Objective：To compare and analyze the combined effects and complications of 3D and 2D laparoscopic radical prostatectomy in the treatment of prostate cancer.Methods：Eightytwo patients undergoing laparoscopic radical prostatectomy from June 2015 to April 2017 were selected and divided into group I（3D laparoscopy）and group II（2D laparoscopy）according to the surgical approach.Each group had 41 cases，of which clinical data were retrospectively analyzed.The operation time，intraoperative blood loss，intraoperative nerve retention，urethral reconstruction time，surgical margin positive rate，and other surgical parameters were compared between the two groups.Patients were followed up for half a year and the postoperative urine was compared between the two groups.Incidence of incontinence，retention of erectile function success rate，postoperative biochemical recurrence rate，and other complications.Results：Compared with the 2D group，the operation time（61.35±16.45）min，the intraoperative blood loss（98.73±80.56）ml，and the urethral reconstruction time（23.65±11.39）min were significantly lower in the 3D group，the difference was statistically significant（P<0.01）.Compared with the 2D group，the positive rate of surgical margin（7.3%）was lower in the 3D group，but there was no statistically significant difference（P>0.05）.The incidence of postoperative urinary incontinence in patients in the 3D group（4.88%）was significantly lower than that in the 2D group（21.95%），the success rate of retention of erectile function（43.90%）was significantly higher than that in the 2D group（9.76%）.the biochemical recurrence rate（0.00%）significantly lower than the 2D group（7.32%），the difference was statistically significant（P<0.05）.Conclusion：Compared with 2D laparoscope，3D laparoscopy can more effectively control intraoperative blood loss，shorten urethral reconstruction time，improve the success rate of erectile function retention，and reduce the incidence of postoperative complications.More obvious，worthy of clinical promotion.

Objective：To investigate the antimicrobial resistance pattern of main pathogens in male inpatients with urinary tract infection in department of urology，provide clinical evidences for clinicians to prescribe the appropriate antibiotics and prevent antibiotic resistance.Methods： Analyze the medical records of 2168 cases of male inpatients retrospectively，including age，disease，blood routine examination，urine examination，urine culture and antimicrobial susceptibility test.Results：A total of 2168 cases of patients were collected，of which 402 cases with positive urine culture，the urine culture positive rate was 18.54%.The main pathogens of urinary tract infection are Escherichia coli（37.06%），Enterococcus faecalis（19.9%），Pseudomonas aeruginosa（7.96%），Klebsiella pneumoniae（7.46%），Candida albicans（5.22%）.For Escherichia coli most susceptibility was to Tigecycline，meropenem，imipenem and the most resistance to Ampicillin，piperacillin，cefazolin.For Enterococcus faecalis most susceptibility was to Fosfomycin，teicoplanin，Tigecycline and the most resistance to erythromycin.Conclusion：The pathogens of urinary tract infection are mainly Escherichia coli and Enterococcus faecalis.In clinical work，we can give empirical antibiotic therapy based on the distribution of pathogens in this region or the hospital before we have the results of urine culture，and adjust antibiotic therapy according to the results of urine culture.

Objective：To explore the clinical effect of prostate ultrasound in treating prostatic calculus.Methods：68 patients with prostatic calculi were divided into observation group（n=36）and control group（n =32）according to the final treatment，the observation group was given ultrasonic conductive microwave therapy，while the control group was given conventional treatment，the size of prostate stones and the International Erectile Function Index5 score and so on were observed before and after treatment.Results：1 and 3 months after treatment，the size of prostate stones in the observation group were（23.10±3.82）mm2 and（17.82±1.82）mm2，which were significantly lower than those in the control group（P<0.05）.The IIEF5 scores of the observation group at 1 month and 3 months after treatment were（16.29±2.70）and（13.82±1.91），which were significantly lower than those of the control group（P<0.05）；The maximal urinary flow rate at 1 month and 3 months after treatment in the observation group were（8.72±0.98）ml/s and（14.10±1.21）ml/s，were significantly higher than that in the control group（P<0.05），while the residual urine volume was（40.02±3.82）ml and（16.90±2.20）ml，were significantly lower than that in the control group（P<0.05）；The PSA of the observation group at 1 month and 3 months after treatment were（7.28±1.20）μg/L and（1.65±0.98）μg/L，were significantly lower than that of the control group（P<0.05）.Conclusion：Ultrasoundguided microwave treatment of prostate stones has a better effect，is conducive to improving sexual function，uresis function.

