ObjectiveTo investigate the adequate surgical procedures for well-differentiated thyroid cancer (WDTC) located in the isthmus.MethodsNineteen patients with WDTC located in the isthmus were identified with WDTC and managed by surgery in Department of General Surgery in Xuanwu Hospital of Capital University from Jun. 2013 to May. 2018.ResultsAmong the nineteen cases, fifteen patients had a solitary malignant nodule confined to the isthmus, four patients had malignant nodules located separately in the isthmus and unilateral lobe. One patient received extended isthmusectomy as well as relaryngeal and pretracheal lymphectomy; six patients received isthmusectomy with unilateral lobectomy and central compartment lymph node dissection of unilateral lobe; four patients received isthmusectomy with unilateral lobectomy and subtotal thyroidectomy on the other lobe as well as central compartment lymph node dissection of unilateral lobe; seven patients received total thyroidectomy or isthmusectomy with unilateral lobectomy and nearly total thyroidectomy on the other lobe, as well as central compartment lymph node dissection of both sides; one patient received total thyroidectomy and central compartment lymph node dissection of both sides, as well as lateral thyroid lymph node dissection of both sides. The median operative time was 126 minutes (67–313 minutes), the median intraoperative blood loss was 30 mL (10–85 mL), and the median hospital stay was 6 days (4–11 days). Hypocalcemia occurred in 12 patients. There were no complications of recurrent laryngeal nerve palsy or laryngeal nerve palsy occurred. All the nineteen patients were well followed. During the follow up period (14–69 months with median of 26 months), there were no complications of permanent hypoparathyroidism occurred, as well as the 5-year disease-specific survival rate and survival rate were both 100%.ConclusionsFor patients with well-differentiated thyroid cancer located in the isthmus with different diameters and sentinel node status, individualized surgical procedures should be adopted.
ObjectiveTo explain the advantage of laparoscopic endoscopic rendezvous procedures used to treat rectal carcinoma, and predict the future direction of the surgery methods for rectal carcinoma. MethodsA review and summary based on the clinical experience of our hospital and the published researches about the laparoscopic endoscopic rendezvous procedures over the past years in home and abroad were performed. ResultsLaparoscopy can monitor the situation of the abdominal cavity.Endoscopy can detect the location of rectal carcinoma.Laparoscopic endoscopic rendezvous procedures used to treat rectal carcinoma can combine the advantage of each other.And the purpose of "less invasion, less pain, and faster recovery" will be achieved.The effect of "1+1 > 2" will be realized. ConclusionLaparoscopy and transanal endoscopic microsurgery hybrid could be a naive form of nature orifice transluminal endoscopic surgery to treat rectal carcinoma.
目的 结合腹腔镜手术的特点，设计出部分顺逆结合法腹腔镜胆囊切除术(LC)，总结该法的应用体会。方法 介绍部分顺逆结合法LC的方法。在1 250例LC中有255例采用部分顺逆结合法切除胆囊，其中慢性胆囊炎146例，急性、亚急性胆囊炎65例，慢性萎缩性胆囊炎44例。结果 所有患者均获痊愈。术中发现胆囊三角区细小副肝管4例，胆汁渗漏3例，均予妥善处理，无严重并发症发生。结论 该法吸取了开腹顺逆结合法胆囊切除术的优点，又符合腹腔镜手术的特点，适用于胆囊三角解剖结构不清者的手术。该法对发现解剖变异及避免胆管损伤有一定的作用。
目的 探讨十二指肠损伤后预防肠瘘的合理手术方式。方法 对我院2005年3月至2009年10月期间收治的28例十二指肠损伤患者的临床资料进行回顾性分析。结果 28例均行手术治疗，其中1例因多器官功能衰竭于术后第2天死亡，3例十二指肠瘘均经保守治疗后痊愈。27例患者术后随访2～6个月（平均3.5个月），2例发生不全性肠梗阻，1例发生盆腔脓肿，均经非手术治疗后痊愈。结论十二指肠损伤后选择合理的手术方式是预防术后发生十二指肠瘘的关键因素。
The incidence of rib fracture in patients with chest trauma is about 70%. Simple rib fractures do not need special treatment. Multiple rib fractures and flail chest are critical cases of blunt trauma, which often cause serious clinical consequences and need to be treated cautiously. Nowadays, there is a controversy about the diagnosis and treatment of multiple rib fractures and flail chest. In the past, most of the patients were treated by non-operative treatment, and only less than 1% of the patients with flail chest underwent surgery. In recent years, studies have confirmed that surgical reduction and internal fixation can shorten the hospital stay, and reduce pain and cost for patients with flail chest, but there is still a lack of relevant clinical consensus and guidelines for diagnosis and treatment, which leads to great differences in clinical diagnosis and treatment plans. This article reviewed the treatment, surgical indications and surgical timing of multiple rib fractures and flail chest.
ObjectiveTo summarize the clinical research progress of surgical procedures for cubital tunnel syndrome. MethodsThe related literature on surgical procedures for cubital tunnel syndrome was summarized and analyzed. ResultsMultiple surgical procedures have been applied to treat cubital tunnel syndrome, including simple decompression, subcutaneous transposition, submuscular transposition, medial epicondylectomy, intramuscular transposition, and ulnar groove plasty. Each procedure has its own advantages and disadvantages. With the development of minimally invasive surgical technique, endoscope-assisted surgery has been gradually applied to treat cubital tunnel syndrome. ConclusionOptimal surgical procedure remains controversial and individualized treatment decision based on patient's clinical conditions is recommended.