Objective:To explore the feasibility and safety of sternal traction hook-assisted subxiphoid single-hole thoracoscopy in anterior mediastinal tumor surgery.Methods:From January 2021 to June 2022, 46 cases of anterior mediastinal tumors were treated with single-hole thoracoscopy with a sternal traction hook. A 4–5-cm longitudinal incision was made under the xiphoid process, and the sternal traction hook was inserted under the left third intercostal space/xiphoid process. The anterior mediastinal tumors were completely removed by single-hole thoracoscopy with an incision-protective sleeve.Results:Subxiphoid single-hole thoracoscopic surgery was successfully completed in 46 cases; however, 2 cases were converted to thoracotomy or additional auxiliary incision. The operation time was 60–90 (74.46±7.16) min, and the median blood loss was 50 (20–200) mL. The duration of thoracic drainage tube placement was 3–5 (3.62±0.58) d, and the postoperative hospital stay was 4–10 (5.39±1.27) d. Postoperative pathology findings were as follows: 2 cases with thymoma type A, 4 with thymoma AB type, 5 with thymoma B1, 7 with thymoma B2, 3 with thymoma squamous cell carcinoma, 14 with thymic cyst, 4 bronchial cyst, 1 teratoma, 5 thymus hyperplasia, and 1 with metastatic squamous cell carcinoma of the thymus.Conclusions:Single-hole thoracoscopy with the help of a sternal traction retractor is safe and effective in the surgical treatment of anterior mediastinal tumors, and can be considered for widespread clinical use.

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.

Background: Pectus excavatum is not rare in China. Many treatments for this disease have proved to have many shortcomings. Nuss procedure has been a ground-breaking technology, but it also has some dis-advantages. Hence, this study was conducted to review our experience in the use of modified Nuss procedure in our hospital. Methods: Data from 259 patients suffered from pectus excavatum between August 2020 and August 2021 who were treated with modified Nuss procedure was analyzed retrospectively. Result: Age was from 3 to 37 years. The average was 15.54 years. The male was 213 cases and the female was 46 cases. The time patients or their family members found pectus excavatum varied. 10 cases had been repaired previously when patients were admitted in our hospital. The clinical symptoms also varied. Each case had an improvement in Haller index. The average of the postoperative hospitalization was 3.97 days. Most cases were inserted 1 bar. Complication rate was also very low. All patients or their parents or their guardians were satisfied with the appearance of the chest wall after operation. There was no death in the whole observation period. Conclusion: From our experience, this modified Nuss procedure have obtained optimistic outcomes with more minimal invasion and low complication rate. This surgical method may be applied to many other hospitals in the future. (c) 2023 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).

目的 探讨两种不同类型的肋骨接骨板治疗多发性肋骨骨折的临床疗效.方法 回顾性分析2019年3月—2020年9月上海交通大学医学院附属第九人民医院胸外科收治的92例切开复位内固定术的多发性肋骨骨折患者资料,按照不同的内固定手术方式分为观察组和对照组,每组46例.观察组采用形状记忆环抱接骨板治疗,男性28例,女性18例;年龄21～65岁,平均42.1岁;撞伤23例,跌伤21例,其他2例;骨折数量3～8根,平均4.2根.对照组采用肋骨锁定接骨板治疗,男性30例,女性16例;年龄20～66岁,平均45.4岁;撞伤20例,跌伤23例,其他3例;骨折数量3～6根,平均3.5根.观察并记录两组患者的手术时间、术中出血量、胸管引流量、拔除引流管时间、住院时间等围术期指标,比较两组胸痛缓解时间以及术后并发症(包括伤口感染、肺部感染、肺不张、骨折延迟愈合等)的情况.结果 经手术治疗后,观察组较对照组手术时间更短[(58.11±13.43)minvs.(75.31±10.56)min,P<0.05].两组患者术中出血量[(50.45±9.78)mLvs.(51.36±8.90)mL]、拔除引流管时间[(5.15±1.32)dvs.(5.24±1.08)d]、胸腔引流量[(330.24±150.78)mLvs.(348.53±148.29)mL]及住院时间[(7.45±2.01)dvs.(8.02±1.76)d]比较差异无统计学意义(P>0.05);两组在治疗24h和48h后VAS均有所降低,且观察组明显低于对照组[(7.85±0.55)分vs.(8.53±0.62)分,(7.01±0.27)分vs.(7.89±0.18)分,P<0.05];观察组患者术后并发症发生率更低(8.7％vs.21.7％,P<0.05).结论 采用形状记忆环抱接骨板进行肋骨骨折固定较肋骨锁定接骨板可以有效缩短手术时间,患者术后疼痛程度较轻,并发症发生率低,值得临床广泛应用.

