Anteroposterior Cricoid Split Interposition Grafting for Severe Glottic and Subglottic Stenosis in Children

Objective To investigate the effects of anteroposterior cricoid splitting interposition graft for severe glottic and subglottic stenosis in children. Methods This is a retrospective study, from 1996 to 2006 years, 43 children with severe glottic and subglottic stenosis were operated with anteroposterior cricoid split laryngotracheal reconstruction at our unit. There were 8 boys and 5 girls aged from 2.5 to 15 years old （mean age at 5.5 years old）. All of 43 patients were tracheostomy dependent before reconstruction. The surgical technique consisted of laryngo-tracheostomy, cricoid lamina midline vertical incision, graft interposition which concluded costal cartilage graft （31 cases）, muscular fasciae, perichondrium or split-thickness skin graft （10 cases） and pedicle arytenoid cartilage graft （2 cases） and silicon T-tube stenting for 3 to 6 months. Results 41 patients （95.3%） were successfully decannulated with good airway patency and effective phonation. Two patients failed to decannulation. The follow up period ranged from 1 to 10 years. The effect of operation was steady and the growth and development of children was normal. Conclusion The anteroposterior cricoid split interposition grafting is a safe and effective method for treatment of severe glottic and subglottic stenosis in children.     

Management of primary small cell carcinoma of the esophagus

Background Primary small cell carcinoma of the esophagus is rare. Although surgery is successful in eradicating local tumor, the five-year survival rate of patients with primary small cell carcinoma of the esophagus after resection is lower than that of patients with primary squamous cell carcinoma of the esophagus. The purpose of this study was to analyze the clinical manifestations, pathological features and treatment of primary small cell carcinoma of the esophagus. Methods A total of 73 patients with primary small cell carcinoma of the esophagus who had been treated by surgery from 1984 to 2003 were analyzed retrospectively. Results In this series, the overall resection rate was 94.5% （69/73）, the radical resection rate 89.0% （65/73） and the operative mortality 1.4% （1/73）. The 1-, 3- and 5-year survival rates of patients were 50.7%, 13.7% and 8.2%, respectively. Conclusions Primary small cell carcinoma of the esophagus is rare with a poor prognosis. Surgical resection is the leading method for patients with stage Ⅰ or Ⅱ primary small cell carcinoma of the esophagus. Postoperative chemotherapy is beneficial to these patients. The patients of stage Ⅲ or IV should be given chemotherapy and radiation therapy.     

Surgical treatment of cicatricial esophageal stenosis in infants

Objective To review the results of surgical management of cicatricial esophageal stenosis secondary to chemical burn. Methods Retrospective study was carried out on 30 children ( male 20, female 10 ) with esophagageal cicatricial stenosis. The mean age was 29 months (17 to 60 months) and body weight ranged from 5 to 20 kilograms. One child ingested pesticide whereas the remaining ingested acidic of caustic solutions. There children had complete obliteration of cervical esophagus, 5 had near-complete obliteration and the remaining showed stringy esophageal outline on barium meal study. Five children developed stridor and inspiratory dyspnea. Six children had previous gastrostomy. All patients underwent retrosternal colonic replacement based on left ascending colonic artery. Results Post-operatively, one patient developed anastomotic leakage and one anastomotic stenosis. One patient underwent a post-operative tracheostomy. There was no mortality. All patients were followed-up for 4-20 years with normal de     

Anteroposterior cricoid split interposition costal cartilage grafts for laryngotracheal stenosis in children

Objective： To investigate the effects of anteroposterior cricoid spliting interposition costal grafting for moderate and severe laryngotracheal stenosis in children. Methods： From 1995 to 2005, 87 children （aged 1.2 to 14 years） with moderate and severe glottic and subglottic stenosis were retrospectively studied. They were operated with cricoid spliting laryngotracheal reconstruction in our hospital. All of 87 patients were tracheostomy-dependent before surgery. Results; Eighty-five patients （95%） were successfully decannnulated and got an effective phonation. The follow-up time was more than 5 years. The effect of operation was satisfactory and the growth and development of children was normal. Conclusion： Anteroposterior cricoid split interposition costal cartilage graft is a safe and effective treatment method for moderate and severe glottic and subglottic stenosis in children.     

