ObjectiveTo summarize the clinical experience of thoracoscopic and laparoscopic esophagectomy for esophageal carcinoma. MethodWe retrospectively analyzed the clinical data of 38 patients with esophageal carcinoma undergoing thoracoscopic and laparoscopic esophagectomy in Central Hospital of Chongqing Three Gorges between March 2011 and March 2013. There were 25 males and 13 females aged 64.25±7.68 years (ranged 45-79 years). The esophagus was freed and the lymph nodes were cleaned under the thoracoscope in the left lateral position. Then the stomach was freed under laparoscope and lifted up to anastomose with the esophagus through the passageway behind the sternal bone. ResultsAll surgical process progressed successfully without intraoperative death or major hemorrhage. The total operating time ranged from 250 to 340 minutes. The intraoperative hemorrhage ranged from 80 to 350 ml. The number of lymph nodes cleaned ranged from 7 to 15 (10.24±2.04) and a total of 8 patients were found of tumor metastasis. Postoperative stage grading indicated 8 patients of T1N0M0, 16 patients of T2N0M0, 5 patients of T2N1M0, 6 patients of T3N0M0 and 3 patients of T3N1M0. Postoperative complications included chylothorax in 1 patient, pulmonary infection in 4 patients, and cervical anastomotic leakage in 4 patients. All 38 patients were followed up for 3 to 12 (6.31±2.18) months, and 1 patient was lost. Two patients died from cervical anastomotic leakage resulting in chest infection. The other all achieved recoveries without metastatic or recurrence of tumor. ConclusionThe intraoperative and postoperative complications of thoracoscopic and laparoscopic esophagectomy for esophageal carcinoma are less frequently than traditional surgery, so it's worthy of promotion in large regional general hospitals.
ObjectiveTo assess the value of multi-slice spiral CT (MSCT) in the diagnosis and resectability judgement of hepatic alveolar echinococcosis (HAE). MethodsThe CT findings of 28 patients who were confirmed HAE by surgical pathological examination were retrospectively analyzed. Comparative analysis were made between the CT findings and surgical pathology. ResultsAltogether 45 lesions in hepatic were detected. Lesions mainly revealed an infiltrating tumor-like hepatic mass with irregular margins and heterogeneous contents with varied attenuation, including scattered hyper-attenuating calcifications and hypo-attenuating areas corresponding to necrosis, no substantial enhancement, however, the fibro-inflammatory component surrounding the parasitic tissue was enhanced faintly in the delayed phase, and clearly demarcated from surrounding parenchyma. MSCT angiography (CTA) depicted signs of infiltration of hepatic vessels such as pushed, compression, displacement, stenosis, encasement and interruption. Compared with findings of operation, the sensitivity and specificity value of MSCT for evaluating the hepatic artery system disorders were 67%, 97%; and for portal venous system were 83%, 93%; and for hepatic venous system were 84%, 91%; while for inferior vena cava were 85%, 100%. Twelve cases which were evaluated as resectable by MSCT were in accordance with surgical findings. In the rest 16 patients which were judged as non-resectable by MSCT, only 2 patients were radical treatment through partial excision, repair and reconstruction for the involvement of large vessels and bile ducts. ConclusionMSCT is accuracy in the diagnosis and assessment of vessels complication of HAE. It has an important value to evaluate the resectability of HAE and the planning of treatment.