Objective　To explore the risk factors and causes affecting the operative mortality in esophagectomy patients with esophageal can cer. Methods　1400 cases with a curative esophagectomy for neopl asm of esophagus hospitalized from Mar,1973 to June, 2000 were reviewed. There w ere 31 died within 30 d or during hospitalization after esophagectomy as a group , and 1 369 survival cases, after operation, as another group. Sixteen factors t hat may influence the operational mortality were selected. A multi-variate anal ysis of these individual variables was performed by the computer′s logistic reg ression model. Results　The operative mortality was 2.2%(31/1400 ). The causes of death included respiratory complication 17 cases (including res piratory failure caused by pneumonia or atelectasis), 15 cases, and adult respir atory distress syndrome (ARDS) 2 cases, the mortality was 54.8% in the death gro up), anastomotic leak 11 cases (34.5%), Chylothorax 2 cases (6.5%) and postopera tive digestive tract hemorrhage 1 case (3.2%). The results showed that the major risk factors that affected operative mortality in cases with esophageal cancer were history of long-herm heavy smoking, duration of operation and the year of operational (P<0.05). Conclusion　To minimize operative mort ality of esophagectomy, some means must be noticed, including the reinforcemen t of the perioperative care, the improvement of anastomotic methods and surgical skill, reduing operative time as p ossible, disposing pulmonary complications in time and using respirator if neces sary.

Objective To investigate the value of carotid and lower limbs arteries atherosclerosis in prediction of intracranial atherosclerosis combined with type 2 diabetes (T2DM). Methods Seventy-four patients with T2DM received the carotid artery , lower limbs arterial color Doppler ultrasound and cranial MRA examination. The data was analysised by Pearson correlation and Binary Logistic methods. Results With the increasement of degree of peri-arterial atherosclerosis , the intracranial arteriosclerosis was in a trend of increase. The correlation coefficients, OR values and AUC of LLAS and CAS + LLAS for intracranial atherosclerosis were 0.28 (P < 0.05) and 0.33 (P < 0.05), 0.14 (P < 0.05) and 9.28 (P < 0.05), 70.30% (P < 0.05) and 70.60% (P < 0.05), respectively. The cut-off point of LLAS and CAS + LLAS was lever 2. Conclusion The LLAS and CAS + LLAS with T2DM are independent risk factors for intracranial atherosclerosis , owning certain forecast values.

Objective To analyze the clinical effect through 20 adult atrial septal defect repair cases with totally thoracoscopic and summarize the experience of totally thoracoscopic cardiac surgeries.Methods From March 2014 to August 2016, 20 adult atrial septal defect cases repaired by totally thoracoscopic were enrolled in the study. Extracorporeal circulation was established by inserting artery pump tubes into the right femoral artery and vein tubes in to the right femoral vein, cold blood cardioplegia was perfused ante gradely through the aortic root in order to protect the myocardium, then atrial septal defect repair cardiac surgeries were implemented by perforating 3 holes through the right chest wall. Analyze the operation time, aortic cross clamping time, CPB time, amount of drainage, hospital stay, postoperative complications and so on.Results The operation time was 3.5~5.0 h, and the average level was (3.8 ± 0.5) h. The blocking duration of the ascending aorta ranged from 28 to 46 min, and the average level was (29.8 ± 8.2) min. The duration of extracorporeal circulation ranged from 86 to 108 min, and the average level was (80.6 ± 11.5) min. Ventilation time ranged from 5 to 8h, and the average level was (6.0 ± 0.8) h. The amount of thoracic drainage ranged from 100 to 260 ml, and the average level was (150.0 ± 35.0) ml. Hospital stay ranged from 6 to 9 days, and the average level was (6.5 ± 1.2) days. All the operations were completed successfully. There were no in-hospital death or serious post-operative complications. UCG performed 3~5 days after the operation revealed surgical results were satisfactory. Follow up to 1~28 months were available in all cases. During the period, the heart function was conifrmed asⅠ level.Conclusion Adult atrial septal defect repair surgeries with totally thoracoscope is safe and reliable and have advantages of less injury, rapid discovery, light pain, and less postoperative drainage.

Objective To study the anti-calcification function properties of bovine jugular conduit with valves stabilized by dye-mediated photooxidation.Methods Sixteen bovine jugular conduit with valves were divided into two groups and treated with dye-mediated photooxidation(groupⅠ) and glutaraldehyde(group Ⅱ).The bovine jugular vein was cut into pieces and implanted subcutaneously in the 16 weanling SD rats.After 90 days,all the rats were sacrificed and the retrieved specimens were undergone histological examination by electron microscope and microscope.The calcium content was determined by flame atomic absorption spectrophotometer.Results The walls and valves of bovine jugular vein treated by dye-mediated photooxidation had less calcification than those of the group Ⅱ.Conclusion The dye-mediated photooxidation can effectively preserve the calcification of bovine jugular conduit with valves compared with the way treated by glutaraldehyde.

Objective To compare the influences of off-pump and on-pump coronary artery bypass grafting operation on plasma thyroid hormones.Methods Forty patients undergoing coronary surgery were randomly divided into off-pump group(n=20)and on- pump group(n=20).Plasma thyroid hormones(T_3,T_4,FT_3,FT_4,rT_3)and thyroid-stimulating hormone(TSH)were studied perio- peratively.Results Before operation,the values of aU the variables were within normal range in the two groups.In off-pump group, T_3 and FT_3 concentration dropped significantly after operation,reaching the lowest value at first day postoperatively[T_3:(39.7?6.2) ng/dl vs.(78.6?2.1)ng/dl,P0.05),which were within normal range all along,rT_3 concentration rose significantly after operation,reaching the highest value at third day postoperatively[(82.1?26.8)ng/dl vs.(42.3?15.6)ng/dl, P0.05),whereas baseline,operative and postoperative variables were similar.Con- clusion Off-pump operation has some influences on plasma thyroid hormones,showing"low T_3 syndrome"postoperatively,that is similar to what on-pump operation does.

0.05).Follow-up data showed that there were less angina pectoris attack and higher levels of LVEF in LPG comparing with SPG;showing as 1.26?0.72/day vs 1.75?0.88/day(P=0.040)and 57.2?8.6% vs 52.0?8.5%(P=0.037)respectively.Conclusions Long period application of tirofiban following PCI in patients with STEMI is safe and effective,providing alleviation both on angina pectasis and left ventricular ejectory fraction.(J Intervent Radiol,2007,16:796-798)

Objective To evaluate the security and effectiveness of emerging sternal rigid plate by comparing with wires closure. Methods 60 patients who undergoing median sternotomy from two centers were enrolled in this study, 30 received wire cerclage( control group) and the other 30 received rigid plate fixation( experimental group) . Patients' sternal were closed with wires or rigid plates, and the painness, sternal union and status of wires or rigid plates were followed up and assessed one week, three months and six months after procedures. Results All patients survived and were followed up. 117 rigid plates were implanted. There was no significant difference in pre-operative data, post-operative painness, sternal union and status of wires and plates between control and experimental group. No patient reached the standard of clinical sternal union one week post-operation, but all patients reached the standard of clinical sternal six months post-operation. One patient in control group suffered sternal nonunion, movement and wound infection after sternotomy. Conclusion Compared to wire closure, sternal closure with rigid plates is the same safe and effective.