Objective To explore the safety,feasibility and superiority of single-incision laparoscopic sleeve gastrectomy.
Methods A retrospective analysis of 56 cases of sleeve gastrectomy completed in our department from January 2018 to April 2019 was made,including 28 cases of single-incision laparoscopic sleeve gastrectomy(single-incision group) and 28 cases of traditional laparoscopic sleeve gastrectomy(traditional group).The differences in operation results and follow-up results between the two groups were compared.
Results The operation time of the single hole group was significantly longer than that of the traditional group[(156.7±13.2)min vs.(113.4±11.7)min,P<0.05],the hospitalization time was significantly shorter than that of the traditional group[(4.80±0.69)d vs.(5.30±0.64)d,P<0.05],and the scores of postoperative pain[(3.5±0.5) vs(4.8±0.6),P<0.05] and beauty satisfaction[(4.5±0.6) vs(4.0±0.7),P<0.05] were better than that of the traditional group.However,there was no statistical difference in the incidence of postoperative complications,excess weight loss and the remission of co-morbidities after 12 months between the two groups(P>0.05).
Conclusion Single-incision laparoscopic sleeve gastrectomy is safe,effective and feasible,and has more advantages in cosmetic results.

Objective To analyze the risk factors for in-hospital death of patients for non-traumatic subarachnoid hemorrhage in the Neurosurgical Intensive Care Unit(NICU）.
Methods The clinical data of patients for non-traumatic subarachnoid hemorrhage (SAH) in the Neurological Intensive Care Unit (NICU) of Zhongnan Hospital of Wuhan University were analyzed retrospectively.Divided into operation group and non operation group,The clinical characteristics of patients in two groups were compared.Logistic regression model was used to analyze the risk factors of the mortality of patients,and then the receiver operating characteristic curve (ROC) was used to evaluate the predictive value of risk factors.
Results A total of 356 patients with non-traumatic SAH in NICU were included,including 303 patients in the surgical group and 53 patients in the non-surgical group.There were 58 deaths (19%) in the surgery group and 17 deaths (32%) in the non-surgery group.A total of 83 patients developed acute kidney injury,including 69 patients in the surgical group and 14 patients in the non-surgical group.Multi-logistic regression showed that AKI was the most powerful independent risk factors associated with the morality of surgical patients with non-traumatic  subarachnoid hemorrhage (SAH) in NICU(OR=5.095,95%CI 2.261～11.483,P＜0.001),other risk factors included hyperglycemia,high APACHE Ⅱscores.For predicting SAH mortality,APACHE Ⅱ scores displayed an excellent areas under the ROC curve (AUC=0.811,P＜0.001).
Conclusion AKI significantly increases the hospital mortality,which is an important factor affecting the prognosis of non-traumatic  subarachnoid hemorrhage (SAH)  surgical patients in NICU.The APACHE Ⅱ scores was the best predictor of mortality of patients.

Objective Investigate the effect of the fenestrated thoracic endovascular aortic repair(TEVAR) in the treatment of aortic arch disease.
Methods Clinical data of 57 patients with aortic arch lesions admitted to our hospital from April 2012 to January 2017 were retrospectively analyzed.All patients were treated with fenestrated TEVAR technology,and the efficacy was observed by immediate postoperative internal leakage,stent displacement,cerebral infarction,branch vascular patency rate,secondary intervention and survival outcome.
Results (1)Perioperative conditions: clinical surgical success rate 96.5% (55/57),intraoperative complications were 10.53% (6/57),2 cases of fenestration position offset emergency to chimney,2 cases of  model of leakage,2 cases of Ⅲ type of leakage,3 cases of postoperative leakage within 30 day review intraoperative disappeared,no new deaths.New stent related complication rate 3.51% (2/57),including acute cerebral infarction,Ⅲ leakage in 1 case,Ⅲ leakage in the secondary surgery in 1 case.(2) survival outcome: the follow-up period was 3～36 months,and the follow-up rate was 92.98%(53/57).New stent related complication rate 5.26% (3/57),acute cerebral infarction,left common carotid artery occlusion,Ⅲ type of leakage in 1 case.Two cases of secondary surgical intervention.There were 3 deaths.The 3-year survival rate was 89.47% (51/57).
Conclusion The application of fenestrated TEVAR technique in the treatment of aortic arch disease is safe and effective.

