The application of tissue adhesives in small bowel anastomoses

One layer everted end-to-end anastomosis was performed on the small bowel of mongrel dogs. Cultures of Serratia marcescens were injected into the lumen. Twenty-four hours later the animals were reexplored, and peritoneal cultures were observed. In animals where Fibrin Seal (consisting of fibrinogen, cold insoluble globulin, factor XIII, platelet growth factor, antiplasmin, thrombin, and calcium chloride) was applied to the suture line, negative cultures were found except for two experiments in which dehiscence or contamination from the Serratia injection site occurred.     

The role of fibrin adhesive in vascular surgery

Fibrin Seal (FS) (a natural adhesive material composed of fibrinogen, cold insoluble globulin, factor XIII, platelet growth factor, antiplasmin thrombin, and calcium chloride) was utilized in the construction of vascular anastomosis of the femoral artery of mongrel dogs. A significant decrease in the number of sutures necessary to achieve adequate anastomosis and minimize the likelihood of postoperative bleeding was noted. There was no long-term increase in tissue reaction or decrease in arterial patency. On the basis of these preliminary results the role of FS as a hemostatic agent in vascular and especially microvascular surgery warrants further investigation.     

A new technique of esophagogastrostomy above the aortic arch— covering and suspending of the anastomotic area with mediastinal pleural flap

The postoperative anastomotic leakage is the most severe complication and the principal cause of death after resection of esophageal carcinoma. Especially, anastomosis above the aorta arch is accompanied by high incidence of anastomotic leakage usually with fatal prognosis. The authors improved the conventional method of anastomosis by using a mediational pleural flap to cover and suspend the anastomotic area with excellent result. From January 1990 to April 1995, total 210 patients with esophageal carcinoma underwent surgery resection with this procedure. No anastomotic leakage or stricture developed. Only one patient died of extensive myocardial infarction with an overall mortality of 0.47%. The major merit of this procedure was that the mediastinal pleural flap could cover the area of anastomosis and sustain dragging force acting on this area, providing a better condition for the anastomosis to heal and thus reducing the possibility of anastomotic leakage.     

羟基磷灰石、红骨髓、骨形态发生蛋白及纤维蛋白复合物异位诱导成骨的实验研究

目的 探讨骨形态发生蛋白、自体红骨髓、羟基磷灰石及纤维蛋白复合物的制备方法及其诱导成骨活性。方法 在大白鼠股后肌群分别植入(1)红骨髓(RBM)、(2)纤维蛋白-红骨髓复合物(FS-RBM)、(3)纤维蛋白-羟基磷灰石-红骨髓复合物(FS-HA-RBM)、(4)纤维蛋白-羟基磷灰石复合物(FS-HA)、(5)纤维蛋白-羟基磷灰石-骨形态发生蛋白复合物(FS-HA-BMP)、(6)纤维蛋白-羟基磷灰石-骨形态发生蛋白-红骨髓复合物(FS-HA-BMP-RBM),按1,2,4周三个时间点进行大体标本、组织学观察及ALP检测,比较各组间诱导成骨活性。结果 FS-HA-BMP-RBM组复合物有较多的新生软骨和骨形成。各组ALP活性比较显示,HA-FS-BMP-RBM组最强,且于第2周最高。结论 FS-HA-BMP-RBM复合物具有良好的诱导成骨能力。     

改进三切口方法手术治疗食管癌的临床研究

目的：应用改进的三切口方法手术治疗食管癌，探讨食管癌的切除率、根治彻底性、围手术期并发症、术后复发及临床疗效和长期生存率之问题。方法：对连续收治的食管癌560例均采用改进的手术方法(右上腹直肌／右胸后外侧／右颈部)三切口进行手术治疗并作回顾性分析。结果：通过该手术方法治疗的560例病人中围手术期并发症发生率9．3％，手术切除率99．6％，无手术死亡，无吻合口瘘发生。1、2、3、5年生存率分别为86．1％、71．4％、63．6％和44．7％。结论：改进的三切口手术方法可明显降低围手术期并发症，尤其是吻合口瘘等重要并发症，可明显提高手术切除率、淋巴清扫的彻底性及减少术后复发，提高生活质量和远期生存率．该三切口治疗食管癌是目前食管癌根治性手术治疗效果较好的临床方法。     

