Tracheoesophageal fistula (TEF) associated with thoracic malignancy can seriously affect patients’ long-term survival. Most of these patients have poor basic conditions and can only choose palliative treatment. Preventing TEF and diagnosing it early is key to potentially improving its long-term prognosis. The emergence of new diagnostic and treatment technologies has brought new hope to these patients. This article summarized the progress and prospect of thoracic tumor-related TEF in four parts: pathogenesis, diagnosis and classification, treatment and prognosis, hoping to provide some reference for clinical work.
Thymoma is the most common tumor of the anterior mediastinum, and complete surgical resection is an important factor for the patient's recurrence and survival. With the update of minimally invasive surgical concepts and the development of devices, the surgical treatment of thymoma has gradually diversified, but the choice is controversial.
Castleman病是一种原因不明的淋巴组织增殖性疾病，发病率较低，又称巨大淋巴结细胞增生症、血管滤泡性淋巴组织增生，或血管瘤性淋巴错构瘤[1]。1956年首先由Castleman在一系列病例中描述[2]。Castleman病约70%见于胸腔，颈部占15%，腹部和骨盆占15%[3]。本病易误诊，现总结山西省汾阳医院分别于2021年3月及2022年7月收治的2例纵隔Castleman病患者病例资料，结合文献对其进行分析，以提高对该病的诊治水平。
目的:介绍一种治疗复合式胸壁畸形的联合微创手术方法。方法:收集上海新华医院2020年1月至2022年6月采用三明治联合微创手术方法治疗的复合式胸壁畸形病例，回顾性分析该组患者年龄、手术方法、手术时间、术中出血量、术后住院时间以及随访结果。结果:共21例复合式胸壁畸形患者采用三明治联合微创手术，手术年龄12~17（13.68±1.51）岁，Haller指数2.03~2.25（2.15±0.38）。所有患者均放置一根鸡胸矫形钢板和一根漏斗胸矫形钢板，术中无心脏及肺部并发症发生，手术时间45~81（58.35±12.80）min，术中出血均小于20 mL，术后患者畸形均完全矫正。术后住院时间4~7（5.50±1.05）天。术后随访6~15（10.17±3.19）个月，随访过程中无钢板移位、切口感染等并发症发生。结论:三明治联合微创手术治疗复合式胸壁畸形短期效果好，是一种可选择的微创手术方法。
Rib fractures are the most common injury in thoracic trauma. As one of the important treatment methods for rib fractures, surgery has been developed in China and abroad for more than one hundred years, but the pace of its development has always been slow. In recent years, with the advancement of science and technology and concepts, research related to the surgical treatment of rib fractures has been increasing. The research mainly focuses on surgical indications, surgical timing, and surgical methods. At the same time, some unresolved problems have also been exposed. This article reviews the progress and existing problems of surgical treatment of rib fractures.
Objective:To investigate the etiology, diagnosis, treatment and significance of a new type of suppurative costochondritis.Methods:The clinical data of 13 patients with suppurative costochondritis in the Thoracic and Cardiac Surgery Department of the Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University from May 2007 to April 2022 and the guiding effect of the new classification on the operation were retrospectively analyzed. The new classification includes: type Ⅰ, single costochondral infection; type Ⅱ, combined costal cartilage infection on one side; type Ⅲ, bilateral combined costicartilage infection without accumulating the sternum; type Ⅳ, bilateral combined costicartilage infection and sternum.Results:All patients underwent surgical resection of the lesion, with a total of 19 operations. Six patients had mild abnormal breathing, and no perioperative death. The prognosis was good.Conclusions:The misdiagnosis rate of suppurative costochondritis is high. Combining different preoperative localization methods with intraoperative exploration and complete resection of the focus is an effective method to treat the disease. The new classification is of guiding significance to the operation mode, and greatly improves the probability of complete resection of lesions.
Thoracic surgery is a discipline with a wide spectrum of diseases, high difficulty and high risk of operation, and rapid development of diagnosis and treatment technology. An excellent thoracic surgeon not only needs to master solid theoretical knowledge and excellent clinical skills but also needs to have strong psychological quality and the ability to integrate across disciplines. Therefore, the training period for thoracic surgeons is long and difficult, and standardized and systematic training is particularly important. This article briefly describes the characteristics of the training system for thoracic surgeons and discusses the current challenges faced by the training of thoracic surgeons in China. We hope that it can be used as a reference for the training of thoracic surgeons in China and promote the improvement of the quality of thoracic surgeon training.
