Objective：To analyze the efficacy and safety of Flexthreedimensional thoracoscopic lobectomy and lymph node dissection in the treatment of primary lung cancer.Methods：Sixtyfive patients with primary lung cancer who planned to undergo thoracoscopic lobectomy and lymph node dissection in our hospital from January 2017 to June 2020 were selected and divided into control group(n=32) and observation group(n=33) according to the random number table method.The control group was treated with twodimensional thoracoscopic lobectomy,and the observation group was treated with Flexthreedimensional thoracoscopic lobectomy.The number of lymph node dissections,postoperative pathological staging results,surgical results and clinical indicators,postoperative visual analog pain score(VAS) and complications were compared and observed between the two groups.Results：The number of lymph node dissections in the observation group was 423.The postoperative pathological staging was 29 cases in stage Ⅰ,3 cases in stage Ⅱ,and 1 case in stage Ⅲ.The number of lymph node dissection in the control group was 408.The postoperative pathological stages were 25 cases in stage Ⅰ,4 cases in stage Ⅱ,and 3 cases in stage Ⅲ.There was no significant difference in the results between the two groups(P>0.05).There was no significant difference in intraoperative blood loss between the two groups(P>0.05).The operation time of the observation group was shorter than that of the control group(P>0.05).The VAS scores of the two groups decreased gradually with the passage of operation time.The VAS scores of the observation group were lower than those of the control group at 3 days,1 month and 3 months after surgery(P<0.05).There were no serious complications and deaths in the two groups.The incidence of atelectasis in the observation group was lower than that in the control group(3.03% vs.9.38%,P>0.05).Conclusion：Flexthreedimensional thoracoscopic lobectomy and lymph node dissection are effective in the treatment of primary lung cancer.Through the threedimensional restoration of the anatomical tissue structure,the clarity of the operation and the accuracy of the operation are improved,and it can effectively shorten the operation time,it can reduce the degree of postoperative pain and has high safety.

Objective:To observe the effect of microwave ablation on immune inflammatory response and prognosis in patients with advanced lung adenocarcinoma.Methods:A total of 86 driver genenegative patients with advanced lung adenocarcinoma who were admitted to Hefei Second People's Hospital from February 2016 to February 2019 were selected and divided into a microwave ablation group and a control group according to the random number table method,43 cases each.The control group received gemcitabine + carboplatin chemotherapy,and microwave ablation treatment was added to the microwave ablation group.The changes of stress indexes,inflammation indexes,immune indexes and shortterm efficacy in both groups were observed.The patients were followed up to April 2020 to observe the survival of the two groups of patients.Results:The objective response rate(58.14%) and disease control rate(83.71%) of the microwave ablation group were higher than those of the control group(34.88%,65.12%,P＜0.05).After 4 weeks of treatment,the microwave ablation group MDA[(135.1±11.0)mg/L],SOD[(5.4±2.2)U/L],CRP[(8.3±2.5)mg/L],IL6[(76.9± 7.1)pg/ml],PCT[(5.9±1.5)ng/ml] were not statistically different from the control group[(129.6±10.9)mg/L,(5.2±2.0)U/L,(8.6±2.9) mg/L,(75.8±8.9)pg/ml,(5.1±2.0)ng/ml,P>0.05],CD4+[(44.9±5.1)%],CD4+/CD8+(1.49±0.58) in microwave ablation group after treatment were higher than the control group[(30.8±4.9)%,(1.31±0.52),P＜0.05].The followup time was 1348 months.The average followup time was(29.4±4.9) months.The successful followup rate was 94.2%.The KaplanMeier method and log rank test showed that the cumulative survival rate of the microwave ablation group was higher than that of the control group(P＜0.05).Conclusion:Microwave ablation therapy can significantly improve the shortterm efficacy and survival of advanced lung adenocarcinoma.It has high safet,improve immune function and does not affect the stress response.

