Objective: The role of planned neoadjuvant radiotherapy or chemoradiotherapy in the non-radical resection of esophageal squamous cell carcinoma was unclear. The study aimed to evaluate their therapeutic effect and analyze the prognostic factors. Methods: We retrospectively analyzed the clinical data of locally advanced esophageal squamous cell carcinoma who received neoadjuvant radio therapy (33 patients) and concurrent chemoradiotherapy (119 patients) from January 2004 to December 2016 in our single-institution database.The survival rates were calculated by Kaplan-Meier method. The prognostic factors were analyzed by using Log rank test and Cox proportional hazards model. Results: The median follow-up was 29.8 months. One hundred and one patients survived more than 3 years. The rates of overall survival (OS) and disease-free survival (DFS) at 3 years were 63.9% and 55.6%, respectively.The rates of complete, partial and minimal pathological response of the primary tumor were 50.3%, 38.4%, 11.3%, the corresponding 3-year OS were 75.5%, 57.4%, 27.3% (P<0.001) and 3-year DFS were 72.0%, 44.7%, 17.6% (P<0.001), respectively.The postoperative lymph node metastasis rate was 27.0%. The 3-year OS and DFS of the lymph node positive group was 45.6% and 32.8%, significantly lower than 70.8% and 63.7% of the negative group (both P<0.001). The 3-year OS and DFS of pathologic stage Ⅰ, Ⅱ, ⅢA, ⅢB and Ⅵ A were 76.2%, 57.4%, 64.7%, 35.0%, 33.3% (P<0.001) and 70.1%, 49.3%, 41.2%, 22.1%, 33.3% (P<0.001), respectively.The operation-related mortality was 3.3%. Multivariate analysis showed that chest pain, postoperative respiratory failure, pathological differentiation, more than 15 lymph node dissection and ypTNM stage were the independent prognostic factors of OS (P<0.05 for all). Conclusions: The planned neoadjuvant radiotherapy or chemoradiotherapy for the non-radical resection of advanced esophageal squamous cell carcinoma could result in favorable survival. The chest pain, postoperative respiratory failure, pathological differentiation, the number of lymph node resection and ypTNM stage are the independent prognostic factors of the prognosis of these patients.

食管胃交界部腺癌(adenocarcinoma of esopha-gogastric junction,EGJ)在国内传统上常常称为贲门癌.因其解剖位置的特殊性,虽然在肿瘤的命名、手术入路、消化道重建方式及淋巴结清扫范围等方面达成了诸多共识,但一直以来也存在较多争议.我们通过分析各学会最新的指南与分期系统,结合最新文献,探讨目前 EGJ外科治疗中的争议与共识.

Objective: To study the impact of the advance of the times and technological progress on the surgical treatment of lung cancer. Methods: The data of patients with non-small cell lung cancer treated by thoracic surgery at Cancer Hospital of Chinese Academy of Medical Sciences from 2005 to 2015 were retrospectively analyzed. The population distribution, operation methods and treatment results were analyzed retrospectively. Results: 510 patients (in 2005) and 1 235 (in 2015) non-small cell lung cancer patients were included in this study. The proportions of male patients (79.0% vs. 55.8%), smoking (52.9% vs. 30.1%), squamous cell carcinoma (50.2% vs. 22.4%) and video-assisted thoracoscopic surgery (VATS) (0 vs. 61.1%), stage Ⅰ (15.2% vs. 36.8%), the number of lymph node dissection (21.8 vs. 16.6), intraoperative blood transfusion rate (9.6% vs. 1.9%), palliative resection rate (7.5% vs. 2.0%), the average length of stay (10.8 d vs. 7.6 d) were significantly changed. There was no significant difference in the average age of patients and operation time. Conclusion: There was a significant change in the distribution of population and surgical techniques in patients undergoing lung cancer surgery in last ten years.

