Objective:To explore the perioperative dynamic changes of cellular immune function and its clinical significance in patients with chest surgery.Methods:The numbers of CD3、CD4、CD4/CD8、CD8 T lymphocyte and nature killer(NK) cells in peripheral blood were examined in 45 patients with chest surgery before operation and 1、3、5 and 7 days after operation by flow cytometry.45 patients were devided randomly into groups.The perioperative changes of T lymphocyte subsets and NK cells were compared among mediastinal disease,pulmonary operation,esophagus and gastric cardia surgery.Results:CD4/CD8 decreased 1 day after surgery and CD4 decreased at the 3rd postoperative day in patients with chest surgery.In patients with mediastinal disease,CD4/CD8 decreased 1 day after surgery and CD4 decreased at the 3rd postoperative day.In patients with pulmonary operation,CD8 decreased at the 1st day and 7th day after surgery.NK cells decreased at the 5th postoperative day CD3 increased at the 5th day after surgery.CD4/CD8 increased at the 7th day after operation.In patients with esophagus and gastric cardia surgery,CD4/CD8 decreased 1 day after operation,CD3 and CD4 increased at the 7th postoperative day.All differences are statistically significant( P

Ojective To study the application and the effect of extrathoracic minimally invasive surgery on the patients with mediastinal mass. Methods The therapeutic result of 6 cases of mediastinal mass resected through minimal extrathoracic approach were retrospectively reviewed. Results 6 patients underwent successfully operation and recovered smoothly without any complication or operation death. A following up period lasting two years showed that no recurrence or metastasis occurred. Conclusions Extrathoracic minimally invasive surgery has the advantages of minimal invasion, quicker recovery and complete resected tumor. It may substitute the classical thoracotomy and could obtain the same therapeutic in the selective cases.

Objective To compare the values of classic thoracotomy (CT), subaxillary mini thoracotomy (SAMT), and video-assisted thoracoscopic surgery (VATS) in the treatment of pneumothorax. Methods Postoperative parameters of 3 groups (a total of 78 patients with pneumothorax)-Group CT, Group SAMT, and Group VATS-were compared retrospectively. Results Recurrent numbers of the 3 groups were 1, 1, 0, respectively. Among the 3 groups, the Group CT had the longest drainage time ((4 1?3 1) days) and hospital stay ((11 8?4 6) days), the most drained fluid ((585 0?564 4) ml) and the maximum of Dolantin requirement ((71 7?42 2) mg) ( F =8 087, 41 191, 11 126, 12 528, respectively; P =0 001,

Objective To enhance the understanding of chest primitive neuroectodermal tumor (PNET) and improve the results of management. Methods The results of 10 cases of chest PNET, which had been surgically treated and pathologically confirmed from 1999 to 2004 were retrospectively analyzed. Results There were 6 intrathoracic tumors, 2 in the chest wall, 1 in the pericardium, and 1 in the posterior mediastinum. Two intrathoracic tumors were completely resected, 2 partially resected, tumor and the involved lung were removed in 2 cases. Two had tumor with the affected ribs removed and the chest wall reconstructed. Tumor and the invaded pericardium were removed in 1 case. The PNET in the posterior mediastinum, invading into spinal canal as a bell tumor, was excised by the thoracic surgeon cooperating with neurosurgeon. There was no hospitalization death. All the specimens demonstrated positive reaction to CD99 and negative to LCA. 4 cases received postoperatively adjuvant chemotherapy, 4 radiotherapy and chemotherapy, the other 2 cases had none adjuvant therapy. 7 patients died during 6 years of follow-up, with 9 to 27 months survival. 3 patients are alive and have over 12 months survival so far. Conclusion PNET is an aggressive and invasive malignant tumor with poor prognosis. Difficulties exist in diagnosis. Besides common microscopic examination, pathological histology and immunochemistry, even electron microscopic examination may be required in differential diagnosis. Complete removal of tumor and involved tissue plays an important role, postoperative adjuvant therapy, including radiotherapy or combination with chemotherapy, may prolong survival. Modalities that are more effective should be developed to improve the treatment results.

OBJECTIVETo investigate the changes and influencing factors of early postoperative pulmonary function of thoracotomy.

METHODSPre- and early postoperative pulmonary function was studied in 64 consecutive cases with optimal thoracotomy. Pain assessment was done before pulmonary function test, and the chief complaints of patients were recorded after the procedure. The changing curves of pulmonary function were done and the differences associated with groups, surgical styles, pain assessment, epidural analgesia, chief complaint and preoperative conditions were analyzed.

RESULTSPulmonary function was severely lowered to about 40% of the base line on the first day, and it was rehabilitated to about 60% of the base line on the eighth day. There was a greater gradient on the recovery curve on the 3rd and 4th days. Epidural analgesia was able to improve pain relaxation and pulmonary function in some degree. Single-factor analysis showed that postoperative pain, postoperative day and surgical style were the significant influencing factors for early postoperative pulmonary function. By multiple-factor analysis, preoperative pulmonary function, age and postoperative pain were the main factors, while surgical style had only weak effect on it.

CONCLUSIONSEarly postoperative pulmonary function is severely impaired by thoracotomy. It rehabilitate gradually with time. Improvement of preoperative pulmonary function, reducing surgical procedure injuries, especially injury to respiratory muscle system, and enough postoperative pain relief are the most important means that would reduce pulmonary function impairment and consequently reduce postoperative pulmonary complications.

