ObjectiveTo summarize the treatment of simple renal cysts experience,the advantages and disadvantages of the two surgical options. MethodsRetrospective analysis of 15 cases of renal cysts after general anesthesia in patients with laparoscopic cyst decompression in the clinical data and 21 cases of renal cysts underwent open surgery in patients with clinical data,comparative analysis of advantages and disadvantages of both types of surgery were conducted. ResultsIn this study,14 patients with laparoscopic surgery were successful,1 patient converted to open surgery,laparoscopic surgery in patients with blood loss,postoperative complications and time of staying hospital after operation postoperative hospital stay were significantly less than group of open surgery. ConclusionThe laparoscopic renal cyst decortication was a safe and effective treatment for simple renal cysts,compared to traditional open surgery in patients with trauma,less bleeding postoperative pain,rapid recovery,shorter hospital staying and so on.

Objective The patients with metastatic spinal tumors often suffered from severe back pain and spinal cord compression directly caused by tumor tissue or severe spine kyphosis.In order to treat or prevent spinal cord paralysis,decompression and stabilization should be performed on the patients with spinal pain and /or severe spinal cord compression.Methods From July1998through July2001,62patients(27women and35men)with metastatic spinal tumors had been treated at our department.Of 62patients,the thoracic vertebrae were involved in37cases,lumbar vertebrae in19and cervical vertebrae in6.Among43of 62patients who pre sented with neurological dysfunction,24patients were incompletely para plegic and the others were completely paraplegic.The fol low-up ranged from8to36months.Results Pain relief was ob-tained in58of 62patients(94%),and good neurological recovery was obtained in33of the43patients.Improved bowel and bladder function was obtained in12of 25patients who presented with bowel and blad der dysfunction.After decompression,neurological function,evaluated as Frankel grade E or D,was ob-tained in5patients whose neurological function had been evaluated as Frankel grade A or B,and other9pa-tients ex perienced a neurological recovery from Frankel grade A or B to C or D.Conclusion The time developing from neurological dysfunction to complete para plegia is the most important prognostic factor.Poor prognosis is often inevitable when complete paraplegia appeared less than48hours.Complete loss of bowel and bladder function is also a factor for poor prognosis.Decompression should be performed immedi -ately if the patient is presented with neurological dysfunction.Spinal metastasis of thyroid or breast cancer has a rela tive good prognosis.However,metastasis of lung or liver cancer is associated with a short-term survival.Neu rological function of patients with spinal metastasis at thoracic region is more difficult to recover.Com-mon motor and sensory functions are often improved earlier than bowel and bladder function.Thorough re-section of metastatic tumor and stable in ternal fixation should be performed when single vertebra is involved.Conservative tumor resection,decompression and posterior internal fixation should be performed when two or more seg ments are involved in order to alleviate paraplegia,improve spinal stability and the quality.[

Objective To anatomically reconstruct massive bone deficiency w it h prosthesis-devitalized bone composites after bone tumor resection. Methods Fr om July 1997 to December 2000, twenty-four patients with malignant bone tumor we re treated with a limb salvage procedure including wide tissue resection and rec onstruction. The resected bone were debrided of gross tumor tissues, and treated with 200 g/L saline for 30 minutes and 95% alcohol for 20 minutes, then the dev italized bone was implanted back to resection sites. Eleven diaphysis defects we re reconstructed with devitalized bone fixed with interlocked intramedullary nai ling, the other 13 defects were reconstructed with prosthesis-devitalized bone c omposites. Results The mean follow-up period was two and half years. One patient s had nonunion at the graft-host junction. There were only two patients(9%) dev eloping local recurrence in half to two years after the surgery. These indicate that this method can be accepted by the limb salvage protocol. Conclusion Prosth esis devitalized bone composite enabled surgeons to reconstruct massive bone def iciency after bone tumor resection. Compared with allografts, devitalized bone h as the following advantages: 1) This technique reduces the rate of nonunion; 2) This technique also reduces the rate of local infection; 3) This technique reduc es the cost; 4) Few absorption has been found in devitalized bone at the last fo llow up. Immersion within 200 g/L saline then after 95% alcohol provides thoroug h devitalization of tumor hosting bone.

