Objective To study the clinicopathologic features which influence the prognosis of patients with stage Ib nonsmall cell lung cancer (NSCLC) after operation, and discuss the indication of postoperative chemotherapy. Methods From January 2002 to December 2002, the clinical materials of 152 patients who underwent complete pulmonary lobectomy and were confirmed to have stage Ib NSCLC by postoperative histopathological examination were collected from Shanghai Chest Hospital. There were 82 male and 70 female cases aged from 33-80 years. The mean age was 63.0 years. KaplanMeier method was used to compare and analyze the age, gender, tumor diameter, tumor location, lymphatic or vascular carcinoma embolus, differentiation, pleural invasion and chemotherapy of patients. Cox regression model was used to do prognostic multivariate analysis to above factors. Results The 5year survival rate was 71.1%. The median survival time was 44.20 months. The results of single factor analysis showed that the tumor diameter was longer than 5 cm（χ2=4.020，P=0.042）, lymphatic or vascular carcinoma embolus existed（χ2=14670，P=0.001）, poorly differentiated tumor（χ2=8.395，P=0.004）, and those whose tumors were located on middlelower lobars had a poor prognosis（χ2=3.980，P=0.045）. The age(χ2=0.478，P=0.740), gender(χ2=0.571，P=0.450), pathological type(χ2=0.406，P=0.816), pleural invasion(χ2=0.022，P=0.882) and postoperative chemotherapy of patients (χ2=1.067，P=0.302)had no relationship with postoperative survival. The results of multivariate analysis showed that lymphatic or vascular carcinoma embolus（P=0.006，95%CI:1.491,10.524） and poorly differentiated tumor（P= 0.001,95%CI:0.116,0.578） were the main factors which influenced the survival rate of patients. Conclusion The tumor differentiation and lymphatic or vessel carcinoma embolus of patients with stage Ib NSCLC are important factors which influence prognosis and survival rate. The poorly differentiated tumor and lymphatic or vessel carcinoma embolus could be regarded as one of the indications of postoperative chemotherapy.
Objective To present a method for quantifying the anastomosis between two vessels based on angiograpy and provide a theoretical basis for vascular study in skin flap. Methods Ten bilateral skin flaps of 20 cm×20 cmbased on deep iliac circumflex vessels were elevated fromthe abdominal wall including musculus rectus abdominis and deep superior epigastric vessels in 5 minipigs which were 100-115 cm in length and 25-35 kg in weight. One side was inserted an expander under the panniculus carnosus and was expanded regularly with 30-40 ml isotonic Na chloride injection (expanded group) and the other was unexpanded group which were without any treatment. A X-ray image of the flap vessles was obtained after a gelatinlead oxide mixture was carotid arterially injected and 24 hours of cryopreservation of the body. Three parallel lines with equal interval perpendicular to long axis of the two vessels were designed at the communication area. Vessel anastomosis quantifying was determined by counting the number of marks derived from the intersections of the lines and the vessels and statistical analysis was carried out. Results The mark of intersectionin expanded group (81.20±10.33) was more than that in unexpanded group (22.40±5.41), showing significant difference(Plt;0.01). Conclusion The method for quantifying vessel anastomosis in skin flap is simple, reliable, and easytoperform. The principles of this procedure may also be applied to other experimental and clinical studies.
OBJECTIVE: To study the clinical result of treating firearm-wound with the vessel pedicel tissue flap. METHODS: From May 1992 to October 2000, 21 cases of firearm-wound of upper limbs underwent transplantation with the vessel pedicel tissue flap. Of them, the locations of the wound were upper arm in 11 cases, forearm in 7 cases, hand in 3 cases. The size of wound was 1.0 cm x 0.5 cm to 8.0 cm x 6.5 cm; the wound course was 3 minutes to 8 hours with an average of 3 hours and 30 minutes. The patients were followed up 3 months to 2 years. RESULTS: In 21 cases, the results were excellent in 19 cases and poor in 2 cases. The good rate was 90.5%. CONCLUSION: Treatment of firearm-wound with vessel pedicel tissue flap has the good effect.
OBJECTIVE: To study the anatomical basis for reconstruction of vertebral artery with neighboring non-trunk arteries. METHODS: Twenty preserved adult cadavers were used in this study to observe the morphology of superior thyroid artery, inferior thyroid artery, transverse cervical artery, thyrocervical trunk and extracerebral portion of vertebral artery, and reconstruction of vertebral artery with these arteries was simulated in two preserved cadavers. RESULTS: The calibers of superior or inferior thyroid artery, or transverse cervical artery were more than 2 mm in diameter, and the arteries had suitable free length for end-to-side anastomosis with vertebral artery. Thyrocervical artery had similar caliber to vertebral artery so that end-to-end anastomosis could be carried out between them, but only 38.5% of this artery had adequate artery trunk (more than 10 mm). It was proved from the simulated procedures that the reconstruction of vertebral artery with these neighboring non-trunk arteries was possible. CONCLUSION: Reconstruction of vertebral artery with neighboring non-trunk arteries has anatomical basis and can be used clinically for treatment of the lesion affecting the first or second portion of vertebral artery.
