Objective:This study aimed to explore the feasibility of using a digitally customized and individualized titanium alloy sternal prosthesis to reconstruct chest wall defects in patients with radical resection of sternal tumors.Methods:A case series study of the relevant case data of five patients with primary sternal tumors, who were admitted to the Thoracic Surgery Department of Renmin Hospital of Wuhan University from August 2020 to October 2021, was conducted. All patients were male, aged 23-60 years (average age of 43.5 years). The cases included manubrium sternal tumor (one case) and mesosternal tumor (four cases). On the basis of the preoperative thoracic CT scan data of patients, 3D printing technology was used to construct 1∶1 three-dimensional bone and tumor models of the patients' sternum and part of the ribs and clavicle connected to it. Meanwhile, a personalized titanium alloy sternum prosthesis was designed and digitally customized. Tumor resection was simulated on the 3D printed model. Then, the titanium alloy prosthesis was implanted into the defect sternum model to match, and the prosthesis implantation was simulated. In the whole group, radical resection of sternal tumor was performed under general anesthesia, and the digitally customized and individualized titanium alloy sternal prosthesis was implanted to repair the sternal defect. Autologous tendon was used for reconstructed sternoclavicular articulation in the case of manubrium sternal tumor. Operative time, intraoperative blood loss, perioperative death, postoperative chest wall stability and chronic pain, patients' survival status, shoulder joint function in patients with sternoclavicular joint reconstruction, and postoperative complications such as sternal prosthesis displacement or rupture, pleural effusion, and lung infection were observed.Results:The operation of the five cases went smoothly. No perioperative death or unplanned reoperation occurred. The operation time was 115-165 min, and the intraoperative blood loss was 80-260 mL. The postoperative pathological types included giant cell tumor of the bone (one case), myeloid sarcoma (one case), chondrosarcoma (two cases), and solitary plasmacytoma (one case). Performing musculocutaneous flap transfer to repair the chest wall was not necessary in all cases. The surgical incisions all healed well, and no implant infection occurred. The chest wall was intact and stable, and no chest wall floating nor abnormal breathing was observed. In one case, the removal of the chest tube was delayed due to pleural effusion. The longest postoperative follow-up of the whole group was 24 months, and the minimum was 12 months. The whole group had no implant fracture, displacement, pleural effusion, pulmonary infection, chronic pain, and other complications. In the case of manubrium sternal tumor, the function of sternoclavicular articulation had no disorder after reconstruction.Conclusion:A digitally customized and individualized titanium alloy sternal prosthesis was used for the reconstruction of chest wall defect after radical resection of sternal tumor. This surgical scheme is feasible and easy to operate, with good postoperative chest wall stability and few complications. It deserves further clinical exploration.

Objective To explore the safety and efficiency of sequential operation of Tirelizumab combined with chemotherapy in neoadjuvant therapy for locally advanced esophageal cancer.Methods A retrospective analysis was conducted on 60 patients with locally advanced esophageal cancer admitted to Renmin Hospital of Wuhan University from August 2018 to June 2022.The immunotherapy combined with chemotherapy sequential surgery patients were selected as the observation group(29 cases)and the chemotherapy sequential surgery patients were selected as the control group(31 cases)according to the treatment method.The study aimed to analyze whether there were differences in efficacy and safety between the two groups.Results There are 28 patients with R0 resection in the observation group,and 14 case reached ORR.In the control group,29 cases were resected with R0,and 7 cases reached ORR.The proportion of ORR patients in the observation group was significantly higher than that in the control group,which was statistically significant(P＜0.05).There were 9 patients with pCR in the observation group and 2 patients with pCR in the control group,and the proportion of pCR patients in the two groups was significantly different(P＜0.05).There were no significant differences between the two groups for preoperative and postoperative adverse events.Conclusion Immune checkpoint inhibitors combined with chemotherapy sequential surgery are safe and reliable in patients with locally advanced esophageal cancer,with significant short-term efficacy,and long-term efficacy remains to be observed.

