Objective To compare the levels of serum CEA, NSE and CYFRA21-1 of patients with lung cancer and those with benign lung diseases, and to evaluate the clinical differential diagnostic value of combined detection of serum CEA, NSE and CYFRA21-1 in patients with lung cancer. Methods CEA, NSE and CYFRA21-1 were determined with enzyme-linked immunosorbent assay in 122 patients with lung cancer and 37 patients with benign lung diseases. The data was analyzed by t test. Results The serum levels of CEA(12.95?33.04ng/ml), CYFRA21-1(4.87?0.638ng/ml) in patients with lung cancer were significantly higher than that in those with benign lung diseases (1.92?0.84ng/ml and 4.87?0.638ng/ml, respectively)(P0.05). The levels of serum CEA, NSE and CYFRA21-1 were related to types of pathology. The highest levels of CEA, NSE and CYFRA21-1 appeared in adenocarcinoma, small cell carcinoma and squamous cell carcinoma, respectively. The level of serum of NSE (26.05?20.69ng/ml) in patients with small cell carcinoma was significantly higher than that of the patients with benign lung disease, adenocarcinoma (11.26?6.97ng/ml) and squamous cell carcinoma (12.71?7.64ng/ml), respectively (P0.05). Conclusion Combined determination of serum levels of CEA, NSE and CYFRA21-1 is helpful in differential diagnosis of lung cancers.

Objective To review and sum up the clinicopathologic features and surgical therapeutic efficacy of intrathoracic Castleman′s disease (CD). Methods 14 patients with intrathoracic Castleman′s disease, 7 in each sex, aged from 19 to 52, admitted during 1982 to 2005, all underwent surgical treatment, among which 11 with localized type and 3 with multicentric type, were retrospective analyzed on their clinicopathologic features, radiological signs, treatment and prognosis. Results Clinically, 3 patients of localized type were with systematic symptoms; all the patients of multicentric type were with various severity systematic symptoms. Pathological type: 9 cases with hyaline vascular type (HV), 2 cases with Plasma type (PC), and 3 cases with Mixed type (Mix). A different pattern of pathologic alterations existed between HV、PC and Mix types of CD. Radiological features: in localized type of CD, the lesion presented as a solitary soft-tissue mass with a mean diameter of 5.05cm, the mean CT value was 37.39HU. In 3 cases with multicentric type of CD, diffuse mediastinal lymphadenopathy and pleural effusion were observed. All patients survived after surgical resection, long-term survival was achieved in 11 cases with localized type and 2 cases with multicentric type, no recurrence occurred in the 13 patients. Recurrence occurred twice in a patient with multicentric Mix type in the fourth and the ninth year after surgery, respectively, thus the operative treatment followed. Conclusions The diagnosis of CD is based mainly on its histopathological features. The patients with intrathoracic localized type of CD and part of the patients with multicentric type CD could be cured, while part of the patients with multicentric type CD got a poor therapeutic efficacy and unfavorable prognosis even underwent with radiotherapy and integrated treatment.

Objective To investigate the biodistribution and positron emission tomography (PET) imaging of 3′-deoxy-3′-~ 18 F-fluorothymidine (~ 18 F-FLT) in a murine model of pulmonary carcinoma, and to evaluate the use of ~ 18 F-FLT as a new PET tracer for diagnosis of pulmonary malignant tumor. Methods 40 T739 mice bearing the pulmonary adenocarcinoma were randomly divided into five groups according to different tracers and time after their injection (n=8/group). The biodistribution of mice for ~ 18 F-FLT was measured with well-gamma detector at 30min, 60min, 90min, 120min after injection via the tail veins. The biodistribution of mice for ~ 18 F-FDG was examined at 60min after injection as controls. In addition, the PET imaging of mice was performed using two tracers. Results In the biodistribution study of ~ 18 F-FLT, considerable radioactive uptake in tumor was observed, and high radioactivity was showed in the kidney and spleen. The T/NT ratios of tumor/blood, tumor/muscle and tumor/lung was all above 2.0. The tumor PET images with ~ 18 F-FLT were clear, as well. Conclusions The uptake of ~ 18 F-FLT in pulmonary adenocarcinoma is higher than that in normal tissues, thus the pulmonary neoplasm could be identified accurately with PET imaging. Our preliminary study of ~ 18 F-FLT in lung carcinoma xenografts is satisfactory, and it provides a basis for further clinical study.

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.

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.