Objective:To compare the effects of total laparoscopic IvorLewis surgery and laparoscopic combined with small upper abdominal incision IvorLewis surgery on stress response and gastrointestinal function in patients undergoing radical esophagectomy.Methods:The clinical data of 86 patients with radical esophagectomy in middle and lower esophagus treated in our hospital from January 2017 to April 2019 were retrospectively analyzed.According to the surgical method,they were divided into the total endoscopic group(46 cases,full endoscopic IvorLewis Surgery) and laparoscopic combined incision group(40 cases,IvorLewis operation combined with laparoscopic combined small incision in upper abdomen).The difference of operation index,complication,stress index,gastrointestinal function index and prognosis between the two groups were compared.Results:The postoperative hospital stay(12.2±2.4)d and the first postoperative exhaust time(2.8±1.2)d in the full endoscopic group were shorter than those in the endoscopic combined incision group[(14.6±2.6)d,(3.9±1.4)d](P＜0.05).There were no significant differences in hospitalization expenses,intraoperative blood loss,operation time,and the number of lymph node dissections between the two groups(P>0.05).After surgery,the MDA of the total endoscopic group was (7.90±2.26)μmol/L,which was lower than that of the combined incision group[(9.29±2.78)μmol/L,P＜0.05].SOD of the total endoscopic group was(73.62±7.54)U/L,motilin was (124.11±11.00)ng/L,gastrin was(64.22±6.82)ng/L,which was higher than the endoscopic combined incision group[(62.97±6.46)U/L,(100.51±11.78)ng/L,(51.11±5.59)ng/L](P＜0.05).There was no significant difference in recurrence rate(13.9% vs.10.8%),metastasis rate(9.3% vs.8.1%) and mortality(4.6% vs.2.7%) between the two groups(P>0.05).Conclusion:IvorLewis surgery has the advantages of fast recovery,and little effect on gastrointestinal function and stress response.The shortterm effect is remarkable.

Objective:To explore the clinical value of preoperative chest plain scan threedimensional reconstruction technique and enhanced CT threedimensional reconstruction technique in anatomical resection of pulmonary segments.Methods:The clinical data of 40 patients who underwent thoracoscopic anatomical segmentectomy from March 2019 to January 2021 were retrospectively analyzed.Among them,22 patients underwent preoperative plain CT,and 18 patients underwent preoperative enhanced CT.All the patients underwent preoperative threedimensional computed tomography bronchography and angiography(3DCTBA) using the Mimics software to show the anatomy of pulmonary segments,and the safe cutting edge of 2 cm from the pulmonary nodule was constructed.This study was divided into two groups:plain scan reconstruction group and enhanced reconstruction group.The general clinical characteristics,operation complexity,operation time and postoperative recovery of the two groups were compared.Results:There were no significant differences in operation complexity,operation time,intraoperative blood loss,postoperative total drainage volume,postoperative drainage tube indwelling time,postoperative hospital stay and postoperative pathological types(P＞0.05).Conclusion:Preoperative application of 3DCTBA with chest plain CT or enhanced CT can be used to guide anatomic segmentectomy to achieve accurate segmentectomy,which is safe and effective.

Objective:To explore the corresponding measures to prevent anastomotic stenosis after esophagectomy for esophageal and cardiac cancers.Methods:Retrospective analysis was made on the clinical data of 315 patients with esophageal and cardia cancers with oesophagectomy performed in the department of Thoracic Surgery of the Nanyang central hospital from January 2013 to January 2018.In the experimental group(146 cases),oral gentamicin saline was taken before operation,anastomosis was performed after intraoperative gastric wall pouch suture,and anastomotic tension was reduced.Solid food and oral acidinhibiting drugs were taken as early as possible after operation.The control group(169 cases) only adopted stapler anastomosis directly.Postoperative followup has been conducted for two years,and the incidence of anastomotic stenosis in the two groups was compared.Results:The incidence of anastomotic stenosis in the control group was 11.0%,while the incidence of anastomotic stenosis in the experimental group was 3.8%.The difference was statistically significant（P＜0.05）.Conclusion:Preoperative oral administration of gentamicin saline,intraoperative pursestring suture of the stomach wall before anastomosis,and reduction of anastomotic tension can actively prevent anastomotic stenosis.

