To compare the effect of surgical and non-surgical treatment for multiple fractured ribs retrospectively, with 30 cases in each group. Patient's length of stay, visual analogue scale ( VAS) pain, independent ambulation time, cost of hospitalization, thoracoplasty degree and the lung ventilation function were evaluated. The results showed that VAS declined obviously in patients of surgical group, length of stay and independent ambulation time were shorter. Compared to the non-surgical group, the maximal voluntary ventilation increased significantly and ref-erral rib reduction was significantly better, but cost of the surgical group was higher. It's an effective treatment for using nickel titanium memory alloy embracing fixator in the treatment of multiple fractured rips, and is worthy of clinical application.

Objective To investigate the change and effect of operation on TK1,CEA, SCC-Ag and CYFRA21-1 level in non-small cell lung cancer patients. Methods From January 2013 to August 2013, 55 patients with NSCLC and 29 patients with benign lesions were recruited. The tumor indexes including TK1,CEA, SCC-Ag and CYFRA21-1 were measured by electrical chemiluminescence assay. Results ① Serum TK1, CEA, SCC-Ag and CYFRA21-1 level and the positive rates in NSCLC patients during preoperative period were higher than the benign disease control group ( P<0. 05 ) . ② Serum TK1 level changes in NSCLC patients preoperative and postoperative one week and one month showed a trend of hump-shaped curve, there was no obvious statistically significant differ-ence ( P>0. 05 ) . Serum CEA , SCC-Ag and CYFRA21-1 level of postoperative one week and one month in NSCLC patients were significantly lower than the level before the operation ( P<0. 05 ) . Serum CEA and CYFRA21-1 level of postoperative one week and one month in NSCLC patients showed no significant difference compared with benign disease control group ( P>0. 05 ) , serum TK1 and SCC-Ag level of the postoperative one week showed statistically significant difference compared with benign disease control group ( P<0. 05 ) , the postoperative one month level of serum TK1 and SCC-Ag showed no significant difference compared with benign disease control group ( P>0. 05 ) .③The preoperative level of TK1 and CEA in adenocarcinoma were higher than that in squamous carcinoma ( P<0. 05 ) . ④ The preoperative level of serum TK1 and CYFRA21-1 in female NSCLC patients were higher than male patients, the difference was statistically significant ( P <0. 05 ) , preoperative serum CEA and SCC-Ag level of NSCLC patients showed no obvious statistical correlation with gender ( P>0. 05 ) . The preoperative level of serum TK1 in NSCLC patients negatively correlated with the degree of differentiation of lung cancer, the difference was statistically significant ( P<0. 05 ) . Conclusion The perioperative level of tumor markers in NSCLC may be useful in monitoring diagnosis and differential diagnosis of NSCLC, especially in analyzing the invisible tumor burden of NSCLC patients. The perioperative level of tumor markers in NSCLC is related with the surgical effect and tissue types, and serum TK1 and CEA are more suitable for the evaluation of patients with lung adenocarcinoma. There is some value in the clinical applications.

Objective To investigate the characteristics of lymph node metastasis in T 1 stage of lung cancer and the curative effects of minimally invasive surgery and open surgery .Methods Totally 120 cases of T1 stage of lung cancer were divided into two groups ,68 cases in the minimally invasive surgery group and 52 cases in the open surgery group ,the number of lymph node me‐tastasis in the patients with lung cancer in T 1 stage were studied ,the perioperative related indicators for different tumor size were compared between the two different surgical methods .Results All patients were successfully completed the operation without op‐erative death case .The two groups had no significant difference in the aspects of operation time ,intraoperative bleeding volume and number of lymph node dissection .The lymph node metastasis rates in the maximum tumor diameter ≤1 .0 ,1 .0 -3 .0 cm were 1 .3% and 9 .7% respectively .N1 ,N2 squamous cancer of the maximal tumor diameter ≤1 .0 cm had no metastasis .The periopera‐tive related clinical indicators in the maximal tumor diameter ≤1 .0 cm had significant differences between the two kinds of opera‐tion method(P<0 .05) ,the perioperative related clinical indicators in the maximal tumor diameter 1 .0-3 .0 cm had no significant differences between the two kinds of operation method .Conclusion The patients with T1 stage of lung cancer and the maximal tumor diameter ≤1 .0 cm are more suitable for the minimally invasive surgery ,but the patients with T1 stage of lung cancer and the maximal tumor diameter>1 .0 cm have little difference in minimally invasive surgery and open surgery .

ObjectiveTo discuss the surgical treatment for patients with anastomotic stoma cancer,gastric cardial cancer or esophagus cancer after subtotal gastrectomy.MethodsThe clinical data of 21 patients with anastomofic stoma cancer,gastric cardial cancer or esophagus cancer after subtotal gastrectomy were analyzed retrospectively.There were 4 cases with anastomotic stoma cancer after operation of gastric cardial cancer,2 cases with gastric cardial cancer after subtotal gastrectomy due to gastriculcer,3 cases with upper esophagus cancer after subtotal gastrectomy due to gastric ulcer,6 cases with mid-esophagus cancer and 6 cases with distal esophagus cancer after subtotal gastrectomy due to gastric ulcer.There were 6 cases treated with partial esophagus resection,resection of remaining stomach and jejuna-esophagus anastomosis,3 cases treated with partial esophagus and stomach resection and esophagus-gastric anastomosis,12 cases with subtotal esophagectomy and colon interposition.ResultsOne case with incision infection,1 case with anastomosis leaks,1 case dead of pulmonary infection.In the 20 follow-upcases,4 cases were dead of cardiac and cerebral accidents at the third year after operation,and other 16 cases survived and had normal diet.ConclusionsReoperation is still one of the best choices for patients with anastomotic stoma cancer,gastric cardial cancer and esophagus cancer after subtotal gastrectomy when their body condition are acceptable and without distant metastasis.The organ for digestive tract reconstruction should be decided according to the situation of the first gastrectomy and the proficiency of the operator.

