Objective: This study aims to investigate the effects of transcutaneous auricular vagus nerve stimulation (taVNS) on the development of systemic lupus erythematosus (SLE) in MRL/lpr mice. Methods: MRL/lpr mice were treated with taVNS for ten weeks. Locus coeruleus (LC) tyrosine hydroxylase positive (TH+) neurons were selectively lesioned by stereotactic injection of 6-hydroxydopamine (6-OHDA) or selectively activated by chemogenetic methods. Sympathetic denervation was conducted by intraperitoneal injection of 6-OHDA. Results: TaVNS activated the TH + neurons in LC. TaVNS produced central therapeutic effects by reducing the number of hippocampal microglia, and increasing the number of surviving LC TH+ neurons in MRL/lpr mice. TaVNS also retarded the development of lymphadenectasis and splenomegaly, decreased the proportion of double-negative T (DNT) cells, and alleviated nephritis in MRL/lpr mice. The lesion of LC TH+ neurons eliminated both these central and peripheral therapeutic effects of taVNS, while chemogenetic activation of LC TH+ neurons mimicked most central and peripheral protective effects of taVNS in MRL/lpr mice. Furthermore, taVNS regulated the autonomic nervous system in MRL/lpr mice. Conclusion: This study provides direct evidence that taVNS can retard the development of peripheral and central symptoms of SLE, which is mediated by the LC TH+ neurons.

机器人辅助腹腔镜在泌尿外科领域得到越来越广泛地应用,但治疗良性前列腺增生疾病缺乏专家共识和指南指导临床实践.本共识收集中英文数据库中有关机器人治疗良性前列腺增生的文献资料,手术方式主要包括机器人耻骨后单纯前列腺切除术、机器人经膀胱途径单纯前列腺切除术和机器人耻骨后入路保留尿道前列腺切除术三种.前两者不保留前列腺部尿道,后者保留前列腺部尿道.后者在保留患者尿道的完整性,防治逆行射精,保持勃起和性功能方面显示出优异的疗效.机器人治疗良性前列腺增生适合前列腺增生伴有中、重度下尿路症状患者,特别是由于身体条件限制而无法接受经内镜治疗的患者,如尿道下裂或狭窄患者.但由于接受骨盆手术或放射治疗而导致前列腺手术平面封闭的患者,不适合行机器人手术治疗.

Objective: To compare the perioperative outcomes of patients undergoing retroperitoneal laparoscopic partial nephrectomy(LPN) and retroperitoneal robot-assisted partial nephrectomy (RPN) by matched analysis using R.E.N.A.L. nephrometry scoring system. Methods: Relevant clinical data of 543 case of laparoscopic and robot-assisted partial nephrectomy performed by a single surgeon via the RP approach from January 2016 to March 2020 from our database were screened and analyzed. Two groups were matched 1:1 (112 matched pairs) by R.E.N.A.L. nephrometry score, gender, and age. Statistical analysis was done to compare perioperative outcomes. Results: There was no significant difference between the LPN group and RPN group in terms of age, gender, body mass index (BMI), tumor size, American Society of Anesthesiologists (ASA) score or preoperative estimated glomerular filtration rate (eGFR). Patients undergoing LPN had a slightly higher proportion of the left side tumor (51.7％ Vs 42.9％, P=0.032). No significant differences regarding to operative time, estimated blood loss, postoperative LOS, postoperative eGFR, transfusion or postoperative complications were found between the two groups. However, Warm ischemia times (WIT) in the RPN group were significantly shorter than that in the LPN group (18.9 min Vs 22.6 min, P=0.032). Subset analysis based on complexity indicated that WIT of complex tumors in the RPN group was significantly shorter than that in the LPN group (21.1 min Vs 26.3 min, P=0.012), but no difference of WIT was found on simple tumors between the RPN group and LPN group (16.4 min Vs 18.3 min, P=0.085). Conclusion: Retroperitoneal RPN showed shorter WIT and generally equivalent perioperative results to retroperitoneal LPN. Robotic surgery may have advantages over the traditional laparoscopic surgery on complex tumor excision and renorrhaphy in the limited retroperitoneal space.

