ObjectiveTo discuss the method, technical main points and initial efficacy of minimally invasive correction of pectus carinatum. MethodsFive patients underwent minimal invasive operation for pectus carinatum. The pectus carinatum was corrected by a curved Nuss steel bar applying pressure to the anterior chest. The steel bar was placed subcutaneously anterior to the protruding sternum and locked to the ribs through two plates. ResultsFive patients received operations successfully without complications. Operation time was ( 102.6 ± 23.8) min, blood loss was( 14.0 ± 9.7) ml,postoperative hospital stay was(6.6 ± 1.6) d. Postoperative follow-up was 4-12 months, no steel bar movement was found.ConclusionThe minimally invasivecorrection of pectus carinatum seems to be a simple,safe and effective technique with minimal complications.

Objective To investigate the clinical characteristics,surgical strategy,pathological features and prognosis of pulmonary pleomorphic carcinoma.Methods The clinicopathological data of 23 patients with pulmonary pleomorphic carcinoma who underwent surgical resection from January 201 0 to March 201 4 in Tongji Hospital were collected.Results There were 1 6 male patients and 7 female pa-tients,with the male /female ratio of 2.3∶1 .The mean age of was 54(35 ~75)years old.A total of 1 7 pa-tients were heavy smokers and the mean smoking index was 688(400 -1 200).The initial main symptoms were cough,blood in phlegm and hemoptysis.It was difficult for fiberoptic bronchoscopy to confirm the di-agnosis.All patients underwent surgical resection,including 22 cases of radical resection and one case of biopsy.Microscopically,neoplastic epithelial cells and pleomorphic components were found in pulmonary pleomorphic carcinoma in 1 9 cases,and pleomorphic components only in the other 4 cases.Positive CK ex-pression in pleomorphic components was observed.The longest survival time was 1 8 months and the pa-tient was still alive.The median survival time was 1 2 months.Conclusion Pulmonary pleomorphic carci-noma usually occurs in middle-aged and elderly male smokers.Immunohistochemistry staining contribute to the diagnosis.The main treatment is surgery and the prognosis is poor.

Objective To investigate the expression of miR-200b in lung cancer and its relationship with clinicopathological features of lung cancer.Methods The specimens of lung tumor tissue and adjacent normal lung tissue of 36 cases of lung cancer who received surgical treatment in our department were collected,and then quantitative real time PCR (qRT-PCR) was applied to determine the expression of miR-200b in lung cancer tissue and adjacent normal lung tissue.Results The expression of miR-200b in lung cancer was significantly lower than adjacent normal lung tissue (P =0.000),and in small cell lung cancer was also significantly lower than adenocarcinoma and squamous cell carcinoma (0.13 ± 0.09 vs.0.64 ± 0.33,0.75 ± 0.30) (P =0.005 and P =0.001).The expression of miR-200b in patients with positive lymph nodes,advanced stage of lung cancer and in smokers were significantly lower than those with negative lymph nodes,early stage of lung cancer and in non-smokers,respectively (0.52 ± 0.29 vs.0.87 ± 0.35,0.46 ±0.25 vs.0.90 ±0.32,0.52 ±0.27 vs.0.90 ±0.39) (P =0.004,P =0.000 and P =0.015).Conclusions Low expression of miR-200b may participate in the occurrence and progression of lung cancer,especially in small cell lung cancer,and correlates with the metastasis of lung cancer.The down-regulated expression of miR-200b may be induced by smoking.Thus,miR-200b perhaps is a new target for the treatment of lung cancer.

Objective To compare the changes of blood coagulation system and the clinical interventional effect of low molecular weight heparin (LMWH) in elderly patients who had received thoracic surgery. Methods Ninety-six thoracic surgery patients (age≥70 years) were divided into control group ( 54 cases ) and experimental group ( 42 cases ) ( postoperative 1-7 days, subcutaneous injection with LMWH ) from September 2007 to December 2009 by random digits table. Observed perioperative changes in prothrombin time (PT),activated partial thromboplastin time (APTT),platelet (Plt),D-dimer (D-D),fibrinogen (Fib), anti- X a activity, and clinical performances. Also observed the influence of diabetes mellitus of surgery coagulation function. Results The preoperative indexes of coagulation function were no significant (P ＞ 0.05 ). In control group PT prolonged, Fib and D-D increased, the differences between preoperative and postoperative each time were significant (P ＜ 0.05 ). Fib and D-D in control group increased than those in experimental group postoperative each time (P ＜ 0.05 ). In experimental group anti- X a activity increased postoperative each time (P ＜ 0.05 ),compared with control group was also significant (P ＜ 0.05 ). Diabetes mellitus had no significant influence on coagulation function. One patient appeared pulmonary thromboembolism in control group,and no one appeared venous thromboembelism and bleeding adverse reactions in experimental group. Conclusion Thoracic surgery in elderly patients have high blood coagulation state, prone to venous thromboembolism, LMWH given early postoperative prophylactic treatment is beneficial to improve the hypercoagulable state and have better security.

