[Summary] This paper reported a patient suffering from hemorrhage after percutaneous liver biopsy treated by contrast enhanced ultrasound-guided percutaneous injection of thrombin in June 2015.Firstly,we performed contrast-enhanced ultrasound examination to find the position of active bleeding.And then,percutaneous injection of thrombin was performed under the guidance of ultrasonography.The active bleeding was stopped successfully.

Objective To evaluate the feasibility,safety,and cosmetic results of single-incision laparoscopic appendectomy by using conventional instruments. Methods From January 2013 to May 2014,clinical data of 52 patients undergoing single-incision laparoscopic appendectomy in our hospital were retrospectively analyzed. The appendectomy was performed by using conventional instruments through three 5-mm trocars via a 2-cm curved incision above the umbilical margin. Results The single-incision laparoscopic appendectomy was successfully completed in all the 52 cases without conversion to conventional laparoscopic or open surgery.The mean operative time was 43 ±7 min (range,30 -90 min).The average postoperative hospital stay was 2.5 ±0.5 days (range,1 -7 days).During follow-up visits for 1 -3 months,there were no postoperative complications.The scars were not obvious in all the patients. Conclusion Laparoscopic appendectomy can be achieved through a single incision by using conventional instruments.This approach is feasible,safe,and concealing.

[Summary] A 60-year-old man was admitted with main complaint of chest pain on exertion.Coronary angiogram showed severe triple vessel disease.He underwent the hybrid technique of treatment through two left minithoracotomy incisions.Both internal thoracic arteries were harvested under direct vision.The left internal mammary artery (LIMA)and right internal mammary artery (RIMA) compositing Y grafts was constructed. The LIMA was anastomosed to the left anterior descending branch and the RIMA was anastomosed to the ramus intermedius.The operation time was 306 min.The amount of bleeding during operation was 50 ml.Five days later he underwent percutaneous coronary intervention at right coronary artery lesion successfully.He was discharged from hospital 8 days after operation,and didn’t complain of chest pain during fellow-up for one month.This technique demonstrates to be an effective and minimally invasive alternative to treat patients with multivessel coronary artery disease.

Objective To explore the treatment method and curative effect for lower limb varicose vein or swelling secondary to Cockett syndrome. Methods From March 2014 to March 2015,a total of 25 cases of lower limb varicose vein (22 cases)or swelling (3 cases)secondary to Cockett syndrome were treated with percutaneous transluminal angiography (PTA).Stents were placed in the veins in 19 cases,and 22 patients with varicose veins were treated with the great saphenous vein high ligation and point type stripping at secondary stage. Results The operations were successful.The iliac vein PTA was performed in all the 25 patients.The iliac vein stent implantation was performed in 17 cases of varicose veins and 2 cases of lower limb swelling.The saphenous vein high ligation and point type stripping was performed in 22 cases of varicose veins of lower extremity at 1 month after the interventional treatment.Postoperatively,no complications such as lower limb swelling,infection,or deep vein thrombosis occurred.Follow-up at the first postoperative month showed 20 cases of cured and 5 cases of alleviated.Follow-up for 3 -15 months (mean,12.4 months)in the 25 cases showed no lower limb swelling,recurrence of varicose vein,or deep vein thrombosis. Conclusions Cockett syndrome patients can be treated with iliac vein PTA.Whether or not a stent placement is required is determined according to the extent of vein stenosis.Postoperatively,lower limb swelling can be significantly alleviated.For patients with secondary varicose vein of lower extremity,saphenous vein ligation and point type stripping is recommended after 1 month.

Objective To evaluate the application value of the VATS combined with artificial pneumothorax in extended thymectomy. Methods From March 2013 to November 2014, we completed 45 cases of expanded thymectomy in patients with myasthenia gravis .According to the choice of patients , the surgeries were divided into two groups .The artificial pneumothorax group (24 cases) was given thoracoscopic expanded resection under artificial pneumothorax , while the conventional surgery group (21 cases) was given conventional thoracoscopic surgery .The operation time , intraoperative bleeding , operative field show ( to expose the offside mediastinal fat and cardiophrenic angle fat fully ) and symptom relief were compared between the two groups . Results The operations were successful in all the 45 cases.As compared with the conventional surgery group , the artificial pneumothorax group had shorter operation time [(93.8 ±16.8) min vs.(119.5 ±23.3) min, t=-4.293, P=0.000], less intraoperative hemorrhage [(54.2 ±43.7) ml vs.(92.9 ±41.0) ml, t=-3.048, P=0.004] and better operation exposure [91.7% (22/24) vs.57.1%(12/21),χ2 =7.228, P=0.007].However, there was no significant difference in symptom remission rate between the two groups . Conclusion VATS under artificial pneumothorax for thymus expanded resection can fully expose the operation field , with shorter operation time and less blood loss .

