Objective To explore the significance of mitoxantrone hydrochloride injection and carbon nanoparticles suspension injection in endoscopic radical thyroid cancer surgery.Methods A retrospective analysis was carried out on patients who underwent endoscopic radical surgery for unilateral thyroid cancer at the Depart-ment of General Surgery,Gansu Provincial Central Hospital,from December 2022 to February 2024.The patients were classified into two groups according to the intraoperative tracer employed:the mitoxantrone group and the nanocarbon group.After a 6-month postoperative follow-up,the baseline data of the two patient groups were compared.The intraoperative visualization of lymph nodes and parathyroid glands in both groups was observed.Additionally,the hospitalization costs and the incidence of postoperative complications were compared between the two groups.Results In this study,110 cases were included in the Mitoxantrone group and 126 cases in the nanocarbon group.The staining time of the central lymph nodes was significantly shorter in the nanocarbon group compared to the mitoxantrone group(P<0.05).The blue staining rate of MHI reached 97.5%,while the black staining rate of CNSI was 98.3%.The difference between them was not statistically significant(P>0.05).Regarding the number of central lymph nodes dissected,it was 9.34±0.22 in the Mitoxantrone group and 9.88±0.24 in the nanocarbon group,with no statistically significant difference(P>0.05).Similarly,the parathyroid misdissection rates were 1.8%and 0.8%in the two groups respectively,and no significant statistical difference was observed(P>0.05).Postoperative blood calcium and PTH levels measured at 1 day,1 month,and 6 months did not show any statistically significant differences between the two groups(P>0.05).The incidence of transient hypoparathy-roidism and hypocalcemia was comparable in both groups(P>0.05),and no patients developed permanent hypo-parathyroidism or permanent hoarseness.None of the patients in one Mitoxantrone group experienced postoperative hemorrhage,coeliac leakage,or skin staining.In contrast,in the nanocarbon group,there was one case of postop-erative hemorrhage and one case of coeliac leakage,and two case of skin staining.Conclusions In laparoscopic unilateral thyroid cancer radical surgery,when it comes to lymph node tracing and parathyroid gland protection,no significant disparities were detected between MHI and CNSI.Nevertheless,CNSI exhibits a shorter staining time for central lymph nodes.In contrast,MHI is more manageable,features a faster metabolic rate,and has been demonstrated to be more cost-effective.

Objective:To investigate the clinical efficacy of laparoscopic hiatal hernia repair (LHHR) combined with Nissen, Toupet, or Dor fundoplication.Methods:The retrospective cohort study was conducted. The clinical data of 102 hiatal hernia patients who were admitted to 4 hospitals including Gansu Provincial Central Hospital from January 2019 to December 2023 were collected. There were 46 males and 56 females, aged (54±4)years. Among the 102 patients, 37 cases who underwent LHHR combined with Nissen fundoplication were assigned to the Nissen group, 34 cases who underwent LHHR combined with Toupet fundoplication were assigned to the Toupet group, and 31 cases who underwent LHHR combined with Dor fundoplication were assigned to the Dor group. Observation indicators: (1) surgical conditions and postoperative recovery; (2) dysphagia before and after surgery; (3) gastroesophageal reflux disease questionnaire (GERD-Q) scores before and after surgery. One-way analysis of variance (ANOVA) was used for comparison of measurement data with normal distribution among groups. In ANOVA, if there were statistically significant differences among groups, the least significant difference (LSD) method was further used for pairwise compari-son. Repeated-measures ANOVA was applied for comparison of repeated measure-ment data. Comparison of count data among multiple groups was conducetd using the chi-square test or Fisher exact probability, and the Dunn-Bonferroni correction was used for further pairwise comparison. Comparison of ranked data between groups was conducted using the Kruskal-Wallis H test. Results:(1) Surgical conditions and postoperative recovery. There was no significant difference in operation time, volume of intraoperative blood loss, time to postoperative first flatus, length of hospital stay, or the incidence of postoperative in-hospital dysphagia, abdominal distension, abdominal pain, diarrhea among the three groups ( P>0.05). At 12 months after surgery, there was no hernia recurrence in the Nissen group, 1 case of recurrence in the Toupet group, and 1 case of recurrence in the Dor group, showing no significant difference among the three groups ( P>0.05). (2) Dysphagia before and after surgery. Before surgery, there was no significant difference in the incidence of dysphagia among the three groups ( P>0.05). At 1 month after surgery, the number of patients with dysphagia in the Nissen group, Toupet group, and Dor group was 20, 18, and 7, respectively, showing a significant difference among the three groups ( χ2=8.39, P<0.05). There was no significant difference between the Nissen group and Toupet group ( P>0.05). There was a significant difference between the Nissen group and Dor group, between the Toupet group and Dor group ( χ2=6.98, 6.32, P<0.05). However, at 6 and 12 months after surgery, there was no significant difference in the incidence of dysphagia among the three groups ( P>0.05). (3) GERD-Q scores before and after surgery. The GERD-Q scores before surgery, at 1 month and 6 months after surgery were 10.8±1.9, 8.5±2.1, 7.1±1.9 of the Nissen group, 11.0±1.6, 8.6±1.9, and 7.1±1.7 of the Toupet group, 10.7±1.6, 8.7±1.9, 7.2±1.8 of the Dor group, respectively. For the GERD-Q scores of the three groups before and after surgery, there was a significant difference in the time effect ( F=104.17, P<0.05), while no significant difference was found in the inter-group effect and interaction effect ( F=0.13, 0.16, P>0.05). Intra-group comparison of GERD-Q scores in the three groups before surgery, at 1 month and 6 months after surgery showed significant differences respectively ( F=38.37, 40.29, 27.20, P<0.05). Conclusions:LHHR combined with Nissen, Toupet, or Dor fundoplication is safe and effective in the treatment of hiatal hernia , which can achieve good anti-reflux effects. The Dor fundoplication is associated with a lower short-term incidence of postoperative dysphagia.

