Health and medical big data is an important basic strategic resource of the country，and primary liver cancer big data（PLCBD）is the key to improve the diagnosis and treatment of primary liver cancer（PLC）and achieve precise prevention and treatment of PLC.Standard terminology is the foundation of information sharing and business collaboration between heterogeneous systems in open sharing environment，and is also the important basis for effective data fusion of multi centers.However，there is no systematic terminology related to PLC.In order to standardize the construction of big data of primary liver cancer，relevant experts of the Chinese Chapter of the International Hepato-Pancreato-Biliary Association and Big Data Alliance for Liver Disease and Liver Cancer were organized to formulate the Clinical Standard Terminology of Primary Liver Cancer，aiming to improve the data quality and promote multi-center data fusion.

Objective To detect the role of LncRNA SNHG1 in human cholangiocarcinoma and explore its correlation with clinical characteristics of cholangiocarcinoma.
Methods We detected the expression of LncRNA SNHG1 in 36 human cholangiocarcinoma tissues and normal bile duct tissues by real-time PCR.And we divided the cholangiocarcinoma patients into high level SNHG1 expression group and low level SNHG1 expression group.And we analyzed the factors influencing the expression level of LncRNA SNHG1 and their relationship with survival of cholangiocarcinoma patients.
Results The expression of LncRNA SNHG1 in human cholangiocarcinoma tissues was significantly higher than the normal bile duct tissues（P＜0.05）.The lymph node metastasis was the influencing factor of LncRNA SNHG1 expression level.The ratio of low expression level of LncRNA SNHG1 was higher than that of high expression level of LncRNA SNHG1 in patients with lymph node metastasis（P＜0.05）.The age，CA19-9 expression level and expression level of LncRNA SNHG1 were an independent factor influencing the clinical prognosis of patients with cholangiocarcinoma（P＜0.05）.
Conclusion The expression of LncRNA SNHG1 is related to the distant metastasis of cholangiocarcinoma，which could be an independent risk factor for prognostic judgement and  potential therapeutic target.

Objective To study the Clinical observation of laparoscopic cholecystectomy under different time windows in the treatment of acute cholecystitis in the elderly.
Methods The clinical data of 72 patients with acute cholecystitis in our hospital in recent years were analyzed retrospectively.According to the different operation time，they were divided into three groups：early group（≤3d），middle group ＞3d and ≤7d）and late group（＞7d），24 cases in each group，all of them underwent laparoscopic cholecystectomy，The perioperative indexes and postoperative complications of the three groups were compared，and the stress indexes and immune function of the three groups before and after operation were compared.
Results The operation time，intraoperative bleeding volume，first anal exhaust time，first time out of bed after operation and hospitalization time of the three groups were significantly different ，early group < metaphase group < late group（P<0.05）.The level of C-reactive protein（CRP）in the three groups after operation was lower than that in the early group，early group < metaphase group < late group（P<0.05）.The levels of IgA，IgG and IgM in the three groups were significantly higher than those in the early group，the middle group and the late group，early group > middle group > late group（P<0.05）.The total incidence of complications in early group，middle group and late group were 16.67%，29.17% and 37.50%，respectively，with no significant difference（P>0.05）.
Conclusion Early laparoscopic cholecystectomy in patients with acute cholecystitis can reduce the amount of bleeding，reduce the body's stress response，and speed up the recovery of patients.