Objective:To investigate the safety and efficacy of the novel single-port surgical robotic surgical system in extraperitoneal urological surgery.Methods:From February to April 2022, patients was prospectively enrolled who required laparoscopic radical prostatectomy, partial nephrectomy and adrenal tumor resection in urology department. Inclusion criteria were: age ≥ 18 years old; BMI 18.5-30 kg/m 2; American Society of Anesthesiologists (ASA) physical status classification system grades 1 to 3; can cooperate with the completion of the visits and related examinations stipulated in the plan, and participate voluntarily clinical trials, and consent or the guardian agrees to sign the informed consent form; tumor indicators meet one of the following surgical treatment indications: kidney tumor T 1 stage, single, maximum tumor diameter ≤ 4 cm; prostate cancer, stage ≤ T 2b, preoperative PSA ≤ 20 ng /ml; Gleason score ≤ 7; adrenal tumor diameter ≤ 7 cm, for non-functioning adrenal adenoma, tumor diameter ≥ 3 cm. Exclusion criteria were: patients with other malignancies or a history of other malignancies and the investigators believe that they are not suitable for inclusion in this researcher; patients who have received the same type of urological surgery in the past and are not suitable for participating in this study as assessed by the investigators; included Those who have undergone other major surgery within the first 3 months and during the trial period, or who cannot recover from the side effects of any such surgery; syphilis, hepatitis B, HIV infection and carriers; long-term use of anticoagulants or blood system diseases; Unable to use effective contraception during the trial period and other conditions that the investigators deem inappropriate to participate in this trial. All operations were performed by a novel single-port robotic surgical operating system, and all surgical procedures were performed through an extraperitoneal approach. Surgical method: the surgical system is mainly composed of a remote console including a high-definition display, a surgical equipment trolley, a surgical execution system that accommodates a serpentine robotic arm, and a bendable serpentine robotic arm. In this study, the extraperitoneal approach was used. For radical prostatectomy, the patient was placed in a supine position, a longitudinal incision of about 3 cm was made below the umbilicus, the anterior rectus sheath was incised, the extraperitoneal space was separated, and an operating sheath was placed. A 12 mm trocar is placed between the right McBurney point and the umbilicus as an auxiliary hole. For partial nephrectomy and adrenal tumor resection, the patient is placed in the lateral position, and an 3cm incision is made 2 cm above the iliac crest on the midaxillary line as the main operating hole. The skin, subcutaneous tissue, and muscle were incised to the retroperitoneal cavity, and a 12mm trocar was placed at the level of the anterior superior iliac spine on the anterior axillary line as an auxiliary hole. The operation was performed after connecting each robotic arm. After the operation, the specimen was placed in the specimen bag, and a drainage tube is placed in the auxiliary hole, the specimen was taken out, and the incision was closed in turn. Preoperative basic information, operation time, blood loss, incision size, postoperative complications, preoperative and postoperative PSA score, eGFR index, postoperative pathological information and other perioperative information were collected. Results:A total of 17 patients were included in this study, including 6 with prostate cancer, 8 with renal tumor, and 3 with adrenal tumor. There were 9 males and 8 females, with an average age of (56.7±14.6) years and a BMI of (23.3±3.4) kg/m 2. The mean operation time of radical prostatectomy was (244.6±35.1) min, the mean operating time of the chief surgeon was (184.0±39.0) min, and the mean blood loss was (36.6±23.8) ml. Postoperative positive margin was found in 2 cases. The average operation time of partial nephrectomy was (189.6±49.4) minutes, the average operating time of the chief surgeon was (115±39.7) minutes, the average blood loss was (12.7±8.3) ml, and the average warm ischemia time was (23.1±10.8) minutes. There was no significant difference in the eGFR index before and after the operation ( P>0.05). The average operation time of adrenalectomy was (177.6±26.9) min, the average operating time of the chief surgeon was (99±20.4) min, and the average blood loss was (11.6±6.2) ml. The overall average operation time of the three surgical methods was (206.9±50.1) min, the overall average operating time of the chief surgeon was (136.5±51.1) min, the overall average blood loss was (21.0±9.2) ml, and the overall average incision size was (3.5±0.5) cm, all added a 12 mm auxiliary channel, and the overall average hospital stay was (8.1±2.7) days. All operations were successfully completed, and there was no conversion to open surgery during the operation, and no operation holes were added. There was no Clavien-Dindo≥grade 3 complication after operation. Conclusions:The novel single-port robot could safely and effectively perform radical prostatectomy, partial nephrectomy and adrenalectomy which are common in urology through extraperitoneal approach.

