Objective Summarize 8 cases of non-small cell lung cancer (NSCLC) that has accepted completely video-as-sisted thoracoscopic sleeve lobectomy in People's Hospital of Peking University in china,to explore the safety,effectiveness indications and experience of this procedure.Methods Between September 2011 and December 2011,Medical records of 8 cases of non-small cell lung cancer that has accepted complete thoracoscopic sleeve lobectomy were reviewed (7 male,1 female).Median patient age was 62.4 years.And median maximal diameter of solid tumors was 2.3 cm.This group consisted of 5 cases of right upper lobe sleeve lobectomy,2 case of left lower lobe sleeve lobectomy and 1 case of left upper lobe sleeve lobectomy.The operation procedure was completely VATS anatomic sleeve lobectomy combined with systematic lymph node resection (at least 3 groups of lymph nodes in the mediastinum area).All procedure were underwent under general anesthesia with double-lumen endotracheal intubation.The patient was placed lateral decubitus position.Three incision were made at the seventh intercostal space on the median axillary line,the fourth intercostal space anterior axillary line and the seventh intercostal space subscapularis line.Bronchial were anastomosed combine with simple continuous suture anastomosis of membranous part of bronchus and simple interrupted suture anastomosis of cartilaginous part of bronchus,and then covered by? Surrounding tissue with blood supply? Results All procedures were carried out smoothly without serious complication.The median operative time was 240min median,the median bronchial anastomosis time was 45 min,the median blood loss was 200 ml,and median number of resected lymph nodes was 19.8.There were no conversion to open thoracotomy.Post operative show pathology squamous cell carcinoma in 7 cases and adenocarcinoma in 1 case.pTNM staging show 1 case of T1a N0 M0,4 cases of T1b N0 M0,2 case of T1b N1 M0 and 1 case of T1b N2 M0.There was 1 case of slight post operative complication.The median postoperative chest tube drainage duration was 7 days,and median postoperative hospital stay was 9 days.All patients were well during the followed up for 3-8 months.Conclusion Completely thoracoscopic sleeve lobectomy was a safe and effective surgical procedure for patients with non-small cell lung cancer; the operative incision placed at the fourth intercostal space anterior on the axillary line was convenient for anastomosis; anastomosis combine with simple continuous suture anastomosis of membranous part of bronchus and simple interrupted suture anastomosis of cartilaginous part of bronchus was a fast and secure mode; keeping azygos vein does not affect the anastomosis.

Objective To access the analgesia effect and side effect of flurbiprofen axetilcombined with sufentanil.Methods Thirty-eight patients underwent cardiac surgery were randomlydivided into two groups with nineteen cases each.Group S was given sufentanil 250μg diluted to 125ml via PCIA after surgery.Group F was given sufentanil 125 gg plus flurbiprofen axetil 150 mgdiluted to 125 ml via PCIA after surgery.The PCIA pump was set at a rate of 0.2 ml/h,bellus dosewas 0.8 ml.lockout time interval was 10 min. Analgesia grade was accessed,vital sign and sideeffects were recorded.Results 'Fhere was no significant difference in analgesia grade between tWOgroups.The side effects were lower in group F than those in group S.Conclusion Flurbiprofen axetilcombined with sufentanil can obtain similar analgesia effects to sufentanil alone,but can reduce sideeffects and fever temperature.

Objective To discuss the technical strategies for thoracoscopic lobectomy.Methods Between September 2006 and May 2008,a total of 91 patients underwent thoracoscopic lobectomy in our hospital.The lobectomy and lymph node resection were completed via three mini incisions with the same procedures as those in an open surgery.Among the cases,75 had primary or metastatic malignancies,and 16 showed benign tumor.By thoracoscopy,upper right lobectomy was carried out in 21 patients,right middle lobectomy in 12,lower right in 20,upper left in 18,and lower left in 20.Results Only two cases were converted to open thoracotomy.In the other 89 patients,the mean operation time for the thoracoscopy was(185.8?52.9)minutes(ragne,60-300 minutes),and the mean blood loss was 213.2 ml(range,50-650 ml).In this series,the chest drainage lasted(6.9?2.9)days;the patients were discharged from the hospital in(9.4?3.2)days after the surgery.No severe complications or perioperative death occurred in the cases except in one patient,who developed chylothorax after the treatment.Two patients,who had primary lung cancer,showed distant metastasis at 15 and 3 months respectively after the surgery.No recurrence or metastasis was found in the other cases.Conclusions Thoracoscopic lobectomy is safe and effective for patients with indications for the surgical procedure.Surgical skills for dissection of vessels and lymph nodes are the key to the operation.

