제3회 톈진 흉부 외상 및 흉벽 재건 포럼 및 전국 릴레이 프로그램: 늑골 골절을 위한 최소 침습 수술 기법이 성공적으로 마무리되었습니다!
The 3rd Tianjin Thoracic Trauma and Chest Wall Reconstruction Forum - and National Relay Program: Minimally Invasive Surgery Technique for Rib Fracture Learning Class, sponsored by China Collaborative Clinical Research Group for Thoracic Trauma (CCIRS), co-organized by the Thoracic Trauma Group of the Chinese Medical Association, hosted by Tianjin Tianjin Hospital and assisted by Changzhou Jishuo Medical Devices Co. More than 20 experts from other provinces and cities and more than 40 experts in thoracic surgery in Tianjin attended this meeting.
Prof. Wang Dongbin of Tianjin Hospital presided over this meeting.
Prof. Yang Yi, Chairman of Chinese Thoracic Trauma Clinical Research Collaborative Group and member of Shanghai Sixth People's Hospital, delivered a speech.
Address by Prof. Yang Yi: Congratulations on the successful opening of the 3rd Tianjin Thoracic Trauma and Chest Wall Reconstruction Forum! Thoracic trauma is getting more and more attention, but at the same time, it also faces many challenges, for example, many doctors still can't really accept minimally invasive surgery for thoracic trauma. We thoracic surgeons should start from ourselves to standardize the operation procedure and enhance the public recognition of minimally invasive thoracic surgery. With the improvement of people's life concept, I believe minimally invasive surgery in thoracic surgery will have a broader application prospect. We hope everyone will work together to promote more!
Address by Prof. Zhang Xun, Honorary Chairman of the Congress, Tianjin Chest Hospital.
Address by Prof. Zhang Xun: Warmly congratulate the 3rd Tianjin Chest Trauma and Chest Wall Reconstruction Forum! In the past, there was no outstanding discipline in chest wall trauma and reconstruction in Tianjin. Since Professor Wang Dongbin came to Tianjin Hospital, he has made full use of the resources of thoracic surgery and trauma surgery in Tianjin Hospital, and well built this platform which is conducive to the mutual exchange of workers engaged in chest trauma and chest wall reconstruction nationwide. With the increase of traffic flow and the increase of high-rise buildings, the chance of chest wall trauma also increases greatly, and the need for nearby medical treatment is relatively high. How to improve the standardization, standardization and homogenization of chest wall trauma in various hospitals, especially the primary hospitals, deserves attention. We wish the conference a great success!
Address by Prof. Wang Guangshun, Honorary Chairman of the Conference, Tianjin Baodi District People's Hospital.
Address by Prof. Wang Guangshun: It is a great pleasure to participate in the 3rd Tianjin Thoracic Trauma and Chest Wall Reconstruction Forum! Thoracic trauma is an important part of thoracic surgery, and the prognosis of trauma is of great concern to both patients, doctors and society! Thoracic trauma is also an important duty of surgeons, and how to do a good job in saving and treating thoracic trauma deserves attention. The situation of chest trauma varies from patient to patient, so there are great differences in treatment, and we have to make more efforts in the rescue and treatment of chest trauma in the future. Professor Wang Dongbin is the leader of chest trauma and chest wall reconstruction in Tianjin, and I believe that the technical level of chest trauma and chest wall reconstruction in Tianjin will be more advanced under the leadership of Professor Wang Dongbin, and finally I wish the 3rd Tianjin Forum on Chest Trauma and Chest Wall Reconstruction a great success!
Consensus on Concept and Guideline
Moderator: Prof. Zhang Xun, Prof. Wang Guangshun
Professor Yang Yi from Shanghai Sixth People's Hospital shared "Establishment and application of chest trauma database": Professor Yang introduced the current situation of chest trauma database in the United States, Britain and Japan, as well as some regional trauma databases in China, pointing out that there is no comprehensive database in trauma medicine in China at present. The functions of the database were also introduced, such as the role to clinical, to scientific research and to medical resources allocation. Shanghai Sixth People's Hospital has created a thoracic trauma database based on rib fracture data with many personalized functions together with software companies, and more than ten hospitals in China have participated in the construction of this database. We hope that more hospitals will join in to make it a national database and contribute to the development of trauma in China.
