Objective:To evaluate the efficacy and safety of video-assisted thoracoscopic surgery (VATS) and thoracotomy in the treatment of pulmonary echinococcosis.Methods:Pubmed, ScienceDirect, Medline, Wanfang Data Knowledge Service Platform, China National Knowledge Infrastructure (CNKI) and VIP Chinese Journal Service Platform were searched by computer from the earliest publication time of the documents included in the database to August 2020. Comparative studies on VATS and thoracotomy in the treatment of pulmonary echinococcosis were included and the quality was evaluated. The data were combined and analyzed by RevMan 5.3 software.Results:Eleven articles were finally included, including two randomized controlled trials (RCT) articles, and the rest were case-control studies. A total of 878 patients were included, including 447 in VATS group and 431 in thoracotomy group. The results of meta analysis showed that compared with thoracotomy group, VATS operation time [ MD (95% CI): - 28.59 (- 41.79, - 15.39)], intraoperative blood loss [ MD (95% CI): - 35.83 (- 49.65, - 22.01)], postoperative drainage volume [ MD (95% CI): - 94.83 (- 150.55, - 39.01)], postoperative catheterization time [ MD (95% CI): - 2.26 ( - 2.94, - 1.59)], hospital stay [ MD (95% CI): - 4.59 (- 6.51, - 2.67)], and postoperative complications [ MD (95% CI): 0.48 (0.32, 0.73)] in VATS group were significantly lower ( P < 0.05). There was no significant difference in postoperative recurrence between VATS group and thoracotomy group [ MD (95% CI): 0.75 (0.26, 2.16), P > 0.05]. Conclusions:Compared with thoracotomy, VATS in the treatment of pulmonary echinococcosis has the advantages of shorter operation time, less intraoperative blood loss, less postoperative drainage volume, shorter postoperative catheterization time and fewer postoperative complications. VATS is a safe and effective surgical method for the treatment of pulmonary echinococcosis.

Objective: To investigate the application and surgical experience of total laparoscopic pancreaticoduodenectomy (TLPD) in treating children with solid pseudopapillary neoplasm (SPN) of pancreas. Methods: Clinical data 4 children with SPN who underwent TLPD in Jilin University First Hospital from April 2017 to June 2018 were retrospectively analyzed. Results: Among the 4 children, a case was male and 3 cases were female. Their age ranged from 9 to 14 year-old, the height ranged from 1.2 to 1.7 meters, and body weight ranged from 30 to75 kg. All patients complained of upper abdominal pain, one child had nausea and vomiting, and one child had abdominal mass. All patients underwent abdominal enhanced CT scan before operation, which showed a mass-like low-density shadow or mixed density shadow in the pancreatic head, with slightly uneven enhancement or no obvious enhancement. All 4 patients underwent TLPD, and the operation was successful without conversion to open surgery. The duration of operation time ranged from 250 to 365 minutes, the intraoperative blood loss ranged from 80 to 120 ml, the tumor size ranged from 4 to 8 cm, and the hospital stay ranged from 10 to 22 days. One patient developed grade B pancreatic fistula after surgery and was cured after conservative treatment. Pathological examinations of all patients confirmed the diagnosis of pancreatic SPN. All patients were followed up until February 2019, and no significant discomfort was observed and no recurrence or metastasis was found. Conclusions TLPD was safe and feasible in children in relatively large pancreatic surgery centers with extensive laparotomy and TLPD experience.

Objective:To analyze the difference of positioning accuracy by cone beam CT(CBCT) between modified head neck shoulder thermoplastic mask and breast bracket in intensity modulated radiotherapy for breast cancer patients after modified radical mastectomy.Methods:A total of 68 cases of breast cancer treated with IMRT after modified radical mastectomy were selected from August 2015 to December 2018. According to the different immobalization methods, the patients were divided into two groups: modified head neck shoulder thermoplastic mask group (body mask group, 42 cases) and breast bracket group (bracket group, 26 cases). After the first, sixth, 11th, 16th and 21st treatment, the patients were scanned by CBCT. The positioning errors in left and right (RL), anterior and posterior (AP) and head and foot (SI) directions were obtained, and the duration of radiotherapy positioning was recorded. The positioning error, distribution ratio and positioning duration were compared between two groups, and the respective MPTV margin were calculated. The influence of various factors on the setup error of patients was analyzed in the mask group. Results:There were 210 scans in the body mask group and 130 in the bracket group. The setup errors of the body mask group and bracket group in RL, AP and SI directions were (2.12±2.01) and (2.38±1.92) mm, (3.29±2.46) and (3.88±2.76) mm, (3.47±2.29) and (4.11±3.15) mm, respectively, and the differences in AP and SI directions were statistically significant ( t=-2.05, -2.16, P<0.05). The proportion of setup errors less than or equal to 3 mm in the direction for body mask group was higher than that of bracket group ( χ2=4.97, P<0.05). The proportion of setup errors more than 5 mm in AP and SI directions for body mask group was lower than that of bracket group ( χ2=5.21, 9.29, P<0.05). The positioning duration of mask group was shorter than of bracket group ( t=-2.16, P<0.05). The MPTV margins of the mask group in RL, AP and SI directions were smaller than those of the bracket group. The modified head, neck and shoulder thermoplastic mask immobalization method led to large setup errors in AP and / or SI directions for the elderly (≥ 60 years old), the patients with body mass index (BMI) ≥ 24 kg/m 2 and the patients who were relatively unfamiliar with the radiotherapy process (treatment time≤ 2 weeks). The setup error for patients aged < 60 years old in SI direction was smaller than that for the elderly (≥ 60 years old) patients ( t=-2.43, P<0.05). The setup error for patients with BMI <24 kg/m 2 in AP and Si directions was smaller than that with BMI ≥24 kg/m 2 ( t=-2.21, -2.04, P<0.05). The setup error for treatment time > 2 weeks in AP direction was smaller than that for treatment time ≤ 2 weeks ( t=2.23, P<0.05). Conclusions:In IMRT radiotherapy for breast cancer patients after modified radical mastectomy, the application of modified head neck shoulder thermoplastic mask can reduce the setup error in the anterior-posterior and superior-inferior directions, and shorten the positioning duration. For the elderly (≥ 60 years old), BMI ≥ 24 kg/m 2 and the patients who are not familiar with the radiotherapy process (treatment time ≤ 2 weeks), attention should be paid to the setup of anterior-posterior and superior-inferior directions to ensure the treatment effect of radiotherapy.