Objective To assess the predictive value of preoperative chest HRCT consolidation/tumor ratio (CTR) in patients with multiple ground-glass opacity (GGO).
Methods A total of 91 patients with N0 stage lung cancer were enrolled.The patients were divided into GGO group and solid nodule group by CTR=0.5.The difference of clinical and pathological features and 3-year recurrence survival rate (RFS) of the two groups were compared.
Results Among the 91 patients enrolled，35 (38.5%) had multiple GGO nodules.The maximum diameter of the GGO group was significantly smaller than that of the solid nodules group (10.2mm vs 21.6mm，P<0.05).COX multivariate regression analysis showed that tumors≥20mm (HR：1.22，P=0.043) and solid nodules (CTR≥0.5) were independent predictors of RFS.Kaplan-Meier survival curve analysis showed that the RFS of the GGO group was 91.4%，while the RFS of the solid nodule group was 75.0%.There was a significant difference between the two groups (P<0.05).
Conclusion The CTR value displayed by HRCT is an effective reference for follow-up and treatment of patients with multiple GGO.Surgical intervention is the preferred treatment when CTR is greater than 0.5.

Objective To summarize the experience of cardiopulmonary bypass(CPB)in the surgical treatment of severetracheal stenosis.
Methods Three patients with severe tracheal stenosis were retrospectively analyzed from January 2009 to May 2014.After establishing normothermic femoral artery-vein extracorporeal circulation,tracheal tumor resection and end-to-end anastomosis,resection of giant goiter,and benign tracheal stenosis resection and end-to-end anastomosis were employed under general anesthesia,respectively.
Results With the assistance of CPB,the operation was successfully and safely finished in 3 patients.The CPB time was 30～120 minutes.The bleeding was 100～1000ml during the operation and the patients recovered uneventfully after the operation.There was no recurrence in 3～9 years follow-up.
Conclusion Surgery is an important method for the treatment of tracheal stenosis.CPB is an effective and feasible method for the patients with severe tracheal stenosis to get through anesthesia,intubation and surgery,while related complications should be taken to avoid.

Objective To investigate the effect of breast mass biopsy on the accuracy of sentinel lymph node biopsy in breast cancer.
Methods Open biopsy and hollow needle biopsy were performed in 107 cases and 122 cases respectively.During the operation,fluorescent detector and methylene blue double tracer were used for sentinel lymph node biopsy.According to the proportion of blue staining sentinel lymph nodes,the difference of accuracy of sentinel lymph node biopsy was calculated by the incision position.
Results Multivariate regression analysis showed that the accuracy of SLN biopsy was significantly affected by the length and location of the incision and breast biopsy method(P<0.05).The results of multivariate analysis showed that there was significant difference between the open biopsy and hollow needle biopsy(P<0.05).
Conclusion The accuracy of sentinel lymph node biopsy was affected by the way of breast biopsy,the position and size of incision.

Objective To explore the predictive factors and protective strategies of hypoparathyroidism after operation for papillary thyroid carcinoma(PTC）.
Methods The clinical data of 588 cases of patients with PTC who underwent the first surgery in the same diagnosis and treatment group of general surgery of the Affiliated Hospital of Nanjing University of Chinese Medicine from July 2016 to October 2019 were analyzed retrospectively.The clinicopathological features of hypoparathyroidism were analyzed.The predictive factors of hypoparathyroidism after operation for PTC by logistic regression.
Results The total incidence of hypoparathyroidism was 40.8%,and the incidence of permanent parathyroid injury was 0.9%.The proportion of nodular goiter,multifocal cancer,thyroid capsule invasion,total thyroidectomy and bilateral CLN dissection in low parathyroid hormone(PTH）group was higher than that in normal PTH group(P＜0.05).Multivariate logistic regression analysis showed that the risk of hypoparathyroidism after operation in PTC patients with nodular goiter,multifocal cancer and thyroid capsule invasion was significantly increased (OR: 2.196,3.071,1.554;P<0.001,<0.001,0.030).In terms of operation method,the risk of hypoparathyroidism in PTC patients after total thyroidectomy was significantly increased (OR: 3.630,P:<0.001).
Conclusion Combined with nodular goiter,multifocal carcinoma and thyroid capsule invasion are independent predictors of postoperative hypoparathyroidism in PTC patients.For the patients who had the above factors in preoperative examination,the current methods should be used to protect parathyroid gland,so as to reduce the incidence of hypoparathyroidism.

