Objective To discuss the causes, prophylaxis, and treatment of the complications of mediastinoscopy. Methods Mediastinoscopy was performed in 262 consecutive patients from September 1981 to November 2005 in this hospital. Of them, 12 patients experienced preoperative or postoperative complications. Results During the operation, massive hemorrhage from branches of the innominate artery occurred in 1 patient. After the extension of cervical incision, the bleeding was stopped by pressure tamponade for 2 hours. Wound infection happened in 5 patients. One patient was clarified as having pulmonary tuberculosis, with enlargement and necrosis of mediastinal lymph nodes that led to the diabrosis of biopsy passage. The wound infection was cured by cut-open, drainage, and dressing changes. Wound infection in another 4 patients healed after dressing changes. Hoarseness of voice developed in 2 patients and spontaneously subsided at 1 and 3 postoperative months respectively. Two patients with abnormal electrocardiogram were treated with cedilanid. Pneumothorax was found in 2 patients and spontaneously healed at 4~6 days after operation. Conclusions Complications of mediastinoscopy can be avoided in experienced hands, on the basis of proficiency of mediastinal anatomy and careful surgical manipulation.

Purpose:To evaluate the effect of cisplatin-based peri-operation chemotherapy (CT) on survival after completed resection of non small cell lung cancer (NSCLC)Methods:A prospective, randomized, multicenter study was conducted by Shanghai Lung Cancer Team since Feb 1995 to Dec 2003 for stage Ⅰ~ⅢA NSCLC with completed resection. Patients were randomly assigned to receive pre-operative CT or no pre-operative CT (pre-op CT). Post-operative CT (post-op CT) were used for majority of the patients, except for partial stage I patients. Accumulated survival, log rank, MST, Cox uni-variance and multi-variance analyses, HR were used as statistics for evaluation Results:A total of 337 patients underwent randomization, 169 cases received pre-operative CT, and 168 cases didn't receive pre-operative CT. There was statistical survival difference between the group with no pre-op CT and with pre-op CT, 5-yr survival rate were of 47.85%∶ 36.52%, MST were 56.63∶39.14(P=0.03), respectively. Stage and post-op CT were the only two meaningful parameters with statistical survival difference calculated by multi-variance analyses (P0.05). There were 121 cases received more than 3 cycles post-op CT, 216 cases received less than 3 cycles post-op CT. The patients received more than 3 cycles had better yr-survival and MST than those received less cycles (P=0.04).Post-op CT was not benefit to the survival rate of stage I. In stage Ⅱ and ⅢA ,the patients received ≥3 cycles post-op CT had better yr-survival than those received less cycles(P

Objective To discuss the cause,prevention,treatment of airway anastomosis stenosis after lung transplantation.Methods From Jan.2003 to Sep.2005,8 homogeneity variant single lung transplantations were performed successfully at our hospital.All the cases were subjected to a running suture on the membranous wall and single stitches on the anterior cartilaginous part.Among the 11 cases,9 were still alive well. In 4 patients having aspergillus infection after operation,2 patients suffered from bronchial anastomosis stenosis.Results There were bronchial anastomosis stenosises in the 2 patients one month and 7 months after transplantation, respectively.All of them were cured by stenting.Conclusions Airway anastomosis stenosis was associated with bronchial ischemia,aspergillus infection,suture technique and so on.The stenting was positively effective for airway anastomosis stenosis.

Objective: To treat the senile severe emphysema by single lung transplantation. Methods: The candidate was a 63-year-old male patient who had suffered from severe dispnea for more than 23 years and experienced an advancing exacerbation during the last 3 years. He showed very poor lung function and other related clinical date the pre-operative clinical examination: FEV 1 was 0。64L (24%), PaO 2 was 45 mm?Hg, PaCO 2 was 36。3 mm?Hg, pulmonary artery pressure is 38 mm?Hg, 6MMT was 59 m and dispnea staging was 4. An allograft left lung transplantation was performed under general anesthesia in January 9th, 2003. Three immunosuppressors were given to the recipient orally after the operation. Results: 6 months after lung transplantation, the recipient showed a significant clinical relief and lung function improvement: FEV 1 is 1.20L (40%), PaO 2 is 92 mm?Hg and 6MMT is 227 m. Conclusion: The single lung transplantation is efficient in treating the end-staged emphysema.

Objective To discuss the prophylaxis, surveillance, and therapy on the aspergillus colonization and infection in lung transplant recipients. Methods From Jan 2003 to Sep 2004, single lung transplantation was performed in 6 patients. In 4 patients there was presence of positive aspergillus cultures from sputum after operation. Results Of these, two patients were symptomless, though treated by Itraconazole for two months. The third one has symptomatic bronchial stenosis, bronchomalacia and saprophytic colonization in the first postopearative month, which was proved by bronchoscopic biopsy and cured by stenting. The last one with invasive, disseminated pneumonia duo to aspergillus was cured after six weeks by itraconazole and aerosolized amphotericin B. Conclusion Antifungal prophylaxis with itraconazole and aerosolized amphotericin B prevent fungal infection during the early postoperative period of lung transplantation.