[目的]探讨食管癌根治术后颈部吻合口瘘的独立危险因素.[方法]回顾性分析930例接受食管癌根治术并行颈部吻合患者的临床病理资料.详细记录患者各项围术期指标,分析患者发生颈部吻合口瘘的危险因素.[结果]患者颈部吻合口瘘的发生率为16.1％(150/930),颈部吻合口瘘相关死亡率为0.6％.单因素分析结果显示,一秒用力呼气容积与用力肺活量比值、一氧化碳弥散量占预计值比值、胸部手术史、腹部疾病史、慢性阻塞性肺疾病、外周血管疾病史、胰岛素使用、美国麻醉医师协会(ASA)分级、降主动脉钙化、腹腔干钙化、肝动脉钙化、术后使用呼吸机、二次开胸、呼吸衰竭、术后声嘶均与食管癌术后发生颈部吻合口瘘相关(P＜0.05).多因素Logistic分析结果显示一氧化碳弥散量占预计值比值、腹部疾病史、外周血管疾病史、降主动脉钙化以及术后使用呼吸机为食管癌术后发生颈部吻合口瘘的独立危险因素(P＜0.05).[结论]食管癌根治术后颈部吻合口瘘的发生和多种因素密切相关,关注这些因素并做好围术期管理,可减少颈部吻合口瘘发生,避免出现严重的术后并发症.

Objective: To analyze risk factors of anastomotic leakage after McKeown'sesophagectomy. Methods: The clinical data of 635 esophageal cancer patients, who underwent McKeown's esophagectomy at Cancer Hospital of Chinese Academy of Medical Sciences from January 2012 to December 2015, were retrospectively analyzed. The risk factors of cervical anastomotic leakage were identified through analysis of medical history, surgical procedure, tumor characteristics and vascular calcification. Results: Among all the 635 patients, anastomotic leakage occurred in 111 (17.5%)patients. Univariate analysis showed that the American Society of Anesthesiologists (ASA) risk class, prior thoracic surgery, upper digestive tract ulcer, COPD, hypertension, peripheral vascular disease, renal insufficiency, FEV1% predicted, DLCO% predicted, duration of surgery and calcification of descending aorta, celiac trunk and left postceliac arteries were associated with a statistically significant increase in risk of cervical anastomotic leakage (P<0.05 for all). Logistic regression analysis showed that ASA risk class, peripheral vascular disease, renal insufficiency and calcification of descending aorta and celiac trunk were independent risk factors of cervical anastomotic leakage after McKeown's esophagectomy (P<0.05 for all). Conclusions: ASA risk class, peripheral vascular disease, renal insufficiency, calcification of descending aorta and celiac trunk are independent risk factors of cervical esophageal anastomotic leakage after McKeown's esophagectomy.

近年来,宫腔镜电切术在国内临床上已广泛开展,为子宫肌瘤患者的康复带来了福音.2011年5月至2015年5月我院应用宫腔镜下电切术(TCRM)或加用宫腔镜子宫内膜切除术(TCRE)治疗子宫黏膜下肌瘤患者取得了满意效果,本文对宫腔镜下子宫黏膜下肌瘤电切术的临床效果及安全性进行回顾分析,报告如下.

本文通过对2014年1～6月我科诊断的82例异位妊娠患者的彩超声像学资料进行回顾性分析,以探讨彩超诊断异位妊娠的要点与注意事项,报告如下. 1 资料与方法 1.1 临床资料 2014年1～6月在我院就诊并行腹腔镜微创手术治疗的异位妊娠患者82例,年龄21～46岁、平均32.6岁,停经时间33～68天.本组患者术前均行彩超检查获得诊断并经手术及术后病理检查确诊.

