[Summary] Benign esophageal strictures can arise from various causes and mainly induce dysphagia .Commonly , the majority of benign esophageal strictures can achieve long-term relief through about three dilation sessions .However, some refractory benign esophageal strictures require other treatments , such as endoscopic stent placement and intralesional drug injection , but these treatments just attain short-time satisfactory results with a disappointingly low rate of long-term improvement.Recently, biodegradable stents and drug-eluting stents are developing and have obtained the positive effects .In this paper , we performed a review about the treatment of benign esophageal strictures .

Objective To evaluate the analgesic efficiency and safety of patient-controlled intravenous analgesia ( PCIA) with both flurbiprofen and sufentanil after Han-uvulopalatopharyngoplasty ( H-UPPP) surgery. Methods Patients undergoing H-UPPP surgery ( n=60 ) were randomly divided into four groups with 15 cases in each group .They received PCIA after operation with a loading dose of 2 ml, lockout time of 15 minutes, background infusion rate of 2 ml/h and liquid volume of 100 ml.The PCIA formulation in each group was as follows:sufentanil 3.0 μg/h in group A;sufentanil 3.0 μg/h+flurbiprofen 4.0 mg/h in group B;sufentanil 2.0μg/h+flurbiprofen 4.0 mg/h in group C;sufentanil 1.0μg/h+flurbiprofen 4.0 mg/h in group D.The visual analogue scale (VAS) and Ramsay sedation scale were recorded at 2, 6, 12, 24, and 48 h after surgery (T1 -T5 time points).Patient pressing times and the adverse effects within 48 h after surgery were counted . Results The VAS scores of the group D were higher than those in the other three groups at T1 and T2 time points (P<0.05).The Ramsay scores of the group D were lower than those in the other three groups at T1 and T2 time points (P<0.05).The numbers of pressing times in the group D were more than those in the other three groups (P<0.05). Conclusion PCIA with both flurbiprofen 4.0 mg/h and sufentanil 2.0 μg/h is effective for postoperative analgesia after H-UPPP.

Objective To investigate the safety and clinical effect of laparoscopic radical parametrectomy in the treatment of unexpected cervical cancer . Methods A retrospective analysis was made on clinical characteristics of 15 patients who were diagnosed as unexpected cervical cancer from January 2008 to December 2014.The age of the patients was between 29 and 67 years old, with an average of 43.9 years old.The indications for hysterectomy were cervical intraepithelial neoplasia (CIN) grade 2-3 in 7 cases, uterine myoma in 3 cases, dysfunctional uterine bleeding in 2 cases, uterine prolapse in 2 cases and adenomyosis in 1 case. Pathological results after the hysterectomy included 13 cases of cervical squamous carcinoma and 2 cases of adenocarcinoma .The lesions were all confined to the cervix , with 4 cases of stage ⅠA2 disease and 11 cases of stage ⅠB1 .The lymph-vascular space invasion was found in 4 cases.The operation interval between the two operations was 3-7 d (mean, 4.6 d).They were all given laparoscopic radical parametrectomy . Results The operation time was 212-285 min (mean, 249.6 min), and the blood loss was 250-500 ml ( mean, 376 ml) .Postoperative pathological findings showed no residual disease .Only one patient had left pelvic lymph node mestastasis .Two patients had intraoperative complications , including 1 bladder injury and 1 ureteral injury .There were 3 cases of postoperative complications , including 2 cases of uroschesis and 1 case of lymphocyst .The follow-up time was 6-84 months ( median, 48 months).No recurrence was seen.The 1-, 3-, 5-year survival rates were 100%, 93.3%, 86.7%, respectively. Conclusions Laparoscopic radical parametrectomy in the treatment of unexpected cervical cancer is difficult to perform and has more complications . This surgical method is applicable to those who refused postoperation radiotherapy or required retaining ovarian function .

[Summary] With the development of diagnosis and treatment levels and the improvement of survival rates of breast cancer , related lymphedema has received increasing attention .In a long term, it is regarded as the primary complication after the breast cancer therapy , which affects the quality of life of patients .Due to lack of consensus in many aspects worldwide , it continues to be a challenge to diagnose and treat the disease .This article aimed to summarize the diagnosis and therapeutics of breast cancer related lymphedema .

[Summary] The mechanisms of gastroesophageal reflux disease ( GERD) include abnormal antireflux function and esophageal mucosa attacked by regurgitation .Gastroesophageal flap valve ( GEFV) located in the gastroesophageal junction is one mechanism of the antireflux barrier .An increased GEFV grade is associated with an increased incidence of erosive esophagitis and Barrett ’ s epithelium.With abnormal esophageal acid exposure and prevalence of a mechanically defective sphincter , patients usually have severe symptoms and lower efficiency of medication .Therefore , GEFV is valued in the diagnosis and treatment of GERD .This review summarized the relationship between GEFV and GERD .

Objective To explore advantages of laparoscopic sphincter preserving surgery for ultra low rectal cancer . Methods From April 2006 to January 2015, we performed laparoscopic sphincter preserving surgery in 108 cases of ultra-low rectal cancer.After laparoscopic mesorectal resection and lymph node dissection were completed , transection of the rectum was performed with the Endo-GIA at 2 cm from the lower margin of the tumor .The right lower abdomen main operation port was expanded to remove the lesion and introduce the stapler base .The proximal colon was returned and the pneumoperitoneum was re-established .A colorectal end-to-end anastomosis was conducted through the anus by using a carliber 29 circular stapler . Results Laparoscopic operation was successfully accomplished in all the 108 cases.No conversion to open surgery was required .No operative mortality was encountered . The operation time was 68 -145 min ( mean, 104 min ) , the intraoperative blood loss was 10 -100 ml ( mean, 40 ml ) , the postoperative flatus time was 1-3.5 d (mean, 2.3 d), and the number of removed lymph nodes was 8-37 (mean, 12.5).There were 98 patients followed up for 6-62 months (mean, 24.6 months).No tumor metastasis or recurrence was found . Conclusion Laparoscopic total mesorectal excision of ultra low sphincter preserving operation is feasible .