Objective To investigate the expression of NOBp1 in breast cancer tissues and its correlation with clinicopathological factors and prognosis.
Methods A total of 90 patients with breast cancer admitted to our hospital from April 2013 to April 2014 were enrolled.Breast cancer tissues were taken and immunohistochemistry (IHC) was used to detect the expression of NOBp1 in cancer tissues.Followed up to October 2019,the correlation between NOBp1 expression level and clinical pathological factors and overall survival (OS) was analyzed.
Results Of the 90 patients,32 (35.6%) were positive for NOBp1 and 58 (64.4%) were negative for NOBp1.The expression of NOBp1 was correlated with lymph node metastasis status,tumor size and TNM stage (P<0.05),and there was no significant difference with age,menstrual status and molecular typing (P>0.05).As of October 2019,the patients were lost to follow-up in 5 patients.A total of 85 patients were followed up.The median follow-up time was 49 months,OS range:21～62 months,and 20 patients died during follow-up.Kaplan-Meier analysis showed that OS in the NOBp1 negative group was longer than the NOBp1 positive group (P=0.004).Univariate COX analysis showed that tumor size,lymph node status,TNM,molecular typing,NOBp1 expression were the prognostic factors affecting OS in breast cancer patients (P<0.05).Multivariate COX analysis showed lymph node status,TNM,Molecular typing and NOBp1 expression were independent prognostic factors affecting OS in breast cancer patients (P<0.05).
Conclusion Patients with elevated NOBp1 expression have shorter OS and are risk factors for breast cancer prognosis.Patients with elevated NOBp1 expression have poor prognosis.

Objective To investigate the prognostic significance of AGGF1,which plays an important role in tumor angiogenesis,and its expression in triple negative breast cancer.
Methods Immunohistochemistry and Western blot methods for AGGF1 expression in 102 triple negative breast cancer specimens were detected,study the correlation between AGGF1 expression and various pathologic factors and breast cancer survival.
Results There was positive correlation between the results of Immunohistochemistry and Western blot assay （r=0.859，P=0.00）.The expression of AGGF1 in triple negative breast cancer tissues was associated with Ki-67 expression（P<0.05）,but not with age,tumor size,TNM stage and lymph node metastasis（P>0.05）.The positive and negative expression of AGGF1 were observed in 42 and 60 of all 102 triple negative breast cancer patients.17 and 3 patients died in each group during the follow-up.The positive expression of AGGF1 was correlated with poorer overall survival than the negative expression group（P<0.05）.
Conclusion Positive expression of AGGF1 was poor prognostic factor in triple negative breast cancers.Further investigation is essential to determine whether AGGF1 might be effective therapeutic targets for triple negative breast cancer.

Objective To explore and analyze the risk factors of anastomotic leakage after esophageal cancer eradication.
Methods According to the occurrence of postoperative anastomotic leakage,300 patients underwent esophagectomy in our hospital from December 2016 to December 2018 were divided into anastomotic leakage group (84 cases) and non-anastomotic leakage group (216 cases).Univariate analysis,and logistic regression analysis was used to analyze the risk factors of anastomotic leakage after esophageal cancer eradication.
Results Univariate analysis showed that the main influencing factors of anastomotic leakage included operation mode,anastomotic position,preoperative radiotherapy and chemotherapy,serum albumin level,respiratory diseases and operation time.Logistic regression analysis showed that operation mode,anastomotic position,preoperative radiotherapy and chemotherapy,combined with respiratory diseases,operation time and albumin level were independent risk factors of anastomotic leakage after esophagectomy.
Conclusion There are many risk factors of anastomotic leakage after radical resection of esophageal cancer.Therefore,effective prevention and treatment measures should be made according to these independent risk factors.

