ObjectiveTo systematically evaluate the effectiveness and safety of single-incision video-assisted thoracic surgery (VATS) versus conventional three-port VATS for primary spontaneous pneumothorax. MethodsWe searched databases including PubMed, EMbase, The Cochrane Library, CBM, CNKI and WanFang Data from inception to Dec. 2014, to collect randomized controlled trials (RCTs) and cohort studies comparing single-incision VATS and conventional three-port VATS for primary spontaneous pneumothorax. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, RevMan 5.3 software was used for meta-analysis. ResultsA total of 8 cohort studies involving 483 patients were finally included. The results of meta-analysis showed that:Compared with conventional three-port VATS, single-incision VATS had shorter operation time (MD=-3.90, 95%CI -7.22 to -0.58, P=0.02), less amount of intraoperative bleeding (MD=-9.34, 95%CI -15.26 to -3.42, P=0.002), shorter chest drainage time (MD=-0.66, 95%CI -1.02 to -0.29, P=0.000 4), lower VAS score of 24h-postoperative pain (MD=-0.90, 95%CI -1.14 to -0.66, P<0.000 01) and lower incidence of postoperative paresthesia (OR=0.15, 95% CI 0.07 to 0.31, P<0.000 01). Meanwhile, there were no statistical differences between both groups in hospital stay (MD=-0.30, 95%CI -0.63 to 0.03, P=0.08) and the recurrence of pneumothorax (OR=0.68, 95%CI 0.25 to 1.83, P=0.53). ConclusionCurrent evidence shows, single-incision VATS is superior to conventional three-port VATS in the treatment of spontaneous pneumothorax. However, due to limited quality and quantity of included studies, more large-scale, high-quality studies are needed to verify the above conclusion.
ObjectiveTo explore the expression of vascular endothelial growth factor receptor-2(VEGFR-2) protein in esophageal squamous cell carcinoma (ESCC) and to analyze the relationship between VEGFR-2 and prognostic of esophageal cancer in Uygur of Xinjiang. MethodsThe expression of VEGFR-2 protein including 72 patients with ESCC[with 56 males and 16 females at age of 57 (43-79) years] and paracarcinomatous tissues of 28 patients were detected by immunohistochemistry staining (SP) between January 2007 and september 2009 in this hospital. The Kaplan-Meier and Cox proportional hazards analysis were used to analyze the prognosis of ESCC. ResultsThe positive expression rate of VEGFR-2 protein in 72 patients with ESCC was 80.56% (58/72) and 0 in paracarcinomatous tissues. The expression of VEGFR-2 protein in the ESCC was much higher than that in paracarcinomatous tissues with a statistical difference (P<0.05). The expression of VEGFR-2 protein was significantly correlated with depth of invasion, lymph node metastasis, distant metastasis and TNM staging (P<0.05). Tumor size was no correlation with expression of VEGFR-2 protein (P>0.05). Kaplan-Meier survival analysis indicated that five-year survival rate in positive expression of VEGFR-2 was higher than that in the negative group. Lymph node metastasis, TNM staging, and the positive expression of VEGFR-2 protein were independent prognostic factors. ConclusionVEGFR-2 protein is expressed more in ESCC and might be used as the index to predict prognosis and metastasis of esophagedal carcinoma in Uygur.
ObjectiveTo investigate the long-term efficacy and the influencing factors of thymectomy for thymoma patients associated with myasthenia gravis. MethodsWe retrospectively analyzed the clinical and follow-up data of 126 thymoma patients associated with myasthenia gravis underwent extended thymectomy from June 2002 to December 2015 in our hospital. There were 26 males and 37 females at the mean age of 54.51±12.62 years. We built up survival analysis model to analyze the effect of those following factors on postoperative result:sex, the age when operated, the preoperative course of disease, the condition of associating with other diseases, history of critical illness, steroid administration time before operation, Osserman classification, Masaoka staging, WHO pathological type, surgical approach, tumor size and so on. Result The average follow-up time was 35(5-96) months. During follow-up period, 12 patients (19%) achieved complete remission, 39 patients (62%) achieved partial remission, 7 patients (11%) kept stable, 5 patients (8%) deteriorated and the total effective rate was 81%. The result of log-rank analysis showed that the preoperative course of disease (P=0.027), history of critical illness on myasthenia gravis (P=0.035) and Osserman classification (P=0.018) were related to incomplete remission, whlie the result of Cox regression analysis showed that the preoperative course of disease (P=0.001) and Osserman classification (P=0.012) were the independent risk factors for incomplete remission. ConclusionExtended thymectomy is an effective treatment for thymoma patients associated with myasthenia gravis, but the symptom of those patients whose preoperative course of disease are more than 12 months or Osserman classification is at ⅡB, Ⅲ and Ⅳ type of Osserman classification have poor effect after operation.
