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find Author "王允" 21 results
  • 贲门失弛缓症合并食管癌手术治疗一例

    Release date:2016-09-08 09:27 Export PDF Favorites Scan
  • Minimally Invasive Esophagectomy for the Treatment of Esophageal Carcinoma

    Esophagectomy and extensive lymphadenectomy still remain effective treatment strategies for patients with resectable esophageal carcinoma (EC). However,traditional esophagectomy is performed via open approaches and associated with significant postoperative morbidity and mortality. In order to reduce morbidity and mortality after esophagectomy,various minimally invasive techniques have been introduced to esophagectomy by many medical centers,and minimally invasive esophagectomy (MIE) has been widely developed in thoracic surgery. MIE has been proven to be a safe and feasible approach for the treatment of EC. Compared with open esophagectomy,MIE can reduce surgical blood loss,achieve complete and standardized tumor resection and lymph node dissection,and obtain equivalent long-term survival results. However,there are still controversies in some aspects of MIE for the treatment of EC,and the superiority of MIE has not been fully demonstrated. In this review,we focus on five aspects of MIE for the treatment of EC,including MIE techniques,perioperative outcomes,completeness and standard of tumor resection,long-term survival results and current problems.

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  • Short-term Outcomes of Thoracoscopic and Laparoscopic-assisted Minimally Invasive McKeown Procedure for EsophagealCancer

    Objective To explore clinical application values of thoracoscopic and laparoscopic-assisted minimally invasive McKeown procedure for esophageal cancer. Methods Clinical data of 196 patients with esophageal cancer (EC) who underwent thoracoscopic and laparoscopic-assisted minimally invasive McKeown procedure in West China Hospital of Sichuan University from February 2008 to August 2012 were analyzed retrospectively. There were 145 male and 51 female patients with their age of 40-76 (58.8±6.6) years. There were 43 patients with EC in the upper segment of the esophagus, 115 patients with EC in the middle segment of the esophagus and 38 patients with EC in the lower segment of the esophagus.Results Total operation time was 215-780 (305.0±40.7) minutes,including thoracoscopic operation time of 50-580 (105.0±38.4) minutes and laparoscopic operation time of 28-105 (54.0±8.6) minutes. Intraoperative blood loss was 20-440 (285.4±38.5) ml. The number of dissected lymph nodes was 6-39 (20.4±1.6) for each patient. Postoperative hospital stay was 7-93 (12.8±5.2) days. Sixty patients (30.6%) had postoperative complications,including 28 patients (14.3%) with pulmonary comp-lications,5 patients (2.5%) with chylothorax,5 patients (2.5%) with arrhythmias,15 patients (7.6%) with anastomotic fistula,10 patients (5.0%) with recurrent laryngeal nerve injury,and other complications in 2 patients. Conclusion Thoracoscopic and laparoscopic-assisted minimally invasive McKeown procedure is a safe and feasible operation for esophageal cancer.

    Release date:2016-08-30 05:47 Export PDF Favorites Scan
  • Concealing Incision Video-assisted Thoracoscopic Surgery for 11 Patients

    Abstract: Objective To explore the feasibility and safety of concealing incision video-assisted thoracoscopic surgery (VATS). Methods We retrospectively analyzed the clinical data of 11 patients who underwent concealing incision VATS in West China Hospital of Sichuan University between September and November 2011. There were 2 male patients and 9 female patients with their mean age of 34.0 years (ranging from 16 to 59 years). There were 4 patients with myasthenia gravis, 4 patients with thymoma, 2 patients with thymus cyst, and 1 patient with hyperhidrosis. Extended thoracoscopic thymectomy was performed in 10 patients, and endoscopic thoracic sympathectomy was performed in 1 patient. Results All the VATS procedures were performed successfully, and there was no intraoperative and postoperative complication. The operation time ranged from 30 to 105 minutes with an average time of 70.5 minutes. All the intraoperative blood loss was less than 5 ml. The time of postoperative thoracic drainage was less than 48 hours, and the drainage volume ranged from 30 to 80 ml with a mean volume of 55.5 ml. The mean postoperative hospital stay was 3.5 (2-4)days. The incision was small with a concealed and esthetic appearance. For 10 patients with extended thoracopscopic thymectomy, histopathology test aftre operation showed 4 patients with thymic hyperplasia, 4 with thymoma, and 2 with cystofthymus. Conclusion Concealing incision VATS is a safe and feasible technique, and it can meet the esthetic requirement of patients.

