Reasons for Conversion to Thoracotomy in 83 Cases during Video-assisted Thoracic Surgery Lobectomy: A Summary of 1,350 Consecutive Operations by A Single Surgical Team / 中国肺癌杂志

BACKGROUND@#Video assisted thoracic surgery (VATS) is the main surgical method for lung cancer. The aim of this study was to analyze the reasons for conversion to thoracotomy in 83 cases among 1,350 consecutive cases who underwent video-assisted thoracic surgery (VATS) lobectomy by a single surgical team, in order to achieve a deeper understanding of the rules and the opportunity for conversion to thoracotomy in VATS lobectomy under normal conditions.@*METHODS@#The clinical data of 1,350 patients who underwent VATS lobectomy between September 21, 2009 and June 1, 2020, by a single surgical team in the Fifth Department of Thoracic Surgery of the Fourth Hospital of Hebei Medical University were retrospectively analyzed. There were 773 males and 577 females, aged 8-87 years, with a median age of 61.3 years, including 83 cases of benign diseases, 38 cases of lung metastases, and 1,229 cases of primary lung cancer. The cases with stage I, II and IIIa were 676, 323 and 230, respectively. The cases of left upper, left lower, right upper, right middle, right lower, right middle and upper and right middle and lower lobectomy were 301 (22.30%), 231 (17.11%), 378 (28.00%), 119 (8.81%), 262 (19.41%), 16 (1.19%) and 43 (3.19%), respectively.@*RESULTS@#In the cohort of 1,350 consecutive patients with VATS lobectomy, 83 patients (6.15%) were converted to thoracotomy for different reasons. The conversion rate of benign lesions was significantly higher than that of malignant tumors (P<0.05). The conversion rate in stage IIIa was significantly higher than that in stage I and II (P<0.05). The conversion rate of combined lobectomy was significantly higher than that of single lobectomy (P=0.001). The conversion rate of left upper lobectomy was significantly higher than that of other single lobectomy (P<0.001). The conversion rate of right middle lobectomy was significantly lower than that of other single lobectomy (P=0.049). The main reasons for conversion were vascular injury (38.55%), lymph node interference (26.51%) and dense adhesion in thoracic cavity (16.87%). In the conversion group, the total operation time was (236.99±66.50) min and the total blood loss was (395.85±306.38) mL. The operation time in patients converted to thoracotomy due to lymph node interference was (322.50±22.68) min, which was significantly longer than that in the other groups (P<0.05). The intraoperative blood loss in patients converted to thoracotomy due to vascular injury was (560.94±361.84) mL, which was significantly higher than that in the other groups (P<0.05). With the increase in surgical experience, the number of vascular injuries gradually decreased at the early stage, mid-stage and late stage (P=0.045).@*CONCLUSIONS@#In VATS lobectomy, benign lung lesions and more advanced malignant tumors led to more surgical difficulties and higher conversion rate. The conversion rate was different in different lobectomy sites, with the highest in left upper lobectomy, and the lowest in right middle lobectomy. Vascular injury, lymph node interference and dense adhesion were the main reasons for conversion to thoracotomy, which led to prolonged operation time and increased blood loss. With the increasing number of surgical cases, the rate of conversion to thoracotomy in VATS lobectomy continues to decline, which may be mainly due to the more advanced treatment of pulmonary vessels.

Effects of early enteral immunonutrition on short-term quality of life and clinical outcome in patients with totally endoscopic esophagectomy / 重庆医学

