[Experimental study of replacement of an esophageal segment with an nitinol alloy composite artificial esophagus].

OBJECTIVE: To observe the feasibility of a segment thoracic esophagus replaced by using a nitinol alloy composite artificial esophagus. METHODS: A nitinol alloy composite artificial esophagus was made of a nitinol tube coated with a silicone membrane with a dacron flange 1 cm proximal to each end. There were ten pigs for the models of experimental animal. The models of experimental animal were established by excised a segment of 7 cm long thoracic esophagus and replaced with the graft. In accordance with the different anastomosis connective way 10 pigs were divided into group I and group II, every group had 5 pigs. In group I monolayer end-to-end anastomosis was used with this prosthesis. In group II monolayer end-to-end anastomosis was used with this prosthesis and above the site of anastomosis adding dacron strip fixed. After operation the operate animals were observed for eating and health. Esophagography and flexible esophagoscopy were performed once a month at the first, second, and third postoperatively month. Three pigs of the grafted prostheses sloughed out spontaneously at different postoperatively period were killed for autopsy and pathologic examination of the neoesophagus. RESULTS: All pigs had no leakage at the site of anastomosis and survived over 6 months. The longest survival was 20 months. Seven of 10 pigs the grafted prostheses sloughed out spontaneously at 2 to 6 months after the operation (4 in group I and 3 in group II). The grafted prostheses sloughed out spontaneously less than 3 months after operation, marked neoesophageal stenosis in the grafted portion was recognized (3 in group I). They displayed serious difficulty in eating. But the prostheses sloughed out spontaneously more than 3 months after operation, neoesophageal stenosis was increased slightly and the stenosis was only temporary and gradually resolved. (1 in group I, 3 in group II) They lived in good health and without difficulty in eating. Three of 10 pigs the grafted prosthesis still stayed in the grafted place over 10 months (1 in group I, 2 in group II). The neoesophageal had no stenosis. They were perfectly well in eating. CONCLUSIONS: A segment excised pig esophagus replaced with a nitinol alloy composite artificial esophagus is feasible and takes a better result.

[A clinical study of lobectomy with minimally invasive incision].

OBJECTIVE: To study the application of small thoracic incision for lobectomy with effects comparable to that of conventional incision. METHODS: A total of 386 patients with lung tumors were prospectively randomized into thoracic small incision group (n=184; average length of incision, 12.7 cm) and standard thoracic incision group (control group, n=152). The incision length, operation time, intra-operative bleeding volume, postoperative drainage volume, transfusion, hemostatic dosage, ambulation time, hospital stay and major complications were compared between the two groups. RESULTS: All of the indices in small incision group were significantly better than those of the control group (P<0.01) except the operation time (P>0.05). No severe complications occurred in small incision group, and in 4 cases conventional thoracotomy was performed instead due to adhesion or giant tumors. CONCLUSIONS: Muscle-sparing thoracic small incision can achieve excellent clinical result and has such advantages as less invasiveness, reduced bleeding volume, pain and hospital stay, less complications, and better postoperative appearance. This procedure meets the requirements of lobectomy and provides an alternative for routine lobectomy for pulmonary tumors.

[The value of three-phase pulmonary helical CT in diagnosing peripheral pulmonary cancer (diameter

OBJECTIVE: To evaluate the value of three-phase pulmonary helical CT in diagnosing peripheral pulmonary cancer (diameter