Objective: To investigate whether patients with lung adenocarcinoma require systematic lymph node dissection (LND) of lymph node metastasis and to identify the predictive factors of lymph node metastasis. Methods: Lymph node metastasis status was retrospectively analyzed in 198 lung adenocarcinoma patients with small peripheral nodules. The patients' clinical factors were analyzed. Maximum standardized uptake values (SUVmax) in patients who underwent positron emission computed tomography (PET-CT) were recorded. Univariate and multivariate analyses were used to determine significant clinical factors of lymph node metastasis. Results: Lymph node metastasis was not found in the 34 cases with pure ground-glass opacity (pGGO). Of the 72 patients with mixed groundglass opacity (mGGO), 67 (93.1%) had no lymph node metastasis, whereas 5 (6.9%) had lymph node metastasis. Of the 92 patients with solid opacity, 29 (31.5%) had lymph node metastasis, and there was a significant difference (P < 0.01). In the univariate analysis, tumor diameter > 1 cm, mixed/solid nodules, and carcinoembryonic antigen (CEA) level > 5 mu g/L were important predictors of lymph node metastasis. In addition, in the analysis of the SUVmax in the patients who underwent PET-CT, the patients with SUVmax > 5 showed a higher lymph node metastasis potential, with a statistically significant difference (P<0.05). For such patients, LND is necessary. Conclusion: Lymph node metastasis is rare in lung adenocarcinoma patients with pGGO on high-resolution CT imaging. Patients with tumors > 1 cm in diameter, mixed/solid nodules on CT, CEA levels > 5 ng/mL, SUVmax > 5 on PET-CT are more prone to lymph node metastasis, suggesting that these patients require systematic LND.

[Objective]To explore the effects of shock waves on promoting angiogenesis and revascularization.[Meth-ods]A total of 40 healthy Sprague Dawley rats of 340 ~ 380 g were randomly divided into experimental and control groups.Ischemic abdominal tissue 8 cm×10 cm was prepared.The experimental group was subject to shock wave imme-diately after surgery.At Day 1,4 and 7 post-operation,tissue circulation was observed and pictures were taken.The per-fusion of tissue microcirculation was monitored by laser Doppler flowmetry (LDH).And the status of vascular prolifera-tion was assessed after hematoxylin & eosin (HE)staining.[Results]At Day 7 post-operation,the survival rate of ex-perimental group was higher than that of control group (P <0.05).And the differences were statistically significant.The mean perfusion unit of abdomen in experimental group was obviously greater than that in control group.After HE stai-ning,vascular proliferation in experimental group was obviously greater than that in control group under microscopy.[Conclusion]Low-energy extracorporeal shock wave can enhance ischemic tissue perfusion and promote microvascular hy-perplasia so as to boost the survival rate of ischemic tissue.

目的 研究新研制的镁合金可吸收肋骨髓内钉(AZ31B)的生物力学性能,并与进口的聚左旋乳酸可吸收肋骨髓内钉(PLLA)及纯钛爪型肋骨接骨板(TPRP)内固定方法进行比较,为临床应用提供科学依据.方法 采集40根成人新鲜第5肋骨侧肋标本,行侧肋腋中线处肋骨骨折模型,分别采用AZ31B镁合金可吸收肋骨髓内钉(AZ31B组),聚左旋乳酸可吸收肋骨髓内钉(PLLA)刚子(PLLA组)、纯钛爪型肋骨接骨板(PTRP钛板组)3种内固定方法固定,运用实验应力分析手段测试各组试件的生物力学特性,并进行比较.另设正常肋骨标本组以作对照.结果 (1)三点弯曲强度测量表明,AZ31B组接近对照组(P＞0.05),而AZ31B组与PLLA组、PTRP组差异显著(P＜0.05);(2)扭转强度测量表明,AZ31B、PTRP组与对照组无显著性差异(P＞0.05),而比PLLA固定优越(P＜0.05).结论 AZ31B的抗弯曲能力优于TPRP和PLLA,在扭转强度上接近TPRP和正常肋骨,是一种理想的新型肋骨内固定材料.本研究在生物力学上为该材料今后的研究提供了支持.