    Release date:2016-08-30 05:50 Export PDF Favorites Scan
  • Clinical Analysis of Patients with Atrial Fibrillation after Surgical Treatment for Esophageal Carcinoma

    ObjectiveTo investigate the high risk factors for perioperative atrial fibrillation (AF) and its effect on the postoperative short term outcome in esophageal carcinoma patients. MethodsSixty three patients with AF after esophagectomy (AF group) and 126 patients without AF after esophagectomy in control group were analyzed by χ 2, and logistic regression, and compare with patient the postoperative mortality and duration hospitalization in two groups.ResultsThe rates of age above 65 (χ 2=7.02, P lt;0.01), male sex (χ 2=4.06, P lt;0.05), history of cardiac disease (χ 2=6 03, P lt;0.05), history of chronic obstructive pulmonary disease (COPD, χ 2=29.14, P lt;0 01), postoperative thoracic gastric dilatation ( P lt;0.01), and postoperative lower oxygen saturation ( P lt;0.01) in AF group were significantly higher than those in control group. No significant relevance was found between history of diabetes or hypertension, choice of operative approach, site of stoma and postoperative AF. 1 in 15 AF patients regain sinus rhythm after remove the pathological factors, and the others resumed after antiarrhythmic drug therapy. The postoperative hospitalization time was 10.65±0.87 d in patients developing AF group and 9.98±0.96 d in control group ( P gt;0.05). No difference was observed between two groups with regard to mortality ( P gt;0.05).ConclusionAF occurs more frequently after esophagectomy in aged and male sex. Other factors contributing to AF are history of cardiac disease, COPD and lower oxygen saturation. And in this study, early occurrence of AF after operation for esophageal carcinoma does not show any negative impact on mortality or on postoperative duration hospitalization.

    Release date:2016-08-30 06:24 Export PDF Favorites Scan
  • Clinical Application and Experimental Study of Layered Anastomosis in Esophagogastrostomy

    Objective To summarize the clinical application of esophagogastrostomy with layered anastomosis and to observe the healing quality of anastomotic stoma in animal experiments. Methods One thousand and twenty-four patients suffered from carcinoma of esophagus or carcinoma of gastric cardia had undergone esophagogastrostomy by layered anastomosis with absorbable suture. Twenty-four experimental dogs (adult male healthy hybrid dogs) were divided into two groups: the experimental group and the control group. The former (experimental group) underwent the layered anastomosis, the diameter of esophagogastric stoma and the length and depth of stomal scar were measured under anesthesia in both groups on 5th,8th,14th,and 42th postoperative day, respectively. So were done the histological measurement, such as the count infiltrating inflammatory cells, the proliferation of blood capillary and other cells. And the cytokines related to wound healing (LsAB technique) such as epidermal growth factor(EGF), transforming growth factor-beta 1 (TGF-beta 1) were detected, either. Results One thousand and twenty-four patients had no anastomotic leakage. There were only 6 patients suffered from mild anastomotic stricture, and they got well after one dilatation. The results of the measurement of 24 experimental dogs revealed that, in the experimental group, the mucosa was in good connecting condition, had a soften anastomotic stoma and a thin scar. The counts of inflammatory cells and fibroblast showed more in number at the early time after operation (Plt;0.05), while showed less in number at the advanced time of operation (Plt;0.05). In the control group, however, the mucosa were in a bad connecting condition, the scar was thicker, and the muscle layer was frequently exposed. The counts of inflammatory cells and fibroblast were fewer at the early time after operation, however, they had a clearly tendency of increasing at the anaphase after the operation. On the cytokines related to the healing of wound in the experimental group, there was a high expression and activity at the early period. There were a little expression up to postoperative 42 d. Whereas, in the control group, there had a low expression level,increased clearly on postoperative 8 d, and still a higher expression up to postoperative 42 d. Conclusions The esophagogastrostomy by layered anastomosis has a high healing quality with a thin scar. The proliferation of cells and the expression of growth factors benefits the normal healing of wound by first intention.

    Release date:2016-08-30 06:25 Export PDF Favorites Scan
  • 核增殖抗原表达基因Ki67与人肺癌临床病理生理特征及其预后的关系

    目的 研究细胞增殖状态与肺癌临床病理生理特征和预后的关系,探讨Ki67对临床诊断和预后判断的价值。方法 应用免疫组织化学法检测166例肺癌组织标本和37例肺良性病变组织中Ki67的表达水平。结果 (1)肺癌组织中Ki67指数显著高于肺良性病变组织(P<0.01),而癌旁组织与良性病变组织相比差别无显著性意义;(2)肺癌组织中Ki67表达水平增强与肺癌组织学类型、细胞分化程度有关(P<0.05),而与患者PTNM分期、淋巴结转移程度、吸烟与否以及患者的性别、年龄无明显关系;(3)Ki67高表达组肺癌患者的术后生存时间显著低于低表达组(P<0.01),按PTNM分期分层后这种差别仍然存在(P<0.05)。结论 Ki67能较好地反映肺癌细胞的增殖状态,并对临床诊断和预后判断有一定价值。