Objective：To investigate the effect of highly selective minimally invasive treatment of varicocele and its effect on serum indexes.Methods：To screening 120 cases of the patients with varicocele as research subjects，which were divided into study group with 60 cases and control group with 60 cases，patients in control group were given laparoscopic cluster spermatic vein ligation and patients in study group were given laparoscopic highselectivity spermatic vein ligation，then the two groups were compared in terms of clinical efficacy and so on.Results：The clinical efficiency in study group（95.0%） was higher than the control group（80.0%）（P<0.05）；There were no significance in immune indexes（P＞0.05）.The immune indexes of IgG，IgA and IgM in study group were （16.8±2.2）g/L，（2128.2±583.0）mg/L，（2518.4±412.2）mg/L，respectively；while in control group were （11.5±1.8）g/L，（1643.9±421.5）mg/L，（1711.7±336.8）mg/L，respectively.The difference between the two groups was statistically significant（P＜0.05）.There was no difference in serum reproductive hormone T，LH and FSH between the two groups（P＞0.05）.The reproductive hormone indexes of T，LH and FSH after surgery in study group were（1.90±0.27 ）ng/ml，（2.42±0.50） mIU/m，（1.45±0.12） mIU/ml，respectively；while in control group were（1.78±0.24 ）ng/ml，（2.84±0.51） mIU/ml，（1.67±0.13） mIU/ml，respectively（P＜0.05）.There was no significant difference in sperm concentration，sperm motility and sperm malformation rate between the two groups（P＞0.05）.Postoperative sperm concentration in the study group was（53.20±7.46）×106/ml，the sperm activity was （72.62±9.52）%，the rate of sperm malformation was （14.35±5.14）%，while in control group were（44.58±7.54）×106/ml，（62.86±8.53）%，（19.66±6.29）%，respectively（P＜0.05）.Conclusion：The laparoscopic highselectivity spermatic vein ligation in the treatment of the patients with varicocele is significant，it is worthy of popular〖LM〗ization and application.

Objective：To analyze the difference in the efficacy of extracorporeal shock wave lithotripsy（ESWL） in the treatment of upper ureteral calculi by transthoracic and dorsal ultrasound.Methods：260 patients with upper ureteral stones treated with ESWL were randomly divided into two groups.The ventral ultrasound was used as the observation group，and the dorsal ultrasound was used as the control group.Ultrasound positioning，therapeutic effect，differences in postcomplications were compared between the two groups.Results：The distance between the observation group and the skin was（3.8±1.3）cm，which was significantly lower than that of the control group[（8.2±2.4）cm]（P<0.05）.The stone location time of the observation group was（5.2±2.4）min，which was significantly shorter than the control group[（12.1±3.2）min]（P<0.05）.The primary clearance rate of the observation group was 90.0%，which was significantly higher than that of the control group（80.0%，P<0.05）.The secondary treatment rate of the observation group was 10% and the three treatment rates were 0，which were significantly lower than the control group（20.0% and 7.7%，respectively），all P<0.05.There was no significant difference in the number of hematuria，renal hematoma and urinary infection between the two groups（P>0.05）.Conclusion：Transthoracic ultrasonography is more accurate than traditional dorsal localization，which is beneficial to further improve the ESWL efficacy of upper ureteral stones，and has high safety.It is worthy of clinical application.