Surgical treatment of brachiocephalic vessel involvement in Takayasu’s arteritis

Background Takayasu＇s arteritis （TA） is a chronic idiopathic inflammatory disease that affects large and medium size arteries. The brachiocephalic trunk is the most frequently involved site in TA, and multi-vessel lesions are common. Surgical treatment includes vessel reconstruction surgery and percutaneous transluminal angioplasty （PTA）. Herein, we report our preliminary experience with surgical treatment of cerebral ischemia caused by cervical arterial lesions due to TA.Methods From January 2000 to December 2007, 38 patients with cerebral ischemia caused by cervical arterial occlusive lesions due to TA were treated surgically. There were three males and 35 females, with an age range of 15-42 years （mean 26.5 years）. All patients had operative repairs undertaken. Twenty eight patients received bypass operation and 10 patients received percutaneous transluminal angioplasty. One case with coronary stenosis received coronary artery bypass simultaneously. Patients were followed up for 11 months to eight years.Results There were no peri-operative deaths in cerebrovascular reconstruction patients. Symptoms of cerebral ischemia were improved or cured in 25 of 38 patients. There was a low incidence of cerebral reperfusion syndrome. Two patients died at five and seven years after surgery due to heart failure. Another 8 patients （20%） required further surgery for stenosis （5 patients） or anastomotic aneurysms （3 patients）. Percutaneous transluminal angioplasty was performed successfully for treatment of aortic and renal lesions. Repeated angioplasty for revascularization was performed in six PTA cases with restenosis after 5-24 months.Conclusions When cerebral perfusion has potential to be affected by TA, a definitive corrective procedure is advised when the patient is relatively stable. Although the recurrence rate is very high, percutaneous transluminal angioplasty is the first choice procedure. Bypass operation is optimal for brachiocephalic-vessel involvement in TA. Cerebral reperfusion syndrome can be avoided by careful selection of the operation method and improved post-operative treatment.     

食管纵膈胃颈部吻合术治疗食管癌疗效分析

目的 总结食管癌行食管次全切除胃代食管颈部吻合术的临床经验.方法 回顾性分析132例胸段食管癌手术患者,所有患者均采用食管次全切除胃代食管经食管床颈部吻合术式.结果 全组无围术期死亡患者,无切缘癌阳性.吻合口瘘4例(3.0%),吻合口狭窄5例(3.8%),喉返神经损伤3例(2.3%).103例获随访,所有患者术后生活质量满意,无明显胃食管返流的症状;3、5年生存率分别是78.5%、34.6%.结论 食管次全切除食管纵膈胃颈部吻合术能显著降低食管癌患者围术期病死率和并发症发生率,是治疗食管癌的一种安全有效的手术方式. Abstract： Objective To conclude the clinical experience of subtotal esophagectomy and cervical gastroesophagostomy for the treatment of esophageal carcinoma. Methods One hundred and thirty-two patients with esophageal carcinoma of thoracic part who underwent surgical treatment were analyzed retrospectively.All patients were given subtotal esophageal resection and cervical gastroesophagostomy. Results There were no perioperative mortality,no edge-residual cancer,no postoperative gastroesophageal reflux in all patients.Complications included:cervical anastomotic leakage of 4 cases(3.0%);anastomotic stenosis of 5 (3.8%); larygeal nerve injury of 3 (2.3%).One hurdred and three patients who were followed up showed normal and satisfied life quality.The 3-year,5-year survival rate were 78 5%,34.6%, respectively. Conclusions Cervical gastroesophagostomy after subtotal esophagectomy can decrease peioperative mortality and incidence of complications and can be used as a safe and effective surgical procedure for the treatment of esophageal carcinoma.     

Reconstruction of esophagus with whole stomach through esophageal bed after resection of the upper esophageal carcinoma. A report of 160 cases.

From September 1985 to December 1992, 160 cases of reconstruction of the esophagus with the whole stomach through the esophageal bed after resection of the upper esophageal carcinoma were performed with neither operative mortality nor intrathoracic complications. The leakage rate of the cervical anastomosis with Gambee's single layer methodwas 1.2%. The main steps of the operative procedure consisted of: (1) making a right thoracotomy for dissecting and removing the entire thoracic esophagus; (2) laparotomy for mobilizing the whole stomach, constricting it to tube shape and doing a pyloroplasty; and (3) pulling up the mobilized tube-like stomach through the posterior mediastinal space(i.e, the esophageal bed) out of the left neck incision and then the esophagogastrostomy with Gambee's single layer anastomosis was performed.     

Gastrointestinal tract

The effects of enteral nutrition vs parenteral nutrition on gastric motility and gastroenteric hormones after subtotal gastrectomy： a perspective randomized compared clinical trial , Reconstruction with free jejunal interposition for defect after tumor resection of hypopharyngeal and cervical esophageal cancer     

THORACIC AND CARDIOVASCULAR SURGERY——Pleura, pleural cavity, mediastinum, diaphragm

Study of gastric function after esophagectomy and cardiectomy with vagus nerve preserved and reconstruction of gastric funds in patients with esophageal or cardiac cancer; Benign gastric strictures after transthoracic esophagectomy and esophagogastrostomy： an analysis of 9 cases; The experimental study of the artificial esophagus composed of resorbable porcine thoracic aortas acellular matrix; Experimental reconstruction of chest wall defects with degradable biomaterial in dog; Etiology and treatment of intra thoracic gastric perforation after esophageal reconstruction with stomaeh;Surgical treatment of synchronous esophageal cancer associated with gastric cancer;……     