目的 探讨腹腔镜肾癌根治术后手术切口感染的手术室相关因素分析及术前血清中性粒细胞与淋巴细胞比值(NLR)及血小板与淋巴细胞比值(PLR)的意义.方法 选取2013年12月～2021年12月在中国科学院大学宁波华美医院泌尿外科861例行腹腔镜肾癌根治术患者为研究对象,手术后合并切口感染的患者作为研究组,手术后未并发切口感染的患者作为对照组.同时比较研究组和对照组患者血清NLR及PLR水平,统计分析手术后发生切口感染的患者的手术室相关因素.结果 非层流手术室、手术时间>3 h、术中低体温(P<0.05)是手术后切口感染的独立危险因素;研究组血清NLR及PLR水平高于对照组;血清NLR及PLR联合诊断切口感染敏感度及特异度较高.结论 非层流手术室、手术时间>3h、术中低体温是腹腔镜肾癌根治术后切口感染发生的危险因素,感染组患者血清NLR及PLR水平,可作为诊断术后感染及评估病情的重要生物学指标.

Objective:To investigate the clinicopathological features and prognosis of adult Xp11.2/TFE3 gene fusion-associated renal cell carcinoma (TFE3 RCC).Methods:The clinical data of 55 patients with TFE3 RCC admitted to the First Affiliated Hospital of Zhejiang University Medical College from January 2013 to February 2021 were retrospectively analyzed, including 26 males and 29 females. The patients’ mean age was (40.6 ± 14.7) years. The median tumor size was 4.0 (1.9-20.0) cm. Tumors were located in the left kidney in 30 cases (54.5%) and the right kidney in 25 cases (45.5%). Preoperative imaging assessment was well-circumscribed in 41 patients (74.5%) and ill-defined in 14 patients (25.5%). There were 2 cases of regional lymph node metastasis and 2 cases of distant metastasis, including 1 case of lung metastasis and 1 case of bone metastasis. Preoperative staging included stage I in 38 patients (69.1%), stageⅡ in 5 patients (9.1%), stage Ⅲ in 9 patients (16.4%), and stageⅣin 3 patients (5.5%). Nephron-sparing surgery was performed in 31 patients (56.4%) and radical nephrectomy in 24 patients (43.6%). Progression-free survival curves were plotted by the Kaplan-Meier method and analyzed by the log-rank test. Cox proportional hazards regression model was applied for multivariate analysis of factors influencing progression-free survival.Results:Postoperative pathological stage included pT 1 in 41 patients (74.5%), pT 2 in 5 patients (9.1%), pT 3 in 8 patients (14.5%), and pT 4 in 1 patient (1.8%). Four patients (7.3%) had N 1 stage and 2 (3.6%) had M 1 stage. After immunohistochemical analysis, TFE3 showed diffuse strong positive reaction in 55 patients, cathepsin K positive in 36 patients (65.5%), CD10 positive in 48 patients (87.3%), CK7 positive in 7 patients (12.7%), CA-IX positive in 2 patients (3.6%), and PAX8 positive in 35 patients (63.6%). Two cases were tested by fluorescent in situ hybridization (FISH), and the results were positive. The proportion of nuclei with mitotic signals was 40% and 30%, respectively. The median follow-up time was 27 (3-96) months. The results of survival analysis showed that the 3-year and 5-year progression-free survival rates were 80.0% and 64.0%, respectively. The results of univariate analysis showed that tumor size ( P = 0.009), pT stage ( P<0.001), regional lymph node invasion ( P = 0.003), and surgical approach ( P = 0.006) were associated with the prognosis of TFE3 RCC patients. Multivariate analysis of the Cox model was performed on significant univariate factors, and its results showed that pT stage ( HR=4.824, 95% CI 1.129-20.604, P=0.034) and regional lymph node invasion ( HR=5.522, 95% CI 1.066-28.611, P = 0.042) were independent prognostic factors for progression-free survival in TFE3 RCC patients. The results of stratified analysis showed that for patients with pT 1 disease, the effect of surgical approach on the prognosis of patients was not statistically significant ( P=0.091). The 3-year progression-free survival rates for nephron-sparing surgery and radical nephrectomy were 94.7% and 81.5%, respectively. Conclusions:Given that TFE3 RCC imaging studies often lack characteristic features, diagnosis mainly relies on immunohistochemical analysis and FISH tests. Most of the patients with TFE3 RCC have a better prognosis after surgical treatment. However, pT stage and regional lymph node invasion were prognostic factors in patients with TFE3 RCC.