Objective To explore the complications of the total elbow arthroplasty after the resection of the peri-elbow tumor. Methods Between June 1998 and June 2002, eight patients underwent total elbow arthroplasty after resection of tumors, which involved 7 males and 1 female (mean age, 42.6 years; range, 22-63 years). The patients included 1 metastasis, 1 GCT, 2 MFH, 1 osteosarcoma, 1 lymphoma, 1 desmoid fibroma, and 1 synovial sarcoma. The tumors located 3 in distal humerus, and 5 in proximal ulna. For those of the distal humerus, after the resection of the tumors, the origins and the insertions of the musculi flexors, extensor, pronators and supinators were repaired as far as possible. The application of the prothesis was relatively simple, the prosthetic stem of the distal humerus was cemented, the intercondylar notch was sawn off, but both the lateral and medial epicondyles were kept, the prothesis impacted in the notch; While for those tumors located on the proximal ulna, the stem was spiraled in the intramedullary cavity, Patients were evaluated according to the Mayo Elbow Performance Score. Results All the patients were followed up at least one year or to death (mean duration, 2.5 years). Pain scores decreased from a mean of 3.6 to 2.0. Mean elbow motion from extention to flexision arc improved from 29? to 73? (range, 55?-105?). Seven cases were excellent or good (87.5%), and only one was poor (12.5%). There were none of the complications, such as infection, incision non-union and nerve injury. All patients without local recurrence as well. The X-ray didn't reveal any sign of loosening or breakage for the artificial elbow joint. Conclusion Total elbow arthroplasty after resection of tumors can decrease the pain and improve the function substantially. For metastatic tumors, this technique can be also used to alleviate symptom if there is no other good option.

[Objective]To evaluate the diagnostic strategy for bone metastasis from unknown primary. [Method]One hundred and twenty five patients with unknown primary bone metastasis were treated from June 2003 and December 2006.The distribution of bone metastasis while initial diagnosis mainly focused on spine,sacrum,pelvis,femur and humerus.The diagnostic strategy contained a series of physical examination,laboratory test,imaging study and pathological examination.[Result]The primary tumor was found in 70.4% cases,while 40% was in the lung,8% in kidney,5.6% in prostate,4.8% in liver,4% in breast,both 2.4% in thyroid and gastric,and 3.2% in other visceras.The physical examination revealed the occult primary site of the malignant tumor in only 9.6% cases.Although,43.2% patients had higher level of tumor antigen,but most of them were non-specific.Sixty percent of primary tumor was found by various imaging studies including plain radiograph,computed tomography and ultrasound.The pathological result after biopsy or operation identified or suggested the primary tumor in 66.4% cases.The one year survival rates after diagnosis were 58.57% and 22.93% in patients of bone metastasis with known and unknown origin,respectively.[Conclusion]The primary tumor can be diagnosed in most bone metastasis patients with no cancer history after careful examination,and patients will get benefit on survival time for targeted treatment.

[Objective] A retrospective study of patients with osteosarcoma in the proximal humerus was carried out to evaluate the effect of limb salvage surgery.[Methods]Thirty-eight patients received neoadjuvant chemotherapy and limb salvage were included in the study.Extraarticular or intraarticular resections of the proximal humerus were performed in 5 patients and 33 patients,respectively.The reconstructions included 31 custom-made prosthetic replacements,4 allograft prosthetic composites,1 bone cement spacer,and 2 autografts.The image files of patients receiving intraarticular resection were studied to identify tumor invasion of glenoid and deltoid muscule.[Results]Local recurrence encountered in 5 patients(13.2%)including 1 with extraarticular resection and 4 with intraarticular resection.In patients with intraarticular resection,image study revealed gleoid and deltoid muscule invasion occurred in 7 patients,of whom only 4 had local recurrence.The overall 5-year survival rate was 56.4%,and the disease-free survival rate was 40.5%.Complication rate of limb salvage surgery was 18.4%,which included two autograft bone fractures,one embolism of upper limb artery combined with radial nerve injury,and 4 shoulder joint instabilities.The functional outcomes of mean MSTS 93 score was 22.7 points(75.6%).The active external extension of shoulder joint was restricted in patients with extraarticular resection of no more than 30 degrees,and in patients with intraarticular resection of mean 45 degrees.[Conclusion]Acceptable oncological result and better function could be obtained after intraarticular resection of osteosarcoma in proximal humerus if glenoid or deltoid muscle invasion was not found on image study.Prosthetic replacement in these patients had lower complication rate,and better upper limb or hand function.

