Objective:To evaluate the feasibility and technical advantages of 3D guidance technique in endovascular aortic repair.Methods:This was a retrospective single center study.From November 2016 to December 2018，38 patients undergoing thoracic endovascular aortic repair（TEVAR）or endovascular aortic repair（EVAR）with assistance of 3D guidance technique and intraoperative DynaCT.Meanwhile，40 patients were received standard endovascular aortic repair（control group）.The proximal anchorage area was insufficient for branch vascular reconstruction in 16 patients.Comparative analysis of intraoperative and followup data between the two groups was undertaken.Results:The results of this study showed that compared with conventional DSA，3D guidance technique and intraoperative DynaCT reduced contrast dose（TEVAR 60.31ml vs 73.34ml P=0.032；EVAR 83.43ml vs 94.83ml P=0.013），intraoperative radiation dose（TEVAR 293.04mGy vs 385.71mGy P=0.002；EVAR 431.84mGy vs 584.51mGy，P=0.043），number of radiography（TEVAR 2.36 vs 3.56，P=0.016；EVAR 3.43 vs 4.01，P=0.029），operation time（TEVAR 64.09min vs 71.42min P=0.001；EVAR 142.14min vs 153.39min P=0.057），meanwhile，reduced the risk of postoperative aortarelated reintervention（2.63% vs 10% P=0.042），meeting the precise requirements for anatomical positioning and immediate effect determination during endovascular aortic repair.Conclusion:3D guidance technique improves the accuracy during positioning in complex endovascular aortic repair，could reduce aorticrelated reintervention rate，radiation exposure time and contrast dose.Further studies and development are needed to obtain optimal image quality and higher precision.

Objective:To evaluate the method and effect of hybrid operation for treating Stanford type A aortic dissection.Methods:From  January 2016 to December 2016，a total of 22 patients received hybrid operation for Stanford type A aortic dissection in Second Hospital of Hebei medical university were enrolled.The angiography was made just after operation.The data of computed tomography（CT），general condition and blood flow of bypass grafts were followedup at 1month，3month after operation.Results:The surgical operation and stent grafts implantation were completely successful.Angiography showed no obvious displacement or end leakage of stent grafts in operation.Blood flow in true lumen of aortic dissection was recovered and all of bypass grafts were unobstructed.All patients were followedup with 3 months，and all patients resumed normal life.Enhanced CT scanning at 1month，3month after operation showed no end leakage，stent grafts translocation and bypass graft obstruction.Conclusion:It is demonstrated that Stanford type A aortic dissection could be treated by hybrid operations.Hybrid operation is safe and effective，and could reduce surgical trauma and sufferings of patients.Hybrid operation could expand the indications of endovascular treatment，but longterm effect still needs further observation.

Objective：To investigate the high risk factors of poor wound healing after cardiovascular surgery，and to analyze these high risk factors and their countermeasures.Methods：The medical records of patients undergoing cardiovascular surgery from April 2010 to April 2018 were analyzed.86 patients with poor wound healing after operation were selected as treatment group and 172 patients with good wound healing as control group.The data of perioperative period were compared and analyzed between the two groups.Results：The two groups of patients in over 70 years old，female patients，combined surgery，preoperative skin preparation，absorbable suture use，the utilization rate of surgical membrane，the saline irrigation incision before suture have no significant difference（P>0.05）.There were significant differences in incidence of hypoproteinemia in the two groups，ejection fraction<40 after operation，emergency surgery，unplanned reoperation，the use of internal mammary artery，pericardial effusion，temperature<34℃，operation time>4h and cardiopulmonary bypass time>2h（P<0.05）.〖WTHZ〗Conclusion：Gender，age>70years old，combined operation，skin preparation before operation are not significantly related to wound healing，but malnutrition，organ dysfunction，operation timing，incision local environment are the high risk factors of incision healing.

Objective：To analyze the detection trend，age and double breast distribution of invasive carcinoma of no special type.Methods：The pathological data of 5117 patients with breast diseases in the First Affiliated Hospital of Jinzhou Medical University from 2013 to 2018 were retrospectively collected.The data of 1721 women with unilateral breast invasive cancer were collected.The detection trend，age and distribution of double breasts were described and analyzed.Results：The proportion of invasive carcinoma of no special type breast  in breast cancer patients was 75.02%.The detection of breast cancer in the past six years showed an increasing trend.The most common age group was 51～60 years old，followed by 41～50 years old.There was no statistical difference in the detection of left and right breast in different age groups and years（P>0.05）.Conclusion：The prevention and treatment of invasive carcinoma of no special type breast cancer should be emphasized in Jinzhou area；the prevention and education and early screening of breast cancer should be emphasized according to age；the prevention and treatment of left and right breast cancer should be given equal attention.

