Objective：To discuss the clinical presentations and therapeutic principles of postoperative lobar torsion after video assisted thoracoscopic surgery（VATS）pneumonectomy.Methods：To analyze retrospectively 3 cases of postoperative lobar torsion after VATS right upper lobectomy，including 2 systematic lymph node dissection and 1 lymph node sampling.Results：3 cases were all the postoperative middle lobar torsions.Postoperative radiographs demonstrated atelectasis in 1 patient and atelectasis and consolidation in 2 patients.Bronchoscopy showed different narrowing bronchus orifice of the middle lobe.The diagnosis of lobar torsion was made an average of（3.67±2.52）d（range 1 to 6days）after the initial operation；2 patients underwent direct resection and 1 patient underwent reposition.Average hospitalization was（8.67±4.73）d and range from 5 to 14 days.No Complications happened after reoperation.Conclusion：Complete pulmonary fissure and higher range of motion of the residuary lobe are the major risk factors of postoperative lobar torsion after VATS pneumonectomy.For patients with high suspicion of lobe torsion，reVATS should be performed as quickly as possible.Indirect resection is still preferred if the lung function permits.

Objective：To investigate the longterm efficacy and prognostic factors of minimally invasive esophagectomy of advanced esophageal cancer.Methods：The clinical data of 128 cases of advanced esophageal cancer minimally invasive esophagectomy were collected.The outcome measures included treatment，postoperative pathology，follow-up and prognostic factors.Onefactor analysis was conducted by χ2 test.The influencing factors of P<0.05 in Onefactor analysis were further included into cox regression model for multifactor analysis.Results：128 patients successfully completed the operation，and none of them were converted to open.The operation time of 128 patients was（287±61）min，and the intraoperative blood loss was（134±181）ml.The number of lymph node dissection in 128 patients was（21±8）per case，all of which were R0 resection；tumor diameter was（4.5±2.3）cm；The 5year overall survival rate of 128 patients was 24.2%，and the progressionfree survival rate was 18.0%.Univariate analysis showed that age，N stage，M stage and TNM stage were related factors affecting the 5year overall survival rate of postoperative minimally invasive esophagectomy；also，affecting 5year progressionfree survival rate.Multivariate analysis showed that N stage，M stage and TNM stage were independent influencing factors of 5year overall survival rate and progressionfree survival rate after minimally invasive esophagectomy of advanced esophageal cancer.Conclusion：The longterm results of minimally invasive esophagectomy of advanced esophageal cancer are satisfactory.The tumor N stage，M stage and TNM stage are independent factors affecting the overall survival rate and progressionfree survival rate of postoperative patients.

Objective：To determine the expression of Snail and Ecadherin in esophageal squamous cell carcinoma （ESCC）.To detect the effect of Snail on influencing the migration and invasion of ESCC by targeting Ecadherin.Methods：The expression of Snail and Ecadherin were detected in 30 clinical ESCC samples and its adjacent normal epithelial samples via Polymerase Chain Reaction （PCR）.The relative expression of Snail and Ecadherin in ESCC and its adjacent normal tissue were analysed with these 30 patients’ clinical pathological characteristics .The expression of Snail and Ecadherin in 4 random pairs of these 30 samples were investigated via Western Blot.Based on cell transfection of one ESCC cell line，the expression of Snail was downregulated with the Snail small interfering RNA （siRNA）.Then the expression of Snail and Ecadherin expression in these models were analyzed and the cell wound healing assay and invasion functional experiment were carried out.Result：The relative expression of 30 cases of esophageal squamous cell carcinoma was higher than that of the adjacent tissues of Snail（1.96±0.75/0.52±0.43，P=0.04），the relative expression of Ecadherin was low（0.66±0.31/2.19±0.62，P=0.02）.Depth of tumor invasion （P=0.009）and tumor metastasis to lymph nodes （P=0.047）were associated with overexpression of Snail and lowexpression of Ecadherin .In 4 random matched samples，the expression of Snail was 0.73±0.13 in cancer samples and 0.23±0.08 in its adjacent samples，meanwhile the expression of Ecadherin was 0.10±0.06 in tumor tissues and 0.60±0.14 in normal tissues（P=0.00）.The cell line EC109 was selected into the transfection model.Compared with negative control group，depression of Snail（0.53±0.05/1.00±0.15，P=0.00）could restore the expression of Ecadherin （3.28±0.26/1.00±0.18，P=0.00）in mRNA level，as well as in the level of protein（0.25±0.05/0.41±0.10，P=0.03；0.83±0.11/0.29±0.05，P=0.02）.Downregulated the expression of Snail also decreased the capability of migration and invasion in EC109（P<0.05）.Conclusion：Relatively high expression of Snail in ESCC may influence the migration and invasion in ESCC by regulating Ecadheirn.