Objective:To explore the correlation between the baseline expression of inducible costimulatory factor(ICOS) and the prognosis of patients with esophageal cancer after surgery.Methods:A total of 139 patients with esophageal cancer diagnosed and treated from June 2016 to April 2018 in Zouping People's Hospital were included as the research subjects.After admission,the clinical data and ICOS expression levels of the patients were collected,and the median ICOS expression level was used as the cutoff value.Divided into ICOS low expression group(n=60) and ICOS high expression group(n=60).All subjects underwent esophageal cancer resection.After 2 years of followup,the two groups of patients after esophageal cancer resection were compared with the twoyear risk of poor prognosis.According to the prognosis of all subjects,they were divided into a poor prognosis group and a good prognosis group.To analyze the risk of poor prognosis of patients after esophageal cancer resection and the influencing factors that affect the shortterm prognosis of patients with esophageal cancer resection,draw a working characteristic curve(ROC) to analyze the predictive power of baseline ICOS expression level.Results:As of the last followup time on April 27,2020,139 patients,120 patients in total,completed the followup,and 120 patients were finally enrolled.Among them,a total of 55 patients with a poor prognosis were classified as the poor prognosis group,and 65 patients without a poor prognosis were regarded as the prognosis Good group.KM survival analysis curve showed that the twoyear risk of poor prognosis in patients with high ICOS expression group after esophageal cancer resection was lower than that in ICOS low expression group(P<0.05);multivariate Logistics multivariate showed lymph node metastasis(OR=0.132) and degree of differentiation(OR=0.359) Baseline ICOS low expression(OR=0.303) is a risk factor for poor prognosis of patients after esophageal cancer resection;ROC curve analysis shows that baseline ICOS low expression predicts the AUC of poor prognosis risk for patients after esophageal cancer resection Is 0.726.Conclusion:Lymph node metastasis,degree of differentiation,and low baseline ICOS expression are risk factors for poor prognosis of patients after esophageal cancer resection.Low ICOS expression can be used as an important indicator for predicting the risk of poor prognosis for patients after esophageal cancer resection.

Objective:To study the safety and efficacy of clinical application of autologous tumor infiltrating lymphocytes (TIL) after in vitro amplification，in combination with antiPD1 monoclonal antibody for the treatment of advanced hepatocellular carcinoma (HCC).Methods:The patients with postoperative recurrence or extrahepatic metastasis that are not operable were selected for the study.TIL were isolated from the tumor samples obtained through local resection under laparoscopy,and TIL were amplified up to 2×109 cells and administered intravenously to the patients.After TIL infusion,antiPD1 monoclonal antibody injection was followed every 21 days,and IL2 was continuously injected to maintain the activity of TIL for two weeks,and the adverse effects and treatment efficacy were evaluated.Results:TIL were successfully isolated,amplified and administered in 4 patients with advanced liver cancers.All 4 patients showed good tolerance and minor adverse effects.At present,the median followup period was 7.5 months,2 patients are under observation,one with lung metastatic lesion disappearing and the another with adrenal metastatic lesion partially necrotizing.The other 2 patients died due to high tumor load and advanced stage of tumor,and their survival time was 3 months and 6 months,respectively.Conclusion:TIL amplification and reinfusion combined with antiPD1 monoclonal antibody is safe and feasible in the treatment of advanced HCC,and the longterm efficacy requires further studies.Application of TIL amplified in vitro combined with antiPD1 monoclonal antibody is likely a hopeful new therapy for HCC.

