To culture creative persons with ability,experimental teaching systems has to be revolutionized.Comparatively concentrated and appropriately dispersed experimental managing pattern can be adopted to build up a new experimental teaching system,which combines systematic teaching and further exploration.The questions on how to develop open laboratory,change traditional experimental teaching pattern,improve the use of instrument and laboratory,pool fund to avoid repeated construction,and achieve fully share of resources are discussed in this article.

Objective:To analyze the risk factors associate with apex or basal positive surgical margins in patients after radical prostatectomy.Methods:During the period from January 2013 to December 2017, data was collected in 180 patients undergoing radical prostatectomy in Urological department of Peking University Cancer Hospital. Surgical margins were stated negative, positive, apex positive, basal positive. Dichotomous logistic regression analysis was used to evaluate the age, total prostate volume, biopsy positive cores, D’Amico risk classification, tumor pathology stage, Gleason score, tPSA, f/tPSA and pelvic lymph nodes metastasis with the PSMs.Results:PSMs were detected in 97 cases, including 78 cases with positive apex, 51 cases with positive basal, and 83 cases with negative margin, the PSMs proportion was 53.9%. In univariable analysis, pT 3b( OR=6.871, P=0.010), pT 4( OR=12.13, P<0.05), Gleason≥8( OR=4.989, P=0.005), pelvic lymph nodes metastasis( OR=9.516, P=0.043) associated with higher proportion of PSMs. In multivariable analysis, pT 3b( OR=5.782, P=0.030), pT 4( OR=10.15, P<0.05), Gleason≥8( OR=11.13, P=0.012) were the independent factors positively associated with higher proportion of PSMs. In univariable analysis, pT 3b( OR=4.040, P=0.026), Gleason≥8( OR=2.390, P=0.010) associated with higher proportion of apex positive. In multivariable analysis, Gleason≥8 ( OR=1.980, P=0.030) was the only independent factor associated with higher proportion of apex positive. In univariable analysis, D’Amico high risk ( OR=1.847, P=0.035), pT 4 ( OR=1.780, P=0.001) associated with higher proportion of basal positive. In multivariable analysis, D’Amico high risk ( OR=1.540, P=0.041) was the only independent factor associated with higher proportion of basal positive. Conclusions:In patients radical prostatectomy, pathology staging and Gleason score were associated with positive surgical margins.Gleason score was associated with positive apex margins, and D’Amico risk classification was associated with positive basal margins.

Objective To investigate the clinical efficacy of laparoscopic hepatectomy and summarize its experiences.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 2 048 patients who underwent laparoscopic hepatectomy in the Southwest Hospital of the Third Military Medical University from March 2007 to October 2016 were collected.The resectability of lesions and liver functional reserve were preoperatively evaluated,and then laparoscopic hepatectomy was conducted.Observation indicators:(1)surgical and intraoperative situations;(2) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect the patients' postoperative survival up to June 2017.Measurement data with normal distribution were represented as (x)±s.Count data were evaluated by the percentage.The survival rate was calculated by the Kaplan-Meier method.Results (1) Surgical and intraoperative situations:all the 2 048patients received successful laparoscopic hepatectomy,including 1 985 undergoing traditional laparoscopic hepatectomy and 63 undergoing Da Vinci robot-assisted and laparoscopic hepatectomy.Non-anatomical and anatomical hepatectomies were respectively applied to 1 052 and 996 patients.The rate of conversion to open surgery of 2 048 patients was 6.738％ (138/2 048).Operation time,volume of intraoperative blood loss and rate of intraoperative blood transfusion in 2 048 patients were (225±27)minutes,(455± 152)mL and 5.615％ (115/2 048),respectively.The incidence of postoperative complications was 11.816％ (242/2 048),42.149％ (102/242) of postoperative complications included reactive pleural effusion and effusion in the resection margin,and other postoperative complications included peritoneal effusion,pulmonary infection,abdominal infection,bile leakage,bleeding,incision liquefied,thrombus and acute liver injury.The incidence of postoperative severe complications was 0.488％ (10/2 048),including 6 with intraperitoneal bleeding,1 with acute respiratory distress syndrome,1with cardiac failure,1 with hepatic failure and 1 with renal failure.Of 242 patients with postoperative complications,6 with intraperitoneal bleeding received reoperations and were improved,1 died of extensive thrombus of portal vein system induced liver failure,and 235 were improved by conservative treatment.Duration of hospital stay in 2 048 patients was (10.7± 1.0)days.(2) Follow-up situations:912 of 1 070 patients with malignant liver tumors were followed up for 8-120 months,with a median time of 51 months.The 1-,3-and 5-year overall survival rates and 1-,3-and 5-year tumor-free survival rates in 912 patients with malignant liver tumors and follow-up were 94.1％,82.2％,53.6％ and 82.3％,61.3％,32.8％,respectively.Conclusions Laparoscopic hepatectomy is safe and feasible,with definite effects.In the premise of breakthroughs of technical bottlenecks in the bleeding control and exposure of special liver segment,the indications for laparoscopie hepatectomy have been expanded and there is no restricted area.

