Objective To compare and analyze the surgical efficacy of different ways of left and right transthoracic ap-proaches on patients with middle thoracic esophageal cancer. Methods The 120 patients with middle esophageal carci-noma were divided into observation group (60 cases) and the control group (60 cases) randomly. The patients in obser-vation group were treated with right chest-belly-neck three-incision. The control group accepted left breast single in-cision. The operation duration, postoperative hospitalization time and indwelling chest tube time, the number of lymph node dissection, the rate of proximal spread of tumor, incidence of postoperative complications and 2-year survival rate were recorded and analyzed. Results Compared with control group, the operation duration, postoperative hospitalization time, the number of lymph node dissection and 2-year survival rate in observation group were higher. The rate of proximal spread of tumor in observation group were lower than in control group (P<0.05). The incidence of pulmonary infection and anastomotic leak were higher (P<0.05). Conclusion Compared with left breast single incision, right chest-belly-neck three-incision can provide a wider extent of lymphadenectomy, especially for mediastinal and abdominal, which may improve the survival in two years of patients with middle esophageal carcinoma. But the operation time may be longer and the incidence of pulmonary infection and anastomotic leak may be higher. Surgery should be selected according to the specific circumstances of patients.

Objective To explore the hemodynamic characteristics in functional side-to-end (STE) anastomosis arteriovenous fistula (AVF) by computational fluid dynamics (CFD), so as to provide theoretical basis for clinical application of the AVF. Methods AVF models of functional STE anastomosis (STE group) and conventional STE anastomosis (cSTE group) were established. The hemodynamic parameters of models in two groups under retrograde and antegrade flow states were analyzed, including blood flow velocity, pressure drop, low wall shear stress area (LWSSA). Results Under retrograde flow, the total LWSSA in STE group was 5.70% lower than that in cSTE group, and the LWSSA on venous wall in STE group was 49.71% lower than that in cSTE group. Under antegrade flow, the total LWSSA in STE group was 6.97% greater than that in cSTE group, and the LWSSA on venous wall in STE group was 10.62% lower than that in cSTE group. Conclusions Under retrograde flow state, functional STE anastomosis can significantly decrease the LWSSA of AVF, while under antegrade flwo state, functional STE anastomosis has no significant impact on improving the LWSSA of AVF.