Objective:To explore the safety, effectiveness, economy and surgical techniques of bronchial priority treatment in single-port thoracoscopic right upper lobectomy by comparing it with conventional single-port thoracoscopic right upper lobectomy.Methods:Clinical data of 72 patients who underwent single-port thoracoscopic right upper lobectomy from Mar. 2019 to Feb. 2022 were collected. According to different surgical treatment sequences, the patients were divided into observation group (bronchial priority treatment, 36 cases) and control group (conventional surgery, 36 cases). The general clinical characteristics, operation time, intraoperative blood loss, postoperative hospital stay, postoperative complications, postoperative pain score, and number of staplers used in the two groups were compared.Results:All operations were successfully completed without conversion to thoracotomy. There was no significant difference between the two groups in clinical characteristics, intraoperative blood loss [ (25.3±12.8) ml vs 32.5±14.2) ml, P>0.05], postoperative hospital stay[ (4.7±1.6) d vs (4.9±1.5) d, P>0.05], postoperative pain score [ (3.3±1.1), (4.8±1.4), (3.7±1.1) vs (3.5±1.2), (5.5±1.4), (4.1±1.4), P>0.05], number of lymph node dissection (9.1±1.8 vs 8.3±1.7, P>0.05), or postoperative complications (16.7% vs 27.8%, P>0.05). Compared with the control group, the observation group had significant advantages in the operation time [ (87.2±6.1) vs (106.4±21.8) min, P<0.05] and the number of staplers used (3.7±0.8 vs 5.8±1.3, P<0.05) . Conclusions:Single-port video-assisted thoracoscopic right upper lobe resection with bronchial priority treatment is safe and effective. It simplifies the surgical procedure, reduces the use of disposable consumables, does not increase the risk of perioperative period, and has clinical application prospects.

Objective:By comparing the advantages and disadvantages of different forms of purse suture, to explore how to minimize the incidence of anastomotic complications after cervical anastomosis of esophageal cancer.Methods:The clinical data of 45 patients with esophageal cancer who underwent mediastinal endoscopy combined with laparoscopic radical resection of esophageal cancer from Jan.2019 to Jun.2020 in Department of Thoracic Surgery, Henan Chest Hospital were selected. In the observation group, 22 cases were sutured with spiral packing at the esophageal stump, and in the control group, 23 cases were sutured with conventional loading forceps. The clinical effects of the two groups were objectively evaluated.Results:There was no significant difference between the two groups in operation time, intraoperative blood loss or hospitalization days ( P>0.05) . In terms of postoperative complications, the incidence of anastomotic leakage and anastomotic stenosis in the observation group (4.54%, 9.09%) was significantly lower than that in the control group (17.39%, 39.13%) , and there was significant difference in the incidence of anastomotic stenosis ( P<0.05) . Conclusion:The spiral continuous suture of esophageal stump can reduce the incidence of anastomotic fistula/anastomotic stenosis without increasing surgical trauma or prolonging operation time, which is worthy of clinical application.

Objective:To investigate the clinical efficacy of double-stitch full-layer pancreaticojejunostomy (DSFLPJ) in laparoscopic pancreaticoduodenectomy.Methods:The clinicopathological data of patients who underwent laparoscopic pancreaticoduodenectomy with DSFLPJ from Jan 2016 to Sep 2019 in Fujian Provincial Hospital were retrospectively analyzed.Results:Procedures were successfully performed in 82 patients. The average operation time was (321±55) minutes, among which the mean DSFLPJ time was (22±6) minutes. Intraoperative blood loss was (185±96) ml. Pancreatic fistula occurred in 11 patients, 7 with Grade A, 3 with Grade B and 1 with Grade C. The average postoperative hospital stay was (13±5) days. After the median follow-up of 9 months (1 to 44 months), two patients of pancreatic head cancer suffered recurrence.Conclusions:DSFLPJ is a safe and effective method in laparoscopic pancreaticoduodenectomy.

