Surgical resection of sternal tumors and reconstruction with titanium mesh.

OBJECTIVE: To evaluate the use of titanium mesh reconstruction after sternal tumor resection. METHODS: From January 2007 to January 2011, 14 patients with sternal tumors were admitted into Peking Union Medical Hospital. The clinical characteristics, surgical resection, and technique of reconstruction were reviewed. RESULTS: Of the 14 patients, 3 had a metastatic sternal tumor, the primary sites of which were as follows: hepatic carcinoma in one case (metastasis 19 years after operation), breast carcinoma in another case (metastasis 5 years after operation), and renal carcinoma in the other case (found simultaneously). Two patients showed local involvement of the sternum: 1 had thymic carcinoma, and the other had myofibrosarcoma. The remaining 9 patients had primary tumors: 4 were osteochondroma, 3 chondrosarcoma, 1 eosinophilic granuloma, 1 non-Hodgekin's lymphoma. En bloc resection of the sternal tumor was performed in all the 14 patients. The defect was repaired with the titanium mesh adjusted to the shape of the defect and fixed with the stainless steel wire. Eleven patients were followed up for a period from 2 months to 4 years, during which no translocation or broken of the titanium mesh was observed. CONCLUSIONS: Radical en bloc excision remains the treatment of choice for sternal tumors. Sternum defect reconstruction using titanium mesh as a rigid replacement proves appropriate and effective.

Early postoperative pulmonary function study: changing curve and influencing factors analysis / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the changes and influence factors for early postoperative pulmonary function of thoracotomy.</p><p><b>METHODS</b>Pre- and early postoperative pulmonary function was detected in 64 consecutive cases with optimal thoracotomy. Pain assessment was conducted before pulmonary function test, and the chief complaints of patients were recorded after the procedure. The changing curves of pulmonary function were made and the differences associated with groups, surgical styles, pain assessment, epidural analgesia, chief complaint and preoperative conditions were analyzed using SPSS10.0 medical statistic software.</p><p><b>RESULTS</b>Pulmonary function was severely lowered to (39 +/- 14)% of the base line on the first day. It was rehabilitated gradually, and recovered to (62 +/- 10)% of the base line on the 8th day. Epidural analgesia could improve pain relaxation and pulmonary function in some degree. Single-factor analysis showed that postoperative pain, postoperative day and surgical style were the significant influence factors for early postoperative pulmonary function. Multiple-factor analysis showed that preoperative pulmonary function, age and postoperative pain were the main factors, while surgical style had only weak effect on it.</p><p><b>CONCLUSIONS</b>Early postoperative pulmonary function is severely impaired by thoracotomy. It rehabilitate gradually with time. Improvement of preoperative pulmonary function, reducing surgical procedure injuries, especially injury to respiratory muscle system, and enough postoperative pain relief are the most important means that will reduce pulmonary function impairment and consequently reduce postoperative pulmonary complications.</p>