Objective To analyze the clinical value of intraoperative methylene blue test in reducing the incidence of bile leakage after hepatectomy for hepatolithiasis.
Methods The clinical data of 58 patients after hepatectomy，from September 2018 to June 2019 in the second affiliated hospital of Kunming medical university was retrospectively analyzed.According to the therapy method，58 patients were divided into the methylene blue group（n=30）and comparative group（n=28）.The conditions for the methylene blue group are treated by using methylene blue text to verify whether biliary system is patency and whther the bile duct residual exist; The conditions for comparative group are treated by traditional white gauze cover or biliary injection test to find the bile leakage.The observational index are general information，operation time，intraoperative blood loss，intraoperative bile leakage decetion rate，postoperative bile leakage，total bilirubin of drainage，abdominal drainage tube removal time and total hospitalization days.
Results 58 patients were succeed in hepatectomy.There are 1 cases of bile leakage occurred，1 case of postoperative bleeding occurred and 3 case of infection in methylene blue group.Besides，There are 7 cases of bile leakage occurred，1 case of postoperative bleeding occurred and 4 case of infection in comparative group.They were cured after active symptomatic treatment.Intraoperative bile leakage decetion rate in the methylene blue group were high than comparative group.Postoperative bile leakage，total bilirubin of drainage，abdominal drainage tube removal time and total hospitalization days in the methylene blue group were all less than comparative group with statistically significant difference（P<0.05）.No statistically significance was observed in operation time，intraoperative blood loss，postoperative bleeding and infection between the two groups（P>0.05）.
Conclusion Intraoperative methylene blue test can effectively improve intraoperative bile leakage decetion rate and reduce the incidence of bile leakage after hepatectomy for hepatolithiasis.

Objective To observe the effect of percutaneous transhepatic biliary drainage（PTCD）in elderly patients with cholecystolithiasis and common bile duct stones undergoing laparoscopic biliary exploration.
Methods Cholecystolithiasis with choledocholithiasis in 60 cases，30 cases of elderly patients with cholecystolithiasis and common bile duct stones who underwent PTCD and laparoscopic cholecystectomy who were treated in the Hepatobiliary and Pancreatic Surgery of the First People's Hospital of Suqian City were selected as the PTCD group.At the same time，30 elderly cholecystolithiasis patients undergoing laparoscopic choledocholithotomy patients with common bile duct stones served as the control group.On the basis of the control group，the PTCD group received PTCD before surgery and was decompressed and drained for 3～6 days after surgery.The surgical indicators，postoperative recovery，complications，pain（VAS score），and recurrence rate of stones within 1 year were compared between the two groups.
Results The laparoscopic operation time in the PTCD group was shorter than that in the control group，and the intraoperative blood loss was lower than that in the control group（P<0.05）.Both groups successfully completed the operation without conversion to open surgery.There was no significant difference in the residual stone rate between the two groups after surgery（P> 0.05）.At 12 hours after operation，the VAS score of the PTCD group was（3.9±1.0）and had no significant difference with the control group（3.8±1.1）（P> 0.05）.The hospitalization time，drainage tube removal time，and postoperative exhaust time in the PTCD group were shorter than those in the control group，and the differences were statistically significant（P<0.05）.There was no significant difference in the incidence of pulmonary infection，biliary tract infection，bile duct hemorrhage，bile leakage，and total complications between the two groups（P>0.05）.One case was lost to follow-up in the PTCD group，2 cases were lost to follow-up in the control group，and 1 year was followed up.There was a statistically significant difference in recurrence rates between the two groups（3.45% vs.3.57%，P>0.05）.
Conclusion For older patients > 65 years old and common bile duct diameter ≥1.0cm with choledocholithiasis and common bile duct stones，PTCD 〖LM〗can shorten the operation time，reduce tissue damage and promote postoperative recovery.

Objective To explore the clinical value of laparoscopic cholecystectomy in preserving the deep branch of gallbladder artery.
Methods From March 2016 to March 2019，150 patients with gallbladder disease were selected，all of whom were confirmed to have deep branches of gallbladder artery during operation，and they were sorted in order.They were randomly divided into observation group and control group according to odd and even method.Each group had 75 cases in each group.In the observation group，the deep branches of gallbladder artery were carefully separated and preserved during the operation.In the control group，the deep branches of the gallbladder artery were clamped .The two groups were followed up for 12 weeks.The liver function indexes，abdominal distention and abdominal pain were compared at 2，4 and 12 weeks postoperatively，and the quality of life of the patients in the two groups were compared at 4 weeks postoperatively.
Results The two groups were cured.Compared with the control group，the operation time of the observation group was longer than that of the control group，and the amount of intraoperative bleeding was relatively more，the difference was statistically significant（P<0.05），and there was no significant difference in the length of stay between the two groups（P>0.05）.The levels of AST，ALT and TBIL in the observation group were significantly lower than those in the control group at 2 weeks，4 weeks after operation（P<0.05）.There was no significant difference in the level of AST，ALT and TBIL between the two groups at 12 weeks（P>0.05）.The incidence of abdominal pain and abdominal distention was significantly less at 2 weeks and 4 weeks（P<0.05），but the incidence of abdominal pain and abdominal distention was similar at 12 weeks（P>0.05）.The quality of life score of the observation group was significantly higher than that of the control group ，after 4 weeks（P<0.05）.
Conclusion Keeping the deep branch of gallbladder artery in laparoscopic cholecystectomy is helpful to accelerate the recovery and reduce the incidence of abdominal pain and distention.