背景:现有报告指南对手术技术的报告详细度和全面度重视不足。"手术技术报告清单和标准"（SUPER）旨在通过定义手术技术的报告标准来填补这一空白。SUPER指南旨在适用于任何研究设计、外科学科和手术创新阶段中包含手术技术的文章。方法:按照EQUATOR协作网（促进健康研究的质量和透明度）的方法，16名外科医生、期刊编辑和方法学家审查了与手术技术相关的现有报告指南，审查了来自15个顶级期刊的论文，并进行头脑风暴来起草SUPER的初始条目。来自13个国家和地区的21名多学科德尔菲小组专家进行3轮德尔菲调查，对初始条目进行修订。经过一次在线共识会议解决意见分歧，以及3轮所有16个SUPER工作组成员和5个SUPER顾问完善措辞后，形成了最终的SUPER条目。结果:SUPER报告指南包括22个条目，这些条目被认为是良好和信息丰富的手术技术报告的关键。这些条目分为6个部分：背景、依据和目的（条目1~5）；术前准备与要求（条目6~9）；手术技术细节(条目10~15）；术后注意事项和工作（条目16~19）；总结与展望（条目20~21）；其他（条目22）。结论:SUPER报告指南可能指导外科医生进行详细、全面、透明的手术技术报告。它也可能帮助期刊编辑、同行评审人员、系统评价人员和指南制定人员评估手术技术论文，并帮助手术技术践行人员更好地理解和重现手术技术。
Objective:To explore the feasibility and clinical efficacy of Complete Thoracoscopic surgical stabilization of rib fractures (CTSSRF) in patients with rib fracture.Methods:The CTSSRF cases admitted to The Third Hospital of Shijiazhuang from September 2019 to September 2021 were retrospectively collected, and the patients’operative time, thoracic drainage, pain score, internal fixation displacement and satisfaction degree of fracture reduction were analyzed for an initial analysis of the feasibility of operation and clinical effect.Results:A total of 18 cases of CTSSRF were completed, and the posterior rib fracture near the covering area of the scapula was all fixed under CTSSRF, including 1 case of CTSSRF and 17 cases of CTSSRF combined with conventional open surgical stabilization of rib fractures (SSRF) at other parts. A total of 45 rib fractures were fixed under CTSSRF (mean 2.5 ribs/person) and 77 ribs were fixed under conventional open SSRF (mean 4.3 ribs/person). The average operation time was 90 (50–150) min, and the thoracic drainage tube was removed 2–5 days after surgery. The thoracic drainage volume was (530.33±244.84) mL. The postoperative visual analogue scale (VAS) score was 3 (3.0–4.0), which was significantly lower than preoperative score of 7 (6.75–8.0), the difference was statistically significant (Z=1.886, P=0.002). The postoperative internal fixation displacement rate of CTSSRF is 4.44% (2/45), and the poor fixation reduction rate is 26.67% (12/45). All patients had no obvious thoracic malformations after surgery, and the incision healed well. They were followed up by telephone for 12 to 24 months. And the ability to work was recovered half a year after surgery, with no obvious symptoms of chest discomfort, and no obvious discomfort when the temperature changed and the body surface was touched, and no internal fixation was removed due to discomfort after surgery.Conclusions:CTSSRF is safe and feasible, especially suitable for high posterior rib fracture near the scapula covering area. It is a beneficial supplement to traditional surgery. However, there are still some defects such as surgical difficulties, high incidence of displacement of internal fixation and poor fracture position, extensive pleural injury, and a large amount of postoperative pleural effusion, which still need to be further summarized and discussed.