Prof. Yang Jinliang from the Third Hospital of Hebei Medical University shared "Interpretation of International Consensus and Guidelines on Rib Fracture Treatment": Prof. Yang interpreted and summarized the international consensus and guidelines on rib fracture treatment issued at home and abroad, and emphasized the key points, such as: the ideal timing of surgery is the earlier the better; to recognize the site of surgery; to make a timely decision on the site of air leakage in the lungs. The lung leak site should be made in time and other organs should be treated in time; the use of standard rib fixation processes such as the process of anesthesia, the way of incision, the method of exploring the thoracic cavity, the surrounding tissue damage, and the advantages of using lumpectomy. The lumpectomy for rib fracture exploration and repair is also recommended in the consensus.
Prof. Su Zhiyong from the Affiliated Hospital of Chifeng College shared "Current status of minimally invasive surgery for rib fractures": Prof. Su reviewed the treatment of rib fractures before the advent of lumpectomy and introduced in detail the techniques of minimally invasive surgery for rib fractures from several aspects with his team's work experience, and summarized six ideas about the principles of treatment. He emphasized that lumpectomy is the means and the whole management is most important; the benefit of surgery should outweigh the trauma of surgery. He predicted that absorbable material is the main direction in the future, and then with braided bundling technique will be a good choice.
Prof. Zhang Qiang from Beijing Jishuitan Hospital shared "Application of ERAS concept in rib fracture surgery": Prof. Zhang introduced various methods and surgical techniques to accelerate patients' recovery in terms of materials and surgical techniques, with the goal of reducing surgical trauma and sequelae of patients around the concept of accelerated recovery surgery (ERAS). He introduced various methods and procedures for accelerating patients' recovery in terms of materials and surgical techniques. He proposed that specific salvage measures should be developed according to the differences in body size and specific trauma of different patients, such as the use of 3D printing technology to address the treatment of obese patients. At present, many materials are not yet suitable to be paired with thoracoscopy. He emphasized the importance of surgical preparation, which can shorten the operation time and also accelerate the recovery of patients, and with the development of materials, minimally invasive thoracic surgery is the future trend.
Prof. Xia Fei from the Affiliated Hospital of Guizhou Medical University, Prof. Hu Ping from the Affiliated Central Hospital of Chongqing University, Prof. Shi Jin from the Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Prof. Jiang Wei from the Affiliated Central Hospital of Shenyang Medical College, Prof. Jiang Haifeng from the Affiliated Chuzhou Hospital of Anhui Medical University, Prof. Zou Zhiqiang from the 960th Hospital of the People's Liberation Army, and Prof. Li Xiaoliang from the Qinghai Red Cross Hospital fully discussed the sharing of several experts respectively.
Clinical Basic Research
Moderator: Prof. Lu Xi Ke Prof. Zhang Weidong
Prof. Huang Lijun from Tangdu Hospital of the Fourth Military Medical University shared "Thoracic surgery medical-industrial cross-transformation research": Prof. Huang shared the work done by Tangdu Hospital of the Fourth Military Medical University in thoracic surgery medical-industrial cross-transformation. He introduced the process of applying 3D printing to children with funnel chest for the first time in 2015, as well as other subsequent attempts, and deciphered the thinking and improvement process behind it. In terms of material selection, polyether ether ketone (peek) has better biocompatibility and adjustable mechanical properties, and 3D printing with peek as the material has been applied in 35 hospitals in China. All these applications can not be achieved without the help of engineering experts.
Prof. Wang Liming from Tianjin Hospital shared "Research progress on the role of EIT in the assessment of ventilation function in multiple rib fractures": Electrical impedance tomography (EIT) is an important monitoring tool for patients with multiple rib fractures in intensive care units, by monitoring ventilation characteristics, it can find the stress point, quantify gas oscillation and reflect the degree of injury. EIT has a high spatial and temporal resolution and is simple to perform, which can provide positive reference value for physicians to adjust the treatment plan in a timely manner.
Professor Meng Xianghong from Tianjin Hospital shared "The application of AI technology in rib fracture diagnosis": Thoracic fractures have different types of typing, some of which are easily overlooked. The combination of AI results and manual review has greatly improved the accuracy of staging, and the unified use of structured reports makes the results more intuitive. AI has a high auxiliary value for the qualitative and quantitative evaluation of blunt chest injuries, and the combination of patient imaging data is of great significance for projecting patient prognosis.
