OBJECTIVETo evaluate the result of surgical treatment of the middle and upper-middle esophageal carcinoma with a new operation, performing the anastomosis posterior to the aortic arch at the apex of the thoracic cavity.

METHODSFrom April 1996 to May. 2000, 179 patients with esophageal carcinoma were treated. Sixty-eight of these patients (49 in the middle and 19 in the upper-middle segment) were treated by esophogogastrostomy at the top of the chest, posterior to the aortic arch. There were squamous cell carcinoma 50, adenocarcinoma 16, undifferentiated carcinoma 2, including 8 double-primaries. The lesions were stage I 9 and stage II-III 59.

RESULTSAll patients have been alive after follow-up of 2 months to 3 years. Without any positive margins, anastomotic leak or perioperative death, this new method has merits: 1. Length of esophagus resected was maximal through one single incision. It would be especially useful for some of the upper-middle lesions. 2. This new method requires a shorter transposed stomach than that required by the combined triple cervico-thoraco-abdominal approach. 3. As the site of thoracic stomach was on the bed of esophagus, there was less chance of post-operative embarrassment in respiration due to the dilatation of the transpositioned stomach and pylorostenosis, etc. 4. There would be less chance of reflux esophagitis because of the "blocking" by the aortic arch, thereby, the patients life is improved.

CONCLUSIONThis radical operation for esophageal carcinoma with anastomosis at top of the thoracic cavity posterior to the aortic arch, being a newly designed surgical method, is especially useful for carcinoma in the middle and upper-middle esophageal segment.

Anastomosis, Surgical ; methods ; Aorta, Thoracic ; surgery ; Esophageal Neoplasms ; surgery ; Follow-Up Studies ; Humans ; Thoracic Surgical Procedures ; methods ; Treatment Outcome

Objective:An ultra-high performance liquid chromatography coupled with quadrupole-orbitrap high resolution mass spectrometry （UPLC-Q-Orbitrap HRMS） was developed to analyze and identify the chemical constituents in Coptis chinensis inflorescence. Method:The chromatographic separation was performed on ACQUITY UPLC BEH C₁₈ column （2.1 mm×100 mm， 1.7 μm） with the mobile phase of 0.1% formic acid aqueous solution （A）-acetonitrile （B） for gradient elution （0-15 min， 10%-22%B； 15-20 min， 22%B； 20-25 min， 22%-44%B； 25-35 min， 44%-50%B； 35-40 min， 50%-60%B； 40-55 min， 60%-85%B）， the flow rate was 0.15 mL·min^-1， the injection volume was 3 μL and the column temperature was 30 ℃. HRMS was equipped with electrospray ionization （ESI） and scanned in positive and negative ion modes by means of full scan/data dependent secondary scan （Full MS/dd-MS²）. Compound Discoverer 3.0 software combined with mzCloud， mzVault， ChemSpider databases and HRMS database of components in traditional Chinese medicine were used to analyze and identify the collected data by HRMS， based on accurate relative molecular mass， retention time and characteristic ion fragmentation of the compounds， as well as literature information and relevant reference materials. Result:A total of 51 chemical constituents were identified in C. chinensis inflorescence， including 16 alkaloids， 14 flavonoids， 7 phenylpropanoids， 7 organic acids and 7 others. Among them， 10 components ［berberine， palmatine， coptidine， rutin， quercetin， isoquercitrin， chlorogenic acid， cryptochlorogenic acid， D-（-） quinic acid and D-proline］ were unambiguously identified by comparing with reference standards. Conclusion:The established UPLC-Q-Orbitrap HRMS can be used to accurately analyze and identify chemical constituents of C. chinensis inflorescence. A total of 41 chemical constituents are reported from C. chinensis inflorescence for the first time and 6 alkaloids are found from the C. chinensis for the first time. These findings can provide methodological reference and experimental basis for the basic research of quality evaluation and efficacy materials of C. chinensis inflorescence， and lay a foundation for its further development and utilization.