Objective To investigate the predictive value of trauma index on the prognosis in pa-tients with traumatic spinal cord injury.Methods Enrolled 168 cases of patients with traumatic spinal cord injury,the traumatic index score and the American Spinal Injury Association (ASIA)grade were as-sessed on admission,then followed up for 6 months,the Spearman correlation analysis was performed to a-nalysis the relationship between trauma index and ASIA grade,and Receiver operating curve (ROC)anal-ysis was used to evaluate the relationship between trauma index and prognosis.Results There was a sig-nificant negative correlation between trauma index score and ASIA grade(r =-0.68,P <0.01).A total of 157 cases (93.5%)completed follow-up,the trauma index score had a good predictive value on the traumatic death in these patients,it's sensitivity was 71.4%,specificity was 76.1%,the best cut-off point was 25 points(P <0.01 );Compared with the low score group (<25 points),the high group (≥25 points)showed a lower ASIA grade and higher mortality,the differences were statistically significant (P <0.01).Conclusion The trauma index score was related with the spinal cord injury,and it is a predictive factor of poor prognosis in patients with traumatic spinal cord injury.

Objective To comparison of clinical efficacy between mini-invasive transforminal lumbar interbody fusion(mis-TLIF) assisted by Quadrant system and open posterior lumbar interbody fusion (PLIF)treatment for lumber spondylolisthesis,to find a better treatment for lumbar spondylolisthesis.Methods A total of 65 cases who were under lumber spondylolisthesis were retrospectively selected from our hospital,26 cases in mini-invasive transforminal lumbar interbody fusion assisted by Quadrant system (mis-TLIF group).39 cases in open posterior lumbar interbody fusion(PLIF group).Record the incision length,intraoperative blood loss,opertive time,bed time,hospital time,pre-and post-operative visual analogue scale(VAS) and Oswestry disability index(ODI) score were recorded respectively.After surgery,the imaging(X-Ray) evalute the vertebral fusion status.Results There were no significant difference between mis-TLIF group and PLIF group in BMI [(22.77 ± 4.38) kg/m2 and (21.28 ± 5.24) kg/m2],preoperative VAS score [(6.46 ± 1.67) and (6.59 ± 1.56)],preoperative ODI score [(58.70 ± 7.19) ％ and (60.10 ± 9.56) ％] (all P ＞ 0.05).There were significant difference between two groups in incision length [(6.10 ± 0.95) cm and (11.12 ± 2.02) cm],intraoperative blood loss [(247.31 ± 36.72) ml and (340.51 ± 64.32) ml],opertive time[(179.96 ± 17.54) min and(151.85 ± 16.06) min],bed time[(3.62 ± 1.44) d and (4.98 ± 1.74) d],hospital time [(9.38 ± 2.60) d and (11.95 ± 3.61) d] (all P ＜ 0.05).Postoperatively VAS score was assesssd at 1 month [(3.15 ± 1.08]),3months [(1.58 ± 0.81)],6months [(1.08 ± 0.74)] and ODI score was(30.77 ± 6.45) ％,(25.54 ± 6.33) ％,(20.23 ± 7.05) ％,respectively in mis-TLIF group were lower than those of PLIF group (P ＜ 0.05).There were no significant difference between two groups in the fusion rate in 3 months,6 months after operation.Conclusion Mis-TLIF had a lot of advantages relative to PLIF in the treatment of lumber spondylolisthesis,be like less trauma,less bleeding,less hospital time,quick rehabilitation and good curative effect,provide a new minimally invasive method for lumber spondylolisthesis patient.

Virtual reality technology is a kind of information technology,which can achieve the interaction between the users and the virtual environment by using relevant devices.This article introduces the application and validity of virtual reality technology in surgery of orthopedics,general surgery,neurosurgery and urology surgery and surgical training.It discusses the advantages and disadvantages and development prospects of the virtual reality technology in the field of surgery and surgical training as well.

Objective To investigate the value of the proximal colon resection in the operation of rectal cancer.Methods 143 cases of rectal cancer in our hospital were selected and randomly divided into observation group (82 cases)and control group (61 cases).The observation group was treated with the excision of the membrane of the colon,and the control group was treated with routine operation.The pathological report of two groups was analyzed,the number of lymph nodes resection and the positive lymph nodes were compared,and the incidence of postoperative complications in the two groups were observed.Results In the observation group,1487 lymph nodes were detected,the average number of lymph nodes was 18.1,the lymph nodes metastasis were 203,and the average number of lymph nodes metastasis were 2.5.No recent complications occurred.The control group of 61 patients,a total of 749 lymph nodes were detected,the average number of lymph nodes detected 12.3,lymph nodes metastasis were 103,the average number of metastatic lymph nodes metastasis were 1.7.No recent complications occurred.There was a significant difference between the average detection rate of lymph nodes in the two groups(P ＜ 0.05).Conclusion The proximal colon resection can improve the resection rate and reduce the residual of positive lymph nodes,which can reduce the recurrence and metastasis of rectal cancer.

