Objective To evaluate the clinical effects of thoracic close drainage with thin drainage tube assisted to thick drainage tube after video-assisted thoracic surgery(VATS)lobectomy. Methods We ret-rospectively reviewed 89 patients received VATS lobectomy in Chinese PLA General Hospital from January 2014 to September 2014. The patients with non-small cell lung cancer were divided into two groups:treatment group (50 patients)and control group(39 patients). Treatment group took thin tube assisted to thick tube of thoracic close drainage and control group took general thoracic closed drainage tube. We studied the operation time,the bleeding of operation,the number of lymph node dissection,time of first activity out of bed,the hospitalization time of post-operation,post-operative complications,the days of post-operative drainage,drainage volume,the effect of drainage,the VAS evaluation score of post-operative pain in the two groups. Results Compared with control group,there was no statistical significance in the differences of the time of operation[(2. 58 ± 0. 57)h vs(2. 57 ± 0. 50)h;t = 0. 127,P = 0. 681],bleeding of operation[(108. 00 ± 52. 84)ml vs(114. 10 ± 107. 18)ml;t = 0. 352,P = 0. 334],the number of lymph node dissection[(14. 20 ± 5. 95)vs(11. 21 ± 4. 71);t = 2. 576,P = 0. 068)],the staying time of drainage[(5. 66 ± 2. 53)d vs(5. 82 ± 2. 02)d;t =0. 324,P = 0. 219],the postoperative drainage volume[(1 141. 76 ± 819. 26)ml vs(1 022. 95 ± 464. 84) ml;t = 0. 889,P = 0. 367]and the occurrences of the post-operative complications(8. 00% vs 10. 25% ;χ2 =1. 750,P = 0. 726). There was statistical significance in the differences of the post-operative time of off-bed [(11. 28 ± 8. 78)h vs(13. 97 ± 7. 83)h;t = 4. 027,P = 0. 045],the time from surgery to discharge [(8. 36 ± 2. 63)d vs(9. 56 ± 2. 89)d;t = 2. 952,P = 0. 043]and the drainage effect(costophrenic angle sharp:72. 0% vs 46. 2% ;χ2 = 5. 329,P = 0. 017). In the two groups,there were statistical significance differences in scores of VAS for the 24 to 72 hours resting and coughing of post-operation:24 h[(2. 78 ± 1. 13)vs(3. 74 ± 1. 68);t = 3. 226,P < 0. 001)],48 h[(1. 98 ± 0. 59)vs(3. 33 ± 1. 72);t = 5. 189,P <0. 001)],72 h[(1. 94 ± 0. 55)vs(3. 15 ± 1. 60);t = 5. 010,P < 0. 001)],coughing[(3. 64 ± 1. 23)vs (5. 33 ± 1. 95);t = 5. 005,P < 0. 001)]. Conclusion The thin drainage tube assisted to thick drainage tube for thoracic close drainage make the drainage more effective,release the pain,shorten the hopital stay;moreo-ver,it is simple and safe for operation and easy to popularize with high modified value.

【Objective】 To compare the efficacy and safety of blue laser en bloc enucleation and traditional plasmakinetic electrocautery in the treatment of non-muscle invasive bladder cancer (NMIBC). 【Methods】 A total of 50 NMIBC patients treated in our hospital during Oct.2018 and Dec.2019 were enrolled. A randomized, incomplete blinding, parallel control design and non-inferior test method was adopted. The control group (electrocautery group) used plasmakinetic electrocautery for transurethral resection, and the experimental group (blue laser group) used semiconductor blue laser for transurethral en bloc enucleation. The effective resection rate, operation time, postoperative catheter indwelling time, length of hospital stay, perioperative hemoglobin changes and obturator nerve reflex were compared. 【Results】 There were 24 patients in the blue laser group and 26 in the electrocautery group. The effective dissection rate and hemostasis rate in both groups reached 100%. The blue laser group had slightly longer operation time than the electrocautery group (55 min vs.42 min, P=0.009), but lesser hemoglobin decrease (5.7 g/L vs. 10.4 g/L, P=0.007). There were no significant differences in urinary catheter indwelling time, length of hospital stay and reoperation rate between the two groups. The electrocautery group had 3 cases of obturator nerve reflex, while the blue laser group had none. 【Conclusion】 Compared with the traditional electrocautery, blue laser has good vaporization cutting and coagulation hemostatic effects on bladder tumor tissue, and can completely enucleate tumors in a front-firing model with less bleeding and no obturator nerve reflex, which can be used as a new, efficient, safe and easy-to-learn method for NMIBC surgery. However, its effects on postoperative recurrence rate and progression rate still need further studies.

