2015年 · 第53卷第10期

The 3rd National Academic Forum of Young General Surgeons and the competition of "Chinese Young Scholars of Surgery" jointly sponsored by the Surgery Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Surgery have been successfully concluded recently. The purpose of this forum is to promote the academic exchange of young physicians in general surgery, encourage more outstanding young talents to stand out, discover and cultivate young academic talents in general surgery, select reviewers and reserve talents of the editorial board of Chinese Journal of Surgery, and conduct the "2015 Chinese Surgery Young Scholar Award".

With the advancement of medical technology, nephron sparing surgery (NSS) has gradually become the first choice for the treatment of exophytic small renal carcinoma^[1]。 The key of NSS surgery is to have an objective and accurate understanding of the size, location and surrounding relationship of tumor before surgery^[2]。 Knowing the tumor location and spatial relationship as detailed as possible before surgery will help to formulate the best surgical plan and more effective doctor-patient communication, reduce surgical risks and improve surgical success rate. Three-dimensional printing technology can reconstruct the physical model of the target tissues and organs by editing the tomographic CT images of patients through specialized three-dimensional processing software and connecting the three-dimensional printer. This technology has been applied in the fields of orthopedics, neurosurgery, vascular surgery and cardiac surgery at home and abroad^[3,4,5,6,7]。 However, there are few reports on the application of 3D printing technology in urological surgery. Our hospital applies three-dimensional printing technology to assist NSS surgery and preoperative doctor-patient communication. We now report our preliminary application results.

With the development of imaging technology, more and more small pulmonary nodules have been found, and definite pathological diagnosis is the key to further treatment^[1]。 With the progress of rapid recovery surgical concept and means, single-port thoracoscopic surgery has gradually become an important treatment for small pulmonary nodules^[2,3,4]。 In recent years, spontaneous respiratory anesthesia has been widely used in thoracoscopic surgery because of the rapid postoperative recovery of patients^[5,6,7]。 To provide a 24-hour solution for patients with small pulmonary nodules, we successfully carried out single-port non-catheterization thoracoscopic surgery under spontaneous respiratory anesthesia (anesthesia does not require tracheal intubation, no intraoperative urinary catheter, and no postoperative thoracic drainage tube), and conducted a randomized controlled study with tracheal intubation general anesthesia multi-porous catheterization group as the control group. The results are reported below.

Total laparoscopic simultaneous radical surgery for colon cancer and resection of liver metastases have been widely used in clinical practice because of their advantages such as less surgical trauma and quick postoperative recovery, and their safety, feasibility and radical tumor treatment have been recognized^[1]。 With the advent of the mature Da Vinci robotic surgery system, this system has been widely used in urology, obstetrics and gynecology, cardiothoracic surgery, hepatobiliary and pancreatic surgery, gastrointestinal surgery and other fields^[2]。 From November to December 2014, 58 cases of Da Vinci abdominal surgery were performed in our hospital, including 3 cases of left hemicolectomy and liver metastasis resection at the same time. Based on clinical data, the safety, feasibility and advantages of Da Vinci system-assisted left hemicolectomy and liver metastasis resection at the same time are preliminarily discussed.

Treatment modalities for thoracic spinal stenosis caused by ossification of the posterior longitudinal ligament or herniated disc have changed dramatically in recent years. Thoracic spine surgery is a familiar approach to spine surgeons, the posterior median approach, but because of the sometimes large ossification tissue, access from only one side cannot be completely removed. Therefore, we attempted to apply the posterior median approach, accessing bilaterally, to remove the ossified tissue compressing the thoracic spinal cord to achieve annular decompression for the treatment of thoracic spinal stenosis, with satisfactory results, which are reported below.

A 40-year-old male was admitted to the hospital on 3 January 2013 due to "pain in the right upper abdomen aggravated for more than 2 months and 2 days". He has a history of chronic hepatitis B for 20 years and a family history of hepatitis B (the patient's father and brother both died of liver disease). Physical examination: clear mind, good spirit, good nutrition, no obvious yellowing stain of skin and sclera, no liver palm and spider nevus, flat and soft abdomen, no subcostal reach of liver and spleen, tenderness in right upper abdomen (+), rebound pain (–), Murphy's sign (+), no obvious mass in the whole abdomen, intestinal sound 4 times/min, mobile voiced sound (–), percussion pain in both kidneys (–), no edema in both lower limbs, knee reflex, and no pathological reflex. Results of abdominal color ultrasound examination: (1) gallstones and cholecystitis; (2) thickening of liver echo; (3) No obvious abnormalities were found in pancreas, spleen and bilateral kidneys. There were no obvious abnormalities in thoracic X-ray, electrocardiogram, blood routine, blood biochemical examination, blood amylase and coagulation function. Infection immunization routine: hepatitis B surface antigen (+), hepatitis B surface antibody (–), hepatitis B e antigen (–), hepatitis B e antibody (+), hepatitis B core antibody (+), syphilis antibody (–), hepatitis C antibody (–), HIV antibody (–). Preoperative diagnosis: gallstones with acute cholecystitis.

Female, 13 months of age, admitted to hospital on 19 August 2010 due to "pain in right hip, right hip due to traffic accident, restricted movement for 7 h". Physical examination showed obvious pelvic deformity, enlarged left and right transverse diameters, obvious swelling and deformity of the right lower limb, and subcutaneous ecchymosis in many places such as perineum, right popliteal fossa and back of the calf. Admission diagnosis: hemorrhagic shock, right iliac fracture, right superior and inferior pubic branch fracture, left sacroiliac joint dislocation, right intertrochanteric fracture. After admission, he underwent anti-shock, blood transfusion, catheterization and other treatments. After his condition stabilized, he underwent "open reduction and internal fixation of left sacroiliac joint dislocation, closed reduction and internal fixation of right intertrochanteric fracture and pelvic external fixation" under general anesthesia on August 24, 2010. Under general anesthesia with tracheal intubation, the lateral thigh was taken, and the proximal femur was crossed and fixed with two Kirschner wires of appropriate diameter. The anterior approach of Simpson's left sacroiliac joint was taken, and the skin was incised along the left iliac crest for about 8 cm to expose the left sacroiliac joint. After reduction, the sacroiliac joint was fixed with a plum blossom plate. The right iliac fracture was not reduced, and the bilateral iliac wings were fixed with external fixators. Intraoperative hemorrhage of approximately 300 ml, infusion of 1 unit red blood cell suspension. The child had a smooth operation and a good postoperative recovery. Retrospective pelvic X-ray showed good fracture healing 36 months after surgery (Figure 1)。 The child has no pain, bilateral lower limbs are equal in length, and walking and other activities are normal.