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 analyze the relationship between rs830083CG mutation of damage specific DNA binding protein 2（DDB2）single nucleotide polymorphism locus and lung cancer susceptibility of non-smokers.Methods One hundred and fifty-eight patients with non-smoking lung cancer admitted to a hospital in Nanyang City from March 2020 to March 2021 were selected as the study group,and another 100 healthy people in the same period were selected as the control group. The single nucleotide polymorphism（SNP）of DDB2 gene rs830083 polymorphism from both groups was detected,and the relationship between DDB2 gene polymorphism and the susceptibility of non-smoking people to lung cancer was analyzed by unconditional logistic regression model. The interaction between environmental exposure factors and the rs830083 polymorphism of DDB2 gene was evaluated. Results The genotype frequencies of CC,CG and GG at rs830083 of DDB2 gene in the study group and control group were36.08%,52.53%,11.39% and 53.00%,39.00% and 8.00%,respectively. The frequencies of C and G alleles were 62.34%,37.66% and 75.50%,27.50% respectively,with significant differences between the two groups（P ＜ 0.05）. The genotype distribution of rs830083 of DDB2 gene was statistically significantly different between the two groups in dominant mode（P ＜ 0.05）,but not in recessive mode（P ＞ 0.05）. Compared with the CC genotype,the CG+GG genotype was associated with the lung cancer susceptibility of non-smokers. Passive smoking exposure increased the risk of lung cancer（adjusted OR = 2.411,95%CI:1.149-5.061,P ＜ 0.05）. Compared with non-exposed individuals with CC genotype at rs830083,the risk of lung cancer in the exposed individuals with CG+GG genotype was increased by 4.444 times（95%CI:1.212-16.294,P＜0.05）. There was an interaction effect between passive smoking exposure and DDB2 gene rs830083 locus polymorphism（P＜0.05）. Conclusion The rs830083CG mutation of DDB2 single nucleotide polymorphism locus is related to the susceptibility of lung cancer in non-smokers. Non-smokers carrying the G allele may have a higher risk of lung cancer,for the gene has an interaction effect with passive smoking exposure.

目的:探讨原发性食管鳞癌患者血清白蛋白/纤维蛋白原(A/F)比值对预后判断的价值.方法:选取72例原发性食管鳞癌患者作为研究对象,根据术前A/F比值分为高A/F组(A/F比值＞12.00,n=51)与低A/F组(A/F比值≤12.00,n=21),对比低A/F组与高A/F组的生存率、中位生存时间,采用K-M法绘制生存曲线,采用ROC曲线分析A/F比值预测预后价值.结果:低A/F组与高A/F组浸润深度、淋巴结转移、TNM分期、术前白蛋白、术前纤维蛋白原比较,差异有统计学意义(P＜0.05).低A/F组的2 a生存率低于高A/F组,而中位生存时间短于高A/F组(P＜0.05).ROC曲线分析显示,A/F比值预测术后生存的AUC(95％CI)为0.998(0.993～1.000),敏感度100.00％,特异度98.00％.结论:原发性食管鳞癌患者A/F比值下降与病理进程、预后具有一定关系,可将其作为预后评估的预测因子.

随着医疗技术的进步,临床中用于治疗肺癌的方法越来越多,而手术微创技术和通过多种通道介入治疗的杂交融合在诊疗过程中发挥着重要作用.该文对各通道诊疗优劣和肺癌手术介入杂交诊疗作一阐述.

目的:探讨肺气肿与早期肺癌患者肺切除术后长期预后、死亡率和术后并发症之间的关系.方法:回顾性分析2010年01月至2014年12月在我院行手术治疗的非小细胞肺癌(non-small cell lung cancer,NSCLC)患者364例.采集患者人口学、疾病特征、手术方式、手术相关并发症和随访资料.选择术前2周内拍摄的全肺CT图像,采用Pulmo图像分析软件分析低衰减区百分比(LAA％).公式为LAA％=肺低衰减区/全肺体积×100％.LAAs>10％定义为肺气肿.结果:63例(17.3％)患者出现肺气肿.无肺气肿组和肺气肿组的5年总生存率分别为89.0％和61.3％(P<0.001),5年无复发生存率分别为81.0％和51.7％(P<0.001).多因素Cox回归分析发现,肺气肿的存在、吸烟指数较高、组织学分级较高是总生存率差的独立预测因子(P<0.05);而肺气肿的存在、吸烟指数较高、用力肺活量占预计值的百分比[FVC(％)]降低、组织学级别高和胸膜浸润是无复发生存率差的独立预测因子(P<0.05).术后Clavien-Dindo系统分级≥Ⅱ级的心肺并发症中,肺气肿组发生需要抗生素治疗的肺炎(P=0.001)和需要药物治疗的室上性心动过速(P=0.026)高于无肺气肿组.结论:肺气肿的存在影响早期肺癌患者的远期预后和术后并发症的发生.建议术前应使用CT对肺癌患者的肺气肿情况进行评估.

