Objective To explore the effect of bladder muscle flaps for long segment defect of ureter middle-lower segment and reconstruction method in laparoscopic surgery. Methods Clinical data of 3 patients with long segment defect of ureter middle-lower segment, all of whom underwent laparoscopic surgery from May 2014 to April 2016 was retrospectively evaluated. There were 1 male and 2 females, in 2 cases with history of ureteroscopy holmium laser lithotripsy in ureter middle-lower segment, in 2 cases with history of repeated ESWL. Preoperative urinary tract ultrasound, CT and intravenous urography imaging showed severe hydronephrosis, ureter middle-upper segment severe hydroureter, ureter middle-lower segment severe stricture. Results Operations were successful in 3 cases. After reconstruction bladder muscle flaps average length of is 9.6 cm, The average operation time of 180 min, The average length of hospital stay for 10 d, Postoperative eighth weeks extracted the double J tube and used ureteroscopy showed anastomotic unobstructed, it may smooth Through 8.5 F ureteroscopy, and no infection and urinary leakage occurred, Follow-up ranged from 3 to 18 months. 3 cases hydronephrosis and hydroureter significantly reduce, ureter unobstructed, no narrow in ureter and muscle flap of tube joint, serum creatinine valueswere in normal range. Conclusions The bladder muscle flaps for the treatment of long segment defect of ureter middle-lower segment in laparoscopic surgery was a safe and effective therapy, but it must be accomplished by seasoned doctors.

Objective To evaluate the clinical efficacy of the over-the-scope-clip (OTSC) for endoscopic closure of acute refractory non-variceal upper gastrointestinal bleeding. Methods This retrospective study selected 16 refractory patients, including 2 cases with Mallory-Weiss syndrome, 7 cases with gastric ulcer, 1 case with gastric carcinoma and 6 cases with duodenal ulcer, underwent OTSC treatment of acute non-variceal upper gastrointestinal bleeding from January 2015 to June 2016 as study subjects. Results All of the 16 patients with bleeding lesions were successfully controlled. The successful rate is 100.0%. The mean procedure of OTSC for endoscopic bleeding closure was between 5.0 and 6.0 min. Conclusion The Over-the-Scope-Clip system is safe and effective for closure of acute non-variceal upper gastrointestinal bleeding in refractory patients, and deserves further clinical applications.

Objective To discuss the feasibility of single hole thoracoscopy of pleural fibreboard endarterectomy surgical treatment on chronic tuberculous empyema. Methods Retrospective analysis of minimally invasive treatment of 52 cases of chronic tuberculous empyema form January 2013 to May 2016, 50 cases applied single hole thoracoscopy surgery, video-assisted mini-thoracoscopy for another 2 cases. Results There was no death, operation time 60 ~ 240 min, average 160 min, bleeding 150 ~ 2000 ml, average 350 ml, postoperative chest tube drainage time 3 ~ 21 d, average 7 d, postoperative persistent leakage in 3 patients, 3 cases of atelectasis, incisional infection in 1 case, pleural effusion in 1 case, 3 cases of arrhythmia. All the cured patients are received the corresponding treatment, the follow-up of 3 ~ 36 m, the chest CT scan show no atelectasis. Conclusion Under the condition of strict selection of indication, single hole thoracoscopy of pleural fibreboard endarterectomy in treatment of chronic tuberculous empyema is safe and feasible, so it is worthy of making further clinical promotion and application.

Objective To present our experience with management of craniopharyngiomas by endoscopic endonasal approach Methods A retrospective review of clinical data of 65 patients who were treated for craniopharyngiomas by endoscopic endonasal approach from February 2012 to May 2016. All patients were analyzed by treatment effect, complications, and follow-up result. Results Total removal of the tumors were completed in 52 cases (80.0%), subtotal removal in 11 cases (16.9%), and partial resection in 2 cases (3.1%). The pituitary stalks were identified in 57 cases when surgery, and severed in 41 cases (71.9%). Postoperative visual acuity was improved in 31 cases (47.7%), and 6 cases remained in the preoperative level, whereas worsening occurred in 1 case. Worsening of the anterior pituitary function was reported in 21 cases (32.3%). Transient diabetes insipidus after operation was occurred in 45 patients (69.2%), and long-term diabetes insipidus was occurred in 9 cases (13.8%). Postoperative cerebrospinal fluid (CSF) leak was occurred in 4 cases (6.2%), accompanied with intracranial infection, and all these cases were repaired under endoscope again, 3 cases were saved, but 1 case was dead. Perioperative mortality rate was 4.6%. 52 patients were followed up for 4.0 ~ 45.0 (mean, 20.8) months, and 44 patients (84.6%) returned life to normal. Obesity developed in 8 patients (15.4%), with 2 recurrent cases and no deaths during follow-up period. Conclusion The endoscopic endonasal approach is a safe and effective minimally invasive surgery approach for treating craniopharyngiomas, and has its own unique advantage.

