＂Wrapping the gastroduodenal artery stump＂ during pancreatoduodenectomy reduced the stump hemorrhage incidence after operation

Objective： After pancreaticoduodenectomy （PD）, the postoperative gastroduodenal artery stump （GDAS） hemorrhage is one of the most serious complications. The purpose of this study is to determine whether wrapping the GDAS during PD could decrease the postoperative GDAS hemorrhage incidence. Methods： A retrospective review involving 280 patients who underwent PD from 2005 to 2012 was performed. Wrapping the GDAS during PD was defined as ＂Wrapping the GDAS using the teres hepatis ligamentum during PD＂. A total of 140 patients accepted the ＂wrapping＂ procedure （wrapping group）. The other 140 patients didn＇t apply the procedure （non-wrapping group）. Age, sex, preoperative data, estimated intraoperative blood loss, postoperative complications, pathologic parameters and hospitalization time were compared between two groups. ResultsI There were no significant differences in patient characteristics between two groups. After wrapping, the incidence of postoperative GDAS bleeding decreased significantly （1/140 vs. 9/140, P=0.01）. The rates of the other complications （such as intra-abdominal infection pancreatic fistula, billiary fistula, gastrointestinal bleeding, et aL） showed no significant differences. Conclusions： Wrapping the GDAS during PD significantly reduced the postoperative GDAS hemorrhage incidence. And the ＂wrapping＂ had no obvious influence on other complications.     

Clinical study on radiotherapy combined with surgical treatment of 162 patients with cervical cancer

Objective: To compare the 5-year survival rates and complications of internal and external irradiation therapy combined with operation in patients with Ⅱ-Ⅲ period of cervical cancer.Methods: 162 cervical cancer patients after the whole palace resection pelvic lymphadenectomy were divided into three groups, and then accepted radiotherapy.The first group with 91 cases was accepted internal and external irradiation therapy before operation; the second group with 37 cases was given internal irradiation therapy before operation; the third group with 34 cases was given routine postoperative radiotherapy.External irradiation used 60Co irradiation or a linear accelerator, to the whole basin, and the irradiation dose of "B" point in preoperative radiotherapy was 26-30 Gy, in postoperative radiotherapy was 46-50 Gy; intraluminal brachytherapy used 192lr,the dose of "A" point was 5-15 Gy.Results: The 5-year survival rate of preoperative combined radiotherapy group was 78.0%(71/91), preoperative intracavitary radiotherapy group 64.9% (24/37), and postoperative radiotherapy group 35.3% (12/34).Comparing the 5-year survival rates of the preoperative combined and postoperative irradiation groups, there was significant difference (P＜0.05).The major complications were radioactive proctitis and cystitis, the complication incidences of three groups were 35.2% (32/91), 32.4% (12/37), 38.2% (13/34), respectively, and the differences were not statistically significant (P＞0.05).Conclusion: The intraluminal brachytherapy plus external irradiation can significantly increase the 5-year survival rate of patients with Ⅱa-Ⅲa stages, and the incidence of complications was not significant difference.     

肺功能中度减退的肺癌患者术后并发症分析

Objective： To analyze the tolerance of lung cancer patients with moderate pulmonary hypofunction to open-chest operation. Methods： The postoperative complications of 31 patients with moderate pulmonary hypofunction （study group） and 62 patients with normal pulmonary function （control group） were reviewed. Statistical t test and χ^2 test were set to examine the data, and logistic regression was performed to find the associated factors. Results： In patients with moderate pulmonary hypofunction, hypoxemia （41.9%）, arrhythmia and cardiac dysfunction （25.8%）, and pulmonary inflammation （25.8%） were common postoperative complications, and respiratory failure and cardiac failure （9.2%） severe complications. In-hospital mortality rate was 3.2%. In the control group, the incidence of the above 4 postoperative complications was 16.1%, 8.1%, 9.6% and 3.2% accordingly, and no case died in hospital. Regression analysis showed that age and resection range were associated with the occurrence of the complications. Conclusion： Common postoperative complications （hypoxemia） in patients with moderate pulmonary hypofunction are remarkably higher than those in control group, but severe complications and in-hospital mortality rate are not significantly high. Patients with older age and larger resection range undergo higher complication rate.     