Objective：To investigate the impact of warmed and humidified carbon dioxide on patients undergoing laparoscopic general surgery.Methods：152 patients undergoing laparoscopic general surgery were randomly divided into two groups（n=76）：Group WH（Wet &Heat）received warmed（37℃）and humidified（98%RH）insufflation carbon dioxide.Group CD received unprocessed carbon dioxide.Operation duration，awakening time were recorded.Body temperature was measured postpneumoperitoneum 30 mins，60 mins，90 mins.Blood coagulation value and pH were observed before surgery and 60 mins after pneumoperitoneum.Results：The operation duration was no difference between two groups.Awakening time of Group WH was shorter than Group CD（P＜0.05）.Body temperature decline after pneumoperitoneum in Group CD Group WH were lower than Group WH after pneumoperitoneum in 60 and 90 mins（P＜0.05）.The two groups of patients showed no significant difference in coagulation value（P＞0.05）.And the pH value of Group CD was lower than Group WH.Conclusion：Heating and humidifying the carbon dioxide gas can better maintain the temperature of patients in the perioperative.

Objective：To explore the risk factors of gastrointestinal dysfunction after laparoscopic radical resection of right colon cancer，and to establish a risk prediction model for intestinal dysfunction.Methods：The clinical data of 161 patients undergoing laparoscopic radical resection of right colon cancer were analyzed retrospectively from January 2016 to April 2019 in the department of gastrointestinal surgery，Renmin Hospital of Wuhan University.The independent risk factors for the occurrence of gastrointestinal dysfunction after operation were determined by single factor and multifactor analysis.The sensitivity and specificity of ROC and AUC were calculated.Results：The incidence of gastrointestinal dysfunction was 17.3%.Multivariate analysis showed that preoperative malnutrition（P<0.05）and preoperative incomplete intestinal obstruction（P<0.05）were independent risk factors for postoperative gastrointestinal dysfunction.Based on this，a predictive model of postoperative gastrointestinal dysfunction was established.The area under ROC curve was 0.750（95% CI：0.658～0.841）.The sensitivity and specificity of the curve were 0.786 and 0.639，respectively.Conclusion：Preoperative malnutrition and preoperative incomplete intestinal obstruction are independent risk factors for gastrointestinal dysfunction after laparoscopic radical resection of right colon cancer.The sensitivity and specificity of the established prediction model are high，which can provide reference for the prediction of gastrointestinal dysfunction after laparoscopic radical resection of right colon cancer.

Objective：To compare the efficacy and safety of endoscopic and surgical treatment for elderly singleearly early gastric cancer with extended indications of endoscopic submucosal dissection（ESD）.Methods：72 patients with elderly singleearly early gastric cancer treated by endoscopic surgery and 32 patients with early gastric cancer treated by surgery at the same time were respectively enrolled in the endoscopic group and the surgical group.Both groups met the expanded indications of ESD.The operation time，hospitalization time，residual lesions，recurrence，5year survival rate and complications were compared between the two groups.Results：The operation time，fasting time and hospitalization time of the endoscopic group were significantly shorter than those of the surgical group，and the hospitalization expenses were significantly lower than those of the surgical group（P<0.05）；the total incidence of shortterm complications in the two groups was close（P>0.05），but the total incidence of longterm complications in the endoscopic group was significantly lower than that in the surgical group（P<0.05）；the curative resection rate and the total resection rate of the endoscopic group were significantly lower than those in There was no significant difference in residual rate and recurrence rate（P>0.05）.The 5year complete survival rate and diseasefree survival rate were 100% （72/72）and 95.83%（69/72） in endoscopy group,respectively,while in surgery group were 96.88%（31/32） and 93.75%（30/32）,respectively.There was no significant difference between the two groups（P>0.05）.Conclusion：Endoscopic surgery forelderly singleearly early gastric cancer，which meets the expanded indications of ESD，has the advantages of short operation time，less longterm complications and quick recovery.

