Objective To compare and analyze the clinical efficacy and safety of anterior small incision approach and modified Miccoli endoscope assisted thyroidectomy in the treatment of benign thyroid tumor.Methods A total of 66 cases with benign thyroid tumor were enrolled in our hospital from Apiil 2014 to April 2017,and divided into two groups according to different surgical methods.The 31 patients who underwent modified Miccoli endoscope assisted surgery was made as the observation group and the 35 patients who underwent anterior neck small incision approach was made as the control group.The operation,cosmetic satisfaction,visual analogue scale (VAS) at 6 hour,12 hour and 24 hour after operation,the incidence of postoperative complications and the voice handicap index (VHI) of the two groups were recorded and analyzed.Results ①The operation time,hospitalization time,intraoperative blood loss in the observation group were(44.68 ± 23.30) mins,(3.28 ± 1.69) dsys and (43.57 ± 23.73) mL,respectively,which were lower than those[(59.43 ± 30.61) mins,(4.36 ± 1.42) days and (59.43 ±30.61)mL] in the control group(P ＜ 0.05).The hospitalization expense in the observation group was (9.73 ± 1.22) KRMB,which was higher than that [(5.83 ± 1.35) KRMB] in the control group (P ＜0.05).②The degree of cosmetic satisfaction in the observation group was 96.77％,which was significantly higher than 80％ in control group(P ＜0.05).③The score of VAS at 12 hour and 24 hour in the observation group were(3.11 ± 0.55)and (1.63 ± 0.21)respectively,which were significantly lower than those [(4.17 ± 0.73) and (2.59 ± 0.36)] in the control group (P ＜ 0.05).④The incidence of postoperative complications in the observation group was 6.45％,which was statistically insignificant when compared with that (11.43 ％) in the control group (P ＞ 0.05).⑤The VHI in the observation group was (0.70 ±0.45),which was statistically insignificant when compared with that(0.65 ± 0.39) in the control group (P ＞ 0.05).Conclusion For patients with benign thyroid tumors,the modified Miccoli endoscope assisted surgery and anterior small incision approach are both safe and effective.The former has the advantages in shortening the operation time and hospitalization time,reducing the blood loss and promoting the cosmetic effect,but it may increase the hospitalization expenses.

Objective To analyze the clinicopathological characteristics of patients with benign thyroid nodules(BTN) and thyroid carcinoma(TC),and explore the clinical value of fine-needle aspiration biopsy (FNAB)in diagnosis of TC.Methods A retrospective analysis was conducted on the data of 2918 cases with thyroid carcinoma,who underwent surgery in the People's Hospital of Wuhan University between January 2011 and February 2015.Results Patients aged younger than 45 years old accounted for 26.23％ and 51.26％ in BTN group and CT group,respectively,and the difference between the two groups were statistically significant (P ＜ 0.05).Male patients accounted for 16.82％ and 20.15％ in BTN group and CT group,respectively,and the difference between the two groups were statistically significant (P ＜ 0.05).Patients with family history of thyroid related diseases accounted for 2.93％ and 3.70％ in BTN group and CT group,respectively,and there was no statistically significant difference between the two groups (P ＞ 0.05).Patients with solitary lesion accounted for 40.42％ and 47.95％ in BTN group and CT group,respectively,and the difference between the two groups were statistically significant(P ＜ 0.05).Af ter the application of FNAB,the percentage of the patients diagnosed with TC was increased by 4.83％ (P ＜ 0.05),and the diameter of nodular was increased by 4 cm (P ＜ 0.01).Conclusion Patients with TC have a characteristic of earlier onset age,higher proportion of male patients and lower incidence of multifocality compared with patients with BTN.There was no statistically significant difference between the TC group with family history of thyroid related diseases and the BTN group.The application of FNAB avoids of unnecessary surgeries on some BTN patients with small pathological diameter of nodule,it is important for preoperative diagnosis of thyroid nodules.