    Release date:2016-08-30 06:33 Export PDF Favorites Scan
  • 食管癌术后呼吸衰竭的高危因素分析

    目的 探讨食管癌术后发生呼吸衰竭(RF)的高危因素.方法 将我院胸心外科1985~1998年收治的食管癌术后发生RF的58例患者临床资料,与按1∶2比例随机抽取的同期手术后未发生RF的116例食管癌患者的资料做对照,用χ2检验比较两组患者的术前肺功能,术前、术后其它合并症,吻合口部位,手术当天静脉液体入量和患者年龄、吸烟量的差异,应用Logistic回归分析肺功能各异常指标与术后RF发生的相关强度,推测可能导致食管癌术后RF发生的高危因素.结果 RF组的最大通气量(MVV),残气容积/肺总量比值(RV/TLC),第一秒用力呼气容积(FEV1),最大呼气流量(PEF),75%肺活量最大呼气流量(V75)以及肺一氧化碳弥散量明显差于对照组(Plt;0.01);手术当天(含术中)静脉晶体液入量和输血量明显高于对照组(Plt;0.01), RF组术后其它并发症发生率和颈部吻合率明显高于对照组(Plt;0.01).结论 术前肺功能提示重度慢性支气管炎、肺气肿及吻合口瘘等术后并发症是术后发生RF的高危因素,对颈部吻合患者应加强呼吸功能监护,术中严密止血是预防术后RF发生的重要环节之一.

    Release date:2016-08-30 06:35 Export PDF Favorites Scan
  • Diagnosis and Treatment of Esophageal Multiple Carcinoma

    目的探讨食管多源癌的诊断及治疗方法。 方法回顾性分析2008年3月至2009年11月在四川大学华西医院行手术治疗的15例食管多源癌患者的临床资料,其中男14例,女1例,中位年龄62.5(48~75)岁。15例行手术治疗食管多源癌的患者中,行Sweet术式8例,左胸-左颈两切口4例,胸腹腔镜联合McKeown术式2例,开胸探查而未能切除肿瘤1例。 结果术前确诊11例,术前确诊率为73.3%(11/15)。术后1例发生肺部并发症,3例发生吻合口瘘,围术期无死亡。除肿瘤未能切除的患者外,随访13例,随访5年,1年生存率61.5%(8/13)、3年生存率30.8%(4/13)、5年生存率15.4%(2/13)。第一病灶位置与预后关系密切,第一病灶位于胸上段的食管多源癌患者,其中5例顺利完成手术,吻合部位均在颈部,2例食管残端存在癌残留(R1),1年内死亡3例,无1例获得3年生存。第一病灶位于胸中、下段的9例食管多源癌患者均完成根治性切除,食管及胃残端均无癌残留(R0),1年生存率75.0%,3年生存率50.0%,2例获得5年长期生存。 结论对于食管多源癌,如第一病灶位于胸中、下段,首选手术治疗。如第一病灶位于胸上段,不宜首选手术治疗,这类患者采用新辅助放化疗后再手术或直接采用其他治疗模式,这需要以后进一步研究比较。

    Release date:2016-10-02 04:56 Export PDF Favorites Scan
  • Comparison between Video-assisted Thoracoscopic Surgery and Conventional Surgery for Multiple Rib Fractures

    ObjectiveTo compare clinical outcomes between video-assisted thoracoscopic surgery (VATS) and conventional surgery for the treatment of multiple rib fractures. MethodsA total of 173 consecutive patients with multiple rib fractures were admitted to Dujiangyan People's Hospital from January 2010 to December 2012. There were 122 males and 51 females with their age of 19-71 (41.3±7.1) years. According to different treatment strategies, all the patients were divided into 3 groups:conservative treatment group (83 patients with a mean of 4.9±1.3 fractured ribs, including 20 patients with flail chest), conventional surgery group (41 patients with a mean of 5.2±1.1 fractured ribs, including 11 patients with flail chest) and VATS group (49 patients with a mean of 5.3±1.5 fractured ribs, including 14 patients with flail chest). Length of hospital stay, duration of postoperative pain, incision length, operation time, chest drainage duration and morbidity were compared among the 3 groups. ResultsThe incision length (5.2±1.5 cm vs. 8.5±2.3 cm, P=0.031), operation time (1.1±0.3 hours vs. 1.8±0.2 hours, P=0.003), chest drainage duration (0.3±0.0 day vs. 3.2±1.1 days, P=0.007) and length of hospital stay (13.7±1.5 days vs. 17.3±2.3 days, P=0.017) of VATS group were significantly shorter than those of the conventional surgery group. A total of 159 patients were followed up, and chest x-ray was examined at 1, 3 and 6 months after discharge. After 3 months, bone callus formation was evident around the rib fractures in chest x-ray in patients undergoing surgery, while bone union with deformity was shown in some patients of the conservative group. ConclusionWith the development of various internal fixation materials, surgical internal fixation has become a trend for patients with multiple rib fractures, and VATS internal fixation is minimally invasive with satisfactory clinical outcomes.

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