To evaluate and summary clinical experience in video assisted thoracoscopic surgery (VATS)for some thoracic diseases, clinical data of 616 patients (644 times) subjected to thoracoscopic surgery in our hospital from December 1993 to December 2001 were retrospectively analyzed. Among them, spontaneous pneumothorax occurred in 276 patients, emphysema in 44, mediastinal tumor or cyst in 55, esophageal diseases in 78, pulmonary malignant or benign diseases in 75, and other diseases in 65. Double lumen tracheal tubes were placed in 576 patients, single one was placed to ensure one lung ventilation in 6 patients and two lung ventilation in 34 patients. surgical procedures were completed by VATS in 593 cases, and 23 cases were converted into thoracotomy because of pleural adhesion or tumor invasion. Postoperative complications occurred in 24 cases with a morbidity rate of 4 0%. Persistent air leak (over 7 days) were noted in 15 cases and postoperative bleeding in 3. One case with spontaneous pneumothorax and type Ⅱ respiratory failure died of repiratory failure on the fifth day postoperatively. Six of 276 patients with spontaneous pneumothorax relapsed. VATS has more advantages than tranditional thoracotomy for some selected chest diseases,so thoracic surgeons shoulds convert tranditional thoracotomy method to perfom VATS step by step.

Objective To discuss the necessity of mediastinal lymph node dissection in the resection of lung cancer. Method 740 patients with lung cancer underwent lobectomy or pneumonectomy during Jan. 1987 to Dec. 2002 in our hospital were retrospectively analyzed. Totally 3492 lymph nodes were removed and checked up pathologically. Result Lymph nodes with metastasic were confirmed in 362 out of the 740 cases, and the metastasis ratio was 48.9%, and among them in 276 patients suffered N_2 lesion, with the ratio of 37.3%. The statistic result showed that lymph node metastasis was correlated to the location, cell type, the size, T stage and differentiation of lung cancer. Conclusion Lymph node metastasis in lung cancer is common and related to multiple factors. In order to obtain radical cure, both mediastinal and hilar lymph nodes should be removed.

Objective To retrieval the ways of prevent complications of video-assisted thoracoscopic surgery. Methods The operation included bullectomy in 462 patients, resection of mediastinal tumor or cyst in 86; esophageal diseases in 94, lobectomy or wedge resection of lung in 140, VATS hemostasis in 22, partial pericardial or pleural excision in 54 and biopsy for undetermined chest diseases in 54. Combined anesthesia with intubations of double lumen tracheal tube was performed in 866 patients and single-lumen tracheal tube in 46. Results 886 operations were completed by VATS, and 26cases were converted into thoracotomy for various reasons. Complications occurred in 36 patients (3.95%), including 10 cases occurred during the operation (esophageous mucous rupture in 4, nerve injury in 2 and insufficient hemostasis leading to postoperative bleeding in 4). 26 cases (2.85%) developed complications postoperatively, including persistent air leak (≥7 days) in 19, pleural effusion making a second water-sealed drainage necessary in 3, atrial fibrillation in 2 and infection in 1. One died for respiratory failure on the fifth postoperative day. Conclusion VATS experience should be gained systematically. In order to reduce the complications, more attentions must be paid to training of the thoracic surgeons in order to master the skill and the correlated knowledge of VATS.

Objective To report our experience on video-assisted thoracoscopic surgery(VAMT)for the treatment of benign esophageal neoplasm.Methods A total of 56 patients with benign esophageal neoplasm received VATS with or without auxiliary mini-thoracotomy in our hospital from March 1995 to January 2008.Under the assistance of a fiber gastroscope,through a 1.5-cm and two 2-cm incisions,the neoplasm was removed by using 3 trocars.In some cases,a 5-cm subaxillary incision was made.ResultsAmong the cases,the neoplasm was removed in 54 patients with VATS(with auxiliary mini-thoracotomy performed in 8),in which postoperative pathological examination showed esophageal leiomyoma in 47 and interstitialoma in 7.Two patients were converted to open surgery because of huge leiomyoma invading the muscular layer with an active growth,or low-malignant potential leiomyoma.Partial esophagectomy and end-to-end anastomosis were carried out in these two patients.No patient died intra-or peri-operation.No serious postoperative complication occurred in this series.A 2-to 128-month follow-up(mean,58.6 months)was achieved in 49 of the patients,none of them complained of dysphagia or developed recurrence during the period.Conclusions VATS(combined with mini-thoracotomy)is safe and effective for benign esophageal neoplasm.It can be the first choice for the treatment of the disease.

Objective To explore the methodology of the preventing the absorption after autog-enous fat granule mammaplasty, and the main point of the operative methods.. Methods The clinical data were reviewed in 30 cases of patients with liposuction combined with fat-grafting injection for breast mammaplasty in the past four years. The tumescent technique was used in liposuction and the volume of fat tissue aspirated was between 500 ml and 3250 ml. Using appropriate way we prepared pure fat granules and then evenly injected into the layer beneath the pectoralis major muscle, submam-mary layer and subcutaneous layer of the breast, respectively. Results The effect of the method was satisfying because sucking area was significantly decreased. From six months to 10 months follow-up, grafts showed no obvious absorption. The breast looked symmetry. Conclusion Fat grafting injection is a practicable method for breast mammaplasty. The key point is to use appropriate way to get pure fat granule and to prevent infection. It deserves to be recommended.