Objective To explore the clinical characteristics，diagnosis，treatment and prognosis of sarcomatoid carcinoma of the gallbladder.
Methods Symptoms，syndrome，preoperative imaging，tumor markers，surgery and prognosis of five patients confirmed with sarcomatoid carcinoma of the gallbladder in our hospital from April 2012 to April 2020 were retrospectively analyzed.
Results The five patients had no obvious specificity.Preoperative tumor marker examination showed that CA-199 increased significantly in 2 patients.CA-125 increased significantly in 2 patients.CEA increased slightly in 1 patient，and ferritin increased significantly in 5 patients，there was no significant difference between the imaging findings and gallbladder adenocarcinoma.Four of them underwent R0 resection and one case underwent R1 resection.Up until the last follow-up visit，one patient survived at 8 months after surgery and the other four cases did not survive for a long term（survival time 63～340 day）.
Conclusion Sarcomatoid carcinoma of the gallbladder has no specific clinical manifestations，so it isgenerally diagnosed via pathological examination and immunohistochemical examination.The cancer is highly malignant and progresses very rapidly.Radical excision is dominant in clinical treatment.Because its incidence rate is very low，more cases should be followed up for long term to search for better treatment.

Objective To compare the clinical effect of laparoscopic splenectomy and open surgery combined with pericardial devascularization in the treatment of portal hypertension.
Methods From May 2016 to March 2019，100 cirrhotic patients with portal hypertension were randomly divided into control group and observation group（50 cases each）.Patients in the observation group were treated with laparoscopic splenectomy and pericardial devascularization.The perioperative indexes，blood routine，liver function，adverse reactions and the degree of gastric varices were compared between the two groups.
Results The operative time，postoperative hospital stay，postoperative blood loss and abdominal drainage tube placement time of the observation group were statistically significant compared with the control group（P<0.05）.Platelets and white blood cells in the observation group were higher than those in the control group，and the difference was statistically significant（P<0.05）.AST and ALT in the observation group were higher than those in the control group，the score of Child-Pugh which was lower than and the control group，the difference were both statistically significant（P<0.05）.The postoperative complications in the observation group were lower than those in the control group within 2 weeks after operation，and the postoperative improvement degree of gastric varices was better than that in the control group，with statistically significant difference（P<0.05）.
Conclusion Laparoscopic splenectomy combined with pericardial devascularization can effectively reduce the impact on liver function，shorten the postoperative recovery period and reduce the incidence of postoperative complications.

Objective Exploring the effect of functional residual liver volume and spleen volume ratio（FreLSVR）on postoperative liver dysfunction and liver function recovery in patients.
Methods A total of 78 patients with primary hepatocellular carcinoma who underwent liver resection from June 2016 to August 2018 were enrolled.The liver CT data were retrospectively analyzed.The residual liver volume and spleen volume were calculated after three-dimensional reconstruction and the relationship between functions.
Results FreLSVR is associated with liver function in patients.The greater the FreLSVR，the better the postoperative liver function，and the median time of hospitalization in FreLSVR>1.0 is 15 days（8～22 days），while the median hospitalization time of FreLSVR≤1.0 was 21 days（13～36 days），and the difference in hospital stay was statistically significant（P<0.05）.
Conclusion Functional residual liver volume to spleen volume ratio（FreLSVR）can reflect the recovery of postoperative liver function.

