of the 575 cases undergoing resection of carcinoma of esophagus and cardia,48 cases were associated with 56 postoperative complications (9.73%) which were mainly anastomatic leakage (15),paralysis of recurrent laryngeal nerve (6),colonic obstruction (5),empyema (5),pneumonia (5),and bowels through diaphragmatic incision into pleural cavity (4),and which were rarely paralysis of radial nerve,injury of colonic medium artery or chylothorax.There were 34 cured,5 permanent functional disturbances and 5 died in the 48 cases.The causes and prophylactic measures of the major complications including anastomotic leakage,pulmonary complications,bowels through diaphragmatic incision into pleural cavity and colonic obs-ruction were discussed.

BACKGROUND:Inflammatory cellactivation and the generation of oxygen free radicals are important factors of lung ischemia-reperfusion injury. Adding the drugs with anti-inflammation and antioxidant effects into the lung preservation solution used, can improve the protection fluid, and play a crucial role in the study of lung ischemia-reperfusion injury and protection of the function of transplanted lung. OBJECTIVE:To discussion the effect of harmine in canine model of pulmonary ischemia-reperfusion injury. METHODS:Twelve healthy hybrid dogs were randomly divided into two groups, with six rats in each group. A canine model of lung ischemia-reperfusion injury was established, and the protecting liquid was perfused with the clockwise irrigation method. Control group:low potassium dextran protective fluid;experimental group:low potassium dextran+harmine protective fluid. After 2 hours of ischemia, the left lung circulation was recovered. The left lung tissue and blood samples were col ected from two groups of animal models after reperfusion, and their cytokines levels and the lung wet/dry weight ratio were detected and calculated. Bronchoalveolar lavage fluid was col ected to observe the pathological indicators. The main pulmonary artery pressure, left and right pulmonary artery pressure were recorded by continuous monitoring. RESULTS AND CONCLUSION:There were no statistical y significant differences in the interleukin-17, tumor necrosis factorαand endothelin 1 content in the left lung tissue and the blood between the two groups at 2 and 4 hours after reperfusion (P>0.05). After 4 hours of reperfusion in both groups, the neutrophil number, the number of lymphocytes, alveolar edema index, and vascular wal damage in bronchoalveolar lavage fluid showed no statistical y significant differences (P>0.05). Through the analysis of variance, the main pulmonary artery pressure, left pulmonary artery pressure and right pulmonary artery pressure also had no statistical significance between the two groups (P>0.05). By the analysis of cytokines, pathological indicators, lung wet/dry weight ratio, and pulmonary arterial pressure, harmine has no significant lung protection effect in canine model of lung ischemia-reperfusion injury.

Objective To introduce the standard procedure of Cattell Braasch maneuver and evaluate the complication and clinical value of this maneuver as a important exploration method in the surgery of pancreatic tumors. Method The clinical data of 13 cases of pancreatic tumors explored by Cattell Braanch maneuver before undergoing tumor resection were analyzed. Results Among these 13 cases there were 6 cases of tumors of the head (the pancreatic adeuocarcinoma in 4 cases, solid pseudo-papillary tumor and endocrine tumor in one each cases) and 7 cases of tumor of the body and tail of the pancreas (adenocarcinoma in 4 cases, solid pseudo-papillary tumor in 1 case, endocrine tumor in 2 cases) Pancreaticoduodenectomy was performed in 6 cases, including segmental resection of the tumor invading the superior mesenteric vein( SMV )with length varying from 3 to 7 cm and direct end-to-end reanastomosis in 3 cases. Distal pancreatectomy plus spleuectomy was performed in the other 7 cases, including the case in which extended tumor resection demanded left nephrectomy. Operations lasted from 2. 5 hrs to 11 hrs, in which only 10 ～ 15 mins were needed for Cattell Braasch maneuver . The blood lose was from 300 ml to 1000 ml. There were neither mortality nor severe complications in these series. Conclusion Cattell Braasch maneuver facilitates the exploration and tumor resection in patients suffering from pancreatic neoplasms especially malignances with better view of the operation field,it helps to avoid incidental iatrogenic injury, and also to the nongraft PV/SMV end-to-end anastomosis after the resection of tumor invaded segment.

