Esophageal cancer is ranked the eighth most common cancer worldwide,which severely threatens the health of human beings.Radical esophagectomy and regional lymphadenectomy through open approach offer the standard management for patients with locoregional disease,but it is associated with significant postoperative morbidity and mortality.It has been reported that minimally invasive esophagectomy (MIE) is associated with a substantial decrease in blood loss,complication rate and duration of hospital stay,and the resection rate,lymph node dissection and postoperative mortality were comparable to those of traditional open surgery.In this article,current views related to indications and contraindications,surgical options,operative positions,prevention of postoperative complications,as well as learning curve of MIE were discussed so as to promote the popularization of MIE.

Objective To retrospectively review the experience of esophageal manometry and 24-hour pH monitoring in esophagus surgery. Methods From 1982 to 2010, patients with unspecific chest pain and undergone esophageal surgery were received esophageal manometry and 24-hour pH monitoring. Results Among the patients with unspecific chest pain, 70.4%(74/105) were diagnosed as esophageal origin. Lower esophageal sphincter pressure (LESP) can be continuously maintained by using 360° fundoplication. Only a minority of patients who underwent transabdominal esophagocardiomyotomy and partial posterior fundoplication had acid reflux postoperatively. Incidence rate of achalasia of upper esophageal sphincter (UES) and pharyngeal "shoulder wave" in side-to-side stapled anastomosis is significantly lower than in traditional hand-sewn anastomosis,as well as contractive pressure in anastomosis region and occurrence of swallow discomfortableness. There is a high pressure region at the esophageal entrance in patients with bilateral platysma muscle flap for cervical esophagus defect following removal of hypopharynx cancer. And the pressure of the region is significantly lower than in healthy controls. Basal pyloric pressure and peak pressure of pylorus in phase Ⅲ of the migrating motor complex increased significantly after gastric conduit was made and anastomosed, but decreased appreciably following pyloric digital fracture. Peak pressure, frequency and duration time of isolated pyloric pressure wave ( IPPW ) decreased after pyloric digital fracture significantly. Conclusion Esophageal manometry and 24-hour pH monitoring are important tools for and diagnosing unspecific chest pain and evaluating the outcome of new surgical procedures.

Objective To study the feasibility and efficacy of operative method of maximal thymectomy by video-assisted thoracoscopic surgery(VATS)for myasthenia gravis(MG).Methods From August 2005 to June 2007,27 patients with MG received maximal thymectomy by VATS(VATS group).The thymus and fat tissues in the anterior and upper mediastinum were resected.Patients who received transsternal thymectomy from May 2004 to July 2005 served as a control(conventional group).Results In the VATS group,the maximal thymectomy by VATS was completed in 26 patients,one patient was converted to open surgery because of the injury to the brachiocephalic vein.Compared with the conventional group,the patients in the VATS group had fewer blood loss [(46.0?5.7)ml vs(120.0?18.8)ml,t=-19.231,P=0.000],lower level of analgesic requirement(3 vs 12,?2=7.068,P=0.008),and shorter postoperative hospital stay [(7.0?1.2)d vs(11.0?2.5)d,t=-7.379,P=0.000].There was no significant difference in the operation time,myasthenia gravis crisis,and surgical outcomes between the two groups.Conclusions Maximal thymectomy by VATS is feasible and safe for patients with MG.Patients have shorter hospitalization,less surgical trauma and pain,lower rate of complication,and quicker recovery after the treatment.Further studies are needed to investigate its long-term efficacy

Objective　To explore the expression of Fas ligan d (FasL) protein in human non-small cell lung cancer (NSCLC) and its clinic al significance. Methods　Expression of FasL protein was detecte d by immunohistochemical method in 32 resected tumors of NSCLC. Results 　FasL protein was detected in all of these 32 resected tumors with variant pos itive expression levels ranging from 3.0% to 98.7% ［mean (62.0±32.0)%］. T here wa s significant difference between the tumors of different pathological types no s ignificant difference was found between the tumors of different differentiation nor among the tumors of different pTNM stages (P>0.05). Conclusion　 The results indicated that NSCLC can counterattack the immune cells of t he body and may be the molecular basis for the easily metastasis of adenocarcino ma to in the early stage.