Objective To investigate the diagnostic value and safety of thoracoscopy routine pleural biopsy combined with frozen biopsy for pleural effusion. Methods A retrospective analysis was made on the pathological diagnosis rate of pleural effusion. Results 120 cases in thoracoscopy, 103 cases were confirmed with routine biopsy specimens (85.8%), 16 cases found in the lesions with conventional clamp not satisfactory tissue specimens, combined with frozen cut obtained satisfactory specimens, the diagnostic accuracy rate of 16 cases of cryobiopsy was 100.0%, and the total diagnostic accuracy rate of medical thoracoscopy combined with pleural biopsy and cryobiopsy was 95.0%. There was significant difference between conventional biopsy and cryobiopsy (P < 0.05). Conclusion Medical thoracoscopy combined with pleural biopsy and cryobiopsy can achieve a higher rate of pathological diagnosis, and the complications are mild, so it is worthy of clinical promoting.

Objective To explore the learning curve of transbronchial needle aspiration by evaluating the procedure time and the positive rate for respiratory physicians who have already mastered the bronchoscopy. Methods Clinical data of 60 patients who received TBNA procedure from May 2013 to August 2014 were retrospectively analyzed. The patients were divided into four groups (A, B, C, D) according to the time sequence of receiving the TBNA procedure, 15 patients in each group were set as a learning stage. The patients were received TBNA by the same doctor. The average time in each stage of puncture, positive rate, and puncture complications were compared among each groups. Results There did not show any significant differences in gender, age, etc. (P > 0.05) among the four groups. Puncture time in group A (15.2 ± 2.0) min and in group B (14.7 ± 2.2) min were significantly longer than that in group C (8.3 ± 1.6) min and in group D (7.6 ± 1.3) min (P < 0.05). In terms of the positive rate after the puncture, group A (26.7%) and group B (33.3%) were significantly lower than group C (80.0%) and group D (80.0%) (P < 0.05). There were no significantly different between group A and group B, and group C and group D in terms of puncture time and positive rate. Complications in each group was similar to intravascular puncture, after-puncture bleeding, pneumothorax, mediastinal hematoma, mediastinal bleeding and mediastinal infection did not show significant differences. Conclusion The learning curve of transbronchial needle aspiration for respiratory physicians who havemastered the bronchoscopy is around 30 cases.

Objective To study the influence of laparoscopic radiofrequency ablation combined with intravenous chemotherapy on hepatoma cell growth mediated by PTEN and Wnt pathway. Methods 90 cases of hepatocellular carcinoma patients from May 2013 to June 2016 were chosen as study subjects, all patients were divided into observation group (n = 45), control group (n = 45) randomly. Patients in observation group received laparoscopic radiofrequency ablation combined with intravenous chemotherapy, while those in control group received intravenous chemotherapy only. One week after treatment, two groups patients' liver lesion tissue PTEN signaling pathway, Wnt signaling pathway related gene mRNA expression were detected by RT-PCR method; serum contents of tumor markers were tested by Radioimmunoassay. Results One week after treatment, liver lesion tissue PTENmRNA expression was higher in observation group than that in control group, HIF-1, VEGF mRNA expression were lower in observation group than those in control group, the difference was statistically significant (P < 0.05); liver lesion tissue Wnt pathway related genes mRNA expression such as β-catenin, CyclinD1, c-myc, MMP-7 were lower in observation group than those in control group, the difference was statistically significant (P < 0.05); serum contents of tumor markers such as AFP, GGT-Ⅱ, IGF-2, CA19-9 were lower in observation group than those in control group, the difference was statistically significant (P < 0.05). Conclusion Laparoscopic radiofrequency ablation combined with intravenous chemotherapy can inhibit the growth of HCC cells through the PTEN and Wnt pathway, which has positive clinical significance.

