ObjectiveTo report the effect and experience of the extended resection and reconstruction of superior vena cava(SVC) and innominate vein for invasive mediastinal tumors.MethodsA retrospective study of 11 patients who underwent extended resection and grafts of SVC and innominate vein for invasive mediastinal tumor in Peking Union Medical College Hospital from 2001 to 2003 was performed. Radical resection was performed in 9 cases, among which SVC and left innominate vein were reconstructed with pericardium patch in 2, with prostheses(ringed GoreTex) interposed in 7.The other 2 patients who had incomplete resection also underwent prostheses interposition for SVC reconstruction. During operation, SVC and left innominate vein were clamped in turn,to avoid total interruption of blood return, clamping time for each site was 22.15±6.29 min. The volume of blood loss was 1 342.86± 692.48ml during operation.ResultsThe tumor included 4 invasive thymoma, 5 thymic cancer, 2 primary mediastinal small cell carcinoma. The patency was good in the grafts with external ring support and no SVC symptoms were observed in all cases postoperatively. One patient died of respiratory infection two weeks after operation, others are alive till now. The longest patent and functional graft is 30 months postoperatively.ConclusionSVC and innominate vein reconstruction by prostheses interposition can effectively eradicate the SVC syndrome. Clamping SVC needs careful study. Attention to the invasive extention of tumor should be made to avoid palliative operation,because complete resection is most important for long term survival.
ObjectiveTo investigate the value of different minimally invasive surgical techniques, stent placement, laparoscopic surgery, and sustained-releasing 5-fluorouracil, in solving intestinal obstruction due to colorectal cancer. MethodsFrom May 2000 to May 2010, total 68 patients with obstructed colorectal cancers in three centers were treated in two ways in terms of the stage: The first, patients with resectable tumors underwent colorectal stent placement as a ‘bridge to surgery’ guided by enteroscope under X-ray. After clinical decompression and bowel preparation, laparoscopic radical resection was performed. The second, patients with unresectable tumors underwent rectal stent placement just for palliation. Sustained-releasing 5-fluorouracil was implanted into the local cancerous intestinal tract through stent walls. ResultsFifty-one of 52 patients underwent laparoscopic radical resection successfully following stent placement, while one failed and died during follow-up 93 d postoperatively. Forty patients with successful laparoscopic surgery were followed up in 3 to 36 months (with an average of 15 months) without tumor planting in the incision, postoperative local recurrence or anastomotic stricture. Fifteen unresectable patients and one high-risk, intolerable patient underwent rectal stent placement and implantation of sustained-releasing 5fluorouracil. During follow-up 3 to 24 months (with an average of 14 months), 11 died, who survived for (350±222) d (range 101-720 d), and 5 were still alive for 3 to 13 months (with an average of 9 months) without intestinal obstruction. ConclusionsLaparoscopic surgery combined with stent placement is an effective and safe procedure for resectable obstructed colorectal cancer. For unresectal obstructed rectal cancer, rectal stent placement combined with sustained-releasing 5-fluorouracil can prolong survival time avoiding colostomy.
Objective To study the change of immunologic function of the patient with obstructive jaundice. Methods The level of the sIL-2R, TNF-α, IL-6 and IL-8 in 36 cases of obstructive jaundice before and after operation were measured. Results The level of the sIL-2R, TNF-α, IL-6 and IL-8 in 36 cases of obstructive jaundice before operation was higher than normal control group (Ｐ＜0.01). It decreased after the obstruction was removed, and it was close to normal control on 14th day after operation. Conclusion The result suggest that relief of jaundice could improve the immunologic function of the patient.