Objective：To explore the preoperative influencing factors for cervical lymph node metastasis in thoracic midupper esophageal carcinoma patients.Methods：A total of 64 esophageal carcinoma patients were divided into two groups，namely the metastasis group（20 cases）and nonlymph node metastasis group（44 cases）.The preoperative clinical data of the two groups were compared and analyzed the independent risk factors of cervical lymph node metastasis.Results：In the preoperative clinical data of patients with midupper esophageal carcinoma，the results of ultrasound examination included short diameter，aspect ratio，internal echo，RI value were closely related to the occurrence of cervical lymph node metastasis，and were statistically significant（all P<0.05）.Thoracic lymphatic enlargement，thoracic lymphatic enlargement along recurrent laryngeal nerve have significantly difference between the two groups（all P<0.05）.ROC curve analysis demonstrated important significance of short diameter and RI value in predicting cervical lymph node metastasis，with the area under ROC curve being 0.823，0.694，respectively.Logistic regression analysis showed that aspect ratio，thoracic lymphatic enlargements along recurrent laryngeal nerve were independent risk factors for cervical lymph node metastasis in esophageal carcinoma patients.Conclusion：The short diameter，aspect ratio，internal echo，RI value，thoracic lymphatic enlargement and thoracic lymphatic enlargement along recurrent laryngeal nerve may be important indexes in predicting cervical lymph node metastasis in patients with thoracic midupper esophageal carcinoma，moreover，the lymph node aspect ratio，thoracic lymphatic enlargement along recurrent laryngeal nerve are the independent risk factors of cervical lymph node metastases in patients with esophageal carcinoma.

Objective：To investigate the gene distribution of esophageal squamous carcinoma in han population in northwest China.Methods：52 patients with esophageal squamous cancer who had undergone esophagectomy were studied.The clinical data and the results of genetic test of these patients were collected.The relationship between gene expression and the clinical pathological characteristics were studied.Luminer liquidphase chip and FISH method were used.Results：Eighteen esophageal cancer related genes，including ERCC1，BRCA1，TYMS，RRM1，TUBB3，STMN1，TOP2A，EGFR，PDGFR，VEGFR1，VEGFR2，VEGFR3，KIT，HER2，IGF1R，PTEN，PDL1and 21gene，were tested and only 10 genes were positive expressed（positive rate 55.2%），including ERCC1，BRCA1，TYMS，RRM1，TUBB3，STMN1，TOP2A，VEGFR1，HER2，PTEN.The expression levels of ERCC1，TUBB3，HER2 and PTEN had no significance correlation with clinicopathological characteristics in esophageal squamous cancer patients.The lymph node metastasis rate and tumor stage of low expression level of TYMS patients was statistically higher than high expression patients（P<0.05）.The expression level of RRM1 was statistically associated with smoking（P<0.05）.Conclusion：The gene expression was specific in esophageal squamous cancer patients of Chinese Han population from singlecenter of northwest China and this study may supply the potential targets for the genetic treatment of esophageal squamous cancer.

Objective：To compare the results of the two different uniport locations between the 4th anterior axillary intercostal space and the 7th mid axillary intercostal space to develop a better surgical approach.Methods：Nintysix patients with unilateral primary spontaneous pneumothorax were treated with uniport VATS operation. They were divided into two groups, 37 cases of which took the anterior axillary line of the 4th intercostal space as the surgical incision, and 59 cases of them took the middle axillary line of the 7th intercostal as the surgical incision,the incision length was 2cm.The perioperative indicators differences were analyzed by statistical method.Results： None case with complications appeared from uniport to multiport, opening the chest, death, postoperative infection and chest infection. There were significant differences in the hospital stay, the amount of drainage, operation time, the time of chest drainage tube keeping, the time of pleural leakage, pain duration after operation, and hospitalization cost (P<0.05).The number of surgical stapler in the 4th intercostal group was less than the 7th intercostal group, the number of pulmonary bulla ligation in the 4th intercostal group was more than the 7th intercostal group(P<0.05).Conclusion：The study indicated that uniport VATS in the 4th anterior axillary intercostal space for the treatment of primary spontaneous pneumothorax is feasible and reliable, and can be used as a priority way.