Objective To investigate the clinical efficacy of pericardial devascularization (PCDV) combined with splenectomy and partial gsstric fundus resection (PGFR) in the treatment of portal hypertension-induced severe gastric varices complicated with gastrorenal shunt (GRS).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 18 patients with portal hypertension-induced severe gastric varices complicated with GRS who were admitted to the Fujian Provincial Hospital from January 2010 to December 2015 were collected.According to the stage of technical development,open surgery or laparoscopic surgery was selected based on patients' and their family's wishes.Observation indicators:(1) surgical and postoperative recovery situations;(2) postoperative pathological examination;(3) follow-up and survival.The follow-up using outpatient examination and telephone interview was performed once every 3 months within 1 year postoperatively and once every 6 months after 1 year to detect long-term complications and survival up to June 2017.The reexaminations of gastroscopy,enhanced scan of X-ray computed tomography (CT) on the epigastric region or magnetic resonance imaging (MRI) were done at 1 month postoperatively for detecting resection of fundus ventriculi varicosity.Measurement data with normal distribution were represented as (x)±s.Measurement data with skewed distribution were described as M (range).The survival rate was calculated by the Kaplan-Meier method.Results (1) Surgical and postoperative recovery situations:18 patients underwent successful PCDV combined with splenectomy and PGFR,including 12 with open surgery and 6 with laparoscopic surgery (1 with conversion to open surgery due to intraoperatively uncontrollable bleeding).There was no perioperative death.The operation time,volume of intraoperative blood loss,recovery time of gastrointestinal function,time of postoperative drainagetube removal and duration of hospital stay were (192± 20) minutes,(280± 30) mL,(33 ±6) hours,8 days (range,5-9 days),8 days (range,5-12 days) in 12 patients with open surgery and (208±40)minutes,(210±10)mL,(28±5)hours,7 days (range,5-26 days),7 days (range,5-10 days) in 6 patients with laparoscopic surgery,respectively.One patient with laparoscopic surgery had intraoperative condensed erythrocyte infusion with 2 U.Seven,1,0 patients with open surgery and 4,1,1 patients with laparoscopic surgery were respectively complicated with pleural effusion,delayed gastric emptying and pancreatic leakage in level A,and they were cured by conservative treatment.(2) Postoperative pathological examination:results of postoperative pathological examination in 18 patients showed that a large number of varicose veins in the mucous and seresal layers of gastric fundus and moderate or severe hepatic cinr hosis.(3) Follow-up and survival:18 patients were followed up for 8-78 months with a median time of 39 months.The gastroscopy and enhanced scan of X-ray CT at 1 month postoperatively showed that no varicose veins in the gastric fundus.During the follow-up,there was no recurrence of gastric varices with GRS and esophageal stenosis.Of 4 patients with portal vein thrombosis,1 died of portal hypertensive gastropathy-induced upper gastrointestinal bleeding due to stop taking warfarin,and other 3 patients had portal vein patency by warfarin therapy.One patient was complicated with liver cancer at 32 months postoperatively and received radiofrequency ablation therapy.Two patients died,including 1 dying of hepatic failure at 35 months postoperatively and 1 dying of advanced liver cancer at 54 months postoperatively.The 1-,3-and 5-year overall survival rates of 18 patients were respectively 93.8％,84.4％ and 70.3％.Conclusion The PCDV combined with splenectomy and PGFR is safe and effective in the treatment of portal hypertension-induced severe gastric varices with GRS,with a dissemination value for appropriate patients.

Objective To compare the effects of remifentanil and fentanyl in urologic surgery under endoscopic anesthesia and the incidence of adverse reactions in patients.Methods A total of 170 patients undergoing urological surgery admitted to the Second People 's Hospital of Jinzhong from February 2015 to April 2016 were randomly divided into the study group and control group according to the digital table ,with 85cases in each group. Remifentanil and fentanyl was used in the study group and control group respectively .The preoperative anesthesia was performed in the patients who received anesthesia before and after tracheal intubation and before and after tracheal intubation,and the time of induction of anesthesia ,the operation time and the time of postoperative wakefulness were compared between the two groups.Pressure and heart rate changes ,the incidence of adverse reactions were recorded and compared between the two groups.The amount of anesthesia ,anesthesia surgery costs and the amount of bleeding during surgery were compared.Results The induction time of anesthesia in the study group was significantly shorter than that in the control group (9.8min vs.6.9min,t＝12.029,P＜0.05).The mean arterial pressure and heart rate in the study group were significantly larger than those in the control group ( all P＜0.05).The incidence rate of adverse reactions in the study group was significantly lower than that in the control group (5.9% vs.12.9%,χ2＝7.935,P＜0.05).The cost and blood loss of the study group were significantly lower than those of the control group (2 871.4 CNY vs.3 014.9 CNY;23.4mL vs.32.7mL,t＝20.391,17.907,all P＜0.05).Conclusion The application of remifentanil in preoperative anesthesia of urologic surgery can save time ,reduce the economic burden of patients and the incidence of adverse reactions in patients.It is worthy of widely recommended in clinic.

