Laparoscopic vagal-sparing esophagogastrectomy / 中华消化外科杂志

Laparoscopic vagal-sparing esophagogastrectomy for the treatment of early esophageal cancer has the advantages of minimal invasion,functional sparing and better quality of life,and it can radically resect the tumor.The clinical data of 3 patients in the Daping Hospital of Third Military Medical University and 9 patients in the Xijing Hospital of Digestive Diseases who received laparoscopic vagal-sparing esophagogastrectomy from September 2009 to August 2013 were retrospectively analyzed.All the 12 patients were followed up for 1-24 months.One patient was complicated with transit hoarseness and 1 with cervical anastomotic fistular,and they were cured by conservative treatment; 1 patient was complicated with cervical anastomotic stricture,and was cured by dilatation for 3 times; no dysphagia and recurrence was observed in the other 9 patients during the follow-up.Laparoscopic vagal-sparing esophagogastrectomy is a good option for early esophageal cancer and benign esophageal diseases.

Comparafive study on arterial blood gas analysis and pulmonary functions of emphysematous rabbits after unilateral and bilateral lung volume reduction surgery / 中华胸心血管外科杂志

Objective Describes the changes of arterial blood gas analysis and pulmonary functions of emphysematous rabbits after unilateral and bilateral lung volume reduction surgery.Methods Sixty rabbits were randomly and equally divided into 6 groups:control group(A),emphysema group( B),unilateral sham operation group(C),unilateral lung volume reduction surgery group( D),bilateral sham operation group( E ) and bilateral lung volume reduction surgery group(F).Obstructive emphysema was induced with somg and papain in tie rabbits of the remaining groups except the control one.Eight weeks later,arterial blood gas analysis and pulmonary functions were detected.Results Compared with group B,pH,PaO2,PaCO2,SaO2,forced expirratory volume in 0.5 s,froced expiratory capacity,functional residual capacity,total lung capacity,dynamic compliance,and resistance in expiartory phase could be improved in group D ( P ＜ 0.05 ).The amelioration of those results were more obvious in group F ( P ＜0.05).Two rabbits in group F died after opertation.Conclusion Bilateral lung volume reduction surgery could more markedly improve the arterial blood gas analysis and pulmonary functions of emphysematous rabbits than unilateral operation.

Short-term outcome of side-to-side stapled cervical esophagogastrostomy after esophagectomy / 中华消化外科杂志

Objective To evaluate the short-term outcome of side-to-side staple cervical esophagogastrostomy after esophagectomy. Methods The clinical data of 105 patients with esophageal cancer who were admitted to the Daping Hospital from January 2006 to March 2009 were retrospectively analyzed. Of the 105 patients, 97 received side-to-side stapled cervical esophagogastrostomy and eight received traditional hand-sewn end-to-end cervical esophagogastrostomy. Nine patients were selected from the 97 patients who received side-to-side stapled cervical esophagogastrostomy to conduct matched pair analysis. The efficacy of the two methods was analyzed using the t test. Results No postoperative death was observed. The mean operation time of side-to-side staple cervical esophagogastrostomy was (21 ± 3 )minutes (range, 15-30 minutes). Postoperative complications were observed in 16 patients, including pulmonary complications in seven patients, vocal cord paralysis in four patients, anastomotic leakage in three patients and anastomotic stricture in two patients. The mean anastomotic diameter of patients who received side-to-side staple cervical esophagogastrostomy was ( 3. 01 ± 0. 17 ) cm, which was significantly longer than ( 1.69 ± 0. 26) cm of patients who received traditional hand-sewn end-to-end cervical esophagogastrostomy (t =2. 093, P ＜0.05 ). Dysphagia occurred in two patients who received side-to-side stapled cervical esophagogastrostomy and in four patients who received traditional hand-sewn end-to-end cervical esophagogastrostomy.Conclusions Side-to-side stapled cervical esophagogastrostomy is simple, safe and effective for patients with esophageal cancer after esophagectomy. This technique could decrease the incidence of postoperative dysphagia and improve the pharyngo-esophageal motor function.

Application of circular stapler in the reconstruction of intrathoracic esophagus / 中华消化外科杂志

Objective To review the outeonle of intrathoracic esophageal reconstruction using circular stapler after esophageal or cardiac cancer resection.Methods From June 1996 to April 2007,744 patients underwent tumor removal and intrathoracie esophageal reconstruction in Daping Hospital.Of all patients,658 suffered from thoracic esophageal cancer and the other 86 from cardiac cancer.The operative modalities consisted of gastroesophageal anastomosis at the top of tim thoracic cavity or above the aortic arch in 402 patients,gastroesophageal anastomosis below the aortic arch in 317,and total gastrectomy in 25(esophageal replacement with colon in 21 patients and esophagojejunostomy in 4).Results Anastomotie bleeding oecurred in 5 patients intraoperatively.One patient died of acute respiratory distress syndrome,1 of septic shock and 1 of hepatic failure postoperatively.Psychiatric disorder was observed in 5 patients,respiratory complications in 34,anastomotie fistula in 4,and anastomotic stricture in 20.Three weeks after the operation,the esophageal manometric examination in 25 patients showed that intraesophageal,anastomotie and intragastric pressures were(-0.2±2.0),(1 1.2±4.4)and(2.4±1.5)mm Hg(1 mm Hg=0.133 kPa),respectively.Twenty-four hour pH monitoring demonstrated that 13 patients had abnormal DeMeester score(＞14.72),3 of thenl developed reflux symptoms and got relieved after receiving acid suppression therapy for 1.0-2.2 months.The 13 patients with abnormal DeMeester score were followed up for 3-38 months,and the pH value of the esophagus was back to normal in 2 patients,and it almost remained the same in 9 patients.Two patients died of tumor reculTenee of metastasis.Conclusions Intratlmracic esophageal reconstruction with circular stapler is safe,reliable and able to reduce the postoperative complications such as anastomotic fistula.