目的 探讨甲状腺髓样癌(medullary thyroid carcinoma,MTC)颈侧区淋巴结转移的危险因素,研究血清降钙素(calcitonin,Ctn)预测颈侧区淋巴结转移的价值.方法 回顾分析47例经术后病理诊断为MTC的临床病理资料,按颈侧区有无淋巴结转移分为两组,单因素和Logistic回归分析颈侧区淋巴结转移的危险因素,通过ROC曲线研究Ctn值预测颈侧区淋巴结转移的敏感性和特异性.结果 单因素分析显示,颈侧区转移组MTC直径更大(P=0.004),血清Ctn(P=0.000)和癌胚抗原(P=0.003)更高,肿瘤多发比率(55.56％vs 13.79％,P=0.004)及中央区淋巴结转移率更高(77.78％vs 37.93％,P=0.015).回归分析发现,血清Ctn(P=0.036)升高及中央区淋巴结转移(P=0.017)是颈侧区转移的独立危险因素.当Ctn截点为300.9 ng/L时,其预测颈侧区淋巴结转移的敏感性是94.4％,特异性是62.1％,ROC曲线下面积(AUC)是0.808.结论 血清Ctn升高及中央区淋巴结转移是MTC颈侧区淋巴结转移的独立危险因素,Ctn可作为预测颈侧区淋巴结转移的一种敏感性指标.

目的 探讨现场机器人手术视频在泌尿专科医师培训中的应用价值.方法 选择参加泌尿外科专科培训的医师30名,随机分组为现场机器人手术视频组与非现场机器人手术视频组并接受相应培训,培训后比较两组书写手术记录和剪辑手术视频的考核结果.结果 培训后现场机器人手术视频组考核成绩优秀率明显高于非现场组(χ2=6.12,P<0.05).结论 现场机器人手术视频是泌尿外科专科医师培训有效的途径.

过敏性休克严重患者可出现心源性休克、恶性心律失常等严重并发症,进而发生急性心跳骤停,围手术期死亡率较高.浙江大学医学院附属邵逸夫医院麻醉科在手术室内对一名患者进行麻醉诱导后突发心率,血压严重下降,进而发生心跳骤停,手术室内医护迅速进行心肺复苏(CPR),同时积极抗休克、机械通气、器官支持等治疗,并快速建立体外膜肺氧合(ECMO),后恢复心跳,送ICU继续积极治疗后于4天后顺利撤除ECMO及呼吸机,最终救治成功顺利出院,患者无明显并发症.