Objective:To observe and analyze the therapeutic effect of right hemihepatectomy by liverhangingmaneuver anterior approach.Methods:60 patients with primary liver cancer were randomly divided into experimental group(n=30) and control group(n=30) from March 2014 to March 2019.The control group was treated with traditional hepatectomy,and the experimental group was treated with liverhangingmaneuver anterior approach hepatectomy.The surgical indexes,postoperative complications and prognosis of the two groups were observed and compared.Results:Compared with the control group,the experimental group had less intraoperative blood loss,shorter operation time,less tumor rupture and less plasma infusion,and the differences of operation related indexes between the two groups were statistically significant(P<0.05).The incidence of postoperative complications of infection,pleural effusion，bilirubin elevation and 1year mortality in the experimental group were 33.3% and 6.67% respectively,while those in the control group were 73.3% and 20.0%，respectively.There were significant differences in the incidence of postoperative complications and 1year mortality between the two groups(P<0.05).Conclusion:The application of liverhangingmaneuver anterior approach hepatectomy in patients with primary liver cancer can reduce postoperative complications and mortality.

Objective:In this study we aimed to identify the AIM2 expression in colorectal tissues and relationship between AIM2 expression and clinic pathological parameters.Methods:Paired samples of CRC tissues and corresponding noncancerous colonic tissues from 64 CRC patients taken from surgical excision specimen were included in this study.The expression of AIM2 was analyzed by quantitative realtime PCR assay(qRTPCR).We used immunohistochemical staining assay to evaluate the expression of AIM2 in protein level in 68 pairs of colorectal specimen,and we analyzed the relationship between AIM2 expression and clinic pathological parameters.Result:The result of qRTPCR suggested that the expression of AIM2 was significantly decreased in colorectal cancer tissues compared with the corresponding noncancerous colonic tissues(P<0.01).The immunoreactivity score and positive rate of colorectal cancer tissues was also significantly lower than corresponding noncancerous colonic tissues.The of colorectal cancer tissues was associated with the tumor grade of colorectal cancer.The immunoreactivity score is decreased in the one which tumor grade was lower.Conclusion:The expression of AIM2 was significantly decreased in colorectal cancer tissues,and the AIM2 expression was associated with the tumor grade of colorectal cancer.

Objective:To compare the influence of totally laparoscopic total gastrectomy(TLTG) and laparoscopicassisted total gastrectomy(LATG) on postoperative rehabilitation and expression of programmed cell deathLigand 1(PDL1) on peripheral blood cells for patients with gastric cancer.Methods:108 patients underwent laparoscopic radical gastrectomy were randomly divided into the TLTG group and LATG group,54 cases/group.The intraoperative conditions,postoperative rehabilitation and complications were compared in 2 groups.Peripheral blood T lymphocyte subsets and cell surface programmed cell death1(PD1)/PDL1 were measured before and after surgery.Results:Both groups had completed the operation.There were no statistically significant differences in the number of lymph node dissections,intraoperative blood loss,esophageal jejunal anastomosis,total surgery time,ground activities,CD8+,and cell surface PD1 in 2 groups(P＞0.05).Compared with the LATG group,the incision length,analgesia,first exhaust,inflow(soft) food,postoperative hospital stay,total,high and moderately poorly differentiated cell surface PDL1 expression and complications had induced,T lymphocyte subsets had increased(P＜0.05).Conclusion:Compared with LATG,TLTG has the advantages of minimal invasiveness,less postoperative pain and faster recovery in the treatment of gastric cancer,lower T lymphocyte subsets and PDL1,and less stress response or immunosuppression.