Effects of unilateral lung volume reduction surgery with different resection volumes on pulmonary functions and alveolar morphology of emphysematous rabbits / 中国组织工程研究

BACKGROUND: Rehabilitation exercise and conservative treatment do not bring about good therapeutic effect for severe obstructive emphysema.And lung volume reduction surgery (LVRS) is an effective method for this kind of disease. How much emphysematous tissue should be resected in LVRS to achieve the best curative effect has been a concern.OBJECTIVE: To evaluate the pulmonary functional and alveolar morphologic changes in emphysematous rabbits after unilateral LVRS, and to compare the effects of different resection volumes.DESIGN: A completely randomized and controlled trial.SETTING: Thoracic Surgery Center of Daping Hospital of the Third Military Medical University of Chinese PLA.MATERIALS: This study was completed at the Laboratory of Thoracic Surgery Center of Daping Hospital of the Third Military Medical University of Chinese PLA from Frebruary 2003 to August 2003. Totally 50 New Zealand white male rabbits of cleaning grade were involved. These animals were divided randomly into groups of emphysema (A), less volume LVRS (B), middle volume LVRS (C), larger volume LVRS (D), and shame operation (E) .METHODS: Making of the rabbit emphysema model: Rabbits were put into an organic glass box and they inhaled passively smog produced from the cigarettes. Within seven weeks, 15 cigarettes (Yinxiang .Brand) were lighted for about 30 minutes every time, once per day and five times a week. Elastase for 3 mL(2000 U/kg) from porcine pancreas (SERVA Co.,Ltd) was injected into the rabbits' trachea in the fourth week. Intervention for different groups: Rabbits in Group A received no operation at all. Animals in other four groups were given general anesthesia by muscular injec tion of Sumianxin Ⅱ and they were then fixed supinely on the operation table. The rabbits were intubated with a 3-mm endotracheal tube and mechanically ventilated (HX-200 ventilator) with a tidal volume of 12 mL/kg and a respiratory rate of 40-50/minute. Thoracotomy was conducted through anterolateral incision of the fourth right intercostals area. The upper and lateral pulmonary tissues of the first lobe of the right lung were resected in Group B. For group C, the upper and lateral pulmonary tissues of the first and the second lobes of the lung were resected. For Group D, the upper and lateral pulmonary tissues of the first, second and the third lobes of the right lung were resected. The pulmonary removal was about a half of the total volume of the lobe. The specimens were removed, followed by 3-0 mattress suture of the wounds. Then, fibrin sealant was insufflated to avoid air leakage after the operation. Thoracotomies without any resection of lung parenchyma were carried out in Group E. Histologic inspection and quantitatively morphologic analysis of the left lung was postoperatively carried out eight weeks later.MAIN OUTCOME MEASURES: Quantitative analysis of pulmonary functions and alveolar morphology in rabbits with emphysema after lung volume reduction surgery with different resection volumes RESULTS: All the fifty rabbits were analyzed, and there were ten animals in each group. ① Comparison of ventilation volume in each group: In Group C, vital volume (VT), forced expiratory volume in 0.3 s (FEV0.3),FEV0.3/forced expiratory capacity (FVC) were all higher than those of Group A [(6.69±0.83) mL, (6.39±1.35) mL, (64.5±16.1)％; (5.76±0.84) mL,(5.23±1.37)mL, (50.2±15.6)％, P＜ 0.05], while functional residual capacity (FRC) was lower than that in group A [(14.3±1.9)mL; (19.3±3.1)mL, P＜ 0.05].Compared with Group A, no obvious difference in the above lung functions of Groups B, D and E was observed (P ＞0.05). ② Histopathological observation results: In group C, obvious repairs to dilatation and destruction of alveolar ducts or cyst were observed and the aggregation of macrophage and neutrophils in the end-terminal bronchiole decreased. In Group D, the inflammatory cells decreased, but alveolar destruction and dilatation became more marked. ③Comparison of the total lung capacity (TLC): TLC of Group C was less than that of group A [(42.1 ±5.8)mL, (58.5±7.6)mL, P＜ 0.05].Compared with group A, no obvious difference in the above lung functions of Groups B, D and E was observed (P ＞0.05). ④ Quantitative analysis result of alveolar morphology: The number of alveoli (Na) and density of alveolar septum (Ds) in Group C were much larger than those of group A [(17.6±3.1)/field, (18.6±2.1)％; (11.3±2.7)/field, (15.2±3.6)％, P＜ 0.05] while the diameter of the alveoli (Da) in Group C was significantly lower than those of Group A[(78.1±7.1),(93.4±10.2)μm, P ＜ 0.05].CONCLUSION: Combination of smog and elastase successfully induced rabbit model of obstructive emphysema. Unilateral LVRS could improve emphysematous rabbits' pulmonary functions. Improved in pulmonary functions was not obvious by LVRS with less (12.5％) or larger (37.5％) resection volume of lung parenchyma. LVRS with appropriate resection volume (25％) could effectively eliminate airway inflammation, alleviate alveolar dilatation and destruction of the residual lung parenchyma, and thus improve pulmonary ventilation function.

