Objective To observe the effects and benefits of the gastroscopy-assisted thoracoscopic modified Heller operation for the treatment of achalasia of cardia. Methods Retrospective analysis was conducted on the clin﹣ical data of 33 cases in our hospital. The surgical approach was gastroscopy-assisted thoracoscopic modified Heller operation. The intraoperative and postoperative effect and complications were observed. All patients were followed up for six months. Results After operation 33 achalasia patients' symptom of obstruction is alleviated. 1 case changed to open operation because of severe adhesion; 4 cases esophageal mucosal were injured and need to be repair assisted by thoracoscope. 1 case had esophagopleural fistula after operation and was cured by conservative treatment in one month. 1 case had gastroesophageal reflux symptoms after operation and relief symptoms after conservative treatment. All patients were follow-up more than six months, only 1 patient recured eating obstruction in 3 months after opera﹣tion, and was cured by gastroscopic expanding treatment. Conclusions The results of gastroscopy-assisted thoraco﹣scopic modified Heller operation to patients with Achalasia is significant. The operation is easy to perform and the complications is less, it can be promoted and applied in clinical practice.

Objective To detect the expressions of VEGF and nm23 in non-small cell lung cancer (NSCLC) tissues and their relationships,and explore their clinical value in the diagnosis and treatment.Methods lmmunohistochemistry(SP method) was used to detect the expressions of VEGF and nm 23 in NSCLC and peritumor tissues.Results The positive expression rate of VEGF in NSCLC(63.3 ％,38/60)was significantly higher than in the peritumor tissues(16.7 ％,10/60)(x2=27.22,P＜0.01).nm 23 is on the contrary (53.3 ％,32/60)(x2=17.79,P＜0.01).The positive expression of VEGF in NSCLC was positively correlated significantly with the lymph node metastasis and histological classification(P＜0.05).The positive expression of nm 23 in NSCLC was negative correlated significantly with lymph node metastasis,P＜0.01.2-year survival rate of the VEGF-positive patients was significantly lower than that of VEGF-negative patients,and nm 23 is on the contrary(x2=5.55,P＜0.05).No correlation was found between the expressions of VEGF and nm 23 in NSCLC (x2=1.83,P＞0.05) Conclusion The VEGF and nm 23 may be closely associated to carcinogenesis and progression of NSCLC.Detection of VEGF and nm 23 are beneficial to indicate the biologic behavior of NSCLC.It has positive effect on diagnosis and treatment of NSCLC.

Objective To compare the effect of postoperative intercostal nerves cryoanalgesia and patient controlled epidural analgesia (PCEA) in patients undergoing thoracic surgery. Methods From April 2006 to May 2008,89 patients undergoing thoracic surgery were randomly divided into intercostal nerves cryoanalgesia group (group A,47 cases) and PCEA group (group B,42 cases). The scores of pain, use of pain medication and time of out-of-bed activity after the operation were used to evaluate the effect of pain between two groups. Results The scores of pain in group A and group B were (1.49 ± 0.80) and (2.43 ± 1.21) scores respectively. There were significant differences in the scores of pain. The use of pain medication [(1.28 ± 0.62) times vs (2.02 ± 1.05) times]and time of out-of-bed activity after the operation [(43.15 ± 12.22) h vs (64.10 ± 14.25) hi were significant difference between the two groups(P< 0.05). Conclusions For reducing the post- thoracotomy pain,intercostal nerves cryoanalgesia is superior to PCEA. Intercostal nerves cryoanalgesia can provide satisfactory analgesia after thoracic surgery.

Objective To evaluate the efficacy and adverse reaction of three-dimensional conformal radiation therapy (3D-CRT) combined with chemotherapy of paclitaxel in treatment of brain metastases from breast cancer in the elderly.Methods The 50 patients were randomly divided into observation group (n=26,radiation combined with chemotherapy) and control group (n= 24,simple radiation).In the early stage,both groups received common two-dimesional conformal radiation therapy.The total dose (DT) of whole brain irradiation was 30-40 Gy.In the later stage,the reduced field for the local lesion of brain metastases would be altered to 3D-CRT for the post period with 2 Gy 5 times a week.DT was added from 10-24 Gy up to total DT of 50-64 Gy.The patients were given paclitaxel 65-85 mg/m2 by intravenous drip at 1st and 8th day with synchronization of 2-4 weeks,having paclitaxel chemotherapy of 2-4 circle,28 days a circle.After 2 month treatment,the efficacy and adverse effects of the two groups were observed.follow up for 2 years,the long-term efficacy and survival rate were evaluated.Results The effective rate was 76.9% in observation group and 45.8% in control group,respectively (x2 =5.120,P＜0.05) and the KPS score was 80.8% and 54.2%,respectively.The quality of life was improved in observation group versus control group (x2 =4.059,P＜0.05).Compared with control group,hypoleukemia was significant in observation group (P＜0.05).The complications such as nausea and vomiting,hepatic dysfunction were more in observation group than in control group,but there was no statistical significance between two groups.There was statistic ally significant difference in 2-year survival rate between two groups (x2= 4.7260,P＜0.05).Conclusions The 3D-CRT combined with paclitaxel chemotherapy is a prefered choice for locally advanced brain metastases from breast cancer.More side effects and adverse reaction are observed in observation group.However,all the patients could tolerate them.It is worthy of popularization and application.