Objective：To investigate the efficacy and application of holmium laser lithotripsy with 4.8F visual needle puncture lithotripsy combined with Niaoshitong in the treatment of <1.5cm renal calculi.Methods：A retrospective analysis was made of the clinical data of 43 patients with renal calculi < 1.5cm treated by 4.8F visual needle puncture lithotripsy combined with holmium laser lithotripsy.The observation group received oral urolithotripsy and water 2500ml/day after operation，and the control group received water 2500ml/day after operation.The stonefree rate and stonefree time of the two groups within 3months after operation were compared.Results：There was no significant difference in age，sex and stone size between the two groups（P>0.05）.The stonefree rate of the observation group was 95.5%（21/22）in the first month after operation，compared with 71.4%（15/21）in the control group（P<0.05）.The stones in the observation group were cleared at the second month of reexamination，and 90.5%（19/21）in the second month and 100% in the third month of the control group.There was no statistical difference between the two groups（21/21）.The stone clearance time in the observation group was（1.05±0.21）months，which was shorter than that in the control group（1.38±0.67）months，with statistical significance（P<0.05）.Conclusion：4.8F visual needle puncture lithotripsy combined with holmium laser lithotripsy can effectively comminute kidney stones less than 1.5cm.Urolithotripsy can promote the excretion of residual stones after operation.The combination of the two methods has certain clinical application value.

Objective:To study the effect of skull base reconstruction after neuroendoscopic transsphenoidal pituitary adenoma resection on the quality of life of patients.Methods:90 patients with pituitary adenoma received the treatment of neuroendoscopic transsphenoidal pituitary adenoma resection combined with skull base reconstruction in our hospital.The resection of pituitary tumors，occurrence of complications and improvement of symptoms 1 month after operation were observed and recorded.The hormone levels were measured before and 1 month after surgery.After 3 months of followup，the Chinese version of SNOT20 scale was used to score the patient's nasal quality of life.Results:The total removal rate of pituitary adenoma was 81.11%.The structure of nasal cavity of 7 patients changed after operation，and the symptoms of menstrual disorder，visual impairment，headache and sexual dysfunction were significantly relieved（P<0.05）.After operation，the abnormal rates of PRL，ACTH，TSH and HGH decreased significantly（P<0.05）.Compared with preoperative，the score of the patient's nasal quality of life tested by the Chinese version of SNOT20 scale were significantly improved.Conclusion:In the treatment of Neuroendoscopic transsphenoidal pituitary adenoma combined with skull base reconstruction，the total resection rate of pituitary tumor is high，the postoperative complications occur less，and the symptom relief rate is high，which can effectively improve the nasal quality of life of patients.

Objective:To explore the relationship between ambient cistern and common complications in patients with craniocerebral trauma.Methods:279 cases of decompressive craniectomy in our hospital from November 2013 to November 2016 were selected to explore the relationship between ambient cistern and common complications in patients with craniocerebral trauma.Results:136 cases with narrow ambient cistern，38 cases had no postoperative complications，58 cases had a kind of complications，31 cases had two kinds of complications，9 cases had three kinds of complications.38 cases of gastrorrhagia，24 cases of pulmonary infection，21 cases of hyperglycaemia，16 cases of urinary tract infection，20 cases of diarrhea，14 cases of delayed intracranial hematoma，15 cases of the others.There were 84 cases of unilateral ambient cistern occlusion.There were 30 case of one kind of complications，42 case of two kinds of complications，12 case of three or more kinds of complications，including 49 cases of gastrorrhagia，38 cases of pulmonary infection，25 cases of hyperglycaemia，8 cases of urinary tract infection，13 cases of diarrhea，9 cases of delayed intracranial hematoma and 11 cases of the others.There were 59 cases of both sides of blocked ambient cistern.There were 6 case of one kind of complications，18 case of two kinds of complications，35 case of three or more kinds of complications，including 53 cases of gastrorrhagia，51 cases of pulmonary infection，33 cases of hyperglycaemia，2 cases of urinary tract infection，2 cases of diarrhea，6 cases of delayed intracranial hematoma and 10 cases of the others.Conclusion:The more serious the change of the ambient cistern，the more kinds of postoperative complications.The incidence of gastrorrhagia，pulmonary infection and hyperglycaemia was positively associated with the degree of compression，the incidence of diarrhea was negatively correlated to the degree of compression，delayed intracranial hematoma and urinary tract infection was not associated with the degree of compression.