10-YEAR SURVIVAL RATE FOR PATIENT WITH NASOPHARYNGEAL CARCINOMA AFTER RADIATION THERAPY CLINICAL ANALYSIS OF 367 CASES

Of 1 344 patients with nasopharyngeal carcinoma treated during 1961-1965 at the Shanghai Cancer Hospital, 367 who sarvived over 10 years after radia- tion therapy, were analysed. The iesults showed that the patients with stage I , n nasopharyngeal carcinoma and those with stage Ⅲ, IV,the 10-year survival rates were 41.5% and 22.8% respectively, the overall 10-year survival rate being 27.3%. The 10-year survival rate was higher for female patients than for males, and was not related to the age of the patients and the pathological type of this carcinoma. The optimal tumor dosage was thought to be 60-70 Gy 350(95.4%) out of the 367 patients received radiotherapy only once. The rest received repeated irradiation for recurrence. For the reirradiated patients, the 10-year survival rate was 13.5%. Most recurrences occurred 5 years after radin- therapy(12 / 17), and only 5 within 3 years.     

残胃贲门癌的外科治疗探讨

目的 :对 12例残胃贲门癌的外科治疗进行回顾性分析。方法 :首次胃大部切除术后至残胃贲门癌的确诊时间为 6a～ 2 4a。本组全部行残胃全切除。消化道重建 :横结肠间置代胃 3例 ,空肠Roux_Y代胃 9例。结果 :术后存活 3a以上者占 5 0 % (6 / 12 ) ,3例已存活 6a。结论 :①横结肠代胃有明显的食物储存作用 ,并可预防或减少反流性食管炎 ,是全胃切除后重建消化道的理想术式 ;②首次胃大部切除术后 10a为残胃贲门癌发病高峰期。首次胃大部切除的术式与残胃癌的发生有关 ,BillrothⅡ式发病率远高于Ⅰ式 ,并且发病时间较短 ;③胸腹联合切口较腹部切口有诸多优点     

近端胃大部分切除术后改良间置空肠吻合的临床应用研究

目的 探讨近端胃癌行近端胃大部切除后理想的消化道重建方式.方法 对60例近端胃癌患者行根治性近端胃大部分切除后采用两种常用的消化道重建术式：食管与胃直接吻合31例（直接吻合组）,食管与胃之间空肠间置吻合29例（间置吻合组）.对两种重建术的手术时间、术中出血量、术后并发症、术后1年吻合口狭窄发生率、反流性食管炎发生率及营养状况进行比较.结果 与直接吻合组比较,间置吻合组手术时间显著延长（P＜0.01）,但术中出血量、术后并发症发生率两组的差异无统计学意义（均P＞0.05）;术后1年间置吻合组反流性食管炎发生率较直接吻合组明显降低（P＜0.01）,而吻合口狭窄发生率及营养状况两组间的差异无统计学意义（均P＞0.05）.结论 食管残胃间空肠间置吻合是近端胃大部分切除后较为合适的消化道重建术式.     

胃手术后食管癌的再次手术治疗

目的 探讨胃手术后食管癌患者再次手术的方式。方法 对15例胃手术后食管癌患者进行手术治疗，其中食管空肠Roux—Y吻合4例，空肠代食管6例，结肠代食管胸顶吻合2例，结肠代食管颈部吻合3例。结果 胸腔内吻合12例无吻合口漏；颈部吻合3例，1例吻合口漏。无住院死亡病人。结论 胃手术后食管癌患者再次手术应根据不同情况选择相应的消化道重建术，食管空肠Roux—Y吻合、空肠代食管和结肠代食管是重建消化道的重要方式，上段食管癌可以行结肠代食管术，以颈部吻合为佳。     

结肠间置术治疗良性食管疾病40例

目的 评估结肠间置术用于良性食管疾病治疗的有效性。方法 回顾总结1979－11／2000－03我科用结肠间置术治疗40例良性食管疾病的临床治疗,包括食管化学烧伤36例、先天性食管狭窄3例和食管失驰缓症术后食管胃吻合狭窄1例。结果 术后死亡1例,死亡率2．5％;术后并发症率57．5％（23／40）,最常见并发症为颈部吻合口瘘,发性率为30％（12／40）;患者术后生活质量满意。结论 本组术后死亡率低,疗效满意,我们认为结肠间置术是治疗良性食管疾病的有效方法。     