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 discuss the clinical effect and safety of the unilateral C2 pedicle screw-plate(C2PSP)combined with contralateral C2 laminar screw-rod(C2LSR)for atlanto-axial joint and occipital cervical fixation.Methods 11 patients were treated by internal fixation with pedicle screw plate system combined with contralateral C2 laminar screw rod system.The cause of atlantoaxial instability was fresh type Ⅱ odontoid fracture in 5 patients,old odontoid fracture in 3 patients,occipitalization mal-formation in 2 patients,atlantoaxial instability in 2 patients.6 patients had small pedicle of the vertebral arch,2 patients had a high-riding vertebral artery(VA),2 patients had an asymmetrical VA,1 patient re-ceived a revision operation.9 patients performed C1-2 fixation,2 patients performed occipito-cervical fixa-tion.1 patient of irreducible atlantoaxial dislocation also performed anterior atlantoaxial joint release before posterior Fixation.All patients performed bone grafting to achieve a further occipito-cervical fusion or at-lantoaxial fusion.Before and after the operation,the neurologic function was scored according JOA scale. The X-ray and CT-scan also performed at regular intervals to evaluate cervical alignment and the fusion. Results All cases were complete reposition without vertebral artery,spinal cord or never root injuried.All patients were followed up for 6-32 months ( mean 16 months ),clinical symptom were improved visibly. The mean postoperative JOA scores was 14.9(13-16).The postoperative JOA score improvement rate was 76%-92%,and its mean value was 83%.All patients achieved bone fusion approved by CT scan after six months of operation.The reduction maintained well and the internal fixation was well positioned.Conclu-sion It will be an effective and safe way to achieve atlantoaxial fusion by posterior unilateral C2 pedicle screwing combined with contralateral C2 laminar screwing,but this study had not including clinical com-parative study.

Objective To analyze the clinical effects of sinus tarsi approach with minimal-inva-sive percutaneous screw fixation of calcaneal fractures. Methods From February 2014 to July 2015,28 ca-ses of calcaneal fracture patients(Sanders Ⅰ ~ Ⅲ)were treated with minimal-invasive percutaneous screw fixation via sinus tarsi approach in our department. There were 18 males and 10 females with age ranging from 16 to 68 years(mean,32 years). According to the classification of Sanders,six cases were classified as Type I,twelve as Type Ⅱ,and ten as Type Ⅲ. The Bohler angle and Gissane angle were compared be-fore and after operation. Clinical results were evaluated with the Maryland foot scoring system. Results All the patients were followed up for 14 to 20 months(mean,15. 5 months). Anatomic or almost anatomic reduction was achieved in all patients according to the results of postoperative images. All fractures healed,and the healing time ranged from 4 to 7 months(average,5. 3 months). There was no wound infec-tion,necrosis or bone nonunion. According to the Maryland foot scoring system,16 cases were defined as excellent,10 cases as good,and 2 cases as poor. The good and excellent rate was 92. 8% . Conclusion For calcaneal fractures,sinus tarsi approach with minimal-invasive percutaneous screw fixation has the ad-vantages of small trauma,safe operation,limited complication,and stable fixation,which is a satisfactory clinical treatment.

Objective To discuss the surgical treatment and prognosis of solid pseudo papillary tumor of the pancreas. Methods The clinical data of 45 patients with solid pseudo papillary tumor of the pancreas were analyzed retrospectively. Surgical treatment was performed in all cases,including 11 cases of local excision of the pancreas,20 cases of resection of the pancreatic body and tail,5 cases of resection of the pancreatic body,tail plus spleen,and 9 cases of pancreaticoduodenectomy. Results A total of 43 ca-ses were followed up for 6 ~ 160 months,with an average of(41. 5 ± 1. 5)months. There were 8 cases of dyspepsia,2 cases of pancreatic fistula,2 cases of pleural effusion,2 cases of incision liquefaction and in-fection,and 1 case of early hemorrhage of the digestive tract. All patients were cured by conservative treat-ment. No metastasis,recurrence or death occurred after the operation. Conclusion The pseudo papillary tumor of the pancreas is a potential low grade malignant tumor which mainly appears in females. Surgery is the only radical treatment and its prognosis is generally good.