目的:探讨结肠代食管手术在食管狭窄支架植入后发生气管食管瘘患者中的应用效果.方法:回顾性分析武汉大学人民医院胸外科2015年4月到2019年7月治疗的7例继发性食管狭窄放置支架后出现气管食管瘘患者的临床资料,总结结肠代食管术在该类患者中的应用经验.结果:全组患者无围手术期死亡发生.一期手术4例,分期手术3例.行结肠代食管7例(胸骨后隧道6例,胸部皮下隧道1例).术后发生肺部感染2例,心律失常1例,均经保守治疗后痊愈.术后随访半年至1年,无气管食管瘘复发.患者均能正常进食,体重较术前增加3～10 kg.结论:采用结肠代食管手术治疗继发性食管狭窄置入支架导致的气管食管瘘效果良好,该术式为类似患者的治疗提供了一种新的选择.

肺癌是全球范围内发病率和死亡率最高的恶性肿瘤.对于可手术切除的局部进展期非小细胞肺癌(NSCLC)患者,当前国内外相关指南建议采取多模式联合治疗,包括手术、放化疗、靶向治疗及免疫治疗等.术前新辅助治疗指在恶性肿瘤手术切除前给予化疗或放疗,近年随着靶向药物与免疫检查点抑制剂(ICI)的快速发展,新辅助治疗又延伸出新辅助靶向治疗及新辅助免疫治疗.本文主要综述了可手术切除的局部进展期NSCLC患者新辅助治疗进展,以提高临床医生对肺癌新辅助治疗的认识.

目的 分析免疫检查点抑制剂(ICI)联合化疗治疗可切除Ⅲ期非小细胞肺癌(NSCLC)的疗效,并探讨患者近期预后的影响因素.方法 回顾性收集2019年1月至2021年5月武汉大学人民医院收治的可切除Ⅲ期NSCLC患者45例为研究对象.患者均经ICI联合含铂双药化疗方案治疗后进行手术治疗.记录患者临床疗效、毒副作用发生情况、手术情况、术后住院时间、术后并发症发生情况、随访情况.以主要病理缓解(MPR)为可切除Ⅲ期NSCLC患者近期预后评定指标,并根据其将患者分为MPR组与非MPR组;采用多因素Logistic回归分析探讨可切除Ⅲ期NSCLC患者近期预后影响因素.结果 45例患者完成ICI联合化疗1～4个周期.完全缓解(CR)4例,部分缓解(PR)23例,病情稳定(SD)14例,疾病进展(PD)4例,客观缓解率(ORR)为60.0％,疾病控制率(DCR)为91.1％.ICI联合化疗过程中出现不同程度的毒副作用,其中出现反应性皮肤毛细血管增生症/皮疹最多,达31例(68.9％).完成手术治疗40例,手术切除率为88.9％.术后病理结果显示达到MPR 22例(55.0％);MPR组与非MPR组美国东部肿瘤协作组(ECOG)评分、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、乳酸脱氢酶(LDH)和程序性死亡配体1(PD-L1)表达水平比较,差异有统计学意义(P<0.05).多因素Logistic回归分析结果显示,ECOG评分〔OR=8.146,95％CI(2.842,23.344)〕、NLR〔OR=8.146,95％CI(2.842,23.344)〕是可切除Ⅲ期NSCLC患者近期预后的影响因素(P<0.05).结论 ICI联合化疗治疗可切除Ⅲ期NSCLC患者疗效确切,具有一定安全性,ECOG评分、NLR是可切除Ⅲ期NSCLC患者近期预后的独立影响因素.

患者男，67岁，因“发现胸前肿块1年余”于2021年10月18日入院。入院前1年余患者无意间发现胸前肿块，局部无疼痛，无活动后气促、吞咽困难、呼吸困难等不适，患者未予以重视，亦未就医；入院前2个月患者发现胸前肿块较前增大明显，伴胀痛及劳累后疼痛，遂在当地医院就诊，并行胸部CT检查，提示胸骨骨质改变、胸骨柄肿瘤性变。随后到武汉大学人民医院东院胸外科就诊并入院治疗。入院后专科查体：胸部正中稍偏右侧，乳头连线上方可见局部隆起约5 cm×8 cm大小，局部皮肤无红肿、溃破，无胸壁静脉曲张；触诊肿物上缘至胸骨颈静脉切迹，下缘在胸骨角上方约0.5 cm，双侧至第1、2肋软骨，胸骨体无叩击痛。入院后行胸廓CT三维重建、MRI检查及ECT骨扫描提示：胸骨骨质破坏，孤立性胸骨肿瘤样变（图1A）。