Objective：To explore the diagnostic values of long noncoding RNA (lncRNA) ANRIL，matrix metalloproteinase2 (MMP2) and serum amyloid protein A (SAA) for esophageal cancer，and the relationship between the three and the clinicopathological features of esophageal cancer.Methods：80 cases of esophageal cancer diagnosed in our hospital from January 2016 to December 2017 were collected，and 100 healthy people were recruited in our hospital during the same period.The levels of lncRNA ANRIL in the peripheral blood of subjects were detected by realtime quantitative PCR (RTPCR).Enzymelinked immunosorbent assay (ELISA) and enzyme methods were used to detect MMP2 and SAA levels，respectively.Results：Serum lncRNA ANRIL，MMP2 and SAA levels in patients with esophageal cancer were significantly higher than those in healthy subjects，and the difference were statistically significant (P<0.05).In addition，the expressions of lncRNA ANRIL，MMP2 and SAA in serum of patients with esophageal cancer were significantly correlated with TNM stage，histology classification and differentiation degree of tumor(P<0.05)，and the levels of lncRNA ANRIL，MMP2 and SAA in advanced esophageal cancer，esophageal adenosquamous carcinoma and poorly differentiated esophageal cancer patients were increased most significantly.When combined with lncRNA ANRIL，MMP2 and SAA，the area under the curve (AUC) to distinguish between esophageal cancer and healthy subjects was 0.927（95% CI：0.900～0.954，P<0.05），the sensitivity was 80.1%，specificity was 90.4%.Multivariate analysis showed that serum lncRNA ANRIL，MMP2 and SAA levels were independent risk factors for esophageal cancer.Conclusion：lncRNA ANRIL，MMP2 and SAA have diagnostic values for esophageal cancer.In addition，lncRNA ANRIL，MMP2 and SAA can also serve as reference index for predicting the risk of esophageal cancer.

Objective：To investigate the expression of interferoninduced transmembrane protein 3（IFITM3），Galectin7 and Galectin9 of midthoracic esophageal squamous cell carcinoma（ESCC）and relationship with lymphatic metastatic recurrence after modified Ivorlewis esophagectomy.Methods：91 patients with midthoracic ESCC underwent modified Ivorlewis esophagectomy with twofield lymphadenectomy were enrolled，the expression profile of IFITM3，Galectin7，Galectin9 protein of samples of the ESCC tissues and paracarcinoma tissues were detected by immunohistochemistry（IHC），the relationship of IFITM3，Galectin7，Galectin9 expression and lymphatic metastatic recurrence was analyzed.Results：The expression of IFITM3 and Galectin7 in samples of ESCC tissues was significantly higher than the paracarcinoma tissues，while the expression of Galectin9 was significantly lower than the paracarcinoma tissues，the  differences were statistically significant（P＜0.05）.The positive expression rate of IFITM3，Galectin7，Galectin9 in samples of ESCC tissues was 57.14%，65.93% and 60.44%，respectively；and the positive expression rate was 13.19%，5.49% and 89.01% in samples of paracarcinoma tissues，respectively.Tthe difference was statistically significant（P＜0.05）.With the increase of TNM stage，the positive expression rates of IFITM3 and Galectin7 were significantly increased（P＜0.05）.There was 37 patients（40.66%）with lymphatic metastatic recurrence within 3 years after surgery，the TNM stage，IFITM3 and Galectin7 overexpression，and Galectin9 underexpression were independent risk factors forymphatic metastatic recurrence（P＜0.05）.Conclusion：IFITM3，Galectin7 overexpression and Galectin9 underexpression might involve in occurrence and development of the midthoracic ESCC.It may be closely related to improved lymph node metastasis after Ivorlewis surgery.

Objective：To analyze the clinical features，the extent of tumor removal and the prognosis of patients of cerebellum solidcystic tumors in different age groups.Methods：The clinical datas of 68 cases of cerebellum solidcystic tumors with MRI was retrospectively analyzed.Patients younger than 18yearold or 18yearold were grouped into the adolescent group and patients older than 18yearold were grouped into the adult group.Results：The predominant pathological type of tumors was pilocytic astrocytoma（PA）（n=20，55.5%）in adolescent group，and hemangioblastoma（HB）（n=13，40.6%）in adult group（χ2=28.69，P＜0.01）.Additionally，tumor resection rate and curative rate of medulloblastoma（22.2% and 33.3%）in adult group was lower than those in adolescent group（50.5% and 44.4%）.The 100% of total tumor resection rate of PA and HB was demonstrated in adolescent group and adult group，however，tumor curative rate of PA in adolescent group was 94.7% and of HB in adult group was 81.8%.No statistical difference of occurrence rate of postoperational complications was detected in these two groups.Conclusion：The predominant pathological type of tumors was PA in adolescent group and HB in adult group.Patients with PA and HB have a high resection rate and a good prognosis.However，the total medulloblastoma resection rate of adult and adolescent patients was low and the prognosis was even worse.

