Objective To confirm the difference between internal and external pressure of cervical esophageal and to discuss the relations between cervical esophageal pressure difference with the formation of cervical anastomotic leakage. Methods In the present study, 12 New Zealand white rabbits were used. We applied a pressure transducer to describe the variation of pressure of intrathoracic, thoracic esophagus, cervical esophagus and upper esophageal sphincter during resting and cough. Pressure value was recorded and read through MD3000 system. And the difference between each point was analyzed. Results The pressures resulting from the cough induced were significantly higher in intrathoracic than in thoracical esophagous (10.2±0.6 cm H2O vs. 36.7±1.0 cm H2O), exhibited significantly higher in upper esophageal sphincter and thoracic esophagous than in cervical esophageal (7.5±0.2 cm H2O vs. 12.0±0.4 cm H2O, vs. 10.2±0.6 cm H2O). Conclusion Cervical anastomotic leaks are affected by many factors.And the most notabe one is the constant pressure from inside-out around cervical anastomotic.
ObjectiveTo evaluate the prognosis of benign esophageal perforation by Pittsburgh scoring system (perforation severity scores, PSS) combined with co-disease index (Charlson comorbidity index, CCI).MethodsThirty patients with benign esophageal perforation from August 2016 to August 2018 in our hospital diagnosed by imaging or endoscopy were selected, including 14 males and 16 females, aged 68.660±10.072 years. After treatment, we retrospectively analyzed whether there was any complication in the course of treatment, the healing of esophageal perforation at discharge and the follow-up after discharge. And the patients were divided into a stable group (20 patients with no complication, clear healing of esophageal perforation at discharge or death during follow-up) and an unstable condition group (10 patients with complications, esophageal perforation at discharge or death during follow-up). Complete clinical data of all the patients were obtained and were able to be calculated by the scores of PSS and CCI scoring system. The difference of PSS and CCI scores between the two groups was compared, and the clinical value of PSS combined with CCI score in the prognosis of benign esophageal perforation was analyzed.ResultsIn the stable group, the PSS was 2.750±1.372 (95%CI 2.110 to 3.390), CCI score was 2.080±1.055 (95%CI 1.650 to 2.500) with a statistical difference between the two systems (P=0.000). In the unstable group, PSS was 7.300 ±1.829 (95%CI 7.300 to 8.120), CCI was 4.640±1.287 (95%CI 4.220 to 5.060) with a statistical difference between the two systems (P<0.05). The area under the receiver operating characteristic curve of PSS and CCI scores in the prognostic evaluation of benign esophageal perforation was 0.982 and 0.870 respectively, which was statistically significant (P<0.05).ConclusionEsophageal perforation is a dangerous condition. It is of great practical value to evaluate the condition of esophageal perforation by PSS and CCI scores.
ObjectiveTo investigate the safety and feasibility of thoracoscopic surgery of anterior mediastinal tumors via subxiphoid approach under scissors position (SASP) and lateral thoracic approach under lateral position (LALP).MethodsClinical data of 69 patients who received anterior mediastinal tumor excision surgery in our hospital from June 2016 to November 2019 were retrospectively analyzed, including 32 males and 37 females with an average age of 46.38±11.52 years. The clinical effects of the two groups were compared.ResultsThere was no perioperative death or conversion to thoracotomy. There was no statistically significant difference between the two groups in the operative time (123.34±12.64 min vs. 125.05±17.02 min, P=0.642), intraoperative blood loss [50.00 (73.75) mL vs. 50.00 (80.00) mL, P=0.643], tumor diameter (2.75±0.57 cm vs. 2.89±0.45 cm, P=0.787) and total hospital expenses [32.70 (5.30) thousand yuan vs. 32.90 (4.80) thousand yuan, P=0.923]. However, the postoperative catheterization time [2.00 (1.00) d vs. 4.00 (1.50) d, P=0.000], postoperative drainage [260.00 (200.00) mL vs. 400.00 (225.00) mL, P=0.031], postoperative pain index [2.00 (1.00) points vs. 4.00 (2.00) points, P=0.000], postoperative analgesic time [1.50 (1.00) d vs. 3.00 (2.00) d, P=0.000], postoperative fever time [1.50 (1.00) d vs. 2.00 (1.00) d, P=0.000] in the SASP group were better than those in the LALP group.ConclusionThoracoscopic surgery via SASP is more suitable for the treatment of anterior mediastinal tumor with rapid postoperative recovery and reduced pain, and the postoperative curative effect is definite. However, there is a high requirement for the surgical experience and techniques. It can be promoted in the clinic.
Objective To explore the feasibility of establishing a rabbit model of flail chest. Methods Flail chest model was eatablished in 12 New Zealand white rabbits after anesthesia and sterile surgery. The paradoxical movement of chest wall was recorded by the biological signal acquisition system, arterial blood was collected for blood gas analysis, the vital signs were recorded by electrocardiogram (ECG) and the lung tissue was taken for the pathological analysis at the end of the experiment. The effect of flail chest on the respiratory function of experimental animals was analyzed to evaluate the feasibility of establishing flail chest model. Results All surgeries were successful without mortality. The operation time was 41.42±7.08 min. Duration of endotracheal intubation was 79.33±12.21 min. Statistical results showed that the pH, partial pressure of arterial carbon dioxide (PaCO2) and base excess (BE) increased; while partial pressure of oxygen (PaO2) and oxygen saturation (SaO2) reduced. Pathological results showed that flail chest not intervented for a long period would lead to organic lesions. Conclusion The rabbit model of flail chest is feasible, safe, repeatable, easy and simple to handle. The animal is easy to access which is the foundation to study the disease process, recovery procedure and the efficacy after intervention.