Objective To evaluate the prognostic value of intraoperalive detection in rib bone marrow micmmetastasis(BMMs)of patients with non-small-cell lung cancer(NSCLC)and the relationship between the micROmetast ases and clinicopathologic factors.Method From April 2004 to May 2007,146 patients undergoing surgical treatment for NSCLC were prospectively investigated for the presence of BMMs by the immunohistochemisury method.Remits 30.82%(45/146)of NSCLC patients were detected with BMMs,15(33.33%)patients developed remote metastases of the 45 patients with BMMs,14(13.86%)patients developed metastases of the 101 patients without BMMs.Patients with BMMs demonstrated an earlier metastasis and a lower survival rate compared with patients without BMMs(P＜0.05).There Was trend for ahigher frequency and the occurrence of BMMs changed with tumor stages and the histologic differentiation of the tumor.No relationship was found between BMMs and age,T grade,as well as tumor dimension.Conclusions The detection of BMMs can predict the prognosis of NSCLC patients and identifies patients withNSCLC who are at significantly increased risk for metastasis and survival,which may be useful in evalnatingpatients for adjuvant treatment

Objective To evaluate the prediction value on distant metastases of fib bone marrow micrometastases (BMM) of patients with non-small lung cancer ( NSCLC ). Methods From January 2003 to March 2006, 168 patients undergoing surgical treatment for NSCLC were prospectively investigated for the presence of BMM by using immnnohistochemistry. The sensitivity and specificity of the rib bone marrow micrometastases technique were also calculated. Receiver operating characteristic curve (ROC curve)was drawn according to data. Results Occult BMM were detected in 29.76 %(50/168) of patients with NSCLC. 15(29.76 %) patients developed metastases in the 50 patients with BMM and 15 (12.71%) patients developed metastases in the 118 patients without BMM. The sensitivity and the specificity of the technique was 61.54 % and 79.84 %. The false negative rate was 38.46 % and the false positive rate was 20.16 %. The positive predictive value, negative predictive value and Youden' s index were 87.5 %, 93.33 %, 74.33 % respectively. Conclusion The detection of BMM could predict the distant metastases of non-small lung cancer patients through receiver operating characteristic curve evaluation, however, the detecting sensitivity should be improved.

Objective To investigate the changes of hemodynamics and cardiac function in pediatric living donor liver transplantation (LDLT).Methods 50 cases of pediatric living donor liver transplantation in our hospital from January 2016 to January 2017 were collected.The hemodynamics was monitored by Mostcare with the radial artery.Acquisition of heart rate (HR),mean arterial pressure (MAP),peripheral vascular resistance index (SVR/SVRI),stroke volume / stroke index (SV/SVI),cardiac output (CO/CI),cardiac index / stroke volume variability (SVV),dp/dtmax (cardiac contractility),cardiac cycle efficiency (CCE) at the moment of the start of operation(T0),before occlusion of the inferior vena cava (T1),immediately after occlusion of the inferior vena cava (T2),anhepatic phase 30 min (T3),immediately after reperfusion(T4),neohepatic phase 5 min (T5),30 min (T6) and 60 min (T7).Results There were no significantly hemodynamic fluctuations before occlusion of the portal vein.At T3,the increased of MAP,CI,SVRI (T3 vs T0,P＜0.05),while CCE decreased significantly (T3 vs T0,P＜0.05);MAP,SVRI,lower HR,CI and dp/dtmax have different degrees of liver T4,but the change was not significant.SVV fluctuated in the anhepatic phase at 11％ ～ 15％,maintained in the new liver stage at 12％ ～ 15％,but fluctuated slightly.Conclusion Mostcare can be used to monitor the hemodynamic and cardiac function changes in pediatric living donor liver transplantation,but the reasons for the change of the monitoring indicators and the significance of guiding the perioperative treatment need to be further studied.