Objective To study the anatomy,exposure and operation method in prevention of recurrent laryngeal nerve injury in thyroid surgery.Methods The clinical data of 520 patients with thyroid disease in treatment of operation were retrospectively analyzed,and exposure of recurrent laryngeal nerve in 268 cases,non exposure of recurrent laryngeal nerve in 252 cases; resection of the majority of thyroid in 232 cases,resection of ipsilateral thyroid lobe+ isthmus+on the side of most resection operation in 220 cases; resection of ipsilateral thyroid thyroidectomy+contralateral subtotal+ipsilateral lymph node dissection operation in 68 cases.Results Exposure of recurrent laryngeal nerve in 268 cases.The recurrent laryngeal nerve in the external laryngeal branch was single 214 cases,accounted for 79.9％ (214/268); two 42 cases,accounted for 15.7％ (42/268),more than 12 cases,accounted for 4.5％ (12/268).The laryngeal recurrent nerve during thyroid artery through the rear 143 cases,accounted for 53.4％(143/268) ; during thyroid artery through the front 92 cases,accounted for 34.3％ (92/268); walk line between thyroid artery branches 33 cases,accounted for 12.3％(33/268).The thyroid permanent damage rate of exposure of recurrent laryngeal nerve surgery was 1.1％(3/268),lower than that in non exposure of recurrent laryngeal nerve surgery 6.0％ (15/252) (P ＜ 0.05).The thyroid permanent damage rate between resection of the majority of thyroid and resection of ipsilateral thyroid lobe + isthmus + on the side of most resection operation had no significant difference (P ＞0.05),compared with the former two,resection of ipsilateral thyroid thyroidectomy + contralateral subtotal + ipsilateral lymph node dissection operation increased significantly (P ＜0.05).Exposure of.recurrent laryrngeal nerve in benign 173 cases,6 cases of thyroid transient damage,permanent damage in 1 case; 95 cases of malignant thyroid,6 cases of thyroid transient damage,permanent damage in 2 cases,the thyroid permanent damage rate in both had no significant difference (P ＞ 0.05).Conclusion Exposure of recurrent laryngeal nerve operation can significandy reduce the incidence of recurrent laryngeal nerve injury,for the partial thyroidectomy,can chose non exposure of recurrent laryngeal nerve operation method.

Objective To investigate the effect of neoadjuvant chemotherapy on gastric cancer based on FOLFOX7 or XELOX,so as to achieve evidence of clinical practice.Methods From January 2005 to June 2010,a retrospective analysis was performed for those patients with gastric cancer and underwent surgery.The patients were divided into neoadjuvant chemotherapy group and conventional chemotherapy group according to the chemotherapy method.The clinical efficacy,Ro resection rate and survival rate were evaluated in two groups.Results A total of 185 cases were included in neoadjuvant chemotherapy group (FOLFOX7 or XELOX,113 cases) and conventional chemotherapy group (72 cases).There was no significant difference in general status between two groups (P ＞ 0.05).Complete remission was in 48 cases,partial remission was in 51 cases,stable was in 14 cases,progression of disease was in 0 case in neoadjuvant chemotherapy group,and the effective rate was 87.6％ (99/113).Complete remission was in 30 cases,partial remission was in 25 cases,stable was in 15 cases,progression of disease was in 2 cases in conventional chemotherapy group,and the effective rate was 76.4％(55/72).There was significant difference in the effective rate between two groups (P＜ 0.05).The R0 resection rate in neoadjuvant chemotherapy group was higher than that in conventional chemotherapy group [60.2％ (68/113) vs.38.9％ (28/72)],and there was significant difference between two groups (P＜ 0.01).There was no significant difference in survival rate between two groups (P ＞ 0.05).Conclusion Neoadjuvant chemotherapy can reduce the tumor stage and improve the R0 resection rate,but has no obvious advantage in improving the survival rate during follow-up period.

