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Objective:To investigate the surgical treatment of the tumors at cervicothoracic junction.Methods:A retrospective analyses was performed for 63 patients with tumors at the cervicothoracic junction receiving surgery from Mar 2008 to May 2020 in the Department of Thoracic Surgery, Zhongshan Hospital, Fudan University. Clinical data about manifestation, surgical approach, resection degree and pathological types were collected. There were 43 cases of asymptomatic patients and 20 cases of patients with ≥1 clinical manifestations. Twenty two patients receiving radical resection with video-assisted thoracoscopic surgery. Anterior approach was the most popular treatment in open surgery (24 cases, 38.1%), and 8 cases of anterolateral approach(6 cases of Hemiclamshell incisions, 2 cases of trap-door incisions), 1 case of posterior approach, 2 cases of posterolateral approach and 1 case of supraclavicular combined posterolateral approach.Results:Pathological examination suggested 61 cases of radical resection and 2 cases of microscopic residual. Neurilemmoma was the most common pathological type (27 cases, 42.9%), the second common pathological type was tumor originated from fibrous tissues (6 cases, 9.5%). The 3-year overall survival rate of those 63 patients was 88.9%, while the 5-year overall survival rate was 84.1%.Conclusion:Tumors involving the cervicothoracic junction are characterized as special location, complicated anatomy and various histopathological subtypes. Individualized approach and surgery improve safety and normalization of tumors at cervicothoracic junction treatment.
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Objective To reconstruct the three-dimensional structure of human brachial plexus including its outer contour and delicate pathways of nerve fascicles inside, and to explore an useful and practical method for three-dimensional reconstruction of brachial plexus. Methods Taking woman hair as the localizing marks, two left-side brachial plexus from healthy adult cadaver were serially horizontally sliced with each section 0.2 mm in thickness(from the outlet of nerve root canal to the origin of median nerve, about 20 cm in length on an average), each slice was stained by AchE histochemical method. Each section of the two-dimensional image was taken by high-resolution digital camera, and the three-dimensional microstructure of brachial plexus was reconstructed and computer-assisted. Results The three-dimensional structure of brachial plexus reappeared successfully, including its outer contour and its delicate pathways of nerve bundles inside, the topographic anatomy of every nerve fascicle and its relationship in arbitrary sections as well as the patterns of branching, intersection and recombination of nerve bundles in the whole length. It could also display the outer contour of brachial plexus and the delicate pathways of nerve bundles inside either separately or totally. The reconstructed microstructure of the brachial plexus was smooth, natural and realistic, it could be rotated, zoomed and divided in any direction. The fascicular number of C7 root was more than C6 or C8, while C5 and T1 were the least. Conclusion The three-dimensional structure of brachial plexus inside is very complicated. The nerve bundles crisscross and recombine with each another. It combines a fine and delicate nerve network. Using the advanced localizing method, a good result is obtained. This is a practical method for three-dimensional reconstruction of the microstructure of brachial plexus.
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Objective To study the etiolgy and clinical features of pathological fracture in femur. Methods 17 cases of pathological fracture in femur,including 10 males and 7 females with average age 39.5(13～74),were all treated surgically and their pathological diagnosis were achieved,which were consistent with the clinical diagnosis.Results 12 patients (70.59%) suffered from fracture resulted from malignant tumor,of which lung cancer and breast cancer were the commonest with 3 cases respectively (50%).The fracture of proximal end accounted for 65%.8 cases of spontaneous fracture and 2 cases of multiple fracture were all malignancy sufferers.Conclusion Malignancy is the main cause of pathological fracture in femur,of which lung cancer and breast cancer are the commonest.Proximal end of femur is the most frequent part to which fracture happens.Both spontaneous and multiple fractures are resulted from malignancy.