Objective:To study the joint mesangial thyroid resection in the application of thyroid cancer radical.Methods:A prospective study of hospitalized in our department of 17 patients with thyroid cancer，using joint mesangial block resection of thyroid，statistics postoperative complications（bleeding，low calcium convulsions，voice hoarse，choking cough），number of lymph node cleaning，laryngeal recurrent nerve and protection，parathyroid gland，parathyroid hormone reduce，etc.，to evaluate the safety and clinical efficacy.Results:17 patients had smooth operation，16 cases of papillary carcinoma and 1 case of follicular carcinoma.The recurrent laryngeal nerve was revealed all the way after the free film in the operation，without injury.A total of 29 parathyroid glands of A1 and A2 were identified.Six B1 parathyroid glands were isolated and pathologically confirmed in the film.The average number of lymph nodes was 5.6±2.1，and the positive lymph node was 3.3±1.2.Intraoperative hemorrhage was（28.0±5.6）ml，and the incision drainage fluid was（34.0±7.6）ml.No hoarseness and cough were observed after the operation.There were 2 cases of temporary parathyroid hormone reduction after operation，and normal after calcium supplementation，and no permanent parathyroid hormone decreased.Conclusion:Thyroid joint mesangial block resection，can quickly and show all the laryngeal recurrent nerve，prevent damage；Can be more thoroughly cleaning the lymph node in central region，effectively protect the parathyroid gland；Surgery is safe，effective，reduce the operation difficulty，improve the quality of operation，more in line with the whole piece of tumor resection and diseasefree contact principle.

Objective:To study the feasibility of abdominal mediastinal drainage tube placement for “nontube no fasting” enhanced recovery after surgery for oesophageal cancer.Methods:108 oesophageal carcinoma patients who underwent minimally invasive oesophagectomy（MIE）in our department.There were 56 cases in group A and 52 cases in group B.All patients underwent MIE by the same surgeon.Only the mediastinal canal was placed postoperatively（No chest tube,stomach tube,nutrition tube,etc）.Group A were treated with a transthoracic mediastinal drainage tube，Group B were treated with an abdominal mediastinal drainage tube.The incidence of postoperative complications and pain scores were compared between the two groups.Results:The maximum pain scores in Group B were significantly lower than those in Group A from the first to the fourth postoperative days：[（3.9±0.7）vs.（2.3±0.7），（3.5±0.8）vs.（2.1±0.7），（3.3±0.8）vs.（1.7±0.8）and（3.1±0.7）vs.（1.7±0.8），all P<0.05].Group B contained fewer postoperative analgesic drug users[（39.3% vs.15.4%），P<0.05]，included fewer cases of closed thoracic drainage[（10.7% vs.0），P<0.05].Conclusion:Mediastinal drainage tube placement in the abdominal cavity after MIE can reduce postoperative pain，promote postoperative recovery and improve postoperative quality of life.The treatment was safe and feasible.

Objective:The experience of treating giant mediastinal tumor was summarized.Method:A total of 31 patients received radical surgery.The surgical rout was based on the location and growth direction of the tumor，while the surgical mode depended on the involved tissues surrounding the tumor.Three Tshape incisions，5 Hemiclamshell incisions and 23 posterolateral incisions were performed.The parameters associated with perioperative managements were analyzed.Result:14 malignancies and 17 benign tumors were included.The average age was younger for patients with malignancies than benign tumors（P<0.05）.The average volume was larger for patients with malignancies than benign tumors（P<0.05）.The durations of surgery，drainage and stay in hospital were longer for malignancies（P<0.05）.The bleeding was much more for malignancies（P<0.05）.Extended tumorectomy were always made for malignancies.Piecemeal resection was suitable for gigantic tumors within superior mediastinum（especially for malignancies）.All the malignancies received adjuvant chemotherapy after surgery and achieved good prognosis.Conclusion:Surgery was recommended for giant mediastinal tumors.It was sufficient evaluation before surgery and rational surgical strategy that achieved better prognosis.The selectivity of surgical rout and mode was the key to success.

Objective:To explore the clinical application of cervical incision combined with videoassisted thoracoscopic surgery approach in cerviomediastinal benign tumor resection.Methods:We retrospectively analyzed clinical data of six patients with cervicomediastinal tumor undergoing resection via a cervical incision combined with videoassisted thoracoscopic surgery.Results:All the six patients were successfully completed the surgery，without conversion to open surgery or any other surgical related complications.The average operative time was（108.3±16.9）min，and intraoperative bleeding was（51.7±16.3）ml.The postoperative hospitalization stay was（4.3±1.0）d with short cervical drainage[（1.3±0.5）d]and chest tube[（（2.7±0.8）d] indwelling time.Pathological reports demonstrated four cystic lymphangiomas，one nodular goiter and one lipomyoma.No tumor recurrence was seen during 6～32 months followup period.Conclusion:Cerviomediastinal benign tumor resection via cervical incision combined with videoassisted thoracoscopic approach is safe and effective.