Objective Analysis of ultrasound imaging features of biliary atresia and hepatitis in infants.
Methods Retrospective analysis of the preoperative sonographic features of 38 cases of biliary atresia（BA）confirmed by surgery in our hospital from June 2016 to October 2019 and 26 cases of infant hepatitis（IHS）discharged from hospital Image analysis for comparison.
Results Thirty-eight children were confirmed by pathology after operation，aged 31d to 90d.Twenty-six IHS children aged 19d to 8 months.Of the two groups，the gallbladder structure of the children in the BA group was mostly abnormal，IHS the children were mostly normal，and the difference was statistically significant（P<0.05）.Comparison of gallbladder size between the two groups was statistically significant（P<0.05）.Compared gallbladder shrinkage rate，the difference was statistically significant（P<0.05）.Based on the ultrasound The image showed that the outer diameter of the common bile duct was widened and hypoechoic in 28 of the 38 BA children，but there were no other abnormalities.In 24 of the 26 IHS children，the outer diameter of the common bile duct was not widened and hypoechoic，and the color blood flow signal of the lymphatic portal was CDFI.Of the 38 children BA 29 showed that the lumen closure at the confluence of left and right hepatic ducts was fibrous stripe-like ，3 had hepatic portal cysts，and the rest had normal structure;26 HIS had tubular structure at the hepatic portal.There were 35 BA cases of edema in the catchment area of the liver（widening of the Greenson sheath）and no edema in the other 3 cases;5 of the HIS cases showed widening of the Greenson sheath.The echo of the vascular wall in the liver was enhanced in the rest of the children.All the 38 children with BA had different degree of liver enlargement.Fifteen of HIS children had slightly larger livers.
Conclusion Ultrasonography has the advantages of convenience，good visualization，strong reproducibility，and dynamics.It can be used as the first choice for the differential diagnosis of BA and IHS.

Objective To explore the diagnostic efficiency of phospho-tau（P-tau）and phospho tau-total tau radio（P-tau/T-tau）for predicting death and prognosis situation within half a year in traumatic brain injury（TBI）patients.
Methods 90 TBI patients treated in our hospital from June 2017 to June 2019 were employed as research targets.Patients’ death situation and prognosis by Glasgow outcome score（GOS） in half a year of follow-up were recorded and thus all patients were divided into death group，survival group，good prognosis group and bad prognosis group.Using Logistic regression to analyse the related factors of death，analysing relation among P-tau，P-tau/T-tau within 6h of injury and GOS scores，constructing ROC curve to assess prediction efficiency of P-tau and P-tau/T-tauon TBI patients’ death and prognosis.
Results There were 86 cases were employed.The duration from onset of symptoms to admission，P-tau and P-tau/T-tauin the death group were higher than those in the survival group（P<0.05）；Both of P-tau and P-tau/T-tau were the risk factors of death（P＜0.05）；GOS score in good prognosis group was higher than that bad prognosis group，P-tau and P-tau/T-tau in good prognosis group were lower than that bad prognosis group（P<0.05）；P-tau and P-tau/T-tau were negatively correlated with GOS score（r=-0.773、-0.745，all P=0.000）；The AUC of P-tau and P-tau/T-tauto predict patients’ death and prognosis were 0.767 and 0.873，0.968 and 0.961，respectively.There were no significant difference respectively between both of them in sensitivity of predicting death（91.30% and 91.34%）and prognosis（94.11% and 91.24%，P>0.05）.
Conclusion P-tau and P-tau/T-tau can effectively predict TBI patients’ death situation and prognosis within half a year.