[Objective]To summary wound related complications and risk factors of sacral tumor surgery,and discuss the prevention and treatment strategy in order to decrease surgical risk and prevent the related complications.[Methods]From August 1997 to June 2008,302 patients with sacral tumors who underwent operations were retrospective studied to review complication types,risk factors and treatment strategies of complications.[Results]Wound nonunion,deep infection,cerebrospinal fluid leakage,viscera injuries and severe bleeding were the most common complications of peri-operation stage.Tumor diameters larger than 10cm,surgery and radiation history were the major risk factors of wound nonunion,deep infection and viscera injuries.Severe bleeding happened in 11 patients,and the major risk factors were tumor larger than 10cm,tumor locating at S2 or higher and en bloc surgery.Surgery and radiation history were the main reasons of cerebrospinal fluid leakage.[Conclusion]Understanding the risk factors of complications of sacral tumor surgery are helpful to judge and prevent complications after surgery.Some measures of prevention and treatment are effective to decrease the surgical risks.

[Objective] To discuss the surgical treatment strategy of spinal hemangioma.[Methods]Data on 33 patients with spinal hemangioma treated from October 1997 to October 2008 were reviewed.There were 19 females and 14 males.The average age was 54 years old.Chief complaints were pain(n=13),myelopathy(n=12),radiculopathy plus local pain(n=8).Nine patients without spinal cord and radial nerve compression underwent percutaneous vertebroplasty(PVP),and 24 patients with spinal cord and radial nerve compression,paravertebral soft tissue mass or spinal unstability were treated by operation.Anterior,anteroposterior and posterior approaches were used in 9,12,and 3 patients respectively.Transarterial embolization was done in 3 patients.[Results]No perioperative complication was observed in 9 patients after PVP,with a mean follow-up of 41 months.Pain was relieved.There was no perioperative death among the 24 patients who received operation.The blood loss during operation was 2739 ml and 1619 ml for anterior and posterior approaches,respectively(P=0.12).One case of paravertebral hematoma,one case of spinal canal hematoma,and one case of wound infection were observed in this group.Pain was relieved in 89%(17/19)of the patients.According to the Frankel Scale,the neurologic situation was improved in all the 12 patients with myelopathy.By a mean follow-up of 48 months,no internal fixation failure was seen.Tumor recurrence or growth was found in 4 patients,two had no symptoms and one underwent radiotherapy for pain.Repeated operation was performed in one patient with myelopathy.[Conclusion]Most patients with symptomatic spinal hemangioma could be treated successfully by surgery.Individual surgical plan should be made according to the reason causing symptoms and the general condition of the patient.

Objective To evaluate the clinical applicational value of color doppler flow image(CDFI)to perforation of ventricular septum resulting from myocardial infarct.Methods Before 7 cases confirmed perforation of ventricular septum though DSA,were examined by CDFI.The two results were compared to study the difference of bothes.Results All patients' results though CDFI were as the same as those though DSA,and accuracy rating was 100%.Conclusion CDFI may be applicated to early diagnose perforation of ventricular septum.

Objective To investigate technique,effect,complications of limb salvage surgery for malignant tumors of the proximal tibia involving the fibula.Methods Between November 1998 and February 2010,32 patients with malignant tumors of the proximal tibia involving the fibula underwent limb salvage surgery in our institute.There were 21 males and 11 females,aged from 10 to 66 years (average,23.4years).There were 23 cases of osteosarcoma,5 cases of chondrosarcoma,1 case of malignant giant cell tumor,and 3 cases of soft tissue sarcoma.All patients received en bloc resection of tumor including proximal tibia and fibula.During operations,ligation of anterior tibial vessels was performed in 14 patients,anastomosis of posterior tibial vessels in 1 patient,both ligation of anterior tibial vessels and anastomosis or replacement of posterior tibial vessels in 5 patients.The common peroneal nerve was resected in 4 patients,and the deep peroneal nerve was resected in 5 patients.The reconstruction methods included prosthetic replacement in 24 patients,replacement with inactivated autograft-prosthesis composite in 5 patients,and replacement with inactivated autograft in 3 patients.The caput mediale musculi gastrocnemii flap was transferred to reconstruct soft tissue defect in 14 patients,while caput laterale musculi gastrocnemii flap was transferred in 1patient.Results All patients were followed up for 11 to 159 months (average,39.4 months).Local recurrence occurred in 6 patients (18.8％).The overall 5-year survival rate was 51.2％.Fourteen patients died of tumor metastasis,2 survived with tumor,and 16 patients survived without tumor.Variant complications occurred in 15 patients (46.9％).The complications included ischemia of the lower leg in 4 patients,peroneal nerve palsy in 12 patients (permanent palsy in 9 patients and temporary palsy in 3 patients),wound healing problem in 4 patients,deep infection in 1 patient,and periprosthetic fracture in 1 patient.The mean MSTS 93 score was 21.6 points (72％).Conculusion The indications of limb salvage surgery for malignant tumors of the proximal tibia involving the fibula should be restricted.Although complications are encountered frequently,most patients have acceptable postoperative function.