超声检查在肝胆胰手术中的应用

Objective： To explore the reference value of intraoperative ultrasonography in the operative procedure and postoperative treatment with relation to hepatopancreatobiliary surgery. Methods： 103 cases of hepatopancreatobiliary operations were collected in our hospital from January 1996 to October 2005, in which 68 cases were males and the others were females, age ranged from 45 to 76 years. Hepatocellular carcinoma were 26 cases, gallbladder carcinoma were 5 cases, cholangiocarcinoma were 6 cases, pancreatic carcinoma were 10 cases and other 56 cases were gall stone and/or choledocholithiasis. Intraoperative ultrasonography with high frequency probe was used in all cases. Results： Some minimal occult focuses was found by intraoperative ultrasonography. We found vascular tumor thrombosis in 70% cases of hepatocellular carcinomas. One case was diagnosed as pancreatic carcinoma before operation and found choledochal tract dilatation concurrently with cholangitis by intraoperative ultrasonography. Eight cases of gallstones with no choledochal stones before operation were found by intraoperative ultrasonography that stone lain in low segment of common bile duct. Conclusion： The image data of high quality obtained by intraoperative ultrasonography could not only direct our more proper operative practice but also favor us to make more reasonable postoperative treatment plan.     

Postoperative complications and weight loss following jejunostomy tube feeding after total gastrectomy for advanced adenocarcinomas

Objective:Patients undergoing total gastrectomy for cancer are at risk of malnourishment.The aim of this selfcontrolled study was to examine the effect of jejunostomy tube feeding (JTF) and other factors on postoperative weight and the incidence of jejunostomy-related complications in patients undergoing total gastreetomy for cancer.Methods:All consecutive patients who underwent total gastrectomy for gastric cancer with jejunostomy placement were included from a prospective single-center database (2003-2014).Jejunostomy-related complications and postoperative weight changes were evaluated up to 12 months after surgery.Multivariable linear regression analysis was performed to identify factors associated with weight loss 12 months after gastrectomy.Results:Of 113 patients operated in the study period,65 received JTF after total gastrectomy for a median duration of 18 d [interquartile range (IQR),10-55 d].Jejunostomy-related complications occurred in 11 (17％) patents,including skin leakage (n=3) and peritoneal leakage (n=2),luxation (n=3),occlusion (n=2),infection (n=l) and torsion (n=1).In 2 (3％) patents,a reoperation was needed due to jejunostomy-related complications.The mean preoperative weight of patients was 71.8 kg (100％),and remained stable during JTF (73.9 kg,103％,P=0.331).After JTF was stopped,the mean weight of patients decreased to 64.9 kg (90％) at 12 months after surgery (P＜0.001).A high preoperative body mass index (BMI) (≥25 kg/m2) was associated with high postoperative weight loss compared to patients with a low BMI (＜25 kg/m2) (16.3％ vs.8.6％,P=0.016).Conclusions:JTF can prevent weight loss in the early postoperative phase.However,this is at the prize of possible complications.As weight loss in the long term is not prevented,routine JTF should be re-evaluated and balanced against the selected use in preoperatively malnourished patients.Special attention should be paid to patients with a high preoperative BMI,who are at risk of more postoperative weight loss.     

改良POSSUM评分评估肺癌手术风险的应用价值(英文)

Objective: The aim of this study was to explore the modified physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) scoring system and the relationship between predicted data and actual data of complication and surgical mortality of lung cancer radical surgery made by such score system. Methods: Retrospective analysis on the 86 cases of the clinical materials of patients with primary lung cancer radical surgery for thoracic surgery of line lung cancer in the 81st Hospital of PLA from October 2010 to October 2011 and using the POSSUM scoring system to predict the cases of postoperative complication and death toll, then making a comparison with the actual cases. Results: The POSSUM scoring system predicting 29 cases of postoperative complications, but 32 cases of practical complications, the difference between them has no statistical significance (P﹥0.05), 8 cases of predicted postoperative deaths, 2 cases of practical deaths, by comparison, there was statistical significance (P﹤0.05). Conclusion: The modified POSSUM scoring system can be used to predict the postoperative complication of lung surgery patients, but sometimes overestimates the postoperative death cases.     

