During years of managent practice of postgraduate training,it is found that great attention of leadership is a good foundation,that pre-service training is an essential part,that srtict implementation of the requirements on postgraduate,advisor-responsibility system unified instruction under subject,focusing on process-management of training and exploring actively effective incentive training methods is necessary.

Objective To discuss the significance of the retrograde urethrography in diagnosis and treatment of urethraltrauma. Methods 78 cases with urethraltrauma treated by the retrograde urethrography were retrospectively analyzed. Results The location and extent of urethral injury was determined according to the place and speed of contrast medium overflow and the diffuse range. Among 78 cases ,29 cases were bulbar urethral trauma and other 49 cases were membranous urethral trauma.Conclusion Retrograde urethrography is simple, practical and easy to operate for determining the injured part of urethra and the extent of damage of urethraltrauma, and was instructional for the choice of operation method and incision.

Objective The study of capsaicin (CAP) on the effect and mechanism of indomethacin induced acute gastric mucosal injury in different period.Methods 80 SD rats were randomly divided into 8 groups with 10 rats in each group.The experiment was completed in two phases,and the Ⅰ period was 2 weeks,the Ⅱ period was 4 weeks.The Ⅰ period including group A1 (control group),group B1 (model group),group C1 (CAP group),group D1 (CAP + indomethacin group).The grouping method of the two periods were the same.The rats' gastric mucosa were damaged by indomethacin,and then killed the rats 4 hours later.Last,astric juice was collected to determine the total acidity of gastric acid,counted thegastric mucosal injury index,observed the gastric mucosa pathological injury,detected the expression of TRPV 1、CGRP、MDA、SOD and PGI2.Results The Ⅰ period:the gastric mucosa of group A1 and C1 had no damage.Group D1 compared with group B1,there was no significant difference in gastric mucosa injury (P ＞ 0.05),total acidity decreased significantly (P ＜ 0.05),MDA was no significant difference (P ＞ 0.05),SOD、PGI2 increased significantly (P ＜ 0.05),the expression of TRPV1、CGRP increased significantly (P ＜ 0.05).The Ⅱperiod:the gastric mucosa of group A2 and C2 had no damage.Group D2 compared with group B2,the gastric mucosa injury were significantly reduced (P ＜ 0.05),total acidity decreased significantly (P ＜ 0.05),MDA decreased significantly (P ＜ 0.05),SOD、PGI2 increased significantly (P ＜ 0.05),the expression of TRPV1、CGRP increased significantly (P ＜ 0.05).Conclusion There was no damage to the general morphology and histology of gastricmucosa in rats by intragastric CAP 1 mg/(kg· d) for 2 weeks and 4 weeks.2.It could prevent that indomethacininduced acute gastric mucosal injury in rats by pretreated with CAP 1 mg(kg· d) for 4weeks.

Objective To explore the rule of central region lymph nodes metastasis in differentiated thyroid carcinoma (DTC) and the significance of central region lymph nodes neck dissection in surgical operation for DTC.Methods The clinical and pathological data of 122 lymph nodes in 109 patients (31 female and 78 male) with DTC undergoing neck lymph nodes ( central region lymph nodes included) dissection from Jan.2003 to Jun.2007 in our hospital were analyzed retrospectively.According to preoperative physical examination and imaging analysis,patients were divided into clinical cervical lymph nodes metastasis ( cN + ) group and clinical no cervical lymph nodes metastasis (cNO) group and compared respectively with their pathological data after surgery.Resuits Of the 122 lymph nodes,lymph node metastasis rate was significantly higher in region Ⅵ than in region Ⅱ,Ⅲ and Ⅳ.The difference had statistical significance (P ＜0.01 ).65.6％ (80/122) metastasis was in the central region.81.2％ (56/69) patients in cN + group and 45.3％ (24/53) patients in cN0 group had central region lymph nodes metastasis.Conclusions Central region lymph nodes metastasis is common for patients with DTC.Routine neck dissection in central region should be done in DTC operation.

Objective To investigate the exposure and protection of recurrent laryngeal nerve (RLN) in the reoperation for thyroid diseases.Methods Clinical data of 214 cases undergoing thyroid reoperation were retrospectively analyzed.The patients with a short interval between the 2 thyroid operations or with external-infiltrated thyroid cancer were approached at the lateral strap muscles and the leading edge of the sternocleidomastoid.RLNs were exposed in the lateral region of superior mediastinum tracheoesophageal groove or at the point where RLN enters to throat.RLNs of patients with lymph node metastasis were exposed beside the enlarged lymph nodes.The patients with a long interval between the 2 thyroid operations and with benign tumor or tumor without external infiltration were exposed their thyroids at the anterior midline and then RLNs were exposed at the posterior lateral of the middle thyroid veins or at the inferior thyroid artery.Results Among the 214 cases,344 RLNs were anatomically exposed including 188 right and 156 left.84 cases had single exposure and 130 cases had bilateral exposure.44 RLNs were exposed at the point where RLN enters to throat,104 RLNs at the posterior lateral of the middle thyroid veins,40 RLNs at the inferior thyroid artery,124 RLNs at the lateral region of superior mediastinum tracheoesophageal groove,and 32 RLNs beside the enlarged lymph nodes.For the 2 cases suffering hoarse voice the day after they underwent thyroid operation in other hospital,suture ligation at the the entrance point was found when they received the reoperation in our hospital.Three of the total 344 RLNs (0.87％ ) had RLN branch injury in the entire group.Conclusion It is possible to reduce RLN injury during the reoperation for thyroid disease if surgeons are familiar with the dissection of RLN under normal or pathological condition,avoid adhesive or scar tissues,and select the appropriate anatomic approach.

Objective To explore the method and effect of thumb and finger reconstruction and repair by emergent primary toes transplantation. Methods Three hundred and fourteen fingers of 282 cases including finger thumb defect and complex injury with hyperthena palm radid soft tissue of forearm were reconstructed and repaired by the second toes, wrap-around flap and the second third toes wrap-around flap combined with distal flap of leg or other complex tissue flap transplantation. Results Three hundred and eight reconstructed fingers survived, the survival rate was 98%. After a follow up to 6 months to 6 years, the reconstructed thumbs and fingers have accepted nip, grasp, opponent function. The result was graded as excellent in 214 fingers, good in 63, fair in 26, poor in 5. The excellent and good rate was 88%according to the upper limb functional evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association. Conclusion Different type of toes and combined toes transplantation can obtain preferable clinical effect on emergent primary thumb and finger defect.

Objective To discuss the prevention and treatment of the complications of modified radical mastectomy with nipple-areola complex (NAC) sparing. Methods The clinical data of 124 breast cancer patients who had a NAC sparing modified radical mastectomy from January 1998 to December 2008 were analyzed retrospectively. The causes of complications were evaluated and the proposal of prevention and treatment was put forward. Results Of the 124 patients, 18 had nipple necrosis (14.52%), 9 had skin infections and necrosis (7.26%), 7 subcutaneous hydrops(5.65%), 5 upper extremity lymphedema (4.03%), 3 chest muscle contracture with ipsilateral upper limb dyskinesia (2.42%), and 2 operative residual cavity hemorrhage(1.61%). Conclusion All the post-operative complications listed above could be possibly avoided by more careful operation procedure.