Background To evaluate therapeutic efficacy of minimally invasive and small incision surgery [minimally invasive surgery (MIS)] in patients with non-flail chest rib fractures through a prospective cohort study. Methods This study included 98 patients with non-flail chest rib fractures (≥3 displaced fractures) and 66 patients undergoing MIS served as the experimental group and 32 patients receiving conservative treatment served as the matched control group. Pain index and indicators of pulmonary function [vital capacity (VC); forced expiratory volume in one second (FEV1); peak expiratory flow (PEF)] for the two groups were assessed and compared at the time of admission and before discharge. In addition, duration of pain, time required for the patient to regain the ability to perform daily self-care, mental labor, and moderate-to-severe physical labor, and duration of chest discomfort were measured during long-term follow-up and compared between the two groups. Results There were also no significant differences (P>0.05) in pain index (8 vs. 8) or indicators of pulmonary function (VC: 31.0% vs. 26.5%; FEV1: 29.9% vs. 26.7%; PEF: 15.2% vs. 12.0%) were found between the MIS and conservative treatment groups at the time of admission; while pain index (3 vs. 6), VC (42.1% vs. 35.3%), and FEV1 (44.2% vs. 35.9%) were significantly different between the two groups (P<0.05) but not in PEF (21.2% vs. 19.6%) before discharge. Long-term follow-up showed that duration of pain, time required for the patient to regain the ability to engage in daily self-care, mental labor, and moderate-to-severe physical labor, and duration of chest discomfort in the MIS group were significantly more improved than in the conservative treatment group (P<0.05). Conclusions MIS was a simple and safe treatment that significantly relieved chest pain and rapidly restored pulmonary function and improved the long-term quality of life of patients with non-flail chest rib fractures of ≥3 ribs with displacement.

目的 探讨多发肋骨骨折患者手术治疗的最佳时机,以及合并其他部位骨折患者行同期联合手术的安全性和有效性.方法 回顾性分析2007年12月-2017年12月在上海交通大学附属第六人民医院行手术治疗的1 573例肋骨骨折患者的临床资料,筛选794例行单纯肋骨骨折手术的患者作为研究对象,根据伤后至手术的时间,分为＜3 d组(221例)、3～7 d组(337例)和＞7d组(236例),比较3组患者骨折断端平均固定时间、术后皮下负压引流时间和并发症情况.选择合并其他部位骨折行手术治疗的患者441例,分为同期联合手术组(同期手术组,316例)和分期手术组(125例),比较两组患者的治疗时间、麻醉费用和并发症情况.结果 在手术时机的研究中,3～7 d组的患者骨折断端平均固定时间显著短于＜3 d组和＞7 d组,＜3 d组显著短于＞7d组(P值均＜0.05).＜3 d组患者的术后皮下负压引流时间显著短于3～7 d组和＞7d组,3～7 d组显著短于＞7 d组(P值均＜0.05).3～7 d组患者的术后切口不良事件和肺部感染发生率均显著低于＜3d组和＞7d组(P值均＜0.05),＜3 d组与＞7 d组间的差异均无统计学意义(P值均＞0.05).在合并伤联合手术的研究中,分期手术组的住院时间、术后静脉镇痛药物使用时间均显著长于同期手术组(P值均＜0.05),麻醉费用显著高于同期手术组(P＜0.05).两组患者术后切口不良事件和肺部感染发生率的差异均无统计学意义(P值均＞0.05).结论 肋骨骨折手术时机的选择对患者的治疗和术后并发症的发生均有影响.伤后3～7 d是肋骨骨折手术的最佳时间.对于合并其他部位骨折的患者,同期联合手术可缩短治疗时间,减少多次麻醉带来的创伤和风险,并降低治疗费用,是经济、有效且安全的.

The diagnosis and treatment of tumors involving the sternum are managed by thoracic and those of tumors of the clavicle by orthopedic surgeons. Presently, there are a number of reports documenting sternoclavicular joint reconstruction after sternal tumor resection (1,2). However, the management of clavicular tumors is controversial (3,4). When the lesion involves the sternoclavicular joint, it is often necessary to resect not only parts of the sternum and clavicle but also the sternoclavicular joint. The process of sternoclavicular joint reconstruction is challenging, and the need for it is often questioned by both thoracic and orthopedic surgeons. There is a paucity of literature on this subject. In this report, we retrospectively reviewed 5 patients with sternoclavicular joint pathologies who were treated between 2016 and 2017. By combining our findings with existing reports, we discuss the approaches to the management of this disease.