目的 总结分期手术策略应用于结肠代食管术的临床经验.方法 行结肠代食管手术病人35例,均采用了分期手术策略,其中合并胃大部切除术后食管癌病人20例,食管癌术后再发食管癌5例,胸胃癌4例,食管癌病人术后存在并发症4例(气管食管瘘2例,胃坏死2例),食管化学灼伤并瘢痕狭窄放置食管支架导致气管食管瘘2例.其中先行食管病变切除术,择期再行结肠代食管术28例;7例病人先行结肠代食管术,择期行食管病损切除.结果 35例病人均按计划方案顺利完成手术,分期行食管病变切除及结肠食管重建,手术的间隔时间为3～12个月.术后发生颈部吻合口瘘1例,乳糜胸1例,肺部感染2例,均经保守治疗后痊愈出院.随访1年病人均恢复正常饮食,体重较术前明显增加.结论 分期手术策略应用于结肠代食管术效果良好,并发症较少.

目的:探究基质细胞衍生因子-1α(CXCL12)在脂多糖(LPS)诱导的急性肺损伤(ALI)中是否具有保护作用.方法:通过使用不同浓度的LPS(0.25,0.5,1 μg/mL)刺激RAW264.7细胞,探究LPS的最佳刺激浓度,并建立细胞炎症模型(LPS组);在炎症模型的基础上使用不同浓度的CXCL12(1,10,50,100 ng/mL)处理,分为1、10、50、100 ng/mL CXCL12四组.使用 RT-qPCR 和 Western Blot 检测 NC 组、LPS 组和4个不同浓度 CXCL12组中炎症因子肿瘤坏死因子-α(TNF-α)和白细胞介素6(IL-6)的表达水平.结果:CXCL12在LPS诱导的急性肺损伤中在一定浓度内呈剂量依赖性.当CXCL12＜50ng/mL时,TNF-α的表达随CXCL12浓度的增加而降低;当CXCL12为100 ng/mL时,TNF-α又重新升高;与LPS组相比,当使用50 ng/mL的CXCL12刺激炎症模型时,IL-6和TNF-α的表达明显降低(P＜0.05).结论:当CXCL12＜50 ng/mL时具有保护作用,可为临床上治疗急性肺损伤提供新的思路.

Objective: To explore the factors affecting the condition and prognosis of COVID-19. Methods: The clinical data of 228 patients with COVID-19 diagnosed in Renmin Hospital of Wuhan University from January 15 to March 1, 2020 were collected. The relationship between the levels of serum lactate dehydrogenase (LDH)/creatine kinase(CK) and the condition/prognosis of these patients were retrospectively analyzed. Results: The levels of serum LDH/CK in male patients with COVID-19 were significantly higher than those in female patients, and increased with age;more importantly, the levels of serum LDH and CK in severe group were significantly higher than those in non-severe group (P< 0.05);LDH and CK levels were related to the overall survival (OS) of COVID-19 patients. The OS of LDH increasing group was lower than that of normal LDH+CK group, and OS of LDH+CK increasing group was lower than that of LDH increasing group. Conclusion: The increase of LDH and CK can reduce the overall survival of COVID-19 patients, and serum LDH and CK levels can be used as risk factors to predict the progression of the disease. © 2021, Editorial Board of Medical Journal of Wuhan University. All right reserved.

目的 评价3D腹腔镜单向式胃游离法应用于食管癌微创化根治术的安全性、可行性及短期疗效.方法 回顾性分析武汉大学人民医院胸外科2018年2月至2019年12月收治的行胸腹腔镜下McKeown三切口食管癌根治术(二野淋巴结清扫)的118例食管癌患者的临床资料,其中男94例、女24例,年龄53.7(41～77)岁.其中55例患者采用传统腔镜下行胃常规游离(传统胃游离组),63例患者采用3D腔镜下单向式胃游离(单向式胃游离组).比较两组患者的临床资料.结果 全组手术切缘均为阴性,R0切除率均为100％,无死亡和切口相关并发症发生,术后并发症总发生率22.9％.术后两组患者脾脏损伤、胃损伤、中转开腹、腹部再手术、颈部吻合口瘘的发生率差异均无统计学意义(P＞0.05).单向式胃游离组患者的胃游离相关并发症总发生率为1.6％(1/63),低于传统胃游离组的12.7％(7/55),差异有统计学意义(P＜0.05);胃游离时间也明显短于传统胃游离组(P＜0.05).结论 3D腹腔镜单向式胃游离技术行食管癌根治术是安全可行的,近期效果满意.