对91例低位直肠癌患者行直肠癌根治联合末端回肠保护性造口手术中采用皮瓣支撑和支撑棒支撑两种方式，比较两组患者术前、术中和术后情况。皮瓣支撑组与支撑棒支撑组的手术时间、出血量、造口旁疝及BMI≤24 kg/m 2患者造口渗漏次数相比差异均无统计学意义(均 P>0.05)；两组开腹切口感染率、造口周围皮炎发生率及BMI>24 kg/m 2患者造口渗漏次数相比差异均有统计学意义(均 P<0.05)。利用自体带蒂皮瓣支撑末端回肠襻式肠造口安全简单、并发症少，可以避免支撑棒的2次取出，值得在临床上推广应用。

疝修补是普通外科常见的手术之一.LeBlanc和Booth于1993年首先介绍腹腔镜腹壁疝修补术(laparoscopic ventral hernia repair, LVHR )[1].与开放腹壁疝修补术(open ventral hernia repair,OVHR)相比,LVHR术后恢复快、手术部位事件发生更少,且术后复发率并未增加.随着腹腔镜疝修补理念的发展、腹腔镜器械的更新换代、合成补片和缝合、固定新材料的研发及临床应用,LVHR正逐步推广普及,适应证有序扩大,复发率进一步降低.为更好规范LVHR,推进其质量控制及提高,中华医学会外科学分会组织国内疝和腹壁外科专家编写"腹腔镜疝与腹壁外科手术缝合技术与缝合材料选择中国专家共识(2021版)"[2].基于临床证据并结合大多数专家共同的经验和认识制定本专家共识,指导外科医师在腹腔镜疝与腹壁外科手术缝合技术与缝合材料选择的临床实践.本文对专家共识中切口疝部分作相关解读.

手术是治疗甲状腺癌最有效的手段，术后效果影响着患者的康复。多项临床研究通过特定的评估量表来评价手术效果和患者的康复情况，但是评估量表种类繁多。本文根据测评目的将量表分为4类：评估术后主观不适感受、瘢痕性状、瘢痕关注度和生活质量。分别介绍各评估量表并评价其优缺点，并基于评估量表对甲状腺癌患者术后的康复情况进行综述。.

目的 通过检测miRNA-29c在前列腺癌患者中的表达量,探讨其对前列腺癌诊断的意义.方法 收集40例前列腺癌患者血清及其癌和癌旁组织、30例前列腺增生患者血清、30例健康对照血清,采用实时荧光定量PCR法检测miRNA-29c的表达水平.结果 miRNA-29c在前列腺癌、前列腺增生及健康对照血清中的表达量分别为(0.357±0.012)、(0.836±0.023)和(0.818±0.015),在前列腺癌患者血清中miRNA-29c的表达量显著低于前列腺增生患者及健康对照组,差异有统计学意义(P<0.05),在前列腺增生和健康对照组中表达无统计学意义(P>0.05).前列腺癌患者血清中miRNA-29c的表达在不同Gleason评分、临床分期及有无远处转移上差异具有统计学意义(P<0.05),而不同血清前列腺抗原(PSA)水平的患者间差异无统计学意义(P>0.05);miRNA-29c在前列腺癌组织中的表达量明显低于其癌旁组织,差异有统计学意义(P<0.05).结论 miRNA-29c在前列腺癌中低表达,可能参与前列腺癌的发生、发展过程,可作为前列腺癌早期诊断和预后判断的指标.

Osteoarthritis (OA) is a common joint disease that ultimately causes physical disability and imposes an economic burden on society. Cartilage destruction plays a key role in the development of OA. Vorinostat is an oral histone deacetylase (HDAC) inhibitor and has been used for the treatment of T-cell lymphoma. Previous studies have reported the anti-inflammatory effect of HDAC inhibitors in both in vivo and in vitro models. However, it is unknown whether vorinostat exerts a protective effect in OA. In this study, our results demonstrate that treatment with vorinostat prevents interleukin 1α (IL-1α)-induced reduction of type II collagen at both gene and protein levels. Treatment with vorinostat reduced the IL-1α-induced production of mitochondrial reactive oxygen species (ROS) in T/C-28a2 cells. Additionally, vorinostat rescued the IL-1α-induced decrease in the expression of the collagen type II a1 (Col2a1) gene and the expression of Sry-related HMG box 9 (SOX-9). Importantly, we found that vorinostat inhibited the expression of matrix metalloproteinase-13 (MMP-13), which is responsible for the degradation of type II collagen. Furthermore, vorinostat suppressed the expression of E74-like factor 3 (ELF3), which is a key transcription factor that plays a pivotal role in the IL-1α-induced reduction of type II collagen. Also, the overexpression of ELF3 abolished the protective effects of vorinostat against IL-1α-induced loss of type 2 collagen by inhibiting the expression of SOX-9 whilst increasing the expression of MMP-13. In conclusion, our findings suggest that vorinostat might prevent cartilage destruction by rescuing the reduction of type II collagen, mediated by the suppression of ELF3.

