This paper analyzed the problems that currently exist in clinical practice and put forward the countermeasures to improve the quality of clinical practice,such as enhancing ideological and political education of practice students,mending check-up system in clinical practice,and so on.

Fast-track surgery (FTS) protocols was introduced to reduce surgical stress and facilitate postoperative recovery.It has been more than 20 years since it had been proposed and it was successfully used in many special subjects such as orthopedic,upper gastrointestinal,gynecological,thoracic,vascular,endocrine et al,but the implication in radical cystectomy was insufficient.The propose of this article was to summarize the implication of FTS in radical cystectomy and to promote the development of the protocol in radical cystectomy.

Objective To study the indication and means in dissection lymph nodes of the No.10 and No.11 without splenectomy in radical gastrectomy for gastric cancer. Methods According to the location, type of pathology, clinical and pathological classification, lymphatic drainage and spread of gastric carcinoma togather with the immunological function of spleen, selection of operative procedure without splenectomy should be considered, so the related literatures were reviewed. Results Retained spleen had been shown to improve 5 year survival of patients with gastric cancer of stage Ⅰ,Ⅱ and Ⅲ,splenectomy had been shown to improve 5 year survival of patients with gastric cancer of stage Ⅳ,whose carcinoma was infiltrating splenic and the lymph nodes of the No.10. The complications of different means of dissection of the lymph nodes made no difference.Conclusion Dissection of the lymph node without retained spleen or allogenic spleen transplantation is indicated for the patients with cancer of stage Ⅳ,whose spleen is invaded by the tumor.

The thread-dragging therapy, as a new external treatment of traditional Chinese medicine, could eliminate pathogenic factors and restore the vital qi by promoting qi and activating blood circulation to advance tissue repair in treating refractory sinus tracts or fistulae. This article reviewed its origin and development, and introduced its use in treating refractory sinus tracts or fistulae.

Objective To analyze laparoscopic lymphadenectomy and the safety of gastrectomy for gastroesophageal junction cancer.Methods From Jan 2011 to Dec 2012 72 gastroesophageal junction cancer patients were enrolled, including 46 patients in laparoscopic group, and 26 in open surgery group.Results There was no significant difference in the numgbers of lymph node dissection between the two groups and nor difference in the number of positive lymph node dissection.Esophagus resection length in open group was (2.0 ± 1.0) cm, while that was (3.0 ± 0.8) cm in laparoscopic group (t =0.471, P ＜ 0.001).5 (19％)patients in open group had positive margins compared to six in laparoscopic group (13％), x2 =0.491, P =0.483.7 patients in the open group underwent thoracoabdominal resection, while in laparoscopic group 3 patients did, x2 =5.781, P =0.016.Laparoscopic splenic hilar lymphnodes dissection harvested more lymph nodes (t =0.260, P =0.011).Laparoscopic gastrectomy used less operation time (t =0.237, P =0.021) experinced less blood loss (t =0.451, P ＜ 0.01) than open group.There was no difference in major complications between the two groups.Conclusions Laparoscopic splenic hilar lymphnodes dissection in gastroesophageal junction cancer surgery is superior to open surgery, with more lymph nodes harvested, longer esophageal cutting distances, lower incidence of thoracoabdominal surgery, shorter operation time, and less blood loss.

Objective To introduce a novel technique of intracolonic shunt procedure used in the anus - preserving operation for acute intestinal obstruction resulted from cancer at low and middle portions of rectum and assess the clinical significance. Methods In total, 81 patients with acute obstruction of low and middle portion of rectum caused by cancer were randomly ( random number) divided into control group and study group. In control group, 42 patients were operated with preventive transverse colonostomy or terminal ileum stoma after low proximal resection of rectum involved in cancer, while 39 patients were operated with intracolonic shunt procedure by using a biodegradable anastomosis ring and a condom placed 5 cm above anastomosis for protection in study group. Results There were no significant differences in sex, age, tumor site, tumor size and the distance from anstomosis to anal-edge between two groups. In both groups, the bowel movement resumed in 2 ~ 5 days after operation (P > 0.05). In study group, the rate of anastomosis leakage was 7.7% (3/39), and leakages were treated with drainage for 7.1 days in average to be healed, and the biodegradable anastomosis ring detached and were discharged in 14 -23 days (17 days in average), and there were no complications of drainage happened. The anastomotic stenosis occurred in three patients (7. 7% ) within 6 months after operation. In control group, 11.9% patients (5/42) had anastomosis leakage and they treated with drainage for 18.2 days in average to get the leakage healed, and 35. 7% patients (15/42) had stoma complications, and anastomotic stenosis happened in 28.6% patients (12/42) within 6 months after operation, and 7. 1% patients need another operation because of severe anastomosis stenosis. There were no significant differences in rate of anastomosis leakage between tow groups ( P > 0. 05), but there were significant differences in drainage days after anstomosis leakage happened and 6 - months anastomosis stenosis between two groups (P<0.05). Conclusions In the anus -preserving operation for acute intestinal obstruction at low and middle portions of rectum caused by cancer , the intracolonic shunt procedure is convenient and safty, and reduces the hazard incurred by anastomosis leakage and anastomosis stenosis compared with classic stoma operation.