Objective To detect methylation of p16 gene in lung cancer tissues of non-small cell lung cancer patients,and to approach its clinical diagnostic value.Methods The methylation of p16 gene in DNA from 47 non-small cell lung cancer tissues and corresponding nomalignant tissues were tested with methylation-specific PCR(MSP).Results The total frequency of p16 methylation was significantly higher in lung cancer tissues than that in the corresponding malignant tissue(44.7%vs 17%)(P＜0.01).But there was no significant difference in detectiveness,clinical staging,clinical pathology type and clinical classification(P＞0.05).Conclusion The detection of methylation of p16 gene may be helpful to clinical diagnosis for non-small cell lung cancer,but its specify,sensitivity and feasibility need to be further studied.

Objective To investigate the feasibility of combined laparoscopic and thoracoscopic esophagectomy for esophageal carcinoma and gastro-esophageal anastomosis in right thoracic cavity.Methods We retrospectively analyzed the clinical data of 38 patients who underwent esophagectomy for esophageal carcinoma and gastro-esophageal anastomosis in right thoracic cavity from October 2011 to August 2012.To remove the stomach in laparoscopic and the esophagus in thoracoscopy.The main portion of a gastric conduit is created using three to four firings of a linear stapler(Ethicon Endo-surgery,Cincinati,OH) and jejunum stoma.Gastric conduit was pulled into the chest cavity and anastomosed to the esophagus.Results The average operative time was 280 minutes,the mean operative blood loss was 120 ml.No patient required laparotomy.No pulmonary complications or anastomotic leaks occurred.One had gastric retention,another one had chylous hydrothorax.All patients were cured,no one dead in hospital.Conclusion Combined laparoscopic and thoracoscopic esophagectomy for esophageal carcinoma and gastro-esophageal anastomosis in right thoracic cavity is technically feasible and safe,minimized trauma,less operative blood loss and quick recovery.

Objective To explore the clinical effect of different thoracoscopic operation modes in the treatment of early lung cancer.Methods One hundred and twenty cases of early lung cancer surgery were selected as the research subjects and divided into 38 cases of thoracoscopic assisted small incision lobectomy group (group A),42 cases of thoracoscopic lobectomy (group B) and 40 cases of thoracoscopic lung segment resection (group C).Then the perioperative indicators,lung function recovery,complications occurrence rate and prognosis were compared among 3 groups.Results The perioperative indicators in the group B and C were decreased compared with the group A (P＜0.05),the postoperative pleural drainage amount in the group C was lower than that in the group B (P＜0.05).The postoperative lung function indexes in the group A were lower than those in the group B and C (P＜ 0.05),while the lung function indicators in the group C were higher than those in the group B (P＜0.05).The incidence rate of postoperative complications in the group B and C was lower than that in the group A,the difference was statistically significant (P＜0.05);the median follow up period in the three groups was 15 months(12-18 months).No recurrence or metastasis was found.Conclusion For the treatment of early lung cancer,the thoracoscopic lung segment resection can reduce postoperative pleural effusion and better protect pulmonary function,moreover the survival and prognosis have no obvious difference and its clinical curative effect is worth to be affirmed.

OBJECTIVETo investigate the safety and feasibility of forgoing postoperative nasogastric tube decompression in minimally invasive esophagectomy for patients with esophagus carcinoma.

METHODSClinical data of 90 eligible patients who underwent elective minimally invasive esophagectomy in our department from January 2012 to May 2013 by the same surgical team were retrospectively analyzed. Among them, 45 patients did not receive the use of postoperative nasogastric tube decompression and 45 patients received nasogastric tube decompression after operation. The observation parameters included the time to first flatus, the time to intake of fluid diet, the duration of postoperative hospitalization, pharyngalgia, vomiting, and postoperative complications, as well as the need for placing or replacing the nasogastric tube.

RESULTSThe incidence of pharyngalgia was significantly higher in nasogastric tube group (100% vs 44.4%, P<0.001). The time to intake of fluid diet [median 2 d(2-4 d) vs. median 9 d(7-20 d), P<0.001] and the time to first flatus [median 3 d(3-8 d) vs. median 6 d(3-9 d), P<0.001] were all significantly shorter in non-nasogastric tube group as compared to nasogastric tube group. Compared with the nasogastric tube group, the non-nasogastric tube group had shorter postoperative hospital stay (P<0.001). There were no significant differences in the incidence of postoperative complications and vomiting between two groups.

CONCLUSIONMinimally invasive esophagectomy without the use of postoperative nasogastric tube decompression is safe and feasible, which can improve recovery and shorten postoperative hospital stay.

Decompression ; Esophageal Neoplasms ; surgery ; Esophagectomy ; methods ; Humans ; Incidence ; Intubation, Gastrointestinal ; Minimally Invasive Surgical Procedures ; methods ; Postoperative Complications ; Postoperative Period ; Retrospective Studies