OBJECTIVE: To explore the feasibility of reconstructing tissue engineered vessel in vitro. METHODS: Bovine endothelial cells were isolated from calf thoracic aorta by enzyme digestion methods and subcultured and purified. The endothelial cells of the 3rd to 7th passages were seeded into the inner surface of tubular scaffold material by polyglycolic acid(PGA) coated with cross-linked collagen, and cultured in vitro for 10 days using dynamic rotation culture technique. Scanning electron microscopy was used to analyse the morphological characteristics, and prostacyclin released by endothelial cells was measured by radioimmunoassay of 6-keto-prostaglandin F1 alpha. RESULTS: The VIII factor staining of cultured endothelial cells was positive. The endothelial cells adhered well on the inner surface of tubular scaffold material with confluent monolayer covering(91.2 +/- 1.5)%. The endothelialized model released prostacyclin at a rate of (4.6 +/- 0.5) micrograms/cm2.min. There was significant difference to control group (P lt; 0.05). CONCLUSION: The PGA coating with collagen is an ideal scaffold for endothelial cells, the coverage rate is increased through dynamic rotation culture technique. It will lay a good foundation for architecture of a laminated structure of tissue engineered vessel.
OBJECTIVE: To sum up the experimental development and clinical application of prefabricated flap. METHODS: The reported experimental results and clinical application of prefabricated flap extensively reviewed. RESULTS: Previous studies had proved that the revascularization of prefabricated flap mainly through anastomoses of implanted vessels and the original vessels of the flap, the implanted vessels slowly formed a new and complete blood vessel network, which could dominate the whole flap, three to four weeks later, the new vessels were mature and the flap could be transferred. Clinically, the superficial temporal vessels, gastroepiploic vessels, circumflex femoral vessels and thoracodorsalis vessels could be harvested for prefabricated flap with satisfactory results. CONCLUSION: Prefabricated flap provides a new method for the treatment of complicated defects.
OBJECTIVE: To sum up the experience of clinical application of distal base sural island flap. METHODS: From January 1997 to April 1999, the posterior island flap of leg pedicled with sural nerve and its nutrient vessels was applied to repair heel or dorsum of foot in 6 cases, chronic ulcer of heel in 2 cases, chronic osteomyelitis in 2 cases, scar contracture of bone defect accompanying fistulation in 1 case. The range of flap was 5 cm x 8 cm to 8 cm x 12 cm. RESULTS: All the flaps survived completely without vascular crisis. All the wounds healed by first intention. Followed up 3 to 12 months, no ulcer, osteomyelitis, fistulation were recurrence, and the sensation of flap was recovered slightly. CONCLUSION: The flap do not damage critical blood vessels and nerves, the donating region is hidden. The manual of operation is simple and blood supply of flap is sufficient. It can repair the defect of soft tissue on heel and dorsum with high survival rate.
In the study of repair of massive bone defect with free vascularized fibula graft, 13 cases were reported, in which traumatic defect in 7 cases, segmental resection of bone from tumors in 5 cases and osteomylitis in 1 cases. They all were treated successfully with vascularized fibular graft. After a follow-up of 6 months to 7 year, bone healing was observed with satisfactory and rehabilitation of functions. In one case, fatigued fracture occured twice due to early walking. It was concluded that free vascularized fibular graft was very helpful in the repair of massive bone defect, but prolonged external fixation after operation might be important to prevent fractur of grafted bone.
To investigate the feasibility of using the pedicled patella for repaire of the superior articular surface of the medial tibial condyle, 37 lower limbs were studied by perfusion. In this series, there were 34 obsolete specimens and 3 fresh specimens of lower legs. Firstly, the vessels which supply to patella were observed by the methods of anatomy, section and casting mould. Then, the form and area of the patellar and tibial medial conylar articular surface were measured in 30 cases. The results showed: (1) the arteries supplied to patella formed a prepatellar arterial ring around patella, and the ring gave branches to patella; (2) medial inferior genicular artery and inferior patellar branches of the descending genicular arterial articular branch merge and acceed++ to prepatellar ring at inferior medial part of patella; (3) the articular surface of patella is similar to the superior articular surface of the tibial medial condyle on shape and area. It was concluded that the pedicled patella can be transposed to medial tibial condyle for repaire of the defect of the superior articular surface. The function of the knee can be reserved by this method.
Abstract In order to have more selective sources of skin flaps to repair soft tissue defects, the prefabricated flap combining with skin expander was tried. Implanted the dorsal thoracic artery and vein with a muscle bundle of latissimus dorsi into the lateral thoracic wall subdermally andset a skin expander subcutaneously. Injected saline into the expander to inflate the flap gradually. In a month, an axial flap with the dorsal thoracic vesselswas prepared. the flap was transferred to the defect by vascular anastomosis technique. This method was applied in two cases, one to the left ankle, another to the left side of the neck. The sizes of the two flaps were 20cm×14cmand 22cm×15cm respectively. After operation, the flaps were alive completely. The advantages included selective source of vascular pedicle, thinpliable flap with enough blood supply, and direct closure of the donor site without skin graft.