Objective To explore the feasibility of a novel incisionless laparoscopic technique in the treatment of colorectal tumor, and evaluate the preliminary clinical result of this technique. Methods The clinical data of 12 consecutive resected specimens of high located rectal or sigmoid tumor removed by traditional laparoscopic surgery were analyzed to probe the indication of this technique and the first 2 cases received incisionless laparoscopic anterior resection. Postoperative follow up was made to evaluate the clinical feasibilities. Results Among 12 explanted fresh specimens there were 1 adenoma and 3 adenocarcinoma cases in which the key steps of the new technique were successfully demonstrated. In two cases, the bowel above the tumor was cut and the distal end was inverted and pulled through the anus laparoscopically, the tumor along with the bowel resected, the stump pushed hack, and intralumen sigmoidproctostomy fashioned. In these two patients, one of sigmoid cancer and one of large rectal adenoma with focal canceration, the mean operation time was 200 min, mean blood lose was 50 ml, mean bowel function recovery time was 1.5 days. After 13 and 15 respective months fullow up there was no complications nor tumor recurrence. Conclusions Ineisionless laparoscopic surgery, while in line with tumor free principles, has the advantage of safety, cost-effectiveness and being cosmetic in selected cases.

Objective:To discuss the role of incision for short-term outcomes of simultaneous resection in synchronous colorec-tal liver metastases (sCRLM). Methods:We reviewed the data of 37 patients who underwent simultaneous resection between January 2009 and December 2014 in our department and compared the short-term outcomes between Mercedes and midline incisions. Results:Mercedes and midline incisions were used in 19 and 18 patients, respectively. The two groups showed similarities in patient characteris-tics, major hepatectomy, surgery time, blood loss, and hilar block time. The midline group comprised more rectal cancer patients (P<0.001). The two groups did not differ significantly in complication incidence (47.4%vs. 16.7%, P=0.08) and postoperative stay time (22.1 ± 9.5 d vs. 17.2 ± 6.7 d, P=0.08). At body mass index (BMI)<25, the complication incidence (P=0.046) and postoperative stay time (P=0.051) were lower in the midline group than in the Mercedes group. Conclusion:Midline incision provided similar exposure in simultaneous resection for sCRLM and was better than Mercedes incision in rectal cancer patients. Patients with midline incision may attain better short-term outcomes if BMI is<25.

This study tested the hypothesis that controlled reperfusion with warm blood cardioplegia containing mannitol would result in more effectively improved recovery of myocardial mitochondrial function by preventing or reducing a potentially harmful component of reperfusion. Myocardial mitochondrial function was significantly depressed after 60 min reperfusion, but slightly depressed in the controlled reperfusion group. Significantly increased MDA content and decreased SOD activity were observed after 60 min reperfusion. Hearts in the controlled reperfusion group had low MDA content and might protect the activity of SOD. The- results indicate that controlled reperfusion after ischemia provides benefit in avoiding myocardial mitochondrial reperfusion injury.

OBJECTIVE: To study the preparation technique of tanshinone dispersible tablets.METHODS: Taking the disintegration time - limit, in vitro dissolubility and suspensibility as indices, the formula of tanshinone dispersible tablets was screened by orthogonal design.RESULTS The dispersible tablets could completely disintegrate within 30 seconds and pass through 710m seive mesh, which all conformed to the requiremtes of BP(1993) .The in vitro dissolubility of this product was superior to that of ordinary tablets obviously .CONCLUSION: The preparation technique of tanshinone dispersible tablets is mature and the quality is reliable.