Neoadjuvant chemoradiation therapy for the treatment of esophageal carcinoma

An esophagectomy with three-field lymph node dissection is the standard therapy for esophageal cancer in many countries, including Japan. However, the results of esophagectomy are still unsatisfactory in comparison to the results of surgical treatment for gastric cancer or colon cancer. On the other hand, definitive chemoradiation therapy has recently shown progress as a treatment modality for resectable esophageal cancer, with data indicating the potential efficacy of combination therapy with chemoradiation and an esophagectomy. In fact, preoperative chemoradiotherapy for resectable esophageal cancer is becoming a standard therapy in Europe and North America. The latest metaanalysis concerning neoadjuvant chemoradiotherapy for resectable esophageal cancer concluded that a significant survival benefit was evident with preoperative chemoradiotherapy. However, there are still no supportive data for neoadjuvant chemoradiation and surgery from a well-designed large-scale randomized control trial (RCT). A well-designed large-scale RCT is needed to determine the utility of neoadjuvant chemoradiation. Future trials based on precise diagnosis and surgical procedures are required for the adequate interpretation of the results of treatment for resectable esophageal cancer. Of course, quality control of the operation is a very important factor, because operative mortality influences these results.     

EXPRESSION OF mdr-1 GENE IN CANCER TISSUE AND ITS ASSOCIATION WITH MORPHOLOGICAL INDEXES OF ESOPHAGEAL CARCINOMA IN ANYANG

Multipledrugresistance(MDR)ofcancercellsisoneofthemostinterestingareasinthecurrentcancerresearches.IthasbeenshownthatmanytumorshaveMDR.OneofthemolecularbaseofMDRistheamplificationofmdr-lgeneandoverexpressionofitsproduct,pl70,whichwerethoughtasthedirectcauseofchemothcrapyfailurebymanyinvestigators.'--'Moreover,othersicbelievethatmdr-1geneexpressionincancertissuewasamalignantbiologicalindicatorforneoplasms.UPtodate,fewresearchreportswerefoundintheliteratureonmdr-lgeneexpressioninesophaguscan…     

食管癌组织中miRNA表达差异研究

目的探讨食管癌组织microRNA（miRNA）表达的差异,为研究miRNA在食管癌发生、发展中的作用提供新线索。方法 Trizol法抽提食管癌及癌旁组织总RNA,分离miRNA,采用基因芯片技术,将组织中miRNA与哺乳动物miRNA芯片杂交,采用图像软件和SAM version 2.1进行数据分析。结果与正常癌旁组织相比,有23个miRNAs在食管癌组织中有显著差异,包括18个上调和5个下凋。结论部分差异表达miRNAs可能参与食管癌癌变分子机制,为进一步探索提供思路。     

食管癌合并糖尿病患者的围手术期处理

目的：探讨食管癌合并糖尿病的围手术期治疗措施。方法：对外科治疗的48例食管癌合并糖尿病患进行回顾性分析。结果：48例患均行手术治疗，术后并发症12例，无死亡病例。结论：食管癌合并糖尿病只要围手术期严格控制血糖，仍然是安全的。     

THE DIAGNOSIS AND TREATMENT FOR RECURRENT DYSPHAGIA OF ESOPHAGEAL CARCINOMA AFTER RADICAL RADIOTHERAPY

ＴＨＥＤＩＡＧＮＯＳＩＳＡＮＤＴＲＥＡＴＭＥＮＴＦＯＲＲＥＣＵＲＲＥＮＴＤＹＳＰＨＡＧＩＡＯＦＥＳＯＰＨＡＧＥＡＬＣＡＲＣＩＮＯＭＡＡＦＴＥＲＲＡＤＩＣＡＬＲＡＤＩＯＴＨＥＲＡＰＹＣｈｅｎＫｅｎｅｎｇ陈克能ＣｈｅｎｇＢａｎｇｃｈａｎｇ程邦昌Ｄｅｐａ...     

