Objective To investigate the effect of surgical strategy and therapy and the factors affecting tumor recurrence in craniopharyngioma.Methods Retrospective analysis clinical data of 375 surgical treatment cases with craniopharyngioma.Evaluate the surgical modalities，techniques and therapeutic effects of different types of craniopharyngioma.Results The growth mode and location of tumor：218 cases above diaphragma sellae，43 cases in diaphragma sellae and 114 cases in three ventricles.Surgical approach selection：classic pterodactory or subordinate approach in 288 cases，transsphenoidal approach in 46 cases，longitudinal corpus callosum approach in 23 cases，cortical ventricular approach in 17 cases，combined approach in 1 cases.Tumors of 272 cases（72.53%）were totally removed and 103 cases（27.47%）were sub-totally removed，confirmed by intra-operative observing and postoperative imaging.The patients were improved in 356 cases，poor in 19 cases and 5 cases died.Conclusion The individualized surgical treatment is based on the growth pattern and characteristics of craniopharyngioma.The total cut of the tumor with the protection of the pituitary-hypothalamic function remains the key to well prognosis and reducing relapse.

Objective To compare the efficacy and safety of lumboperitoneal shunt（LPS）and ventriculoperitoneal shunt（VPS）for patients with idiopathic normal pressure hydrocephalus（iNPH）.Methods 96 patients with iNPH were retrospectively analyzed.Twentyeight patients were treated with LPS（goup LPS） and 68 cases treated with VPS（group VPS）.The clinical symptom，modified Rankin Scale（mRS）score and postoperative complications were compared.Results The improvement of symptoms for group LPS and VPS，were as follows：gait disorder was 60.0% versus 63.5%，dementia was 54.2% versus 57.9%，and urinary inconvenience was 44.4% versus 47.7%（all P>0.05），respectively.The improvements of modified Rankin Scale（mRS）for group LPS and VPS were（-0.9±0.5）versus（-1.0±0.9）（P>0.05）.The proportion of patients experienced postoperative complications were no significant difference between group LPS and VPS（17.9% vs.16.2%，P>0.05）.Conclusion The efficacy and safety rates of group LPS are comparable to those of group VPS in the treatment of patients with iNPH，while LPS can avoid cerebral parenchymal hemorrhage caused by ventricular puncture.

Objective To investigate the effect of early cranial defect repair on nerve function of patients.Methods 60 patients with cranial defect admitted to our hospital were selected.They were randomly divided into control group（n=30）and observation group（n=30）.The control group was treated with traditional cranial defect repair（3～ 6 months after operation）and the observation group with early cranial defect repair（1～3 months after operation）.The ADL score，Fugl-Meyer score and quality of life score were compared between the two groups.Results The excellent and good rate of the patients with early cranial defect repair was 93.33%，which was significantly higher than that of the control group（66.67%，P<0.05）.Tthe ADL score and Fugl-Meyer score of the observation group with early cranial defect repair was significantly higher than that of the control group（P<0.05）.The scores of neurological impairment of the observation group were significantly lower than those in the control group（P<0.05），and the scores of the SF-36 scale in the observation group were significantly higher than those in the control group（P<0.05）.Conclusion Early cranial defect repair can help patients with skull defect to improve the clinical efficacy，improve the ability of daily life，quality of life，motor function and reduce the somatic pain and the degree of postoperative neurological deficit.The clinical effect is remarkable.

Objective To explore the method of implant coverage with pectoralis major fascia in immediate implant-based breast  reconstruction  and  to evaluate the feasibility and security.Methods 27 patients with early breast cancer underwent immediate implant-based breast reconstruction after mastectomy with the implant covered by a musculofascial layer composed of the pectoralis major muscle and the superficial pectoral fascia.The therapeutic efficiency and safety was evaluated by retrospectively analyzing the clinical data including the short-and long-term complications，cosmetic results，local recurrence，distant metastases and mortality rates.Results Minor and major complications were reported in a period of follow-up ranging from 3～28 months（median，13 months）.One patient had partial nipple necrosis postoperatively and was cured，and no other postoperative complications of hematoma，infection was found.During the follow-up period，no exposure of the implant，implant displacement and capsular contracture were observed.The reconstructive outcomes were excellent in 21 cases and good in 6 case，with an excellent and good rate of 100%.No local recurrence or distant metastasis or death occurred in any of the patients.Conclusion The superficial pectoral fascia flaps can be effectively and safely used as an autologous tissue layer to cover implant in immediate breast reconstruction after mastectomy.