ObjectiveTo explore the effect of liver metastases of intraoperative and postoperative portal vein chemotherapy and combined with folfox4 regimen chemotherapy for patients with obstrutive colorectal cancer. MethodsA total of 94 obsrutive colorectal cancer patients that could be radical resection were collected from February 2007 to May 2011 in our hospital and divided into two group. Forty-six patients in treatment group received portal vein chemotherapy after the portal vein pump were placed intraoperative, and 3-4 weeks after operation taken FOLFOX4 chemotherapy combined with portal vein infusion chemotherapy 6 courses. Forty-eight patients in the control group received only FOLFOX4 chemotherapy 6 courses 3-4 weeks after operation. Ninety-four patients were followed up for 3 years to observe the incidence of postoperative liver metastasis, at the same time comparing two groups of clinic toxicity during chemotherapy. ResultsIn three years after operation the incidence of liver metastasis were 21.7% in treatment group (10 cases had hepatic metastases), 58.3% in control group (28 cases had liver metastases), the difference in two groups was statistically significant(P < 0.01). Comparing the clinical toxicity in two group, AST in treatment group increased on first day (P < 0.01), and recovered normal on third day (P > 0.05) after operation. There were no marked difference in renal function, ALT, ALP, GGT, and LDH of liver function, medullary restraining, and reaction of gastrointestinal tract (P > 0.05). ConclusionChemotherapy via portal vein intraoperative and postoperativ combined postoperative FOLFOX4 chemotherapy can reduce the risk of postoperative liver metastasis for the patients with obstrutive colorectal cancer.
ObjectiveTo understand research progress of animal model of esophageal achalasia and discuss its pathogenesis briefly.Method Literatures about research progress of animal model of esophageal achalasia were reviewed. ResultsThe models of esophageal achalasia could been made in several ways, such as the obstruction model, the classic denervation model, and the increasingly popular gene model. These models were all based on the theory of the corresponding causes, with the processing of different factors, then completed the preparation of animal model. Conclusionsanimal model of esophageal achalasia goes through three stages: obstruction model, denervation model, and gene model. gene model of esophageal achalasia based on congenital theory could help us understand this disease better and make an ideal animal model, which could provide a reliable evidence for etiology study.
ObjectiveTo investigate the effects of smoking combined with intermittent hypoxia on the pathophysiology of lung tissue and thoracic aorta, and the endothelial injury.MethodsTwenty-four rats (SPF, female, six weeks old) were divided randomly into 4 groups (n=6). The control group was given false smoking and normal oxygen exposure, the smoking-exposed group was exposed in smoking, the intermittent hypoxia group was exposed in intermittent hypoxia environment, and the overlap group was exposed to smoking and intermittent hypoxia. After 8 weeks, body weight, right ventricular hypertrophy index (RVHI), the pathological changes of lung tissue and thoracic aorta were measured, and the level of endothelin-1 (ET-1), endothelial nitric oxide synthase (eNOS), vascular endothelial growth factor (VEGF) and stromal cell-derived factor-1α (SDF-1α) in serum of rats were evaluated.ResultsRVHI of rats in the smoking-exposed group, intermittent hypoxia group, overlap group were higher than that in the control group. In addition, RVHI in the overlap group was higher than that in the smoking-exposed group, intermittent hypoxia group (all P<0.05). The levels of ET-1, VEGF and SDF-1α in the serum of the smoking-exposed group, intermittent hypoxia group and overlap group were higher than those in the control group, while the level of eNOS was lower than that in the control group, (all P<0.05), the most significant difference was between control group and the overlap group. Pathological observation of lung tissue and thoracic aorta showed obvious emphysema in the smoking-exposed group and overlap group, which was more obvious in the overlap group than that in the smoking-exposed group (all P<0.05). Lung interstitial inflammatory infiltration, bronchial wall lymphocyte hyperplasia and pulmonary fibrosis were shown in different degrees in the smoking-exposed group, intermittent hypoxia group and overlap group, and the pulmonary arteriole wall showed thickening, fibrosis and peripheral inflammatory infiltration also were found in these groups. Thoracic aorta in the smoking-exposed group, intermittent hypoxia group and overlap group showed different degrees of endothelial cell injury, middle membrane thickening, and collagen fiber hyperplasia. The pathological features of the overlap group were most obvious compared to the other two groups.ConclusionsSmoking and intermittent hypoxia exposure can lead to different degrees of lung tissue and vascular endothelial injury and decrease of vascular endothelial protective factors in rats, resulting in dysfunction of vascular endothelial cells, which leads to the structural remodeling of pulmonary arterioles and aorta, such as thickening, fibrosis, etc. Combined smoking and intermittent hypoxia exposure can lead to more serious pathological damage.