Abstract： Objective To summarize the application experience of Gore-Tex patch in clinical chest wall reconstruction. Methods A retrospective analysis was performed in 33 patients who underwent chest wall reconstruction using Gore-Tex patch from January 2001 to December 2010 in Shanghai Changhai Hospital, Second Military Medical University. There were 19 men and 14 women, ranging in age from 20 to 73 years with a median age of 45.7 years. The surgical strategies included choosing different incisions according to tumor location and size, and preserving normal chest wall soft tissue as much as possible during surgery. Gore-Tex patch was used to reconstruct the huge chest wall defect, and covered by transferred muscle flaps. Results All the 33 patients underwent surgical reconstruction successfully and there was no perioperative death. Complete tumor resection was performed in all the patients, including 25 patients with malignant tumor and 8 patients with benign tumor. The diameter of the resected tumors ranged from 8 to 20 cm. All the patients were followed up from 5 to 60 months, except that 3 patients （9.09%） were lost during follow-up. There was no rejection response, abnormal breathing and foreign body sensation during follow-up. The infection incidence was 3%（1/33）. Conclusion Gore-Tex patch is a safe and effective material for chest wall reconstruction due to its excellent biocompatibility. Appropriate selection of muscle flap for covering Gore-Tex patch can reduce postoperative complications.
Abstract: Objective To explore the outcomes of videoassistedthoracoscopic surgery (VATS) in the treatment of esophageal leiomyoma. Me thods [WTBZ] We reviewed and analyzed the clinical data of 87 patients with esophageal leiomyoma treated with VATS in Changhai Hospital of Second Military Medical University between June 2002 and January 2009. [WTHZ]Results [WTBZ]Videoassisted thoracoscopic leiomyoma enucleations was performed in 80 patients, whilea conversion to minithoracotomy was required in 7 others. All procedures werecompleted smoothly and the postoperative recovery was uneventful, without mortality or severe complications. The patients were drinking liquids from postoperative day 1 and were eating a normal diet from day 3. All patients were pathologically diagnosed with leiomyoma after operation. Followups of 6 months to 6.5 years (mean: 3.8 years) found no recurrence. [WTHZ] Conclusion [WTBZ]Videoassisted thoracoscopic enucleation can be the first choice for esophageal leiomyomas derived from lamina propria. Patients with esophageal leiomyomas of diameter gt;1.0 cm should be treated with VATS .
ObjectiveTo explore the feasibility of CORFLO feeding tube in enternal nutrition after video-assisted thoracoscopic Ivor Lewis esophagogastrectomy for esophageal cancer and cardiac adenocarcinoma. MethodsA total of 107 patients with esophageal cancer and cardiac adenocarcinoma undergoing video-assisted thoracoscopic Ivor Lewis esophagectomy or resection of cardiac adenocarcinoma in our department between October 2014 and January 2016 were enrolled, among whom 10 patients received jejunostomy and 97 patients (60 males, 37 females, median age of 66 years, range, 47-75 years) received the insertion of CORFLO feeding tubes. ResultsIn 97 cases with insertion of feeding tubes, median insertion time was 7 (3-11) min and median depth was 83 (75-90) cm. The first-attempt success rate during the operation was 77.3% (75/97), and the second attempt at the bedside postoperatively was successful in 8 cases. The overall success rate was 85.6% (83/97). Insertion was successful in 77 esophageal cancer patients and 6 cardiac adenocarcinoma patients. Conclusion Blind insertion of CORFLO feeding tube in video-assisted thoracoscopic Ivor Lewis esophagogastrectomy for esophageal cancer and cardiac adenocarcinoma is feasible and safe. This noninvasive method is simple, effective and repeatable.