目的 探究超声刀与电凝钩在微创电视胸腔镜下纵隔肿瘤切除术中的应用价值及对患者预后的影响.方法 回顾性分析2017年1月至2019年5月河南省南阳市中心医院胸外科收治行微创电视胸腔镜下纵隔肿瘤切除术的97例患者的临床资料,按术中能量器械使用情况分为超声刀组(n=51)与电凝钩组(n=46),比较两组手术情况(手术入路、手术时间、术中出血量、切除组织质量、胸腔引流量、首次下床活动时间、拔除引流管时间、住院时间),术后第24、48、72小时及1周均采用视觉模拟评分法(VAS)评估患者切口疼痛程度;术前、术后24小时、术后72小时均采血测定皮质醇(COR)、促肾上腺皮质激素(ACTH)浓度变化,测定T淋巴细胞亚群水平(CD3+、CD4+、CD8+、CD4+/CD8+)的变化;统计手术并发症发生率,并进行为期6个月的随访调查,统计纵隔肿瘤复发率.结果 超声刀组手术入路为剑突下入路,所占比例高于电凝钩组,手术时间较电凝钩组长,术中出血量少于电凝组,切除组织质量较电凝钩组重(P<0.05);超声刀组术后第24、48、72小时切口VAS评分均低于电凝钩组,存在组间、时间、交互效应(P<0.05);术后24、72小时超声刀组COR低于电凝钩组(P<0.05),超声刀组术后24、72小时CD3+、CD4+、CD4+/CD8+比值高于电凝钩组,存在组间、交互效应(P<0.05),超声刀组术后24小时CD8+低于电凝钩组(P<0.05);两组手术并发症、随访复发率比较,差异无统计学意义(P>0.05).结论 微创电视胸腔镜下纵隔肿瘤切除术中应用超声刀、电凝钩均可获得较好的近期预后,但超声刀微创价值更高,可减少术中出血量,减轻手术应激及术后早期免疫抑制程度.

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.

目的 总结预防食管癌、贲门癌术后发生吻合口狭窄的措施.方法 2013年1月～2018年1月我院胸外科收治的食管癌、贲门癌病人315例,均采用手术治疗.实验组146例,术前口服庆大霉素生理盐水,术中行胃壁荷包缝合后再进行吻合、减轻吻合口张力,术后及早进食固体食物和口服抑酸药物;对照组169例,仅直接采用吻合器吻合.术后随访2年,比较两组吻合口狭窄发生率.结果 对照组术后吻合口狭窄发生率为11.0％,实验组为3.8％,两组比较差异有统计学意义(P＜0.05).结论 术前口服庆大霉素盐水,术中行胃壁荷包缝合后再进行吻合、减轻吻合口张力等措施可预防吻合口狭窄.

目的 探究脱氧葡萄糖(FDG)正电子发射计算机断层扫描(PET-CT)显像代谢参数最大标准摄取值(SUVmax)、代谢体积(MTV)和病灶糖酵解总量(TLG)对预测食管癌近期疗效中的价值.方法 回顾性分析2018年3月至2019年4月在本院行放射治疗的206例食管癌患者的FDG PET-CT显像资料与临床资料,分析SUVmax、MTV和TLG与各临床因素的关系,根据治疗效果将患者分为有效组(141例)和无效组(65例);采用Logistic回归模型对影响食管癌近期疗效的多因素进行分析.结果 接受化疗后,治疗总有效率为68.45％,有效组的SUVmax、MTV和TLG值均小于无效组(P<0.05);患者性别、年龄和肿瘤位置间的SUVmax、MTV和TLG值差异无统计学意义(P>0.05),临床分期及病灶长度间的SUVmax、MTV和TLG值差异有统计学意义(P<0.05);Logistic回归分析显示,MTV、临床分期和病灶长度是影响食管癌近期疗效的独立危险因素(P<0.05).结论 FDG PET-CT显像的代谢参数在预测食管癌近期疗效中具有一定价值,且MTV的预测价值更高,能帮助制定个性化治疗方案,提高患者预后.

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.