近年来，胸腔镜手术已成为许多有经验的医疗中心的首选手术方法，目前胸腔镜手术通常采用2~4孔法。单孔腔镜技术是在传统胸腔镜技术上，只留一个3 cm左右的孔，同时作为观察孔和操作孔，但因为其操作相对困难，目前尚未广泛应用[1,2,3,4,5]。根据经验，在经过一定量的训练后，单孔腔镜技术可以顺利完成较为复杂的解剖性肺切除手术，其有效性及安全性都是值得信任的。肺袖状切除手术被认为是一项具有挑战性的胸外科手术，该术式最初用于无法耐受全肺切除的患者，目前已被认为是一种比全肺切除更适合肿瘤的治疗方法[6,7]。临床上，单孔腔镜技术结合肺袖状切除技术会更具挑战性，现展示1例单孔腔镜右上肺袖状切除病例。
Objective:To investigate the effect of protein regulator of cytokinesis 1 (PRC1) on lymph node metastasis, migration, proliferation and prognosis of lung adenocarcinoma.Methods:The non-small cell lung cancer expression matrix was obtained from Gene Expression Omnibus (GEO), including GSE7670, GSE32863 and GSE68465. Firstly, differential analysis was performed on the three datasets to obtain differentially expressed genes, which were then subjected to enrichment analysis. Secondly, the clinical and expression data of differentially expressed genes were obtained from The Cancer Genome Atlas (TCGA) database. The data was used for weighted gene co-expression network analysis (WGCNA) to obtain the module most relevant to clinical characteristics including tumor stage and lymph node metastasis. Thirdly, the hub gene was obtained through analysis of the module genes using the Search Tool for the Retrieval of Interaction Genes/Proteins (STRING) and binary logistic regression analysis. Subsequently, the expression level of PRC1 in both mRNA and protein levels between lung adenocarcinoma and normal tissues was validated. After knocking down the expression of PRC1 in human lung adenocarcinoma cell line H1299, in vitro functional experiments were conducted to validate the impact of PRC1 on the proliferation, migration, and invasion abilities of lung adenocarcinoma cells. T-test was used to compare the difference of PRC1 expression between normal and tumor tissues, and binary logistic regression analysis was performed to identify independent factors affecting tumor prognosis. Additionally, the downstream mechanism of PRC1 in regulating the metastasis of lung adenocarcinoma cells was investigated.Results:The expression level of PRC1 was higher in lung adenocarcinoma tissues compared to normal lung tissues, at both mRNA and protein levels, with statistical significance. The cells in the Si-PRC1 group were significantly lower than that in the control group in migration experiments (P<0.001), invasion experiments (P<0.001), and scratch experiments (P<0.001). The proliferation ability of Si-PRC1 group cells was significantly lower than that of the control group at 72 and 96 hours. Patients with high expression of PRC1 in lung adenocarcinoma had shorter overall survival (P=0.0014). The qPCR results showed that E-cadherin expression was significantly upregulated (P<0.001) in PRC1 knockdown cells, while N-cadherin and Vimentin expression were significantly downregulated (P<0.01). Western blot results showed that the activated phosphorylated MAPK signal was weakened in PRC1 knockout tumor cells.Conclusions:PRC1 is associated with poor prognosis of LUAD patients and affects lymph node metastasis and tumor cells proliferation, migration and invasion. PRC1 is a potential therapeutic target for lung adenocarcinoma.
Objective:To access the efficacy and safety of minimally invasive surgery of modified Nuss technique without being turned over for the treatment of adult recurrent pectus excavatum.Methods:From July 2008 to September 2021, 48 adult recurrent pectus excavatum cases were treated with minimally invasive surgery of modified Nuss technique without being turned over in the Department of Thoracic Surgery of Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and in the Department of Cardiothoracic Surgery of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, among which 22 cases were performed previously by Ravitch procedure, 23 cases were Nuss procedure, 2 cases were Ravitch combined with Nuss procedure, 1 case was uncertain respectively.Results:All 48 cases were performed by minimally invasive surgery of modified Nuss technique without being turned over successfully. The average postoperative hospital stays were 5.58 days. The Hallex index was improved. The complications were mild. The patients were all satisfied with their chest appearance after the operation.Conclusions:Minimally invasive surgery of modified Nuss technique without being turned over is effective and safe, which will be a surgical choice for the treatment of adult recurrent pectus excavatum in the future.
In addition to the common thoracic deformities (pectus excavatum, pectus carinatum, flat chest and barrel chest), there are other rare thoracic deformities. Because of the low incidence rate, few doctors have paid attention to them. With the appearance of the conception of chest wall surgery, of which thoracic deformity has been regarded as the main operation content, various rare deformities have been noticed by surgeons, and thus promoting the development of diagnosis and treatment of such deformities. This article reviews the status of surgical treatment of rare thoracic deformities in clinical practice.