Adult ; Age Factors ; Aged ; Analgesia, Epidural ; Female ; Forced Expiratory Volume ; Humans ; Male ; Middle Aged ; Pain, Postoperative ; etiology ; physiopathology ; therapy ; Postoperative Period ; Respiratory Function Tests ; Thoracotomy ; adverse effects ; Vital Capacity

Objective Placental transmogrification of the lung(PTL) is rare;summarizes the reported cases and add our two cases, to explore the best diagnosis and treatment strategy.Methods Review of the cases reported in the literature, combined with the 2 cases described in this article, summarizes the characteristics of PTL and analyzed the best diagnosis and treatment strategy.Results We reported two cases of placental transmogrification of the lung, both presented in the right lower lobe, imaging performance as a giant bulla with a cystic nodule.VATS lobectomy was performed in both cases, no complication after operation.Combined with literature review of 34 cases of patients to analyze the best diagnosis and treatment strategy.Conclusion Grossly and microscopically, the lesion resembles placental tissue, with formation of placental villus-like papillary structures covered by epithelial cells.The most common imaging manifestation of PTL is a bullous emphysema pattern or with a mixed pattern of thin-walled cystic lesions and nodules.Early diagnosis and surgical operation should be performed as soon as possible, these lesions are best treated by minimally invasive surgery, leaving as much normal lung tissue and avoiding pneumonectomy if possible.Surgical treatment is usually curable and leads to successful improvement of symptoms and quality of life.

BACKGROUNDLung cancer is still the most common cause of cancer death. Although it is reported that the 5-year survival rate for lung cancer has been greatly increased, surgical results are controversial. The aim of this study is to investigate and evaluate the improvement of survival of lung cancer surgically intervened in PUMC hospital during the last 15 years.

METHODSFrom January 1989 to December 2003, 1574 cases of lung cancer underwent surgical treatment and obtained follow-up. The results were retrospectively a- nalysed . All cases in this series were divided into two groups according to time, group A (1999-2003) and group B (1989-1998), and the differences of survival rate between group A and group B were compared.

RESULTSThe morbidity and mortality of group A decreased significantly when compared to group B (11.2% vs 19.2%, 1.06% vs 1.93%, respectively, P < 0.01). However, the 3- and 5-year survival rates had been obviously raised from 42.35% to 56.07%, and from 28.46% to 38.99%, respectively (P < 0.05 ). A significant improvement in survival was observed in patients with stageI, stage II and stage IIIA, but not in stage IIIB and stage IV. Also, the patients with lobectomy had better results but those with exploratory thoracotomy, limited resection, pneumonectomy and sleeve resection did not show better results.

CONCLUSIONSLobectomy associated with systematic dissection of mediastinal lymph nodes has become the standard mode for the resectable lung cancer. Combination of complete resection and lymph nodes dissection, with postoperative adjuvant chemotherapy based on platinum/3rd generation medicine, have preliminarily been justified and proved an important approach for effective improvement of long-term survival of lung cancer.

OBJECTIVETo understand the clinical manifestations, diagnostic methods, surgical management and prognosis of retrosternal thyroid masses in various pathological types.

METHODSSixty-four cases of retrosternal thyroid masses with surgical intervention were analyzed retrospectively.

RESULTSTrachea-compressed symptoms (65%) and shadows beside the trachea at thoracic inlet (94%) were the most common clinical findings, chest X-ray (70%) and CT scan (96%) had higher diagnostic rate. No death occurred during operation or hospitalization among these patients. Total complications occurred in 15.7% cases (11/70) (including 3 preoperative cases with hoarseness) and postoperative pathological results were mainly multinodular goiter (54.7%), thyroid adenoma (21.9%) and thyroid carcinoma (15.6%) (including local carcinomatous change).

CONCLUSIONSDiagnosis of retrosternal thyroid mass can be correctly made by chest X-ray and CT scan. Most operations on retrosternal thyroid masses can be performed safely through cervical incision with minimal morbidity and low recurrence rate. Retrosternal thyroid carcinoma was potentially invasive and could hardly be resected completely, hence with poor prognosis.

Adenoma ; diagnosis ; surgery ; Adult ; Aged ; Carcinoma ; diagnosis ; surgery ; Female ; Goiter, Nodular ; diagnosis ; surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Thoracotomy ; Thyroid Gland ; diagnostic imaging ; surgery ; Thyroid Neoplasms ; diagnosis ; surgery ; Thyroidectomy ; Tomography, X-Ray Computed

OBJECTIVETo study the clinical manifestations, diagnostic methods, surgical management and prognosis of patients with neurogenic tumors of the mediastinum.

METHODOne hundred and ten patients with neurogenic tumors of the mediastinum were analyzed retrospectively.

RESULTSAfter operation, 2 patients died in hospitalization and 8 experienced such complications as Horner's syndrome or laryngeal recurrent nerve paralysis. In 102 patients with benign tumors, 2 patients had recurrence, and 4 patients with neurofibrosarcoma or malignant neurilemmoma died within 3 years postoperatively.

CONCLUSIONSMost neurogenic tumors of the mediastinum are benign and could be diagnosed by chest X-ray or CT. The clinical manifestations, diagnosis methods, surgical management of the dumbbell tumors differ from others. Minimal invasive surgery and video assist thoracoscopy surgery are of special value in treatment of the selected neurogenic tumors of the mediastinum. Benign neurogenic tumors rarely recur after complete resection, and malignant neurogenic tumors have poor prognosis.

Adolescent ; Adult ; Aged ; Child ; Female ; Humans ; Male ; Mediastinal Neoplasms ; diagnosis ; mortality ; surgery ; Middle Aged ; Neurilemmoma ; diagnosis ; mortality ; surgery ; Neurofibroma ; diagnosis ; mortality ; surgery ; Prognosis ; Retrospective Studies