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Objective: To summarize the preliminary experience with transoral endoscopic thyroidectomy via vestibular approach (TOETVA). Methods: A total of 150 consecutive patients with thyroid disease underwent TOETVA from November 2014 to February 2017 at Department of Thyroid Surgery, the Second Affiliated Hospital of Zhejiang University School of Medicine. The patients were comprised of 138 females and 12 males. The mean age of the patients was (31.7±7.6) years (ranging from 15 to 51 years). There were 108 patients of differential thyroid carcinoma (T1 or T2 ≤3 cm, cN0 or cN1a, M0) and 42 patients of benign thyroid disease (solid nodule ≤6 cm). The criteria analyzed were clinicopathologic characteristics, types of operation, operation time, complications and results of follow-up. Results: Two cases were converted into open surgery due to an incredible unexpected tumor size and tracheal invasion, respectively. One hundred and three patients with papillary carcinoma underwent transoral central neck dissection (CND), with the mean operation time of (146±34) minutes for hemithyroidectomy with CND, and (187±36) minutes for total or near total thyroidectomy with CND. The mean number of lymph node yields was 8.2±4.7, and the lymph node metastasis rate was 41.7% (43/103). Regarding postoperative complications, transient hoarseness occurred in 3 patients, and permanent recurrent laryngeal nerve occurred in 2 patients. One patient had local infection or transient mental nerve palsy. Transient hypocalcemia occurred in 31.8% of 22 patients who underwent total, near-total, or subtotalthyroidectomy, and no permanent hypocalcemia was registered. Mean hospital stay after operation was (3.5±0.6) days (ranging from 2 to 5 days). Mean follow-up period was (11.5±7.8) months (ranging from 1 to 28 months), no recurrence or metastasis occurred. Conclusions: TOETVA is feasible and safe for strictly selective patients. It brings perfect cosmetic effect. Long-term follow-up and further study is needed to assess its curative effect.

Objective: To evaluate the effects of lentiviral vector-mediated RNA interfere gene Nogo receptor (NgR) of rat cortical neurons in repairing spinal cord injury., Methods: The recombinant-lentiviral vector with small inferring RNA siNgR199 which had been constructed was transfected into rat cortical neuron cells in vitro in 3 multiplicity of infection (MOI). The infection rate was determined with fluorescent microscope, and the target gene was detected by PCR analysis. Then, the recombinant was injected into the cortical motor area of the rats with severe spinal cord injury, and the saline was also injected into other rats with severe spinal cord injury as a match control. The functional recovery of the rats' hindlimb was assessed using BBB score and the nerve fiber of the injured region was observed by nerve tracing., Results: The rate of recombinant infecting rat cortical neuron in vitro exceeded 99%. PCR analysis confirmed that the effect of lentiviral vector-mediated RNA interfering gene NgR of rat cortical neurons in vitro was 61%. Although all rats with spinal cord injury were observed to have the hindlimb functional recovery, these rats injected with recombinant had better hindlimb functional recovery than others showing by more BBB score (P < 0.01). Moreover, it was found that some nerve fiber passed the injured spinal cord region of the rats which were injected with recombinant., Conclusion: The recombinant lentiviral vector with siNgR199 which had been constructed is able to promote the growth of nerve fiber and the functional recovery of the rats' hindlimb.

Objective: To investigate the diagnosis and surgical treatment of parathyroid carcinoma., Methods: The clinical data of 9 cases of parathyroid carcinoma treated from January 1967 to December 2009 was analyzed retrospectively with the review of related Chinese literatures., Results: Parathyroid carcinoma accounted for 8.9% (8/90) of all patients with primary hyperparathyroidism in our hospital, and the other one case was transferred from another hospital. Of the patients, 8 cases were found with primary hyperparathyroidism. Primary surgery was carried out with small incision: 5 patients underwent en bloc resection, among which, 3 cases received central lymph node dissection; 2 patients received simple parathyroidectomy; one case underwent palliative tumor resection. The case from another hospital received subtotal thyroidectomy. Considering preoperative, intraoperative data and frozen sections pathology, all patients were diagnosed as parathyroid carcinoma. Nine patients were followed-up for 1 - 14 years, no recurrence occurred, and the patient received palliative resection died from carcinoma two years after the operation. In previous Chinese literatures and this group, there were total 146 patients reported as parathyroid carcinoma. Those patients were diagnosed through routine histopathology, accounted for 1.8% - 11.5% of patients with primary hyperparathyroidism., Conclusions: The diagnosis of parathyroid carcinoma is established according to severe hypercalcemia, clinical features, subset B-ultrasound and Tc(99m)-sestamibi scanning, intraoperative finding of adherence to close structures and histopathology. The initial surgical procedure of choice is en bloc resection of the tumor by minimally invasive small incision, including adjacent structures and ipsilateral thyroidectomy. The prognosis is favorable after the operation.