OBJECTIVETo explore the clinical characteristics of patients with bilateral synchronous multiple primary non-small cell lung cancer (NSCLC) and identify the prognostic indicators associated with survival.METHODSFrom January 2010 to December 2014, clinicopathological data of 96 patients with bilateral synchronous multiple primary NSCLC, who met the modified Martini-Melamed criteria and underwent radical surgical resection, were retrospectively reviewed. Survival was estimated using the Kaplan-Meier method, and the clinical parameters associated with survival were analyzed using a log-rank test. Cox proportional hazards regression models were used to identify the risk factors for this cancer.RESULTSOf the 96 patients, two patients who died of severe postoperative complications were excluded, and 94 patients were analyzed. Of the 94 cases, a two-stage operation was performed in 93 patients, while a single-stage bilateral surgery was performed in only one patient using video-assisted thoracic surgery (VATS). 79 patients had 2 tumors and the other 15 patients had 3 or more tumors. There were 82 patients with synchronous tumors located in different lobes and 12 patients had at least two tumors located in the same lobe. Seventy-six patients were found to have multiple lung adenocarcinoma and 12 patients had multiple squamous cell carcinoma (SCCs). Five patients had adenocarcinoma and SCC, and one patient had adenocarcinoma and adenosquamous carcinoma simultaneously. Univariate analysis showed that the large maximum tumor diameter, highest pT stage and lymph node involvement were associated with an unfavorable DFS (P<0.01 for all), while female gender, small maximum tumor diameter, early highest pT stage and pN0 were associated with a better overall survival (OS). Multivariate analysis showed that highest pT stage and lymph node metastasis were independent prognostic factors for DFS and OS. Patients with a lower highest pT stage and negative lymph node metastasis had longer DFS and OS (P<0.05 for both).CONCLUSIONSThe diagnosis for patients with bilateral synchronous multiple primary NSCLCs should be made very carefully. Two stage surgical treatment is safe, reasonable and effective for patients with bilateral synchronous multiple primary NSCLCs in a relatively early stage. The highest pT stage and pN status are important predictors for long-term survival. Adequate pulmonary tissue resection with complete resection of multiple nodules and systematic lymphadenectomy are suggested.

目的：主要针对妇科慢性盆腔炎的临床治疗效果进行了分析研究。方法选用2012年4月至2014年4月期间我院收治的患者86例，随机划分为中药灌肠治疗组和常规西药对照组，每组43例。其中，常规西药对照组患者运用的是临床常用的西药抗炎抗感染手段用以治疗慢性盆腔炎，中药灌肠治疗组患者在此治疗手段上运用了具有清热化瘀之效的中药灌肠用以治疗慢性盆腔炎，并对比两组患者的临床疾病的治疗效果。结果两组患者经过我院常规治疗手段和中药灌肠治疗后，各项控制指标都有明显改善，但中药灌肠治疗组的指标改善情况显然要优于常规西药对照组。结论慢性盆腔炎作为妇科的常见生理疾病，在临床上应用中西医结合的治疗手段治疗该病的疗效十分明显，可以积极在临床上予以深度推广和应用。

Objective To investigate the effect of different surgical options on the short-and long-term outcomes of patients with esophageal gastrointestinal stromal tumors (E-GIST). Method The clinical and treatment characteristics of 28 consecutive E-GIST patients were retrospectively reviewed. Result All the patients underwent curative surgery, including endoscopic submucosal dissection (ESD, n=4), enucleation (n=13), esophagectomy (n=11). Patients in the esophagectomy group had the largest tumors (P<0.001), the longest mean operative time (P<0.001), and the mean post-operative hospital stay in this group was prolonged (P=0.001), while the incidences of perioperative complications of the three groups were similar (P=0.096). After a median follow-up of 48 months (range 3-156 months), two patients who underwent esophagectomy experienced recurrence, one patient developed liver metastasis, one patient had local re-currence and liver metastasis. Conclusion Surgical resection remains mainstay for the treatment of E-GIST, ESD and enucleation are the preferred surgical options.