Objective: To investigate the management strategies for lung transplant patients in Wuhan areas during the COVID-19 epidemic period (from January 1, 2020 to April 8, 2020). Methods: During the epidemic period in Renmin Hospital of Wuhan University, three potential lung transplant patients on the waiting list were suspended for operation, one who underwent lung transplantation was carefully quarantined and the surrounding environment was disinfected, nine patients after lung transplantation received epidemic prevention instructions and were followed up through phone call or online communication. The clinical and follow-up data of these patients were collected and analyzed. Results: The patient with lung transplantation performed in the early stage of the epidemic was survived and didn't infected with SARS-CoV-2. Of the postoperative cases, only one was infected with SARS-CoV-2 which eventually caused death during the epidemic. Conclusion: During the COVID-19 epidemic, effective management strategies adopted in affected areas could reduce the incidence of SARS-CoV-2 infection in lung transplant patients. © 2021, Editorial Board of Medical Journal of Wuhan University. All right reserved.

INTRODUCTION:We report the case of a 65-year-old Coronavirus disease 2019 (COVID-19) patient with pneumonia and subsequent end-stage pulmonary failure who required 63 days of mechanical ventilation (MV) and 62 days of extracorporeal membrane oxygenation (ECMO). METHODS:On Day 45, a comprehensive interdisciplinary discussion on the best course of treatment resulted in the general consensus that his lungs would not recover. As such, he was evaluated and listed for a lung transplant. RESULTS:We performed a bilateral lung transplant, and the patient was weaned off ECMO and MV postoperatively. This is the first report of lung transplants in patients with COVID-19 in Wuhan. CONCLUSIONS:We suggest that a lung transplantation may be a viable treatment for patients with end-stage pulmonary failure secondary to COVID-19 in selected situations.

目的 探讨胃代食管术后再发胸胃癌外科治疗的可行性.方法 回顾性分析武汉大学人民医院胸外科2013年6月～2018年12月期间收治或手术会诊的7例食管癌根治术并胃代食管术后再发胸胃癌病人行胸胃癌切除术的临床资料.结果 本组7例病人中,男性6例,女性1例;年龄53～73岁,平均年龄63.2岁.首次手术与胸胃癌诊断间隔时间2.8～15年不等.本组无围术期死亡病例;手术时间170～580分钟,出血量350～1100 ml;术后发生肺部感染2例,心律失常1例;颈部吻合口瘘1例,经切口换药两周后治愈.所有病例均获随访12个月,均获得正常进食,体重无下降.结论 对于食管癌术后再发胸胃癌的病人,如果病变较为局限,外科切除是一个可供选择的治疗方案.

古代时期,人们对体罚的接受程度很高,惩罚在很多时候都是以体罚的形式出现.随着教育观念的更新,体罚的弊端逐渐为人所知,中外各国都开始逐渐禁止体罚儿童.体罚不仅会伤害幼儿的身心健康还会引发新的问题行为.但实际上幼儿园中的体罚现象依然存在.幼儿教师对体罚和惩罚的认知不到位是此问题频发的缘由之一.划清体罚与惩罚之间的界线,正确使用惩罚,普及法律知识可以帮助幼儿教师正确认识体罚的危害,从而进一步减少幼儿园体罚儿童的现象.

目的 探索可降解材料聚乙醇酸垫片(奈维垫片)在胸腔镜食管癌根治术中的应用价值.方法 行全腔镜食管癌根治术病人301例,分为奈维组(206例)和常规组(95例),比较两组病人手术前后的手术相关指标、术后病理以及术后并发症情况.结果 奈维组和常规组吻合口漏并发症发生率分别为11.2％ 和13.7％,差异无统计学意义P>0.05),食管气管瘘并发症发生率分别为0.5％ 和7.4％,差异有统计学意义(P<0.05).结论 奈维垫片在食管癌根治术中对于预防食管吻合口漏发生并无明显优势,但在吻合口漏发生后预防气管瘘方面有显著作用.

