Objective To investigate the value of emergency interventional embolization in the treatment of traumatic splenic rupture.Methods Clinical data of 45 patients with traumatic splenic rupture in our hospital were analyzed retrospectively.Selective splenic artery embolization (embolization group) was performed in 29 patients guided by DSA,and surgical resection or repair operation (operation group) was performed in 16 patients.Results Data of two groups were compared:①For operation time and length of hospital stay,the intervention group was significantly better than the operation group (P<0.05);②For incidence of postoperative fever and pleural effusion,the operation group was lower than the intervention group (P<0.05);③For the postoperative abdominal pain index,there was no significant difference between the two groups (P>0.05);④Compared with the operation group,patients in the intervention group had less long-term complications,and did not require long-term anticoagulation therapy.Conclusion Interventional embolization in the treatment of traumatic splenic rupture is safe and effective, and has less postoperative complications.The interventional embolization improves spleen preservation rate and improved the life quality.

Objective To evaluate the effect of the percutaneous lumbar puncture to treat sciatica caused by lumbar disc herniation.Methods 75 cases of lumbar disc herniation with significant clinical signs were confirmed by CT scan. The technique of the percutaneous lumbar puncture led the needle to approach nerve root and injected medicine diffusing into extraduramater, and then relieved the symptom of sciatica. Results The rate of success of percutaneous lumbar puncture guided by CT reached to 100%. After two weeks of follow up, the symptom of pain was obviously improved and disappeared in 63.3% cases. There were 23.0% cases needed a second proceduse, and no change was obsesved in 9.3% cases.Conclusions The percutaneous lumbar puncture guided by CT to treat sciatica resulted from lumbar disc herniation is one of the safe ,reliable,effective new methods with no complication. The long term effectiveness is still in need of investigation.

Objective To evaluate CT scanning in diagnosing pancreatic lymphoma.Methods CT findings in 6 patients with pathologically-proved pancreatic lymphoma were retrospectively analyzed.Results There was no characteristic in findings of pancreatic lymphoma. The main findings were diffusely enlarged masses in the head and body of pancreatic. The masses were composed of irregular lesions in pancreatic, porta hepatis and retroperitoneal space.Conclusion CT can show pancreatic lymphoma lesions and enlarged lymph nodes in abdominal cavity or retroperitoneum are accompanied as well as, and can find the in jury of other object.

Objective To present the technique of super-minimally invasive bilateral thoracoscopic extended thymectomy,and evaluate the early clinical results by using of this technique.Methods Twenty-three patients with myasthenia gravis (MG) with thymoma underwent with super-minimally invasive bilateral thoracoscopic extended thymectomy in our institution between July 2014 and January 2016.Two operate-poles are 5mm trocar,one is three intercostal space at the anterior axillary line,and the other is four intercostal space at the midclavicular line.A 10 mm trocar is inserted through the 6th intercostal space in the mid axillary line.The perioperative variables and outcomes were collected and analysed retrospectively.Results In the 23 patients who underwent Super-Minimally invasive bilateral thoracoscopic extended thymectomy,the mean operation time was (163.2 ± 14.4) min and the average blood loss was (148.2 ± 39.5) ml.The chest tube duration was (4.14 ± 0.27) days.There were no mortalities.Conclusion Our preliminary report showed that Super-Minimally invasive bilateral thoracoscopic extended thymectomy for mediastinal tumour resection was a promising and safe technique with regard to short-term clinical outcome.

Esophageal cancer is one of the common malignant tumors in China.Although it is currently treated by multidisciplinary treatment,esophageal cancer's prognosis is still poor.The occurrence of esophageal cancer is closely related to the metabolism of trace element zinc.Zinc deficiency can induce the development of esophageal cancer by inducing inflammatory reaction and microRNAs imbalance.Zinc ion can play an important role in esophageal cancer by regulating the activity of ion channel.The formed zinc finger protein can function as an oncogene or a tumor suppressor gene in esophageal cancer.Zinc metabolism is accompanied by complex biological changes in the pathogenesis of esophageal cancer,and multiple mechanisms interact and are closely linked.The article reviews the research results of recent years on the mechanism of zinc deficiency,zinc ion-regulated ion channel and zinc finger protein in the development of esophageal cancer.