Objective To study whether the lymph node metastasis of lung adenocarcinoma and in need of systematic lymph node dissection and to identify predictive factors. Method A retrospective analysis of our hospital 198 cases of peripheral type small nodules in the lung adenocarcinoma patients with lymph node metastasis, and the clinical factors were analyzed, records of patients undergoing PET-CT SUVmax value, the single factor analysis and multi factors, looking for easy to lymph node metastasis related clinical factors. Result The 34 cases of CT imaging types for the pure ground glass shadow at noon in patients with lymph node metastasis, 72 cases of mixed type of ground glass shadows in 67 cases (93. 1%) without lymph node metastasis, only 5 cases (6. 9%) occurred in patients with lymph node metastasis, and performance for the solid nodules in 92 patients with a total of 29 cases (31. 5%) lymph node metastasis, P<0. 01, significantly, there was statistical significance. In univariate analysis, tumor di-ameter greater than 1cm, mixed nodules and solid nodules and CEA>5ng/ml became an important predictive factor. By analyzing the maximum standardized uptake value in patients with PET-CT showed that, SUVmax>5, patients have higher incidence of lymph node metastasis, P<0. 05, significant difference, there was statistical significance. To this kind of patient needs a lymph node dissection. Conclusion Patients with adenocarcinoma of the lung with lymph in high resolution CT pure ground glass shadow node metastasis is less, the tumor diameter greater than 1cm, imaging uptake value for mixed nodules or solid nodules, carcinoembryonic antigen CEA>5ng/ml, PET-CT (SUV-max) standard >5 with lymph node metastasis occurred, suggesting a need systematic lymph node dissection.

Objective To study the biomechanical characteristics of a new magnesium AZ 31B alloy intr-amedullary nail for treatment of rib fracture .This study was made to provide some biomechanical evidences for better clinical operation .Methods Thirty adult ribs were divided into 3 groups randomly ,and made models for the mid-dle fractures.The fractured ribs were fixed with AZ31B alloy intramedullary nail (AZ31B) and Poly-L-lactic acid intramedullary nail (PLLA),respectively.In addition,healthy ribs were taken as control group .The biomechanical test was performed and the stress was analyzed . Results ( 1 ) The bending strength of internal fixation with AZ31B was close to the control group (P>0.05);there was remarkable difference between PLLA group and AZ 31B group (P<0.05).(2) The torsion strength of internal fixation with AZ31B was close to the normal group(NS), but stronger than the PLLA group(P<0.05); (3) The tensile strength of AZ31B internal fixation was larger than the PLLA group(P<0.05);the anti-putout power of internal fixation with AZ31B was remarkably larger than the PLLA group(P<0.05).Conclusion The bending strength,tensile strength and anti-putout power of AZ31B are larger than those of PLLA.The internal fixation with AZ31B is an ideal method for treating rib fracture .

Objective To investigate the curative effect of the treatment of severe traumatic flail chest patients with multiple injury by non- surgical method versus internal fixation. Methods A total of 116 flail chest patients with sternum fracture and multiple injury in our unit from Jan. 2004 to May 2013 were divided into three different surgical treatment groups( n = 24,n = 26,n = 28) and non- surgical group( n = 38),and the clinical data were retrospectively analyzed. Results The ratio of complications( such as chest wall deformity,delayed hemopneumothorax,pulmonary infection,pulmonary atelectasis,respiratory failure) in surgical group was significantly different compared with the non- surgical group( P 0. 05). The results of the pulmonary functions tested four months after management indicated that in the surgical group the patients had a less restrictive pattern than patients in the nonsurgical group( P 0. 05). Conclusion Chest internal fixation can reduce complications in flail chest patients with sternum fracture and multiple injury,and the operative fixation has some short and long-term benefits for flail chest.