目的:评估机器人辅助腹腔镜肾部分切除术治疗肾血管平滑肌脂肪瘤的有效性与安全性.方法:回顾性分析2016年1月至2021年6月浙江大学医学院附属第一医院泌尿外科收治的207例肾血管平滑肌脂肪瘤患者的临床资料.结果:所有患者均成功实施机器人辅助腹腔镜肾部分切除术,未有中转开放者;经腹入路51例,占24.6％,经腰入路156例,占75.4％;平均手术时间(96.0±26.9)min;平均术中出血量(137.3±26.9)ml;平均肾动脉血流阻断时间(18.6±3.9)min;平均术后住院时间(5.7±1.2)d;术后随访1～60个月,平均23.9个月,所有病例均未见肿瘤复发.结论:机器人辅助腹腔镜肾部分切除术治疗肾血管平滑肌脂肪瘤安全、有效.

目的 探讨治疗青少年男性腹股沟疝的最佳手术方式.方法 采取问卷调查研究,以一位16岁男性腹股沟斜疝患者为例,设定不同内环口缺损直径大小(1?cm、4?cm)和不同BMI(20?kg/m2、35?kg/m2)的4种情况,邀请外科医师在开放或腔镜疝囊高位结扎、开放或腔镜不可吸收补片修补、开放或腔镜生物补片修补以及开放组织缝合修补等七项术式中作出最佳选择,问卷内容还包含医师的专业范围、所属医院级别和技术职称.结果 共获得128份有效问卷结果.83份(64.8％)为普通外科医师(包括疝外科),45份(35.2％)为儿外科医师.当患者BMI=20?kg/m2、内环口缺损直径为1?cm时,84.4％的普通外科医师选择成人型修复(补片或组织缝合修复),而78.8％的儿外科医师选择疝囊高位结扎;当内环口缺损直径增大至4?cm时,86.8％的普通外科医师和55.6％的儿外科医师选择不可吸收补片修补.当患者BMI=35?kg/m2、内环口缺损为1?cm时,79.5％的普通外科医师和82.2％的儿外科医师选择腹腔镜手术;当内环口缺损直径增大至4?cm时,73.5％的普通外科医师和75.6％的儿外科医师选择腹腔镜手术.结论 关于青少年男性腹股沟疝的修补方式,儿外科医师与普通外科医师的选择倾向不同,所以目前的决定因素是术者的从业类型,而不是疾病本身的特点.

目的 总结经腹膜外耻骨上机器人辅助腹腔镜单纯前列腺切除术(RASP)治疗良性前列腺增生的手术经验,探讨该术式的疗效及安全性.方法 回顾性分析2015年4月至2018年11月接受经腹膜外耻骨上RASP的15例良性前列腺增生患者资料,记录手术时间、术中出血量、术后膀胱冲洗时间、术后引流时间、术后导尿管留置时间、术后住院时间及并发症发生情况,比较术前与术后国际前列腺症状评分(IPSS)、生命质量评分(QoL)、残余尿量(PVR)和最大尿流率(Qmax)的差异.结果 15例手术均顺利完成.手术时间(控制台时间)为(92.0±28.3)min,术中出血量为(105.0±42.5)mL,没有患者需要输血治疗;术后膀胱冲洗时间为(2.2±0.5)d,术后引流时间为(1.8±0.6)d,术后导尿管留置时间为(5.7±1.2)d,术后住院时间为(4.1±1.3)d.术后3例发生Clavien-Dindo分级Ⅰ级并发症,1例发生Ⅱ级并发症.术后3个月随访,患者IPSS、QoL、PVR和Qmax均较术前改善(P均<0.01).结论 经腹膜外耻骨上RASP是一种安全有效的良性前列腺增生治疗方式.