Objective To evaluate prognostic factors for early bronchopleural fistula after pneumonectomy with non small cell lung cancer,and establish a validated clinical model to estimate the risk of early-BPF.Methods We reviewed the medical records of 429 patients who underwent pneumonectomy for NSCLC at our institution.We used univariate and multivariate analysis to identify potential independent risk factors for early-BPF after pneumonectomy for NSCLC.A model to estimate risk of early-BPF was developed by combining independent risk factors.Results The rate of early-BPF after pneumonectomy for NSCLC was 6.5％ (28/429).Three factors were independently associated with early-BPF:neoadjuvant therapy (HR:2.406),bleeding (HR:2.171)and diabetes (HR:1.144).A scoring system for early-BPF was developed by assigning 2 points for each major risk factor (neoadjuvant therapy and bleeding) and 1 point for each minor risk factor(diabetes).Scores were grouped as low (0-1),intermediate (2-3),and high (3),yielding the rate of early-BPF was 14％,27％,and 43％,respectively.Conclusion This clinical model is established on the basis of independent risk factors.This model can be used as a predictive tool for early-BPF after pneumonectomy for NSCLC.

Objective:To investigate the immune depression to donor-origin cells induced by the Mixed Chimera after sublethal whole body irradiation.Methods:Recipients in the experiment were Wistar and SD rat,and Wistar rats were selected as the donor.Donor and recipient rats were divided randomly into three groups.Recipient were conditioned with sublethal whole body irradiation (WBI).Group A was infused with bone marrow cells (BMC) of Wistar rats;group B infused with bone marrow mesenchymal stem cells (BM-MSCs)of Wistar rats;and group C with normal saline.Then they were administered cytoxan(CTX) by intraperitoneal injection.The mechanisms for immune depression were explored by performing mixed lymphocyte reaction (MLR).Results:The results showed that donor lymphoid chimeras could be found in the immune depression SD rats and chimerac cells in group A was more than in group B by FCM assay (P

Objective Lungs from non-heart-beating donors for transplantation require protection against warm ischemic damage.This study investigated the preservative effect of Ventilation with cooled carbon monoxide during warm ischemia in non-heart-beating donor rat lungs.Method 18 rats were divided into a CO group (n =6),which received ventilation with low-dose carbon monoxide at normal temperature during a 4-hour warm ischemic period; a Control group (n =6),which received no ventilation at normal temperature; a cooling CO group (n =6),which received ventilation with cooled carbon monoxide.PaO2,Myeloperoxidase (MPO) activity,Bronchoalveolar lavage (BAL) neutrophil count and the wet-to-dry (W/D) lung weight ratio were recorded in every group.Quantitative real-time RT-PCR was used to analysis the expression of IL-1β and caspase 3 mRNA in graft lung tissures.Result Endobronchial temperatures and lung surface temperatures in the Cooling CO group were lower than those in the corresponding Control group and CO group (P＜ 0.01).Lower wet/dry lung weight ratio,MPO activity,BAL neutrophil count,expression of IL-1β and caspase 3 mRNA in graft lung tissures were seen in the Cooling group compared with the Control group and CO group (P＜0.05).Conclusion Ventilation with cooled carbon monoxise can decrease lung temperature and improve the protecting effect on non-heart-beating donor rat lungs againt worm ischemic injury by inhibiting the expression of proimflammatory factor IL-1β and apoptosis-associated gene caspase 3.

Objective　To investigate the molecular pathogenesis of non-small cell lung cancer (NSCLC) in Shanghai. Methods　About 200 patients with NSCLC from Shanghai urban residents entered in this study. Oncogenes (C-myc, C-erbB2 and EGFR)， tumor suppressor genes (p53 and p15) and some chromosomes instability (3p14, 3p25 and 17p13.3) were determined respectively by DNA slot blot, PCR, PCR-SSCP, and DNA sequences. Results　The rate of co-amplification of oncogenes from 174 cases of NSCLC was significantly higher in stage Ⅲ(50.6％, 40／79) and Ⅱ (31.1％, 14／45) than that in stage Ⅰ (16％, 8／50). Total rate of mutations in p53 gene exons was 49.2％(31／63), while the rate of exon 8 point mutation was the highest. The rate of loss of homozygosity of p15 gene was higher in stage Ⅲ (61.4％, 43／70) than that in stage Ⅰ (34.6％, 18／52) (P＜0.05). 40％(8／20) of loss of heterozygosity at 17p13.3 and 66.7％(108／162) at 3p14 or 3p25 were observed. The rate of co-deletion on 3p14 and 3p25 of adenocarcinoma was higher than that of squamous cell carcinoma. Conclusion　The results suggest that the features of molecular pathogenesis in this series include: (a) 3p deletion in precancerous lesion; (b) p53 mutation and 17p13.3 deletion in carcinoma in situ; (c) amplification of oncogenes for C-myc, c-erbB2, EGFR and deletion of p15 gene in invasion and metastasis carcinoma of the lung.

Purpose:To investigate methods of prevention and treatment,pathogenicity for Acute Respiratory Distress Syndrome (ARDS) following resection of pulmonary carcinoma. Methods:17 cases were analysed for characteristic of incidence, pathogenicity and treatment for ARDS following lung cancer surgery. Results:The subjects, who had chronic obstructie pulmonary disease, hypertension, senility or smoking for a long time were prone to ARDS. Injury to lung during operation, shock and pulmonary infection were probably causes ARDS. The keypoint treatments in rescuing patients successfully included clearing away respiratory tract secretion, preserving free ventilation of respiratory tract, controlling pulmonary infection, alleviating pulmonary edema by diuresis,early tracheotomy or mechanical ventilation by tracheointubation. Conclusions:It is suggested that factors were related to ARDS following resection of pulmonary carcinoma. Those such as shock, injury to lung in operation, pulmonary infection, are important factors leading to post operative ARDS of lung cancer patients. Early treatment can reduce mortality of ARDS. [