[Objective]To investigate the effect of treating degenerative spondylolisthesis by transforaminal lumbar interbody fusion with microendoscopic surgery.[Method]From January 2005 to December 2005,17 cases who underwent transforaminal lumbar interbody fusion with a pedicle screw system by microendoscopic surgery were analyzed retrospectively.The index diagnosis was degenerative lumbar spondylolisthesis with herniated nucleus pulposus in 11 cases,and with spinal canal stenosis in 5 cases.There were 10 male and 7 female,average age was 47.6(ranged,35～68)years.According to Meyerding grading system,roentgengram showed that there were 10 cases of grade Ⅰ?,7 cases of grade Ⅱ?,11 cases of L_4 and 6 L_5.[Result]Seventeen cases were reviewed after surgery.The postoperative follow-up ranged from 12 months to 24 months(averaged 16.2 months).Operative time averaged 160 minutes.Estimated blood loss averaged 120 ml.Mean length of hospital stay was 8 days.There were no nerve injury occurred during operation.No cases converted to open operation.In complications,one case suffered from intervertebral infection.Outcomes were quantified using Oswestry Disability Index.The average Oswestry score decreased from 48.3% preoperatively to 16.5% at 3 month and 14.0% at 6 month postoperatively.The rate of excellent and good was 97.5%.At last follow-up,all patients had solid fusions by radiographic criteria.[Conclusion]Transforaminal lumbar interbody fusion for lumbar vertebral degenerative spondylolisthesis by microendoscopic surgery has the advantages of shorter skin incision,less tissue damage,less blood loss and quicker postoperative recovery.

A retrospective analysis was conducted for male Han patients aged 46 years or above undergoing serum test of total prostate specific antigen (tPSA) at our hospital from 2007 to 2009.Among them,there were 109 patients with complete clinical data (including a history of hypertension and dyslipidemia),including 36 type 2 diabetics and 73 non-diabetics.For type 2 diabetes and non-diabetes groups,the median values (lower quartile,upper quartile) of serum tPSA test results were 1.01 (0.44,3.43) μg/L and 2.26 (1.04,5.48) μg/L (t =-2.65,P ＜0.01) respectively.The serum level of tPSA in type 2 diabetics was significantly lower than that in non-diabetics.

Objective To study the clinical value of peritoneal cavity non-drainage after the operation of acute perforating appendicitis.Methods 196 patients with perforating appendicitis were randomly divided into drainage group and non-drainage group.The incidence rates of wound infection and ankylenteron and hospital durations in the two groups were observed and compared with each other.Results The incidence rate of wound infection and ankylenteron were 19.0%,10.7% in the drainage group and 8.0%,4.5% in the non-drainage group respectively(P0.05).The mean postoperative hospital stay of the drainage group was(9.3?2.7)days,which was significantly longer that of the non-drainage group(5.1?1.9)days,P

BRAFV600E mutation is the most common genetic alteration in the papillary thyroid carcinoma.It plays an important role in the tumorigenesis,invasiveness and metastasis of the papillary thyroid carcinoma.Testing of BRAFV600E mutation is of great value in diagnosis,which also can be used as a prognostic maker of papillary thyroid cancer.Inhibitors treatment targeted to BRAF kinase and its downstream effectors is a new area in the treatment of BRAFV600E mutated thyroid cancer.

TSH suppression therapy plays an important role in differentiated thyroid carcinoma. It can lower mortality and recurrence rate in high risk patients. Meanwhile, it also has potential side effects on cardiovascular and skeletal systems. Thus, TSH suppressive therapy should be individualized in regard to its possible benefit and potential adverse effects.

Objective To investigate the cause of reoperation for high differentiated thyroid carcinoma and the risk factors of neck lymph node metastasis in reoperation. Methods Retrospectively reviewed the clinical data of 54 high differentiated thyroid cancer patients from 1998 to 2005, who received reoperation and neck lymph node dissection simultaneously. Results The residual thyroid carcinoma rate and lymph node metastasis rate were higher in 39 patients who initially received partial thyroidectomy than in 15 who previousely underwent radical operation(P <0. 05). Age less than 45 years, lymphadenectasis before initial operation, tumor residued or relapsed, muhicentricity of primary cancer and blurred boundary between cortex and medulla of lymph node were the risk factors for ipsilateral lymph node metastasis(P <0. 05), while mul-ticentricity of primary cancer and contralateral thyroid cancer were the risk factors for contralateral lymph me-tastasis (P < 0. 05). Conclusions Individual standard radical operation and necessary lymph node dissection are important measures to prevent recurrence and reoperation. Completion thyroidectomy and modified or selec-tive neck dissection are recommended for reoperation patients with the risk factors of lymph node metastasis.

