Objective:Evaluate the role of video-assisted thoracic surgery (VATS) in the treatment of bilateral synchronous multiple primary lung cancers.Methods and Results:Two paitents diagnosised as bilateral synchronous multiple primary lung cancers received one-stage treatment combined conventional thoracotomy with video-assisted thoracic surgery,performing open lobectomy to remove the larger tumor,performing wedge resection using thoracoscopy to excise the smaller one.The surgery time is short.Patients all recover smoothly without complications.To date,these two patients all alive without any sign of recurrence or metastasis of tumor,median follow-up time is 5 months (2 months+8 months).Conclusions:It is feasible to carry out one-stage treatment combined conventional thoracotomy with video-assisted thoracic surgery on patients with bilateral synchronous multiple prima-ry lung cancers,when one of the tumors of bilateral synchronous multiple primary lung cancers is classificated as T1N0M0.

Objective:To study the effect of endoscopic ligation for early stage carcinoma and benign polyp of stomach.Methods:The early stage cancer in situ and polyp (d＜1.0cm) of stomach were sucked and resected with the endoscopic ligation advice which is used in esophgeal varice ligation.The remained tissue were observed histopathologically whether there had any malignant cell in it and follow-up of 3～6 months was mode by endoscopy.Results:Form 1996 to 1999,56 patients received endscopic ligation.Of these patients,8 cases had gastric early carcinoma (2 cases superficial flat type,4 cases superficial elevated type,2 cases carcinoma in situ),48 cases had gastric benign polyps (38 cases infammatory polpy,10 cases polpypous adeoma).After the endscopic ligation,no malignnant cell was found in remained tissues and no polyp recured within the follow-up period.So this method was demonstrated to be safe,cheap and good effective method for early stage carcinoma,minicarcinoma,carcinoma in situ and benign polyp (d＜1.5cm) of stomach.It deserves being widespread.

Objective:To study the effect of endoscope on the treatment of Hepatocellular Carcinoma (HCC) combined with biliary tract obstrucition (BTO).Methods:We have analyzed retrospectively the results of twelve patients suffering from HCC combined with BTO from 5,1990 to 5,2000.Among these cases,various reasons were found.5 of them were intrabilitary cancer embolus,7 were billary calculus.7 of them were treated with endoscope and following surgical resection,1 was treated with endoscope、TAE and resection,the 3 rest of them were solely treated with endoscope.Results:Of all the 12 cases,1 died of resection,2 failed to follow the survey,these 3 cases above took 25%;among the rest of 9 cases,2 of them survived for 3 to 6 months,3 for half to 1 year,3 for 1 to 2 year,1 for at least 2 years.Those cases suviving for more than 1 year were received surgical resection.Conclusions:We should have no fixed way but to deal with each patient of HCC combined with BTO on his/her merits.As our recognition towards them began accumulating,we found that,in the early stage of obstruction,active endoscopic treatment would prove to be preferable.If combined with other therapy such as surgical resection and TAE,Endoscopy would improve the curative effect of HCC combined with BTO substantially.

Objective:To investigate the methods of the anesthetization of the foreign body extraction in respiratory tract of infants.Methods:This clinical study compared two anesthetic methods in foreign body extraction of respiratory tract of infants:Ketamine+Sodium r-hydroxybutyrate intravenous (group A) and Ketamine+propofol intravenous (group B) and analyzed the advantages and disadvantages of both methods.Results:Compared with group B,the extent of the changes of heart rate and blood oxygen saturation in patients of group A is littler,and the incidence rate of breath holding and asphyxiation is littler too.Conclusions:The anesthetic effect of Ketamine+Sodium r-hydroxybutyrate intravenous in better than that of Ketmaine+propcfol intravenous.

Objective:To investigate expression of cyclinD1 and p21WAF1 and their relationship with multistage process of colon carcinogenesis.Methods:Immunohistochemical staining was performed with SP assay on archival materials from 40 colorectal carcinomas,28 colorectal adenomas,and 14 normal mucosa,cyclinD1 and p21WAF1 expression were compared.Results:The positive staining rate for cyclinD1 in colorectal adenomas and carcinomas is 92.9% and 67.5% respectively,which are both higher than that in the normal mucosa (35.7%) (Padenoma＜0.01，Pcarcinoma＜0.05) and the expression of cyclinD1 is not correlate with differentiation and lymph node metastasis of colorectal carcinoma.The positive stainimg rate for p21WAF1 in normal mucosa (92.9%) is higher than that in colorectal carcinoma(37.5%) (P＜0.01) and the expression of p21WAF1 is correlate with differentiation and lymph node metastasis of colorectal carcinonma.Conclusions:The aberrant expression of cyclinD1 and p21WAF1 is a common event during multistage process of colon carcinogenesis.