Objective:To investigate the expression level of macrophage-capping protein (CAPG) in esophageal squamous cell carcinoma (ESCC) and its effect on migration, proliferation and invasion of ESCC cells in vitro as well as the related mechanisms.Methods:Comprehensive analysis for single cell transcriptome data of ESCC from Gene Expression Omnibus (GEO) datasets was performed in order to reveal the tumor heterogeneity. After raw data from GSE188900 was integrated and standardized, Principal Component Analysis (PCA) was used for dimensionality reduction and clustering of the standardized data. Then, the Single R algorithm was used for cell annotation, and the inferCNV R package was used to identify tumor cells. Esophageal epithelial cells were finally identified as tumor cells and Gene Set Variation Analysis (GSVA) was performed on highly variable genes. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to verified the expression level of hub gene in esophageal squamous cell carcinoma patient samples. Next, small interfering RNA (siRNA) targeting CAPG was transfected into human esophageal squamous cell carcinoma cell line EC1 in order to knock down the expression of CAPG in EC1 cells. In vitro functional assays was performed to verify the effect of CAPG on EC1 cells, including proliferation, migration, invasion and wound-healing assays. Finally, the effect of CAPG knockout on the expression of EMT pathway-related genes in esophageal squamous cell carcinoma cells was verified by qRT-PCR.Results:The single cell sequencing data of esophageal squamous cell carcinoma showed that esophageal epithelial cells were the source of tumor cells and EMT pathway-related genes were significantly enriched in esophageal epithelial cells. We intersected epithelial cells-related genes with EMT pathway-related genes to obtain the hub gene: CAPG. The expression of CAPG was significantly higher in esophageal squamous cell carcinoma tissues compared to normal tissues. In vitro functional experiments demonstrated that the knockout of CAPG markedly impeded the proliferation, migration and invasion abilities of esophageal squamous cell carcinoma cells. Furthermore, CAPG knockout influenced the expression of several genes associated with EMT pathway. Finally, CAPG acts as a member of EMT pathway-related genes and promotes clonal proliferation and metastasis of ESCC cells.Conclusions:In esophageal squamous cell carcinoma tissue, CAPG is significantly up-regulated and promotes the proliferation, migration, and invasion abilities of ESCC cells. Additionally, knockout of CAPG affects the expression of several genes related to EMT pathway.
Objective:Benign anastomotic stricture represents a frequent complication after esophagectomy and esophagogastric reconstruction. Some patients had to go through several endoscopic dilations. This study was undertaken to investigate whether early endoscopic examinations after surgery was associated with benign anastomotic stricture development by analyzing morphological change of the anastomosis and gastric tube stump.Methods:Data of 172 patients with early endoscopic examinations following McKeown procedure and gastric tube reconstruction between July 2020 and December 2020 were prospectively collected. Correlations among various potential risk factors including neoadjuvant therapy, adjuvant therapy, severity of mucosal defect and development of benign anastomotic stricture were explored using multivariate logistic analysis.Results:Fifty patients (29.0%) had developed benign anastomotic stricture with a median of 90 days, requiring a median of 2 endoscopic dilations. No necrosis or leakage at anastomosis or gastric tube stump had ever developed anastomotic strictures. In multivariate analysis, lack of postoperative chemotherapy was the only significant risk factor for BAS (P=0.04). Twenty-nine patients (58.0%) had developed refractory anastomotic strictures. In multivariate analysis, lack of postoperative radiotherapy (P=0.01) and chemotherapy (P=0.03) were the risk factors for refractory anastomotic strictures. Most refractory anastomotic strictures had tendency to develop early after surgery regardless of the adjuvant therapy regimens.Conclusions:Early postoperative esophagogastric endoscopy is a safe tool that would not increase the incidence of anastomotic necrosis or leakage. Lack of postoperative radiotherapy or chemotherapy was associated with RAS, while asymptomatic mucosal defect had limited predictive value for the occurrence of anastomotic stricture at the anastomotic site and gastric stump.
With the development of society, economy and modern high technology, the concept of esophageal cancer treatment in China and the treatment model under its guidance have gradually shifted from a single disciplinary treatment model of radical tumor resection guided by the concept of tumor histomorphology, to an adjuvant treatment model of tumor cells removal guided by the concept of cytopathology, then to a gene and immune target treatment model guided by the concept of molecular biology, and then to the individualized multidisciplinary comprehensive treatment model guided by the concept of precision medicine. This evolutionary process fully conforms to the development concept of modern oncology. This article retrospectively reviews the evolution and progress of treatment concepts and models for esophageal cancer in China.