Objective：To explore the diagnosis and treatment of antepartum mastitis.Methods：The clinicopathological，operative and followup data of 23 cases of antepartum mastitis were retrospectively analyzed.Results：The clinical and pathological data of all the 23 patients were complete.All patients had received core biopsy in the outpatient department.Among the 14（60.8%）patients treated with antibiotics alone，4（17.4%）patients had complete response after antibiotic treatment，6（26.1%）patients had abscess  during treatment，2（8.7%）patients had no significant remission，and 2（8.7%）patients underwent radical surgery after symptom aggravation.Abscess formation was found in 9（39.1%）patients at the initial diagnosis，and a total of 15（65.2%）patients underwent abscess incision and drainage with small incision.Postoperative complications such as hemorrhage and recurrent infection were not found in any patients.All patients gave birth normally，without premature birth，abortion，overdue birth，deformed baby，etc.，and the fetus was healthy.The patients were followed up for 2 years，and no recurrence was found.Conclusion：Prenatal mastitis patients，need to consider the safety of the fetus，according to the condition of the choice of the least damage，the best therapeutic regimen.

Objective：To study the clinical effect of laparoscopic highly selective pericardial devascularization combined with splenectomy in the treatment of portal hypertension.Methods：48 patients with portal hypertension were divided into the laparotomy group (open pericardial devascularization) and the endoscopic group (Laparoscopic pericardia devascularization) according to the surgical methods. Each group had 24 patients, and the clinical efficacy of the two groups was observed and compared.Results：After surgery, the decrease of alanine aminotransferase(ALT), aspartate aminotransferase(AST)and total bilirubin(TBIL)in the laparoscopic group(△〖AKX-〗=45.00、△〖AKX-〗=35.59、△〖AKX-〗=25.79) was significantly greater than that of open surgery group(△〖AKX-〗=49.34、△〖AKX-〗=43.17、△〖AKX-〗=27.88). The difference between the two groups was statistically significant(P<0.05).The overall complication rate in the laparoscopic surgery group (16.67%) was significantly lower than that of the open surgery group (58.33% ). The patients were followed up for 1 year, the overall incidence of complication of laparoscopic surgery group (4.17%) was lower than that of open surgery group (29.17%), the difference was statistically significant(P<0.05).Conclusion：Portal hypertension treated by laparoscopic pericardial devascularization with ALT, AST, TBIL recover faster,less postoperative complications, and better quality a life than pericardial devascularization.  

Objective：To evaluate the feasibility and safety of simple splenectomy with miniincision.Methods：It reviewed the perioperative outcomes of 13 patients who received simple splenectomy with miniincision from April 2016 to December 2017.Results：The average hours of spelenectomy were 40min. The average length of incision was 10cm The average amount of bleeding during operation was 200ml and the average days of postoperative discharging were 10.5d. 2 patients were with postoperative pancreatic fistula, 2 patients were with postoperative splenopyretic and 2 pantents were with postoperative left pleural effusion. No complications or deaths directly resulted from the surgery happened in the rest patients.Conclusion：Simple splenectomy with miniincision is a new method of splenectomy with feature of less time consuming, minimal invasive, easy to popularize, safety and feasibility, which is suitable for various kinds of the spleen disease.

Objective：To compare the efficacy of midline sphincterotomy plus anal sinus drainage or lateral incision of internal sphincter in chronic anal fissure.Methods：106 chronic anal fissure patients treated were selected and randomly assigned to two groups, 53 cases each group. The study group was treated with midline sphincterotomy plus anal sinus drainage; the control group was treated with lateral incision of internal sphincter. The therapeutic effect was compared.Results：The total effective rate in the study group and control group was 98.11% and 94.34%, without statistical differences (P＞0.05); the complication rate and recurrence rate in the study group was 5.66% and 7.55%, which was lower than that of control group (16.98%, 20.75%) (P＜0.05); the wound healing time and hospitalization time in the study group was shorter than control group (P＜0.05); before surgery, the VAS (visual analogue scale) scores and quality of life scores showed no statistical differences (P＞0.05); after surgery, the related scores in the study group were better than control group (P＜0.05).onclusion：The midline sphincterotomy plus anal sinus drainage or lateral incision of internal sphincter have its effect in chronic anal fissure patients, but the former can better shorten the treatment time, reduce the clinical trauma and recurrent rate, relieve the pain and increase the quality of life. 