Objective:To investigate the morphological characteristics and operative methods of mixed total anomalous pulmonary venous connection (TAPVC), and to analyze the risk factors of postoperative death.Methods:From January 2011 to January 2019, 17 cases of mixed TAPVC were operated in Department of Cardiovascular Surgery, Beijing Children′s Hospital, Capital Medical University, with 10 males and 7 females.The average age was (4.4±3.8) months (1-15 months) and the average body mass was (5.6±1.7) kg (3.5-10.0 kg), including 1 case of ventricular septal defect, 17 cases of atrial septal defect and 15 cases of ductus arteriosus.Preoperative pulmonary vein stenosis was discovered in 4 cases and severe pulmonary hypertension was in 10 cases.A total of 5 cases needed ventilator support before operation, and 2 cases needed emergency operation.The diagnosis was confirmed by color Doppler ultrasound and CT before operation.There were 2 cases of type Ⅰ (type 2+ 2), 13 cases of type Ⅱ (type 3+ 1), and 2 cases of type Ⅲ (anatomic variant).Results:All the patients were treated through operation.The principle of operation was to correct all pulmonary veins to the left atrium.The cardiopulmonary bypass time was (182.3±122.8) min, the aortic occlusion time was (84.3±15.9) min, the postoperative ventilator support time was (92.9±70.0) h, and the monitoring room time was (6.9±4.9) d. In this group, 3 cases died in hospital (17.6%) and 1 case died out of hospital (5.9%).Conclusions:The mortality of mixed TAPVC type Ⅲ was high, while preoperative pulmonary vein stenosis, severe pulmonary hypertension and the combination of sub-cardiac type were the important risk factors of death.The operation mode depends on the anatomic drainage mode, so individualized operation is recommended.

Objective:To investigate the diagnosis, surgical methods, perioperative treatment and surgical results of Kommerell's diverticulum with double aortic arch in infants.Methods:From December 2014 to December 2019, 22 cases of double aortic arch combined with Kommerell diverticulum were operated in our hospital, 14 males and 8 females, with an average age of (13.7±11.6) months (1-36 months) and mean body mass of (9.8±3.4)kg (5-20 kg). The children had respiratory symptoms such as asthmatic suffocation, shortness of breath, repeated respiratory tract infection and chronic cough before operation. All patients underwent cardiac CT examination. The average diverticulum was 8 mm×9 mm, in the trachea The average compression degree of the lower segment was 56%±16% (30%-80%). The distal part of the left arch was atresia and Kommerell's diverticulum was found in all patients. The operation methods were left aortic arch separation, ligament separation and diverticulectomy. In one case, tracheal stent was placed simultaneously during the operation because of severe tracheal malacia.Results:The average time in the ward was(1.4±0.8)days (1-4)days, and the average time in hospital was (6.7±2.8)days (4-13 days). The average follow-up period was (25.5±16.9) months (2-60 months). During the follow-up period, 18 children had no persistent respiratory symptoms, and 4 children had only slight respiratory symptoms.Conclusion:Kommerell's diverticulum can also be combined with double aortic arch. The operation method is to separate the aortic arch and ligament at the atresia end and resect the diverticulum at the same time. It has a good early prognosis and may eliminate the residual symptoms and late complications.

Objective To investigate the safety and efficiency of drug-eluting beads (DEB) in the treatment of hepatocellular carcinoma (HCC) with hepatic arterio-portal shunt (HAPS).Methods 26 HCC patients with HAPS who underwent DEB-TACE (transcatheter arterial chemoembolization) were included in this retrospective study.Liver function level included preoperative serum albumin level,ascites,Child-Pugh classification,imaging manifestations of HAPS,follow-up and record survival time and response to cancer treatment.According to the degree of HAPS,all the patients were divided into 4 groups.After performing Kaplan-Meier,survival rate was calculated.Tumor response was measured by mRECIST criteria.Results The median survivals were 310 days,261 days,333 days,and 250 days in the entire study population,group 1,group 2,and group 3,respectively.There was no statistical significance in the survival curve among three groups (P =0.456).In the entire study population,the survival rates were 76.9％,37.3％,and 12.4％ at 6 months,12 months,and 24 months,respectively.After performing proportional hazards model,the preoperative serum albumin level,presence or absence of ascites,and preoperative Child-Pugh classification were independent predict factors for prognosis.Conclusions DEB-TACE is a safe and effective treatment for HCC with HAPS.The preoperative liver function is essential for patients'prognosis.