Objective To review the primary experience of video-assisted rigid laser bronchoscopy in the treatment of tracheobronchial tumors. Methods From Sep.2002 to Nov.2004, 13 patients (15 procedures) with tracheobronchial tumors were treated with video-assisted rigid bronchoscope. Benign tumors with small pedicles were removed directly. For benign tumors with wide pedicles or tumors extending beyond the wall of air-way, total enucleating through thoracotomy were employed. In cases with malignant tumors, stenosis or obstructions were relieved by implantation of stents or cautering with electric argoulaser knife. For malignant but resectable primary tumors of trachea and main bronchi, rigid bronchoscopy might serue as a preparation of radical resection. Results Of the 5 patients with benign tumors, 4 received endoscopic total resection and 1 were conversed into thoracotomy. For the 8 malignant cases, 3 received stent implantation, 2 had palliative ablation and 3 got curative resections through thoracotomy. No peri-operative complications or death occurred in this group. Conclusion Total resection of benign tracheobronchial tumors or palliative therapy for tracheobronchial malignant stenosis or preparation of radical resection can be performed safely and efficiently by video-assisted rigid bronchoscopy.

Objective To evaluate the feasibility and safety of video-assisted rigid bronchoscopy in the treatment of benign tumors of tracheobronchus.Methods Seven patients with benign tumors of tracheobronchus were managed with video-assisted rigid bronchoscopic surgery in this hospital from September 2002 to April 2005.The endoscopic procedure was performed under general transvenous anesthesia and jet ventilation.The tumor was firstly frozen or electocoagulated for better bleeding control,and then was removed with a biopsy clamp by parts,with the pedicle treated with freezing,coagulation or argon plasma coagulation(APC).For tumors with a broad pedicle,after the bulk of tumor was ablated under bronchoscope,a conversion to open local resection was carried out.Results All the 7 operations was accomplished smoothly without mortality or severe morbidity.Except one patient with broad pedicle leiomyoma which was resected through thoracotomy after airway clean-up and intubation,all 6 patients with narrow pedicle tumors underwent a complete tumor removal endoscopically.Postoperative pathological reports confirmed the benign diagnosis as 2 cases of hamartoma,3 cases of leiomyoma,1 case of acidophilus granuloma,and 1 case of inflammation.Follow-up observations in the 7 patients for 3~36 months(mean,17.3 months) showed no recurrence.Conclusions Video-assisted rigid bronchoscopy in the treatment of benign tumors of tracheobronchus is safe and reliable.

BACKGROUNDMediastinoscopy has experienced a renaissance due to the introduction of neoadjuvant treatment protocols and recognition of the limitations of noninvasive mediastinal staging of lung cancer by CT and PET. The aim of this study is to determine the value of video-mediastinoscopy in mediastinal staging of lung cancer.

METHODSA total of 60 patients who underwent video-mediastinoscopy for known or suspected lung cancer were retrospectively reviewed. There were 52 cervical mediastinoscopies, 2 parasternal mediastinoscopies and 6 combined procedures. All the patients were found to have enlarged mediastinal lymph nodes on radiographic examination of the chest (more than 1.0cm on its shortest axis).

RESULTSOf the 60 patients, 42 patients were found with N2 or N3 disease on video-mediastinoscopy and then were confirmed pathologically. The other 18 mediastinoscopy-negative patients underwent thoracotomy for pulmonary resection and mediastinal lymph node dissection in the same operative session, in which thoracotomy-proven N0 was found in 17 patients, and N2 in 1 patient (false-negative result by video-mediastinoscopy). The sensitivity, specificity, and accuracy of video-mediastinoscopy for mediastinal staging of lung cancer were 97.7%, 100% and 98.3%, respectively. In the entire group of 60 patients, there was 1 complication (1.7%) , and no perioperative death.