Objective To explore the significance of mitoxantrone hydrochloride injection and carbon nanoparticles suspension injection in endoscopic radical thyroid cancer surgery.Methods A retrospective analysis was carried out on patients who underwent endoscopic radical surgery for unilateral thyroid cancer at the Depart-ment of General Surgery,Gansu Provincial Central Hospital,from December 2022 to February 2024.The patients were classified into two groups according to the intraoperative tracer employed:the mitoxantrone group and the nanocarbon group.After a 6-month postoperative follow-up,the baseline data of the two patient groups were compared.The intraoperative visualization of lymph nodes and parathyroid glands in both groups was observed.Additionally,the hospitalization costs and the incidence of postoperative complications were compared between the two groups.Results In this study,110 cases were included in the Mitoxantrone group and 126 cases in the nanocarbon group.The staining time of the central lymph nodes was significantly shorter in the nanocarbon group compared to the mitoxantrone group(P<0.05).The blue staining rate of MHI reached 97.5%,while the black staining rate of CNSI was 98.3%.The difference between them was not statistically significant(P>0.05).Regarding the number of central lymph nodes dissected,it was 9.34±0.22 in the Mitoxantrone group and 9.88±0.24 in the nanocarbon group,with no statistically significant difference(P>0.05).Similarly,the parathyroid misdissection rates were 1.8%and 0.8%in the two groups respectively,and no significant statistical difference was observed(P>0.05).Postoperative blood calcium and PTH levels measured at 1 day,1 month,and 6 months did not show any statistically significant differences between the two groups(P>0.05).The incidence of transient hypoparathy-roidism and hypocalcemia was comparable in both groups(P>0.05),and no patients developed permanent hypo-parathyroidism or permanent hoarseness.None of the patients in one Mitoxantrone group experienced postoperative hemorrhage,coeliac leakage,or skin staining.In contrast,in the nanocarbon group,there was one case of postop-erative hemorrhage and one case of coeliac leakage,and two case of skin staining.Conclusions In laparoscopic unilateral thyroid cancer radical surgery,when it comes to lymph node tracing and parathyroid gland protection,no significant disparities were detected between MHI and CNSI.Nevertheless,CNSI exhibits a shorter staining time for central lymph nodes.In contrast,MHI is more manageable,features a faster metabolic rate,and has been demonstrated to be more cost-effective.