Objective: To discuss the application experience and predictive value of circulating tumor cells for urothelial carcinoma. Methods: The clinical data of 96 patients with urothelial carcinoma treated by Beijing Cancer Hospital Urologic Department between September 2017 and September 2019 were analyzed retrospectively to evaluate relationship between the number of CTCs and pathological outcome. The mean age of the entire cohort was 62(40-87)years, with 74 males and 22 females. There were 13 cases of upper urinary tract tumors (pyelocarcinoma and ureteral carcinoma), 83 cases of bladder carcinoma, and 12 cases of lymph node metastasis. There were 77 cases of primary onset and 19 cases of recurrence. 68 cases in single focus group and 28 cases in multiple group. There were 29 cases in non infiltrative T_a stage, 42 cases in infiltrative lamina propria T₁ stage, 16 cases in infiltrative muscle T₂ stage, and 9 cases in extra-muscular≥T₃ stage. At least 3ml of peripheral blood was collected after fasting for at least 8 hours, After cleavage and centrifugation, immunomagnetic beads were added, folate probe was added, and then amplification was carried out. Then the copy number of CTCs in each ml of blood was calculated. Logistic linear regression was used to analyze the risk factors of lymph node metastasis. Results: The mean CNC of all patients was 12.3±7.3; the mean CNC of ≤62 years old group was 10.8±4.2; the mean CNC of >62 years old group was 13.7±9.2; the mean CNC of initial cases was 11.5±5.3; the mean CNC of recurrent cases was 15.5±12.2. Age (P=0.135) and frequency of onset (P=0.087) had no effect on the number of CTCs. The average CNC of single focus group was 10.5±5.2, multiple focus group was 16.5±9.7, T_a stage group was 8.2±2.3, T₁ stage group was 12.0±4.4, T₂ stage group was 16.4±6.8, and ≥T₃ stage group was 19.5±16.6. The number of lesions (P<0.001) was significantly correlated with pathological T stage (P<0.001) and the number of CTCs. Univariate regression analysis showed that T stage (P<0.001) and the number of CTCs (P=0.02) might be correlated with lymph node metastasis; multivariate analysis showed that only T stage could be used as an independent predictor of lymph node metastasis (P=0.002). Conclusions CTCs can be used to predict lymph node metastasis of urothelial carcinoma.

Objective To establish a laparoscopic classification of extrahepatic biliary dilatations (EHBD) that can guide minimally invasive treatment.Methods According to inclusion criteria,124 patients with EHBD who were admitted and treated from July 2001 to July 2017 in the First Hospital Affiliated to Army Military Medical University were included in this study.A new laparoscopic classification of EHBD was proposed based on the preoperative imaging data and laparoscopic findings of the position and extent of EHBD.The minimally invasive diagnosis and treatment strategies were made based on the new classification.Results According to the preoperative imaging data and intraoperative laparoscopic findings,124 patients with EHBD were divided into the following groups:type A (upper segment,34 cases),type B (middle segment,27 cases),type C (lower segment,20 cases),and type D (entire bile duct,43 cases).The clinical symptoms (abdominal pain,jaundice and mass) and reoperation rates were not significantly different among the 4 groups(both P＞0.05).The incidences of comorbidities (calculus or inflammation) were significantly different (P＜0.05).The operative time(type A:237.6±66.7 min,type B:259.2±60.0 min,type C:286.1 ± 74.7 min,type D:347.5±94.4 min) and blood loss (type A:192.6±102.2 ml,type B:201.5±120.2 ml,type C:297.5±162.1 ml,type D:305.8±237.3 ml) were significantly different among the groups (P＜ 0.05).The short-term complication rates after surgery (5.9％ ～ 20.0％) were significantly different (P＜ 0.05),while the long-term complication rates after surgery (7.4％ ～ 10.0％) were not significantly different.The conversion rates to open surgery were significantly higher in patients with type C and D lesions than in those with type A and B lesions (P＜0.05).Conclusion This laparoscopic classification predicted the difficulty of laparoscopic surgery for EHBD and had a guiding significance in the minimally invasive treatment for this disease entity.