This study aimed to evaluate the sensitivity and specificity of the new clinical diagnostic and classification criteria for Kashin-Beck disease (KBD) using six clinical markers: flexion of the distal part of fingers, deformed fingers, enlarged finger joints, shortened fingers, squat down, and dwarfism. One-third of the total population in Linyou County was sampled by stratified random sampling. The survey included baseline characteristics and clinical diagnoses, and the sensitivity and specificity of the new criteria was evaluated. We identified 3,459 KBD patients, of which 69 had early stage KBD, 1,952 had stage I, 1,132 had stage II, and 306 had stage III. A screening test classified enlarged finger joints as stage I KBD, with a sensitivity and specificity of 0.978 and 0.045, respectively. Shortened fingers were classified as stage II KBD, with a sensitivity and specificity of 0.969 and 0.844, respectively, and dwarfism was classified as stage III KBD with a sensitivity and specificity of 0.951 and 0.992, respectively. Serial screening test revealed that the new clinical classification of KBD classified stages I, II, and III KBD with sensitivities of 0.949, 0.945, and 0.925 and specificities of 0.967, 0.970, and 0.993, respectively. The screening tests revealed that enlarged finger joints, shortened fingers, and dwarfism were appropriate markers for the clinical diagnosis and classification of KBD with high sensitivity and specificity.
Adolescent ; Adult ; Child ; Child, Preschool ; China ; epidemiology ; Female ; Humans ; Kashin-Beck Disease ; classification ; diagnosis ; epidemiology ; pathology ; Male ; Middle Aged ; Young Adult

Objective    To explore the risk factors and short-term clinical effect of conversion to open thoracotomy during thoracoscopic lobectomy for lung cancer patients. Methods    We retrospectively analyzed the clinical data of 423 lung cancer patients who were scheduled for thoracoscopic lobectomy between March 2011 and November 2015.There were 252 males and 171 females at median age of 60 (24-83) years. According to the patients who were and were not converted to thoracotomy, they were divided into a conversion group (378 patients) and a video-assisted thoracic surgery group (a VATS group, 45 patients). Then, clinical data of two groups were compared, and the risk factors and short-term clinical effect of unplanned conversions to thoracotomy were analyzed. Results    Lymph nodes of hilar or/and interlobar fissure closely adhered to adjacent vessels and bronchi was the most common cause of unexpected conversions to thoracotomy in 15 patients (33.3%), followed by sleeve lobectomy in 11(24.4%) patients, uncontrolled hemorrhage caused by intraoperative vessel injury in 8 patients, tumor invasion or extension in 5 patients, difficulty of exposing bronchi in 3 patients, close adhesion of pleural in 2 patients, incomplete interlobar fissure in 1 patient. Conversion did translate into higher overall postoperative complication rate (P=0.030), longer operation time (P<0.001), more intraoperative blood loss (P<0.001). In the univariable analysis, the type of operation, the anatomical site of lung cancer, the lymph node enlargement of hilar in CT and the low diffusion capacity for carbon monoxide (DLCO) were related to conversion. Logistic regression analysis showed that the independent risk factors for conversion were sleeve lobectomy (OR=5.675, 95%CI 2.310–13.944, P<0.001), the lymph node enlargement of hilar in CT (OR=3.732, 95%CI 1.347–10.341, P=0.011) and DLCO≤5.16 mmol/(min·kPa)(OR=3.665, 95%CI 1.868–7.190, P<0.001). Conclusions    Conversion to open thoracotomy during video-assisted thoracic surgery lobectomy for lung cancer does not increase mortality, and it is a measure of reducing the risk of surgery. Therefore, with high-risk patients who may conversion to thoracotomy, the surgeon should be careful selection for VATS candidate. And, if necessary, the decision to convert must be made promptly to reduce short-term adverse outcome.

Objective    To explore the feasibility of decompression without gastric tube after minimally invasive esophageal cancer surgery. Methods    Seventy-two patients who underwent minimally invasive esophageal cancer resection at the Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University from 2016 to 2018 were selected as a trial group including 68 males and 4 females with an average age of 58.5±7.9 years, who did not use gastric tube for gastrointestinal decompression after surgery. Seventy patients who underwent the same operation from 2013 to 2015 were selected as the control group, including 68 males and 2 females, with an average age of 59.1±6.9 years, who were indwelled with gastric tube for decompression after surgery. We observed and compared the intraoperative and postoperative indicators and complications of the two groups. Results    There were no significant differences between the two groups in operation time, intraoperative blood loss, postoperative level of serum albumin, postoperative nasal jejunal nutrition, whether to enter the ICU postoperatively, death within 30 days after surgery, anastomotic leakage, lung infection, vomiting, bloating or hoarseness (P>0.05). No gastroparesis occurred in either group. Compared with the control group, the recovery time of the bowel sounds and the first exhaust time after the indwelling in the trial group were significantly shorter, and the total hospitalization cost, the incidence of nausea, sore throat, cough, foreign body sensation and sputum difficulty were significantly lower (P<0.05). Conclusion    It is feasible to remove the gastric tube for gastrointestinal decompression after minimally invasive esophageal cancer surgery, which will not increase the incidence of postoperative complications, instead, accelerate the postoperative recovery of patients.