Objective:To investigate the classification of costal arch fractures (CAFs), the internal fixation methods and its outcomes.Methods:We retrospectively analyzed 71 patients with CAF admitted to Central Hospital Affiliated to Shenyang Medical College for internal fixation from May 2017 to May 2022, including 59 males and 12 females, with a mean age of 49±4.3 years (age range, 17–86 years). According to the clinical manifestations and fracture characteristics, we classified CAFs as either simple or compound. The simple type refers to CAF alone or costal cartilage fractures with ribs attached to the costal arch; the compound type means CAF combined with fractures of 8–10 ribs of the adjacent costal arch. According to the severity of CAFs, and adjacent costal cartilage and rib fractures, the simple type is further divided into CAF Ⅰ and CAF Ⅱ, and the compound type into CAF Ⅲ and CAF Ⅳ. All 71 patients underwent internal fixation surgery using MatrixRIB under a small local incision, with some subjected to additional wire strapping.Results:The patients were followed up for 6 months to 2 years post operation. Until the last follow up, all patients had experienced no pain, without malunion, displacement of the titanium plate, and slipping of the titanium nail.Conclusions:The classification of CAFs has clinical significance for the development of surgical plans, injury assessment and case statistics. Internal fixation is an effective treatment, avoiding long-term pain, failure of healing, and malunion.
Sternal fracture is a relatively rare type of fracture, and its incidence rate is less than 0.5% in all types of fractures. However, in recent years, the incidence of sternal fracture is on the rise with the development of industrialization and transportation. At present, no consensus has been reached on its treatment regime, and the surgical and non-surgical treatments of sternal fracture are still controversial, while the surgical treatment modalities, the choice of materials, and so on vary among individuals. Reasonable grasp of surgical indications, selection of appropriate surgical methods and internal fixation materials can promote the rapid recovery of patients and significantly improve the prognosis. In this review, we give an update on the relevant epidemiology, pathogenesis, and clinical manifestations of sternal fracture and provide an overview of the current surgical treatment and the related research progress of sternal fracture.
黏液表皮样癌（mucoepidermoid carcinoma，MEC）是一种好发于泪腺或涎腺的恶性肿瘤，起源于气管或支气管黏膜分泌腺的恶性肿瘤称为肺黏液表皮样癌（pulmonary mucoepidermoid carcinoma，PMEC）。PMEC为肺部肿瘤中一种罕见的恶性肿瘤，约占肺原发恶性肿瘤的0.1%~0.2%[1]。PMEC的临床及影像学表现无特异性，极易误诊及漏诊。因此，提高对该病的认识至关重要。本文就收治的1例儿童PMEC患者，结合近10年中外数据库中PMEC的相关文献，总结其临床特点，展开论述。
Objective:To analyze the related factors of venous thromboembolism (VTE) in patients with thoracic trauma, and establish a risk prediction model.Methods:The clinical diagnosis and treatment data of 787 patients with thoracic trauma treated in Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University from September 2020 to September 2021 were retrospectively analyzed. The risk factors affecting VTE were analyzed by univariate and logistic multivariate regression models, and the prediction model was established.Results:Among the 787 patients with thoracic trauma, VTE was found in 26 cases. The independent risk factors affecting VTE were age (OR=1.162, 95%CI: 1.089–1.24), number of rib fractures (≥5) (OR=13.356, 95%CI: 1.563–114.132), complicated with brain trauma (OR=6.932, 95%CI: 1.904–25.234), abdominal viscus injuries (OR=34.412, 95%CI: 6.117–193.59), fracture of upper limb (OR=4.128, 95%CI: 1.412–12.062), fracture of lower limb (OR=39.688, 95%CI: 10.749–146.532), blood transfusion (OR=3.34, 95%CI: 1.072–10.404). The area under ROC curve (AUC) of VTE probability for thoracic trauma patients is 0.94 (95%CI: 0.896–0.983) .Conclusions:Age, number of rib fractures (≥5), complicated with brain trauma, abdominal organ injury, upper limb fracture, lower limb fracture, and blood transfusion are independent risk factors affecting VTE in patients with thoracic trauma. The risk prediction model established on this basis can better predict the occurrence of VTE and provide targeted intervention.
