Objective To investigate the value of laparoscopic cholecystectomy through superior margin of public symphysis approach.Methods The clinical data of 72 patients with benign gallbladder diseases who were admitted to the Lihuili Hospital from December 2012 to August 2013 were retrospectively analyzed.There were 54 patients with cholecystolithiasis and 18 with gallbladder polyps.Thirty patients received laparoscopic cholecystectomy through the superior margin of public symphysis approach (new method group).Forty-two patients who received transumbilical single-port laparoscopic cholecystectomy were in the control group.The operation time,intraoperative blood loss,duration of postoperative hospital stay,degree of postoperative pain and cosmetic effect of the 2 groups were compared.Patients were followed up via out-patient examination and phone call till December 2013.Data were analyzed using the t test or chi-square test.Results Two patients in the new method group and 1 patient in the control group were converted to receive traditional laparoscopic cholecystectomy.The operation time,intraoperative blood loss,duration of postoperative hospital stay,scores of satisfaction with the incision and degree of postoperative pain were (28 ± 3) minutes,(23 ± 10) mL,(2.0 ± 0.5) days,4.3 ± 0.5 and 5.8 ± 0.8 in the new method group,and (39±4)minutes,(24±l0)mL,(2.0±0.6)days,3.9±0.5 and 5.9±0.9 in the control group.There were significant differences in the operation time and score of satisfaction with the incision between the 2 groups were detected (t =10.032,2.423,P ＜ 0.05),while no significant differences in the volume of intraoperative blood loss,duration of postoperative hospital stay and degree of pain between the 2 groups (t =1.021,0.000,1.760,P ＞ 0.05).All the patients were recovered,and were administered with semi-fluid food at postoperative day 2.No bleeding,bile leakage,incisional infection occurred,and no patient died perioperatively.Analgesics were not needed in the 2 groups.All the patients were followed up for 1-6 months.Patients were satisfied with the cosmetic appearance of the incision,and no inflammation,pain and infection of the incision occurred.Conclusions Laparoscopic cholecystectomy through the superior margin of public symphysis approach is safe and feasible,with the advantages of short operation time,cosmetic appearance of incision and easy manipulation.

Objective To explore the clinical value of single utility port video-assisted thoracoscopic surgery ( VATS ) for mediastinal tumor . Methods A retrospective analysis was performed on clinical data of 55 patients with mediastinal tumor who received surgical treatment with single utility port video-assisted thoracoscopic surgery in this department from December 2013 to June 2016.Routinely, the surgery was conducted by intraoperatively inserting the thoracoscope via an incision at the seventh intercostals space on the midaxillary line as the observation hole , and making a 3-4 cm transverse incision at the fourth intercostals space between the midaxillary line and the anterior axillary line as the operation hole .Postoperatively , the observation hole served as the passage for closed thoracic drainage tube . Results Among the 55 patients, 50 received total thoracoscopic surgery .In 3 cases with relatively large tumor, the surgery was conducted with additional assisted small incisions .Thoracotomy was carried out in another 2 cases due to bleeding when separating pulmonary artery branch and difficult hemostasis under thoracoscopy .The surgery duration was (100 ±46) min, the intraoperative blood loss was (85 ±38) ml, the postoperative chest drainage volume was (450 ±80) ml, the postoperative time to chest tube withdrawal was (3.0 ±1.6) d, and the postoperative duration of hospital stay was (6.2 ±1.5) d in the 50 cases of VATS.All the patients recovered well .Postoperatively , there were 1 case of myasthenic crisis , 2 cases of pneumothorax and 3 cases of pleural effusion, all of which were improved with symptomatic treatment .All the 55 cases were followed up for 2-24 months (mean, 11.2 ±7.3 months) and there were no tumor recurrences . Conclusion Single utility port VATS of mediastinal tumor resection has advantages in safety , efficacy, and cosmetic outcomes , being worthy of further clinical application .

Objective    To investigate the tunnel-type open reduction and internal fixation of rib fractures (ORIF) with titanium locking plate in traumatic rib fractures. Methods    Clinical data of 10 patients with multiple rib fractures from June 2016 to January 2017 in the Sixth People’s Hospital Affiliated to Shanghai Jiaotong University were analyzed. There were 6 males and 4 males with an average age of 38.5±9.0 years (range, 30–63 years). All patients underwent emergency treatment, chest CT and ultrasound examination before they admitted to the hospital. According to rib fractures and injuries, patients were given the tunnel-type ORIF of rib fractures with titanium locking plates, the chest tube and negative suction drainage. The patients were followed up over three months. Results    All patients were cured. There was no complication during follow-up. No wound infection and death occurred. Postoperative three-month follow-up showed that chest pain was significantly relieved without pulmonary atelectasis and pleural effusion or other complications. Conclusion    Tunnel-type internal fixation of rib fractures with titanium locking plates is effective, which can quickly restore the stability and integrity of the thorax. Surgical procedure is simple and can get fast postoperative recovery to improve the patient's quality of life.