Pancreatic cancer–Palliative therapy: surgery (bypass/resection)

Objective: We compare the outcome of palliative pancreaticoduodenectomy and palliative surgical bypass in patients with advanced pancreatic carcinoma in our hospital. Recent published related articles are also reviewed. Methods: A respective analysis was performed comparing the perioperative parameters and outcome of 20 patients who underwent pancreaticoduodenectomy with a gross suspected cancer residue and 30 patients who underwent a surgical bypass, all of the patients were diagnosed as in advanced stages intra-operatively. Results: The two groups were comparable with patient characteristics, including age, gender, initial symptoms and concomitant major organ diseases. Tumors are similar in size and intra-operatively diagnosed as in advanced stages in both groups. All of the patients in the resection group were microscopically proved having cancer residue. One postoperative mortality occurred in the resection group (5%), zero in the bypass group (P > 0.05). Overall complications were significantly higher in the resection group (30% vs. 0, P < 0.01), including 2 patients developed Acute Respiratory Distress Syndrome (ARDS), zero in the bypass group (P < 0.01); hemorrhage and transfusions in the resection group were much more than that in the bypass group (P < 0.05). Hospital stay after resection was significantly longer than bypass (20 vs. 12 days, P < 0.01). Hospital fee after resection was 4 times more than after bypass (median 61.500 vs. 15. 300 yuan, P < 0.01). Survival was significantly longer after resection (median 12.2 vs. 7.1 months, P < 0.01). Conclusion: Our results show that palliative resection in advanced pancreatic carcinoma lengthens the survival time of the patients, but this is paid for significantly higher complications than bypass.     

胰腺癌:姑息性手术治疗(旁路术/切除术)

Objective:We compare the outcome of palliative pancreaticoduodenectomy and palliative surgical bypass in patients with advanced pancreatic carcinoma in our hospital. Recent published related articles are also reviewed. Methods:A respective analysis was performed comparing the perioperative parameters and outcome of 20 patients who underwent pancreaticoduodenectomy with a gross suspected cancer residue and 30 patients who underwent a surgical bypass, all of the patients were diagnosed as in advanced stages intra-operatively. Results:The two groups were comparable with patient characteristics, including age, gender, initial symptoms and concomitant major organ diseases. Tumors are similar in size and intra-operatively diagnosed as in advanced stages in both groups. All of the patients in the resection group were microscopically proved having cancer residue. One postoperative mortality occurred in the resection group (5%), zero in the bypass group (P ＞ 0.05). Overall complications were significantly higher in the resection group (30% vs. 0, P ＜ 0.01), including 2 patients developed Acute Respiratory Distress Syndrome (ARDS), zero in the bypass group (P ＜ 0.01); hemorrhage and transfusions in the resection group were much more than that in the bypass group (P ＜ 0.05). Hospital stay after resection was significantly longer than bypass (20 vs. 12 days, P ＜ 0.01). Hospital fee after resection was 4 times more than after bypass (median 61.500 vs. 15. 300 yuan, P ＜ 0.01). Survival was significantly longer after resection (median 12.2 vs. 7.1 months, P ＜ 0.01). Conclusion:Our results show that palliative resection in advanced pancreatic carcinoma lengthens the survival time of the patients, but this is paid for significantly higher complications than bypass.     