Objective:With a scrutiny of the gastroscope aspects of hepatogenic ulcer (HU),this sutdy was to find out the relationship between HU and hepatocelluar damage and portal hypertension.Methods:262 cases of portal hyprtension of cirrhosis were reviewed with HU being grouped according to the clinical gravity of cirrhosis and the gravity of esophageal varies (EV).Results:①Duodenal ulcer prevails under endoscopy.Superficial ulceration accounted for 70.49% while ulceration less than 0.5cm in full diameter made up 55.74%.The figure was 62.3% with erosive gastritis.②Out of a total of 262,61(23.28%) cases of HU were found in connection with portal hypertension.The χ2 test showed that HU was related with hepatocellular grade and the gravity of EV (P＜0.05).Conclusions:The incidence of HU were higher than normal.indicating that the onset of HU responded positively to the clinical intensity of cirrhosis and the gravity of EV.

Objective:To study and sum up the experience of diagnosis and treatment of ureter obstruct by Simplification ureteroscope.Methods:the patients of 750 cases for ureterolith underwent ureteroscopic lithotomy and pressune orbit lithotripsy by using caudal anesthesia in outpatient the 11 cases ureterostensis were treated by watery capus expand,ureteroscopic hard expand and ureterotectomy by using of self-made electrode.Then,transurethral electro incisions of ureterocles were carried out for 2 patients.Results:Successful rate of ureteroscopic lithotomy is 98.4%;12 patient of upper ureter stone received ESWL because of stone entering the renal pelvis,and 3 cases complicated ureteral perforation;11 cases ureterostensis and 7 cases ureterocele were cured.Conclusions:It is frist chosen for ureteroscope to ureteral stone,ureteral stricture,and ureteroceles with a diameter of ≤3cm,and the method have ideal cure effect and the patients will receive.

To furtherly reduce the subxiphoid port site pain,improve the cosmetic result and patient satisfaction,and increase the safety for patients underwent laparoscopic cholecystectomy by advanced laparoscopic knotting skill.Methods:Among our 1500 patients underwent laparoscopic cholecystectomy since 1991,120 cases of modified laparoscopic cholecystectomy (MLC) were performed with three 5-mm ports and one 10-mm port(for laparoscope and sepcien withdrawn).There were 25 male and 95 female patients with an average age of 55 years (24～77years).The indications for MLC included polypoid lesions of gallbladder (21),simple cholecystitis(3),cholecystolithiasisi with chronic cholecystitis(84),with acute suppurative cholecystitis(7),with atrophic cholecystitis(5).Results:There were 5 patients underwent combined laparoscopic appendectomy(3),fenestration of hepatic cyst(1),and drainge for liver abscess(1).The average operative time for MLC was 55 minutes(30～150min),blood loss was 10ml(3～50ml),and postoperative stay was 3 days(1～5days).There were no conversion from MLC to either LC or open surgery,without mortality.Complications were limited to two patients(1.7%).One was retained common bile duct stone and another was port site bleeding after operation.They were treated by transduodenal endoscopic stone retrieval and simple suture ligation,respecrtively.Conclusions:The advantages of MLC conducted mainly by advanced laparoscopic knotting techniques were no more laparoscope (either 2-mm or 5-mm)needed,no sacrifice of good illumination and laproscopic image.Most of all,its costeffective and operative safety were all improved furtherly.

To study the clinical application value of laparoscope in purnlent hepatitis drainage.11 patients were done the purnlent hepatitis by laparoscope.10 patients succeeded.The purnlent hepatitis by laparoscope operately cheaply,had small operational wound,patients recovered rapidly,had little postoperative complication,which showed the superiority fully.It was the most common pelviscopy in purnlent hepatitis treatment.

Objective:In order to obtain more effective endoscopic treatment,we analysed 32 cases data of therapeutic ERCP.Methods:Of which 23 were males,9 females with a median age of 56 years.Therapeutic effort was executed in all cases including biliary drainage (n=16)，endoscopic sphincterotomy (EST) (n=15,10 of them received extraction)and extract ascaris(n=1).The discussion focus on the treatment of biliary disease.Results:All common bile-duct stone were cleared up.Satisfactory treatment was achieved in almost all with no severe side effect.Conclusions:Therapeutic ERCP is an effective method for cholangiopancreatic diseases.It is of considerable value and should be promoted in clinical application.