BACKGROUND: At present, the materials that are successful y applied in rib fracture internal fixation mainly include titanium, nitinol rib encircling bone bonding plate, imported poly-L-lactic acid absorbable rib nails and anatomical plate. OBJECTIVE: To study the biomechanical characteristics of new magnesium al oy absorbable rib intramedul ary nail in the rib fracture fixation, and to compare with imported poly-L-lactic acid absorbable rib intramedul ary nail in order to provide scientific basis for clinical application. METHODS: Thirty fresh adult fifth rib specimens were col ected, and the specimens were used to make models for the middle rib fractures. The specimens were fixed with AZ31B magnesium al oy absorbable rib intramedul ary nail (magnesium al oy group) and poly-L-lactic acid absorbable rib intramedul ary nail (poly-L-lactic acid group), and the normal rib specimen group was set as control. The biomechanical characteristics of the nails in each group were tested with stress analysis. RESULTS AND CONCLUSION: Three-point bending strength measurement results showed that the bending strength in the magnesium alloy group was close to the normal value of the specimen (P > 0.05), and there was significant difference in the bending strength between magnesium alloy group and the poly-L-lactic acid group (P < 0.05). Torsional strength measurement showed that there was no significant difference in torsional strength between magnesium alloy group and the normal specimens, and the results showed that the magnesium alloy was better than poly-L-lactic acid in fixation (P < 0.05). Tensile tests showed that the tensile strength and anti-pulling force of the magnesium alloy fixation were better than those of poly-L-lactic acid fixation (P < 0.05). The results indicate that the magnesium alloy absorbable rib intramedullary nail is better than poly-L-lactic acid absorbable rib intramedullary nail in strength and tensile strength, which is the ideal fixation material for rib fixation.

Objective To summarize the experience in the treatment of traumatic pulmonary hematoma.Methods The clinical data of 21 patients with traumatic pulmonary hematoma were retrospectively analyzed.The causative factors of injury,associated injury,hematoma size,therapeutic measure,follow up consequence of pulmonary hematoma were collected.Results The traumatic pulmonary hematoma was related to pulmonary contusion,fractured ribs,hemopneumothorax.The duration of hemoptysis and resolution time of traumatic pulmonary hematoma in the patients with pulmonary hematoma smaller than 20mm were significantly shorter than those with pulmonary hematoma larger than 20mm,and the statistical difference was significant(P0.05).There were 3 cases of traumatic treatment and 18 cases of conservative treatment.Totally 21 cases were followed up for 4-8 months,indicating good prognosis.Conclusion Conservative treatment for the traumatic pulmonary hematoma has a good prognosis.

Objective To investigate the effects of emergency surgical internal fixation on hemodynamics in patients with traumatic flail chest. Methods A total of 34 patients with traumatic flail chest managed by emergency surgical internal fixation were selected.The parameters of heart rate(HR),cardiac output(CO),pulmonary capillary wedge pressure(PCWP),mean arterial pressure(MAP) and central venous pressure(CVP) at the time points of before anesthesia induction,before operation after anesthesia,immediately after operation,4 h after operation and 24 h after operation were monitored and compared. Results Compared with those at the time points of before anesthesia induction and before operation after anesthesia,HR and CVP significantly decreased(P0.05),and CO,PCWP and MAP significantly increased at the time points of immediately after operation,4 h after operation and 24 h after operation(P0.05).Conclusion Emergency surgical internal fixation may improve the hemodynamics of traumatic flail chest,and has some short-term therapeutic effect on flail chest.

Objective To compare the outcomes of traumatic flail chest with multiple injuries treated by operative fixation versus conservative approach. Methods The clinical data of 60 patients with traumatic flail chest with multiple injuries were retrospectively analysed, and the outcomes between operation group (treated by operative fixation, n=32)and non-operation group (treated by conservative approach, n=28) were compared. Results The mean time of hospital stay, ICU stay and mechanical ventilation was significantly shorter, and the prevalences of chest wall deformity, pulmonary infection, pulmonary atelectasis and respiratory failure were significantly lower in operation group than those in non-operation group (P0.05). Six months after discharge, the pulmonary function parameters such as inspiratory capacity, forced vital capacity, forced expiratory volume in one second, peak expiratory flow, total lung capacity and maximal midexpiratory flow were significantly higher in operation group than those in non-operation group (P0.05). Conclusion Traumatic flail chest with multiple injuries treated by operative fixation may lead to less flail chest associated complications. Operative fixation has short- and long-term benefits to flail chest.