Objective To discuss the influence of preventive calcium supplementation on the recovery of parathyroid glands function after total thyroidectomy.Methods 232 patients meeting the selected criteria were randomly assigned to group A and B,and then divided into group A1 (87 cases,PTH ＞8 pg/ml)and A2 (30 cases,PTH ＜8 pg/ml),group B1(83 cases,PTH＞8 pg/ml)and B2(32 cases,PTH ＜8 pg/ml) based on the lowest parathyroid hormone( PTH )value within 3 days after surgery.All patients in group A were immediately supplemented 10％ calcium gluconate intravenously 6 g/d after operation.For group B,post operative calcium supplementation was not given,however,anyone whose PTH ＜ 8 pg/ml was supplemented 10％ calcium gluconate intravenously 6 g/d no matter hypocalcemia occurred or not.The level of serum calcium and PTH of all patients were assayed before operation and at the 1st,2nd,3rd day,1st week and 1st month after operation.In additon,patients with hypocalcemia received serum calcium and PTH detection at the 2nd and 3rd week.Whether hypocalcemia and hypoparathyroidism occurred or not was recorded.Results ( 1 )The serum PTH was obviously higher in group A1 than in group B1 at the 1st week after operation( P ＜0.05 ).The serum calcium was obviously higher in group A1 than in group B1 at the 1st,2nd,3rd day and 1st week after operation(P ＞0.05).The hypocalcaemia and symptomatic hypocalcaemia incidence were obviously lower in group A1 than in group B1 (P ＜ 0.05 ).(2)① Group A2 had obviously higher level of serum PTH than group B2 at the 1 st,2nd,and 3rd week after operation ( P ＜0.05 ) and returned to normal level of serum PTH earlier than group B2.② Group A2had obviously higher level of serum calcium than group B2 from the 1 st day to the 3rd week after operation ( P ＜ 0.05 ) and returned to normal level of serum calcium earlier than group B2.③ The hypocalcaemia and symptomaic hypocalcaemia incidence ware obviously lower in group A2 than in group B2 (P ＜ 0.05 ).Conclusion The preventive calcium supplementation is beneficial for the recovery of the function of parathyroid glands after total thyroidectomy.

Objective:To define the role of lymph tracers in lymph node dissection and pathological examination of papillary thyroid carcinoma. Methods:Patients with papillary thyroid carcinoma who met inclusion criteria were enrolled and randomly assigned into the three groups, namely, carbon nanoparticle (CN), methylene blue (MB), and conventional surgery (CS) groups. The number of detected lymph nodes in each group was summed, and pathological examination was conducted. Histological examination of the lymph node specimens in the tracer group was performed based on the classification of staining and nonstaining groups. Results:Major complications such as anaphylaxis did not occur after injection of CN and MB. The average of the detected lymph nodes was higher in the tracer group than in the CS group, and the detection rate of the lymph node was higher in the CN group than in the MB group. In addition, the rate of cancer metastasis was higher in the group with stained lymph node than in the group with unstained lymph node. The index of the CN group was higher than that of the MB group. Conclusion:The tracing effect and lymphatic tropism of CNs were stronger than MB. The thyroid lymph tracer technique may promote the normalization and thoroughness of lymph node dissection in thyroid cancer.

Objective To study the effect of temporary in vitro preservation of parathyroid on the activity of cells in the process of parathyroid auto-transplantation and function of postoperative in order to improve the survival rate of transplantation.Methods (1)Experimental rabbits for the study were randomly divided into three groups:group A,group B,group C,with 8 rabbits in each group.Then we remove the bilateral inferior parathyroid,in group A,the parathyroid glands were immediately formaldehyde-fixed;in group B and group C,the parathyroid glands were placed in normal saline in 4 ℃ and in room temperature (22-24 ℃) for 30 minutes respectively and then fixed;HE staining was performed on the left parathyroid glands to observe the morphology of the cells;Electron microscopic examination of the right parathyroid glands were performed to observe the ultrastructural changes of the cells.(2)Experimental rabbits were randomly divided into three groups:group D group E and group F,with 8 rabbits in each group,after total thyroidectomy,the double inferior parathyroid glands were took out,in group D,the parathyroid glands were immediately transplanted in bilateral anterior cervical muscles;in group E and group F,the parathyroid glands were placed in normal saline 4 ℃ and in room temperature (22-24 ℃) for 30 minutes respectively and then transplanted.All animals were monitored of serum calcium and PTH on preoperative 1 d and postoperative 1 d,3 d,5 d,7 d;the parathyroid was took out for HE staining to observed survival of parathyroid tissue and pathology damage when 7d after operation.Results (1) The normal parathyroid gland is mainly dominated by the chief cells,the nucleus of the chief cell was round and centered under electron microscope;there were no significant change in the morphology of parathyroid cells,and the mitoehondria of the cells were slightly swollen under 4 ℃;but the parathyroid gland cells were slightly swollen and partially vacuole degeneration,the morphology of the nucleus was irregular,and the mitochondria were extremely swollen and deformed,and the ridge was broken under room temperature.(2)three groups of rabbits after transplantation of parathyroid,serum calcium and PTH decreased significantly,and increased gradually,there was significant difference on the 7th day after the operaion between the two groups (P＜0.05);(3)in group D,the normal parathyroid cells densely distributed in the anterior cervical muscle tissue;in group E,A large number of parathyroid cells survived in muscle tissue,with some vacuolated;in group F,only part of healthy parathyroid ceils scattered in the muscle.Conclusion Parathyroid should be preserved in 4 ℃ normal saline during the operation,and the transplant should be completed in 30 minutes as far as possible.

Objective To investigate the cause and diagnosis of anastomotic fistula following low anterior excision of rectal cancer,and its management and prevention measures.Methods Retrospectively analyzed the clinical data of 6 patients with anastomotic leakage underwent anterior excision of rectal cancer.Results 115 patients accepted anterior excision of rectal cancer,6 patients developed anastomotic fistula.5 patients are cured with effective pelvic drainage and 1 case with ileostomy and pelvic drainage.Conclusions Anastomotic fistula is one of the most serious complications related to pre-operative preparation,blood supply and anastomotic tension,intra-operative technigues and effective of drainage.It can be avoided or reduced by different prophylactic measures.