2016年 · 第32卷第12期

This article, which talks about writing techniques for scientific papers, is written by John B. Chang^[1]It was invited by the professor, which reflects Professor Zhang's academic experience and wisdom. Novice and occasional authors may have many shortcomings in the process of writing, and the way of presenting the paper will significantly affect the acceptance of the research information by the editor and the practical value of the paper to the reader.

Coronary atherosclerotic heart disease (CHD) is one of the main diseases that threaten human health at present. The degree of coronary artery disease often determines the revascularization strategy of patients. Patients with complex coronary artery disease often have a higher incidence of sudden death, and the prognosis of treatment is poor. Coronary artery bypass grafting (CABG) is considered to be the surgical procedure of choice for the treatment of coronary heart disease, especially complex lesions. For decades, CABG has successively developed bypass grafting under cardiopulmonary bypass, non-cardiopulmonary bypass bypass grafting, total arterialized bypass grafting, small incision bypass grafting, robot-assisted bypass grafting, hybrid surgery and other surgical procedures. In 1977, Andreas Gruentzig pioneered percutaneous coronary intervention (PCI), which opened up a new method for the treatment of coronary heart disease. With the advent of a new generation of drug-coated stents (DES) and bioabsorbable stents (BRS), PCI to solve complex coronary artery disease has gradually been accepted clinically. We compiled the Chinese expert consensus on cardiac and surgical revascularization based on the 2014ESC-EACTS Guidelines for Myocardial Revascularization, 2015STS Clinical Practice Guidelines: Coronary Artery Bypass Grafting for Arterial Bypass Grafting, 2015AHA Consensus on Secondary Prevention of Coronary Artery Bypass Grafting, and China's Guidelines for Percutaneous Coronary Intervention (2016).

Enhanced Recovery After Surgery (ERAS), minimally invasive Surgery and injury control Surgery are three new surgical concepts in the 21st century. ERAS was first proposed and practiced by Danish surgeon Kehlet in 1997^[1,2]It refers to the adoption of a series of optimized treatment measures with evidence-based medical evidence during the perioperative period to reduce the physical and psychological trauma stress of surgical patients and achieve the purpose of accelerating recovery. This is a new concept and treatment rehabilitation mode in 21st century medicine. The benefits of ERAS concept are reflected in: (1) improving the effect of physiological and psychological treatment; (2) reducing postoperative complications; (3) accelerating patient recovery; (4) shortening the hospital stay; (5) Reduce medical expenses; (6) Reduce the burden on society and families. At present, ERAS is the most successful application in colorectal surgery^[3,4,5]Some large thoracic surgery treatment centers have gradually applied esophageal cancer surgery to accelerate rehabilitation technology^[6,7,8,9,10]But the scope of application is still not wide. In order to improve the popularization and application of esophageal cancer surgical accelerated rehabilitation technique, this paper draws up the application principle of esophageal cancer surgical accelerated rehabilitation technique according to domestic and foreign literature and expert experience, so as to facilitate the popularization and application of this technique in China.

aortic arch replacement and elephant trunk stenting for acute aortic dissection (AD) have become commonly used surgical methods, but the management of aortic root has not yet formed a unified opinion. The clinical data of 79 cases of Stanford type A aortic dissection admitted to our hospital from January 2005 to June 2015 were retrospectively analyzed, and the relevant experience and long-term effect of root management were summarized.

aortic dissection (AD) has a high mortality rate. The onset age of AD in China is younger^[1,2]。 For the treatment of Standford type B aortic dissection, Thoracic endovascular aortic repair (TEVAR) has become the preferred treatment because the risk of open surgery is significantly higher than that of endovascular treatment. Conventional TEVAR requires coverage of the distal first rupture of the left subclavian artery, requiring sufficient length and healthy anchoring vessels proximal to the rupture. When the first rupture is in close contact with the left subclavian artery opening, or the dissection reverse tear involves the aortic arch, hybrid surgery or endovascular chimney, fenestration, and branching techniques are required to reconstruct the supraarchal vessel. At present, the treatment of Stanford type B dissection with extracorporeal fenestration technology is in the exploratory stage at home and abroad. We now summarize our recent treatment experience of 3 patients with acute Stanford type B dissection with extracorporeal fenestration technology, which is reported as follows.

PatientFemale, 32 years old. In 2013, I was unable to eat after taking strong alkali by mistake. Barium meal angiography showed esophageal atresia below the plane of the piriform fossa, and no esophageal opening was seen at the bottom of the laryngoscopy. The diagnosis was: chemical burn of the esophagus, complete atresia from the origin of the esophagus (Figure 1)。 Permanent gastrostomy was performed in an external hospital because of the inability to reconstruct the digestive tract. One year later, the patient went to the doctor again and asked to repair the digestive tract. She preferred to give up her pronunciation function. She was transferred to our hospital in October 2014. Considering that the patient was a mother of four children, reconstructing the digestive tract by laryngeal resection caused more harm than good, so she decided to establish a neck artificial false tract first, and then perform second-stage esophageal reconstruction after the false tract was completely formed.

PatientFemale, 42 years old. Color Doppler ultrasound of the neck found nodules in the left lobe of thyroid, and left lobectomy was performed in the General Surgery Department of County Hospital of Traditional Chinese Medicine. Intraoperative frozen pathology reported papillary adenocarcinoma of thyroid. One day after surgery, food and digestive juice were overflowed from the neck incision, and barium meal showed barium overflowing from the cervical esophagus, while the thoracic esophagus was not visualized. Esophageal injury and esophageal fistula were diagnosed, but the local hospital could not deal with it, so he was admitted to our hospital on the second day after surgery. Admission physical examination: body temperature 38.5℃, hoarseness, pus odor from the neck incision, redness and swelling, and pus overflow. Gastroscopy showed mucosal erosion at the entrance of the esophagus 15 cm away from the incisors, no normal esophagus 16 cm away from the incisors, a large number of necrosis and flocs, and the normal mechanism could not be distinguished. The endoscope barely entered 20 cm away from the incisors and saw a large number of flocs around the suture, and the endoscope could not continue. Considering that the injury exceeds 24 hours and the neck wound is infected, it is not appropriate to perform digestive tract reconstruction in one stage^[1,2]。

For upper gastrointestinal surgery, especially esophageal cancer surgery, jejunostomy catheterization can provide early postoperative nutritional support, and can provide the best enteral nutrition therapy if complications such as anastomosis or thoracogastric fistula occur after surgery, or severe adverse gastrointestinal reactions occur after postoperative adjuvant radiotherapy and chemotherapy. At present, intraoperative jejunostomy catheterization has been widely used in many esophageal cancer surgery centers at home and abroad^[1,2]。 Since the beginning of 2014, our center has carried out total laparoscopic radical resection of esophageal cancer (without abdominal auxiliary small incision), and has gradually taken jejunal puncture and fistula as a routine surgical procedure. The preliminary experience is summarized as follows.