摘要:目的:探讨晚期食管癌切除、纵隔淋巴结清扫及术中纵隔热灌注化疗对残留于气管、支气管、胸主动脉、奇静脉等器官的癌性肉眼微小病灶治疗效果。方法:选择食管癌病变浸润超过外膜层外侵至气管、支气管、胸主动脉、奇静脉等器官患者112例，随机分为两组:治疗组56例,术中42～43℃无菌蒸馏水2000～2500 mL加入顺铂(DDP)150 mg及氟尿嘧啶(5FU)1200 mg在体外循环下行纵隔热灌注化疗40 min;对照组56例,术中未进行纵隔热灌注化疗。结果:治疗组术后第一年有6例出现纵隔区域肿瘤复发及淋巴结转移,术后第二年有11例纵隔区域肿瘤复发及淋巴结转移;对照组术后第一年有14例出现纵隔区域肿瘤复发及淋巴结转移,术后第二年23例出现纵隔区域肿瘤复发及淋巴结转移。结论:晚期食管癌术中纵隔热灌注化疗可明显减少或延迟纵隔区域肿瘤复发及淋巴转移,提高术后第一至第二年生存率。Abstract: Objective: To explore the advanced esophageal cancer resection, mediastinum, lymph node dissection, mediastinum, hot infusion chemoembolization and clinical observation of residual heat infusion chemoembolization and trachea, or the thoracic aorta, bronchus, eye cancer organs such as intravenous of tiny lesions therapeutic effect. Methods: Select esophageal lesions than the outer membrane layer of infiltrating the trachea and bronchus to the thoracic aorta, and 112 cases of patients with venous organs such as random points to two groups: treatment group treated with perfusion of 56 cases at 4243 degrees Celsius sterile 2000 mL distilled water 2500 mL ~ (DDP) joined cisplatin 150 mg, 5fluorouracil (5FU 1200 mg) in extracorporeal circulation downlink mediastinal hot perfusion 40 minutes, control group treated with perfusion of 56 cases without mediastinal hot perfusion chemotherapy. Results: Treatment group in 6 cases occured after first mediastinal tumor recurrence and regional lymph node metastases after 11 cases, the regional recurrence and lymphatic metastasis mediastinal, control group first fill after 14 cases mediastinal tumor recurrence and bureau of regional lymph node metastasis appeared in 23 cases, surgery between regional tumor locally recurrent lymph node metastases. Conclusion: Advanced esophageal intraoperative mediastinal hot perfusion chemotherapy can obviously reduce or delay mediastinal tumor recurrence and regional lymph node metastases, raise the firstsurial.
ObjectiveTo explore the discipline of superior mediastinum lymph node metastasis of esophageal carcinoma, laying a foundation for the standardization of lymphadenectomy. MethodsWe retrospectively analyzed the clinical data of 586 patients with esophageal carcinoma in our hospital between June 2009 and June 2014. There were 489 males and 97 females at age of 61.61±7.92 years. We analyzed the discipline of lymph node metastasis in these patients. ResultsThe mean number of lymph nodes dissection was 20.48±11.01 per patient. A total of 1 212 lymph nodes metastasis was found in 326 patients (55.63%). The ratio of lymph nodes metastasis in the superior mediastinum, lower mediastinum, and abdominal cavity was 29.35%, 25.94%, and 31.74% respectively with no statistical difference among the three groups (χ2=4.839, P=0.089). In regard to upper thoracic esophageal carcinoma, the ratio of lymph nodes metastasis in the superior mediastinum, lower mediastinum, and abdominal cavity was 43.48%, 3.73%, and 13.73% respectively with higher metastasis rate (χ2=32.692, P=0.000) in the upper mediastinum. In middle thoracic esophageal carcinoma patients, there was no statistical differences in the ratio of lymph node metastasis among upper mediastinum (28.19%), lower mediastinum (29.53%), and abdominal cavity (31.54%, χ2=0.566, P=0.753). While in the patients with the lower thoracic esophageal carcinoma, the ratio of lymph nodes metastasis in the superior mediastinum, lower mediastinum, and abdominal cavity was 22.92%, 27.08%, and 41.67%, respectively with higher ratio of lymph nodes metastasis in abdominal cavity (χ2=17.542, P=0.000). The involved ratio of the right recurrent lymph nodes (19.80%) was the highest among all the lymph nodes in the superior mediastinum (χ2=112.304, P=0.000). ConclusionUpper mediastinum is one of the predilection sites of lymph nodes metastasis of esophageal carcinoma, focusing on the resection of superior mediastinum lymph nodes, especially the right recurrent lymph nodes can decrease the chances of relapse by reducing residual tumor cells.
Objective To compare the effect and degree of satisfaction of different analgesic interventions for tubes of pericardium and mediastinum removal after cardiac surgery. Methods From December 2017 to June 2018, 94 patients undergoing open heart cardiac surgery with tubes of pericardium and mediastinum were allocated randomly into three groups including a group A (32 patients), a group B (35 patients), and a group C (27 patients). In the group A, intravenous Dezocine was given as analgesics. In the group B, intravenous Dezocine plus oral ibuprofen were given. In the group C, interventions of group B plus specific nursing guidance were given. With the help of visual analogue scale (VAS), scores of pain during and after the tubes removal were collected. The degree of satisfaction and other adverse effects were also recorded. Results The VAS scores and fading time of pain in the group B were significantly lower than those of the group A (P<0.017). The score of sleeping was better in the group B as well. The VAS scores and fading time of pain in the group C were also significantly lower than those of the group A, and the scores of mood, activity as well as degree of satisfaction were all higher than those in the group A (P<0.017). The scores of activity and degree of satisfaction in the group C were higher compared with the group B (P<0.017). Conclusion Combination of intravenous Dezocine and oral ibuprofen seems to be more effective than each individual. Professional and specific nursing guidance could increase the degree of satisfaction for chest tube removal after cardiac surgery.
Primary acinic cell carcinoma (ACC) of the lung is extremely rare. The World Health Organization tumor classification defines ACC as "a malignant epithelial neoplasm that demonstrates some cytological differentiation towards (serous) acinar cells". It is considered to be a low-grade malignant tumor. Since the first case described by Fechner in 1972, less than 30 cases have been reported in the literature. The rarity of this tumor may leads it to be confused with other primary lung tumors and incorrectly diagnosed. We reported a female patient with primary ACC of the lung with mediastinum deviation at age of 27 years received a right pneumonectomy. She was followed up for 12 months postoperatively and remains well.
Anterior mediastinal inflammatory myofibroblastoma is a rare tumor with insidious onset and easy misdiagnosis. In this report, we presented a case of anterior mediastinal inflammatory myofibroblastoma with thymoma. The mediastinal tumor was found by physical examination, and the prognosis was good after surgical treatment. For this disease, operation is an effective method for definite diagnosis and treatment, and complete excision can achieve good outcomes.
IgG4-related disease is an immune-mediated chronic inflammatory disease with fibrosis, which can affect almost all organs in the body. In a few cases, only a single organ is affected. The incidence of isolated IgG4-related mediastinal disease is even rarer. This article reports a rare case of isolated IgG4-related middle mediastinal disease and provides a detailed description of its diagnosis and surgical treatment. The patient had a good prognosis and did not receive any medication such as corticosteroids after surgery. Follow-up after 6 months showed no recurrence.