Objective To observe and analyze the related factors of delayed hemorrhage after pancreaticoduodenectomy and to explore the management strategy of delayed hemorrhage.
Methods Reviewing 276 patients who underwent pancreaticoduodenectomy in Fujian Provincial Hospital from January 2015 to January 2020,univariate and multivariate analyses were performed on delayed hemorrhage related factors and treatment strategies were discussed.
Results The incidence of delayed hemorrhageis 9.1%(25/276),Among them,there were differences in age,pancreatic duct diameter,pancreatic fistula,bile leakage,and abdominal infection between the delayed hemorrhage group and the non-hemorrhage group(P<0.05）.While age ≥60,pancreatic duct diameter ≥3mm,pancreatic fistula and biliary leakage are independent factors of delayed hemorrhage.Pancreatic duct diameter ≥3mm is a protective factor,and the remaining three are risk factors.
Conclusion The cause of delayed hemorrhage is complicated and the mortality is high.It requires an experienced pancreatic treatment center and multidisciplinary combined treatment.Timely and appropriate treatment of hemorrhage and rehemorrhage is the key to reducing mortality.

Objective To explore the diagnostic value of multi-slice spiral CT (MSCT) and MRI in abdominal wall involvement in patients with severe acute pancreatitis (SAP).
Methods The clinical data of 78 patients with SAP diagnosed and treated in the hospital between January 2018 and December 2019 were collected.All patients completed MSCT and MRI examinations.With pathological results as the golden standard,the diagnostic value of MSCT and MRI examinations in SAP abdominal wall involvement was evaluated.The MSCT and MRI findings of SAP abdominal wall involvement were observed.The detection rates of the location and depth of SAP abdominal wall involvement by MSCT and MRI were compared.
Results The accuracy and sensitivity of MSCT for diagnosis of abdominal wall involvement in patients with SAP were 87.18% (68/78) and 88.57% (31/35).The accuracy and sensitivity of MRI were 91.03% (71/78) and 94.29% (33/35).The detection rate of the location of abdominal wall involvement in patients with SAP by MRI [91.43 (32/35)] was higher than that by MSCT [80.00% (28/35)] (χ2=1.867,P>0.05).The detection rate of the depth of abdominal wall involvement in patients with SAP by MRI [94.29% (33/35)] was significantly higher than that by MSCT [77.14% (27/35)] (χ2=4.200,P<0.05).The MSCT findings of abdominal wall involvement in patients with SAP included increased density of subcutaneous fat in the abdominal wall,strip-shaped shadows,unclear boundary between the abdominal wall and the muscle,significantly thickened fat at the abdominal wall muscle and signals lower than the density of the same layer of muscle tissue.MRI scan showed that the fat layer on the abdominal wall showed slightly low signals on T1WI and T2WI fat suppression sequence high signal,increased muscle-muscle gap density and unclear boundaries.Muscle tissue showed spot-like,strip-like slightly low and irregular high-signal shadows.
Conclusion The diagnostic value of both MSCT and MRI are high in SAP patients with abdominal wall involvement,but the evaluation value of MRI for the location〖LM〗 and depth of SAP abdominal wall involvement is slightly higher than that of MSCT.

Objective To explore the early treatment plan of massive arterial hemorrhage combined with extradural hematoma in patients with tile type C pelvic fracture,so as to provide reference for clinical early rescue.
Methods From January 2011 to January 2020,29 cases of shock coma with massive hemorrhage of artery and extradural hematoma (extradural hematoma >30ml,CT showed that the midline of brain deviated to the healthy side>5mm) were selected.According to different rescue methods,they were divided into control group and treatment group for retrospective analysis.The control group (n=14): the patients in the early stage were treated with routine rapid volume resuscitation and emergency operation room for pelvic fracture surgical intervention (abdominal packing,external fixation support,etc.).In the treatment group (n=15): patients in the early stage were treated with limited volume resuscitation + interventional room for iliac angiographic embolization.After the vital signs of the two groups were stable,they were immediately admitted to the operating room for craniotomy decompression and hematoma removal.
Results The volume of resuscitated fluid and the time of early treatment: the control group > the treatment group.The laboratory results of 4 hours after resuscitation: the hematocrit,HGB and platelet count of the control group were significantly lower than that of the treatment group,the concentration of blood lactate was significantly higher than that of the treatment group,and the time of prothrombin was longer than that of the treatment group.The rate of complications and mortality: the control group > the treatment group.
Conclusion limited volume resuscitation plus Interventional room angiographic embolization can reduce complications and improve the survival rate of patients with massive arterial hemorrhage and epidural hematoma.