Objective:To investigate the application value of obliquus externus abdominis pedicle flap graft technique in repair of giant abdominal incisional hernia.Methods:The retrospective and descriptive study was conducted. The clinical data of 14 patients with giant abdominal incisional hernia who were admitted to Affiliated Hangzhou First People′s Hospital of Zhejiang University School of Medicine from June 2015 to June 2018 were collected. There were 5 males and 9 females, aged (67±10)years, with a range from 45 to 80 years. All the 14 patients underwent repair of abdominal wall defect and functional reconstruction with obliquus externus abdominis pedicle flap graft technique. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) hernia-related quality of life; (4) follow-up. Follow-up using outpatient examination was performed at postoperative 1 and 12 months, and once a year thereafter to detect the recurrence of incisional hernia or abdominal bulging up to June 2019. Measurement data with normal distribution were represented as Mean± SD, and comparison within groups was analyzed using the paired sample t test. Measurement data with skewed distribution were described as M (range). Count data were described as absolute numbers or percentages. Results:(1) Surgical situations: all the 14 patients underwent repair of abdominal wall defect and functional reconstruction with unilateral obliquus externus abdominis pedicle flap graft technique successfully, and reinforced repair with mesh. All the meshes were standard polypropylene meshes which were placed in the retro muscular or preperitoneal space. The operation time, volume of intraoperative bleeding, mesh size of the 14 patients were (153±34)minutes, (119±59)mL, (450±156)cm 2, respectively. (2) Postoperative situations: the duration of hospital stay of the 14 patients were (14±3)days. Of the 14 patients, 1 had type Ⅲ seroma and was cured after conservative treatment. There were no complications such as ischaemia and necrosis of external oblique muscle flap, incision dehiscence, infection of operation site, intestinal obstruction or intestinal fistula observed in the 14 patients. (3) Hernia-related quality of life: the score of hernia-related quality of life of the 14 patients before operation and at postoperative 12 months were 38±8 and 77±15 respectively, showing a significant difference ( t=12.729, P<0.05). (4) Follow-up: 14 patients were followed up for 12-48 months, with a median follow-up of 16 month. During the follow-up, none of the 14 patients had recurrence of incisional hernia or abdominal wall bulging. Conclusion:Obliquus externus abdominis pedicle flap graft technique can be used for repair of giant abdominal incisional hernia, which will lead to less surgical complications and improve hernia-related quality of life of patients.

全腔镜甲状腺手术(totally endoscopic thyroidectomy,TET)源于1996年美国医生Gagner等[1]的腔镜下甲状旁腺次全切除术,有锁骨下入路、腋窝入路、胸前入路(breast approach,BA)、全乳晕入路(breast areola approach,BAA)、单侧腋乳入路、双侧腋乳入路(bilateral axillo-breast approach,BABA)及口腔入路(trans-oral approach,TOA)等多种入路方式[2].与传统开放甲状腺手术(open thyroid surgery,OTS)相比,TET切口隐蔽,美容效果佳,手术的原则是“治病第一,功能保护第二,美容第三”,如何在三者之间达到平衡,一直是TET技术发展的热点与难点,也是TET技术能否持续发展的关键.

腹部疝修补术(VHR)术后伤口事件是评估手术质量的一项重要的预后指标,目前缺乏识别和处理伤口事件定义的标准,文献报道伤口事件的发生率差异很大,难以进行比较性研究和质量控制.临床上使用标准化定义的伤口事件术语,即手术部位感染(SSI)、手术部位事件(SSO)和需介入处理的手术部位事件(SSOPI),有利于减小伤口事件发生率的差异,便于疝外科医生用一种准确的共同语言进行学术交流,提高对腹部疝治疗循证决策的能力.建议讨论VHR术后伤口事件发生率时采用上述3个术语的标准定义.