We present a minimal invasive technique for the treatment of broncho-pleural fistula (BPF) after pulmonary lobectomy with lung cancer. 2 cases of BPF were found at the 4th and 7th day after pulmonary lobectomy respectively. They were reoperated on by VATS, direct resuture of stump and consolidation with acrylic or fibrin glue. Both cases were cured. Authors consider mentioned procedure might be a feasible therapeutic approach for early broncho-pleural fistula.

Objective To study the clinical application of video-assisted thoracoscopic surgery (VATS). Methods Clinical records of 78 cases of VATS from July 1998 to December 2002 were retrospectively analyzed. There were 40 cases of bullectomy for spontaneous pneumothorax, 12 cases of surgical exploration for chest trauma, 9 cases of wedge resection for solitary pulmonary nodules, 6 cases of pleural biopsy combined with pleurodesis, 4 cases of resection for mediastinal tumor, 4 cases of pulmonary lobectomy, 2 cases of broncho-pleural fistula following lobectomy and 1 case of resection for esophageal leiomyoma. Results A conversion to open surgery was required in no cases, but a supplementary mini incision was needed in 5 cases because of the adhesion of pleural cupula. The intrathoracic drain was all removed within 48 postoperative hours with exception of 3 middle-old aged patients with spontaneous pneumothorax in whom the continuous air leakage was observed and the drain was removed on 7, 8 and 13 postoperative days, respectively. The delayed healing of drain site was seen in 5 cases. The incidence of operative complications was 10 3% (8/78). Conclusions Broad prospects exists in the clinical application of VATS, but the costs of the disposable is subject to reduce. The application of suture or knotting under thoracoscope may save medical costs.

Objective To analyze and evaluate the effect of posterior circumferential fusion for treatment of the mechanical instability of lumbar spine, and discuss the relative merits,indications and contraindications in this procedure. Methods Two hundred and two patients with mechanical instability of lumbar spine treated by the posterior instrumented circumferential fusion technique from January 2001 to January 2007. One hundred and thirty-two patients were selected who were treated with only one segment fusion and followed up for at least 1 year, of them 97 patients suffered lumbar spondylolisthesis, 35 patients suffered degenerative lumbar instability. X-ray was used to evaluate the fusion condition of the bone graft, and VAS and ODI questionnaire were applied to assess the pain of back and leg,and the conventional function. Results All patients were followed up for 12-84 months, averaged (43±23) months,125 patients got bone fusion, accounted for 94.7%(125/132). The VAS of low back pain was (6.71 ± 1.31) points before operation, while (3.20 ± 1.14) points after operation (P < 0.05) ,and the VAS of leg pain was (8.33 ± 1.78) points before operation,while (4.31 ± 1.15) points after operation (P< 0.05). The ODI was (68.6 ± 14.7) % before operation, while (13.6 ± 1.5) % after operation (P < 0.05). Conclusions Posterior circumferential fusion is a positive and excellent treatment for the mechanical instability of lumbar spine. With its merits, the high fusion rate and good clinical results can be received.

Objective To explore the relationship between the apoptosis of esophageal carcinoma tissue and its adjacent tissues with the survival time of patients with esophageal carcinoma by examining the apoptosis in esophageal carcinoma tissue and its adjacent tissues.Methods FCM Wag performed to detect the rates of apoptosis in 68 cases of esophageal carcinoma and their adjacent tissues and 28 cases of normal esophageal mucosae tissue.Sixty-three patients with esophageal carcinoma had been followed up and noted the survival time of every patient from the operated day to the deadline.Results The rate of apoptosis was the highest in the normal esophageal mucosae tissue(12.78±1.32)%,(7.79±1.48)% in adjacent tissue,and(4.16±2.06)% in esophageal carcinoma tissue,respectively.To follow the survival time after operation of 63 cases with esophageal carcinoma showed 60 cases in one year survival time and 35 cases in three years survival time.The rate of apoptosis in the esophageal carcinoma and its adjacent tissues wag(3.45±1.51)% and (3.96±0.94)% in the patients of one year survival time,(3.90±2.53)% and (7.89±2.27)% in the patients of three years survival time,respectively,P<0.05.Conclusions There is the phenomenon of apoptosis-escape in the esophageal carcinogenesis.There is close relationship between the apoptosis of esophageal carcinoma tissue and the survival time after operation.The apoptosis in the adjacent tissue is more important than that in the esophageal carcinoma tissue for evaluating the survival time after operation of patients with esophageal carcinoma.

Objective To study the expression of early growth response gene-1(Egr-1)in esophageal carcinoma tissue,and to explore the relationship between Egr-1 and the survival time of the patients with esophageal carcinoma.Methods RT-PCR was performed to detect the expression of Egr-1 mRNA in68 cases of esophageal carcinoma.The relationship between survival time and prognosis was analyzed.Results The expression of Egr-1 mRNA was the lowest(0.567±0.404),(0.945±0.336)and(1.201±0.347)in esophageal carcinoma tissue,para-cancerous tissue and normal esophageal mucosa tissue,respectively(F=12.709,P＜0.05,P＜0.00).21 cases showed the positive expression of Egr-1 mRNA of both the esophageal carcinoma tissue and the para-cancerous tissue.21 cases showed the positive expression of Egr-1 mRNA in a single esophageal carcinoma tissue or the para-cancerous tissue.26 cases showed the negative expression of Egr-1 mRNA both in the esophageal carcinoma tissue and the paracancerous tissue.The positive rate of Egr-1mRNA expression was 65.71%and 30.00%in the groups of the survival time for three years and the groups of the survival time for one year(P＜0.05).The survival rates in the two groups with positive expression of Egr-1 mRNA were 94.44%and 86.96%,respectively(P＞0.05).Conclusion Decreased level of EGR1 expression may be related to esophageal carcinogenesis.The expression level of Egr-1 mRNA might be associated with the survival time of the patients with esophageal carcinoma.Egr-1 expression in esophageal carcinoma tissue may be of great value for determining prognosis of esophageal carcinoma.

Objective To explore the clinical efficacy of marginal liver from elderly donors in liver transplantation. Methods According to the inclusion and exclusion criteria, the clinical data of 127 donors and recipients were retrospectively analyzed. According to the age of donors, 127 donors were divided into the elderly group (n=27) and control group (n=100). The recovery of liver function, the occurrence of postoperative complications and survival rate of the recipients after transplantation were statistically analyzed between two groups. Results The incidence of primary nonfunction (PNF) and initial poor graft function (IPGF) did not significantly differ between the elderly and control groups (both P > 0.05). Within postoperative 2 weeks, the average levels of alanine aminotransferase (ALT) and serum total bilirubin (TB) of liver transplant recipients in the elderly group was not significantly different from those in the control group (both P > 0.05). There was no significant difference in the incidence of postoperative complications in the postoperative elderly group compared with the control group (all P > 0.05). The 1-and 3-year survival rates of the recipients in the elderly group were 84% and 78% respectively, which did not significantly differ from 89% and 79% in the control group (both P > 0.05). Conclusions Strict and sufficient quality evaluation and functional maintenance should be done for elderly donor livers. It can achieve good transplantation results by intraoperative fine operation, reducing bleeding and trauma, shortening the time of cold ischemia and operation, strengthening postoperative monitoring and implementing enhanced recovery after surgery.