Objective To explore the relationship between the degree of hydronephrosis and the bleeding-related complications following percutaneous nephrolithotomy.
Methods The data of 133 patients who underwent single-tract(F20) percutaneous nephrolithotomy in our hospital from September 2018 to April 2020 were retrospectively analyzed.All patients with single upper ureter or UPJ or renal pelvis stones,or the above stones accompanied by lower calyx stone less than 1cm were included.According to the degree of hydronephrosis before operation,patients were divided into no hydronephrosis or mild hydronephrosis group(group A,n=49),moderate hydronephrosis group(group B,n=37) and severe hydronephrosis group(group C,n=47).All operations were performed under ultrasound-guided puncture to establish F20 percutaneous renal access.All patients' characteristics,surgery-related parameters,and incidence of obvious bleeding-related complications were obtained.
Results All operations were successfully completed.There were 3 cases of obvious bleeding complications in the group A,of which 1 case was treated with angioembolization;4 cases of group C had obvious bleeding after operation,of which 1 case underwent angiography and embolization.No obvious bleeding complications occurred in group B.Multivariate regression analysis showed that moderate hydronephrosis and preoperative hemoglobin levels were independent influencing factors for postoperative bleeding-related adverse events.
Conclusion The degree of hydronephrosis may have an important effect on the risk of bleeding after percutaneous nephrolithotomy.The possible reason is that the degree of difficulty in accurately identifying the fornix of the calyx and dilation under different degrees of hydronephrosis when establishing the access varied.

Objective To investigate the clinical features,auxiliary examination，diagnosis and treatment  of pure red cell aplasia (PRCA) caused by human parvovirus B19 (HPV-B19) infection after kidney transplantation,andto guide the treatment of diseases like this in future.
Methods The clinical treatment and outcome of three patients with PRCA caused by HPV-B19 infection after kidney transplantation between May 2016 and February 2019 were retrospectively investigated.
Results The three patients showed obvious anemia symptoms,lacking other clinical symptoms of viral infection.Two patients accept treatment of adjusting the dose of immunosuppressant;All three patients accept symptomatic treatment and 1 to 2 weeks of intravenous immunoglobulin after positive diagnosis,all of them showed clinical remission.One case occurred recrudescence with HPV-B19 DNA(+）and improved after the same treatment.All patients have blessing performance by now.No serious adverse reactions occurred and all patients had stable graft function.No accidents such as organ failure or immunological rejection showed at all.
Conclusion The main clinical manifestations of PRCA caused by HPV-B19 infection after kidney transplantation are anemia symptoms,blood examination,bone marrow cytology and immunological examination can diagnose HPV-B19 infection.Adjusting immunosuppressant and IVIG can be the safe and effective treatment.

Objective To investigate the diagnosis and treatment of congenital hydronephrotic kidney with traumatic rupture.
Methods From Jan 2016 to Jan 2020,retrospective study was taken on 15 cases of congenital hydronephrotic kidney with traumatic rupture.15 cases were treated with emergency operation,6 cases underwent staging surgery and 9 cases underwent homochronous operation.
Results 15 cases with congenital hydroncele recovered well and there was no case with any complication,such as allantois.
Conclusions Children with sudden onset of flank pain or abdominal cavity effusion after trauma,must be considered to have the possibility of congenital hydronephrotic kidney with traumatic rupture.Urinary color to exceed and CT examination provide vital evidence for being diagnosed; Surgical treatments are the important methods for children with traumatic rupture of congenital hydronephrosis kidney.