Objective To analysis the short-term quality of life and clinical outcome of early enteral immunonutrition(EIN)used after operation in patients with totally endoscopic esophagectomy.Methods This randomized controlled trial enrolled 110 patients receiving totally endoscopic esophagectomy in department of thoracic surgery of the fourth hospital of Hebei medical university between May 2015 and November 2016.The patients were randomly divided into enteral immunonutrition group (EIN group,n =56) and parenteral nutrition group (PN group,n=54).The scale scores of quality of life,the time of first postoperative anal exhaust,the time of removal of drainage tube,the number of postoperative infections and the length of hospitalization were compared between the two groups before operation and after operation.Results (1) There were no significant differences in age,gender,education,marital status,tumor location,clinical stage,intraoperative bleeding between the two groups (P＞0.05).(2) There were no significant differences in the quality of life before operation (P＞0.05);All functional scale scores of EIN group were significantly higher than PN group (P＜0.05),while the symptom scale score were significantly lower than PN group(P＜0.05).(3) There were significant differences in the time of first postoperative anal exhaust,the time of removal of drainage tube,the number of postoperative pneumonia compliCations and the length ofhospitalization in the two groups (P＜ 0.05).There was no significant difference in the incidence of anastomotic fistula between the two groups(x2=0.621,P=0.431 4) The scale scores of quality of life (the overall health status as the representative) had a negatively linear relationship with the clinical outcome(P =0.000),the absolute value of correlation coefficient in EIN group was higher than that in PN group.The higher score of the quality of life,the shorter time of the postoperative anal exhaust,removal of drainage tube and the length of hospitalization.Conclusion Enteral immunonutrition can improve the quality of life,improve the prognosis and promote the rapid recovery of patients with totally endoscopic esophagectomy.

A retrospective comparison of thoracoscopic and laparoscopic esophagectomy between right neck anastomosis and left neck anastomosis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility of right neck anastomosis in thoracoscopic and laparoscopic esophagectomy.</p><p><b>METHODS</b>This study used a retrospective cohort study method. Clinical data of 169 patients with stage I-III esophageal squamous cell carcinoma undergoing neck anastomosis in thoracoscopic and laparoscopic esophagectomy at the Department 5 of Thoracic Surgery, the Fourth Hospital of Hebei Medical University from November 2013 to October 2016 were retrospectively analyzed. Eighty-two cases underwent right neck anastomosis (right neck anastomosis group) and 87 cases underwent left neck anastomosis(left neck anastomosis group). Both groups underwent routine thoracoscopic and laparoscopic radical resection of esophageal cancer. The entry of right and left neck anastomosis group was at the anterior edge of the right and left sternocleidomastoid muscle respectively. Anastomosis of the esophagogastric junction was performed and the drainage tube was placed in the neck incision. The operation time, intraoperative blood loss, lymph node dissection and morbidity of postoperative complications were compared between the two groups.</p><p><b>RESULTS</b>There were 101 males and 68 females among 169 patients with esophageal cancer. There were no significant differences in age, gender, tumor location, clinical stage between two groups(all P>0.05). The total operation time of left and right neck anastomosis groups was (278.3±39.4) minutes and (287.8±39.4) minutes, respectively (t=1.563, P=0.120). The intraoperative blood loss was (134.9±71.5) ml and(147.9±85.5) ml, respectively (t=1.074, P=0.284). The number of lymph node dissections was (17.45±5.68) and (16.47±4.98), respectively (t=1.190, P=0.236). Seventeen cases(20.7%) in the right neck anastomosis group developed postoperative complications, while 31 cases (35.6%) in the left neck anastomosis group developed postoperative complications (χ²=4.609,P=0.032). Compared with left neck anastomosis group, right neck anastomosis group had lower rate of gastric emptying disorder (0% vs. 6.9%, P=0.029), anastomotic fistula (7.3% vs. 18.4%, χ²=4.572, P=0.033), pneumonia (18.3% vs. 32.2%, χ²=4.294, P=0.038) and ICU management (4.9% vs. 16.1%, χ²=4.726, P=0.030).</p><p><b>CONCLUSION</b>Thoracoscopic and laparoscopic esophagectomy with right neck anastomosis is safe and effective, can completely remove the tumor, at the same time, has less complications than left neck anastomosis, and improve the quality of life.</p>

The dose study of radiation gastritis caused by esophageal cancer radical postoperative prophylactic irradiation / 中华放射肿瘤学杂志