Objective：To investigate the safety and effectiveness of subtotal parathyroidectomy with autotransplantation (SPTX+AT) for the treatment of secondary hyperparathyroidism.Methods：Fiftyfour patients with SHPT from January 2019 to October 2019 were collected and treated with SPTX+AT.Information on patients' preoperative and postoperative clinical symptoms,PTH levels,and blood electrolyte levels were collected,and the above indicators were followed up every 3 months after surgery for a period of at least 1 year to judge the safety and effectiveness of the surgery.Results：Fiftyfour patients who met the inclusion criteria successfully completed the surgery,and their postoperative symptoms improved and their PTH,blood calcium and blood phosphorus levels decreased(P<0.05).The surgery was effective in 51(94.4%) cases with PTH below 150 pg/ml or a decrease of more than 70%.8(14.8%) patients developed hypocalcemia,which was stabilized to normal range in the third month of followup.There were 4(7.4%) cases of recurrence at 1 year of followup.Conclusion：The efficacy of SPTX+AT in treating SHPT is accurate and feasible; the incidence of hypocalcemia after surgery is low,and reoperation after recurrence is relatively simple and safe,which has certain advantages over the existing procedures.

Objective：To investigate the quality of life after total thyroidectomy for papillary thyroid carcinoma(PTC) with Hashimoto's thyroiditis(HT).Methods：The 82 patients with PTC complicated with HT underwent total thyroidectomy in our hospital from January 2015 to February 2019 were retrospectively analyzed,and the quality of life of patients 12 months after operation was statistically analyzed.Karnofsky functional status score(KPS) was used to evaluate the quality of life.Univariate analysis was used to analyze the related factors affecting the quality of life after total thyroidectomy;multivariate logistic regression analysis was used to analyze the independent risk factors of quality of life after total thyroidectomy.Results：All patients were followed up for 12 months,the average KPS score was(77.25±13.19).Univariate analysis showed that there were no significant differences in KPS scores among different gender,body mass index,underlying diseases,TSH level,TGAb positive,TPOAb positive,operation time,intraoperative blood loss,postoperative hypocalcemia,postoperative hypoparathyroidism,postoperative oral thyroxine tablets and postoperative 131I patients(P>0.05);KPS score of patients with age > 60 years old was lower than that of patients with age≤60 years old,KPS score of patients with tumor>5 cm was lower than that of patients with tumor≤5 cm,KPS score of patients with stage ⅢⅣ was lower than that of patients with stage ⅠⅡ,and KPS score of patients with lymph node metastasis was lower The KPS score of patients with extraperitoneal invasion was lower than that without lymph node metastasis(P<0.05).Multivariate logistic regression analysis showed that age>60 years old,tumor>5 cm,stage ⅢⅣ,lymph node metastasis and tumor extracapsular invasion were the independent risk factors affecting the quality of life after total thyroidectomy.Conclusion：The quality of life in patients with PTC complicated with HT after total thyroidectomy is affected by many factors,including age,tumor size,clinical stage,lymph node metastasis and tumor invasion.

Objective：To summarize past cases and studied the clinical characteristics of squamous cell carcinoma of renal pelvis associated with kidney stones.Methods：From July 2008 to December 2018,data of 6 patients suffering squamous cell carcinoma associated with kidney stones were collected and clinical characteristics were analyzed.Results：All patients underwent operation because of stone and/or tumor.All patients recovered from the surgery(radical nephroureterectomy or nephrorectomy).But overall survival was about(8.00±3.58) months according to followup.Conclusion：Squamous cell carcinoma associated with kidney stones was extremely aggressive tumour.Urologists should be alert for patients with a long medical history of kidney stones,large stone burden,severe hydronephrosis caused by stone obstruction,nonfunctioning kidneys and/or purulent kidneys,and relevant examinations should be done to exclude the possibility of tumors associated with kidney stones.