Reconstructive operation with colon or stomach for scarred stricture after esophageal burns / 中华胸心血管外科杂志

Objective To summarize the experience and the outcome of the reconstructive operation with colon or stomach for scarred stricture after esophageal burns. Methods This retrospective report reviews the clinical history of reconstructive operation with colon or stomach for scarred stricture after esophageal burns. 74 cases underwent esophageal reconstruction by colon without resection of scarred esophagus, 26 cases esophagogastric reconstruction with resection of scarred esophagus. Results In the group reconstructed with colon there were 5 postoperative deaths, including mediastinal infection caused by necrosis of transposition colon in 2 cases. Other postoperative complications included cervical anastomotic leakage in 14 cases and anastomotic stenosis in 4 cases. In the group reconstructed with stomach, there was no operative death and only 2 anastomotic stenosis and one empyema occurred after operation. Conclusion The proximal esophageal scarred stricture beyond the lower edges of aortic arch could be replaced by colon bypass without resecting the scarred esophagus. The esophagogastrostomy could be performed after excising scarred esophagus with the anastomosis can be made below the aortic arch. The postoperative complications in the group of reconstruction with colon were higher than the group of reconstruction with stomach. Improvement in surgical technique may decrease the complication rate of reconstruction with colon.

Clinical observation on 131 cases of video-assisted thoracic surgery / 第三军医大学学报

Objective　To explore the effect of video-assi sted thoracic surgery (VATS) on common diseases of chest. Methods　Video-assisted thoracoscopic surgery was performed on 131 patients with ches t diseases from April 1994 to December 2000 in which 109 cases were spontane ous pneumothorax and hemothorax, 10 pulmonary tuberculoma, 5 pulmonary carcinoma , 3 esophageal carcinoma, 2 localized benign mesothelioma, 1 pulmonary hamartoma and 1 myasthenia gravis. Results　There was no operative death in all cases. Four patients with spontaneous pneumothorax complicated persist ent air leak(more than 7 d) and 1 patient with hemopneumothorax formed hemoth orax after the operation, which was stopped by the second VATS. The others recov ered well without any postoperative complications. Conclusion　 VATS is characterized by safety and mild tissue injury in the operation, and les s pain, fewer complications, rapid recovery and short duration of hospitalizatio n after the operation.

Expression of epidermal growth factor receptor in thymoma and its clinical significance / 第三军医大学学报

Objective　To study the effect of epidermal growt h factor receptor(EGFR) on the development and progress of thymoma. Me thods Expression of EGFR was detected by immunohistochemical stain in t he tissues of 11 cases of normal thymus and 29 cases of thymoma. Result s　 The positive expression of EGFR was 75.9%(22/29) in thymomas and 18.2%(2/11) in normal thymus. The difference was significant(P<0.01). The positive rate of EGFR was higher in invasive thymomas than in non-invasive ones (P<0.01). T he positive rate of EGFR increased with Masaoka stage with a significant increm ent in Ⅲ-Ⅳ stage compared with I stage (P<0.01). EGFR was strongly expre ssed in 5 cases of invasive thymomas, in which recurrence or metastasis occurred in 3 during the follow-up period after operation. But there was no statistical correlation with whether complicated with myasthenia gravis (MG) and histolog ical type. Conclusion　EGFR might be related to the tumori genesis and development of thymoma. There is high risk of recurrence and metast asis in case of EGFR over-expression and radiotherapy, chemotherapy and follow up should be enhanced.

Clinical Study of 5% D-fructose Injectio for Energy Supply in Surgery Patients / 中国药房

OBJECTIVE: To observe the clinical effect of 5% D-fructose injectio on energy supply in surgery patients. METHODS: By setting 5% glucose injectio as control,the influence of 5% D- fructose injectio on blood sugar level,liver and kidney function indices was detected.RESULTS: 5% D-fructose injectio did not influence liver and kidney functions, serum uric acid and RESULTS: of routine examination of blood and urine.Compared with control group, the change of blood sugar level in experiment group was slighter.CONCLUSION: 5% D-fructose injectio is effective and safe for energy supply in surgery patients.