Objective:To investigate the clinical efficacy of laparoscopic hiatal hernia repair (LHHR) combined with Nissen, Toupet, or Dor fundoplication.Methods:The retrospective cohort study was conducted. The clinical data of 102 hiatal hernia patients who were admitted to 4 hospitals including Gansu Provincial Central Hospital from January 2019 to December 2023 were collected. There were 46 males and 56 females, aged (54±4)years. Among the 102 patients, 37 cases who underwent LHHR combined with Nissen fundoplication were assigned to the Nissen group, 34 cases who underwent LHHR combined with Toupet fundoplication were assigned to the Toupet group, and 31 cases who underwent LHHR combined with Dor fundoplication were assigned to the Dor group. Observation indicators: (1) surgical conditions and postoperative recovery; (2) dysphagia before and after surgery; (3) gastroesophageal reflux disease questionnaire (GERD-Q) scores before and after surgery. One-way analysis of variance (ANOVA) was used for comparison of measurement data with normal distribution among groups. In ANOVA, if there were statistically significant differences among groups, the least significant difference (LSD) method was further used for pairwise compari-son. Repeated-measures ANOVA was applied for comparison of repeated measure-ment data. Comparison of count data among multiple groups was conducetd using the chi-square test or Fisher exact probability, and the Dunn-Bonferroni correction was used for further pairwise comparison. Comparison of ranked data between groups was conducted using the Kruskal-Wallis H test. Results:(1) Surgical conditions and postoperative recovery. There was no significant difference in operation time, volume of intraoperative blood loss, time to postoperative first flatus, length of hospital stay, or the incidence of postoperative in-hospital dysphagia, abdominal distension, abdominal pain, diarrhea among the three groups ( P>0.05). At 12 months after surgery, there was no hernia recurrence in the Nissen group, 1 case of recurrence in the Toupet group, and 1 case of recurrence in the Dor group, showing no significant difference among the three groups ( P>0.05). (2) Dysphagia before and after surgery. Before surgery, there was no significant difference in the incidence of dysphagia among the three groups ( P>0.05). At 1 month after surgery, the number of patients with dysphagia in the Nissen group, Toupet group, and Dor group was 20, 18, and 7, respectively, showing a significant difference among the three groups ( χ2=8.39, P<0.05). There was no significant difference between the Nissen group and Toupet group ( P>0.05). There was a significant difference between the Nissen group and Dor group, between the Toupet group and Dor group ( χ2=6.98, 6.32, P<0.05). However, at 6 and 12 months after surgery, there was no significant difference in the incidence of dysphagia among the three groups ( P>0.05). (3) GERD-Q scores before and after surgery. The GERD-Q scores before surgery, at 1 month and 6 months after surgery were 10.8±1.9, 8.5±2.1, 7.1±1.9 of the Nissen group, 11.0±1.6, 8.6±1.9, and 7.1±1.7 of the Toupet group, 10.7±1.6, 8.7±1.9, 7.2±1.8 of the Dor group, respectively. For the GERD-Q scores of the three groups before and after surgery, there was a significant difference in the time effect ( F=104.17, P<0.05), while no significant difference was found in the inter-group effect and interaction effect ( F=0.13, 0.16, P>0.05). Intra-group comparison of GERD-Q scores in the three groups before surgery, at 1 month and 6 months after surgery showed significant differences respectively ( F=38.37, 40.29, 27.20, P<0.05). Conclusions:LHHR combined with Nissen, Toupet, or Dor fundoplication is safe and effective in the treatment of hiatal hernia , which can achieve good anti-reflux effects. The Dor fundoplication is associated with a lower short-term incidence of postoperative dysphagia.

Objective:To evaluate the effects of parathyroid autotransplantation on total central lymph node dissection and postoperative parathyroid functional recovery in endoscopic radical operation for thyroid carcinoma.Method:The data of 152 patients undergoing endoscopic radical operation for thyroid carcinoma are retrospectively analyzed. The incidence of postoperative hypoparathyroidism, serum PTH and Ca 2+ concentrations at different time points, and the number of lymph nodes cleared were counted. Results:The rate of temporary hypoparathyroidism in the experimental group was higher than that in the control group, and the incidence of permanent hypoparathyroidism was lower than that in the control group, with statistically significant differences ( χ2=6.243, P=0.029). Patient's PTH in the experimental group is significantly higher than that in the control group at 1 week, 1 , 3 , 6 and 12 months after operation, and the difference is statistically significant ( F=25.193, P<0.05); Ca 2+ concentration in experimental group is higher than that in control group at 1, 3, 6 and 12 months after operation, and the difference is statistically significant ( F=3.268, P=0.005); The average number of central zone lymph node dissection and positive lymph nodes per case in the experimental group was higher than that in the control group, and the difference was statistically significant ( t=2.000, P=0.047; t=2.014, P=0.046). Conclusion:In radical lumpectomy for thyroid cancer, parathyroid autotransplantation can effectively prevent permanent postoperative hypoparathyroidism while achieving a more complete lymph node dissection in the central region.

Objective:To investigate the relationship between parathyroid hormone（PTH） level and permanent hypoparathyroidism（PHPP） on the first day after radical papillary thyroidectomy, and its predictive value. Methods:A total of 80 patients with papillary thyroid cancer who underwent total thyroid resection and central lymph node dissection were collected and analyzed from January 2021 to January 2022. According to whether PHPP occurred after surgery, the patients were divided into hypoparathyroidism group and normal parathyroid function group, and univariate and binary logistics regression were used to analyze the correlation between PTH and serum calcium levels and PHPP on the first day after surgery in two groups. The dynamic changes of PTH at different time points after operation were analyzed. The area under the receiver operating characteristic was used to evaluate the predictive power of PTH on the development of PHPP after surgery. Results:Among the 80 patients with papillary thyroid cancer, 10 cases developed PHPP, with an incidence rate of 12.5%. Binary logistics regression analysis showed that PTH on the first postoperative day（OR=14.534, 95%CI: 2.377-88.858, P=0.004） was an independent predictive risk factor for postoperative PHPP. Taking PTH=8.75 ng/L on the first postoperative day as the cut-off value, the AUC of the area under the curve was 0.874（95%CI: 0.790-0.958, P<0.001）, the sensitivity was 71.4%, the specificity was 100%, and the Yoden index was 0.714. Conclusion:PTH level on the first day after total thyroid papillary carcinoma surgery is closely related to PHPP, and is an independent predictor of PHPP.
Humans ; Calcium ; Hypoparathyroidism/surgery* ; Parathyroid Glands ; Parathyroid Hormone ; Postoperative Complications/surgery* ; Thyroid Cancer, Papillary/surgery* ; Thyroid Neoplasms/complications* ; Thyroidectomy