目的 探讨肺移植对终末期肺病的治疗效果,总结肺移植围手术期治疗经验.方法 2016年12月～2019年9月间肺移植围手术期病人13例,回顾性分析其临床资料.结果 主要诊断为慢性阻塞性肺疾病、特发性肺纤维化各4例,支气管扩张3例,尘肺1例,Kartagener综合征1例.手术方式为双肺移植7例,左单肺3例,右单肺3例.围手术期死亡3例,死因分别为鲍曼不动杆菌合并铜绿假单胞菌感染1例,肺炎克雷伯菌感染1例,心跳骤停1例;余10例均治愈出院.结论 肺移植是治疗终末期肺病的有效方法,急诊抢救性手术效果不佳.

急性肺损伤(ALI)是临床常见危重症,急性呼吸窘迫综合征(ARDS)是ALI的严重阶段,是导致危重患者死亡的主要原因.ALI/ARDS主要是紊乱的炎症反应的结果,其中中性粒细胞在ALI/ARDS的发生发展过程中起到了至关重要的作用.由于涉及的炎症机制复杂、治疗困难,目前ALI/ARDS危重患者的病死率仍居高不下.因此,深入研究炎症机制是突破ALI治疗瓶颈的前提.本文就中性粒细胞参与ALI炎症反应及肺组织修复的机制进行综述.

目的 总结胸外科防治严重急性呼吸道综合征冠状病毒-2(SARS-CoV-2)感染的临床经验,提供可行的临床策略.方法 回顾性研究2020年1月10日至2月10日我科疑似和确诊SARS-CoV-2病例及其致医护人员感染SARS-CoV-2的临床资料.结果 确诊SARS-CoV-2感染9例(其中术后患者3例、医护人员6例),急诊手术术前疑似病例1例.根据病情轻重分别予以抗病毒、抗感染或并予以激素及免疫球蛋白等对症治疗;第1例术后患者因呼吸衰竭死亡,余9例恢复良好.结论 SARS-CoV-2疫情期间应推迟择期或限期手术,严格把握急诊手术指征,急诊手术应按三级防护处理.胸外科术后呼吸功能训练易产生飞沫及气溶胶,若有确诊病例易导致病毒在病区传播,应积极排查SARS-CoV-2感染病例.早发现、早报告、早隔离、早治疗,胸外科SARS-CoV-2感染病例预后良好.

Kartagener syndrome (KS) is an autosomal recessive disorder characterized by situs inversus, paranasal sinusitis and bronchiectasis. We report the successful use of double lung transplant (DLTx) to treat end-stage KS. A 49-year-old Han woman was admitted to Renmin Hospital (Wuhan University, China) in September 2017 with a ≥15 year history of chronic productive cough that had worsened during the past year. Clinical examination and imaging investigations revealed respiratory failure and situs inversus consistent with KS. The patient was successfully treated with DLTx involving bilateral bronchial anastomoses. DLTx is a feasible treatment option for end-stage KS.

多孔介质燃烧是集节能、减排、环保于一身的一种全新的燃烧方式.目前,在德国、美国等国家,该技术已实现部分行业的工业应用,然而该技术在我国工业领域应用方面还没有打开局面.本文设计了一种面向中高温加热领域的多孔介质燃烧器及其控制系统,可以实现不同热值气体的高效和清洁燃烧,同时具有防止回火、火焰监测等功能.同时,对几种不同材质(Al2O3,SiC,SiC-Al2O3复合材质)的大孔多孔介质材料进行了燃烧试验,结果表明:不同材质达到稳定燃烧的时间不同,SiC最快,Al2O3材质最慢;三种材质稳定燃烧时多孔介质表面最高温度相当;稳定燃烧时烟气中NOx和CO体积分数水平较低,但也因材质不同表现出一定差异,SiC材质的烟气中NOx体积分数略高于其它两种材质,CO体积分数明显高于其它两种材质.