OBJECTIVETo investigate the surgical techniques and therapeutic effect of eyelid divided nevus.

METHODSFrom January 2000 to January 2014, 27 cases with 27 eyelid divided nevi were treated by staged excision (2 cases), or full-thickness skin graft (20 cases) or frontal and facial expanded flaps (3 cases), or combined expanded flaps with skin grafts (2 cases) for large lesions. One case with skin graft underwent secondary treatment with expanded flap due to obvious scar.

RESULTSExcept for one case with residue lesion (0. 5 cm x 0. 5 cm), all the other cases underwent successful treatment with primary healing. All the patients were followed up for 3-48 months (average, 7. 4 months). Except for one case with secondary expanded flap treatment, all the other patients were satisfied with aesthetic and functional results. No occurrence happened.

CONCLUSIONSStaged excision and full-thickness skin grafts are simple and effective method for eyelid divided nevus. For large lesions, expanded flap, or combined with skin graft should be considered.

Cicatrix ; surgery ; Esthetics ; Eyelid Neoplasms ; pathology ; surgery ; Humans ; Nevus ; pathology ; surgery ; Skin Transplantation ; Surgical Flaps ; Tissue Expansion ; Wound Healing

Objective:To study the effect of combined acupuncture and rehabilitation training on early-stage Barthel index of ischemic stroke cases.Method:Fifty ischemic stroke cases were randomized into a treatment group of 24 cases and control group of 26 cases.In addition to routine internal treatment methods,rehabilitation training was applied to cases in the control group,and combined acupuncture and rehabilitation training were applied to cases in the treatment group.Warming and reinforcing manipulations were applied to Jianyu (LI 15),Quchi (LI 11),Hegu (LI 4),Yanglingquan (GB 34),Yinlingquan (SP 9),Zusanli (ST 36),and Sanyinjiao (SP 6),20 min of needle retaining for each point in one treatment.Then the scores of clinical neurological impairment and Barthel index of stroke cases were evaluated before the treatment and 3 weeks after respectively.Results:The significant progress and progress cases in the treatment group were 14 and 12 respectively,whereas that in the control group were 6 and 11 respectively,coupled with 7 cases of no progress.The therapeutic effect in the treatment is substantially better than the control group (P＜0.05).There was no significant difference (P＞0.05) in neurological impairment and scores of Barthel index of the two groups before the treatment,whereas significant difference (P＜0.05) after the treatment.The scores of neurological impairment in the treatment group were significantly reduced after the treatment (P＜0.05),and the scores of Barthel index were significantly increased (P＜0.05).Conclusion:Combined acupuncture and rehabilitation training can produce significantly better effect on early neurological impairment and Barthel index of stroke cases than rehabilitation training alone.

Objective:To determine the effect of hypoxic stress on glioma cell XBP1 expression, the relationship between XBP1 expres-sion and sugar metabolism, the influence of XBP1 repression on the survival rate of glioma cells under normoxia and hypoxia, and the influence of XBP1 on glioma cell glycolysis. Methods:We tested XBP1 activation in human glioma cell lines cultured under normoxia and hypoxia. XBP1 expression was repressed with siRNA technology. Cells were treated with oxidative phosphorylation inhibitor. We then detected the variation in cell apoptosis, sugar metabolism mode, and cell apoptosis and glycolysis products under normoxia and hypoxia. Results:XBP1 activation increased under hypoxia. Silencing XBP1 expression reduced glioma cell survival level, ATP and lactic acid production, and glucose consumption under hypoxia. After inhibiting cell oxidative phosphorylation, XBP1 repression significantly reduced the survival level of glioma cells. Conclusion:Hypoxia can activate XBP1 in glioma cells. Under hypoxia, XBP1 silencing de-presses cell activity and glycolysis. Glycolysis of glioma cells under hypoxia depends on XBP1 activation.

BACKGROUNDTo explore the feasibility of extended resection in selective patients with centrally located lung cancer.

METHODSFrom January, 1987 to December, 2001, lobectomy or pneumonectomy combined with extended resection of trachea, bronchus, heart or great vessels were carried out in 134 patients with centrally located lung cancer. The operations included bronchoplastic procedures in 80 cases, extended resection and reconstruction of left atrium and/or great vessels in 54 cases (32 cases with contemporary bronchoplasty).

RESULTSOperative death occurred in one case. Postoperative complications happened in 16 cases (11.9%). One hundred and seventeen cases (94.4%) were followed up. The 1-, 3-, 5-year survival rate was 84.7% (61/72), 56.7% (34/60) and 45.7% (21/46) respectively, while of those combined with tracheo bronchoplasty and/or cardiovascular reconstruction, the 1-, 3-, 5-year survival rate was 69.2% (36/52), 46.8% (22/47) and 22.2% (8/36) respectively. (P < 0.05), while expression of KAI1 mRNA did not relate to mutant P53 protein expression (P > 0.05).

CONCLUSIONSExtended resection combined with tracheo-bronchoplasty and/or cardiovascular reconstruction is feasible for selected patients with centrally located lung cancer and could improve the survival and life quality of patients.