Objective To assess the efficacy and safety of modified ligation of the intersphincteric fistula tract (LIFT) for low anal fistula.Methods We follow-up visited 20 patients with low anal fistula underwent modified LIFT procedures (Since the outer edge shape of anal fistula incision fistula and the branch into the intersphincteric groove,proximal lateral internal sphincterotomy ligation.The wound was closed to the whole layer of closed suture after removal of the pipe wall).Median follow-up duration was 10(range 3-15) months.To compile statistics on the wound healing time,the clinical healing rate,the recurrence rate and the fecal incontinence score (Wexner score) of those patients.Results The wound healing time was (15.3 ± 4.8) d.The prime success rate of fistula healing was 75 ％ (15/20) after the modified LIFT procedure.2 cases of low complex anal fistula presented with wound infection,and 3 cases (including 1 cases of simple low anal fistula,2 cases of low complex anal fistula)had fistula with infection.They were cured after appropriate treatment.During follow-up of 3 to 15 (median 10)months,1 cases of simple low anal fistula recurred in third months after surgery.To the end of the follow-up,the total clinical healing rate was 95％ (19/20),of which 12 cases of low complex anal fistula total cure rate was 100％ (12/12).Preoperative fecal incontinence scores (Wexner score)were all 0 points.At the final follow-up,18 (90％)cases of fecal incontinence score were 0 points,1 (5 ％) cases were 2 points and 1 (5 ％) cases were 1 points.Conclusion Modified LIFT is better balance the relationship between cure rate and anal function.The sphincter preservation is complete.The fistula is thoroughly cleared.The cure rate is high.The recurrence rate is low.Does not cause anal defects and deformities.It has little influence on the function of anal control,the operation is simple,and it is suitable to be popularized.

Objective To explore the relationship of preoperative hemoglobin concentration and use of hospital resources.Methods 108 patients receiving cardiac surgery in the central hospital of wuhan were included.The relationship of preoperative hemoglobin concentration was explored on blood transfusion rates,return to the operating room for bleeding and/or cardiac tamponade,postoperative intensive care unit(ICU)and in-hospital length of stay,and mortality.Results For every 10-unit increase in hemoglobin(g/L),blood transfusion requirements were reduced by 8.0%,6.0%,and 3.0% for red blood cell units,platelet pools,and fresh frozen plasma units,respectively.For each 10-unit decrease in hemoglobin(g/L),the probability(over time)of discharge from the ICU and hospital increased 7.0%,16.0% respectively.Conclusion A lower preoperative hemoglobin concentration resulted in increased use of hospital resources after cardiac surgery.Therefore,the correction of decreasing preoperative hemoglobin concentration could improve the use of hospital resources after cardiac surgery.

Objective To observe the effect of controlled infusion on patients who underwent laparoscopy for gastrointestinal neoplasms.Methods Eighty patients who underwent laparoscopy for gastrointestinal neoplasms were randomized into the controlled infusion group(n=40)and the normal infusion group(n=40).In the perioperative period(from intraoperatively to 3 days postoperatively),for the controlled infusion group,infusion volume was controlled in a goal-directed manner based on the patient's left ventricular ejection fraction(LVEF),stroke volume variation(svv),central venous pressure(CVP),blood pressure,base excess(BE),hemoglobin,urine volume and additional loss;for the normal infusion group,fluid infusion were performed per routine protocol for surgical fluid infusion.Both groups were compared regarding mean perioperative infusion volume,postoperative time to first flatus,incidence of complications,length of stay(LOS),and hospitalization expenses.Results No significant difference was found in mean perioperative infusion volume between controlled[(2391.9±494.09)ml] and normal[(2432.4±384.14)ml] infusion groups(P>0.05);postoperative time of first flatus,LOS and incidence of complications were markedly lower and hospitalization expenses were markedly less than those in the normal infusion group,and differences were statistically significant(P<0.05).No case of death was noted in either group.Conclusion Goal-directed control of fluid infusion in the perioperative period of laparoscopy for gastrointestinal neoplasms can help reduce the incidence of postoperative complications,shorten the time to gastrointestinal function recovery and LOS,and cut down the hospitalization expenses.