Objective: To evaluate the operative feasibility and safety of endoscopic thyroidectomy through anterior chest and breast approach for the treatment of the patients with papillary thyroid microcarcinoma (PTMC)., Methods: Endoscopic thyroidectomy was attempted in 164 patients with thyroid diseases. For 28 cases, which were diagnosed as PTMC by frozen section intraoperatively, lobotomy plus central compartment dissection and contralateral subtotal lobotomy was achieved completely by endoscopic thyroidectomy. There were 27 females and 1 male, and their average age was 35.2 years old. Twelve and sixteen cases were diagnosed preoperatively as thyroid microcarcinomas and benign tumors, respectively., Results: The operation time of the 28 cases was (115 +/- 43) min. The maximum diameter of PTMC was 0.2 to 1.0 cm with a mean of 0.56 cm. 17.9% (5/28) of the PTMC patients had transient vocal cord palsy and restored after 1 to 2 months postoperatively. There were no complications such as subcutaneous emphysema and postoperative bleeding and postoperative hypocalcaemia. 46.4% (13/28) had node involvement of the central compartment. Postoperative ultrasonography and scintigraphy showed no evidence of recurrence or residual thyroid tissue in the thyroid bed where lobotomy was performed., Conclusions: The endoscopic thyroidectomy through anterior chest and breast approach is a choice of the surgical treatment for selected cases of PTMC.

Objective: To compare the results of anterior cervical corpectomy and fusion with preserved posterior vertebral wall (PWCF) with the classical anterior cervical corpectomy with fusion (ACF)., Methods: Eighty-four patients with multi-level cervical spondylosis were randomized to ACF (n = 42) or PWCF (n = 42). Postoperative JOA score were evaluated by an independent observer. Fusion rate, segmental lordosis, and disc height were assessed by radiographs at postoperative 3 months, 6 months, and 12 months. Fusion evidence was observed by CT scan., Results: JOA score improvement was similar for both treatments. The operation time was shorter in the PWCF group than in the ACF group. The intraoperative blood loss was less in the PWCF group than in the ACF group. Fusion rate was 100% for both groups 3 months after operation. The segmental lordosis and the disc height increased were similar in both groups., Conclusions: Except for reduced risk, time and blood loss during the operation, PWCF is the same as for ACF procedure. Reservation of posterior vertebral wall results in more reliable fusion. But replication of the results by other team and intensive assessment still need to be carried out.

This paper reports one case with glucagonoma syndrome that resection of the primary glucagonoma in the pancreas was done. There was metastasis one in liver and lymph node. The definitive diagnosis was established by immunohistochemical analysis. The patient by immunohistochemical analysis. The patient remained well for 27 months and gained 5 kg of weight. Another experiences of diagnosis and treatment of 8 cases of malignant glucagonoma collected in chinese literature were reviewed. The clinical specialty of glucagonoma syndrome. diagnosis and management were discussed suggesting two points: on diagnosis the clinical specialty is a important clues: palliative primary tumor resection may be significant clinical improvement and prolonged survival.

From 1977 to 1987, six cases of heterotopic pancreas at the ampulla of Vater and the papilla were encountered. All patients were suffering from obstructive jaundice and misdiagnosed as having periampullary cancer and pancreaticoduodenectomy was done. The entity was rare and extremely difficult to diagnose even during exploration. The pathology, diagnosis and surgical treatment of this disease were discussed.

This paper presents an analysis of 35 GI epithelioid leiomyomas (leiomyoblastoma) including the authors' own 6 cases from 1975 to the end of 1987. Tumors were found in the stomach in 21 cases (60%), in the duodenum in 4 (11.2%), in the jejunum in 7 (19.8%), and in the ileum in 3 (8.5%). The male to female ratio was 1:1.2 ranging in ages from 11 to 68 with an average of 42. Of these, 82.8% were benign and 17.2% were malignant. No case was correctly diagnosed before the operation. Tumors were resected in 97.2% of the patients. In the author's opinion there should be two basic types of the tumor: benign and malignant, though the identification is often quite difficult. The mitosis, the size of primary tumor, the metastasis and recurrence of the tumor should all come into the consideration. Surgical resection of the tumor is the only effective treatment and all tumors should be treated as malignant.