Objective To discuss the types,pathogenesis and treatment of early cardiac arrhyth-mias in infants after open heart surgery with congenital heart diseases. Methods 992 infants after open heart surgeries were divided into control group and arrhythmia group. Another junctionalectopictachycardia ( JET)group was separated from arrhythmia group. Various preoperative and postoperative data were com-pared. Results 197 infants suffered from cardiac arrhythmia within 3 days right after open heart surger-ies. After exactly the same surgery procedures,JET group was significantly different with control group in aortic cross-clamp time,cardiopulmonary bypass time and stay in CICU(p<0. 05). As for time of ventila-tion,no significant difference was found between the two groups. Conclusion Early diagnosis and treat-ment of cardiac arrhythmia can not only improve the success rate of open heart surgery,but also promote early recovery.

Objective To summarize the experience of surgical treatment and to explore the oper-ation method choice of ascending aortic aneurysm caused by Marfan Syndrome. Methods The clinical da-ta of 16 patients from 2005 January to 2011 November were retrospectively analyzed. Results Among all, there was no operative mortality,but 6 cases of early postoperative complications(37. 5%),including 2 ca-ses of arrhythmia,2 cases of pulmonary infection,1 case of renal insufficiency and 1 case of pneumothorax. The follow-up time was 12~63(25 ± 9)months. During follow-up,2 patients died(12. 5%),1 due to rup-tured abdominal aortic aneurysms and 1 due to renal failure. Besides there were 2 cases of anticoagulation complications and 1 case of coronary heart disease. Conclusion Although sparing aortic root replacement of aortic valve has similar curative effect as Bentall operation and avoids the mechanical valve-related com-plications,the indications are relatively strict. Bentall operation is still the first choice for severe patients.

Objective To investigate the effects and their potential mechanisms of splenectomy plus esophagogastric devascularization on non-invasive indexes of liver fibrosis and the cirrhosis progress in portal hypertensive patients with HBV-related cirrhosis. Methods Twenty consecutive portal hypertensive patients with positive HBsAg,negative HBV-DNA and Child-Pugh A(n=14)or B(n=6)were collected in this study. ELISA method was used to test the level of serum MMP-1 and TIMP-1;electrochemilumines-cence was used to measure hyaluronic acid( HA),N-terminal type Ⅲ procollagen peptide( PC-Ⅲ),lami-nin(LN)and collagen typeⅣ(C-IV). Results The serum TIMP-1,HA,PCⅢ,LN,and C-Ⅳwere signifi-cantly lower than the preoperative levels(p<0. 05),and MMP-1 slowly increased compared with the pre-operative levels(p<0. 05). The changes between TIMP-1 and HA,PC-Ⅲ,LN,or C-Ⅳ were positively correlated(r=0. 458~0. 783,p<0. 01/0. 05). The changes between MMP-1 and HA,PC-Ⅲ,LN,or C-Ⅳ were negatively correlated(r= -0. 545~ -0. 873,p<0. 01/0. 05). Conclusion Splenectomy plus esophagogastric devascularization can decrease non-invasive hepatic fibrosis serum markers and cytokines (TIMP-1),conducive to slowing down the disease progression in patients with cirrhosis.

Pancreatic neuroendocrine tumors(pNETs)have a low prevalence,and may be func-tional as secreting biologically active substance or nonfunctional. With the increased understanding of this disease,new technologies are being developed for diagnosis and treatment. However,surgical excision re-mains the primary therapy for localized tumors and the cure rate is not ideal yet. In choosing the appropri-ate therapy for locally advanced/ metastatic pNETs,medical management strategy should be made in a multidisciplinary context. In addition to chemotherapy,there have been significant advances in targeted mo-lecular therapy.