Prof. Li Zhenyu of Guizhou People's Hospital, Prof. Yi Jun of Eastern War Zone General Hospital, Prof. Yu Xiaojun of Hangzhou Fuyang District First People's Hospital, Prof. Li Genzhi of Xiamen Fifth Hospital, Prof. Shen Yuguang of Zunyi First People's Hospital, and Prof. Yang Tao of Tianjin Fifth Central Hospital discussed these contents.
Minimally invasive internal rib fixation technique
Moderator: Prof. Peng Zhang
Prof. Jin Longyu from the Third Xiangya Hospital of Central South University shared "Anatomy and body markings of chest wall": Prof. Jin reviewed the anatomical structures related to thoracic surgery, including chest wall anatomy, linear body markings (anterior median line, sternal line, clavicular line, parasternal line, etc.), muscular body markings (pectoralis major muscle, mastoid muscle, latissimus dorsi muscle, etc.), and bony body markings. ), bony body markings (ribs, sternum, thoracic vertebrae, etc.), etc., and explained the clinical significance of each anatomical structure, as well as the consequences caused by injury, to provide reference for clinical practice.
Professor Fan Xinglong from Qilu Hospital of Shandong University shared the topic of "Choice of access for lumpectomy rib fixation": At present, thoracoscopy has been widely used for the exploration and hemostasis of the thoracic cavity, which is better visualized, less damaged and more accurately evaluated than traditional methods. For secondary fractures, as well as patients with combined thoracic hemorrhage and lung injury, the lumpectomy is more advantageous. Case selection should be relatively easy to perform. Fixation under lumpectomy is challenging and requires a high level of fixation material. The lumpectomy is less traumatic to the body and helps to reduce postoperative complications.
Prof. Zhang Dongsheng from Shijiazhuang Third Hospital shared "Thoracoscopic reverse fixation technique for intra-thoracic rib fracture": Prof. Zhang explained the operation method of lumpectomy rib fracture fixation through video and demonstrated the fixation effect of thoracoscopic surgery through typical cases. Most of the actual operations are performed by single-hole lumpectomy, which has the advantages of small incision, wide field of view, avoiding muscle and nerve damage, and higher safety for damage near large blood vessels. However, it has the risk of large area damage to the pleura; the determination of whether the severed end is well aligned during fixation can be affected; the current internal fixation needs further research and development for improvement; there is a certain risk of dehiscence in some cases, which requires more precise dissection of the ribs and other defects.
Prof. Xu Enwu from the General Hospital of the Southern War Zone of the Chinese People's Liberation Army shared "Bone healing and bone discontinuity theory (BHN) for rib fracture fixation": bone discontinuity involves the basic mechanism of bone healing and is worthy of serious study by thoracic surgeons. Rib fracture osteonecrosis is the most important cause of chronic pain. Augmented and atrophic osteonecrosis are more common in thoracic surgery. Excessive mechanical loading, excessive tension, and poor adaptation to mechanics are thought to contribute to osseous nonunion. Both under-stressing of internal fixation and over-stiffening of fixation can cause bone nonunion. Bone healing and bone discontinuity theory (BHN) for rib fracture fixation reveals that we should choose materials with moderate strength, toughness and elasticity, and good histocompatibility.
Prof. Sui Gang from Shandong Provincial Third Hospital shared "Matrix System in Chest Wall Tumor Reconstruction": Chest wall reconstruction is often required for large malignant tumors in the chest wall, such as the use of autologous tissue (skin slice), soft patch (polyethylene), and hard material (bone, metal, 3D printing material) for chest wall reconstruction after excision of rib cartilage. Chest wall reconstruction has certain requirements for materials, which need to be elastic and supportive. Matrix system has the characteristics of good biocompatibility, easy fixation, easy shaping, easy cutting, etc. It has been used for the reconstruction of many parts such as lateral chest wall tumor, anterior chest wall tumor, sternal stalk tumor and rib arch tumor.
Prof. Shi Xuejun of Tianjin Baodi District People's Hospital, Prof. Xu Hejun of Tianjin Chest Hospital, Prof. Wang Taoyuan of Tianjin Armed Police Specialized Medical Center, Prof. Shang Hongwei of the 983rd Hospital of the Chinese People's Liberation Army Joint Security Force, Prof. Huang Jingtao of Tianjin Nankai Hospital, Prof. Zhang Yunsong of Wuqing Chinese Hospital of Tianjin University of Traditional Chinese Medicine, Prof. Yang Bingjun of Tianjin People's Hospital, and Li Mingjiang of Tianjin First Central Hospital Prof. Yang Bingjun of Tianjin People's Hospital and Li Mingjiang of Tianjin First Central Hospital discussed the above contents.