Objective To study the relationship between radiation gastritis ( RG ) caused by esophageal cancer radical postoperative prophylactic IMRT and the dose of gastric. Methods A total of 49 esophageal cancer patients received postoperative adjuvant radiatherapy after esophagectomy, we analysised the dose?volume histogram of treatment plan and the the occurrence of RG, To analysis those physical indicators may be related to the occurrence of RG. The of ROC curve to analysis the physical index of the occurrence of acute radiation gastritis, Chi square test is compared between groups, Logistic method was used to multivariate analysis. Results The whole group, a total of 19 cases ( 39%) patients with symptoms of acute RG level 2 or higher. The results of ROC curve analysis showed that the physical variables associated with the occurrence of RG include stomach Max,stomach Mean,LSTT5?LSTT40 and V5?V50.According to the ROC curve,the cutoff values of the physical parameters of the patients were grouped. The incidence of acute≥2RG in the group of above boundary value patients significantly higher than below boundary value group, the physical index of the differences between groups were significant (P=0. 000?0. 022),except V5.The results of Logistic multivariate analysis showed that LSTT5 and V40 were independent predictor of≥2 RG (P=0. 026,0. 001). Conclusions According to the results of this study,We should pay attention to the protection of the stomach in develop a treatment plan for the prevention of postoperative patients with esophageal cancer,dose?volume histogram can well predict the occurrence of RG. Stomach LSTT5 and V40 were independent predictor of≥2 RG.The results of this study need to be further studied.

Clinical Observation of Taxol Combined with Cisplatin Neoadjuvant Chemotherapy in the Treatment of Esophageal Cancer / 中国药房

OBJECTIVE:To observe the clinical efficacy of taxol combined with cisplatin neoadjuvant chemotherapy in the treatment of esophageal cancer and effects on serum tumor markers in patients with esophageal cancer. METHODS:100 patients with esophageal cancer were randomly divided into control group(50 cases) and observation group(50 cases). Observation group was given taxol+Cisplatin injection(TP)neoadjuvant chemotherapy,given 175 mg/m2 taxol by intravenous infusion,d1-5. And ev-ery 5 d was a treatment course,the regimen was adjusted based on patients’efficacy;control group was given conventional sur-gery and TP after surgery,the same usage and dosage as observation group,it lasted for 4 courses. Clinical efficacy,high mobility protein B1(HMGB1),carcinoembryonic antigen (CEA) and squamous cell carcinoma antigen (SCC-Ag) level in 2 groups before and after treatment were observed,objective response rate,disease control rate,the incidence of toxicity and severe toxicity,inci-dence of postoperative complications and survival rate of postoperative 1,3 and 5 years were recorded. RESULTS:After treatment, objective response rate in observation group was significantly higher than control group,HMGB1,CEA and SCC-Ag levels were significantly lower than before and control group,HMGB1 and CEA levels in control group were significantly lower than before, the differences were statistically significant(P0.05). CONCLUSIONS:Taxol combined with cisplatin neoadjuvant chemotherapy can significantly improve the efficacy of patients with esophageal cancer and reduce the levels of cancer-related indicators,with good safety.

Changes and significance of serum tumor markers in patients with esophageal squamous cell carcinoma re-section / 实用医学杂志

Objective To explore the dynamic changes of serum HMGB1, CEA and SCC as well as the value in the evaluation of prognosis of patients with esophageal squamous cell carcinoma resection. Methods The dynamic changes in serum levels of HMGB1, CEA and SCC were measured respectively in 100 patients preopera-tively as well as a month after esophagectomy. The relationships between the changes of serum tumor markers and the clinical efficacy were analyzed. Results The 5-years survival rate of the CEA, SCC and HMGB1 negative peo-ple before operation was significantly higher than that of the positive patients (P < 0.05). The 5-years survival rate of those patients with all three markers negative before operation was significantly higher than that of those patients with the three markers positive (P < 0.01). The Median Survive Time of the patients with the levels of all three markers decreased after operation was longer than those with the levels of all the three markers increased (χ2 =6.584, P=0.01). The Median Survive Time of the patients with levels of the three markers decreased by more than 50%was longer than those with the levels decreased by less than 50% (χ2=5.418, P = 0.02). Conclusions The dynamic and combined detections of serum HMGB1, CEA, SCC in patients with esophageal squamous cell carcino-ma resection can effectively evaluate the therapeutic effect and prognosis.