Objective:To investigate the causes and treatment of anastomotic leakage after resection of esophageal carcinoma.Methods:3815 cases of esophageal and cardiac cancer were treated by operation.320 cases of anastomotic leakage were diagnosed after operation，and the causes and related factors of anastomotic leakage were analyzed.According to the conservative treatment of anastomotic leakage，they were divided into 2 groups：the internal drainage group（endoscopic direct drainage under the drainage tube），and the external drainage group（closed thoracic drainage）were 38，282 cases，respectively.The time of extubation，the time of hospitalization and the mortality in the perioperative period were compared between the two groups.Results:The incidence of anastomotic leakage after esophageal cancer resection was 8.39%，and the mortality was 1.88%.Anastomotic leakage was related to age，location of anastomotic position，average gastric flow of 3 days after operation（P＜0.05）.The extubation time[（23.50±18.64）d vs.（30.60±14.08）d] and hospitalization time [（32.45±20.60）d vs.（54.12±25.08）d] of the internal drainage group were significantly shorter than those of the external drainage group （P＜ 0.05），and there was no significant difference in the mortality rate （0 vs.2.13%）（P＞0.05）.Conclusion:The incidence of anastomotic leakage in patients with younger than 60 years，Inferior anastomosis of the aortic arch and more average gastric flow of 3 days after operation was low.The placement of internal drainage through the fistula in endoscopic vision can rapidly improve the symptoms，shorten the extubation and hospitalization time，and is worthy of popularization.

Objective:To analyze the clinical advantages，prognosis and safety of transurethral singlehole laparoscopic cholecystectomy（TULESS）compared with the traditional endoscopic cholecystectomy.Methods:100 patients with benign gallbladder disease were selected in our hospital.According to different surgical methods they were divided into two group，50 cases in each group.Group A treated with TULESS，group B used of traditional laparoscopic treatment.The surgical status，postoperative 3dVAS score，postoperative abdominal aesthetics and hospitalization were evaluated.Results:The average size of incision，blood loss，postoperative exhaust time，hospital stay time，postoperative complications rate，postoperative 3dVAS score and hospitalization costof group A were lower than group B，the difference was statistically significant（P<0.05）.The postoperative aesthetic satisfaction score of abdominal wall in group A was higher than that of group，the difference was statistically significant（P<0.05）.Conclusion:Compared with the traditional endoscopic cholecystectomy，TULESS operation has characterized of less damage to the patient，reduce postoperative complications，rapid recovery，with higher degree of cosmetic abdominal wall.

Objective:To investigate the clinical effect of patella concentrator combined with hollow screw in the treatment of comminuted patellar fracture.Methods:29 cases with comminuted patellar fracture that treated with patella concentrator combined with hollow screw were retrospective analyzed.Fracture healing time，surgical complications and joint function recovery were observed.Results:A total of 29 patients had regular followup from 6 to 17 months（10 months on average），the cases showed excellent，good and poor were 21，7 and 1，respectively.The rate of fineness was 96.9% based on modified Bostman evaluation.The fractures were healed in all the cases without loosening，breakage and reject reaction of internal fixation.Conclusion:Treatment for comminuted patellar fracture using patella concentrator combined with hollow screw should be in accordance with the biomechanical principle，and achieved with anatomical reduction and recovery of joint surface，which is a good and simple method for the treatment of comminuted patellar fracture with stable fixation and fewer complications.