Objective To explore the application of nephron-sparing surgery in giant renal angiomyolipomas with the maximum diameter greater than 15 cm and its relevant surgical experience.Methods Between July 2014 to January 2017,5 patients with giant renal angiomyolipoma greater than 15 cm was admitted to our hospital for nephron-sparing surgery.The patients were all female ranging in age from 32-50 years (43.0 ± 7.1) years.According to the tumor imaging characteristics,we divided them into 3 different types including diffuse endogenous,exogenous and mixed type.All the tumors meet the criterion of exogenous type,ranging in diameter from 15.0-28.0 cm (20.4 ± 5.8) cm.4 patients harbored one single tumor and the other bilateral tumors.All the giant tumors located on the right side.Open transperitoneal nephron-sparing surgery was performed.Result During the operation,to find the joint site between the tumor and normal kidney is the key procedure in order to reserve more normal renal parenchyma.The operation time ranged from 105-175 min (125.4 ± 28.4) min,warm ischemia time 8-20 min (15.8 ±4.8) min,blood loss 50-400 ml (162.0 ± 141.5) ml.The average postoperative drainage volume ranged from 50-165 ml (99 ± 45) ml,the time of drainage tube removal 1-8 days (4.0 ± 2.6) days.The postoperative serum creatinine had no significant change compared to the value before operation (P =0.808).Postoperative hospital stay was 5-12 days (7.2 ± 2.9) days.Benign renal angiomyolipoma with negative margins was diagnosed as expected.No patient had a recurrence after a 1-32 months follow-up.Conclusion Nephron-sparing surgery could be used selectively in patients with giant renal angiomyolipoma greater than 15cm.For the tumors with the characteristic of exogenous type on imaging assessment before operation,open transperitoneal nephron-sparing surgery was an optional choice and could be implemented safely.

Objective:To explore the safety and efficacy of laparoscopic microwave ablation combined with partial nephrectomy in the treatment of cystic renal masses.Methods:The 19 patients with cystic renal masses undergoing laparoscopic microwave ablation combined with partial nephrectomy from November 2017 to December 2019 were retrospectively analyzed. There were 13 males and 6 females. The average age was 46.2 years. The mean body mass index was (25.8±3.1) kg/m 2. The masses located in the left kidney in 7 cases and the right kidney in 12 cases. The ECOG scores were 0. The mean maximum diameter of the tumors was (2.8±1.3) cm. Five cases were diagnosed with Bosniak Ⅲ and 14 cases with Bosniak Ⅳ. According to R. E.N.A.L. scoring, 11 cases were of low difficulty (4-6 points), 7 cases of medium difficulty (7-9 points) and 1 case of high difficulty (10-12 points). The cystic renal masses were ablated by laparoscopic microwave ablation, then followed by partial nephrectomy. Postoperative complications were observed and the prognosis was assessed by CT or MRI. Results:The mean duration of operation was (84.0±20.8) min. The median intraoperative blood loss was 20 (10-50) ml. The median duration of postoperative hospitalization was 3 (2-6) d, and no complications such as bleeding, infection, gross hematuria or urine leakage were observed. According to the malignant degree of cystic renal masses, the patients were divided into low-risk group and high-risk group. The patients with benign cystic kidney tumors or with low biological malignancy were considered as the low-risk group, while the patients with high malignant pathology were considered as the high-risk group. In the low-risk group, there were 4 patients, including 1 patient with papillary adenoma, 1 patient with renal angiomyolipoma, 1 patient with low-grade malignant potential multilocular cystic renal tumor, and 1 patient with renal chromophobe carcinoma (stage T 1a). In the high-risk group, there were 15 cases, including 14 cases of clear cell renal cell carcinoma (AJCC pathological stage: T 1a stage 11 cases, T 1b stage 3 cases; WHO/ISUP classification: 7 cases in grade 1, 6 cases in grade 2, and 1 case in grade 3); 1 case of Type 2 papillary renal cell carcinoma (stage T 1b, grade 2). The median follow-up was 20 months (12-37 months). Both groups survived, and no signs of tumor recurrence, implantation or metastasis were found in chest and abdomen imaging. Blood tests were performed regularly, and no significant abnormalities occurred. Conclusions:The safety and efficacy of laparoscopic microwave ablation combined with partial nephrectomy for the treatment of cystic renal masses is satisfactory, and postoperative pathology is clear, providing a potential option for cystic renal masses treatment.