Objective:To evaluate therapeutic effect of membrane-covered self-expanding metallic stent on high-positioned advanced esophageal carcinoma,esophagotracheal fistula and anastomotic stricture,and relevant problems to stent implantation.Methods:23 membrane-covered self-expandable stents were implanted in 23 patients with high-positioned advanced esophageal carcinoma (12 cases),esophagotracheal fistula (6 cases) and high-positioned anastomotic stricture (5 cases).The implantation of the stents was performed under endoscope or perorally.Results:The severity of dysphagia was reduced,and life quality of the patients was improved significantly.One stent had to be taken out for severe pain. The positions of 3 stents were successfully adjusted by endoscope for improper position after the first implantation.6 patients suffered from the disorder of pharyngeal function after implantation,among which 5 were cured,and 1 had the stent taken out.Conclusion:Membrane-covered self-expanding metallic stent is effective,safe and easy to insert,especially for patients with the stricture of the high-positioned advanced esophageal carcinoma,and the esophagotracheal fistula.However stent is not the first choice for the treatment of anastomotic stricture.Post-implantation pain,improper position of stent and the disorder of pharyngeal function can be solved by active management.

Objective:To summarize the clinical experience in CABG,so as to look for the optimal perioperative management procedure and improve the operative outcome.Methods:The data of coronary artery bypass were analyzed in 9 patients with coronary heart disease.Results:CABG of all patients was performed on hypothermia cardiopulmonary bypass (CBP).Myocardial preservation was carried out by cold blood cardioplegia with potassium.The average length of time of CPB was 178(70～222) minutes,and that of aortic cross clamp was 111(70～150) minutes.A total of 23 cases of coronary artery bypass were performed using 8 left internal mammary arteries and 15 long saphenous veins.One patient with rheumatic valvular disease associated with coronary heart disease received coronary artery bypass grafts and double valve replacement at the same operation.One patient died of respiratory function failure and the rest were discharged with angina disappearing.Conclusion:The success of coronary artery bypass lies in obtaining of grafts,identifying adequate target vessel,complete revascularizing ischemic myocardium and refining blood vessel anastomosis.Good myocardial protection and perioperative management are also important.

Objective:To explore the diagnosis and management of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) after thoracotomy.Methods:The clinical data of three patients with SIADH after thoracotomy (1 radical operation of esophageal carcinoma,1 radical operation of cardia carcinoma,1 pulmonary lobectomy) were analyzed retrospectively.Results:All 3 patients were males with an average age of 71.4(67.5～74)years.Psychiatric symptoms (the state of delirium) were manifestated by all patients during 3rd to 4th day after thoracotomy,and meanwhile their serum sodium decreased significantly(125～126mmol/L);urine sodium increased abnormally(74.9～101 mmol/L);plasma osmolality decreased(255～280mosm/kg H_2O) and osmolality of urine rised(540～695mosm/kg H_2O).The psychiatric symptoms of 3 patients disappeared and their serum sodium,urine sodium,plasma osmolality,osmolality of urine reversed to normal after water restriction(800～1000ml/24h) for 4 to 6 days.Conclusion:The causes of SIADH after thoracotomy may be related to positive pressure respiration,fierce mental stress,and severe pain that can cause ADH secretion.

Objective:To explore the selection of the treatment methods for acute aortic dissection.Methods:Thirteen patients with acute aortic dissection were studied and analyzed.Results:Of the 13 patients,2 received pharmacotherapy;6 underwent surgical treatment;2 were treated with inplantation of intravascular stent-grafts;1 experienced no treatment because of the ischemic necrosis of the abdominal organs,and 2 suddenly died of the rupture of aortic dissection in the course of emergent management.Conclusion:The emergent pharmacotherapy is essential to all patients with acute aortic dissection.The emergent surgical treatment of acute aortic dissection is selected mainly according to the Debakey Classification.Patients with Debakey Type Ⅰ and Ⅱaortic dissection should undergo operation as early as possible.The outcome of pharmacotherapy is similar to that of surgical treatment based on suitable indications for Debakey Type Ⅲ aortic dissection.Debakey Type Ⅲ aortic dissection can be treated by the intravascular stent-grafts too.

Objective:To study the clinical results and the hospitalization cost of video-assisted thoracoscopic surgery (VATS) with ligation and suture for the treatment of spontaneous pneumothorax.Methods:Thirteen patients were treated by VATS with ligation and suture.The consumed time of operation,duration of the chest drainage,amount of the chest drainage,percentage of patient discontinuing anodyne within the postoperative 24 hours,the average length of hospitalization and the hospitalization cost were analysed.Results:Satisfactory therapeutic effects were found in all cases without postoperative death and complications. The average hospitalization time was 3 days.VATS with ligation and suture was preferable to transaxillary minithoracotomy (TAMT) in the clinical results.The hospitalization cost is less for VATS with ligation and suture (7372.47?871.3) than that with Endo-GIA (12524.32?2962.18) (P

OBJECTIVE: To study the effects ethanol extract of Zingiber officinale against myocardial ischemia-reperfusion injury in rats. METHODS: 50 female SD rats were randomly divided into sham group, model group, ethanol extract of Z. officinale groups (low, medium, high-dose group). Acute regional myocardial ischemia-reperfusion injury model was induced with ligation of rat heart left anterior descending coronary artery for 30 min and 90 min of reperfusion. The content of malondialdehyde (MDA) and activity of superoxide dismutase (SOD) were measured while transmission electron microscopy (TEM) was applied to detect the changes in myocardial ultrastructure. RESULTS: As compared with sham group, the content of MDA in model group was significantly increased but the activity of SOD was decreased (P