Objective：To explore the effects of different intracavitary treatments on the prognosis of acute iliofemoral vein thrombosis.Methods：The patients with acute iliofemoral vein thrombosis(Iiiacfemoralvenousthrombosis,IFVT) diagnosed by color Doppler ultrasound in our center from January 2015 to September 2016 were retrospectively analyzed.Different methods of intracavitary treatment were adopted:catheter directed thrombolysis(CDT),AngioJet pharmacomechanical thrombectomy(PMT) and pharmacomechanical thrombectomy combined with catheter directed thrombolysis(PMT+CDT).The followup data of 12 months,24 months,36 months and 48 months after operation were statistically analyzed to evaluate the recurrence rate of venous thrombosis,the incidence and severity of postthrombotic syndrome(PTS).Results：During the 48month followup,the overall thrombus recurrence rate of 102 patients was 19.6% and the incidence of PTS was 22.5%.During the followup,there was no significant difference in the recurrence rate of thrombus and the incidence of PTS among the three groups(P＞0.05).When the patients were followed up for 24 months or more,the Villalta scores in the PMT group and the PMT+CDT group were significantly lower than those in the CDT group,and there was significant difference among the three groups(P<0.05).Conclusion：The three endovascular therapy methods can effectively remove thrombus,protect venous function,and play an active role in preventing the recurrence of DVT and the occurrence of PTS.During the followup of 24 months or more,the severity of PTS in the PMT group and the PMT+CDT group was significantly lower than that in the CDT group.

Objective:To analyze and compare the efficacy and safety of percutaneous mechanical thrombectomy and catheter directed thrombolysis in the treatment of acute deep venous thrombosis of lower limbs.Method:Eighty patients with lower extremity deep vein thrombosis in the Department of Vascular Surgery of our hospital from February 2018 to February 2019 were selected,and divided into percutaneous mechanical thrombectomy group and catheter directed thrombolysis group according to treatment regiments.The venous patency rate,Ddimer,complications,total usage of urokinase and length of hospital stay were analyzed in the two groups.Result:Comparison of percutaneous mechanical thrombectomy group and catheter directed thrombolysis group:Postoperative venous patency score was compared as(1.90±1.02)VS(2.16±1.10),the comparison of vein patency rate was was compared as:(85.84±11.48)% VS(84.40±14.71)%（P>0.05）.The time for Ddimer to drop to normal value:(6.30±1.23) vs(8.2±1.59) days（P＜0.05）.A small amount of various complications(including bleeding,infection,allergy,etc.) occurred during the treatment，and the differences were not statistically significant（P>0.05）.Total use of urokinase:(226±34) 10,000 units of VS(278.4±103.5) 10 000 units,the results showed significant difference（P＜0.05）.Total length of stay:(13.57±4.76) days vs(12.98±4.55) days（P>0.05）.Total hospitalization cost:(9.4±3.1) VS(4.7±2.3) 10 000 Yuan,the results showed significant difference(P＜0.05).Conclusion:Two groups showed good safety during perioperative period and could effectively clear thrombus within a short period of time.In the percutaneous mechanical thrombectomy group,the hospital stay was shorter,the use of thrombolytic drugs was less,and the Ddimer decreased faster,but the cost increased.

Objective:To investigate the clinical characteristics and prevention strategies of acute disseminated intravascular coagulation(DIC) hemorrhage which happened in organ transplant recipients.Methods:The clinical data,DIC treatment strategy,test indicators of 6 patients who underwent organ transplantation between August 2019 and August 2020 with acute DIC hemorrhage,were retrospectively analyzed.Results:The coagulation function and platelets of 6 patients were abnormal on the day of surgery,and were diagnosed as acute DIC according to the DIC rating scale of the International Society of Thrombosis and Stasis(ISTH).DIC was corrected after early.Rapid and massive infusion of clotting substances and platelets during operation,and the coagulation function basically returned to normal within 1 week after the operation as well as graft function,except for DGF in 1 renal transplant recipient.Conclusion:The cause of DIC in organ transplant recipients are complex and dangerous,which may be related to high PRA and abnormal coagulation function before operation;Early,rapid and massive intraoperative infusion of clotting substances and platelets is the key to correct acute hemorrhagic DIC;After the occurrence of actue DIC hemorrhage in organ transplant recipients,the early recovery of graft function is not affected,provided that blood perfusion during the operation is necssary.

