Objective To summarize the experience on the prevention of severe complications of endoscopic thyroidectomy.Methods Twelve cases of bilateral lesions underwent endoscopic thyroidectomy via precordial approach and 41 cases of unilateral lesions, via subaxillary approach. A subcutaneous channel, with a width of about 5 cm from the incision site to the thyroid, was made by using self-made instruments. The CO 2 pressure was set at 4 mm Hg. By ultrasonic scalpel the lesions were divided and removed. Results There were 41 cases of thyroid adenoma (unilateral, 34 cases; bilateral, 7 cases) and 12 cases of nodular goiter (unilateral, 7 cases; bilateral, 5 cases). Postoperative subcutaneous hematoma occurred in 1 case and was cured by conservative management. No nerve damage or parathyroid complications were observed. Conclusions Application of ultrasonic scalpel and continued low cavity pressure are effective means for preventing complications in endoscopic thyroidectomy.

Objective To explore the management of Ttube following laparoscopic common bile duct exploration.Methods A total of 420 cases of extrahepatic with or without intrahepatic bile duct stones were given laparoscopic common bile duct exploration with T-tube drainage from July 1997 to October 2004 in this hospital.The common bile duct stones were identified and then a laparoscopic choledochotomy was carried out to remove the stones.After stone clearance,the choledochotomy wound was closed with primary duct suture or with T-tube drainage.Results The primary closure of the bile duct was performed in 27 cases((6.4%)) while the T-tube drainage was conducted in 393 cases(93.6%).The stones were completely removed during the operation in 236 cases(56.2%).Stone removal under choledochoscope was required in 184 cases(43.8%) after operation.The T-tubes were removed in 209 cases after a T-tube cholangiogram at 3~4 postoperative weeks showing no residual stones.Follow-up examinations for 3(months ~ 6) years(mean,47.5 months) in 420 cases revealed 3 cases of recurrence.Conclusions After laparoscopic common bile duct exploration,the T-tube should be removed at 3~4 postoperative weeks in the absence of residual stones on T-tube cholangiogram.However,if residual stones were found on T-tube cholangiogram,a choledochoscopy is needed for stone removal at 6 postoperative weeks after the tubes clamped for 2 weeks.

Objective To analyze the indication,ways,therapeutic effect,dose prescription and complication of skull base tumor treated by Gamma Knife.Methods Clinical data,including general information,method of treatment and therapeutic effect of 278 benign skull base tumors treated by Gamma Knife were studied retrospectively.Results All patients were followed up for at least 2 years.The clinical conditions improved significantly in 130 patients,remained stable in 125 patients,and worsened in 23 patients.The 5 years progression-free survival rate was 89.5%(249/278)by Kaplan-Meier analysis.The results of Log-rank analysis revealed that better results appeared in patients with smaller tumors.≤3 cm compared with those tumors＞3 am(X2=5.41,P=0.02),and in patients experiencing tumor resection compared with those without history of su~ery respectively(X2=3.96,P=0.047).10 of the 11 cases with tumors＞3 cm who were treated by volume-staged prescription achieved local tumor control.Brain edema occurred in 3 patients,apoplexy of tumor in 1 patient,hydrocephalus in 3 patents,dysfunction of cranial nerves in 12 patients.Conclusion For skull base tumor,Gamma Knife is a major choice,with low risk and maybe an alternative for those small tumors.For those residues after craniotomy,Gamma Knife maybe an auxiliary treatment,and it can be cautiously applied in those with large tumors who cannot tolerate surgery for various reasons.

Objective To evaluate the feasibility of endoscopic thyroidectomy via an incision under the armpit. Methods A skin incision was made under the armpit and a channel was established to thyroid gland and endoscopic thyroidectomy was performed in 32 cases suffering from unilateral thyroid lesion including 24 cases of solitary adenoma, 5 cases of multiple adenoma, 3 cases of cystic goiter. Results The average operative time was 125 min and the average blood loss was 55 ml. There were not any postoperative complications. Conclusion Endoscopic thyroidectomy is a mini-invasive surgery. The operative field was clear and ultrasonic scalpel is capable of dealing with blood vessels during the procedure.

Objective: To assess the quality of syphilis case reporting from hospitals in Hunan Province .Methods The syphilis cases reported by 126 middle second-class and above hospitals in the year 2010 and 2017 were retrieved from unified infectious case reporting network and compared with original reporting cards,medical records and laboratory testing records according to the Diagnostic Criteria for Syphilis （WS 273-2018）and the Guidelines for the Clinical Diagnosis and Treatment of Sexually Transmitted Diseases. The accuracy of syphilis diagnosis and classification were evaluated between different reporting years,types of hospitals,levels of hospitals and departments . Methods: The syphilis cases reported by 126 middle second-class and above hospitals in the year 2010 and 2017 were retrieved from unified infectious case reporting network and compared with original reporting cards,medical records and laboratory testing records according to the Diagnostic Criteria for Syphilis （WS 273-2018）and the Guidelines for the Clinical Diagnosis and Treatment of Sexually Transmitted Diseases. The accuracy of syphilis diagnosis and classification were evaluated between different reporting years,types of hospitals,levels of hospitals and departments . Results: There were 8 947 syphilis cases reported in 2010 and 13 552 syphilis cases reported in 2017. The accuracy of syphilis diagnosis and classification were 98.81% and 98.66% in 2017,which were higher than 36.39% and 36.10% in 2010 （P<0.01）. The accuracy of syphilis diagnosis in the provincial,municipal and county-level hospitals in 2017 were 99.07%,99.20% and 98.17%;the accuracy of syphilis classification were 98.91%,99.03% and 97.99%;the accuracy of syphilis diagnosis and classification were significantly different in different levels of hospitals（P<0.01）. The accuracy of syphilis diagnosis in the general hospitals,traditional Chinese medicine hospitals and maternal & child health hospitals in 2017 were 99.25%,96.92% and 97.57%;the accuracy of syphilis classification were 99.13%,96.72% and 97.30%;the accuracy of syphilis diagnosis and classification were significantly different in different types of hospitals（P<0.01）. The accuracy of syphilis diagnosis in the department of dermatology and non- dermatology in 2017 were 99.13% and 98.74%;the accuracy of syphilis classification were 99.02% and 98.58%;the accuracy of syphilis diagnosis and classification were not significantly different in different departments（P>0.05） . Conclusion The accuracy of syphilis diagnosis and classification have been improved in 2017,which varies in different levels and types of hospitals.