Objective To investigate the efficacy of thoracoscopic radical esophagectomy combined with left cervical anastomosis in the treatment of patients with esophageal cancer，and analyze its effect on the effect on the respiratory function of patients.
Methods 256 patients with esophageal cancer admitted to our hospital from January 2013 to January 2016 were enrolled，and divided into two groups according to their willingness.The thoracoscopic group （n=163） and the traditional group （n=93） received received thoracoscopic radical esophagectomy plus left cervical anastomosis and thoracic esophageal resection plus gastroesophageal intrathoracic anastomosis，respectively.Then the clinical efficacy was compared between the two groups.
Results The operation time of the thoracoscopy group was significantly longer than that of the traditional group，and the intraoperative blood loss was significantly less than the traditional group（both P<0.05）.There was no significant difference in the number of lymph node dissection between the two groups（P>0.05）.The postoperative pulse oximetry （SpO2） level in the thoracoscopy group was significantly higher than that in the traditional group，respiratory rate（RR） and minute ventilation （MV） level was significantly lower than the traditional group（both P<0.05）.The pain degrees showed a decreasing trend in both groups at the postoperative after 12h，24h，48h and 72h，with statistic difference between groups （P<0.05）.The total drainage volume in the thoracoscopic group was significantly less than that in the traditional group，and the recovery time of the right upper limb function，postoperative extubation time and postoperative hospital stay were significantly shorter than the traditional group（P<0.05）.The postoperative complication rate of the thoracoscopy group was significantly lower than the traditional group（P<0.05）.After 3 years of follow-up，the recurrence rate of esophageal cancer in both groups and mortality rate had no significant differences were observed between the two groups（P>0.05）.
Conclusion Application of thoracoscopic radical esophagectomy combined with left cervical anastomosis has the advantages of minimally invasive，can reduce the pain of the patients，and little impact on patitents’respiratory function，which is conducive to postoperative recovery and indicates no significant difference in the long-term prognosis.However，the operation is complex and the indications are limited，so it cannot completely replace open surgery.

Objective To investigate clinical value of ultrasound-guided Mammotome（MMT）in the treatment of breast cancer.
Methods The clinical data of 75 patients with MMT and reoperation were collectedin the treatment of breast cancer.According to whether there was residual tumor after MMT，patients were divided into residual tumor group（39 cases）and non-residual group（36 cases）.The relationship of residual tumorsand clinical and pathological factors between two groups was compared.
Results The rate of residuallesions after MMT was 52.0%，The residual lesionswere closely related to patient age，tumor differentiation，Ki-67expression（P＜0.05）;patient age was an independent risk factor for residual breast tumor（P<0.05）.
Conclusion There was a high rate of residual tumors after MMT in breast cancer.MMT is not recommended for breast cancer.

Objective To explore the relationship between preoperative fibrinogen（FIB）and overall survival Overall Survival（OS）of women with triple negative breast cancer.
Methods A total of 295 women with triple-negative breast cancer treated in the Breast Center of the Fourth Hospital of Hebei Medical University from December 2009 to December 2012 were collected.A retrospective study was adopted，and Kaplan-Meier method and Cox proportional regression risk model were used for survival analysis.Log-rank test was used to analyze the differences between groups.To investigate the relationship between preoperative FIB expression and OS in female triple negative breast cancer patients.
Results X-Tile software was used to find the best cut-off value of FIB（g/L），and the patients were divided into two groups，FIB <3.7g/L group and FIB≥3.7g/L group.Using the Kaplan-Meier method for univariate analysis，OS was significantly reduced in the FIB≥3.7 group（HR，2.4，95% CI，1.1，4.9，P=0.002）; using the COX risk regression model for multivariate analysis，in the FIB≥3.7 group In addition，OS was also significantly reduced（HR，2.2，95% CI，1.1，4.6，P=0.028）.Kaplan-Meier survival curve results established by multivariate analysis showed that the higher the preoperative FIB value，the lower the OS.
Conclusion Low preoperative FIB expression is an independent prognostic factor for overall survival in women with triple negative breast cancer.

Objective To analyze the clinical characteristics and treatment methods of 50 patients with hemorrhage after thyroid surgery，and explore the prevention and treatment of postoperative thyroid bleeding.
Methods The clinical data of 50 patients with hemorrhage after thyroid surgery from January 2015 to November 2019 were retrospectively analyzed.These patients were divided into surgical treatment group（29 cases） and non-surgical treatment group（21 cases） according to the treatment for the postoperative bleeding.The clinical characteristics of the two groups were compared.
Results The results of univariate analysis showed that gender，cause of bleeding，time from the end of thyroid surgery to the discovery of bleeding，and neck symptoms during bleeding were statistically significant in the two groups of cases（P<0.05）.Male（OR value1.38）and Neck swelling（OR value 2.68）was an independent influencing factor for surgical hemostasis.The surgical treatment group found that the most common bleeding site was the anterior jugular vein and its communicating branch with the latissimus dorsi flap.
Conclusion Male and neck swelling is an independent influencing factor for surgical hemostasis.Before closing the incision in thyroid surgery，special attention should be paid to the examination of the anterior jugular vein and the branch of communication with the latissimus dorsi flap.