Objective:To investigate the epidemiological characteristics and current status of surgical management for esophageal cancer in China.Methods:A national database was setup through a network platform. The clinical data of esophageal cancer treated by surgery was collected from 70 major hospitals in China between January 2009 and December 2014.Results:Complete data of 8 181 cases of esophageal cancer patients who underwent surgery were recorded in the database and recruited in the analysis. Among them, 6 052 cases were male and 2 129 were female, the average age was 60.5 years.The epidemiological investigation results showed that 148 cases (1.8%) had history of psychological trauma, 7 527 cases (92.0%) were lower social economic status, 5 072 cases (62.0%) were short of fresh vegetables and fruits, 6 544 cases (80.0%) ate rough food frequently, 3 722 cases (45.5%) drank untreated water directly from lake or river or shallow well, 3 436 cases (42.0%) had a unhealthy eating habit, including habits of eating food fast (507 cases, 6.2%), eating hot food or drinking hot tea/soup (998 cases, 12.2%), eating fried food (1 939 cases, 23.7%), 4 410 cases (53.9%) had the habits of smoking cigarettes and 2 822 cases (34.5%) drank white wine frequently.The pathological results showed that 7 813 cases (95.5%) were squamous cell carcinoma, 267 cases were adenocarcinoma (3.3%), 25 cases were adenosquamous cell carcinoma (0.3%) and 50 cases were small cell carcinoma (0.6%). A total of 1 800 cases (22.0%) received preoperative neoadjuvant therapy due to locally advanced disease or difficulty of resection. The esophagectomies were performed through left thoracotomy approach in 5 870 cases (71.8%), through right chest approach in 2 215 cases (27.1%), and the remain 96 cases (1.2%) received surgery though other approaches.A total of 8 001 cases (97.8%) underwent radical resection, the other 180 cases (2.2%) received palliative resection. The 30-day postoperative mortality rate was 0.5%, the overall ≥ grade Ⅱ postoperative complication rate was 11.6% (951 cases). The 1-yr, 3-yr, and 5-yr overall actual survival rates were 82.6%, 61.6%, and 52.9%, respectively.Conclusions:The data analysis of the national database for esophageal cancer shows that bad eating habits or eating rough food without enough nutrients, lower social and economic status, drinking white wine and smoking cigarettes frequently may be correlated with tumorigenesis of esophageal cancer. However, strong evidences produced by prospective observation studies are needed. Overall, the long-term survival of esophageal cancer patients has been improved gradually due to the application of advanced surgical techniques and reasonable multimodality treatment.

Objective:To investigate the epidemiological characteristics and current status of surgical management for esophageal cancer in China.Methods:A national database was setup through a network platform. The clinical data of esophageal cancer treated by surgery was collected from 70 major hospitals in China between January 2009 and December 2014.Results:Complete data of 8 181 cases of esophageal cancer patients who underwent surgery were recorded in the database and recruited in the analysis. Among them, 6 052 cases were male and 2 129 were female, the average age was 60.5 years.The epidemiological investigation results showed that 148 cases (1.8%) had history of psychological trauma, 7 527 cases (92.0%) were lower social economic status, 5 072 cases (62.0%) were short of fresh vegetables and fruits, 6 544 cases (80.0%) ate rough food frequently, 3 722 cases (45.5%) drank untreated water directly from lake or river or shallow well, 3 436 cases (42.0%) had a unhealthy eating habit, including habits of eating food fast (507 cases, 6.2%), eating hot food or drinking hot tea/soup (998 cases, 12.2%), eating fried food (1 939 cases, 23.7%), 4 410 cases (53.9%) had the habits of smoking cigarettes and 2 822 cases (34.5%) drank white wine frequently.The pathological results showed that 7 813 cases (95.5%) were squamous cell carcinoma, 267 cases were adenocarcinoma (3.3%), 25 cases were adenosquamous cell carcinoma (0.3%) and 50 cases were small cell carcinoma (0.6%). A total of 1 800 cases (22.0%) received preoperative neoadjuvant therapy due to locally advanced disease or difficulty of resection. The esophagectomies were performed through left thoracotomy approach in 5 870 cases (71.8%), through right chest approach in 2 215 cases (27.1%), and the remain 96 cases (1.2%) received surgery though other approaches.A total of 8 001 cases (97.8%) underwent radical resection, the other 180 cases (2.2%) received palliative resection. The 30-day postoperative mortality rate was 0.5%, the overall ≥ grade Ⅱ postoperative complication rate was 11.6% (951 cases). The 1-yr, 3-yr, and 5-yr overall actual survival rates were 82.6%, 61.6%, and 52.9%, respectively.Conclusions:The data analysis of the national database for esophageal cancer shows that bad eating habits or eating rough food without enough nutrients, lower social and economic status, drinking white wine and smoking cigarettes frequently may be correlated with tumorigenesis of esophageal cancer. However, strong evidences produced by prospective observation studies are needed. Overall, the long-term survival of esophageal cancer patients has been improved gradually due to the application of advanced surgical techniques and reasonable multimodality treatment.