肝海绵状血管瘤二种手术方式的选用体会

Objective: To investigate the optimizing of operative techniques on cavernous hepatic hemangioma by compar-ing the effective of the two approaches (enucleation and hepatectomy). Methods: From May 1994 to September 2006, forty-three patients underwent the surgical removal of the cavernous hepatic hemangioma were analyzed retrospectively. Enucle-ation was used for 16 cases and hepatectomy for 27 cases. The relative clinical data and operative factors between the two operative techniques were compared. Results: Statistically significant differences in tumor size, location and intraoperative blood lose between the two groups were observed (P < 0.05 ). Although enucleation was associated with less intraoperative bleeding and transfusion requirement but no significant differences in postoperative liver functional parameter, complication and length of hospital stay were observed. Conclusion: With proper choice, enucleation and hepatectomy both are effective treatments for cavernous hepatic hemangiomas.     

Nonintubated uniportal video-assisted thoracoscopic surgery for primary spontaneous pneumothorax

Objective:The objective of the current study was to evaluate the feasibility and safety of nonintubated uniportal video-assisted thoracoscopic surgery（VATS） for the management of primary spontaneous pneumothorax（PSP）.Methods:From November 2011 to June 2013,32 consecutive patients with PSP were treated by nonintubated uniportal thoracoscopic bullectomy using epidural anaesthesia and sedation without endotracheal intubation.An incision 2 cm in length was made at the 6^th intercostal space in the median axillary line.The pleural space was entered by blunt dissection for placement of a soft incision protector.Instruments were then inserted through the incision protector to perform thoracoscopic bullectomy.Data were collected within a minimum follow-up period of 10 months.Results:The average time of surgery was 49.0 min（range,33-65 min）.No complications were recorded.The postoperative feeding time was 6 h.The mean postoperative chest tube drainage and hospital stay were19.3 h and 41.6 h,respectively.The postoperative pain was mild for 30 patients（93.75%） and moderate for two patients（6.25%）.No recurrences of pneumothorax were observed at follow-up.Conclusions:The initial results indicated that nonintubated uniportal video-assisted thoracoscopic operations are not only technically feasible,but may also be a safe and less invasive alternative for select patients in the management of PSP.This is the first report to include the use of a nonintubated uniportal technique in VATS for such a large number of PSP cases.Further work and development of instruments are needed to define the applications and advantages of this technique.     

Comprehensive treatment and prognostic factors in patients with carcinoma of the cervical stump

OBJECTIVE To evaluate the applicability of combined therapy and the prognostic factors in patients with carcinoma of the cervical stump （CCS）. METHODS The clinical records of 60 CCS patients who underwent combined treatment in our hospital during a period from January 2000 to December 2007, were collected and retrospectively analyzed. The prognostic factors were studied using univariate analysis. Analytical evaluation of the independent prognostic factors was performed using COX proportional- hazards regression model. RESULTS The 1-, 3- and 5-year survival rates of the 60 patients were 95%, 78% and 68%, respectively, with a median survival time of 32 months. Univariate survival analysis showed that these independent prognostic factors included positive pelvic lymph nodes （P = 0.001）, lymphovascular tumor embolus （P = 0.001）, and adjuvant chemotherapy （P = 0.011）. In the 60 cases, postoperative local recurrence in the pelvic cavity occurred in 1 and distant metastasis in 3. Related complications, such as radiocystitis, recto-vaginal fistula and vesico-vaginal fistula were found in 6 of the total cases （10%）. The serum levels of squamous epithelium antigen detected before and after treatment were significantly different （P = 0.000）. The incidence of CCS is low; however, the disease is difficult to cure due to the high incidence of complications and to the frequency of distant metastasis. Therefore, individualized treatment is needed. Complications from subtotal hysterectomy （STH） should be treated and controlled aggressively. Careful follow-up as well as close monitoring and observation for significant symptoms in the postoperative course will enhance clinical outcome. CONCLUSION Cancer of the cervical stump has a low morbidity and severe complications, and most recurrences are distant metastases. Because it is difficult to cure, there is a need to design a treatment regimen for each individual patient based on the factors deemed as high risk. The surgical indications for subtotal uterine resection should be followed and close follow-up after surgery should be maintained.     