Objective: To study the clinical significance of liver pathological changes in patients with rheumatic heart valve disease (rheumatic heart disease, RHD). Methods: Forty one patients with RHD and tricuspid valve incompetence in 30 patients underwent heart valve replacement. Light microscopy and H 800 transmission electron microscopy were used to observe liver tissue harvested by biopsy performed before institution of cardiopulmonary bypass. Results: Typical pathological changes of liver as the following: (1) Changes of liver intercellular substance including sinusoid widening, blood stasis, liver fibroplasia. (2)Hepatocyte changes: hepatocyte swollen, mitochondria swollen, crest disappearence, hepatocyte degeneration and necrosis. There was correlation between liver pathological changes and magnitude of tricuspid valve regurgitation. Conclusion: To improve liver pathological changes, it is important to operate on patients with rheumatic heart diseases and tricuspid valve incompetence as early as possible and to eliminate tricuspid valve regurgitation.

Objective To explore and conclude the influence factors of long-term outcomes of mitral valve repair for moderate and severe mitral regurgitation due to myxomatous degeneration.Methods To review the in-patient data and followup outcomes of 261 patients after mitral valve repair for moderate and severe mitral regurgitation due to myxomatous degeneration from Jan 1993 to Jan 2008 in Changhai Hospital of Second Military Medical University.Results There were 7 perioperative deaths and 254 survivors who obtained satisfactory perioperative outcomes.During the follow-up,24 patients were lost and 230 patients were followed up from 36 months to 174 months (77.3 ±30.3) months and follow-up rate was 90.6％.Multivariate Cox regression shows age ≥ 60 years old,left ventricular ejection fraction ＜ 0.50,undergoing combined coronary artery bypass grafting were the independent risk factors for long-term death after operations and left ventricular ejection fraction ＜ 0.50,New York Heart Association functional classification Ⅲ-Ⅳ,anterior leaflet prolapse were the independent risk factors for long-term recurrent moderate or severe mitral regurgitation after operations and prosthetic ring or band annulopasty was a protective factor.Conclusion The age ≥60 years old,left ventricular ejection fraction ＜ 0.50,undergoing combined coronary artery bypass grafting,New York Heart Association functional classification Ⅲ - Ⅳ,anterior leaflet prolapse,and prosthetic ring or band annulopasty were closely related with long-term adverse events after operations.

Objective To analyze the clinico-pathological characteristics and prognostic factors of patients with gastric neuroendocrine carcinoma(G-NEC).Methods Clinical data of 40 cases of G-NEC form January 2003 to August 2013 at Ren Ji Hospital of Shanghai Jiaotong University were analyzed.Tumors were classified into different grades and stages according to the 2010 WHO classification and the 2006 European neuroendocrine tumor society (ENETS).Follow-up was conducted by telephone.The survival curves were drawn using Kaplan-Meier method.Univariate analysis was performed by the Log-rank test and multivariate analysis was performed by the COX proportional hazards model.Results Among the 40 G-NECs patients,29 were male(72％) and 11 were female(28％),with an median age of 61 years.Tumors located in the gastric cardia in 20 cases,in the gastric antrum in 11 cases and in the gastric body in 9 cases.Tumor ranged from 1 cm-20 cm.All patients were G-NEC (G3).Follow-up rate was 100％ (40/40).The median overall survival rate was 12 months,and one-year survival rate was 82％.Immunohistochemically G-NEC cells were positive for CgA and Syn in 11 cases.Gender (x2 =5.673,P ＜ 0.05),Ki-67 index (x2 =8.612,P ＜ 0.05),and lymphnode involvement (x2 =0.559,P ＜ 0.05) were prognostic factors of G-NEC patients.Conclusions The symptoms of G-NEC are nonspecific.Its diagnosis relies on pathological examination and immunohistochemistry.Syn and CgA are the most important markers.Female gender,lower Ki-67 index and lower lymph node metastasis predict a survival advantage.