目的 探讨恶性胸膜间皮瘤(MPM)的临床特征及预后因素.方法 回顾性分析1990年1月至2013年12月闯收治的151例MPM患者的临床资料,并分析其预后因素.结果 患者中位年龄52岁(16 ～ 78岁),有石棉接触史4例(2.6％).最常见的首发临床表现为胸痛(64例,42.4％).根据侵犯范围分为局限型(43例,28.5％)和弥漫型(108例,71.5％).治疗方式包括单纯手术23例(15.3％),单纯化疗63例(41.7％),手术+辅助治疗57例(37.7％),化疗+放疗8例(5.3％).随访到133例患者,中位随访时间13.0个月(0.3～158个月),中位生存时间19.0个月(95％ CI为11.5 ～26.5).1、2、3及5年总生存率分别为60.0％、44.6％、36.0％和28.3％.单因素分析结果显示,性别(P =0.048)、侵犯范围(P=0.005)、肿瘤分期(P =0.002)与预后相关.多因素分析结果显示,性别(P=0.013)和肿瘤分期(P =0.001)是影响预后的独立因素.结论 恶性胸膜间皮瘤预后差,手术、化疗、放疗及综合治疗的疗效均欠佳.性别及肿瘤分期是影响预后的独立因素.

Objective To provide information for proper diagnosis and treatment for thymus atypical carcinoid (TAC) by investigating the clinical characteristics, diagnosis, treatment and prognosis of the disease. Method The retrospective analysis was performed on the data of 12 patients with TAC from 1999 to 2014 in our hospital, and re-lated literatures were reviewed. Result Although computed tomography scan of the thorax showed the mass, there were nonspecific symptoms and radiological findings in all the 12 patients. 10 of 12 patients received surgical resec-tion, and 2 patients had excisional biopsy or aspiration biopsy, of which the samples were confirmed as TAC with pa-thology and immunohistochemistry. After surgery, 4 patients had not received adjuvant therapy, 3 patients were admin-istered with chemotherapy, and 2 had radiotherapy, chemotherapy plus radiotherapy were performed in 2 and radio-chemical resynchronization therapy in 1. The mean follow-up time was 25.6 months (8-46 months), during which 4 patients were found to be dead after tumor progression (survival time was 10, 25, 39 and 40 months, respectively), 3 patients survived after tumor progression (survival time was 43, 44, 46 months, respectively), 4 patients had tumor-free survival (survival time was 8, 10, 11, 16 months, respectively), 1 patient lost to follow up after 9 months. Con-clusion TAC is a rare and often misdiagnosed disease. The useful method of diagnosis of TAC depends on the pa-thology combined with the immunohistochemistry after surgery. Resection is usually an effective means of cure but the prognosis may not be good.

<正>开胸术后胸腔内气体和液体异常存留,应用胸腔闭式引流术已成为常规且被写进了教科书和各种临床指南。在全世界范围内,肺叶切除术后(包括上叶、下叶、双肺叶和袖状切除)传统的胸腔引流方法是放置两根引流管[1-2],其主要原因是双管引流效果可靠、并发症少,另外也受传统观念和经验习惯的影响。随着外科技术的发展、快速康复外科理念的兴起

Objective To study the method of inhaling isotretinoin with sufficient drug to the target cells for efficacy while avoiding systemic toxicity.Methods Mice were given single intraperitoneal(IP) doses of urethane or benzo(a)pyrene(BaP) or 4(methylnitrosamino)-1-(3-pyridyl)-1-butanone(NNK).The next day,exposures to isotretinoin aerosols for 45 min daily at 1.3,20.7 or 481 g/L were started.The low doses one exposures daily,the mid dose three exposures per week,the high dose twice a week.Results Total deposited doses were calculated to be 0.24,1.6 and 24.9 mg/kg for the low,mid and high doses,of which 16% was estimated to be deposited in the lungs.The deposited pulmonary drug doses were calculated to be 0.01%,0.07% and 1.1% of a previously reported ineffective oral dose in urethane-treated mice.After 10-16 weeks,mice were sacrificed to count areas of pulmonary hyperplasia and adenomas.For all carcinogens,the mice exposed to the high isotretinoin dose showed reductions of tumor multiplicity ranging from 56%-80%(P0.005).The mid dose was associated with reductions of tumor multiplicity by 67%-88%(P0.005).The low dose mice had non-significant reductions of 30%(P0.13) and 16%(P0.30) for BaP and NNK treated mice,respectively.For BaP-and NNK-treated mice,numbers of hyperplastic areas directly correlated to dose level and inversely to tumor number,suggesting arrested progression.Inhaled mid doses isotretinoin caused upregulation of lung tissue nuclear retinoic acid receptors relative to vehicle-exposed mice,RARα(3.9-fold vehicle),RARβ(3.3-fold) and RARγ(3.7-fold).Conclusions These receptors may be useful biomarkers of retinoid activity in this system.The results from this study suggest that inhaled isotretinoin merits evaluation in people at high risk for lung cancer.