In vivo and in vitro anti-tumor activity studies of five sesquiterpenoids from Inula helenium / 中国药理学通报

Aim To detect the antitumor activities of five sesquiterpene lactones from the roots of Inula helenium.Method Using MTT assay to evaluate the antitumor activities of five sesquiterpene lactones to the cell lines of U251SP,T-98,HLE,MM1-CB,HMV-1 and KT,and to explore the relationship between structure and activities.Results Isoalantolactone exhibited significant anti-growth activities to U251SP,HLE and MM1-CB,while other compounds demonstrated weak or moderate anti-growth activities to cell lines even in the 50% inhibition concentration≤100 μmol·L~(-1).Conclusion Isoalantolactone exhibits significant anti-growth activities to three cell lines and its anti-tumor activitiesve close relationship with the structures,α,β-unsaturated five-membered lactone ring is necessary for the activities,and saturated lactone or 5,10-seco and A,B-ring become a ten-membered macro-ring leading to the loss or decrease of anti-growth activity.

Regulation of gastrin and motilin on the tension of human lower esophageal sphincter in vitro / 基础医学与临床

Objective To explore the regulatory mechanism of gastrin and motilin on sling fibers and clasp fibers of human lower esophageal sphincter.Methods Muscle strips of the sling and clasp fibers from human lower esophageal sphincter and the circular layers of the esophagus and gastric fundus were obtained from patients with subtotal esophagectomy.Through the isolated tissue tension detection technique and pharmacological method,the concentration-response curves of the strips responding to gastrin and motilin were constructed,from which E_(max)s were derived.Results All strips contracted to gastrin and motilin with different rules and different intensity in a concentration-dependent fashion.Sling fibers' E_(max)value(4.91?(0.95 mN/mm~(2))) to gastrin was significantly higher than clasp fibers'(0.72?(0.14 mN/mm~(2))).Otherwise,in response to motilin,both sling fibers and clasp fibers contracted to motilin intensively(3.61?(0.65 mN/mm~(2))and 2.64?(0.33 mN/mm~(2))).Conclusions The sling fibers and clasp fibers have different responses to gastrin and motilin.

Experimental study of chemolysis with collagenase outside the intervertebral disk / 中华麻醉学杂志

ve To assess the efficacy of chemolysis with collagenase injected into epidural space and the effects upon intervertebral disk and nerve roots. Methods Sixty-four healthy new Zealand rabbits of either sex, weighing 2.5-3.0kg were divided into four groups of sixteen each: group A, B, C and D. In group A and B herniation of disk was produced by injecting normal salin 0.1ml into the intervertebral disk after surgical resection of spine and posterior arch of L4_6, while in group C and D no herniation of disk was produced. In group A and C collagenase 300u( in normal saline 0.5ml) was injected into the epidural space at the level of L4-6, and in group B and D normal saline 0.5ml was injected into epidural space as control. Three animals from each group were sacrificed on the 7th, 15th, and 30th day after operation and intervertebral disk and nerve roots at the operation site were removed and fixed for light and electron microscopic examination. Sciatic nerve conduction velocity (NCV) was measured before operation and on 1st, 7th, 15th and 30th postoperative day. Results In group A the intervertebral disk was dissolved to some extent. In group B nerve roots were injured to different degree. In group A and C NCV was higher than normal on the 7th and 15th day after operation. Conclusions Collagenase may dissolve the herniated intervertebral disk but does not injure the nerve roots. It may increase NCV.