Forty patients with pulmonary sclerosing hemangioma treated from 1971 to 1999 in General itospital of PLA were analyzed retrospectively for clinical and pathological features,and image characteristics. The results showed that 60%(24 of 40) of patients were middle aged or elderly women,and 40% (16 of 40) of patients had symptoms.On chest radiography,the tumor presented as a round or nearly round nodule or mass with sharp and smooth margin in 37 cases(92 5%).All patients received operation without complication or mortality.Immunohistochemical findings indicated that the tumor cells were positive for neuroendocrine markers,and neurosecretory granules were found in tumor cells by electron microscopy.There was no recurrence or metastasis at the follow up. It suggested that pulmonary sclerosing hemangioma is a benign neuroendocrine tumor that has a good prognosis if it is treated by operation.

Of the 49 patients(male 43, female 6) collected from October 1983 to April 2000, 46 were malignancy with 29 in TNM stage I, 15 in stage II, and 2 in stage Ⅲa. Age ranged from 10～68. Upper lobectomy with sleeve resection was performed in 43 cases(14 in left lung, 29 in right lung) and right upper lobectomy with wedge bronchoplasty in 2 cases, left upper lobectomy with bronchoplasty and angioplasty in 2 cases , left lower lobectomy with sleeve resection in 2 cases. There was no mortality in our group and all patients recovered well. No such major complications as bronchial anastomotic fistula or stenosis occurred. The 1,5 and 10 year survival rates of malignant cases were 93.0%, 48.1% and 8.3% respectively. The results suggested that the operation plan for malignant lung diseases should be made individually. However, instead of a total pneumonectomy, a sleeve lobectomy is sometimes preferabe for the sake of the safety in those with poor cardiopulmonary function to save the lung capacity as much as possible.

To assess the advantage, disadvantage and feasibility of small thoracotomy incision for intrathoracic operations. In 124 patients minimal thoracotomy incisions (MT) were made for infrathoracic surgery from July 1999 to June 2001. The operative approaches consisted of posterolateral incisions in 82 cases, axillary incisions in 17 cases, and anterolateral incision in 25 cases. The operations included 46 lobectomies, 8 pneumonectomies, 27 wedge resections, 13 mediastinum tumor resections, 13 bullae ligations with pleurodeses, 2 esophagectomy and esophagogastric anastomosis, 1 total gastrectomy and esophagojejunostomy, 9 explorations, and 5 other operations. There was no mortality or serious complication in this group. The patients had a faster recovery with less postoperative pain and better cosmetic result. Minimal thoracotomy incisions are safe and feasible approaches for intrathoracic surgery and worth recommending.

Objective To investigate the expression of LRP16 gene in lung cancer, and explore its clinicopathological significance. Methods Fresh resected tissues from 54 patients with primary lung cancer were collected and the clinicopathological data were gathered. The expression of LRP16 protein in cancer tissues and the matched normal tissues were determined by Western blotting, and the relationship between LRP16 expression and clinicopathological data was analyzed. It was defined as overexpression when the LRP16 expression of cancer tissues was twice or more higher than that of matched normal tissues. Results The LRP16 was overexpressed in 15 out of 54 patients with lung cancer (27.8%). Among the 23 patients with adencarcinoma, the overexpression of LRP16 was found in 11 cases (47.8%), while in the patients with squamous carcinoma, the overexpression of LRP16 was only found in 4 out of 27 cases (14.8%), and there was a significant difference between the two groups (Pearson test, P=0.0258). Besides, very low expression or non-expression of LRP16 was found in 2 large cell lung cancer and 2 small cell lung cancer. The overexpression rate of LRP16 was 20.0% (2/10) in tumor with diameter less than 3cm and 29.5% (13/44) in tumor with diameter ≥3cm, and there was no significant difference between the two groups (Pearson test, P=0.7224). Conclusions There were significant differences of LRP16 overexpression in cases of adencarcinoma or squamous carcinoma with or without lymphatic metastasis. It is suggested that LRP16 is a tumor-related gene of lung cancer, and may play an important role in molecular staging of lung cancer.

In this paper the authors submitted their experience in application of video assisted thoracic surgery (VATS) in 204 cases at the surgical clinic of the General Hospital of PLA (Oct.1992 Jun.2002). A retrospective analytic study was carried out to assess the value of VATS in terms of the diseases and the surgical anesthesia, operation modes, complications and result. A satisfying result in the group was obtained in each of the cases. There was no operative mortality or morbidity. The mean operation time was 110 minutes, the overall median duration of chest tube drainage was 2 days, and the mean hospitalization time was 9 days. The postoperative recovery was uneventful. As a minimally invasive surgical technique with very low morbidity, VATS is worth considering and has been established as a procedure of choice with exceptional results in various chest diseases. Our experience confirms the safety of VATS in both diagnostic and therapeutic procedures. Due to progress over the past several years, VATS is by now a standard surgical procedure in thoracic surgery, and has become an inseparable part of thoracic surgery. There are differences of opinion with regard to major pulmonary and esophageal resections for cancer, thus further clinical investigation deserves to be carried out.

