery for dogs acute MI could improve the ventricular room wall motion obviously and wake up more hibernate myocardial.Especially,CABG surgery among two weeks could lessen the effect of MI to the ventricular room wall motion and reduce the scope of myocardial infarction maximatily.

Surgical treatment of spontaneous rupture of esophagus / 中华创伤杂志

Objective To investigate the effect of the modified surgery for spontaneous rupture of esophagus (SRE) so as to improve treatmeut level.Methods Clinical data and surgical methods of 16 SRE patients including four patients with mid-esophagus ruptures and 12 with lower esophagus ruptures treated between February 1999 and June 2011 were analyzed retrospectively.All patients had only one laceration with the gap length of 1.5-5 cm (median 2.5 cm).Eleven patients had rupture into the left breast,two had rupture into the right chest,with no rupture into the chest in three patients.Ten patients suffered from hydropneumothorax and five from subcutaneous emphysema.Thc esophageal mucosas rathcr than muscular layers of all patients were sutured disconnectedly with absorbable thread.Omentum majus were embedded and fixed to muscular layer on the edge of esophagus rupture site.Fundus ventriculi were suspended and fixed to the dome of diaphragm.In the meantime,diaphragmatic hiatus were reconstructed above the esophagus rupture site for lower esophagus ruptures.Results The time from SRE attack to operation ranged from one hour to three days.Eleven patients were repaired within 24 hours of SRE onset and five patients were repaired after 24 hours of SRE onset.All patients got through the perioperative period smoothly and survived the operation with cure rate of 100％.The median hospital stay was 18.5 days.No esophageal narrow or canceration were found during follow-up (range,1-10 years),but two patients suffered from reflux which were relieved significantly after conservative treatment.Conclusion For treatment of SRE,interrupted suture for esophageal mucosal layers,omentum majus embedding instead of esophageal muscular layer suture and simultaneous anti-reflux operations can significantly reduce incidence of complications like esophageal fistula,stenosis and reflux and improve the cure rate.

Diagnosis and timely treatment for spontaneous rupture of esophagus / 中国医师杂志

Objective To explore the diagnostic approach and the idea of timely treatment for the spontaneous rupture of the esophagus (SRE) for improvement of the level of clinical diagnosis and treatment.Methods The relative clinical data and operation method of 16 cases SRE (4 cases of midpiece SREs and 12 cases of lower SRE) collected from February 1999 to June 2011 were analyzed retrospectively.There were one place breach in 16 cases of SRE with a broken length of 1.5 ～5 cm (2.6 ± 1.1 )cm,including 11 cases broken into the left breast,2 into right chest,and 3 no chest broken into.The main symptoms included intense thoracoabdominal pain,fever,difficulty in breathing,and shock.Ten cases of hydropneumothorax and 5 cases of subcutaneous emphysema were found with physical examination.Results Eleven cases were repaired within 24 hours and 5 cases were repaired after 24 hours.The esophaguses of 16 cases were sutured disconnectedly by absorbable suture line,to which omentum majus were sutured and fixed.Improved resisting backflow operation was carried out for 16 cases which got through the perioperative period smoothly and no deaths.There was no esophageal narrow in follow-up visit,otherwise,there were 2 refluxes that relieved significantly through conservative treatment.Conclusions It is the key to treat SRE that early diagnosis and exploration operation through cutting thorax after definite diagnosis,closing broken hole in order to rebuild the alimentary canal on which omentum majus was covered and fixed for the purpose of insuring continuity of digestive tract.

Preoperative diagnosis and operative route of traumatic diaphragmatic rupture / 中国医师进修杂志

ObjectiveTo study preoperative diagnosis and operative route of traumatic diaphragmatic rupture in order to improve postoperative quality of patients' life.MethodsA retrospective analysis was carried out in 63 patients with traumatic diaphragmatic rupture,all that were identified through operation from January 1990 to March 2009.All cases were associated with pneumothorax and/or hemopneumothorax at various degrees.Forty-nine cases complicated with acute peritonitis and 41 cases complicated with hemorrhagic shock.Thirty-seven cases were diagnosed definitely preoperatively,22 cases were found in operations research,4 cases with inefficacious conservation converted to operation.Thoracotomy was performedin 24 cases,laparotomy in 14 cases,combined thoracolaparotomy in 8 cases and thoracotomy plus laparotomy in 17 cases.ResultsFifty-seven cases recovered,6 cases died of hemorrhagic shock (2 cases),pericardial tamponade ( 1 case),acute respiratory failure ( 1 case) and acute renal failure at postoperative 1 week (2 cases).ConclusionDefinite and timely preoperative diagnosis and correct operative approach are striving the rescue time and success and avoiding complication.

A Clinical Study on the Expression of Cathepsin D and P Selectin in Human Non-small Cell Lung Cancer / 中国医师杂志

Objective To investigate the correlation of Cathepsin D and P selectin expression with the clinico-pathologic features and prognosis of non-small cell lung cancer (NSCLC). Methods Immunohistochemistry (S-P method) was applied to detect the expression of Cathepsin D and P selection in 30 NSCLC specimens. Results The positive rates of cathepsin D and P selectin were 66 7% and 76 7% respectively. Cathepsin D expression in NSCLC was positive relation with the tumor size, TNM stage and lymph node metastasis(P0 05). The 3 years survival rate of the patients with the expression of both the Cathepsin D and P selectin was much lower than that of the patients with negative expression of both the Cathepsin D and P selectin(P

Analysis of Clinical and Pathological Features for 32 Cases of Adolescent Patients With Esophageal Carcinoma / 中国医师杂志

Objective To investigate features of the clinical and pathology of the 32 cases adolescent patients with carcinoma of esophagus.Methods Analysis of 32 cases with esophageal carcinoma by case -control study was carried out ,40 cases of up -50 years old patients,as control group.Results Compared with those in the control group,the adolescent patients rarely was found in early stage ,the pathological differentiation were worse,the more higher malignant degree,the more shorter survival time.Conclusion The clinical symptoms of adolescent patients with esophageal carcinoma is ocult, its early diagnosis rate is low ,and so the worse prognosis.