Objective To investigate the feasibility of video-assisted thoracoscopic surgery for anterior mediastinal modules. Methods Thoracoscopic surgery was performed with the patients in supine position and the thoracoscope set at 30?. Three trocars were used during the procedure. One of the trocars was inserted through the fifth or sixth intercostal space at the midaxillary line for direct observation. And the other two were placed at the second or third intercostal space at the midclavicular line,and the fifth intercostal space at the anterior axillary line. The nodules were removed directly during the operation. For inseparable nodules,the whole thymus and the fat tissues in the anterior mediastinum were removed all together. Results The procedure was completed under a thoracoscope in all of the 32 cases. Small assistant incision was made in 3 cases because of hemorrhage in the chest cavity. Postoperative pathological examination showed thymus tumor in 14 cases,hyperplasia of the thymus in 3,thymic cyst in 5,bronchial cyst in 3,pericardial cyst in 2,neurilemmoma in 2,lymph node in 2,and angioma in 1. The accordance rate of pre-and post-operative diagnosis was 68.8% (22/32). Postoperative complications were found in two patients,including one case of pericardial effusion,and one case of lung infection. Both the cases were cured afterwards. Conclusions Thoracoscopic surgery is a minimally invasive procedure for the treatment of anterior mediastinal nodules. It is optimal for young patients and cases with low lung function,as it causes less pain,quicker recovery,and satisfying cosmetic outcomes.

Objective To investigate indications of thoracoscopic resection of esophageal carcinomas. Methods A total of 75 patients with esophageal carcinomas underwent video-assisted thoracoscopic surgery (VATS) from July 1997 to July 2003. The dissection of the esophagus and radical resection of lymph nodes were performed using a right-sided VATS approach. Then the stomach was dissociated through an upper-abdominal incision and was pulled up for esophago-gastric anastomosis in the left neck. Results A conversion to open surgery was required in 3 patients, in 2 of whom the tumors had enroded into the hilum and the posterior wall of the heart, and in 1 of whom the azygous vein was ruptured. The operation time was 160~220 min, with the intrathoracic operation time accounting for 60~90 min. The postoperative blood loss was 300~400 ml. No surgery-related deaths were noted. Postoperative complications included 1 case of volvulus of stomach, 2 cases of anastomotic leakage, 1 case of anastomotic stenosis, and 1 case of chylothorax. Follow-up checkups in 60 patients for 3 months ~ 7 years (mean, 4 years) found 2 cases of supraclavicular lymph node metastasis and 1 case of abdominal lymph node metastasis. The 1-, 3- and 5-year survival rates were 85.0% (51/60), 51.7% (31/60) and 40.0% (24/60), respectively. Conclusions Video-assisted thoracoscopic resection of esophageal carcinomas is feasibly suited to patients with localized lesions at phaseⅠ or Ⅱ.

Objective To analyze the effect and clinical value of health behavior intervention on postoperative hope level and negative emotional in patients with lung cancer surgery.Methods From December 2014 to October 2017,170 cases with lung cancer in Taizhou Hospital of Zhejiang were selected.According to the intervention methods,85 cases were divided into control group and observation group.The patients in the control group were treated with routine nursing,the observation group received routine nursing combined with healthy behavior intervention nursing mode,and the nursing effect of the two groups was analyzed.Results After intervention,the anxiety self-rating scale score,depression self-rating scale score in the observation group were(45.43 ±3.08)points,(46.02 ±3.45)points,respectively,which in the control group were(50.02 ±6.62)points,(53.65 ±6.31)points,respectively,and the differences between the two groups were statistically significant(t=5.287,5.187,all P<0.05).After intervention,the positive attitude,positive action,and keep close relationship with others in the observation group were(13.04 ±2.88)points,(12.99 ±2.97)points,(13.23 ±2.96)points,respectively,which in the control group after intervention were(10.02 ± 1.71)points,(10.13 ±1.86)points,(10.09 ±1.69)points,the differences between the two groups were statistically significant(t=4.871,5.017,4.418,all P<0.05).After intervention,the scores of physical function,role function,emotional function,cognitive function,social function,fatigue,nausea and vomiting,pain in the observation group were(74.04 ±7.73)points,(76.99 ±6.34)points,(75.01 ±7.86)points,(73.76 ±8.54)points,(75.92 ± 6.18)points,(77.98 ±7.08)points,(79.32 ±8.32)points,(72.11 ±7.18)points,respectively,which were higher than those in the control group,the differences were statistically significant(t=11.387,10.386,12.487,11.672,13.987,9.438,14.687,10.438,all P<0.05).Conclusion The application of healthy behavior intervention in patients with lung cancer can reduce anxiety and depression negative emotions,improve the hope level,improve the quality of life,and deserve to be applied in clinical application.

Objective To study the mutation of FLCN gene in Chinese patients with sporadic and familial primary spontaneous pneumothorax. Methods A complete genetic analysis of FLCN by use of SSCP-PCR was performed in 102 unrelated Chinese patients with isolated PSP. Results Three novel mutations (c. 924_926del, c. 1611_1631del and c. 1740C.T) and a previously reported mutation (c. 1733insC) were identified in five familial and five sporadic PSP patients. Of the 21 family members of patients with PSP including 3 previous considered as sporadic, 4 ( 19% ) had history of at least one episode of PSP and 9 (43% ) were FLCN mutant carriers without PSP. Seven of the nine (78% ) mutant carriers had pulmonary cysts detected by high-resolution computed tomography ( HRCT) . Although c. 924_926del and c. 1611 _1631 del were found in eight patients from the same geographic district, haplotype analysis demonstrated that they did not share the same affected haplotype,thus excluding common ancestry. Conclusion This study first demonstrates that FLCN mutation contributes to not only familial but also apparently sporadic' patients with isolated PSP. It suggests that mutation analysis and HRCT scan may be recommended for first-degree family members of PSP patients with FLCN mutations, irrespective of their family history status of PSP.