Objective To investigate the clinical and pathological characteristics of multifocal and multicentric breast cancer.Methods We collected data of 56 cases of multifocal and multicentric breast cancer and 150 cases of unifocal breast cancer（control group）to analyze the clinicopathological features of multifocal and multicentric breast cancer.Results In both the multifocal and multicentric breast cancer and the unifocal breast cancer group，we found the histological type which was invasive lobular carcinoma accounted for 8.9% and 2.0%，respectively.The lymph node metastasis rate was 69.6% and 51.3%，respectively.The lymphatic vessel invasion rate was 35.7% and 13.3%，respectively.The mastectomy and breast-conserving surgery accounted for 92.9%，77.3% and 7.1%，22.7%，respectively.The differences were statistically significant（all P＜0.05）.The detection rate of ultrasonography in multifocal and multicentric breast cancer was 73.2%，and that was 51.8% of mammography.There was a significant difference between the two imaging methods（P＜0.05）.The sensitivity of the two imaging examinations combined to detect this type of patient was 82.1%.Conclusion Compared to unifocal breast cancer，our findings suggest that the risk of axillary lymph node metastasis and lymphatic vascular invasion in multifocal and multicentric breast cancer was higher，and that had a high proportion of invasive lobular carcinoma.Preoperative ultrasonography combined with mammography can increase the accuracy of diagnosis of multifocal and multicentric breast cancer.Multifocal breast cancer can be treated with breast conserving surgery on the premise of negative margin.

Objective To explore the surgical experience of single utility port video-assisted thoracoscopic lobectomy on peripheral lung cancer.Methods Fiftytwo patients with peripheral lung cancer underwent radical resection urder single utility port completely video-assisted thoracoscopy.Operation time，intraoperative occurrence，postoperative complications，length of stay and other data were recorded.Results All the procedures were carried out with no case of death.Conversions to thoracotomy were required in 2 cases.Except these converted to thoracotomy，the surgical duration of 50 cases was 105～220min[mean，（152.6±33.1）min].The volume of intraoperative bleeding was 20～400ml[mean，（160.4±81.5）ml].There was no serious postoperative complications，2 cases of patients with chylothorax cured by conservative treatment.The postoperative hospitalization time was 7～14d[mean，（9.7±1.7）d].Conclusion The operative procedure of radical resection of lung cancer urder single utility port video-assisted thoracoscopy is still being explored and optimized.Individualized operation path should be chosen according to the difference of patients.

Objective There are many differences in the surgical contents of guidelines or consensuses for upper gastrointestinal bleeding in patients with portal hypertension.Comparing and analyzing the causes can promote understanding and recognizing.Methods Seven high-profile guidelines were selected by searching：Baveno Ⅵ consensus，AASLD guidance，UK guideline，Austrian consensus，Brazil consensus，Chinese guideline from Liver Diseases/Digestive Disease/Endoscopy Branch of Medical Association（abbr.Chinese hepatopathy guideline）and Chinese surgery guidelines from Portal Hypertension Group of Surgery Branch，Medical Association（abbr.Chinese surgery guideline）.Surgery parts in contents were selected to analyze by comparing the participants and tracing the relevant references after intensive reading the documents.Besides，different editions of Baveno consensus were compared and analyzed.Results In different guidelines：AASLD，Austrian，Brazil and Chinese hepatopathy guideline enrolled 1 surgery professionals respectively；The ratio of referenced surgery articles in Baveno VI，AASLD，Austrian，Brazil，Chinese hepatopathy guideline and Chinese surgery guideline，is 0，1.4%、5.7%、3.2%、6.1%、6.7%、25.0%，respectively.The surgery parts of the Baveno consensus，showed that shunts and devascularizations are the appropriate means when endoscopic therapy failed on hemostatic treatment in Ⅰ，Ⅱ edition，only shunts are recommended in Ⅲ，Ⅳ，Ⅴ edition，and none surgery approaches recommended except extrahepatic vessel disease in Ⅵ edition.Conclusion The rapid progress of drugs，the advanced skills of endoscopy and Transjugular intrahepatic portosystemic shunt（ abbr.TIPS），the lack of surgery professionals involved，and the lack of citing surgery articles，were one of the reasons for lacking voices of surgery in leading guidelines.The UK Guideline is relatively comprehensive and objective.Doctors is the final decisionmaker on the application to practice of guidelines and consensuses.