Objective    To analyze and compare the perioperative efficacy difference between full-port Da Vinci robotic surgery and thoracoscopic surgery in patients with mediastinal tumor resection. Methods    The data of 232 patients with mediastinal tumors treated by the same operator in the Department of Thoracic Surgery of the Second Affiliated Hospital of Harbin Medical University were included. There were 103 (44.4%) males and 129 (55.6%) females, with an average age of 49.7 years. According to the surgical methods, they were divided into a robot-assisted thoracic surgery (RATS) group (n=113) and a video-assisted thoracoscopic surgery (VATS) group (n=119). After 1 : 1 propensity score matching, 57 patients in the RATS group and 57 patients in the VATS group were obtained. Results    The RATS group was better than the VATS group in the visual analogue scale pain score on the first day after the surgery [3.0 (2.0, 4.0) points vs. 4.0 (3.0, 5.0) points], postoperative hospital stay time [4.0 (3.0, 5.5) d vs. 6.0 (5.0, 7.0) d] and postoperative catheterization time [2.0 (2.0, 3.0) d vs. 3.0 (3.0, 4.0) d] (all P<0.05). There was no statistical difference between the two groups in terms of intraoperative blood loss, postoperative complications, postoperative thoracic closed drainage catheter placement rate or postoperative total drainage volume (all P>0.05). The total hospitalization costs [51 271.0 (44 166.0, 57 152.0) yuan vs. 35 814.0 (33 418.0, 39 312.0) yuan], operation costs [37 659.0 (32 217.0, 41 511.0) yuan vs. 19 640.0 (17 008.0, 21 421.0) yuan], anesthesia costs [3 307.0 (2 530.0, 3 823.0) yuan vs. 2 059.0 (1 577.0, 2 887.0) yuan] and drug and examination costs [9 241.0 (7 987.0, 12 332.0) yuan vs. 14 143.0 (11 620.0, 16 750.0) yuan] in the RATS group was higher than those in the VATS group (all P<0.05). Conclusion    Robotic surgery and thoracoscopic surgery can be done safely and effectively. Compared with thoracoscopic surgery, robotic surgery has less postoperative pain, shorter tube-carrying time, and less postoperative hospital stay, which can significantly speed up the postoperative recovery of patients. However, the cost of robotic surgery is higher than that of thoracoscopic surgery, which increases the economic burden of patients and is also one of the main reasons for preventing the popularization of robotic surgery.

Objective    To investigate the perioperative efficacy and safety of all-port robotic lobectomy versus thoracoscopic lobectomy in stageⅠA non-small cell lung cancer. Methods    The clinical data of patients with stageⅠA non-small cell lung cancer who underwent lobectomy with lymph node dissection performed by the same operator in our center from June 2019 to June 2022 were retrospectively analyzed. The patients were divided into a robotic group and a thoracoscopic group according to different procedures. We compared the relevant indexes such as operation time, intraoperative bleeding, number of lymph node dissection stations, number of lymph node dissection, postoperative tube time, postoperative hospitalization time, closed chest drainage volume, postoperative pain, postoperative complications and hospitalization cost between the two groups. Results    There were 83 patients in the robotic group, including 34 males and 49 females with a median age of 60.0 (53.0, 67.0) years, and 94 patients in the thoracoscopic group, including 36 males and 58 females with a median age of 60.5 (54.0, 65.3) years. There was no conversion to thoractomy or death in postoperative 90 days in both groups. No statistical difference was seen in the operation time, total postoperative drainage volume and postoperative complication rates between the two groups (P>0.05). Patients in the robotic group had less intraoperative bleeding (P<0.001), more lymph node dissection stations (P=0.002) and numbers (P=0.005), less postoperative pain (P=0.002), and shorter postoperative time with tubes (P=0.031) and hospital stay (P<0.001). However, the surgery was more expensive in the robotic group (P<0.001). Conclusion    All-port robotic surgery is safe and effective for patients with early-stage non-small cell lung cancer with less intraoperative bleeding, more lymph node dissection, less postoperative pain, and shorter hospital stay compared with the thoracoscopic surgery.