Objective To explore the effects of smog and elastase on the pulmonary functions and histology during the pathogeny of rabbits' chronic obstructive pulmonary emphysema. Methods Forty-eight New Zealand rabbits were divided into smoking, elastase, combined and control groups,and given smog produced from cigarette or injected elastase into trachea. Seven weeks later, pulmonary functions, artery blood gas analysis and pulmonary histology were detected. Results Compared with control group, vital volume (V T),forced expiratory volume in 0 3 second (FEV 0 3 ),FEV 0 3 /FVC (forced expiratory capacity), PaO 2,PaCO 2,total lung capacity (TLC),functional residual capacity (FRC), density of alveolar septum (Ds), number of alveolus (Na) and diameter of alveolus (Da) in both elastase (P0 05). Morphological changes of obstructive emphysema were noticed under naked eyes and optical microscope in combined group, while only slight changes could be seen in elastase group. No above change was observed in smoking group. Conclusions Rabbits' obstructive pulmonary emphysema can be induced by elastase, and smog can increase its induction and formation.

Objective To summarize the experience and the outcome of the reconstructive operation with colon or stomach for scarred stricture after esophageal burns. Methods This retrospective report reviews the clinical history of reconstructive operation with colon or stomach for scarred stricture after esophageal burns. 74 cases underwent esophageal reconstruction by colon without resection of scarred esophagus, 26 cases esophagogastric reconstruction with resection of scarred esophagus. Results In the group reconstructed with colon there were 5 postoperative deaths, including mediastinal infection caused by necrosis of transposition colon in 2 cases. Other postoperative complications included cervical anastomotic leakage in 14 cases and anastomotic stenosis in 4 cases. In the group reconstructed with stomach, there was no operative death and only 2 anastomotic stenosis and one empyema occurred after operation. Conclusion The proximal esophageal scarred stricture beyond the lower edges of aortic arch could be replaced by colon bypass without resecting the scarred esophagus. The esophagogastrostomy could be performed after excising scarred esophagus with the anastomosis can be made below the aortic arch. The postoperative complications in the group of reconstruction with colon were higher than the group of reconstruction with stomach. Improvement in surgical technique may decrease the complication rate of reconstruction with colon.

Objective To study the clinical significance of cryoanalgesia of intercostals nerves for relieving the chest pain and the stress after thoracotomy. Methods 166 patients undergone post-lateral thoracotomy were enrolled for study, including 107 cases of cryoanalgesia of intercostals nerves as cryo-group and 59 cases of non-cryoanalgesia as control group. The patients who had exploratory thoracotomy were excluded. The visual analogue scales (VAS), dosage of dolantin as well as the plasma levels of cortisol and ?-endorphin, and the complications after operation between the two groups were compared and analyzed. Results After operation, the VAS of cryo-group was much lower than that of control group for 7 days, so did the dosage of dolantin during the first 3 days. The complications in the control group were much more than that in the cryo-group who had lower levels of cortisol and ?-endorphin in plasma. Conclusion Cryoanalgesia of intercostals nerves was proved to be a simple, inexpensive, safe form for relieving post-thoracotomy pain. It could not only dramatically relieve the pain and stress level, but also reduce the risk of complications especially in elderly patients.

0.05) in the two periods,the ratio of tracheostomy was significantly higher (P

Objective To evaluate the therapeutic effect of single-sided lung volume reduction surgery (LVRS) with different resection volumes on obstructive emphysema in rabbit. Methods Obstructive emphysema was reproduced in 50 New Zealand white rabbits with smog and elastase, and they were randomly divided in equal number into emphysema (A), small volume LVRS (B), moderate volume LVRS (C), large volume LVRS (D), and shame operation (E) groups. LVRS with different resection volumes was carried out groups B, C, and D. Pulmonary functions, artery blood gas analysis and pulmonary histology were determined 8 weeks later. Results Compared with those in group A, vital volume (V T), 0.3 second forced expiratory volume (FEV 0.3), FEV 0.3/FVC (forced expiratory capacity), PaO 2, density of alveolar septum (Ds) and number of alveolus (Na) were increased postoperatively, and PaCO 2, total lung capacity (TLC), functional residual capacity (FRC) and diameter of alveolus (Da) were decreased in group C (P0.01). Morphological improvements of emphysema were noticed under naked eye and optical microscope only in C group. Conclusion Single-sided LVRS with appropriate resection volume can improve effectively obstructive pulmonary emphysema in rabbit.

With the increasing of doctor-patient conflicts,the communication between them gradually becomes a critical element in medical service activities.How to improve the doctor-patient communication is an important content in resident communication skill training.Oncology is a developing discipline with fast development and high risk and residents in oncology department need more communications with patients in the era which individualized treatment is emphasized.Systematization and institutionalization of the training system of doctor-patient communication is beneficial to popularizing doctor-patient communication experiences,protecting the rights and interests of them and ensuring the smooth process of medical treatment.