扩张置管治疗癌性复杂性食管狭窄和瘘51例分析

 目的 探讨内镜下覆膜支架治疗癌性难治性食管狭窄和瘘的临床疗效。方法 选择失去手术机会的复杂性食管狭窄和（或）瘘的患者51例进行内镜下扩张及支架置入术，根据病情的不同情况选择不同的治疗方式，并观察治疗后1个月及1年的临床疗效。结果 经过治疗，全部患者症状得到缓解，生活质量提高，51例患者共放置支架66个，置管后狭窄处直径由（4.05±1.34）mm增至（13.03±3.99）mm（P＜0.01），吞咽困难由（3.29±0.44）级改善为（0.95±0.73）级（P＜0.01），食管瘘患者瘘口全部闭合。随访1个月及1年有效率分别为100 %，78.38 %，1年失访共3例，复发共8例，经重复治疗缓解。6 个月、1，2，3年生存率分别为86.3 %，72.6 %，33.3 %，6.3 %。结论 内镜直视扩张置管治疗难治性食管狭窄和瘘，操作直观简便，定位准确，成功率较高，近、远期效果较好。     

The pre- and postoperative course of functional status in patients undergoing esophageal cancer surgery

IntroductionTo optimally target physiotherapy treatment, knowledge of the pre- and postoperative course of functional status in patients undergoing esophagectomy is required. The aim of this prospective longitudinal study was to investigate the course of functional status in patients with esophageal cancer before and after esophagectomy.Materials and methodsFunctional status outcome measures of patients with esophageal cancer who underwent surgery between March 2012 and June 2016 were prospectively measured at 3 months and at 1 day before surgery and at 1 week and at 3 months after surgery. Analysis of repeated measurements with the mixed model approach was used to study changes over time.ResultsHundred fifty-five patients were measured at 3 months and at 1 day before surgery, of which 109 (70.3%) at 1 week and 60 (38.7%) at 3 months after surgery. Mean (SD) age at surgery was 63.5 years (9.3), and 122 patients (78.7%) were male. The incidence of postoperative complications was 83 (53.5%). Three months postoperatively, functional status measures returned to baseline levels, except from handgrip strength (beta [95% CI] −6.2 [-11.3 to −1.1]; P = 0.02) and fatigue (4.7 [0.7to 8.7]; P = 0.02). No differences were observed in the course of functional status between patients with and without postoperative complications.ConclusionFunctional status of patients undergoing esophagectomy returned to baseline values three months after surgery, despite the high incidence of postoperative complications. This requires rethinking the concept of prehabilitation, where clearly not all patients benefit from high functional status to prevent postoperative complications.     

高龄食管癌、贲门癌患者食管切除术结果分析

目的：探讨高龄食管癌、贲门癌患者行食管切除术的危险性及手术死亡率与年龄的关系。方法：１９８５年～１９９０ 年对４４４ 例食管癌、贲门癌患者食管切除术,根据年龄段分为两组：Ⅰ组,年龄≥６５ 岁,５６ 例,Ⅱ组,年龄＜６５ 岁,３８８ 例,比较两组术前危险因素、手术合并症及死亡率、平均住院日和长期生存率。结果：两组病例术后死亡率（３－６ ％ ｖ２－８ ％ ） ,平均住院日（２３－３ 天ｖ２２－３ 天） ,５ 年及１０ 年生存率（３４－５ ％ ｖ ３６－８ ％ ,２４－１％ ｖ２５－７％ ） 均无显著性差别。结论：高龄食管癌贲门癌患者行食管切除术并不增加手术死亡率,而长期生存率与年轻者相比无差异。     

TRAP1在食管癌发展中的作用及机制研究

目的 探究肿瘤坏死因子受体相关蛋白1(TRAP1)在人食管癌进展中的作用及机制。方法 用免疫组化检测人食管癌组织中TRAP1和S100A8的表达水平。在食管癌细胞系KYSE150中建立稳定下调TRAP1的细胞系, 用CCK-8检测细胞的增殖能力, Transwell检测细胞的转移能力, 流式细胞术检测细胞的凋亡。用实时荧光定量PCR检测TRAP1的下游基因E-Cadherin、N-Cadherin和S100A8的表达水平。结果 TRAP1在食管癌组织中的表达水平(55.0%)显著高于癌旁组织(11.7%), 并与S100A8具有一致性(χ²=4.141, P＜0.001)。得到稳定下调TRAP1的细胞系KYSE150-TRAP1, 与对照组细胞系KYSE150-control相比, KYSE150-TRAP1细胞系中TRAP1的表达水平下调85%(P＜0.05), 细胞的转移能力降低46%(P＜0.05), 细胞的增殖和凋亡无显著变化;E-Cadherin的表达水平升高19%(P＜0.05), S100A8的表达水平下降39%(P＜0.05)。结论 TRAP1在食管癌组织中过表达, 并通过调控S100A8的表达促进食管癌的转移。     