BACKGROUNDvinorelbine/cisplatin is an important regimen for advanced non-small lung cancer (NSCLC), but the side effect is severe . This study aims to compare the efficacy and toxicity of vinorelbine/cisplatin and vinorelbine/oxaliplatin regimens in the treatment of advanced NSCLC.

METHODSOne hundred and twenty six inoperatable or recurrent patients with stage III and IV NSCLC were randomized into vinorelbine/cisplatin group and vinorelbine/oxaliplatin group. All of them were treated by the two regimens responsively for 2 or 3 cycles.

RESULTSThe overall response rate was 48.4%(30/62) for vinorelbine/cisplatin group and 42.2% (27/64) for vinorelbine/oxaliplatin group, the partial response rate was 45.2% (28/62) and 40.6% (26/64) respectively. There was no statistically significant difference of overall response rate between two groups (P > 0.05). The major side effects were leukopenia and gastrointestinal reaction, 25 patients (40.3%) in vinorelbine/cisplatin group and 10 patients (15.6%) in vinorelbine/oxaliplatin group had grade III+IV leucopenia (P < 0.05). Eleven patients (17.7%) in vinorelbine/cisplatin group and 3 patients (4.7%) in vinorelbine/oxaliplatin group had grade III+IV gastrointestinal reaction (P < 0.05). Seven patients (11.7%) in vinorelbine/cisplatin group and 60 patients (93.8%) in vinorelbine/oxaliplatin group had neurotoxicity (P < 0.05).

CONCLUSIONSBoth vinorelbine/cisplatin and vinorelbine/oxaliplatin regimens are effective for advanced NSCLC. Compared with vinorelbine/cisplatin regimen, vinorelbine/oxaliplatin regimen has less bone marrow toxicity and gastrointestinal toxicity but higher neurotoxicity.

BACKGROUNDTracheal adenoid cystic carcinoma (TACC) is a rare, low malignant and primary tracheal carcinoma, which is easily misdiagnosed and missedly diagnosed. The aim of this study is to increase the knowledge about TACC.

METHODSData including clinical manifestations and treatment were retrospectively analyzed for 8 cases of TACC confirmed by pathology and follow-up was carried out.

RESULTSThe main manifestations were cough, stridor, hemoptysis and progressive inspiratory dyspnea. Fiberoptic bronchoscope and computerized tomography were reliable examinations for final diagnosis. Five cases underwent operative treatment, and three cases underwent interventional treatment by fiberoptic bronchoscope in which 1 case accepted a second operation after recurrence and 2 cases accepted chemotherapy after operation. One case was lost, 1 case treated by interventional treatment died after 11 months and other 6 cases were followed-up from 2 months to 34 months who were alive.

CONCLUSIONSTACC is low malignancy and has good prognosis. The best treatment is operation. The better palliative treatment is interventional treatment by fiberoptic bronchoscope which can relieve symptoms and improve the patient's living quality.

BACKGROUNDSarcomatoid carcinoma (SC) is a rare malignant cancer with mixed tumor and sarcomatoid tissues. The aim of this study is to investigate the clinical manifestations and pathological findings of sarcomatoid carcinoma of the lung.

METHODSData including clinical manifestations, pathological findings, treatment were retrospectively analysed from fourteen patients with lung sarcomatoid carcinoma confirmed by pathology and follow-up was carried out.

RESULTSMean age at onset was 62 years old and gender ratios (M/F) in these patients was 6:1. The clinical manifestations of lung sarcomatoid carcinoma were similar to that of other types of lung cancer while there were characteristic findings on the enhancement CT scan. Bronchofiberscopy was not a reliable examination for final diagnosis. Cells with endothelial phenotype could be detected by immunohistochemical method.

CONCLUSIONSThe final diagnosis of this disease depends on histopathological observation, while the diagnosis may be missed among patients without surgical intervention. Immunohistochemical examination is helpful for diagnosis and differential diagnosis. The therapeutic strategy is coincident with that for non-small cell lung cancer.

BACKGROUNDMalignant pleural effusion is one of the common complications in patients with advanced lung cancer. Intracavitary injection of drug is a usual method, but it also exhibits unstable efficacy and obvious adverse reaction. The aim of this study is to evaluate the efficacy of hyperthermia combined with intracavitary injection of drug for malignant pleural effusion.

METHODSFifty patients with malignant pleural effusion caused by lung cancer were randomized into two groups after puncture or closed drainage. Group A was treated with hyperthermia combined with intrapleural injection of cisplatin and interleukin-2. Group B was treated only with intrapleural injection of cisplatin and interleukin-2.

RESULTSThe response rate of pleural effusion was 88% in group A and 60% in group B (P=0.024). The quality of life in group A was significantly better than that in group B (P=0.013).

CONCLUSIONSHyperthermia combined with intracavitary injection is effective and secure in treatment of malignant pleural effusion.