ObjectiveTo systematically review the efficacy and safety between intrathoracic anastomosis (IA) and cervical anastomosis (CA) after esophagectomy using gastric tube. MethodsWe electronically searched databases including PubMed, EMbase, The Cochrane Library (Issue 11, 2014), Web of Knowledge, CNKI, CBM, and WanFang Data for randomized controlled trials (RCTs) of IA vs. CA after esophagectomy using gastric tube from inception to Nov, 2014. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by RevMan 5.2 software. ResultsA total of 10 RCTs involving 1 138 patients were included, of which, 570 patients were in the IA group and the other 568 patients were in the CA group. The results of meta-analysis showed that the incidences of anastomotic leak (RR=2.72, 95%CI 1.67 to 4.45, P<0.05) and injury of recurrent laryngeal nerve (RR=5.64, 95%CI 2.41 to 13.18, P<0.05) in the IA group were significantly lower than those in the CA group, but the IA group had a higher rate of positive margins (RR=0.25, 95%CI 0.09 to 0.67, P<0.05). There were no significant differences between two groups in postoperative anastomotic stricture (RR=1.12, 95%CI 0.73 to 1.74), pulmonary complications (RR=1.10, 95%CI 0.60 to 2.01), operation mortality (RR=1.03, 95%CI 0.55 to 1.94), tumor recurrence (RR=1.57, 95%CI 0.72 to 3.44) and chylothorax (RR=0.76, 95%CI 0.24 to 2.36). ConclusionIA after esophagectomy using gastric tube has lower rates of anastomotic leak and injury of recurrent laryngeal nerve than CA but with a higher rate of positive margins. There are no significant differences between the two surgical operations in operation mortality, postoperative anastomotic stricture and pulmonary complications. IA could reduce the incidence of postoperative complications and is an effective and safe surgical operation for digestive tract reconstruction after esophagectomy. Due to limited quality and quantity of included studies, more high quality studies are needed to verify the conclusion for long-term efficacy and the quality of life.
ObjectiveTo explore the risk factors of myasthenic crisis after thymectomy (MCAT) for patients with myasthenia gravis (MG). MethodsWe searched PubMed, EMbase, The Cochrane Library (Issue 8, 2015), Web of Knowledge, CBM, CNKI and WanFang Data from inception to August 31, 2015, to collect case-control studies and retrospective cohort studies about the MCAT for patients with MG. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed using Stata 13.0 software. ResultsA total of 17 studies involving 394 patients with myasthenic crisis and 1642 controls were included. Of the 17 studies, 11 were retrospective cohort studies and 6 were case-control studies. The results of meta-analysis showed that:a) univariate analysis indicated that history of myasthenic crisis (OR=8.05, 95%CI 5.80 to 11.15, P<0.01), bulbar symptoms (OR=5.10, 95%CI 3.01 to 8.67, P<0.01), preoperative severity of gravis (Osserman-stage) (OR=10.55, 95%CI 7.28 to 15.30, P<0.01), postoperative pulmonary infection (OR=10.77, 95%CI 3.88 to 29.95, P<0.01), thymoma (OR=2.37, 95%CI 1.50 to 3.75, P<0.01), dose of pyridostigmine (MD=0.45, 95%CI 0.29 to 0.62, P<0.01), AChRAb level >100 nmol/L (OR=12.14, 95%CI 4.80 to 30.73, P<0.01) and operation time (MD=0.57, 95%CI 0.26 to 0.88, P<0.01) were the risk factors of MCAT; b) multivariate analysis showed that, history of myasthenic crisis (OR=5.06, 95%CI 2.30 to 11.14, P<0.01), bulbar symptoms (OR=5.21, 95%CI 2.62 to 10.35, P<0.01), preoperative severity of gravis (Osserman-stage) (OR=5.82, 95%CI 2.60 to 13.04, P<0.01) and AChRAb level >100 nmol/L (OR=8.38, 95%CI 3.31 to 23.08, P<0.01) were the independent risk factors of MCAT. ConclusionThe independent risk factors of MCAT for patients with MG are history of myasthenic crisis, bulbar symptoms, preoperative severity of gravis (Osserman-stage) and AChRAb level >100 nmol/L.
The high incidence of hydatid disease in seven northwestern provinces, is one of the reason of "Poverty due to illness, and return poverty due to illness" in China. The incidence of chest hydatid disease in China after hepatic hydatid disease ranks second. Department of thoracic surgery in the First Affiliated Hospital of Xinjiang Medical University is on the domestic leading position of the treatment of chest hydatid disease. Since 1956 the first case of pulmonary hydatid cyst were completed, we have successfully finished the surgical treatment of pediatric chest hydatid disease, chest hydatid disease complex, huge pulmonary hydatid cyst, mediastinal and pleural hydatid cyst, and rib hydatid in our department. To further standardize the treatment of chest hydatid disease, a special formulation of "technical specification for chest hydatid disease diagnosis expert consensus" by our department were produced, in order to help clinicians treat chest hydatid disease by more suitable strategies. This consensus was released in July 2015, for the original version. The definition, diagnosis, treatment principle, and prevention of chest hydatid disease were elaborated and clinical experiences of 60 years were combined with in this consensus, in order to help the clinicians for diagnosis, treatment, and prevention of hydatid disease.