Objective To study the risk factors of lymph node metastasis in patients with multifocalgastric cancer and to analyze its influence on the prognosis.
Methods From January 2013 to January 2017，2012 patients were diagnosed by pathology and underwent surgery，36 patients with multifocal gastric cancer were enrolled into this study.The retrospective analysis was performed.The clinic-pathological data were retrospectively analyzed，mainly including age，gender，surgical mode，carcinoma-related date（quantity，location，degree of differentiation，T stage，tumor diameter ，vascular tumor thrombus， nerve tumor thrombus） and lymph node status（number of lymph nodes dissected，lymph node metastasis）.36 patients were divided into non-metastatic group（17 cases）and metastatic group（19 cases）.Logistic regression were performed to analyze the risk factors of lymph node metastasis.The 3-year overall survival rate of the two groups was calculated.The survival analysis was performed using the Kaplan-Meier and log-rank test and multi-factor analysis with the Cox proportional hazard regression model.
Results Univariate analysis showed that the depth of invasion，nerve invasion and lesions distributed in different areas were the risk factors of lymph node metastasis（P<0.05）.Multivariate regression analysis showed that depth of main tumor invasionis independent risk factors for lymph node metastasis（P<0.05）.The 3-year survival rate of lymph node metastasis group was 52.6%.The 3-year survival rate of lymph node non-metastatic group was 88.2%.The results of follow-up showed that the 3-year survival rate of the patients with lymph node metastasis was significantly lower than that of the patients without metastasis，with significant difference（P<0.05）.
Conclusion Multifocal gastric cancer is a special type of gastric cancer，depth of main tumor invasionis independent risk factors for lymph node metastasis.Patients with lymph node metastasis have a poor prognosis.

Objective To compare the curative effect and postoperative complications of hemorrhoids between lauromacrogol injection and surgical ligation，in order to explore the best method for hemorrhoids.
Methods 93 patients with hemorrhoids were divided into two groups：48 patients received endoscopic sclerotherapy; 45 patients underwent surgical ligation.The clinical efficacy，subjective feelings and postoperative complications between the two groups were compared.
Results 44 cases in the study group completed the study，in which 21 cases cured，11 cases markedly effective，8 cases effective，4 cases ineffective，and the total effective rate was 90.91%.42 cases in the control group were completed the study，in which 23 cases cured，13 cases markedly effective，4 cases effective，2 cases ineffective，and the total effective rate was 95.24%.There was no significant difference in clinical efficacy and total effective rate between the two groups（P>0.05）.Before and after treatment，there was no significant difference in European quality of life-5 dimensions，5-level（EQ-5D-5L）and Vaizey scores between the two groups（P>0.05）.The incidence of postoperative adverse reactions in the study group was lower than that in the control group（9.09% vs 28.57%，P<0.05）.
Conclusion Sclerotherapy is equivalent to hemorrhoidectomy in short-term efficacy，but has fewer postoperative complications.

Objective To investigate the safety and clinical efficacy of laparoscopic partial nephrectomy in the treatment of localized renal pelvic neck atresia.
Methods From June 2016 to December 2018，12 patients with localized severe hydronephrosis due to upper cervical sacral atresia were treated in Wuhan University Renmin Hospital.All patients underwent laparoscopic partial nephrectomy.The operation time and intraoperative bleeding，intraoperative warm ischemia time，postoperative hospital stay，intraoperative and postoperative complications and follow-up were counted.
Results All the 12 cases were successful，the average operation time was 112.6min，and the average warm ischemia time was 28.6min.The mean hemoglobin decline during surgery decreased by 5.7g/L，and the average postoperative hospital stay was 7.6 days.No obvious complications were found during or after operation.A total of 10 patients underwent ECT examination with renal function at 6 months after operation，with an average GFR of 29.4ml/min.
Conclusion Laparoscopic partial nephrectomy is safe and effective in the treatment of severe upper hydronephrosis caused by renal sacral atresia in the upper group.