Objective To investigate curative effects and prognostic factors of video-assisted thoracoscopic extended thymectomy ( VATET ) for nonthymomatous myasthenia gravis ( NTMG ) . Methods Clinical records of 43 patients with an established diagnosis of NTMG who underwent VATET from December 2009 to September 2014 were reviewed. Three-port thoracoscopic right thymectomy with resection of fat tissue in anterior mediastinum was conducted.The curative effects and prognostic factors were evaluated and analyzed with the Monden standard. Results The VATET was successfully completed in all the 43 patients.The operation time was 75-240 min (mean, 115.4 min).The intraoperative blood loss was 10-200 ml (mean, 42.2 ml). No peri-operative death occurred.Follow-ups for 4 -60 months ( mean, 36.2 months) showed 12 cases of remission, 18 cases of improvement, 10 cases of unchanged disease, and 3 cases of deterioration.The effective rate was 69.8% (30/43).Multivariate logistic regression analysis showed that pathological type of thymic hyperplasia was the independent risk factor for NTMG postoperative outcomes (β=0.921,95%CI:1.866-2.811, P=0.000). Conclusion Video-assisted thoracoscopic extended thymectomy is effective in most myasthenia gravis patients.

Objective To study the initial experience and outcomes of laparoscopic enucleation with preoperative selective arterial embolization ( PSAE) for the treatment of renal angiomyolipomas. Methods A total of 43 patients with sporadic renal angiomyolipomas from July 2013 to November 2014 underwent laparoscopic nephron-sparing surgery ( NSS) .The patients were divided into either PSAE group ( n =19 ) or non-PSAE group ( n =24 ) .The data of patient demographics, success rate of surgery, perioperative complications rate, operating time ( OT ) , warm ischemia time ( WIT ) , estimated blood loss ( EBL ) , length of hospitalization, kidney estimated glomerular filtration rate (eGFR) and serum creatinine (Scr) level over 3 months, and ipsilateral recurrence were collected and compared between the two groups. Results Enucleation was successful in 100%patients (19/19) of the PSAE group and in 62.5%patients (15/24) of the non-PSAE group,with no significant difference ( Fisher' s test, P=0.105) The EBL was (46.4 ±20.6) ml in the PSAE group, which was significantly less than the non-PSAE group [(89.5 ±30.4) ml, t=-5.287, P=0.000].The OT and WIT were significantly shorter in the PSAE group than those in the non-PSAE group [(90.3 ± 21.1) min vs.(131.7 ±18.6) min, t=-6.831,P=0.000;(9.5 ±5.7) min vs.(24.2 ±4.8) min, t=-9.181, P=0.000]. The length of hospitalization was significantly longer in the PSAE group than that in the non-PSAE group [(7.7 ±1.1) d vs.(6.3 ± 1.3) d, t=3.748, P=0.000].No severe complications occurred in the PSAE group, whereas the non-PSAE group had 1 case of urinary leakage and 1 case of hematoma.The Scr level over 3 months after surgery was more ideal in the PSAE group [(70.1 ±13.7)μmol/L vs.(84.2 ±9.1) μmol/L, t=-4.045, P=0.000].No statistically significant difference was found in the eGFR between the PSAE group and the non-PSAE group [(72.6 ±12.8) ml· min-1· 1.73 m-2 vs.(68.0 ±10.7) ml· min-1· 1.73 m-2, t=1.284, P=0.206].No evidence of recurrence was found during follow-up period in both groups. Conclusions Laparoscopic enucleation with PSAE is a safe and effective minimally invasive procedure for the treatment of renal angiomyolipomas.As compared to traditional laparoscopic partial nephrectomy, it has advantages of less WIT, less EBL, and better protection of renal functions.It can be recommended in well-selected patients.

This paper reported 13 cases of delayed traumatic chest wall abscess from January 2012 to January 2015.All the patients were associated with type 2 diabetes.After local puncture for confirmative diagnosis, a chest wall abscess dissection was carried out as soon as possible.At each site of upper and lower pole, an indwelling drainage tube was placed for irrigation and negative pressure suction.Sensitive antibiotics were selected based on susceptibility test results.The drainage tubes were removed 7-14 days after surgery.There were 8 cases of primary healing of incision and 5 cases of secondary healing of incision.All the patients were cured.Follow-ups for 6-36 months (average, 17 months) showed no recurrence.

Nowadays several minimally invasive techniques such as laparoscopy, hysteroscopy, uterine artery embolization and high-intensity focused ultrasound ( HIFU) have extended deeply into many aspects in the treatment of gynecological diseases.In practice, minimally invasive techniques have many advantages which are not available in conventional technology.In the treatment of adenomyosis, minimally invasive techniques also show superior advantages to other techniques.This paper reviews and summarizes literatures on laparoscopic excision of adenomyosis lesion, laparoscopic excision of adenomyosis lesion combined with uterine artery embolization, hysteroscopic endometrial and endometrial-myometrial junction resection, uterine artery embolization, and high-frequency focused ultrasound in the treatment of uterine adenomyosis.