胃大部分切除术后贲门癌、食管癌的再次手术治疗

1983年以来，作者对15例残胃贲门癌、食管瘤患者行再次手术治疗。其中，采用切除肿瘤，保留部分残胃与食管吻合术治疗贲门癌、食管下段癌10例，全胃切除术治疗贲门癌3例和结肠代食管术治疗食管中上段癌2例。残胃食管吻合采用作者设计的食管-胃浆膜肌层套式吻合法，10例患者手术效果满意，进食良好，术后恢复快，预后较3例全胃切除术好。并就手术中残胃的体积、血液供应及消化道重建方式等问题提出了自己的观点，对手术方式的选择及其与预后的关系进行了讨论。     

结肠上徙治疗良性咽、食管狭窄

报道咽、颈段食管良性狭窄１４例,６例伴有喉狭窄,均用带血管蒂的结肠上徙整复,其中１３例经胸骨后,１例经胸骨前上提结肠,并且一期整复喉狭窄。１３例一期整复成功,１例失败。术后功能恢复良好,无手术并发症。利用带蒂结肠上徙治疗良性咽、食管狭窄是一种理想方法。     

食管、贲门癌切除横结肠移植食管、胃重建术的体会

目的　扩展食管、贲门癌切除食管胃重建术的范围。方法　对胃溃疡胃大部分切除术后 9年又患胸中段食管鳞癌行根治性切除经食管床作横结肠胃食管颈部吻合术 1例 ;贲门癌侵犯食管下段行食管次全切除、全胃切除经食管床作横结肠空肠食管颈部吻合术 1例 ;另外 3例均因贲门癌行全胃切除 ,横结肠十二指肠食管弓下吻合术。本组 5例均切断中结肠动脉采用左结肠动脉升支供血的横结肠行顺蠕动向吻合。结果　其中 1例结肠胃食管颈部吻合术的病人 ,术后第 9日发现颈部吻合口瘘 ,术后第 2 3天痊愈出院。其余 4例病人均顺利出院。结论　横结肠有丰富的血供及足够的长度可移植至任何高度与食管吻合且愈合满意。     

保留幽门间置空肠重建消化道在次全胃切除术中的应用

目的　探讨次全胃切除术后消化道的重建方式。方法　总结我院 1999年 3月至 2 0 0 2年 7月间采用经腹保留幽门次全胃切除、间置空肠重建消化道手术的 17例胃底贲门癌患者的临床资料。结果　无 1例手术死亡 ,无吻合口瘘及狭窄。全组患者均治愈出院。术后半年每顿进食 2 0 0～ 3 0 0g ,每日进餐 3～ 4次 ,餐后无胸骨后灼痛 ,无胆汁返流现象 ,无排空障碍及倾倒综合征。全组患者均无贫血 ,体质量恢复至术前正常水平。结论　严格掌握手术适应证 ,保留幽门次全胃切除、间置空肠重建消化道能起到较好的效果     

带血管蒂空肠在重建消化道中的应用

目的 应用带血管蒂空肠替代食管、胃重建消化道，观察空肠代食管、胃的手术效果及患者的术后生活质量。方法 全组25例患者，其中行近端胃次全切除“P”型襻空肠间置10例；全胃切除主动脉弓下“P”型襻空肠-食管吻合术13例；全胃切除主动脉弓上空肠-食管吻合术2例。术后3个月进行食管内pH值监测，钡餐、胃镜检查，并观察患者的生活质量。结果 全组术后无吻合口漏及胸腹腔感染发生；患者术后均进食通畅，无明显返流性食管炎症状及病理征象；食管pH值均在5．5-6.6。术后存活5年以上8例。结论 带血管蒂空肠代食管、胃重建消化道术式，尤其是对食管中下段癌、贲门癌的效果确切，并发症低，术后生活质量良好，值得推广应用。     

下咽及颈段食管癌手术方法的选择与探讨

目的:探讨下咽及颈段食管癌手术方法的选择与临床效果。方法:分析1995年以来68例下咽及颈段食管癌的手术治疗,其中位于下咽者27例,颈段食管者41例。结果:下咽癌切除26例,切除率为96.3%,手术中重建食管包括口底-食管吻合2例;咽、喉及颈段食管切除后用颈阔肌皮瓣重建11例、游离空肠代食管3例,全咽、全喉、全食管切除后用胃重建10例;颈段食管癌切除38例,切除率92.7%,除1例外均采用非开胸食管切除后用胃重建食管;术后并发症的发生率在用胃重建的47例为27.7%(包括1例术后死于心力衰竭),游离空肠者33.3%,颈阔肌皮瓣重建者为9.1%。随访2~96个月(平均45.5个月),下咽癌的1、3、5年生存率分别为79.3%、60%和31.6%,颈段食管分别为68.3%、9.5%和0。结论:下咽及颈段食管癌的手术切除率高,下咽癌的远期疗效明显优于颈段食管癌。咽、喉及颈段食管切除后采用颈阔肌皮瓣重建是一种安全、有效的手术方法,并发症少,远期效果优良。