Objective To investigate the effects of glucocorticoid on the changes of serum cortisol and 24-hour urinary cortisol in patients undergoing rheumatic valve replacement.Methods 86 patients undergoing rheumatic valve replacement were respectively given 1000 mg methylprednisolone during extracorporeal circulation and intravenously injected 10 mg dexamethasone on the first three days after operation.The enzyme-linked immunosorbent assay (ELISA) was taken to detect the serum cortisol concentration and 24-hour urinary cortisol on the day before operation,the 1st,3rd,5th,and 7th day after surgery.The postoperative complications such as the surgical incision and pulmonary infection were observed during the recovery days.Results Serum cortisol concentrations for patients with different preoperative cardiac function classifications had no significant difference at each observation point during the perioperative period (P＞0.05).Serum cortisol concentration showed a downward trend during the first 3 days after surgery.The serum cortisol level on the 3rd day after surgery was lower compared with that before surgery (P＜0.05),whereas 3 days later the serum cortisol concentration increased gradually and got back to the preoperative levels on the 5th day after surgery.The 24-hour urinary cortisol rose to the peak level on the 1st day after surgery,then decreased to the preoperative level on the 3rd day after surgery (P＞0.05).All the patients recovered.No one died or had complications such as pulmonary infection or incisions healing problems.Conclusions The effects of corticosteroids on perioperative serum cortisol levels in patients with rheumatic heart disease were not clearly correlated with preoperative cardiac function classification.Using glucocorticoid in the first three days after surgery reveals transient inhibitory effect on serum cortisol secreting,however,the cortisol level can quickly go back to the preoperative level after stopping giving glucocorticoid.

Objective To investigate the prognostic factors in patients with esophygectomy after oncologic esophagectomy by analyzing the long-term survival .Methods 104 patients underwent esophagectomy for cancer were retrospectively reviewed from 2007 to 2008 in this hospital ,and the investigation was carried on in questionnaire ,following up 3 years .Various ways ,such as Life Tables ,Kaplan-Meier and Cox regression analysis ,were used to evaluate long-term survival .Results (1)A total of 61 patients died in 3 years .The median survival time was 35 .23 months .The cumulative survival rates at 1 ,2 and 3 year after surgery were 87% , 62% ,and 48% respectively ,and death hazard in 24th month after surgery was the highest .(2)In univariate analysis :drinking ,pres-ence of lymph node metastasis and TNM staging were significant factors that influenced long-term survival .(3)Multivariate analy-sis :lymph node(RR = 2 .399 ,P= 0 .002 ,95% CI :1 .385 to 4 .154) ,drinking(RR = 0 .470 ,P = 0 .008 ,95% CI :0 .269 to 0 .882) ,di-gestive tract construction(RR= 1 .910 ,P= 0 .018 ,95% CI :1 .118 to 3 .262) were the isolated factor influencing the prognosis .Con-clusion Patients after oncologic esophagectomy generally suffer poor survival .The presence of lymph node metastasis ,drinking and different methods of reconstraction are statistically significant factors influencing long-term survival .

Objective To investigate the ipratropium bromide combined with Ambroxol Aerosol Inhalation on preventive effect of pulmonary complications after thoracotomy. Method 115 patients undergoing thoracic operation were randomly divided into 2 groups, 2 groups were given routine nursing before operation, the control group on the basis of Mucosolvan atomization inhalation, the observation group in the conventional nursing combined with ipratropium bromide and atomization inhalation of ambroxol. Results the curative effect of therapeutic group was signiifcantly better than the control group (P<0.05); lung infection in the observation group was significantly lower than that of the control group (P<0.05). Conclusion ipratropium bromide and Mucosolvan aerosol inhalation signiifcantly on the prevention of pulmonary complications after thoracotomy and effect, will help the patient restore.

Objective To evaluate the surgical treatment for renal cell carcinoma with inferior vena cava tumor thrombus and the clinical significance of multidisciplinary treatment. Methods Two cases of renal cell carcinoma with inferior vena cava thrombus diagnosed by Doppler ultrasonography and CT were included in this retrospective analysis. The tumor thrombus was in level Ⅱ in one case and in level Ⅳ in the other. Coagulation test and complete blood count were done again before surgery. Human albumin, fibrinogen, prothrombin complex, plasma, platelet, UW and irrigating solution were prepared before the operation.Under general anesthesia, surgery was performed using abdomen inverted Y shaped incision. Right radical nephrectomy was finished by the urological surgeon; the vena cava was completely dissected from the renal vein level to the secondary porta of the liver by the hepatobiliary surgeon, the vena cava and the surrounding branch vein were blocked in the upper and lower vena cava tumor thrombus; tumor thrombus was removed completely by the vascular surgeon. In one case (patient with level Ⅳ thrombus ) where the tumour thrombus invaded the wall of the vena cava, the thrombus was found to be extending to the cavo-atrial junction but not into the right atrium. The left femoral venous-right atrial bypass was established, the cardiopulmonary bypass lasted for 241 mia, and the aorta was blocked for 18 min. Salvage autotransfusion was used during surgery, and the hepatic vein of the secondary liver porta was anastomosed to artificial vascular graft.The data for surgical indication, operation time, operative blood loss and postoperative hospital stay were analyzed. Results Right radical nephrectomy and inferior vena cava thrombectomy were performed successfully, and the two patients were discharged on the 15th and 27th day after surgery, respectively. The two patients were followed up for 1 and 16 months after surgery, respectively, and both survived without local recurrence and distant metastasis. Conclusion Radical nephrectomy and inferior vena cava thrombectomy is the preferred method for patients without metastasis, and multidisciplinary cooperation could shorten the operation time, reduce the tumor recurrence and increase the survival rate of patients.