Objective To assess the effect of video-assisted thoracoscopic thymectomy in treatment of myasthenia gravis (MG) and the factors associated with clinical efficacy. Methods 183 patients with MG who underwent video-assisted thoracoscopic thymectomy from January 2011 to May 2016 were enrolled, and the clinical data were retrospectively analyzed. Therapeutic efficacy was evaluated based on the MGFA. Furthermore, the potential factors associated with the clinical efficacy were analyzed using univariate analysis and Cox's proportional hazards regression model. Results 173 in 183 patients completed the whole follow-up. Among whom, 115 patients achieved complete stable remission (66.5%), 13 patients achieved pharmacologic remission (7.5%), 2 patients achieved minimal manifestations (1.2%), 20 patients had no changes (11.6%), 8 patients showed recurrent MG (4.6%), and 3 patients died (1.7%). Further analysis shown age (RR = 1.53, P = 0.031), pathological type of thymus (RR = 5.84, P = 0.022) and MGFA classification (RR = 3.72, P = 0.028) were main factors associated with the therapeutic efficacy. Conclusions Thoracoscopic expand resection is effective in the treatment of MG patients with satisfactory therapeutic efficacy, and age, pathological type and MGFA type were the main factors associated with the therapeutic efficacy.

Objective To evaluate the clinical efficacy of percutaneous endoscopic lumbar discectomy (PELD) on treatment of far lateral lumbar disc herniation (FLDH). Methods We retrospectively analyzed 27 patients with FLDH underwent percutaneous endoscopic lumbar discectomy from June 2014 to September 2015, age from 41 to 64, average 52.3. The average operation time, intraoperative blood loss and length of hospital stay were collected. The lumbocrural pain perception of patients before and after surgery was assessed by visual analog scale (VAS) and postoperative lumbar functional recovery after surgery by modified MacNab criteria. Results Average operation time was 69 min (58~109 min), intraoperative blood loss was 18 ml (11~40 ml), and length of stay was 5.0 d (3.0 ~ 10.0 d). VAS score from (8.12 ± 1.25) preoperatively improved to (2.80 ± 1.12) at the 3rd d after operation, (1.59 ± 1.06) at 3 months after operation, and (1.31 ± 0.89) at the last follow-up after operation; There was a statistical difference between preoperative scores and postoperative scores (P < 0.05). Modified MacNab criteria was a ratio of 88.9%. Conclusions PELD on the treatment of far lateral lumbar disc herniation have small area of trauma, faster postoperative recovering and several other advantages,which is a safe and effective minimally invasive surgery.

Objective To investigate whether there has any difference of gastric and small bowel transit time and completion rates between two capsule endoscopes with different size and weight. Methods Clinical data of patients who had undergone OMOM or MiroCam (smaller and lighter than OMOM) capsule endoscopy were retrospectively studied. Comparison of gastric and small bowel transit time and completion rates were made between the two kinds of capsule endoscopy. Results 1, 448 patients (628 in OMOM group and 820 in MiroCam group) were finally includ-ed. In patients with Crohn's disease or suspected Crohn's disease, gastric transit time of OMOM was significantly longer than that of MiroCam [(53.4 ± 52.6) minutes vs (41.1 ± 47.9) minutes, = 0.022]. In patients with gastroin-testinal bleeding, gastric transit time in OMOM was significantly shorter than that in MiroCam [(42.1 ± 44.8) minutes vs (62.0 ± 78.6) minutes, = 0.016). No significant difference in small bowel transit time or completion rate was found. Conclusions We conclude that the differences of gastric transit time, small bowel transit time and completion rates between the two kinds of capsule endoscopy with different size and weight are not significantly. Whereas, in patients with Crohn's disease or suspected Crohn's disease, gastric transit time of smaller and lighter capsule en-doscopy is shorter in patients with gastrointestinal bleeding, but longer of gastric transit time in smaller and lighter capsule endoscopy.