管状胃法在食管癌和贲门癌根治术中的应用效果研究

目的研究管状胃法在食管癌和贲门癌根治术中的应用效果。方法选取2011年1月至2012年12月接受手术治疗的食管癌与贲门癌患者62例,按照食管重建方法分为观察组(31例)和对照组(31例)。两组患者一般资料比较,差异无统计学意义(P>0.05),观察组患者采取管状胃法治疗,对照组患者采取全胃缝缩治疗。结果两组患者手术成功率均为93.5%(P>0.05)。观察组和对照组患者手术后感染率分别为0和19.4%(P<0.05)。观察组和对照组患者手术后死亡率分别为0和12.9%(P>0.05),两组患者其他各项观察指标比较,差异无统计学意义(P>0.05)。结论食管癌和贲门癌采用管状胃法根治术,效果显著,值得在临床上推广应用。     

洛铂联合紫杉醇治疗中晚期食管癌的不良反应

背景与目的:化疗是中晚期食管癌治疗手段之一,选择低毒有效的化疗方案是关键,本研究旨在观察洛铂联合紫杉醇治疗食管癌的不良反应。方法:2010年4月15日至2011年5月之间,共收治中晚期食管鳞癌患者129例,其中初治患者35例,根治术后患者94例,化疗方案:紫杉醇135 mg/m2,第1天;洛铂35 mg/m2,第2天,重复3周。共化疗289个周期,平均每例2.2个周期。结果:在35例初治患者中,完全缓解(CR)7例(20.0%)、部分缓解(PR)21例(60.0%)、无变化(SD)7例(20.0%),总有效率RR(CR+PR)为80.0%;术后辅助治疗有10例(10.6%)出现复发或转移。与化疗有关的不良反应主要表现为:①骨髓抑制,其中白细胞下降Ⅰ、Ⅱ度59例(45.7%),Ⅲ、Ⅳ度16例(12.4%),血小板下降Ⅰ、Ⅱ度27例(20.9%),Ⅲ、Ⅳ度2例(1.6%),血红蛋白下降Ⅰ、Ⅱ度62例(48.1%),Ⅲ、Ⅳ度7例(5.4%);②脱发112例(86.8%);③肌肉或关节痛69例(53.5%);④肝功能损伤Ⅰ、Ⅱ度15例(11.6%);⑤胃肠道反应Ⅰ、Ⅱ度16例(12.4%);⑥无明显肾功能异常及过敏反应。结论:洛铂联合紫杉醇治疗食管癌的不良反应轻,患者能够耐受,近期疗效好,值得临床进一步研究。     

食管贲门癌切除术后四种吻合方式与吻合口漏和狭窄关系的比较研究

目的：比较研究食管贲门癌切除术后4种常用吻合方式与吻合口漏和狭窄关系。方法：对317例分别应用传统的食管胃吻合术（73例）、隧道式食管胃吻合术（67例）、食管胃黏膜、肌层分层连续吻合术（61例），机械吻合术（116例）的4组病人进行统计比较吻合口漏发生率、狭窄发生率。结果：4组病例吻合口漏的发生率分别为4．1％、1．5％、1．6％、1．7％，吻合口狭窄发生率分别为5．5％、2．9％、1．6％、3．4％，均无统计学差异。结论：常用吻合方法都可满足）临床需要，均能将并发症控制在合理的水平。     

Evaluation of stapling technique in surgical treatment of esophageal and cardiac cancer

Esophageal'and cardiac cancer are the very commondiseases in China. The mortality of the esophageal canceris 23.40/100000, and is the 23.53% of the mortality of allcancers. Over 80% patients are beyond 50 years old. Thehighest mortality is seen in 50--69 years old, and this~ality is over 60% of the total. Unsatisfactoryresectional rate and more complications make the survivalrate lower. Anastomotic leakage and stenosis are the mostdangerous complications. From June, 1986 to October,1998, we …     

Combined Therapy of Teicoplanin and Caffeic Acid Phenethyl Ester (CAPE) in the Treatment of Experimental Mediastinitis in the Rat

Abstract

Post-sternotomy mediastinitis affects 1-3% of patients undergoing cardiac surgery and is lethal in 10-47% of these patients.