Objective To evaluate the effect of operative treatment of non-flail chest rib fractures. Methods A retrospective analysis of 109 patients who underwent non-flail chest rib fractures between May 2015 and June 2016 was conducted. We compared patients’ pain index and pulmonary function parameters (vital capacity, VC; forced vital capacity in the first second, FEV1; peak expiratory flow, PEF) at different stages: at hospital admission (IN), on the day before surgery (PRE), and on postoperative days one (D1), two (D2), and seven (D7). Results The 109 patients included 85 men (78.0%) and 24 women (22.0%) between the age of 23 and 74 ( with a mean of 52). 75 had multiple injuries (68.8%), 34 had chest trauma solely (31.2%), the average injury severity score (ISS) was 18.2.The average number of fractured ribs was 5.8 ( ranging from 3-16). The average length of time from admission to operative intervention was 4.4 days (ranging from 1-16). The fractures healed in all patients, while superficial wound infections occurred in two cases (1.8%), skin numbness around the incision occurred in 5 cases (4.6%). Pain and pulmonary function parameters (VC, FEV1, PEF) had improved significantly by postoperative day seven (P<0.05). Conclusions In patients with three or more non-flail chest rib fractures , early surgical treatment is safe, and can effectively relieve pain , leading to rapid recovery of lung function. Key words: Non-flail chest rib fractures; Operative treatment; Lung function; Pain index

This study aim to evaluate surgical procedures for titanium plate internal fixation of sternal fractures with displacement or nonunion.

目的 ：检测肺癌患者手术前后血清血管内皮细胞生长因子-A（vascular endothelial growth factor-A,VEGF-A）和血管内皮生长因子受体-2（vascular endothelial growth factor receptor 2,VEGFR-2）的水平变化。方法 ：选取2014年1—6月我科收治行肺癌根治术患者32例,ELISA法检测术前1d,术后1d、7d血清VEGF-A和VEGFR2水平,分析其变化特点。结果 ：术后1d、7d血清VEGF-A均明显升高,第7d显著高于术后第1d及手术前水平,术后1d、7d血清VEGFR-2均升高,但术后7d与1d比较差异无统计学意义。术前血清VEGF-A和VEGFR-2水平呈显著正相关（r=0.418,P=0.019）,术后血清VEGF-A和VEGFR-2之间呈正相关（r=0.205,P=0.047）。结论 ：手术去除原发肿瘤灶后,VEGF合成分泌增加,其可能机制包括缺氧、组织损伤修复及对抗血管生成平衡被打破,这可能也是肺癌患者术后发现早期转移的原因。

目的 探讨可吸收肋骨钉与记忆合金接骨板内固定两种方法治疗多发性肋骨骨折的效果.方法 回顾性分析2009年1月至2014年1月在上海市第六人民医院胸外科行手术内固定的胸部外伤致多根多处肋骨骨折患者321例的临床资料,其中可吸收肋骨钉组70例,其中男62例、女8例,年龄(48.54±9.74)岁;记忆合金接骨板组251例,其中男187例、女64例,年龄(51.44±10.22)岁.分析两组患者疗效差异.结果 两组患者术前疼痛评分(7.74±0.89 vs.7.66±0.92)、术后疼痛评分(3.80±0.79 vs.3.82±0.85),术后胸腔引流时间[(6.00±2.84)d vs.(5.68±2.98)d]差异均无统计学意义(P＞0.05).记忆合金接骨板组住院时间[(20.06±7.39)d vs.(17.77±7.68)d],及手术时间(101.29±30.67)min vs.(71.95±29.50) min]均短于可吸收肋骨钉组,且差异有统计学意义(P＜0.05).术后3个月随访复查胸部X线,两组患者骨折再移位差异无统计学意义.结论 可吸收肋骨钉与记忆合金接骨板均是治疗多发性肋骨骨折较理想的术式,记忆合金接骨板手术操作更为简单,可吸收肋骨钉手术无需在体内留置金属内固定装置,但固定强度较接骨板略差,应根据情况选择合适的内固定方法.