Hiatal hernia (HH) is a prevalent medical condition characterized by the protrusion of abdominal contents into the thoracic cavity through an enlarged diaphragmatic esophageal hiatus. The most common clinical manifestations of HH include acid reflux, heartburn, belching, coughing, and chest pain. Currently, there is a lack of standardized comprehensive treatment protocols for different types of HH, presenting significant challenges in their clinical management. In light of this, individualized treatment approaches should be followed by surgical practitioners when dealing with HH, in order to formulate the most appropriate clinical treatment plan tailored to each patient′s specific circumstances.

Objective:To compare the effectiveness and recurrence rate of different types of mesh or without mesh in laparoscopic hiatal hernia repair.Methods:From Jan 2016 to Mar 2022 at the three hospital 90 patients with hiatal hernia, including 26 cases without mesh, 29 cases using synthetic mesh, and 35 cases using biological mesh underwent laparoscopic hiatal hernia repair.Results:The surgical procedures was successful in all the 90 cases without conversion to open surgeny. There were no statistically significant differences in operative time, intraoperative blood loss and postoperative hospital stay among the three groups ( P>0.05), and there were statistically significant differences in hospital cost between the group without mesh and synthetic mesh and biological mesh ( P<0.05). Long-term follow-up was achieved in 87 patients, with a follow-up rate of 96.7% (87/90), and a median follow-up time of 44 months. There were no significant differences in the incidence of postoperative complications (diarrhea, dysphagia, abdominal distension, chest pain), recurrence rate of symptoms (acid reflux, heartburn) and patient satisfaction among the three groups ( P>0.05). Conclusion:In laparoscopic hiatal hernia repair, the mesh should be carefully selected according to the specific intraoperative situation for a satisfactory clinical efficacy.

Inguinal incarcerated hernia in adults is a common acute abdomen in hernia and abdominal wall surgery. If not treated in time, it is easy to progress to constrictive hernia, lead to intestinal ischemic necrosis, cellulitis of tegmental tissue outside the hernia, hernia sac empyema, intestinal fistula, and even cause toxic shock, with significantly increased mortality. The types of incarceration are different and the corresponding management methods are different. Based on the proposal of the concept of musculopubic foramen hernia repair, inguinal incarcerated hernia includes incarcerated indirect hernia, incarcerated direct hernia, incarcerated femoral hernia, etc. At present, there is no uniform standard for the comprehensive treatment of different types of inguinal incarcerated hernia, and the clinical management strategies of adult inguinal incarcerated hernia still face serious challenges.

Objective To investigate the recent effect of full arthroscopic dual-beam reconstruction of the posterior cruciate ligament(PCL)using tibial Inlay technique.Methods From March 2007 to September 2009,17 PCL injured patients underwent full arthroscopic dual-beam PCL reconstruction using Inlay technique,including 16 males and 1 female,with an average age of 25 years(range,19-54).Of all cases,Lysholm score was(53.4±2.1)points,International Knee Documentation Committee(IKDC)rated C in 7,D in 10,and posterior drawer test(+)in 17.We used self-designed tibia tunnel drill system to produce the deep-limited bone tunnel.Follow-up began at 12 months after operation.Evaluate Lysholm knee score,IKDC rating,and posterior drawer test to compare the knee stability with that of preoperative.Observe the location of the bone block and healing by checking knee X-ray and spiral CT scan.Results Seventeen patients were followed up between 12 to 28 months,with an average of 17.8 months.In the last follow-up study,Lysholm score(93.5±1.7)points compared with that of preoperative was statistically significant different(P=0.016).IKDC rating of A grade in 15 cases,B in 2,compared with that of preoperative was statistically significant different(P=0.021).Posterior drawer test were negative in 15 cases,slight positive in 2.The X-ray and spiral CT scan showed the location of the bone block were perfect and healed well.Conclusion We can accurately produce the deep-limited bone tunnel by the tibia tunnel drill system with minor trauma,and the recent clinical effects of PCL reconstruction were pretty good.