Objective To study the clinical characteristics and treatment methods of the low rectal stromal tumor.Methods The clinical and follow-up data of 32 patients with low rectal gastrointestinal stromal tumor（GIST）were analysed.Paitents with Dixon and Miles operation were called group expanded resection（14 cases），and patients with endoscopic resection，trans-anal，trans-sacral，trans-perineum resection were called group local resection（18 cases）.Compared the two groups with clinical characteristics and postoperative recurrence or metastasis.Results Operation time of group expanded resection was（152.4±46.2）min，while group local resection was（54.1±17.9）min，the blood loss of the two group was（76.1±36.6）ml and（41.1±20.3）ml，respectively；anus exhausting time of the two group was （3.8±0.6）d and （2.9±0.8）d，respectively；hospital stay of the two group was （10.2±1.6）d and （6.3±1.3）d，respectively（all P<0.05）.There was no significant difference such as surgical complications，local recurrence and distant metastasis between the two groups.Conclusion Low rectal stromal tumor treated by local excision and imatinib did not increase the risk of local recurrence and distant metastasis，but the operation time，blood loss，hospitalization days significantly reduced，It is a safe and effective strategy to low rectal stromal tumor.

Objective To compare the clinical efficacy of percutaneous transforaminal endos-copic discectomy(PTED) and Quadrant minimally invasive system in treatment of the single segment of lumbar disc herniation(LDH). In order to provide a safe and effective surgical method for the treatment of single segment lumbar disc herniation.Methods 74 cases of patients with single lumbar disc herniation treated were retrospectively reviewed, The patients were divided into two groups according to the operation methods.45 patients were treated by PTED(PTED group) and 29 patients were treated by Quadrant minimally invasive system(Quadrant group).Compare the operative time, blood loss,incision length, the time of bed rest，length of hospital stay and intraoperative complications between the two groups. Visual analogue scale(VAS), Oswestry disability index(ODI), Japanese orthopedic Association (JOA) and modified MacNab criteria were used for surgical efficacy evaluation.Result The operation time was （79.5±9.5）min，blood loss was（18.6±3.4）ml, incision length was（0.8±0.1）cm,the time of bed rest was（1.5±0.7）d，length of hospital stay was （5.3±1.0）d,the VAS score in three days after operation was（2.9±0.6） ，which were shorter or lower in PTED group compared with the Quadrant group[（70.3±8.7）min,（44.9±4.6）ml,（4.5±0.3）cm,（3.4±0.6）d,（8.0±0.8）](all P<0.05).The operation time were shorter in Quadrant group（70.3±8.7） compared with the PTED group（79.5±9.5）(P<0.05); The postoperative ODI、JOA and MacNab criteria excellent rate had no significant difference between the two groups(P>0.05).Conclusion Both PTED and Quadrant minimally invasive system are effective in the treatment the single segment of LDH.Comparatively,PTED were less bleeding,short incision length, rapid recovery. It will be a good choice for the treatment of single segment lumbar disc herniation.

Objective To describe the surgical indications and technique for treating patella fracture with cannulated compression screw tension band wire through clinical outcome analysis.Methods A total of 36 patients with patella fractures from two Orthopedic centres were enrolled in this retrospective study（including AO 34-C1，C2 and C3 patella fractures）.All cases were treated with cannulated compression screw tension band wire，with addition of cannulated compression screws to fix fragments in AO 34-C2 and C3 cases.All received post-operation Physiotherapy，followed up for 6-36 months（average，18.7 months）and the retrospective analysis and functional evaluation was performed.Result According to the Bostman score，there were 9 excellent cases，25 good cases and 2 poor cases；the excellent and good rate accounted for 94.4% of 36 cases.No infections，loss of fixation，fracture displacement or implants irritation cases were observed.All the fractures were healed well.Conclusion As long as to master the surgical technique，then the operation can be used for not only AO 34-C1 patellar fracture，and can be fixed with AO 34-C2 and C3 fractures is also effective.