【Objective】 To investigate the feasibility and safety of semiconductor blue laser in the treatment of non-muscle invasive bladder cancer (NMIBC) in the day surgery model. 【Methods】 The clinical data of 22 NMIBC patients (average age 55.8 years and tumor size 1.4 cm) who underwent outpatient screening and accepted blue laser ambulatory surgery in our hospital during Jun.2022 and Sep.2022 were retrospectively analyzed. On the day of admission, transurethral resection of cancer was performed using blue laser en bloc enucleation. On the day of surgery or in the morning of next day, bladder irrigation was stopped, the catheter was removed, and patients were discharged. The baseline data, pre-hospital waiting time, operation time, length of hospital stay, hemoglobin decrease, complications and management, follow-up, medical costs, and patients’ satisfaction rate were recorded. 【Results】 The pre-hospital waiting time was 2 to 7 days, average (4.1±1.3)days. The operation time was 29 to 50 minutes, average (40.8±5.5)minutes. The length of hospital stay was 0.6 to 1.2 days, average (0.9±0.2)days. Hemoglobin decrease was 1 g/L to 8 g/L, average (3.8±1.8)g/L. The catheter was indwelt for 0.5 to 1 day, average (0.7±0.1)day. The medical costs were 13 790 to 16 811 Yuan, average (14 941.5±690.2) Yuan. Patients’ satisfaction rate was 100.0%. Mild intraoperative and postoperative complications occurred in 2 cases. One patient developed symptoms of cystitis which disappeared after 2 days of oral antibiotic cefixime, and another patient developed bladder spasm which was relieved after oral solifenacin succinate tablets. No adverse events such as obturator nerve reflex or bladder perforation occurred. After removal of the catheter, no urinary retention was observed. 【Conclusion】 This study was the first to apply blue laser ambulatory surgery in the treatment of bladder cancer, confirming that it is a safe, feasible, economical and efficient model for selected patients, which can be promoted in suitable hospitals.

【Objective】 To explore the safety and efficacy of neoadjuvant chemotherapy (NAC) combined with immunotherapy before radical cystectomy plus pelvic lymph nodes dissection (RC-PLND) for muscle-invasive bladder cancer (MIBC). 【Methods】 The clinical data of 101 patients with MIBC who underwent neoadjuvant therapy followed by RC-PLND in the Department of Urology, the First Affiliated Hospital of Xi’an Jiaotong University during Jan.2019 and Dec.2023 were retrospectively analyzed, including 71 patients (70.3%) who received NAC (NAC group) and 30 (29.7%) who received NAC combined with immunotherapy (NAC combine immunotherapy group). The clinical and pathological data and adverse events during neoadjuvant therapy were compared.Logistic regression analysis was used to explore the independent predictors of pathological complete response (pCR) and pathological partial response (pPR). 【Results】 There were no significant differences in the baseline data between the two groups (P>0.05).However, the proportion of multiple tumors in patients receiving NAC before surgery was significantly higher than that in the NAC combined immunotherapy group (69.0% vs. 46.7%, P=0.034).Compared with NAC group, NAC combined with immunotherapy group had significantly improved rate of pathological downstaging and pPR (60.6% vs. 83.3%, P=0.026; 45.1% vs. 70.0%, P=0.022).Furthermore, the rate of pCR in patients undergoing NAC combined immunotherapy was higher than those undergoing NAC, but the difference was not significant (53.3% vs. 33.8%, P=0.067).Logistic regression analysis revealed that clinical T-stage and tumor diameter were independent predictors of pCR and pPR (P<0.05).In addition, the most common adverse events during neoadjuvant therapy were anemia, decreased white blood cells, nausea, and vomiting, but most of them were grade 1—2 and could be relieved through symptomatic treatment. 【Conclusion】 NAC combined with immunotherapy is safe and effective, which can improve the rate of pathological downstaging, pPR and pCR, without increasing the incidence of adverse reactions.