CONCLUSIONSVideo-mediastinoscopy is a highly effective and safe procedure. It can be used routinely in mediastinal staging of lung cancer.

Adult ; Bone Neoplasms ; pathology ; surgery ; Femur Neck ; pathology ; Humans ; Male ; Osteochondroma ; pathology ; surgery

Objective To investigate the effect of MT-1 and MT-2 in liver damage in chronic inorganic arsenate exposure mice and to explore the mechanism of arsenic-induced liver damage. Methods The male Kunming mice were randomly divided into control and exposed groups. The control group was given ordinary feed and tap water. The exposed group was given ordinary feed and 300 mg/L of sodium arsenite solution by drinking water. After 10 months of treatment, the activity of serum alanine aminotransferase (ALT), aspartate aminotransferase(AST) and globulin (Glb) content were determined. The total RNA was extracted by the TRIzol-phenol-chlorofor-method from the liver tissue. The quantity of the RNA was determined by spectrophotometry and its purity was judged at a ratio of A260/A280. Then real-time PCR(RT-PCR) was used to measure the mRNA expression of MT-1 and MT-2. Results Compared with the control group, serum ALT, AST activity and Glb content were higher and the MT-1 and MT-2 mRNA content was lower in the exposed group (P

50 000 bp)was extracted from frozen gastric cancer tissue and their corresponding normal samples and used for RLGS assay.The genome DNA was digested by methylation-sensitive restriction enzyme Not Ⅰ, and labeled by radioisotope ~(32)p,then separated by two-dimensional electrophoresis and autoradiography. Experimental conditions for each step were optimized step by step.DNA fragment sequences for the dots on scanning profile were identified according to the human RLGS database.Results RLGS assay was set up and used to get the RLGS profiles of the representative tested samples successfully.These profiles can display more than 1 200 available dots averagely,the profiles of high quality DNA sample can display more than 1 800 dots which is the average level at an excellent RLGS lab,discrepant dots which had weaken or enhanced signals and their sequence information were obtained.The result can be reproduced.Conclusion The RLGS assay is established,stabilized for detection of DNA methylation of tissue samples.

Objective To analyse the difference between stage Ⅰ pure bronchioloalveolar carcinoma (BAC) and stage Ⅰ adenocarcinoma of the lung among operative cases.Methods We use the Lobectomy Cases Registration and Statistics System database (2006-2011) to compare the epidemiology,clinical presentation,image characteristics,surgical outcomes,recurrence and overall survival between BAC and adenocarcinoma groups.All the patients received lobectomy procedure in the department of thoracic surgery of Peking University People' s Hospital.Results Excluding those cases with both BAC and adenocarcinoma aspects,337 patients were enrolled.Thirty-nine patients were stage Ⅰ pure BAC and 298 patients were stage Ⅰadenocarcinoma.BAC has its proper clinical spectrum,occurring more frequently in women (69.2％ vs.52.0％,P =0.042)and in younger patients (57.4 vs.61.8,P =0.014).BAC also seems to be less dependent on tobacco exposure (12.8％ vs.29.9％,P =0.026).The percentage of ground-glass opacity (GGO) in CT scan of BAC patients was much more than that registered in adenocarcinoma patients (35.9％ vs.9.7％,P ＜0.001).And the tumor size of BAC group was smaller than that of the adenocarcinoma group (1.4 cm vs.2.3 cm,P ＜0.001).The operation method,time,blood loss and complications were similar between the two groups.Kaplan-Meier survival curves showed that both 3-year disease-free survival (DFS) and overall survival (OS) were significantly higher in patients affected by BAC (100％ vs.76.1％,P =0.030 and 100％ vs.86.1％,P =0.041).Conclusion BAC presents specificity in its epidemical,clinical,radiological and evolutionary aspects.Stage Ⅰ pure BAC patients have better prognosis following video-assisted thoracoscopic lobectomy and system lymph node dissection than the similar stage adenocarcinoma patients.