Objective：To investigate whether CT value combined with entropy can predict the efficacy of extracorporeal shock wave lithotripsy（ESWL）in the treatment of upper ureteral calculi.Methods：A total of 83 patients with upper ureteral calculi who underwent unenhanced multislice spiral CT（MDCT）and extracorporeal shock wave lithotripsy from October 2017 to June 2018 were collected.According to the stone removal effect 4 weeks after treatment，the patients were divided into successful group（n=52）and failure group（n=31）.The success of ESWL was defined as the absence of residual stone fragments or residual stone fragments no larger than 2mm after 4 weeks of single lithotripsy.The basic data of the two groups，such as sex，age and stone diameter，were analyzed and compared.At the same time，the CT value and entropy of stones in the two groups were statistically compared，and the predictive value of stone CT combined with entropy to the therapeutic effect of ESWL was analyzed.Results：31 patients（37%）failed in lithotripsy.There was no significant difference in basic data such as sex，age and stone diameter between the two groups（P>0.05）.The CT value of success group was（691.73±171.34）HU，and that of failure group was（852.74±180.98）HU.There was significant difference between the two groups.The entropy value of success group was（4.25±0.57），and that of failure group was（4.81±0.41）.There was significant difference between the two groups（P<0.05）.According to the CT value and entropy value，the patients were divided into four risk categories：Ct value >750HU and entropy value >4.5（10/29），Ct value ≤750HU and entropy value >4.5（7/13），Ct value >750HU and entropy value ≤4.5（11/14），Ct value ≤750HU and entropy value≤4.5（24/27），the related ESWL stone removal rates were 34.5%，53.8%，78.6% and 88.9%，respectively.Conclusion：The CT value combined with entropy can predict the therapeutic effect of ESWL in patients with upper ureteral calculi.The lower the CT value and entropy value，the higher the stone clearance rate after ESWL treatment.

Objective：To summariz the outcome of single kidney transplantation（SKT）from infant donors to adult recipients.Methods：From 2014 to 2016，thirtynine adults receiving SKT from deceased small pediatric donors younger than 3 years old were enrolled and analyzed retrospectively.The recipients were divided into infant donor group（≤1 year age，n=9）and young children group（1＜age＜3 years，n=30）.The incidence of complications and delayed graft function（DGF），patient and graft survival outcomes，serum creatinine level（SCr）were recorded and analyzed.Results：All patients recovered without graft loss due to surgical complications.Two patients in infant donor group died of pneumonia in the first 6 months postoperation.In young children group，one patient died of pneumonia，another died of unknown reason.Deathcensored graft survival were 100% in both groups.There were no significant differences in the incidence of DGF（44.4% vs.26.7%，P＞0.05）and the mean SCr at 12month followup [（74.14±18.52）μmol/L vs.（91.46±26.91）μmol/L，P＞0.05）].Moreover，the incidence of proteinuria showed no significant difference（33.3% vs.36.7%，P＞0.05）.Conclusion：SKT from deceased infant donors could be transplanted into adults with moderate graft function and favorable graft survival outcome.Increased incidence of earlyphase proteinuria may be associated with inadequate size of kidney grafts and hyperperfusion injury.

Objective：To study the effect and safety of the transfibula approach and the posterior lateral approach in the treatment of the fracture of the ankle and the posterior lateral approach.Methods：69 patients with ankle fracture were selected from March 2017 to February 2018 in our hospital.According to the criteria of LaugeHansen classification，all of them reached the grade Ⅲ～Ⅳ of posterior circumflex type.According to（RCT）undefineds principle of randomized controlled trial，35 patients in group A were treated with plate screw fixation through fibula approach，34 patients in group B were treated with plate screw fixation through posterolateral approach，and 35 patients in group A were treated with plate screw fixation via posterolateral approach.The clinical operative indexes（operative time，intraoperative bleeding，bone healing time，hospitalization days）and related complications were compared between the two groups.The ankle joint healing was evaluated after 12 months followup.Results：The operative time of group A was（113.78±11.79）min，the intraoperative blood loss was（251.97±36.87）ml，the number of days of hospitalization was（18.57±2.17）d and while the data in group B was （109.87±12.31）min，（266.04±37.19）ml，（17.96±2.01）d，respectively，there was not statistically significant（P>0.05）.The bonehealing time of group B was（51.57±6.18）d，which was significantly shorter than that of group A[（59.68±7.54）d）]，the difference was significant（P<0.05）.The functional scores of AOFAS（40.59±6.29，64.08±6.68，79.84±7.14，92.87±5.58）and the rate of recovery（93.75%）were significantly higher in group B than in group A（32.15±5.17，53.77±5.19，64.87±6.68，83.47±5.09，74.19%）.The difference was significant（P<0.05）.In group A，4 cases of postoperative incision infection，4 cases of bone union still had an ankle joint pain，and only 1 incision infection in group B.There was a significant 〖LM〗difference between the two groups（P<0.05）.Conclusion“” Transperoneal approach or posterolateral approach has a good effect on the treatment of Ⅲ and Ⅳ degree ankle fractures，and the posterolateral approach has more advantages，which can shorten the cycle of bone healing and guarantee the stability of ankle joint，and the posterior lateral approach has the advantages of shortening the cycle of bone healing and ensuring the stability of ankle joint.To promote the recovery of ankle function.