Objective To investigate the influence of clinicopathological characteristics, endostain and epithelial growth factor receptor(EGFR) on the survival of the perioperative non-small cell lung cancer(NSCLC). Methods Fifty patients with NSCLC undergoing surgical treatment in the Department of Cardiothoracic Surgery in Shanghai Sixth People’s Hospital affiliated to Shanghai Jiao Tong University between January 2008 and December 2008 were collected, and were followed up after surgery till January 2014, with the mean time of follow-up of 36.44 months. The survival-related factors for these 50 patients with NSCLC were analyzed using multivariate regression analysis. Results The 5-year survival was 53.7%, and the median survival time was 50.6 months for these 50 patients with NSCLC. The survival in patients with tumor maximum dimmer <3.5 cm was significantly bigger than that in those with tumor maximum dimmer ≥3.5 cm(χ2=8.086, P=0.004). The survival in patients with adenocarcinoma was significantly bigger than that in those with squamous carcinoma(χ2=7.527, P=0.006). The survival in patients with stage Ⅰ NSCLC was significantly bigger than those in patients with stage Ⅱ and stage Ⅲ NSCLC(χ2=4.681, P =0.03; χ2=7.990, P=0.005). The survival in patients with endostatin <20.4 ng/mL before operation was significantly bigger than that in those with endostatin≥20.4 ng/mL before operation(χ2=5.213, P=0.022). The survival in patients with EGFR ≥44.7 pg/mL after operation was significantly bigger than that in those with EGFR<44.7 pg/mL after operation (χ2=13.908, P=0.000). Multivariate regression analysis indicated that EGFR after operation was an independent prognostic factor(P=0.000). Conclusion The patients with low level of endostain before operation and high level of EGFR after operation may gain better survival. Key words: Non-small cell lung, cancer; Endostain; Epithelial growth factor receptor; Survival rate; Prognosis; Follow-up studies

To compare the surgery and conservative treatment of multiple fractured ribs, we designed a randomized controlled trial in the single center of thoracic surgery ward. After admission condition assessment (general clinical evaluation, operation condition assessment, the digital method of pain assessment), the selected multiple fractured rib patients were told to choose surgery or conservative treatment, according to the patient will undergo surgery or conservative treatment. In the acute phase, compared with conservative treatment, patients with mechanical ventilation in time (mechanical ventilation time MV) (3.7 ± 1.4 vs. 9.5 ± 4.3), ICU stay time (8.2 ± 4.3 vs. 14.6 ± 3.2), total hospitalization days (15.3 ± 6.4 vs. 26.5 ± 6.9), the incidence of pneumonia (6.7% vs. 19.1%), mortality (1.3% vs. 5.3%) and pain score on patients (3.3 vs. 5.8) of surgical treatment group were significant lower (P < 0.05). The number of tracheostomy in surgical patients with conservative treatment (4 vs. 7) was no statistically significant difference (P > 0.05). In chronic phase, the surgical patients compared with patients with conservative treatment in the chest wall pain (2.9 ± 1.2 vs. 5.6 ± 1.7), chest wall tension (13.3% vs. 57.3%), dyspnea (5.3% vs. 22.4%) and chest wall deformity rate (4% vs. 93.5%) were lower significantly (P < 0.05). In conclusion, the surgical treatment of multiple fractured ribs could ease the acute chest pain, reduce the mechanical ventilation time and incidence of pneumonia, shorten the hospitalization days and total hospitalization days in the ICU and alleviate the forward chest wall discomfort. The speedy recovery and long-term quality of patients' life had improved significantly.

Background and purpose:The pulmonary metastases is the common phenomenon in the osteosarcoma after operation.The effect of lung metastasectomy in other malignant tumors has been confirmed.This study was to investigate the possibility of surgery treatment to lung metastases of osteosarcomas,to analyze the relationship of living state and the clinic data of these patients that may help to select suitable patients for pulmonary metastasectomy.Methods:Follow-up by telephone to know the living state of 29 osteosarcoma patients with lung metastasectomy.The clinic data of these patients and draw the survival curve by Kaplan-Meier was summarized.And the difference of survival curve in clinic feature,the number and type of metastatic tumor,as well as type of surgical resection,and study these influencing factors with existence using the multivariate COX regression was analyzed.Results:The 2-year survival rate was 46.52%.No perioperative deaths and serious complication occurred.The survival difference was significant between patients with the number of metastates ≤3 and the number of metastates>4(P<0.05).There was no significant difference in clinic data,the type of metastatic tumor and the type of surgical resection(P>0.05).There was also no significant difference between thoracosopy and thoracotomy(P>0.05).Multivariate regression analysis showed that the number of metastasis lesions was independent prognostic factor(P=0.041).Conclusion:The risk of postoperation of surgery treatment to osteosarcoma patients with lung metastates can be accepted.The number of metastaes affected the survival time of osteosarcoma patients with lung metastates and could improve the prognosis of patients.Thoracoscopy was not recommendation for metastasectomy to lung metastates of osteosarcoma.