Thoracoscopic esophagectomy is an alternative to open thoracotomy in treatment of esophageal carcinoma, but its role in esophageal surgery is still controversial. Between May 2000 and May 2002, 9 patients affected by esophageal carcinoma underwent esophagectomy with thoracoscopic dissection of the esophagus. Seven patients were male, 2 were female,and the mean age was 51 (range, 42～56) years.One patient had the carcinoma at cervical segment, 2 at upper third thoracic segment, 5 at middle third, and 1 at lower third.All tumors were squamous cell type and were below stage II.Thoracoscopy and cervical esophagogastrostomy were successfully performed in 8 patients except in one case, in whom conversion to thoracotomy was necessary because of extensive tumor invasion.Thoracoscopic dissection took an average of 70 (range,40～120) minutes and the mean operative time was 252(range,230～270) minutes. the mean operative blood loss was 250ml (range,150～400ml) and the mean number of thoracic lymph nodes harvested was 7(range,5～12).One patient experienced a cervical infection,which healed with conservative treatment.One patient had a temporary left recurrent nerve palsy that disappeared during the following 6 months.These initial data indicate that thoracoscopic esophagectomy is safe and feasible. The short term result of thoracoscopy is comparable with that of open thoracotomy, and the long term result and its role in esophageal surgery deserve further investigation.

To investigate the relationship between partial esophagectomy with staple anastomosis for carcinoma and gastroesophageal reflux (GER). The pressure in the esophagus and intrathoracic stomach was measured with SG-Ⅱ computer manometer in 45 patients. Twenty-four-hour esophageal pH monitoring, endoscopy and pathological examination were performed in 20 patients. Resting pressure above the esophago-gastric anastomosis was higher than that under the esophago-gastric anastomosis. Twenty-four-hour pH monitoring revealed that GER occurred. Abnormal findings were observed in 80% of patients by endoscopic and pathological examinations. The results showed that GER existed in the patients after esophagectomy and esophagogastrostomy for esophageal cancer. The occurrence of GER with stapling anastomosis were similar to that with manual anastomosis. The occurrence of GER was not related with the length of postoperative period. Sleeping in semirecumbent position was an effective method to prevent GER for postoperative patients. Twenty-four-hour pH monitoring was a reliable method for detecting GER.

Objective With the development in optics and video systems, video assisted thoracoscopic surgery (VATS) in the diagnosis and treatment of esophageal lesions has come to clinical use. The experience with the method in 12 patients admitted to the surgical department of the General Hospital of PLA from Oct.1993 to Sept.2001 was summarized. Methods Of the 12 patients (male 10, female 2) with the age ranging from 34 to 63, 10 were suffering from malignant tumors (9 squamous carcinoma, 1 adenoid cysticcarcinoma) with 5 in TNM stage 1, and 5 in stage 2, and 2 were having benign tumors (1 esophageal leiomyoma, 1 esophageal cyst). In 7 patients with malignant tumors, esophagectomy was performed through the right thorasic cavity followed by asophagogastrostomy in the neck, and in 3 patients the anastomosis was done in the right thoracic cavity. A left thoracoscopic extirpation of esophageal leiomyoma and esophageal cyst was performed in patients with benign tumors. Thoracotomy was necessary in 3 patients. All patients were ventilated with a double lumen endotracheal tube, so that only the ipsilateral lung collapsed. Results There was no operative mortality in the group. Mean time for freeing the esophagus through thoracoscope was 70 minutes, and mean overall operation time was 252 minutes. 7 enlarged mediastinal lympha nodes were excised. The mean postoperative drainage volume was 180ml/24h and the mean duration of drainage tube was 2 days. The patients were discharged from the hospitals 9～13 days after the operation. Two postoperative complications occurred, one presented as left recurrent laryngeal nerve injury and the other as incision infection. Conservative therapy was given and recovery was uneventful. Conclusions As a minimally invasive surgical technique, VATS was a feasible and effective option in the treatment of esophageal lesions. Complications of VATS were similar to that of conventional open chest surgery. There is still controversy with regard to esophageal resection with VATS for malignant tumors, therefore further investigation is necessary.

Objective To evaluate the value of intraoperative ultrasonography (IUS) in detecting the lymph nodes in mediastinum and hilum during lung cancer surgery. Methods Lymph nodes were detected in every part of the mediastinum and hilum by IUS in 33 cases with lung cancer during surgery. The number, size and location of lymph nodes were recorded, and the metastasis to lymph nodes was predicted by the sonographic features and geometric measurement respectively. Mediastinum was explored and lymph nodes resection was performed in each case, and each resected lymph node was sent for pathological examination. Results The sensitivity of IUS in detecting lymph nodes in mediastinum and hilum was 83.6% (163/195) and the positive predictive value was 97.0%(165/168). The result of detecting lymph nodes with IUS was influenced by their location and size. The sensitivity, specificity and accuracy of IUS in diagnosing lymphatic metastasis with respect to geometric measurement were 70.3%, 71.7%, 71.2%, respectively, and were 85.7%, 75.0%, 83.3%, respectively, with respect to sonographic features. Conclusions IUS was an effective method for lung cancer surgery in detecting mediastinum lymph nodes.

Objective To investigate a novel therapeutic strategy in the treatment of lung cancer with diffuse pleural metastasis accompanied by malignant pleural effusion. Methods From December 1978 to February 2003, 55 patients of carcinoma of lung with pleural metastasis underwent the comprehensive therapy characterized by pleuropneumonectomy. A follow-up of all the patients after hospital discharge was conducted. Results Death due to complications was found in 2 out of the 55 patients, but remission and significant improvement of symptoms were found in the rest. A follow-up period ranging from 1 to 25 years revealed that 48 patients survived for 5-40 months (median survival time: 14 months), and 5 patients were still living and well. Conclusion Strict control of the surgical indications and radical removal of the malignant tumor can improve the quality of life and prolong the survival time of patients, even there is already metastasis to the pleura.