Objective To investigate the clinical effect of the 1 470 nm diode laser for the treatment of superficial bladder tumor.Methods Two hundreds and sixteen patients diagnosed with superficial bladder tumor were treated in our hospital from January 2012 to January 2014 and divided into the laser group and electric cutting group.The two groups were treated by 1 470 nm diode laser and transurethral plasma kinetic resection respectively.The basic data and the observation indexes were compared be tween the two groups.Results The operation time,intraoperative bleeding volume,indwelling catheter time and hospital stay time in the laser group were significantly less than those in the electric cutting group.The levels of epinephrine,norepinephrine and an giotensin Ⅱ in operation and at postoperative 6 h in the laser group were significantly lower than those in the electric cutting group (P＜0.05).The obturator nerve reflex and bladder perforation did not occur in the laser group,and the total complications occurrence rate was 5.1％,the bladder tumor recurrence rate in postoperative 24 months was 7.1％.The obturator nerve reflex occurrence rate was 7.6％,the vesical perforation rate was 1.7％,the total complications occurrence rate was 15.3％,the bladder tumor recurrence rate in postoperative 24 months was 17.8 ％ in the electric cutting group.The above indexes of the laser group were significantly lower than those of the electric cut group(P＜0.05).Conclusion The 1 470 nm diode laser for the treatment of noninvasive superficial bladder tumor has definitely curative effect,is easy to operate with low postoperative complication occurrence rate,high safety and low middle and long term recurrence rate,moreover has little influence on patient's stress level.

Objective To investigate the clinicalmanifestations,imaging features,diagnosis and differential diagnosis,treatment and prognosis of renal malignant solitary fibrous tumor(SFT).Methods The clinical data in 1 case of rare renal malignant SFT were retrospectively analyzed.Referring to related literatures,the histological origin,pathological features,differential diagnosis,treatment and follow-up of renal malignant SFT were analyzed.Results The patient was preoperatively diagnosed as right renal clear cell carcinoma.Postoperative pathological examination diagnosed as low grade malignant SFT of right kidney.And immunohistochemistry indicated CD34+,BCL-2 +,CD68+,CD99+,vimentin,Ki-67 5％ +,SMA focal weakly positive.No recurrence or metastasis occurred after 4-month follow-up period.Conclusion Malignant SFT of the kidney is very rare,its diagnosis and differential diagnosis depend on postoperative pathological and immunohistochemical examination.Radical nephrectomy is the main option for malignant SFT of the kidney with good prognosis.

Objective To explore the efficacy and safety of Solitaire stent arterial embolectomy in the treatment of acute cardiogenic cerebral embolism.Methods The data of 24 patients who underwent Solitaire stent arterial embolectomy,either alone or in combination with reorganization type tissue plasminogen activator (rt-PA) intravenous thrombolysis,to treat acute cardiogenic cerebral embolism in our hospital were collected.These results between October 2012 and March 2016 were compared with 21 control patients who were treated using only rtPA Ⅳ thrombolysis.The short-term efficacy,long-term clinical outcomes,complications,and mortality rate of these two groups were compared,and the clinical outcomes of these patients with posterior circulation infarction in the two groups were further assessed.Results The time between onset and rt-PA administration in the study group (median time:3.17 h) was significantly shorter than that in the control group (4.00 h,P＜0.05);rt-PA dose used in both two groups was 50 mg.NIHSS scores and Glasgow Coma scale scores at discharge,and modified Rankin scale (mRs) scores 3 and 6 months after treatment in the study group were significantly higher than those in the control group (P＜0.05).There were no significant differences in symptomatic intra-cerebral hemorrhage,high perfusion encephalopathy,incidence of hernia,or mortality between the two groups (P＞0.05).The mRS scores 3 months after treatment in patients with posterior circulation infarction (2) were significantly lower than those in the control group (3,P＜0.05).Conclusions As compared with simple venous thrombolytic therapy,Solitaire stent embolectomy can significantly improve short-term neurological function and long-term prognosis in patients with acute cardiogenic cerebral embolism,enhance their life quality,without increasing the complication incidence and mortality rate.It is safe and effective,and patients with posterior circulation infarction can also be treated by arterial embolectomy.

