ObjectiveTo summarize the clinical experience of thoracoscopic and laparoscopic esophagectomy for esophageal carcinoma. MethodWe retrospectively analyzed the clinical data of 38 patients with esophageal carcinoma undergoing thoracoscopic and laparoscopic esophagectomy in Central Hospital of Chongqing Three Gorges between March 2011 and March 2013. There were 25 males and 13 females aged 64.25±7.68 years (ranged 45-79 years). The esophagus was freed and the lymph nodes were cleaned under the thoracoscope in the left lateral position. Then the stomach was freed under laparoscope and lifted up to anastomose with the esophagus through the passageway behind the sternal bone. ResultsAll surgical process progressed successfully without intraoperative death or major hemorrhage. The total operating time ranged from 250 to 340 minutes. The intraoperative hemorrhage ranged from 80 to 350 ml. The number of lymph nodes cleaned ranged from 7 to 15 (10.24±2.04) and a total of 8 patients were found of tumor metastasis. Postoperative stage grading indicated 8 patients of T1N0M0, 16 patients of T2N0M0, 5 patients of T2N1M0, 6 patients of T3N0M0 and 3 patients of T3N1M0. Postoperative complications included chylothorax in 1 patient, pulmonary infection in 4 patients, and cervical anastomotic leakage in 4 patients. All 38 patients were followed up for 3 to 12 (6.31±2.18) months, and 1 patient was lost. Two patients died from cervical anastomotic leakage resulting in chest infection. The other all achieved recoveries without metastatic or recurrence of tumor. ConclusionThe intraoperative and postoperative complications of thoracoscopic and laparoscopic esophagectomy for esophageal carcinoma are less frequently than traditional surgery, so it's worthy of promotion in large regional general hospitals.
ObjectiveTo assess the value of multi-slice spiral CT (MSCT) in the diagnosis and resectability judgement of hepatic alveolar echinococcosis (HAE). MethodsThe CT findings of 28 patients who were confirmed HAE by surgical pathological examination were retrospectively analyzed. Comparative analysis were made between the CT findings and surgical pathology. ResultsAltogether 45 lesions in hepatic were detected. Lesions mainly revealed an infiltrating tumor-like hepatic mass with irregular margins and heterogeneous contents with varied attenuation, including scattered hyper-attenuating calcifications and hypo-attenuating areas corresponding to necrosis, no substantial enhancement, however, the fibro-inflammatory component surrounding the parasitic tissue was enhanced faintly in the delayed phase, and clearly demarcated from surrounding parenchyma. MSCT angiography (CTA) depicted signs of infiltration of hepatic vessels such as pushed, compression, displacement, stenosis, encasement and interruption. Compared with findings of operation, the sensitivity and specificity value of MSCT for evaluating the hepatic artery system disorders were 67%, 97%; and for portal venous system were 83%, 93%; and for hepatic venous system were 84%, 91%; while for inferior vena cava were 85%, 100%. Twelve cases which were evaluated as resectable by MSCT were in accordance with surgical findings. In the rest 16 patients which were judged as non-resectable by MSCT, only 2 patients were radical treatment through partial excision, repair and reconstruction for the involvement of large vessels and bile ducts. ConclusionMSCT is accuracy in the diagnosis and assessment of vessels complication of HAE. It has an important value to evaluate the resectability of HAE and the planning of treatment.
Objective To explore feasibility and clinical value of low dose computed tomography perfusion imaging (CTPI) in quantitative assessing proximal gastric cancer. Methods A total of 34 patients diagnosed with proximal gastric cancer (a proximal gastric cancer group) were enrolled prospectively in this study. The 25 normal parts of gastric fundus of the included patients constituted a control group. All the patients underwent the low dose CTPI before surgery. The total effective radiation dose was recorded, and a specific post-processing software was used to automatically generate the perfusion parameters values, including the time to peak (TTP), blood flow (BF), blood volume (BV), mean transmit time (MTT), and permeability (PMB). The perfusion parameters in the different histopathologic types and stages of the patients were compared. Receiver operating characteristic (ROC) curves were generated to compare their diagnosis performances. Results The histopathologic findings verified that there were 11 patients with T1+T2 stage and 23 patients with T3+T4 stage; 8 patients with signet ring cell carcinoma and 26 patients with adenocarcinoma; and 17 patients with lymphatic metastasis and 17 patients without lymphatic metastasis. ① Compared with the control group, the BF, BV, and PMB values were significantly higher and the MTT and TTP values were significantly lower in the proximal gastric cancer group. The area under the ROC curve (AUC) values of the BF, BV, PMB, MTT, and TTP in the diagnosing proximal gastric cancer was 0.955, 0.807, 0.987, 0.654, and 0.649 respectively. The BF and PMB represented the best diagnostic performances, and the BV was secondary in the ROC curve results. ② The BF value was significantly lower and the PMB value was significantly higher in the patients with signet ring cell carcinoma as compared with the patients with adenocarcinoma. However, the BV, MTT, and TTP values had no significant differences in both them. And the BF (AUC=0.986) had a better ability than the PMB (AUC=0.856) in the discriminating the histopathological type (P=0.047). ③ The PMB value in the patients with pathological stage T3 and T4 was significantly higher than that of the patients with pathological stage T1 and T2 (P=0.004), but the BF, BV, MTT, and TTP values had no differences in both them. The diagnosis value of the PMB in the discriminating the pathological stage was good with an AUC value of 0.814. ④ None of the parameters had significant difference between the patients with and without lymphatic metastasis (P>0.05). ⑤ The total effective radiation dose of each scan was 8.58 mSv, which was lower than that of the standard radiation dose of CTPI. ⑥ The rates of lymphatic metastasis and high T staging were not related to the histopathological type of the proximal gastric cancer (P>0.05). Conclusion Low dose CTPI used in this study could effectively reduce radiation dose, could quantitatively evaluate angiogenesis in proximal gastric cancer, and has a certain clinical value in identifying of histopathological type and evaluating of pathological stage.
Objective To explore the feasibility of mean temporal phase images calculated from perfusion CT datasets by using CT perfusion (CTP) of liver on the third-generation dual-source CT. Methods Twenty-two consecutive patients with suspected hepatocellular carcinoma were enrolled, we retrospectively compared objective and subjective image quality, leson detectability, and radiation dose between mean temporal arterial (mTA) and mean temporal portal venous (mTPV) images which calculated from perfusion CT datasets with conventional enhanced arterial and portal venous datasets. Results ① Image quality: compared with the conventional enhancement image, the standard deviation (SD) values of CTP images on liver (arterial phase), portal vein (arterial phase), and liver (portal vein phase) were lower (P<0.05); the signal-to-noise ratio (SNR) values of CTP images on aorta (arterial phase), portal vein (arterial phase), aorta (portal vein phase), and portal vein (portal vein phase) were all higher (P<0.05), the contrast-to-noise ratio (CNR) value of CTP images on aorta (arterial phase) was higher (P<0.05). ② The subjective image quality: the subjective image quality scores of CTP images (mTA and mTPV images) were higher when compared to responding conventional enhanced arterial and portal venous datasets (P<0.05). ③ The diagnostic efficiency: the CTP images and conventional enhancement images showed all the lesions, but the diagnostic efficiency images of CTP images was better than the conventional enhancement images, both on lesions of blood supply and lack of blood supply (P<0.05). Conclusions The image quality of mTA and mTPV datasets calculated from CTP datasets are non-inferior when compared to conventional enhanced arterial and portal venous acquisitions in patients with suspected hepatic lesions. Thus, CTP could be used as a stand-alone imaging technique without additionally performed conventional arterial and portal venous CT acquisitions.