We investigated the effect of an antioxidant/anti-inflammatory agent, caffeic acid phenethyl ester (CAPE), in the attenuation of inflammatory response induced by methicillin-resistant Staphylococcus aureus (MRSA) infection in a rat experimental mediastinitis model. Rats, divided into six equal groups, received MRSA precolonized stainless steel wire pieces implanted into their mediastinal spaces. Control group and CAPE control group received saline and CAPE 10 μmol/kg.day^?1 respectively, where Group A received a single dose of teicoplanin 24 mg/kg i.m. for the first day and then 12 mg/kg.day^?1. Group B received teicoplanin as in Group A plus CAPE 10 μmol/kg. day^?1 intra-peritoneally. Group C received teicoplanin 60 mg/kg i.m. for the first day and then 30 mg/kg.day^?1 and Group D received teicoplanin as in Group C plus CAPE 10 μmol/kg.day^?1. By the end of 14 days rats were sacrificed and serum malondialdehyde (MDA), myeloperoxidase (MPO), nitric oxide (NO), urea and creatinine levels were evaluated. Mediastinal organ tissues were collected for histopathological analysis.

Infection rates in all the drug-treated groups were lower than the control groups (P = 0.002) but statistical significance was attained only between the groups A and D (P = 0.018). In connective tissues and the peribronchial area polymorphonuclear leukocytic (PNL) infiltration in the treatment groups, although becoming very close, did not reach statistical significance (P = 0.053, P = 0.075, respectively). PNL infiltration especially in the peribronchial tissues of the Group B animals was found to be significantly less than the Control and CAPE Control groups with P values of 0.013 and 0.010, respectively. MDA and MPO levels were significantly lower in the treatment groups (P < 0.001 and P < 0.001 respectively). Levels of the degradation products of NO were lower in treatment groups compared to two control groups (P = 0.003, P = 0.005). NO levels in Group D were lowest among all treatment groups (P = 0.001).

It has been demonstrated that although bacterial colonization can be controlled in mediastinitis, the inflammatory response persists. The combination of an antioxidant / anti-inflammatory agent, CAPE, added to standard antibiotic therapy might be effective in the treatment of post-sternotomy mediastinitis due to MRSA.     

改良Ivor-Lewis手术或Sweet手术联合放化疗治疗胸段食管鳞癌的疗效分析

目的 回顾性分析改良Ivor Lewis手术或Sweet手术后辅助放化疗治疗胸段食管鳞癌的疗效及影响预后的危险因素。方法 914例胸段食管鳞癌患者按不同术式分为改良Ivor-Lewis手术组（n=424例）和Sweet手术组（n=490）;其中Ⅱ期及以上患者按术后有无联合放化疗分为单纯手术组（n=297）与术后辅助放化疗组（n=446）。采用Kaplan-Meier法计算总生存（OS）,Log-rank检验比较不同手术方式及术后是否联合放化疗患者的生存差异,Cox比例风险模型分析影响预后的危险因素。结果 改良Ivor-Lewis术组与Sweet术组患者的1、3、5年生存率分别为86.3％、63.7％、44.5％和90.2％、64.9％、45.0％。单纯手术组与术后辅助放化疗组的中位OS分别为36.1个月和46.1个月（P=0.004）。改良Ivor Lewis术组单纯手术者和术后辅助放化疗者的中位OS分别为34.6个月和46.8个月,差异有统计学意义（P=0.038）。Sweet术组单纯手术者和术后辅助放化疗者的中位OS分别为37.0个月和 45.1个月,差异有统计学意义（P=0.036）。2种术式无论是单纯手术亚组之间或术后联合放化疗亚组之间的中位OS比较,差异均无统计学意义（P＞0.05）。改良Ivor-Lewis术Ⅱ期患者术后接受放化疗的中位OS较单纯手术者并未明显获益（P＞0.05）,在Sweet术Ⅱ期患者中也得到相似结果（P＞0.05）;Ⅲ期及以上患者术后接受辅助放化疗,其中位OS相较单纯手术者获得改善（P＜0.05）。Cox比例风险模型分析显示,年龄、组织学分化程度、切端、癌栓、浸润深度、阳性淋巴结数、UICC 分期、是否接受术后辅助放化疗均为影响预后的独立因素,而手术方式的选择与预后无关（P＞0.05）。结论改良Ivor-Lewis术和Sweet术均可选择作为胸段食管鳞癌的手术方式,应根据患者的实际情况综合分析并制定个体化治疗方案。对于Ⅲ期及以上患者,术后辅助放化疗能够有效改善预后。