Objective To evaluate the efficacy and safety of COOK cervical dilatation balloon for induced labor in full -term pregnancy . Methods There were 98 cases of cervical ripening and induced labor by using COOK balloon from January 2014 to April 2015 ( experimental group ) and 130 cases of cervical ripening and induced labor by using oxytocin from January 2010 to September 2013 ( control group ) .The cervical scores , childbirth way , and adverse reactions were compared between the two groups . Results After the removal of the balloon, the cervical scores in the experimental group increased from (2.38 ±0.70) points to (6.15 ±0.96) points (t=31.412, P =0.000).The rate of vaginal delivery in the experimental group (79.6%, 78/98) was significantly higher than that in the control group [62.3%(81/130),χ2 =7.910, P=0.005].The incidence of chorioamnionitis in the control group was 5.4% (7/130), which was significantly lower than that in the experimental group [18.4% (18/98), χ2 =9.647,P=0.002).The other adverse reactions in two groups had no statistical difference (P >0.05). Conclusions Use of COOK cervical dilation balloon is a safe and effective method to promote cervical ripening .In combination with artificial rupturing membrane or intravenous infusion of oxytocin can improve the success rate of full -term pregnancy induced labor .

[Summary] Colorectal cancer is the one of the most common malignancies in the world .Currently, surgery is the main treatment for colorectal cancer .Although laparoscopic surgery for colon cancer has been widely accepted , laparoscopic approach for rectal cancer is still in clinical trials .At present, several trails have shown that the short-and long-term outcomes of laparoscopic rectal cancer resection are similar with open surgery , but others have shown that pathological outcomes and total resection rates of laparoscopic surgery are unsatisfactory .Laparoscopic rectal cancer surgery needs more grade Ⅰ evidences .Nowadays , researchers are exploring new ways to treat rectal cancer .

[Summary] Traumatic brain injury ( TBI ) constitutes a major health and socioeconomic problem throughout the world . Increasing traffic accidents and aging of population promote the incidence of TBI .In patients with severe TBI mortality and disability rates are higher .And survivors may suffer physical activity , cognitive and psychological problems due to trauma , leading to shortened life span and higher risk of death than general population .They are also facing with long-term care and rehabilitation .This article reviewed the status and limitations on treatment of severe traumatic brain injury and its clinical significance .

[Summary] This paper reported 10 patients with bilateral vocal cord paralysis from March 2013 to October 2015.The paraglottic space and arytenoid were resected with CO 2 laser.The endotracheal intubation was removed at 3 months after surgery .The patients were followed up for 1-2 years.No dyspnea or eating difficulty was seen .Patient’ s voice was normal.The cavity mucous membrane was smooth .No complications such as granulation tissue growth occurred .

Objective To evaluate the efficacy of modular flexible ureteroscopy combined with holmium laser lithotripsy for the treatment of renal and upper ureteral stones . Methods A total of 97 patients with renal and upper ureteral stones were treated with modular flexible ureteroscopy combined with holmium laser lithotripsy in our hospital from October 2012 to February 2016.Under general anesthesia (90 cases) or epidural anesthesia (7 cases), a flexible ureteroscope was used to find renal or ureteral calculus and holmium laser lithotripsy was applied at a maximum energy of 1.2-1.6 J/10 -12 Hz (12-20 W).F6 or F7 double-J stents and catheters were routinely placed postoperatively .B-ultrasonography , KUB or CT were performed to evaluate the stone free rate 4 weeks after operation . Results Two patients suffered ureteral perforation due to stenosis and tortuosity of the ureter , and were given double-J stent placement under rigid ureteroscopy for 2 weeks and then flexible ureteroscopic treatment .Six patients underwent staged operations because of ureteral strictures .The operations were successful in the remaining 89 patients.Except for unsuccessful exploration in 3 cases of lower calyx calculi , the operation time of other 94 patients was 30-190 min (mean, 100 min).The stone detection rate was 96.9%(94/97), and the stone free rate was 88.6% (86/97).The stone free rates were 100.0% (25/25) for upper and middle calyx calculi, 75.0%(9/12) for lower calyx calculi, and 85.1% (23/27) for pelvis and multiple calyx calculi. Ureteral perforation was encountered in 2 cases.No massive hemorrhage occurred .Postoperative high fever was seen in 5 cases, with a body temperature of 38.5-39.3℃, which were cured after anti-infection treatment for 2 -7 d.The patients were discharged from hospital in 2-7 days (mean, 3.3 days) after operation.Review with B-ultrasonography, KUB or CT at 4 weeks after operation found 5 cases of residual stones >4 mm, including 3 cases located in lower calyx and 2 cases in multiple calyx . Conclusion Modular flexible ureteroscopy combined with holmium laser lithotripsy is effective and safe for the treatment of renal calculi .