Objective To observe the incidence and preventive results of postoperative lung infection in aged patients with esophageal cancer.Methods 129 cases over 60 years old with esophageal cancer were analysized retrospectively.They were divided into two groups to study the differentmethods of preventive influence at the incidence of respiratory tract infection.Results There was a significant difference in lung infection between group A and B(P0.05).Conclusion It can decrease the incidence of postoperative lung infection in aged patients to take some necessary prevention measures preoperatively and postoperatively.

OBJECTIVE:Study the effect of diet Retinoic Acid on retinoic acid receptors(RARs) α,β,γof rat liver.METHODS: Group A fed a physiological RA diet(3 μg/g of diet),GroupB fed a pharmacological RA diet(30 μg/g of diet) for 75 weeks.RESULTS: A diet containing pharmacological RA(30 μg/g of diet) induced liver RARs,RARα by 22-fold,RARβ by 14.6-fold and RARγ by 12.5-fold.A striking increase of RARα expression was evident in the nuclei of hepatocytes.CONCLUSIONS: Dietary RA stimulates liver RARs.These data support the concept that delivery of chemopreventive retinoids to liver tissue by dietary is a more efficacious way to attain up-regulation of the retinoid receptors.

Objective Study the effect of inhalation 13-cis-retinoic acid(13-cis-RA)on retin- oic acid receptors of rat lung.Methods Group A inhaled 13-cis-RA at daily deposited doses of 1.9mg·kg~(-1)·d~(-1);Group B inhaled at an aerosol concentration of 62.2mg/L for durations from 5 to 240min daily for 14 days.Results In group A,at day 1 retinoic acid receptor(RAR)αincreased 4.4-fold, RARβ8.2-fold and RARγ10.7-fold and at day 17 RARcαincreased 5.2-fold,RARβ11.0-fold and RARγ13.9-fold.At a lower aerosol concentration daily deposited doses of 0.6mg.kg~(-1).d~(-1) in group A,it was also effective at 28 days,lung RARαwas induced 5.7-fold,RARβ9.0-fold and RARγby 9.1- fold.Changed dose by adjusting exposure duration,it was also effective.Group B induced all RARs from 31.6-to 75-fold increased compared with the control at the shortest exposure time.Conclusion 13-cis- RA delivered to lung tissue is a potent stimulant of lung.These data support the concept that epithelial delivery of chemopreventive retinoic acid to lung tissue is a more efficacious way to attain up-regulation of the retinoid receptors and possibly to achieve chemoprevention.