目的总结气管疾病患者行外科手术治疗的临床经验。方法回顾性分析2007年7月至2011年2月上海交通大学附属第六人民医院16例气管创伤或气管疾病患者施行气管手术的临床资料,男9例,女7例;年龄7～65岁。气管创伤6例,气管切开后气管狭窄5例,原发性气管肿瘤4例,甲状腺癌侵犯气管1例。因16例患者的病因不同,分别行气管外伤直接缝合或病变段气管环形切除+对端吻合术。结果所有患者均治愈或好转出院,术后无并发症发生。随访15例,随访时间3～12个月,患者呼吸情况良好。随访期间9例行病变段气管环形切除、对端吻合的患者无吻合口狭窄、吻合口裂开。1例甲状腺癌侵犯气管的患者手术后继续行放化疗治疗,3个月后失访。结论气管外科手术依其病因不同分别有其各自的手术处理要点。

随着医用材料学的进步,近年来开始尝试手术治疗多发肋骨骨折,但手术内固定的治疗方法仍存在争议.我们对120例多发肋骨骨折患者,分别用GUNZE可吸收肋骨钉行内固定治疗和保守治疗,比较两种方法治疗效果的差异,评价可吸收肋骨钉对于治疗多发肋骨骨折的作用. 资料和方法选取2009年1月至2010年1月多发肋骨骨折(肋骨骨折数均≥6根,除外合并有严重颅脑、腹部或其他系统创伤者和原有慢性心、肺、肾功能不全者)120例男性患者.按年龄、肋骨骨折数和ISS、AIS配对,分为手术内固定和保守治疗两组患者.入院后均行X线胸片或胸部CT扫描加肋骨三维重建检查,明确肋骨骨折数量和部位.详细创伤和治疗情况见表1.

Objective: To study the relationship between clinical significance and the serum levels of vascular endothelial growth factor receptor 2(VEGFR-2),endostatin(ES) in patients with non-small cell lung cancer(NSCLC).Methods: The serum VEGFR-2,ES levels were detected by ELISA method in 38 patients with NSCLC in Shanghai 6th People's Hospital cardiothoracic surgery department in 2009.The correlations were analyzed among VEGFR-2,ES and the clinical characters,age,sex,pathology,diameter of tumor,clinical stage,micro vessel density(MVD) of tumor.Results: The serum level of ES [(20.29±6.10) μg/L] was uncorrelated with that of VEGFR-2 [(7.42±4.28) μg/L](P0.05);the serum level of ES was correlated with MVD of tumor(r=-0.867,r2=0.752),the linear regression equation was [Y=32.002-0.499X(μg/L)](P0.001);ES and VEGFR2 were uncorrelated with the other clinical characters.Conclusion: The serum level of ES may change the MVD of tumor,ES,VEGFR-2 and the clinical characters are uncorrelated in NSCLC patients.It suggests that VEGFR-2 and ES may be failed to be used as effective markers to predict stages and prognosis in NSCLC patients.

