Primary bronchopulmonary carcinoma occurs in the bronchial mucosa epithelium, also called lung cancer (LC), and has currently become the first cause of death of malignant tumors in China. With constant efforts of Chinese physicians, the diagnosis and management of LC has made certain progress, but standardized surgery for LC still varies to a great extent due to difference regions, nature of medical centers, and technical levels. Complete and standardized surgical resection can provide good long-term survival for patients with stageⅠ, Ⅱand partly ⅢA LC, and cannot be a substitute for other treatment, which shows the importance of standardized surgery. As the most solid member, surgery plays a decisive role in comprehensive multidisciplinary treatment of LC. Today's medical development requires thoracic surgeons to provide most standardized and individualized treatment with principles of evidence-based medicine. This review focuses on progress of standardized surgery for stage Ⅰto ⅢA LC.
ObjectiveTo evaluate the biocompatibility of poly lactic acid/bone matrix gelatin (PLA/BMG) composite biomaterial so as to lay a foundation for bone defect repair. MethodsRats'MC3T3-E1 cells were cultured with leaching solution of PLA/BMG and PLA material respectively for 7 days. The cell proliferation rate was tested by MTT and cell toxicity grading was carried out everyday. The PLA/BMG and MC3T3-E1 cells were co-cultured, the cell shape and proliferation were observed by inverted phase contrast microscope at 1, 3, and 5 days and cell adhesion by scanning electron microscope at 5 days. The PLA and PLA/BMG were implanted subcutaneously in 15 Wistar rats. The histological observation was done, and the thickness of fibrous membrane, the number of inflammatory cells, and the vascularization area were measured at postoperative 2nd, 4th, and 8th week. ResultsThe tests for cytotoxicity in vitro showed that the cell proliferation rates were over 100% and the cell cytotoxic grades were grade 0 at 1-7 days in PLA/BMG group. While in PLA group, the cell proliferation rates were less than 100% and the cell cytotoxic grades were grade 1 at 2, 4, and 7 days. After co-culture of PLA/BMG and MC3T3-E1 cells, cells grew on the surface and in the pores of PLA/BMG, and the cellular morphology was triangle or polygon with abundant microvillus on the surface. After subcutaneous implantation, the rats survived to the end of experiment, and incision healed well. PLA was wrapped by connective tissue where there were a lot of lymphocytes and neutrophilic granulocytes. The cells and tissue grew slowly in PLA. The PLA/BMG materials were wrapped by little connective tissue where there were a few inflammatory cells. The connective tissue ingrowth was observed in the center of PLA/BMG. There was no significant difference in the thickness of fibrous membrane between 2 groups at each time point (P>0.05). The number of inflammatory cells of PLA/BMG group were significantly less than those in PLA group at 2, 4, and 8 weeks (P<0.05); the vascularization area was significantly larger than that in PLA group (P<0.05). ConclusionPLA/BMG composite biomaterials prepared by super critical-CO2 technique are good in cell and tissue biocompatibilty.
ObjectiveTo investigate the application value of modified gastric tube in surgery for mid- and lowerthoracic esophageal cancer compared with gastric tube. MethodsA total of 221 patients with mid- and lower-thoracic esophageal cancer who underwent esophagectomy between October 2009 and June 2013 in our hospital were recruited in the study. They were randomly divided into a modified gastric tube group (n=108) and a gastric tube group (n=113). There were 67 males and 41 females at age of 63.50±6.75 years (ranged 47-73 years) in the modified gastric tube group, including 62 cases of middle esophageal cancer and 46 cases of lower esophageal cancer. There were 69 males and 44 females at age of 63.38±7.21 years (ranged 49 to 76 years) in the gastric tube group, including 68 cases of middle esophageal cancer and 45 cases of lower esophageal cancer. The results of surgery and morbidities were recorded. The respiratory functions were recorded at 3 days before surgery, 1 week and 4 weeks after surgery, respectively. ResultsAll surgeries were successfully performed in two groups. There was 1 case of death and 1 case of anastomotic leakage in the gastric tube group. There was no death or anastomotic leakage occurred in the modified gastric tube group. There was statistical difference in the operation time between the modified gastric tube group and the gastric tube group (150.65±11.88 min vs. 174.58±11.99 min, P<0.05). There were no statistical differences in the amount of bleeding during operation or the length of hospital stay between two groups (P>0.05). There were no statistical differences in respiratory function between two groups at 1 week or 4 weeks after surgery (P>0.05). ConclusionFor patients with mid- and lower-thoracic esophageal cancer, modified gastric tube has a good clinical application value compared with gastric tube. It is easy and safe, and can decrease the operation time without aggravation of pulmonary function after operation. It is a better esophagus reconstruction method in esophagectomy for mid- and lower-thoracic esophageal cancer in primary hospitals.