胰腺癌:姑息性支架术治疗

Pancreatic cancer remains a common and very lethal malignancy with a median survival of approximately 6 months. Surgical resection offers the only potentially curative approach but many patients （80% or more） are ineligible for this kind of therapy, because of age, comorbidities, or locally advanced or metastatic disease that does not benefit from resection. Thus, for many patients with pancreatic cancer treatment remains palliative and endoscopic therapy to relieve bile duct or gastric outlet obstruction becomes of special importance. Although both surgical and non surgical palliative procedures can relieve biliary and duodenal obstruction particularly endoscopic treatment with plastic prostheses or self expanding metal stents was shown to be not only highly effective but also to be burdened with only few complications. The present article summarizes the palliative endoscopic treatment in patients with non resectable pancreatic cancer.     

SURGICAL TREATMENT OF HILAR BILE DUCT CARCINOMA

From June, 1986 to June 1989, 24 cases of hilar bile duct carcinoma were explored in the Surgical Department of General Hospital of PLA, 16/24 cases were resected, a resectability rate of 66%. The increase of resectability rate was due to earlier recognition of this condition and the extension of surgery, including major resection of liver as well as radical dissection of the hepato-duodenal ligament and repairative operations on the blood vessels. Among these 16 cases, major hepatic resection was performed in 10 cases, in which, 3 cases of resections of the middle lobe of the liver were done instead of right or extended right lobectomy. No operative mortality in the 30 days' postoperative period, but the postoperative morbidity rate was still high and most of the complications were related to biliary leakage and infection. Three patients died in the follow up period at 6, 14 and 15 months respectively. All of them died from biliary infection. The remaining 13 patients were still alive, the longest bein     

非小细胞肺癌术后三维适形放疗与常规放疗的疗效比较

Objective： To compare the survival fractions and radiation-induced complications of conventional radiotherapy （CV） vs. conformal radiotherapy （CF） for non-small-cell lung cancer （NSCLC） after surgical resection. Methods： Between 1990 and 2002, 167 patients underwent post-radiotherapy either CV （n = 90） or CF （n = 77） for pathological IliA NSCLC at the University of Texas M.D. Anderson Cancer Center. Patients and tumor charactedstics were balanced in the two treatment groups. Surgical resection mainly consisted of Iobectomy and mediastinal lymph node dissection. In the CV group, postoperative radiotherapy was delivered to 54.3 Gy （range 22-69.6 Gy） in 27 fractions （range 11-58 f） for 5-6 weeks, while the CF group with RT to 53.9 Gy （range 50-63 Gy） in 26 fractions （range 25-33 f） for 5-6 weeks. Overall survival, disease-free survival, local control and distant metastasis-free survival were calculated using the Kaplan-Meier method. The complications of radiotherapy were also compared between the two groups. The median follow-up duration was 36 months in the CV group while 24 months in the CF group. Results： No statistically significant differences were found in terms of disease-free survival, local-regional control and distant metastasis-free survival in the two treatment groups. However, the overall survival was found statistically significant different in the two groups （P = 0.014）. Postoperative radiotherapy complications such as weight loss, skin reaction, dysphagia, and cardiac related complication were similar in the two groups although the lung fibrosis, cardiac complications and hematologic complications were significantly different, and 8 cases of death in the CV group associated with cardiac complications while none was observed in the CF group. Conclusion： The treatment of stage IliA NSCLC using either CV or CF postoperative radiotherapy resulted in similar outcomes in terms of local control, disease-free survival and most of complications. However, CF could achieve better overall survival and less complications such as lung fibrosis, cardiac complications and hematologic complications. The advantage is worth further observation.     