Objective To study and evaluate mini-titanum-plates the effects applied to four limbs bone and joint fracture.Methods 132 patients in our hospital suffered from four limbs fractures treated with open reduction internal fixation of Medicon mini-plate from February 2004 to June 2013 were studied retrospectively,including 60 cases of metacarpal and phalanx fracture(93 lesions),37 cases of metatarsal and phalanx fracture(62 lesions),15 cases of radial head fracture,9 cases of scaphoid fracture,4 cases of coronoid process of ulna fracture,4 cases of patella frature,3 cases of condyles of femur.Results Clinical outcomes:hands and feet group:follow-up postoperative 8-12 months,evaluation results showed that excellent was 78cases,good was 66cases,poor was 11cases,good rate was 92.9％.group of radius head fracture:Fractures got osteal union after 6 months to 1 year.good rate was 93.3％.group of scaphoid bone fracture:Fractures got osteal healing.all cases adopt improved Mayo Evaluation Wrist Function to evaluate,good rate was 88.9％.Including 4 cases of Coronoid process of ulna fracture,4 cases of patella fracture,3 cases of femoral condylar fracture,the excellent good rates was 100％.Conclusions Metacarpal and metatarsals phalanx fracture treated with mini-plate can get reduction anatomically,control rotation,prevent malformation and keep compression,they are the ideal internal fixation material;free fragments for intra-articular fracture fixed by mini-titanum-plate and screws can get reduction precisely,be fixed satisfactory,also can choose the appropriate application.

Objective To investigate the surgical strategy and outcome for occipitocervical extramedullary tumors.Methods 15 patients with occipitocervical extramedullary tumors from January 2007 to July 2010 were reviewed retrospectively.There were 7 males and 8 females with an mean age of 44.6 years (range,21-72 years).All cases were intradural tumors,including 7 cases in dorsolateral,5 cases in lateral side,and 3 cases in ventralis of spinal cord.Functional and neurological statuses were assessed using the Frankel grade and Japanese Orthopaedic Association (JOA) scale.According to Frankel grade system,there were 4 patients with Grade C,8 with Grade D,and 3 with Grade E.The mean preoperative JOA score was 10.5±3.6.Based on the tumor site,there were 5 cases in medulla oblongata-C1 and 10 cases in C1,2.Frankel grade and JOA score were used to evaluate neurological status and general health.The improvement of symptoms and characteristics of surgical strategies were analyzed.Results All cases were followed up for 2-4 years (mean 2.8 years).Complete resection of tumor and good fusion of bone graft were found in radiography postoperatively.The pathological diagnoses included 10 cases of schwannoma,3 cases of meningioma and 2 cases of neurofibroma.There was statistical difference between the preoperative and the final follow-up functional and neurological statuses including Frankel grade and JOA score.At the latest follow-up,2 cases improved from Frankel grade C to D,2from C to E,6 from D to E,but none in 2 cases with grade D.The mean JOA score at final follow-up was 15.6±1.6,and the average improvement rate was 80.7％± 17.4％.The mean preoperative C0-2 angle was 27.0°±4.1 °,and C2-7 angle was 16.8°± 12.7°.C0-2 angle was 27.6°±8.8°,and C2-7 angle was 10.2°±6.8° at the latest follow-up.However,these differences did not reach statistical significance.Conclusion Surgical treatment can effectively maintain or improve neurological function and improve quality of life.Extramedullary tumors can be resected completely by posterior approach,and spinal stabilization can be obtained satisfactorily through selecting appropriate surgical strategies.For medulla oblongata-C1 level,occipitocervical fusion is usually chosen after extirpation of tumor.For C 1,2 level,C1,2 fusion after tumor resection is useful in preventing atlantoaxial instability.