Objective:To evaluate the clinical efficacy of bipolar femoral head replacement for Garden stage Ⅲ and Ⅳ femoral neck fracture patients accompanied with Parkinson’s disease.Methods:23 bipolar femoral head replacement were performed in femoral neck fracture patients with Parkinson's disease.Artificial bipolar femoral head replacement for displaced femoral neck fractures was performed and its efficacy was evaluated.Results:The average blooding loss was（220.0±34.5）ml（120～360ml）.The average operating time was（65.0±10.5）min（50～75min）.Followup was lost in 4 patients，2 patients died of cardiovascular and cerebrovascular events at 3 and 9 months after surgery，and 1 patient died of pulmonary infection at 14 months after surgery.Common postoperative complications were pneumonia，deep vein thrombosis and urinary tract infection.The Harris hip score was excellent in four patients，good in twelve patients，fair in four patients and poor in one patients after one year operation.Two patients died at 3 and 9 months postoperatively without scoring，excellence rate was 69.6%.Conclusion:Bipolar femoral head replacement is a satisfactory treatment for the femoral neck fractures in patients accompanied with Parkinson's disease，but the incidence of complications is high and the function recovery is difficult.

Objective：To explore the risk factors and preventive measures of periprosthetic femur fracture（PFF） after hip replacement.Methods：We retrospectively analysed 150 cases of hip replacement.Logistics regression was carried out to analyse the correlation between the preoperative，intraoperative and postoperative parameters and PFF.Results：130 of the 150 patients finished the followup and the followup rate was 90.0%.The average followup time was 31.2 months（25.3 to 42.5 months）.In the 135 cases of patients who finished the followed up，15 cases（11.1%）had PFF，and 120 cases（88.9%）had no PFF.Logistic regression analysis showed that age and type of prosthesis（biologic type）were the risk factors of PFF after hip replacement.The ROC（receiver operating characteristic）curve showed that area under curve（AUC 0.82）and biological prosthesis（AUC 0.80）owned good predictability for PFF after hip arthroplasty.Conclusion:Age and type of prosthesis（biologic type）were the risk factors of PFF after hip replacement，and special attention should be paid in the clinics.

Objective:To research the MRI examination and diagnostic value of intervertebral space infection after nucleus pulposus extraction in patients with lumbar disc herniation.Methods:86 cases of intervertebral space infection after lumbar disc herniation in our hospital were selected as the research objects.All patients were given MRI examination，and gave positive treatment after diagnosis.Analyzed the MRI diagnostic results，and observed the changes of WBC count，ESR and C reactive protein levels before and after treatment.Result:The location of infection in 86 cases of intervertebral disc infection was mostly located in L4～L5 or L5～S1 intervertebral space.The intervertebral disc showed varying degrees of intervertebral disc fragmentation，smaller，disappeared，and uneven edge.MRI examination showed that the intervertebral disc space of lesion lost normal shape and signal，a 77 cases with long and low T1 signal，9 cases with equal T1 signal，82 cases with long and high T2 signal，4 cases with short and short T2 signal.The lesions in 86 cases of intervertebral disc infection showed different degrees of damage to the vertebral endplate and the adjacent vertebral spongy bone around the intervertebral disc.The surrounding part of adjacent vertebral bodies had abnormal signal appears（75 cases），the whole vertebral body signal was abnormal（11 cases）.Most of them were characterized by long T1 signal and long T2 signal，while a few of the lesions showed mixed signals dominated T2 signal.The soft tissue adjacent to the vertebral body showed swelling and thickening，and T1 showed equal signal，slightly higher signal or mixed signal，and T2 showed high signal.MRI enhanced scan was performed in 21 cases，the pathological changes of intervertebral disc，adjacent vertebral body and paravertebral soft tissue were obviously enhanced.After 6 months of followup，A total of 63 patients with complete disappearance of clinical symptoms，accounting for 73.26%.All the patients had significantly lower WBC counts，ESR and C reactive protein levels than before treatment（P<0.05）.Conclusion:In the diagnosis of lumbar disc herniation discectomy intervertebral space infection after MRI，check to fully display the lesion site of infection，it is important for early diagnosis and treatment of intervertebral space infection.

 

Aortic dissection is recognized as a dangerous disease.Although AD cannot be detected before it occurs，this does not mean that it cannot be prevented.Currently，it is believed that the control of blood pressure can prevent the occurrence of AD，while the stereotyped blood pressure control will affect the normal life of some people.Theoretically，the personalized blood pressure control plan can solve the above problems，but its formulation needs to be based on the elasticity of the aortic wall.This paper will discuss the feasibility of individualized depressurization.