Objective To evaluate the effect of perioperative fluid management on postoperative pulmonary complications (PPCs) of esophagectomy, and to find out the optimal scheme for perioperative fluid administration. Methods This retrospective cohort study enrolled 75 patients with esophageal squamous cell cancer who have received esophagectomy in West China Hospital from June to December 2014. We used the Kroenke's postoperative pulmonary complications classification system to define the PPCs. Patients with PPCs of grade Ⅱ-Ⅳ were considered as PPCs group (n=13, 12 males, 1 female, age of 64.62±8.64 years), and others were considered as non-complication group (n=62, 50 males, 12 females, age of 60.55±8.73 years). Intraoperative and postoperative fluid inputs and outputs as well as clinical characteristics between groups were compared. Results Between two groups, there was a great difference in postoperative albumin infusion, intraoperative fluid administration [net input, total input, net input/kg, total input/kg, net input/(kg·h) and total input/(kg·h)] and fluid input on the first postoerative 1–3 days (total input and total input/kg). The cutoff value for total input/(kg·h) in operation and total input on the first 1–3 postoerative days was 12.07 ml/(kg·h) and 178.57 ml/kg, respectively. Conclusion The speed of fluid infusion in operation and total input on postoperative 1-3 days are most important influence factors of PPCs. The speed in operation should not exceed 12.07 ml/(kg·h) and the total input on postoperative 1-3 days should not exceed 178.57 ml/kg. Within this range, an appropriate increase in fluid volume can make patients feel better.
Objective To investigate the related factors affecting the metastases to left gastric artery lymph nodes in patients of esophageal cancer, and evaluate the clinical significance of resection of left gastric artery. Methods One hundred and eighty-six patients with esophageal cancer undergone esophagectomy and esophagogastrostomy were involved in these case-control study. The left gastric artery, lymph nodes and fat tissue around it were removed in these patients. Patients were divided into 2 groups according to the occurrence of metastases to para left gastric artery lymph nodes. Chi-square test, rank sum test, t-test and the logistic regression were adopted to analyze the correlations between these related factors and the metastases to para left gastric artery lymph nodes. Results Thirty-three patients had para left gastric artery lymph nodes metastases （17. 74%）. Related factors that affect the metastases to para left gastric artery lymph nodes were showed by monovariate analysis as follows： TNM staging of tumor, the metastases to paraesophageal nodes, paracardial nodes and subcarinal nodes （P〈0.001, P=0.025, 0.047,0.038）. Multivariate analysis showed that location of tumor was the only independent factor that influences the metastases of para left gastric artery lymph nodes（P= 0. 002）. Skip metastasis was a distinct feature of esophageal cancer, with a frequency of 78.79%（26/33）. Conclusions This study suggests that the major correlative factor of para left gastric artery lymph node metastasis is location of tumor. Resection of left gastric artery as a routine procedure in radical operation of esophageal cancer should be considered.
ObjectiveTo explore the effects of intraoperative lymphatic chemotherapy (LC) on immune functions of patients after esophageal carcinoma resection. MethodsPatients who underwent intraoperative LC during esophageal carcinoma resection in the Department of Thoracic Surgery of West China Hospital from March to October,2013 were prospectively included in this study, and patients who underwent esophageal carcinoma resection without intraoperative LC during the same period were also included as the control group. All the patients were divided into a pacitaxel LC group,a fluorouracil LC group,and a control group without LC. A total of 37 patients were included in this study including 25 male and 12 female patients with their age of 42-76 (61.89±7.95) years. There were 15 patients in the pacitaxel LC group,15 patients in the fluorouracil LC group,and 7 patients in the control group. Representative indexes of humoral immunity and cellular immunity in peripheral blood of all the patients were examined preoperatively and on the third and seventh postoperative day, and then compared among the 3 groups. ResultsAll the immune indexes of the 3 groups decreased after surgery to different extent. There was no statistical difference in preoperative and postoperative difference of immunoglobulin concentration between LC groups and the control group (P>0.05). CD8+ T cell count recovered more rapidly after surgery in LC groups than the control group. CD3+ T cells recovered most rapidly after surgery in the fluorouracil LC group. ConclusionLC is beneficial for the recovery of cytotoxic effects of T lymphocytes but may not promote humoral immunity for patients after esophageal carcinoma resection.
Objective To investigate the clinical feasibility and effectiveness of the modified grafted tubularized incised plate urethroplasty (G-TIP), namely “glans G-TIP (GG-TIP) ”, in treatment of hypospadias. Methods A clinical data of 137 children with hypospadias qualified by the selection criteria between January 2021 and June 2023 was retrospectively analyzed. Among them, 75 children were treated with GG-TIP (GG-TIP group) and 62 with G-TIP (G-TIP group). There was no significant difference (P>0.05) between the two groups in terms of age, hypospadias type, penile length, penile head width, penile head height, penile curvature, meatus-apex distance, urethral plate width, and distance from the distal endpoint of navicular groove to the dorsal or ventral midline point of the glans corona, and the difference between the two. The operation time, reconstructed urethral length, distance from meatus to ventral glans corona, postoperative complications, maximum urinary flow rate at 2 weeks after operation, and the hypospadias objective scoring evaluation (HOSE) score at 6 months after operation in the two groups were recorded and analyzed. Results The operation time was significantly shorter in GG-TIP group than in G-TIP group (P<0.05); but there was no significant difference (P>0.05) between the two groups in terms of reconstructed urethral length and distance from meatus to ventral glans corona. All urinary meatus located at the tip of glans with vertical fissure shape. All children in the two groups were followed up 6-35 months (median, 26 months). During follow-up, there were 3 cases of urethral fistula, 2 cases of urethral stricture, and 1 case of glans separation in GG-TIP group, and 3, 3, and 1 cases in the G-TIP group, respectively. There was no significant difference in the incidence of complications between the two groups (P>0.05). The maximum urinary flow rate at 2 weeks and the HOSE score at 6 months after operation were significantly higher in GG-TIP group than in G-TIP group (P<0.05). Conclusion GG-TIP is safe and effective for repairing hypospadias in children. Compared with G-TIP, it has the advantages of relatively simple operation, shortened operation time, significant improvement in urinary flow rate, and better cosmetic results.
ObjectiveTo investigate the validity of diagnosis and treatment for lymphoepithelial-like carcinoma (LELC). MethodsWe retrospectively analyzed the clinical data of 8 LELC patients underwent surgical treatment between January 2008 and December 2014 in our hospital. There were 4 males and 4 females at an average age of 57 years ranging from 48 to 67 years. There were 4 patients underwent thoracoscopic lobectomy and another 4 patients underwent ordinary open-chest lobectomy. ResultsIn the patients underwent thoracoscopic lobectomy, the average operation time was 93.75 minutes and the average time of hospital stay was 4.5 days. In the patients underwent ordinary open-chest lobectomy group, the average operation time was 106.25 minutes and the average time of hospital stay was 5.25 days. All 8 patients discharged. One patient suffered from tumor matastasis in contralateral lung and another suffered from tumor matastasis in brain 1 year after operation. ConclusionThe result of surgical treatment for lung LELC is satisfatory. For the patients who are not suitable for surgical treatment, we should consider the comprehensive treatment.