New technology and new progress
Moderator: Prof. Han Xingpeng, Prof. Jiao Jianlong
Prof. Jing Baoli from Xi'an Red Society Hospital shared "The application of various localization methods in minimally invasive rib fracture surgery": Prof. Jing introduced in detail various localization methods for finding rib fracture points, including preoperative localization by palpation, instrumentation (e.g. 3D CT localization, ultrasound localization), and intraoperative localization by ultrasound after anesthesia. Each positioning method has its own advantages and disadvantages. By choosing the optimal positioning of the preoperative minimally invasive incision, the incision can be effectively reduced and the patient's muscles, blood vessels and nerves can be protected to the greatest extent through a reasonable surgical approach, which can reduce surgical complications and promote recovery.
Prof. Wang Zhi of Tianjin Hospital shared the "Structured Fracture CT Report": The structured fracture CT report of Tianjin Hospital is based on standardized scanning technology, close communication with clinicians, close integration of actual clinical needs, and the use of radiological terminology to achieve standardization and standardization. The details of the images are partitioned, accurately located, and the fracture types are described in a standardized manner to produce a standardized diagnosis and treatment report that combines graphics and text. The hospital is currently actively working on artificial intelligence to improve efficiency and liberate the workforce.
Professor Zhou Zhiming from the Central Hospital of Shenyang Medical College shared his experience on the application of arch nail in thoracic rib fracture: the arch nail is a memory material, which can minimize the contact with the bone surface and maintain the blood flow to the bone surface, and it is not easy to cause secondary fracture. The nature of heat contraction helps to promote rapid fracture healing. It is important to choose the right size when selecting the nail and to ensure that it fits after contraction. Bowtie nails are indicated in many scenarios in thoracic surgery. For fractures close to the sternal shank-body joint, they can be used together with titanium plates.
Prof. Pi-Cong You of Tianjin Hospital shared "ERAS in the form of DRG": nutritional status affects metabolic balance, and nutritional therapy and accelerated rehabilitation complement each other and are essential for surgical treatment, especially for malnourished patients with important muscle loss, and for patients who are nutritionally intolerant or unable to eat should be given individualized The nutritional therapy should be individualized for patients with nutritional intolerance or inability to eat. The preoperative, intraoperative and postoperative assessment of the patient's physical condition and active nutritional measures will help to promote the patient's recovery and shorten the patient's hospital stay.
Professor Ren Wanlu from Tianjin Hospital shared "Optimal selection of anesthesia for minimally invasive rib fracture surgery": For minimally invasive surgery under the EARS concept, anesthesiologists should pay more attention to perioperative management. The anesthesiologist is required to evaluate the anesthesia plan, select the best anesthesia method, ensure safe and effective anesthesia, meet the needs of surgery, make the patient comfortable, and provide good postoperative analgesia to enable the patient to recover quickly. The paravertebral nerve block is familiar to everyone, the anterior serratus block has fewer complications and can also be used as an anesthetic supplement to the paravertebral nerve block, and the erector spinae block is used as the first-line anesthetic method abroad, and these are also the main nerve block methods for minimally invasive rib fracture surgery in our hospital at present.
Professor Ren Jie of Tianjin Jinan Hospital shared "Clinical results of incisional internal fixation in patients with multiple rib fractures": Through a randomized controlled study of 76 patients, Professor Ren found that compared with conservative treatment, incisional internal fixation can effectively reposition and fix the fracture site of multiple rib fractures, and can reduce the number of analgesics used, shorten the ICU stay and hospital stay, and reduce the pain level with higher safety.
Prof. Liu Xufeng from Binhai New Area People's Hospital, Tianjin, Prof. Guo Xintao from Tianjin Fourth Central Hospital, Prof. Li Xuedong from Tianjin Jizhou District People's Hospital, Prof. Zhang Xuejun from Tianjin Wuqing District People's Hospital, Prof. Li Lin from Tianjin TEDA Hospital, Prof. Wang Yueming from Tianjin Ninghe Hospital, Prof. Pei Zhijie from Tianjin Xiqing Hospital and Prof. Huang Xin from Tianjin Jinghai District Hospital discussed the above contents.
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