Surgery is still the basic treatment of esophageal carcinoma. Quality of life, a new evaluation criterion for the health and disease, reflects the surgical outcome of esophageal cancer comprehensively. The findings of clinical research demonstrate that in the surgical treatment of esophageal carcinoma, quality of life could provide us with new selections such as surgical method, lymph node dissection and digestive tract reconstruction. Further application of quality of life scale in esophageal carcinoma surgical treatment, will greatly enhance the surgical outcome and improve patients'quality of life.

Objective To evaluate the safety and efficacy of thoracoscopic lobectomy for pulmonary benign diseases.Methods Between July 2002 and September 2007,35 cases with pulmonary benign diseases underwent thoracoscopic lobectomy in our hospital.Of the patients,video-assisted thoracoscopic lobectomy was performed on 12 cases,and totally endoscopic lobectomy was carried out in 23.Results The operation was completed in all of the cases except in one who was converted to open surgery because of massive hemorrhage.In this series,no peri-operational death occurred,however,complications occurred in 3 cases(morbidity rate: 8.6%),including 2 cases of persistent air leak and 1 case of pneumonia.The mean duration of chest tube drainage was 3.6 days(2 to 7 days),and average hospital stay after operation was 7.7 days(2 to 14 days).Postoperative pathological diagnosis included bronchiectasis in 15 patients,pulmonary inflammatory pseudo-tumor in 6,tuberculosis in 5,fungal infection in 5,pulmonary sequestration in 2,and bronchogenic cyst in 2.Conclusions Thoracoscopic lobectomy is safe and effective for pulmonary benign disease.

0 05) between the two procedures in incidence of anastomotic leakage (25 0% vs 10 7%), pulmonary infection rate (31 3% vs 32 1%), incide nce of thoracic cavity infection (0 vs 3 6%), proportion of re-thoracotomy (0 vs 3 6%), incidence of d elayed gastric emptying (3 1% vs 21 4%), postoperative SICU stay (4d?2 3d vs 5d ?3 6d), and peri-operative mortality (3 1% vs 7 1%). The incidence of recurr ent laryngeal nerve injuries (28 1% vs 7 1%, ? 2=4 391,P =0 036) and arr hythmia (43 8 % vs 17 9%, ? 2 =4 627, P =0 031) in the THE Group were significantly higher than those in the TTE Group, while the intra-operative blood loss in the THE Group was signif icantly less than that in the TTE Group ( t = -3 100, P =0 003).ConclusionsVideo- assisted THE is a safe procedure. With the increase of the experience, the incid ence of post- operative complications is subject to further decrease.

Objective To summarize the clinical experience of laparoscopic repair of esophageal hiatal hernia.Methods A total of 15 cases of esophageal hiatal hernia underwent laparoscopic hernia repair and fundoplication from May 2004 to April 2005 in this division.There were 4 cases of type Ⅰ hernia(all of which presented severe gastroesophageal reflux disease),10 cases of type Ⅱ hernia,and 1 case of type Ⅲ.Surgical procedures included laparoscopic Nissen total fundoplication in 9 cases,Toupet partial fundoplicatin in 4 cases,and Dor partial fundoplication in 2.Symptoms of gastroesophageal reflux disease,including heart burn,dysphagia,regurgitation,chest pain,and belching,were evaluated by using the Visual Analogue Scales(VAS) at preoperative period,1 postoperative month,and 6 postoperative months,respectively.Results No conversion to open surgery was required in this study.The operative time ranged 100~187 min(mean,125 min).The postoperative hospital stay was 2~5 days(mean,2.8 days).All the patients were followed for 1~12 months(mean,8.5 months).No hernia recurrence was found.The VAS scores decreased from 5.0?3.9 preoperatively to 0.9?1.3 at 1 month postoperatively(t=3.823,P

The morbidity and nortality of esophageal carcinoma showed an upward trend in recent years.Neoadjuvant radiochemotherapy is the nain mode of treatment for advanced esophageal carcinoma,including neoadjuvant chemotherapy,neoadjuvant radiotherapy and neoadjuvant radiochemotherapy.However,there are still many controversies on efficacies and advantages or disadvantages of treatment mode.In this article,authors will investigate the present situations and future direction of neoadjuvant therapy for locally advanced esophageal carcinoma.

Objective To identify risk factors of lymph node metastasis in superficial esophageal squamous cell carcinoma (ESCC),and to provide evidence for treatment choice under endoscope.Methods From January 2007 to December 2011,285 patients with pathologically diagnosed ESCC who received surgery and had clear record of lymph nodes resection were enrolled.The clinical pathological data of these patients were analyzed,including age,gender,smoking and drinking history,history of cancer,family history of cancer,location,tumor size,presence of esophageal,depth of infiltration,differentiation,and vascular cancer embolus.Univariate analysis (chi square test or Fisher exact probability method) and multivariate Logistic regression analysis were performed for risk factors of lymph node metastasis assessment.According to the rates of lymph node metastasis,patients were divided into three groups as follows:low risk,high risk and extremely high risk of lymph node metastasis.KaplanMeier method was used to calculate the average survival time and cumulative five years survival rate.Results Among the 285 patients with ESCC,40 (14.0 ％) patients with lymph node metastasis.The results of univariate analysis showed that location (x2 =9.333),tumor length (Fisher exact probability method),depth of infiltration (x2 =9.327),differentiation degree (Fisher exact probability method) vascular cancer embolus (Fisher exact probability method) were significantly associated with lymph node metastasis (all P＜0.05).The results of multivariate analysis indicated that tumor length over 5 cm,invasion to submucosal layer and vascular cancer embolus were independent risk factors of lymph node metastasis,and the odd ratio was 17.408(95％ confidence interval (CI) 1.557 to 194.686),3.471(95％CI 1.440 to 8.365) and 6.256(95％CI 1.787 to 21.910),respectively.The lymph node metastasis rates of patients in low risk,high risk and extremely high risk group were 5.2％(6/115),15.8％ (24/152) and 10/18,respectively;the average survival times were (69.9 ± 2.4),(63.8 ± 2.1) and (51.7 ± 1.7) months,respectively.The cumulative five years survival rates were 59 ％,51 ％ and 31％,respectively,and the difference was statistically significant (x2 6.816,P=0.033).Conclusions The risk of lymph node metastasis is high in ESCC patients with tumor length over 5 cm,invasion to submucosal layer and vascular cancer embolus,and the prognosis is poor.Lymph node metastasis should be considered when endoscopic therapy is chosen.