Objective：To investigate the application effect of doublereverse traction reset and fixation with MiPPO for patients with comminuted fractures of middle and distal tibia.Methods：84 patients with comminuted fractures of middle and distal tibia were randomly divided into observation group and control group, with 42 cases in each group. Both groups underwent MIPPO,the observation group was treated with doublereverse traction reset and fixation,the control group was treated with conventional reset and fixation. The perioperative conditions were compared between the two groups,the eduction of fracture,the lower extremity function, ankle function and fracture displacement parameters were evaluated.Results：The operation time, intraoperative blood loss,limited incision rate , postoperative weightbearing time and fracture healing time were significantly lower than the control group(P<0.05),the reduction effect of the observation group was better than that of the control group (P<0.05).The length of the distal movement and distal segment, the inner and outer angle,left and right offset of the proximal ring, and the offset of the proximal ring were significantly reduction (P<0.05), which were better than the control group(P<0.05). At 3, 6, and 12 months after operation, the JohnerWruhs and AOFASAHS scores in the observation group were significantly higher than those in the control group(P<0.05). There was no significant difference in the complication rate between the observation and control group(P>0.05).Conclusion：Doublereverse traction reset and fixation with MiPPO for patients with comminuted fractures of middle and distal tibia can achieve satisfactory reduction, it is beneficial for fracture healing and rehabilitation of lower limb function.

Objective：To investigate the operativeindication，operative method，safety，clinical result on myocardial bridge.Methods：From June 2013 to May 2018，30 patientsof symptomatic myocardial bridge underwent surgical treatment.All the patients received agent therapies first.The patients with poor drug therapy underwent surgical treatment.The surgical methods include coronary artery bypass grafting（CABG）and coronary myocardial bridge loosening，5 patients underwent coronary myocardial bridge loosening surgical treatment，and 25 underwent CABG surgical treatment.20 patient underwent thoracoscopic minimally invasive direct coronary artery bypass grafting（MIDCABG）.Results：There was no died in hospital，The symptoms of all the 30 patients were relieved after surgical treatment.No serious complications.There were no serious angina or infarction，and none of the patients died during a period of followup of 1 to 60 months.Conclusion：The early metaphase clinical result of surgical treament on patients ofmyocardial bridge is good，safe and effective.

Objective：To explore the treatment effect of tipflexible ureteroscope treatment in impacted upper ureteral calculi.Methods：61 cases of impacted upper ureteral calculi were selected as the research object，which divided into either the study group（treatment with tipflexible ureteroscope，n=34）and the control group（treatment with retroperitoneal laparoscopic ureterolithotomy，n=27），and their clinical data was analysised.Results：The amount of bleeding（6.76±2.43）ml 、the operative time （58.85±35.30）min and hospitalization time（11.76±4.02）d in the study group were less than that of the control group [（16.85±9.11）ml，（150.93±54.69）min and（15.26±2.92）d]，and the difference was statistically significant（P<0.05）.Postoperative complications in the study group（5 cases，14.71%）were lower than those in the control group（4 cases，14.81%），and the difference was not statistically significant（P>0.05）.The rate of stone clearance in the study group（33 cases，97.06%）was higher than that in the control group（26 cases，96.30%），but the difference was not statistically significant（P>0.05）.Conclusion：Strictly grasp the indications of treatment，Sun's ureterorenosop is used for the treatment of impacted upper ureteral calculi，which is safe and feasible.The effect of the lithotripsy is accurate，and it can reduce the trauma of the patients and shorten the time of hospitalization.

Thymic malignancies are relatively incident solid tumors.And Lymph node metastasis in thymic malignancies used to be considered a rare phenomenon.Recently，increasing studies have shown that the lymph node metastasis in thymic malignancies is much more common than previously recognized.Yet，impact of lymph node metastasis in thymic tumor on prognosis and the strategy for surgical dissection of lymph nodes in thymic tumors need to be further explored.This paper focus on pattern of nodal involvement，its prognosis impact，and lymph node dissection in thymic malignancies.

In recent years，more and more studies have shown that neoadjuvant therapy combined surgery can significantly improve the survival of patients with locally advanced esophageal cancer.Among them，the important role of neoadjuvant chemotherapy and neoadjuvant radiotherapy and chemotherapy has gradually reached a consensus.There are still many controversies between the advantages and disadvantages of the two new adjuvant treatment options.The author will review the research progress of new adjuvant therapy for locally advanced esophageal cancer in recent years.