OBJECTIVE To study the expressions and clinical significance of urokinase-type plasminogen activator (uPA) and uPA receptor (uPAR) in laryngeal squamous cell carcinoma (LSCC). METHOD The expressions of uPA and uPAR at protein level were examined in 50 cases of LSCC and 10 cases of normal peripheral tissues around cancer (as control) by strep avidin-biotin complex (SABC) immunohistochemical technique. The relationship between the expressions of uPA and uPAR was evaluated by the Spearman's rank correlation test. Mann-Whitney U-test was used to examine association of these factors with conventional clinical pathological factors. Pearson's chi-square test was used to analyze the relationship between uPA, uPAR and cervical lymph node status. RESULT The rates of the positive expression in LSCC of uPA and uPAR were 66% and 62% respectively, and a positive relationship between expression of uPA and uPAR (P < 0.05). There was significant correlation between the level of uPA expression and TNM stage or cervical lymph node status, either between the level of uPAR expression and TNM stage or cervical lymph node status. Neither tumor size, T-category, nor grade was significantly related with the level of uPA or uPAR expression. LSCC cases with concourse positive expression of these proteins revealed significant higher tendency of cervical lymph node metastasis than those with concourse negative expression (P < 0.01). CONCLUSION The expression of uPA and uPAR are increased in LSCC, and uPA, uPAR may contribute significantly to LSCC invasion and metastasis.

Objective To study the expressions of urokinase-type plasminogen activator (uPA) and nm23-H1 and the correlationship to invasion and metastasis in laryngeal squamous cell carcinoma (LSCC). Methods The expression of uPA and nm23-H1 at protein level was examined in 55 cases of LSCC with strep avidin-biotin complex (SABC) immunohistochemical technique. Results The rates of the positive expression in LSCC of uPA and nm23-H1 were 67.3% and 54.5% respectively, and the expression of uPA had a negative correlation with the expression of nm23-H1(P0.05). The expression of uPA was of positive relation to TNM staging or cervical lymph node metastasis(P0.05). The expression of nm23-H1 was of negative relation to TNM staging or cervical lymph node metastasis(P0.05). Cases of LSCC with uPA(+)/nm23-H1(-) revealed significantly higher tendency of cervical lymph node metastasis than those with uPA(-)/nm23-H1(+) (P0.05). Conclusion The expressions of uPA and nm23-H1 are correlated with cervical lymph node metastasis and TNM staging, and combined detection of these two may provide a useful clinical evidence.

OBJECTIVE:An accurate clinical TNM staging of lung cancer is essential for the precise determination of the extent of the disease in order that an optimal therapeutic strategy can be planned. This is especially true in patients with marginally resectable tumors. Clinical over-staging of the disease may deny a patient the benefit of surgery, whereas under-staging may oblige a patient to accept a fruitless or even harmful surgery. We aimed to analyze preoperative clinical (c-TNM) and postoperative surgico-pathologic staging (p-TNM) of lung cancer patients in order to evaluate the accuracy of our clinical staging and its implications on the surgical strategy for lung cancer.METHODS:We did a retrospective comparison of c-TNM and p-TNM staging of 2007 patients with lung cancer surgically treated from January 1999 to May 2003. Preoperative evaluation and c-TNM staging of all patients were based on physical examination, laboratory studies, routine chest X-ray and CT scan of the chest and upper abdomen. Other examinations included sputum cytology, bronchoscopy, abdominal ultrasonography, bone scintiscan, brain CT/MRI, and mediastinoscopy whenever indicated.RESULTS:In the present study the comparison of c-TNM and p-TNM staging of 2007 patients with lung cancer revealed an overall concurrence rate of only 39.0%. In the entire series the extent of disease was clinically underestimated in 45.2% and overestimated in 15.8% of the patients. Among all c-TNM stages the c-IA/B stage of 1105 patients gave the highest rate (55.2%) of underestimating the extent of disease. Clinical staging of T subsets was relatively easy with an overall accuracy rate of 72.9%, while that of N subsets was relatively more difficult with an overall accuracy rate of 53.5%. Analysis also showed that c-IV stage may not be an absolute contraindication to surgery, because in half of the patients, c-M1 turned out to be p-M0, providing the possibility of resectional surgery depending on the status of T and N.CONCLUSION:For reasons to be further determined, the present preoperative clinical TNM staging of lung cancer remains a crude evaluation. Further efforts to improve its accuracy are needed.