目的 探讨食管贲门癌术后非计划二次手术的原因及有效的预防和治疗措施。 方法 回顾性分析 2010 年 1 月至 2016 年 1 月在我院胸外科实施食管贲门癌手术 2 655 例患者的临床资料，37 例（1.4%）患者因严重并发症实施了非计划二次手术，其中男 28 例、女 9 例，年龄 65（48～79）岁，总结该 37 例患者的临床特征、二次手术的原因及治疗方法。 结果 吻合口瘘 11 例：1 例行空肠造瘘，2 例行胸壁切口清创+胸腔置管引流术，3 例行颈部切口清创+上纵隔置管引流术，5 例行胸腔探查术（其中 3 例行瘘口修补术），1 例胸胃瘘行胸胃部分切除+食管颈部旷置+空肠造瘘术。乳糜胸 13 例，经胸行胸导管结扎术，其中 1 例右胸结扎失败后再次经腹腔缝扎胸导管。胸腔出血 6 例行开胸探查止血，腹腔出血 2 例，分别经左胸及腹正中探查止血。1 例胸胃扭转，行吻合口切除+胃-食管端端再次吻合术。1 例因双侧声带麻痹行气管切开；1 例因肺大疱破裂气胸行胸腔镜下肺大疱切除术；1 例因肠梗阻行开腹探查粘连松解+空肠造瘘术。1 例胸内瘘患者因二次术后肺部感染死亡，其余患者均治愈出院。 结论 食管贲门癌术后二次手术的主要原因为吻合口瘘、乳糜胸及出血，提高首次手术质量是预防二次手术发生的关键，对需要行二次手术治疗的严重并发症，及时果断的决定可避免病情进一步恶化和提高二次手术的效果。
ObjectiveTo investigate the impact of thoracic duct ligation (TDL) on metabolism and postoperative complications during esophagectomy in patients with type-2 diabetes mellitus (T2DM).MethodsWe conducted a retrospective clinical data analysis of 230 esophageal carcinoma patients with T2DM who underwent esophagectomy in our hospital from January 2003 to December 2018. Patients were divided into a TDL+ group (n=112), including 78 males and 34 females aged 63.47±7.23 years, and a TDL– group (n=118), including 84 males and 34 females aged 64.38±7.57 years. We compared the blood glucose, liver function parameters and lipid metabolic parameters at different time points before and after surgery. In addition, we compared the postoperative major complications between the two groups. Propensity score-matched (PSM) was used to control the observed confounders.ResultsCompared with the TDL– group, patients in TDL+ group had higher blood glucose level (P<0.05, except the fourth postoperative day). The total protein and albumin levels on the first and fourth postoperative days in the TDL+ group were lower than those in the TDL– group (P<0.05). The alanine transaminase (P=0.027) and aspartate transaminase (P=0.007) levels on the fourth postoperative day in the TDL+ group were higher than those in the TDL– group. More pulmonary complications (P=0.014) and anastomotic leaks (P=0.047) were found in the TDL+ group.ConclusionGiven that TDL may aggravate metabolic disorders, increase anastomotic leaks and the pulmonary complications, it is cautious to perform TDL, and prophylactic TDL should not be performed routinely for patients with T2DM.
ObjectiveTo investigate the risk factors for lymph node metastasis (LNM) and prognosis of T1-stage esophageal squamous carcinoma (ESC).MethodsClinical data of 387 patients with T1-stage ESC who underwent surgical treatment in our hospital from March 2013 to March 2018 were collected. There were 281 males and 106 females aged 60 (41-80) years. The patients were divided into a lymph node metastasis group (n=77) and a non-metastasis group (n=310). The risk factors for LNM and prognosis were analyzed.ResultsAmong 387 patients with T1-stage ESC, 77 (19.9%) patients had LNM. The incidence of LNM was 8.4% (8/95) in T1a-stage patients and 23.6% (69/292) in T1b-stage patients. Univariate analysis showed that tumor size, differentiation degree, depth of invasion and vascular tumor thrombus were associated with LNM (P<0.05). Multivariate logistic regression analysis showed that invasion depth of tumor [OR=2.456, 95%CI (1.104, 5.463), P<0.05] and vascular tumor thrombus [OR=15.766, 95%CI (4.880, 50.938), P<0.05] were independent risk factors for LNM. The follow-up time was 41 (12, 66) months. The 1-year, 3-year and 5-year survival rates were 98.71%, 89.67% and 86.82%, respectively. Univariate analysis showed statistically significant differences in tumor invasion depth, vascular tumor thrombus and LNM between the survival group and the death group. Cox analysis showed that LNM [OR=3.794, 95%CI (2.109, 6.824), P<0.05] was an independent risk factor for prognosis.ConclusionT1-stage ESC patients with deeper invasion or vascular tumor thrombus have a higher risk of LNM. The prognosis of T1-stage ESC with LNM is relatively poor.