Safety and feasibility of video-assisted thoracoscopic surgery for stage ⅢA lung cancer

Objective： The current study was prospectively designed to explore the application of video-assisted thoracoscopic surgery （VATS） radical treatment for patients with stage ⅢA lung cancer, with the primary endpoints being the safety and feasibility of this operation and the second endpoints being the survival and complications after the surgery. Methods： A total of 51 patients with radiologically or mediastinoscopically confirmed stage ⅢA lung cancer underwent VATS radical treatment, during which the standard pulmonary lobectomy and mediastinal lymph node dissection were performed after pre-operative assessment. The operative time, intraoperative blood loss/ complications, postoperative recovery, postoperative complications, and lymph node dissection were recorded and analyzed. This study was regarded as successful if the surgical success rate reached 90% or higher. Results： A total of 51 patients with non-small cell lung cancer （NSCLC） were enrolled in this study from March 2009 to February 2010. The median post-operative follow-up duration was 50.5 months. Of these 51 patients, 41 （80.4%） had N2 lymph node metastases. All patients underwent the thoracoscopic surgeries, among whom 50 （98%） received pulmonary lobectomy and mediastinal lymph node dissection completely under the thoracoscope, 6 had their incisions extended to about 6 cm due to larger tumor sizes, and 1 had his surgery performed using a 12 cm small incision for handling the adhesions between lymph nodes and blood vessels. No patient was converted to conventional open thoracotomy. No perioperative death was noted. One patient received a second surgery on the second post-operative day due to large drainage （〉1,000 mL）, and the postoperative recovery was satisfactory. Up to 45 patients （88.2%） did not suffer from any perioperative complication, and 6 （11.8%） experienced one or more complications. Conclusions： VATS radical treatment is a safe and feasible treatment for stage ⅢA lung cancer.     

Prognostic relevance of number and ratio of metastatic lymph nodes in resected carcinoma of the ampulla of Vater

Objectives： To explore the prognostic relevance of the number and ratio of metastatic lymph nodes in resected Carcinoma of the ampulla of Vater （CAV）. Methods： The clinical data of 155 patients who underwent pancreaticoduodenectomy （PD） for cancer of the ampulla of Vater between January 1990 and December 2010 were retrospectively analyzed. Kaplan- Meier method was used in survival analysis and Log rank method in comparison. Multivariate analysis was performed using Cox proportional hazards model. Results： Among these 155 patients, the in-hospital mortality rate was 4.5%, lymph node positive disease was 21.3%, and the 5-year survival rate was 51.6%. Patients with a lymph node ratio （LNR） 〉20% were more likely to have tumor differentiation, depth of duodenal involvement, depth of pancreatic invasion, T-stage and TNM-Stage. The number of the metastatic lymph nodes is important prognostic factors of the CAV. Univariate analysis showed that the factors associated with the prognosis included tumor size （P=0.036）, tumor differentiation （P=0.019）, LNR （P=0.032）, mtmber of metastatic lymph nodes （P=0.024）, lymph node metastasis （P=0.03）, depth of pancreatic invasion （P=0.001）, T-stage （P=0.002）, TNM stage （P=0.001）, elevated CA 19-9 （P=0.000）, and jaundice （P=0.021）. Multivariate analysis showed that the factors associated with the prognosis were the number of metastatic lymph nodes （P=0.032; RR： 1.283; 95% CI： 1.022-1.611）, tumor size （P=0.043; RR： 1.736; 95% CI： 1.017-2.963）, and elevated CA 19-9 （P=0.003; RR： 3.247; 95% CI： 1.504-7.010）. Conclusions： LNR is a useful factor for predicting the prognosis of the radical treatment for CAV,, whereas the number of metastatic lymph nodes is the most important factor. Further research on the locations, number, and LNR will be clinically meaningful to improve survival in patients with CAV.     