Objective:To explore the clinical application of ileocecal plica(Treves plica) covering in colonic diverticulum perforation in ileocecal part.Methods:A retrospective analysis of zhongshan hospital affiliated to dalian university in September,2015December 2019 treated 40 cases of appendix multiple diverticulum and colonic diverticulum perforation clinical data,divided into two groups,adopting group A blind fold back cover diverticulum perforation position,group B with pedicle retroperitoneum or intestinal fat covering parts repairing perforation,statistical group cure rate,mortality rate,the meal time,the average length of hospital stay and complications.Results:The two groups of patients were cured and discharged without death.The average length of hospital stay in group A was(5±0.56)d,and that in group B was(9±2.59)d.The average postoperative feeding time in group A was(1±0.76)d,and the average postoperative feeding time in group B was(2±1.76)d.P>0.05 was not statistically significant.Complications of the two groups were 5% in group A and 20% in group B,the difference was statistically significant(P<0.05).Conclusion:Ileocecal plica suture and fixation for colonic diverticulum perforation is effective,with fewer postoperative complications and faster recovery time.

Esophageal cancer is one of the most common malignancies in the digestive tract.Different from that adenocarcinoma is much more common in the West,squamous cell carcinoma is the predominate pathological type in more than 90% patients with esophageal cancer in China,majority of which had the cancer located in the middle and lower thoracic esophagus.Radical resection is still the important treatment for resectable esophageal cancer by now.Based on the anatomy of esophagus and staging of esophagus cancer,surgical treatment for the disease includes endoscopic submucosal dissection,transhiatal esophagectomy,transthoracic esophagectomy,and minimally invasive esophagectomy.The aim of this study was to analysis the “best” surgical treatment for middle and lower esophageal cancer,and to help surgeons for treatment decisionmaking.

Neoadjuvant treatment is a critical part of comprehensive treatment of esophageal cancer and can achieve survival benefit for patients.Nowadays amounts of clinical trials related to neoadjuvant treatment have got promising significant outcomes,but there are still many issues that need to be resolved.This manuscript focused on the clinical trials of preoperative chemoradiotherapy,chemotherapy and emerging immunotherapy in esophageal squamous carcinoma patients.Some topical issues such as the efficacy of different treatment regimens,comparison between different neoadjuvant therapy and the choice of timing of surgery after neoadjuvant treatment would be reviewed and summarized.

Jejunal interposition is an alternative reconstructive method for patients with a history of gastrectomy or underwent simultaneously esophagogastrectomy.This operation generally refers to an operation in which a segment of jejunum with a pedicled blood vessel is lifted into the thoracic cavity or neck,the proximal end is anastomosed with the proximal esophagus,while the distal end maintains the continuity of the jejunum.Used in cases where the esophagus cannot be replaced by the stomach or colon.The jejunal conduit has several advantages including rich blood supply and less chance of contamination after the intestinal cavity is opened.We reviewed the literatures on the use of the jejunal interposition,and discussed the surgical methods,shortterm and longterm outcomes,as well as the quality of life.In the future,prospective investigations about jejunal interposition are required to determine the best way for digestive tract reconstruction.

With the rise of highthroughput sequencing and metagenomics,the esophageal microbiome is becoming a hot research field.Numerous studies have shown that complex microbial flora is colonized in esophagus,and its composition changes with the occurrence and development of esophageal diseases.This article will summarize the microbiological characteristics of the esophagus under the normal physiology and disease state,and provide reference significance for further exploring the potential mechanism,diagnosis and treatment of esophageal diseases.

With the progress and development of hemodialysis techniques,more and more patients with advanced renal failure can prolong their life through hemodialysis.However，fistula complications can appear with the long use of the access and can affect the quality of patient's life.For those patients with permanent failure of the access due to various complications caused by longterm use of the access,however,the conventional dialysis access can not be established,the upper arm basilic vein transposition dialysis access can be accepted  as a choice.The author will discuss the advantages and disadvantages,surgical methods and skills of the upper arm basilic vein transposition operation combined with clinical experience and literature.