Objective：To investigate the efficacy of proximal femoral nail anti rotation intramedullary nail（PFNA）and anatomic locking plate（ALP）in the treatment of intertrochanteric fracture in elderly patients.Methods：A retrospective analysis of 140 cases of patients with femoral instability since January 2012～2014 year in May were intertrochanteric fracture，internal fixation according to different methods，they were divided into PFNA group（PFNA internal fixation，62 cases）and ALP group（ALP internal fixation，78 cases）.The perioperative indicators of the two groups were compared and the effects and complications were observed and compared.Results：Two groups of patients were successfully completed the operation，did not appear in the accident.There were 6 cases of pulmonary infection after operation（2 cases of group PFNA，4 cases in group ALP），4 cases of lower limb vein thrombosis（2 cases in each group），all of which were cured after symptomatic treatment.Perioperative index comparison，the operation time of group PFNA were significantly less than group ALP，the amount of bleeding was significantly lower than that of group ALP，incision length was significantly shorter than the group ALP，there were significant differences（P<0.05）.Group PFNA of patients after the tip apex distance was significantly shorter than the group ALP patients（P<0.05）；but the two groups the collodiaphyseal angle of comparison，the difference was not statistically significant（P>0.05）.All the two groups were followed up for 16～24 months.Comparison of postoperative recovery，the patients in the group PFNA load time and fracture healing time were significantly shorter than the group ALP（P<0.05）；the time of followup，group ALP of 2 cases of hip varus deformity，4 cases of femoral neck cut；a case of fracture fixation or loosening，femoral neck cut and coxa vara complication there was not happened in the group PFNA.According to the Harris score at 6 〖LM〗months after operation，the efficacy of the two groups，the excellent rate of group PFNA was 93.5%，and there was no significant difference with the group ALP（92.3%）（P>0.05）.Conclusion：In the treatment of femoral intertrochanteric fracture with internal fixation，PFNA has less trauma，less bleeding，firm fixation，more conducive to fracture healing and early weight bearing exercise.But in the overall efficacy，PFNA and ALP can achieve good results in clinical applications，according to the actual situation of patients with fracture，as appropriate，to choose the appropriate treatment method.

Objective：To evaluate the clinical effects of greater trochanter femoral stem （GTF）and proximal femoral nail antirotation （PFNA）for the treatment of unstable intertrochanteric fractures in the elderly.Methods：A review study was conducted on 88 unstable intertrochanteric fractures in the elderly treated with GTF and PFNA form January 2012 to March 2018.The patients were divided into GTF（n=45）and PFNA（n=43）.The incision length，operation time，intraoperative blood loss，postoperative blood loss，weightbearing time，and Harris score of the last followup were compared between the two groups.Results： All 88 patients were followed up for 1.2 to 6 years with an averaged of 3.3 years.Compared with PFNA group，GTF group had shorter time to get out of bed with load，longer incision length，more bleeding volume during operation and more drainage volume after operation，the difference was statistically significant（P<0.05）.There was no significant difference in operation time between the two groups（P>0.05）.In the last followup，Harris score of hip joint in GTF group was significantly higher than that in PFNA group（P>0.05）.The difference between the two groups was statistically significant（P<0.05）.Conclusion：Both GTF and PFNA are effective methods for the treatment of unstable intertrochanteric fracture in the elderly.GTF can get out of bed early and reduce complications after operation.It can restore hip function as soon as possible with early functional exercise after operation which is especially suitable for unstable intertrochanteric fracture in the elderly.