Background and purpose:Our preliminary research shows that HGFK1 can not only inhibit angiogenesis,but significantly inhibit tumor growth and metastasis,while the expression and clinical significance of HGFK1 in lung cancer has not been reported yet.This study aimed to explore the expression state and clinical significance of HGFK1 in the non-small cell lung cancer patients,so as to provide a new prognostic factor and a potential therapeutic target for lung cancer patients.Methods:The subjects were 119 non-small cell lung cancer (NSCLC)cases.Detected the expression of HGFK1 by Western blot in the surgical resection specimens,and further analysed the relationship between the HGFK1 expression and patients’clinical pathophysiological characteristics and prognosis.Results:The results showed that 22.7%(27/119)of patients with lung cancer expressed HGFK1 protein, while in normal lung tissue the expression of HGFK1 was 68.7%(11/16),which was significantly higher than that of lung cancer tissue.The expression of HGFK1 gene did not associated with patient's age,gender,histological type,and smoking status(P0.05).The expression of HGFK1 was significantly correlated with tumor grade and lymph node metastasis.HGFK1 positive rate in tissues of patients with poor pathological grade(G 3 )was obviously lower(11.5% vs 31.3%)compared to that of patients with relatively good pathological grade(G 1 ,G 2 ).While the HGFK1 positive rate in patients with lymph node metastasis tissues were obviously lower than those without lymph node metastasis (11.6%vs 47.5%).3-year progression-free survival(PFS)and overall survival(OS)of the group that HGFK1 was positive expressed were significantly longer than the HGFK1 negative group(P value is 0.002,0.017,respectively). Conclusion:The expression of HGFK1 gene in normal lung tissues was different from that in NSCLC patients’ lung cancer tissues.Furthermore,different cancer tissues of NSCLC patients had different expression status.The patients who had the better pathological grade or without lymph node metastasis had higher HGFK1 positive rate.The expression of HGFK1 had no significant relationship with patient's gender,histological type,smoking status and other clinical features.HGFK1 expression is significantly associated to better 3 years PFS and OS remains.

Objective:To study the influence and clinical significance of operation on serum levels of vascular endothelial growth factor receptor 2 (VEGFR2) and endostatin (ES) in patients with non-small cell lung cancer (NSCLC).Methods:The serum levels of VEGFR2 and ES were detected by using ELISA method in 38 patients with NSCLC who have received surgery in the Department of Cardiothoracic Surgery of Shanghai Sixth People’s Hospital from January 1st 2009 to December 31st 2009. Their changes and clinical features and significance were analyzed.Results:The serum levels of ES were 9.82 (9.51, 10.13) ng/mL and 9.47 (9.08, 9.86) ng/mL before and after operation, respectively, which was slightly decreased after operation. The difference was significant (P=0.000). The serum levels of VEGFR2 were 8.78 (8.28, 9.28) ng/mL and 8.93 (8.41, 9.45) ng/mL, respectively, before and after operation, respectively, which had slight increase. The difference was not significant (P=0.034). The preoperative serum levels of ES did not correlate with that of VEGFR2(P0.05). But the postoperative serum levels of ES had significantly positive correlation with that of VEGFR2 (r=0.351, P=0.031). The serum levels of ES and VEGFR2, and their changes after operation, had no correlation with gender, pathological classification, maximum diameter of tumor body, and clinical stage of NSCLC (P0.05).Conclusion:The postoperative serum level of ES was decreased and that of VEGFR2 was increased, which could explain the postoperative early metastasis of NSCLC. It suggests that ES should be used in the perioperative period to suppress the early metastasis.

<正>在临床实践中常发现有些食管癌、贲门癌患者,术前B超检查肝胆正常,术后随着时间的推移,可发生胆囊炎、胆石症、慢性肝囊肿等疾病。本文对术前B超检查结果肝胆正常的320例食管、贲门癌患者,术后随诊超过三年的肝胆B超检查资料,进行统计分析发现有胆道疾病40例,现将结果报告如下。

病人 女,26岁.剖官产后3天,发作性血压升高达170/130 mm Hg(27.7/17.3 kPa)伴头痛2次.血压升高时血肾上腺素422.60 pmol/L,血去甲肾上腺素3590.33 pmol/L;

目的分析15例食管癌贲门癌伴门静脉高压症的外科治疗体会。方法15例中根据肝功能Child分级A级12例,B级3例。其中3例行食管癌贲门癌根治同时行脾切除术。15例中5例行食管癌根治颈胃吻合术,10例行左胸弓下食管胃吻合术。结果15例中1例并发吻合口瘘死亡,14例痊愈出院。其中3例同时行脾切除,病情改善明显。结论对于食管癌贲门癌伴门静脉高压症患者手术是首选方法;改善肝功能、纠正低蛋白血症及脾功能亢进是关键,合并脾亢者同时行脾切除术。

我院自1991年1月至2005年11月共手术治疗70岁以上高龄贲门食管癌142例.其中贲门癌94例,食管癌48例,取得较好的治疗效果,总结如下.