Objective To investigate the effect of knee joint reconstruction with anterior cruciate ligament（ACL）reconstruction with knee tendon autograft and its influence on knee joint function.Methods 80 cases of patients with knee micro fracture were selected.The patients were divided into the observation group and the traditional operation group（40 cases of each）according to the operation mode.The observation group was treated with Reconstruction of anterior cruciate ligament with autogenous tendon under knee arthroscopy.The general situation of the two groups of patients was observed，and the difference of knee joint physical signs，knee joint function between the two groups before and after operation were compared.Results There was no difference in the operation time between the observation group and the traditional operation group[（75.32±5.43）min vs（75.36±5.12）min，P＞0.05]，and the amount of bleeding in the observation group[（33.26±3.41）ml] was significantly lower than that in the traditional operation group[（52.42±6.18）ml](P＜0.05）.There was no difference in clinical signs between the two groups.The 3 months after the operation，the knee tenderness，joint mobility and joint swelling score of the observation group were lower than those of the traditional operation group；The knee function of the two groups had no difference before operation.After 3 months，the scores of knee joint stability，tenderness，activity and muscle strength of the observation group were higher than those of the traditional operation group.Conclusion Reconstruction of anterior cruciate ligament with autogenous tendon under knee arthroscopy is a better treatment for knee joint micro fracture，and can improve the knee function of patients，and has good application value.

Objective To investigate the value of preoperative multi-slice spiral CT angiography（MSCTA）and intraoperative ultrasound in laparoscopic occlusion of renal segmental arterial partial nephrectomy.Methods Forty-eight patients with small renal cell carcinoma underwent routine MSCTA examination.According to whether intraoperative ultrasound was performed，28 patients were divided into intraoperative ultrasound group and 27 patients without intraoperative ultrasound.The operation time，blood loss，intraoperative warm ischemia time，microscopic cancer discovery rate，transit opening rate，postoperative leakage of urine，positive margin of cutting edge and glomerular filtration rate（GFR）were measured.Results The intraoperative ultrasound group was better than the non-operative ultrasound group.The operation time was（172.1±3.5）min and（216.3±4.8）min，respectively；the intraoperative blood loss was（70.2±5.0）ml and（90.3±4.0）ml，respectively；the ischemic time was（24.5±4.2）min and（29.3±2.8）min，respectively，and the difference were all statistically significant（P<0.05）.The preoperative and postoperative renal GFR of the intraoperative ultrasound group were（55.1±7.2）ml/min and（54.1±7.7）ml/min（P>0.05），respectively.The non-operative ultrasound group had a renal GFR of（55.8±7.0）ml/min and（41.4±6.5）ml/min before and after surgery（P<0.05）.Conclusion Intraoperative ultrasound can quickly and accurately locate the tumor tissue，preserve the nephron as much as possible，reduce the positive rate of the margin，and facilitate the recovery of renal function after surgery.

Objective To evaluate the effect of children laparoscopic surgery on regional cerebral oxygenation.Methods Forty ASAⅠ～Ⅱ children ，aged 5～10 yr，scheduled for elective appendectomy，were divided into 2 groups by the surgical indication（n=20 each）：laparoscopic surgery group（group L）and open appendectomy group（group O）.General anesthesia with endotracheal intubation which was induced with sufentanil，propfol and rocuronium，and maintained with infusion of remifentanil and propfol in both groups，and 80 percents oxygen concentration was given in mechanical ventilation in both groups.The time of operation and anesthesia，the endtidal carbon dioxide pressure（P_ETCO₂），hemodynamic variables ，such as heart rate（HR），mean arterial pressure（MAP），oxygen saturation（SpO₂），left and right regional cerebral oxygen saturation（RrScO₂ and LrScO₂，）were recorded after anesthesia induction and before start of surgery（T₀），15 min after start of surgery（T₁），30 min after start of surgery（T₂），45 min after start of surgery（T₃），60 min after start of surgery（T₄）and end of the surgery（T₅）.Results The P_ETCO₂ was higher in group L ，compared with group O at T₁、T₂、T₃，there were progressive decreases in both  LrScO₂（L：77.2±5.5，O：79.2±5.5）and RrScO₂ （L：80.1±5.1，O：81.6±3.2）at T₁，compared with T₀ in both two groups，but both were within the normal range.Which were not statistically significant at T₀，T₁，T₂，T₃，T₄，T₅（P>0.05）.Conclusion The laparoscopic surgery may not affect cerebral oxygenation in pediatric patients.