Objective To explore the relationship between skin photo reactions and structural pa-rameters. Methods Benzophenone-1, Benzophenone-2 and Benzophenone-3 were assessed by phototoxici-ty test and photoallergic test on guinea pig. And the phototoxicity index and photoallergic index were cal-culated after clinical assessment. Structural parameters of the three sunscreens like total energy, binding energy, electronic energy, heat of formation, dipole and sum of the net charges were also calculated by the soft of HyperChem7.0, respectively. Results The phototoxicity index rised with total energy, elec-tronic energy and sum of net charges increasing. And the photoallergy index rised only with binding ener-gy increasing. So there was some correlation between phototoxicity index and total energy, electronic en-ergy and sum of net charges (P<0.01). Significant relationship was only between the photoallergy index and binding energy (P<0.01). Conclusions The phototoxicity is correlated with total energy and e-lectronic energy, while photoallergy is related to binding energy. It is possible to establish a model evalua-ting the safety and structural parameters of benzophenone ramifications.

Objective To observe the alteration of skin complexion after UVA and UVB exposure.Methods The back skin of ten females with skin type Ⅲ was subjected to single exposure to solar-simulated UVA of double minimal persistent pigment darkening (MPPD) or UVB of double minimal erythema dose (MED). Skin reflectance was assessed with clinical grading, spectcolometer and Mexameter MX 18 before irra-diation, 6 hours, 1, 7 and 14 days after the irradiation. Results After UVB irradiation, a~* value and erythema index (EI) abruptly increased at 6 hours and peaked on day 2; L~* value sharply declined on day 1; ITA° markedly decreased on day 7; melanin index (MI) declined within the first 2 days, but notably increased on day 7. After UVA irradiation, a~* and El value experienced no apparent changes; L~* value obviously declined at 6 hours; ITA° reached its lowest value on day 14; MI increased only on day 1. Conclusions There is a significant difference in the kinetics and extent of skin complexion changes after UVA and UVB irradiation. EI and a~* value are sensitive and accurate indices for evaluating sunburn, and MI and ITA ° for analyzing tanning.

Purpose　To investigate whether thoracotomy can induce lung injury in the operative side and the protection by ambroxol in this procedure.　Methods　24 patients with esophageal carcinoma who were performed esophagectomy with anastomosis over the arcus aortae were randomized into 2 groups:an ambroxol group (ambroxol 1 g iv gtt qd×3,preoperatively) and a controlled group without any respiratory medication.General anesthesia by tracheo-cannula combined with continuous epidual anesthesia were used in all the patients.Bilateral broncho-alveolar lavage(BAL) was carried out after intubation preoperatively and before removal of the cannula postoperatively.Total Phospholipid(TPL),Saturated Phosphaytidylcholine(SatPC) and Total protein(TP) in the BALF were measured.The ratio of SatPC/TPL and SatPC/TP represented the activity of PS.　Results　In the controlled group,SatPC/TPL and SatPC/TP of the left lung(operation side) showed significant difference(P<0.05),compared with the right side(non-operation side).In the ambroxol group,no significant difference of such ratio was showed.　Conclusions　Thoracotomy can induce lung injury and bring out the decrease of PS and increase of protein exudation in the operative side.Large dose of ambroxol can promote in synthesize and secretion of PS and protect those changes.

Objective: To evaluate the feasibility,the safety and the effect of early postoperative enteral nutrition in patients with esophageal cancer.Methods: On the first postoperative day,40 patients were randomly divided into two groups.One group was given isocaloric total parenteral nutrition through central vein(TPN group) and the other group was fed with enteral nutrition through nasoenteric tubes or jejunostomy tubes which were inserted during the operation(EEN group).All variables were measured before operation and on postoperative day 1 and 8.Blood was drawn at different time points to assess albumin,prealbumin and transferrin.Immune response was determined by immunoglobins,total lymphocytes,T-lymphocyte subsets and NK cells. Inflammatory response were determined by C-reactive protein,IL-6 and TNF-?.Morbidity,mortality and length of hospital stay were also evaluated. Results: Tolerance of enteral nutrition was excellent.Neither mortality nor serious morbidity occurred in all patients during the period of study.After the study,the levels of serum prealbumin,total lymphocytes,CD3,CD4 and CD4/CD8 ratio in the EEN group were significantly higher than the levels in the TPN group.The concentrations of IL-6 and the length of hospital stay in the EEN group were significantly lower than in the TPN group.Conclusion: Early postoperative enteral nutrition in patients with esophageal cancer is safe,and also has the benefit effects of enhancing the body status of nutrition and immune function,and reducing the inflammatory response and the length of hospital stay.