Meta-analysis:prognostic value of survivin in patients with pancreatic cancer

Objective： The aim of the study was to conduct a systematic review of the literature evaluating survivin expres- sion in pancreatic carcinoma as a prognostic indicator. Methods： The relevant literatures were searched using PubMed, EMBASE, and Chinese Biomedicine Databases. A meta-analysis of the association between survivin expression and overall survival in patients with pancreatic cancer was performed. Studies were pooled and summary hazard ratios （HRs） were calculated. Subgroup analysis according to the location of survivin expression was also performed. Results： Seven eligible studies with a total of 448 patients were included in this study. Combined HR suggested that survivin expression had an unfavorable impact on survival of pancreatic cancer patients （HR = 1.65, 95% CI： 1.02-2.68）. When stratified according to the location of survivin expression, the combined HR showed that expression in the cytoplasm was significantly associated with poor prog- nosis of pancreatic cancer patients （HR = 2.09, 95% CI： 1.29-3.40）. In contrast, survivin expression in the nucleus was not significantly associated with poor prognosis （HR = 0.83, 95% CI： 0.24-2.81）, and the heterogeneity was highly significant （I2 = 87.2%, P = 0.005）. Conclusien： Survivin expression was associated with a poor prognosis in patients with pancreatic cancer. Cytoplasmic expression of survivin may be a prognostic factor for pancreatic cancer patients. Based on the current obtained data, there was no evidence that survivin expression in the nucleus had a significant impact on patients＇ overall survival.     

全胸腔镜联合腹腔镜食管癌根治术与常规手术的临床对比研究(英文)

Objective: The aim was to evaluate the best intra-thoracoscopic surgery technique between video-assisted thoracic surgery (VATS) combined with laparoscopy and right open transthoracic esophagectomy, in patients with esophageal cancer. Methods: From November 2006 to May 2008, 221 patients with esophageal cancer were enrolled in this study, prospective randomized in two groups. 111 patients were performed the VATS technique (Experimental group), whereas in the other 110 patients esophagectomy was adopted by thoracotomy (Control group). Results: The time consuming of Experimental group was 272.3 min in average with a standard deviation(std) of 57.9, and it was 218.7 min in average with std of 91.0 in the control group (P=0.000). The operative blood loss was 219.7±194.4 mL in the Experimental group, compared with 590.0±324.4 mL in the control group, with significant difference (P=0.000). Postoperative hospital stay of Experimental group was 9.6±1.7d, and it was 11.4±2.3d in the control group (P=0.000). There was no-delayed union of incision in the Experimental group, but 6.36% in the control group (P=0.007). The disorder of gastric emptying occurred 0.9% in the Experimental group, whereas 6.4% in the Control group. There was no significant difference in survival curves and rates (P=0.555). Conclusion: There were several advantages of VATS technique, such as reduced hemorrhage, better recovery, few complications, and great number of lymph node dissection, although there was no significant difference in long-term survival rate. Thus the VATS combined with laparoscopy technique was worthy of generalization in esophageal surgery with good prospects.     

Pancreatic pseudocyst or a cystic tumor of the pancreas？

Pancreatic pseudocysts are the most common cystic lesions of the pancreas and may complicate acute pancreatitis, chronic pancreatitis, or pancreatic trauma. While the majority of acute pseudocysts resolve spontaneously, few may require drainage. On the other hand, pancreatic cystic tumors, which usually require extirpation, may disguise as pseudocysts. Hence, the distinction between the two entities is crucial for a successful outcome. We conducted this study to highlight the fundamental differences between pancreatic pseudocysts and cystic tumors so that relevant management plans can be devised. We reviewed the data of patients with pancreatic cystic lesions that underwent Jntervention between June 2007 and December 2010 in our hospital. We identified 9 patients （5 males and 4 females） with a median age of 40 years （range, 30-70 years）. Five patients had pseudocysts, 2 had cystic tumors, and 2 had diseases of undetermined pathology. Pancreatic pseudocysts were treated by pseudocystogastrostomy in 2 cases and percutaneous drainage in 3 cases. One case recurred after percutaneous drainage and required pseudocystogastrostomy. The true pancreatic cysts were serous cystadenoma, which was treated by distal pancreatectomy, and mucinous cystadenocarcinoma, which was initially treated by drainage, like a pseudocyst, and then by distal pancreatectomy when its true nature was revealed. We conclude that every effort should be exerted to distinguish between pancreatic pseudocysts and cystic tumors of the pancreas to avoid the serious misjudgement of draining rather than extirpating a pancreatic cystic tumor. Additionally, percutaneous drainage of a pancreatic pseudocyst is a useful adjunct that may substitute for surgical drainage.