2020年 · 第58卷第04期

Since the outbreak of pneumonia caused by novel coronavirus infection, medical workers across the country, under the strong leadership of the CPC Central Committee and the State Council, have fought fully in the forefront of fighting the epidemic, and resolutely implemented the policy of "strengthening confidence, helping each other in the same boat, scientific prevention and control, and precise policy implementation". Under the guidance of * Thought on Socialism with Chinese Characteristics for a New Era, hundreds of millions of hands held together, and all walks of life jointly prevented and controlled, and resolutely won the people's war, the general war and the blocking war of epidemic prevention and control. The Surgery Branch of Chinese Medical Association will continue to unite and lead fellow surgeons all over the country, and work with the people all over the country to overcome the difficulties together. Whether in the front line or in the rear, the majority of fellow surgeons have shown the lofty spirit of respecting lives, saving lives and healing the wounded, being willing to contribute, and loving boundlessly, and handed over satisfactory answers to the people all over the country with their selfless work of fearlessness, no hesitation, bravery and sacrifice themselves to save others.

A 66-year-old male was admitted to the hospital on 5 February 2020 due to "fever with cough discomfort for 3 days". The patient developed fever without obvious trigger on February 2, with the highest body temperature of 38.0℃, accompanied by fatigue and limb soreness; On February 5th, I went to Fuyang No.6 People's Hospital for examination. The results of chest CT examination showed that both lungs were flaky high-density shadows with blurred boundaries, and the novel coronavirus nucleic acid test was positive. I was referred to our hospital for isolation treatment. Epidemiological investigation results show that there is a history of contact with confirmed cases of novel coronavirus pneumonia. Has a history of hypertension and diabetes for more than 30 years. Preliminary diagnosis: viral pneumonia; Hypertension (grade 2, high risk; type 2 diabetes). After admission, the patient was diagnosed with viral pneumonia (severe). He was admitted to the infected ICU, and his condition improved after being treated with mask oxygen inhalation, antiviral and anti-infection. On February 8th, he was transferred to the general isolation ward for continued treatment. The patient complained of abdominal pain on the morning of February 12th, and the physical examination of right lower abdominal tenderness and rebound pain was negative. After consultation with our department, acute appendicitis was considered, and anti-infection and conservative treatment were strengthened. The symptoms progressively aggravated, and the signs of peritonitis were positive. Emergency examination of lower abdominal CT considered right lower abdominal appendicitis with the possibility of peripheral effusion. Further bedside abdominal ultrasound revealed acute suppurative appendicitis, periappendicular abscess possible.

The patient was a 58-year-old female. He was admitted to hospital on April 8, 2019 due to the discovery of painless masses on his left thigh and below his gluteus maximus. The patient is generally in good condition, with no positive signs in cardiopulmonary and abdominal examination. A 6 cm ×4 cm ×3 cm mass can be palpable in the upper left thigh and below the gluteus maximus muscle, and the range of mobility is acceptable. Laboratory tests showed no abnormalities. Clinical consideration of lipoma. Ultrasound examination showed a hypoechoic mass in the subcutaneous muscle layer, about 6.2 cm ×4.1 cm ×3.2 cm in size, with clear boundaries, regular shape, uneven internal echo, closely related to sciatic nerve, and no obvious blood flow signal (FIG. 1A）。 MRI results showed that an oval mass running along the lateral edge of the sciatic nerve could be seen in the upper left thigh and below the gluteus maximus muscle. T1WI showed isosignal and T2WI showed high signal, with a size of about 53 mm ×43 mm ×34 mm and a clear boundary. Multiple tortuous low signal cord shadows could be seen in it, and the DW1 sequence (b =800) showed high signal. The thigh muscles were continuous, complete and layered, and no abnormal signals were observed; The left femur was structurally intact and no abnormalities in bone signals were observed (FIG. 1B，Figure 1C）。 Consider hemangiomas or tumors of nerve origin.

Clinical applied anatomy is based on human anatomy and is used to solve the problems related to clinical diagnosis and treatment^[1]。 In addition to autopsy, it introduces imaging, surgery and other research methods to deeply reveal the morphological structure, embryonic development, tissue composition, physiological function and adjacent relationship of human local anatomy, pay attention to anatomical variation and deformation, and clarify the pathological state of lesions, including qualitative, localization, classification and staging. Clinical applied anatomy is the foundation of formulating surgical diagnosis and treatment strategy and surgical operation, and it promotes and develops mutually with surgical technique. The diseases of biliary tract surgery are complex and the surgical techniques are diverse. The surgeon needs to master more and more in-depth anatomical knowledge and combine it with surgical techniques.