Objective To study the effect of adductor canal combined with obturator nerve block on analgesia and functional rehabilitation of patients undergoing arthroscopic anterior cruciate ligament(ACL) reconstruction.
Methods 60 patients undergoing arthroscopic ACL reconstruction who received therapy from November 2019 to March 2020 in our hospital were selected,they were divided into the observation group and the control group by the the random number table,each group had 30 cases,the observation group was treated with adductor canal combined with obturator nerve block intraoperative,while the the control group was treated with only obturator nerve block intraoperative,The postoperative visual analogue scale(VAS),analgesia,joint function recovery and safetys were compared between the two groups.
Results At postoperative 4h,8h,12h,24h,48h,the rest and activity VAS scores in the observation group were significantly lower than those in the control group(P<0.05);within postoperative 48 hours,the tramadol dosage and number of receiving lornoxicampatients in the observation group were significantly less than those in the control group(P<0.05);at postoperative 72h,the knee joint in American Special Surgery Hospital(HSS) scores in the observation group was significantly higher than those in the control group,and the active straight leg raising time,passive knee flexion 90° time and hospitalization were significantly shorter than those in the control group(P<0.05);there were no complications such as hematoma and hemorrhage at puncture site,local anesthetic poisoning and deep vein thrombosis of lower extremity in the two groups,and there was no significant difference in the incidence of decrease of quadriceps femoris muscle strength,nausea,vomiting and skin pruritus between the two groups(P＞0.05).
Conclusion Compared with single adductor canal block,adductor canal block combined with obturator block has more satisfactory analgesic effect on patients undergoing arthroscopic ACL reconstruction,which can promote the rehabilitation of joint function after operation,and has good safety,it's worthy of application and promotion.

Objective To study effects of analgesic effect and muscle strength recovery of different concentrations of ropivacaine sciatic nerve combined with femoral nerve block for patients with total knee arthroplasty(TKA).
Methods 95 patients with TKA from April 2018 to November 2019 were divided into Group A(31 cases),Group B(32 cases) and Group C(32 cases).All patients given 20 ml 0.4% ropivacaine femoral nerve block,Group A given 20 ml 0.35% ropivacaine sciatic nerve block,Group B given 20 ml 0.37% ropivacaine sciatic nerve block,Group C given 20 ml 0.4% ropivacaine sciatic nerve block.Then RVAS,IVAS,quadriceps femoris muscle strength,anaesthesia induced adverse reactions were compared between three groups.
Result 6h,12h,24h,36h after operation,RVAS of Group A was higher than that of Group B and Group C,RVAS of Group B was higher than that Group C(P<0.05).24h,36h after operation,IVAS of Group A was higher than that Group B and Group C,IVAS of Group B was higher than that Group C(P<0.05).h,12h,24h,36h after operation,muscle strength score of Group A was higher than that Group B and Group C,muscle strength score of Group B was higher than that Group C(P<0.05).There were significant difference in the recovery time of quadriceps femoris between Group A,Group B and Group C[(8.65±1.12)h vs (20.12±2.24)h vs (24.36±2.56)h](P<0.05).There were no significant difference in adverse reactions between Group A,Group B and Group C(35.48% vs 31.25% vs 37.50%)(P>0.05).
Conclusion 0.375% ropivacaine sciatic nerve combined with femoral nerve block anesthesia can ensure satisfactory analgesic effect,which is conducive to the recovery of muscle strength in patients with TAK.

The prevalence of gastroesophageal reflux disease has gradually increased over the past few decades,according to the current research,we know that its related factors are various.Remarkablely,obesity is considered to be one of its important influencing factors.Facing the current increasing incidence of obesity year by year,it is urgent to solve the problem of obesity and its related complications around the word.Fortunately,with the appearance of bariatric metabolic surgery,this problem has been solved gradually.Because of the advantages of high efficiency and safety in solving the problem of obesity,bariatric metabolic surgery has been widely used in the world,and a variety of surgical methods have been produced to adapt to different patients.However,laparoscopic sleeve gastrectomy,as the most widely used in current bariatric metabolic surgery,the influence on gastroesophageal reflux disease is still controversial after solving the problem of obesity and its complications in patients.Some articles pointed out that after laparoscopic sleeve gastrectomy,the symptoms of gastroesophageal reflux were relieved in some patients,however,some articles pointed out that the symptoms of gastroesophageal reflux in a considerable number of patients were significantly aggravated.This paper reviews the relationship between obesity and gastroesophageal reflux diease,the influence of laparoscopic sleeve gastrectomy on gastroesophageal reflux in obese patients,and the changes of gastroesophageal dynamics in patients after laparoscopic sleeve gastrectomy,and then further discusses the significance of highresolution esophageal manometry in the diagnosis of postoperative gastroesophageal reflux diease.