Objective To investigate the effect of ultrasound-guided anterior serratus plane block combined with laryngeal mask on postoperative analgesia and stress response in thoracoscopic surgery with autonomous breathing.
Methods 60 patients with elective thoracoscopic lobectomy were selected.All patients were divided into two groups：Group C（SAPB group）and group N.Blood glucose，norepinephrine and adrenaline were measured before anesthesia induction（T1），10 minutes after operation（T2），30 minutes after operation（T3），and 10 minutes after operation（T4）.The consumption of general anesthesia drugs，visual analogue scores at rest，cumulative sufentanil consumption and the times of PCA compression times were recorded.The recovery time of anesthesia，the time of first exhaust，the time of defecation and the days of hospitalizationwere recorded.
Results The contents of blood glucose，noradrenaline and adrenaline in the two groups increased at T4 ，compared with T1、T2、T3，the difference was statistically significant（P<0.05）.Compared with group N，the contents of blood glucose，noradrenaline and adrenaline in group C were lower（P<0.05）.Compared with group N，intraoperative anesthetic drug dosage，VAS score 24 hours after operation，PCA dose of sufentanil and PCA compression frequency in group C were lower than those in the control group，and the differences were statistically significant（P<0.05）.The recovery time of anesthesia，the time of first exhaust，the time of defecation and the days of hospitalization in group C were all shortened（P<0.05）.
Conclusion The application of ultrasound-guided anterior serratus block in thoracoscopic surgery can effectively inhibit perioperative stress response，provide good postoperative analgesia for thoracoscopic surgery，reduce the use of postoperative analgesic drugs，shorten the time of anesthesia recovery and hospital stay，and promote the postoperative recovery of patients.

Objective To study the effect of dexmedetomidine combined with ropivacaine preemptive analgesia on the perioperative period pain control and serum prostaglandin E2（PGE2），β-endorphin（β-EP）in patients undergoing thoracotomy.
Methods 80 patients with thoracotomy in our hospital were randomly divided into observation group and control group，each group had 40 cases，they were anesthetized by paravertebral nerve block，the control group was given ropivacaine，the observation group was combined with dexmedetomidine，and the anesthesia induction，maintenance and postoperative analgesia were the same in two groups.The anesthesia effect between two groups were compared.
Results The dosage of fentanyl in the observation group was significantly less than that in the control group（P＜0.05）; the RS score of the observation group was lower than that of the control group at the time of extubation and after extubation 5 minutes（P＜0.05）; the VAS score，serum PGE2 and β - EP in the observation group were lower than that in the control group at after operation 2h，6h，12h and 24h（P＜0.05）.
Conclusion Dexmedetomidine combined with ropivacaine has satisfactory effect on perioperative period pain control of patients undergoing thoracotomy，which can avoid the increase of serum PGE2 and β-EP after craniotomy.

Biliary malignancy refers to malignant tumors originating from the biliary epithelium, whose incidence and etiology vary geographically. The progress of comprehensive genomics has found abnormalities in different gene drivers. Advances in comprehensive genomics have revealed abnormalities in different gene drivers. A large number of studies have confirmed that cholangiocarcinoma not only has the characteristics of concealability, invasiveness and refractory, but also presents the multilevel heterogeneity between tumor and intratumor, which is affected by the interaction of different risk factors. Further understanding of its biological characteristics is of great significance for further research, more accurate diagnosis and more effective treatment. The purpose of this article was to review the biological characteristics of biliary tract cancer.

The incidence of biliary tract cancer keeps increasing during the past years，the efficacy of palliative chemotherapy is poor and results the short overall survival period.The exploratory treatment of new chemotherapeutics such as albumin paclitaxel and three-drug combination chemotherapy has improved the chemotherapy effect of advanced biliary malignant tumors.In the past two decades，tumor genome analysis and the progress of molecular biology research clarified furtherly its pathogenesis，and with the continuous development of new drugs，those drugs such as  EGFR inhibitors，anti-angiogenesis inhibitors，MEK inhibitors，IDH1 /2 inhibitors and FGFR inhibitors have shown promising anti-tumor merit against cholangiocarcinoma.Some drugs have been approved for indications.The combination of chemotherapy and targeted therapy has also been explored.This article reviews the progress of chemotherapy and molecular targeting therapy for advanced biliary tract cancer in recent years.