Objective To investigate the results of non dissecting thoracic duct ligation cutting in treatment of recurrent chylothorax.Methods 22 patients suffered from recurrent chylothorax after original thoracic duct ligation surgery were enrolled and their clinical characteristics were collected,including previous thoracic surgical procedure, previous surgical approach,recurrent chylothorax side and postoperative complications.The probable causes of chylothorax recurrence were analyzed and targeted improvements were made,based on the traditional mass ligation procedure of the thoracic duct.Through the previous approach,non dissecting thoracic duct ligation combined with transection of the posterior mediastinal tissue,except esophagus and thoracic aorta,was applied during the reoperation for the recurrent chylothorax.Results All the patients were recovery form chylothorax after reoperations.There were no severe postoperative complications except one patient suffered from respiratory failure.All the patients discharged evenly without chylothorax recurrence during one-year follow-up period.Conclusion Recurrent chylothorax could be successfully and safely treated by non-anatomical mass ligation combined with transection of the thoracic duct,for the anatomical foundation of chylothorax recurrence had been eliminated.

Objective The difficulty of full thoracoscopic Ivor-Lewis is the lack of a safe and low cost anastomosis.By improving the surgical process,to explore the application of circular stapler in the intrathoracic esophagogastric anastomosis.The thoracoscopic operation mode of esophageal cancer changes from simply following the McKoewn procedure to Ivor-Lewis and McKoewn procedure.Methods Retrospective analysis 123 cases of implementation thoracoscopic esophageal cancer from July 2009 to February 2013,which including the cases of intrathoracic anastomosis and cervical anastomosis.Divided it into two groups:intrathoracic anastomosis groups,which including thoracoscopic esophagectomy resection,gastroesophageal anastomosis and anastomotic pedicled omentum embedding,the cervical anastomosis groups,which including thoracoscopic esophageal free and gastroesophageal neck anastomosis.To comparing the incidence of ARDS,postoperative hoarseness,anastomotic complications (Anastomotic leakage and anastomotic strictures within two months after surgery),guardianship time of ICU and postoperative hospital stay between the two groups.Results All the patients were no deaths.The cervical anastomosis group operative time was significantly lower than the intrathoracic anastomosis group.The incidence of anastomotic fistula and anastomotic stricture of intrathoracic anastomosis group was significantly lower than that of the cervical anastomosis group,total hospitalization time of the intrathoracic anastomosis group were significantly lower than that of the cervical anastomosis group,there is no significant differences in postoperative hoarseness and ARDS incidence between the two groups.Conclusion For the lower esophageal carcinoma,it is technically mature and safe to apply the circular stapler for Ivor-Lewis surgery and sleeve omentumembedding anastomotic technique in full thoracoscopic,and the technology should be widely applied; for the upper esophagealcarcinoma,McKoewn procedure should be applied.

Objective To discuss the feasibility,safety,technical points and clinical effects of completely thoracoscopic resection of benign neurogenic tumors on apical chest.Methods From January 2004 to June 2009,11 patients underwent surgical resection of benign neurogenic tumours on apical chest.A complete thoracoscopy was used in 5 cases,and the remaining 6 cases received traditional open thoracotomy.By analysis on the clinical symptoms,tumor types,complications,operative time,blood loss and drainage time after operation,the advantages and disadvantages of complete thoracoscopy were compared to traditional open thoracotomy for resection of benign neurogenic tumors on apical chest.Results There was one patient in each group that suffered from light transient Horner's syndrome,who recovered spontaneously.The group of complete thoracoscopy was superior to the group of traditional open thoracotomy in operative time,blood loss during the operation,drainage time and postoperative hospital stay.Conclusion For benign neurogenic tumors on apical chest,a resection with complete thoracoscopy is as safe and effective as the traditional open thoracotomy,and the former is characterized by less operative trauma and quicker recovery.

Objective To discuss the technical points and clinical effects of thoracic reconstruction after resection of the sternal tumnors with autogenous rib graft and pedicle oinental flap. Method A retrospective study was made on 12 patients,who underwent resection of sternal tumors and thoracic reconstruction with autogenous rib graft and pedicle omental flap between January 2004 and March 2010. The tumor involved the manubrium in 4 patients and the sternal body in 8 patients. Results All operations of 12 patients were succeed with no perioperative mortality or severe complications. Incisions healed by primary intention healing,and no paradoxical breathing was found. The postoperative period was uneventful.Conclusion It's an effective way to treat sternal tumors by the resection and thoracic reconstruction with autogenous rib graft and pedicle omental flap.

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