Objective To evaluate the modularized operative process during video-assisted thoracoscopic esophagectomy for esophageal cancer.Methods The clinical data of 45 patients with esophageal cancer who were admitted to the Daping Hospital from December 2011 to December 2012 were retrospectively analyzed.The influence of modularized operative process on the intra-and post-operative condition and short-term complications after videoassisted thoracoscopic esophagectomy + esophagogastric anastomosis were analyzed to investigate the efficacy and value of modularized operative process.Patients received video-assisted thoracoscopic and laparoscopic resection of esophageal carcinoma or thoracoscopic resection of esophageal carcinoma + gastric mobilization.Thoracoscopic esophageal mobilization and mediastinal lymph nodes dissection were done according to the modularized operative process:(1) Pulmonary ligament mobilization and groups 8L and 9 lymph nodes dissection.(2) Mobilization of the esophagus under the arcus venae azygos.(3) Mobilization of esophagus above the arcus venae azygos.(4) Transection of the arcus venae azygos.(5) Complete removal of thorax esophgus.(6) Ligation of thoracic duct.(7) Dissection of groups 4,5,7,10 and 2L lymph nodes.All the patients were followed up via phone call or mail till February 2013.Patients received thoracoabdominal computed tomography and gastrofiberscopy to detect tumor recurrence or metastasis every 3 months within the first year after the operation,and they were re-examinated every half year at 1 year later.Results Of the 45 patients,29 received video-assisted thoracoscopic and laparoscopic resection of esophageal carcinoma and 16 received video-assisted thoracoscopic resection of esophageal carcinoma + gastric mobilization.The length of the tumor was (4.2 ± 2.5) cm.The numbers of patients in AJCC T1,T2,T3 and T4 stages were 7,14,15 and 9,and the number of patients with AJCC N0,N1,N2,N3 stages were 23,13,7,2,respectively.The intrathoracic operation time,total operation time,volume of intraoperative blood loss,number of lymph node resected and postoperative duration of hospital stay were (72 ± 13)minutes,(249 ± 39) minutes,(183 ± 62) ml,27 ± 7,(18 ± 7) days,respectively.Two patients were transferred to open surgery.No patient died postoperatively,and 11 complications were detected after the operation.Six patients were complicated with cervical anastomotic fistula,4 with anastomotic stricture and 3 with hoarseness.Forty-five patients were followed for 1.5-14.0 months with the median follow-up time of 8 months.One patient died of upper gastrointestinal hemorrhage at postoperative month 12,and 1 died of multi-organ dysfunction syndrome at postoperative month 8.The remaining 43 patients survived.Conclusions The modularized operative process for thoraeoscopic esophagectomy is safe and effective,its short-term efficacy is satisfactory.

Objective To investigate the expression of JNK2 in hyperoxic lung injury ,and explore the protective effect of sub-stance P (SP) on hyperoxic lung injury and its mechanism .Methods Sixteen SD rats were divided into four groups with 4 rats in each group :room-air and f 9 g/L saline group (group A) ,room-air and SP group (group B) ,hyperoxia injury group and f 9 g/L sa-line group (group C) ,hyperoxia injury group and SP group (group D) .Rats ingroup B and D were injected with SP 1 × 10-6 mol · L -1 · kg -1 · d-1 intraperitoneally ,group A and group C were injected with an equal volume of 9 g/L saline .The animals were sac-rificed after 14 days of experiment .Lung pathology was examined with light microscopy ,lung wet/dry (W/D) ratio and the level of SP and PCNA and TUNEL in lung were evaluated .The Superoxide dismutase (SOD) ,malondialdehyde (MDA) and glutathione (GSH) level were assayed respectively in lung tissue .The quanlity of JNK2 protein was detected by Western blot analysis .Results Compared with group A ,the high oxygen groups all had different degrees of lung injury ,,while the lung pathological pictures in group D was improved significantly compared with group C .Western blot showed that level of JNK2 in group C was obviously higher than that of group A ;After the intervention ,level of JNK2 in group D was lower than that of group C .The lung W/D retio , TUNEL and PCNA expression and distribution SOD ,MDA and GSH was consistent with the trends of JNK2 protein expression . Conclusion High oxygen stress can activate damage lung tissue JNK 2 activity ;SP protection mechanism of high oxygen lung injury may be induced by cutting high oxygen activation of JNK 2 to inhibit oxidative damage .