Objective：To observe the clinical effects of ultrasoundguided erector spinae plane（ESP）block on postoperative pain in patients with multiple fractured ribs．Methods：A total of 60 patients with unilateral fractured ribs were randomly divided into 2 groups：ESP group and control group，n=30 in each group.After induction of anesthesia，ultrasoundguided unilateral ESP block were performed in ESP group，while control group received the equal volume of normal saline.All patients received patientcontrolled intravenous analgesia（PCIA）after surgery.Postoperative scores of VAS and PrinceHenry（PH）pain scale were evaluated.The consumption of propofol and remifentanil were recorded，meanwhile PCIA delivered doses and attempts within 48h after surgery were recorded.The adverse effects were recorded.Results：There were no statistical difference in the vital signs and postoperative complications in two groups.Compared with control group the consuption of remifentanil were significantly reduced in ESP group（P＜0.05）.PCIA delivered dose and attempts were significantly reduced in ESP group than control group（P＜0.05）.The VAS scores and PH pain scale at postoperative were significantly lower in ESP group than control group（P＜0.05）.Conclusion：Ultrasoundguided ESP block significantly reduces perioperative opioids consumption，PCIA delivered dose and attempts and can provides good analgesic effects for patients with multiple fractured ribs.

In patients with stage IV nonsmall cell lung cancer（NSCLC），systematic treatments have been recommended.However，a series of studies have shown the effectiveness of lung surgery and local treatment for metastases on survival of oligometastatic NSCLC.The median survival time and 5year survival rate of brain metastatic patients were 11.894.8 months and 11.0%36.8%，respectively.Brain surgery could get the same effect on treating brain metastases compared with stereotactic radiosurgery.The median survival time and 5year survival rate of adrenal metastatic ones were 1266 months and 10.2%34.0%，respectively；ipsilateral metastases indicated a better survival.Laparoscopic surgery was a considerable choice for dealing with adrenal metastases.The ones with bones metastases got worse outcomes than brain and adrenal，but solitary vertebral metastases could get a median survival time of 20 months after surgery.Total enbloc resection could be used for the treatment of vertebral metastases.Lung stage with T12 and N01 were both favorable prognostic factors.We suggest that T12N01 lung cancer patients with brain，ipsilateral adrenal and solitary vertebral metastases could benefit from lung surgery and local treatment for metastases.

Incidence of bladder cancer in China has increased dramatically in recent years，the trend of the radical cystectomy for muscle layer of the main method of invasive bladder cancer treatment，the surgical technology under the condition of constant innovation and upgrading，robot assisted laparoscopic radical cystectomy（RARC）forward curative effect with open surgery and laparoscopic surgery，its security，feasibility has been widely recognized.Although orthotopic bladder surgery is the most ideal method of urinary diversion，uncontrollable urinary diversion is still the main choice due to the limitations of surgical conditions.The sequence of pelvic lymph dissection and expanded pelvic lymph dissection are still unable to form a unified standard.Radical cystectomy with nerve preservation，which can well preserve postoperative sexual function and urinary control，has been widely used.

Duplex kidney is a common anomaly of the urinary system.The deformity is often asymptomatic.A smaller number of them become evident as a consequence of hydronephrosis，vesicoureteral reflux（VUR）or incontinence.Ureteral duplication is often associated with duplicated ureters and ureterocele.Ureteral duplication is often associated with vesicoureteral reflux or ectopic ureter opening.At present，the diagnosis of duplex kidney，ureteral duplication and ureterocele are the following methods ：ultrasonography，excretory urography，computed tomography（CT）and magnetic resonance imaging（MRI）.The main method of treatment is surgery.The article mainly about duplex kidney，ureteral duplication accompanied ureterocele of the latest progress.

Peritoneal metastasis is very common in patients with advanced colorectal cancer and is the second most common site of metastasis in colorectal cancer.Traditionally,it is considered to be poor in prognosis and has no value of surgical treatment.With the progress of surgical techniques,precision temperature controlled intraperitoneal perfusion chemotherapy and multidisciplinary comprehensive treatment,the recognition and treatment strategy of peritoneal metastasis of colorectal cancer has changed greatly.The introduction of new chemotherapy drugs and targeted biological agents has improved the prognosis of patients with metastatic colorectal cancer.It is worth noting that the combination of cytoreductive surgery(CRS) and hyperthermic intraperitoneal chemotherapy(HIPEC) with systemic therapy is the current standard therapy,which effectively extends the survival period of patients with colorectal cancer with peritoneal metastasis.This review focused on the current application value and research progress of CRS and HIPEC in peritoneal metastasis of colorectal cancer.