2016年 · 第54卷第04期

Laparoscopic radical thyroidectomy with transthoracic and breast approach has been widely carried out in recent years and has become the first choice approach for complete laparoscopic radical thyroidectomy^[1,2]。 Because the sternum stem and clavicle occlude the visual field and operating space in this approach, there is a blind spot during lymph node dissection in the central area of the neck, which may not be completely dissected. Therefore, the presence of superior mediastinum and retroclavicular lymph node enlargement before operation is an absolute contraindication of this approach^[3,4]。 The operating angle of laparoscopic thyroid surgery under transoral floor approach is from head side to foot side, and there is no retrosternal and retroclavicular blind area, which makes up for the defects of thoracic-mammary approach^[5,6]。 Since November 2014, our hospital has combined thoracic-mammary approach and floor-of-mouth approach for laparoscopic thyroidectomy plus central lymph node dissection, and explored the feasibility of laparoscopic bilateral total thyroidectomy plus central lymph node dissection with combined transthoracic and transoral approach.

tethered cord syndrome (TCS) refers to the nerve damage syndrome caused by longitudinal traction of the spinal cord, low cone position, and pathological changes of the spinal cord caused by various reasons. Surgical release of tethering factors is an effective treatment for this disease^[1]。 From January 2007 to January 2015, 30 cases of TCS were treated by endoscopic surgery in our department. The treatment experience is summarized and reported below.

The incidence of hypothalamic hamartoma is extremely low, and the clinical manifestations are mainly refractory and mixed epileptic syndrome, cognitive and behavioral abnormalities and precocious puberty; Among them, epilepsy is basically drug-refractory epilepsy, and more than 95% of patients are ineffective in drug treatment^[1]。 Surgical resection of the mass is the main and effective method for the treatment of this disease. However, because the appearance of hypothalamic hamartoma is similar to normal brain tissue, there is no obvious boundary, and the location is deep, it is difficult to remove the mass in one operation. According to data from the Barrow Neurological Institute in the United States, 13% of patients need reoperation^[2], even three times^[3]Treatment can effectively relieve seizures. We reoperated 5 cases of refractory epilepsy caused by hypothalamic hamartoma with good results, which are reported below.

A 61-year-old female was admitted to the hospital on 1 April 2012 due to "pain and discomfort in her right hip progressively worsening for 1 month". The patient had undergone right hip arthrodesis for right hip tuberculosis more than 40 years ago. Admission physical examination: claudication gait, old surgical scar visible on right hip, normal skin color, low skin temperature, no superficial venous distension. Local tenderness and percussion pain were positive. Right hip ankylosis, right knee, ankle movement normal. The X-ray film showed the right hip joint fusion, and the fusion area showed expansive osteolytic bone destruction, cortical thinning, and multiple incomplete bone ridges without obvious sclerosis (FIG. 1A)。 CT scan showed slightly cystic expansive osteolytic bone destruction in the fusion area, thinning of the cortex, patchy slightly high-density shadows and a few punctate calcifications in the capsule, and chamber division, with low-density shadows in the chamber. A little hardened edge was seen around the lesion, and the muscles around the hip joint were atrophied. MRI showed that the right hip lesion showed expansive changes. The lesion was mainly isosignal or slightly low signal on T1WI, with multiple patchy slightly high signal and low signal scattered in the center. On T2WI, there was obvious high signal around the lesion, mixed heterogeneous signal in the center, and annular or incomplete annular low signal bands were seen on T1WI and T2WI at the edge of the lesion (FIG. 1B)。 There were no abnormalities in laboratory examination and thoracic and abdominal CT examination. Preliminary clinical diagnosis: space-occupying lesion of right hip, aneurysmal bone cyst (ABC) possible, after right hip fusion.

The patella is the largest sesamoid bone in the human body. It ossifies from the age of 3 to 5 years old and lasts until the age of 9 to 10 years old. Most children have only one ossification center, and about 23% of children have 2 to 3 ossification centers. About half of the population completed patellar fusion in childhood and adolescence, while the rest of the population failed to fuse the lateral superior accessory ossification center with the main patella, eventually resulting in bipartition or multipartition of the patella. The bipartite patella is usually asymptomatic, but it is one of the causes of anterior knee pain in adolescents and young athletes. Most patients with painful bipartite patella can be cured by conservative treatment, and surgical treatment can be considered when conservative treatment is ineffective. The surgical method most commonly used to treat a painful bipartite patella at present is the removal of the accessory patella, but when the accessory patella is large, the removal can lead to patellofemoral joint discoordination. The new progress in the diagnosis and treatment of bipartite patella is reviewed.

The patient was a 50-year-old male. Due to intermittent painless macroscopic hematuria for 2 weeks. B-ultrasound of urinary system: A strong echoic mass with a maximum diameter of 2.5 cm could be detected in the right side wall of bladder, and no smooth muscle infiltration was observed. Bladder cancer stage T1 was considered. Transurethral resection of bladder tumor was performed, and the tumor was seen by cystoscopy before operation (Figure 1), the tumor was resected to the root and the 0.5 cm bladder mucosa surrounding the tumor was electrocoagulated (Figure 2)。 Postoperative pathological diagnosis: low-grade urothelial carcinoma, G1pT1.