Objective To investigate the clinical effects of VATS lobectomy and VATS segmentectomy in the treatment of old age patients with non small cell lung cancer for stage Ⅰ.Methods 140 patients with non small cell lung cancer for stage Ⅰ were chosen and randomly divided into two group including group A(70 patients)with VATS lobectomy and group B(70 patients)with VATS segmentectomy;and the perioperative clinical indicators,level of lung function and CRP before and after operation and survival rate with follow-up of both groups were compared.Results The operation time,intraoperative blood loss amount,chest drainage volume and time and hospitalization staying time of group B[(118.15±33.61)min,(59.25±10.61)ml,(641.56±135.17)ml,(3.42±0.77)d and(5.08±1.32)d] were significantly better than group A[(135.33±40.10)min,(83.33±14.15)ml,(783.89±180.61)ml、(4.38±0.94)d和(6.52±1.58)d](P<0.05).There was no significant difference in the number of lymph node dissection between group A(12.67±2.64)and group B(12.38±2.58)(P<0.05).The levels of FVC and FEV1 after operation of group B was significantly higher than group A(P<0.05).The levels of CRP after operation of group B was significantly lower than group A(P<0.05).There was no significant difference in the 1 year survival rate with follow-up between group A(94.29%)and group B(94.29%)(P>0.05).Conclusion Compared with VATS lobectomy,VATS segmentectomy in the treatment of old age patients with non small cell lung cancer for stage Ⅰ can efficiently reduce surgical trauma degree,accelerate the recovery process of body,protect the lung ventilation function and be helpful to reduce the inflammatory response levels.

Objective To investigate the results of non dissecting thoracic duct ligation cutting in treatment of recurrent chylothorax.Methods 22 patients suffered from recurrent chylothorax after original thoracic duct ligation surgery were enrolled and their clinical characteristics were collected,including previous thoracic surgical procedure, previous surgical approach,recurrent chylothorax side and postoperative complications.The probable causes of chylothorax recurrence were analyzed and targeted improvements were made,based on the traditional mass ligation procedure of the thoracic duct.Through the previous approach,non dissecting thoracic duct ligation combined with transection of the posterior mediastinal tissue,except esophagus and thoracic aorta,was applied during the reoperation for the recurrent chylothorax.Results All the patients were recovery form chylothorax after reoperations.There were no severe postoperative complications except one patient suffered from respiratory failure.All the patients discharged evenly without chylothorax recurrence during one-year follow-up period.Conclusion Recurrent chylothorax could be successfully and safely treated by non-anatomical mass ligation combined with transection of the thoracic duct,for the anatomical foundation of chylothorax recurrence had been eliminated.

Objective To compare the short-term perioperative outcomes of video-assisted mini-thoracotomy(VAMT),multiple port-video-assisted thoracoscopic surgery(MP-VATS)and single utility port-VATS(SP-VATS)in treatment of early stage non-small cell lung cancer(NSCLC).Methods A total of 157 cases of early stage NSCLC patients were collected and divided into three groups:66 cases received VAMT treatment as group VAMT;45 cases received MP-VATS treatment as group MP-VATS;46 cases received SP-VATS treatment as group SP-VATS.The intraoperative and postoperative conditions,lung function indexes including forced expiratory volume in one second(FEV1),forced vital capacity(FVC)and maximal voluntary ventilation(MVV)among the groups were compared.Results There were no significant differences in the operation time and the number of lymph node dissection among the SP-VATS group,MP-VATS group and group VAMT[(154.89±32.34)min vs(158.43±36.78)min vs(161.21±40.02)min,(12.34±4.55)pieces vs(12.47±3.81)pieces vs(11.78±3.32)pieces,P>0.05];the incision length,blood loss,amount and time of postoperative drainage and the postoperative ambulation in groupSP-VATS were significantly lower than group MP-VATS and VAMT[(4.11±0.65)cm vs(6.42±0.65)cm vs(12.14±2.23)cm;(170.31±45.68)ml vs(166.23±43.21)ml vs(228.96±63.21)ml;(623.42±231.56)ml vs(681.23±278.54)ml vs(924.54±324.51)ml;(5.27±1.32)d vs(7.43±2.27)d vs(7.66±2.89)d;(3.36±0.78)d vs(4.62±1.26)d vs(4.78±1.43)d,all P<0.05].The time of postoperative drainage and postoperative ambulation in group SP-VATS was significantly lower than group MP-VATS(P<0.05);The rate of postoperative complications in group SP-VATS was 2.17%,significantlylower than 15.15% in group VAMT(P<0.05);The postoperative recurrence rate within 6 months among the group SP-VATS, group MP-VATS and group VAMT were no significant difference(6.67% vs 4.44% vs 3.03%,P>0.05);After surgery,the lung function(FEV1,FVC,MVV)among the three groups were significantly decreased,and the group SP-VATS was significantly higher than VAMT group(P<0.05),but there was no significant difference with group MP-VATS(P>0.05).Conclusion The SP-VATS for early stage NSCLC has similar short-term efficacy with VAMT and MP-VATS,but SP-VATS has faster recovery and maller postoperative pulmonary dysfunction.