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.
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.
ObjectiveTo evaluate the effectiveness of mitral valve repair for mitral regurgitation. MethodsWe retrospectively analyzed the clinical data of 47 patients underwent mitral repair in General Hospital of Ningxia Medical University between January 2010 and June 2014 year. There were 36 males and 11 females with age of 10 months to 65 years, mean age of 42.38±15.27 years. ResultsThere was no operative death within follow-up time of 18±7 months (ranged 14 to 1 586 days). Mitral valve function was normal or traces regurgitation in 33 patients (70.21%). Mild mitral regurgitation occurred in 11 patients (23.40%). Postoperative transesophageal echocardiography showed that 2 patients (4.26%) had moderate regurgitation. They underwent mitral valve repair again and cured. One patient (2.13%) underwent mitral valve replacement because of moderate to severe regurgitation. The dimensions of left atrium and left ventricle obviously decreased and heart function improved significantly compared with preoperative ones. ConclusionStrict control of surgical indications for different valve disease, the use of mitral valve repair technique, mitral surgery can get a good clinical efficacy. Preoperative diagnosis by transesophageal echocardiography, intraoperative monitoring, and immediate postoperative assessment for mitral valve repair results provide good technical support.
ObjectiveTo investigate the validity of diagnosis and treatment for lymphoepithelial-like carcinoma (LELC). MethodsWe retrospectively analyzed the clinical data of 8 LELC patients underwent surgical treatment between January 2008 and December 2014 in our hospital. There were 4 males and 4 females at an average age of 57 years ranging from 48 to 67 years. There were 4 patients underwent thoracoscopic lobectomy and another 4 patients underwent ordinary open-chest lobectomy. ResultsIn the patients underwent thoracoscopic lobectomy, the average operation time was 93.75 minutes and the average time of hospital stay was 4.5 days. In the patients underwent ordinary open-chest lobectomy group, the average operation time was 106.25 minutes and the average time of hospital stay was 5.25 days. All 8 patients discharged. One patient suffered from tumor matastasis in contralateral lung and another suffered from tumor matastasis in brain 1 year after operation. ConclusionThe result of surgical treatment for lung LELC is satisfatory. For the patients who are not suitable for surgical treatment, we should consider the comprehensive treatment.