Objective To evaluate the safety and feasibility of primary endoscopic retrograde cholangiopancreatolithiasis (ERCP) plus laparoscopic cholecystectomy (LC) in patients with choledocholithiasis combined with cholecystolithiasis.Methods From January 2023 to August 2024,185 patients with common bile duct stones combined with gallbladder stones were treated at our hospital.Patients who underwent ERCP+LC during the same surgical period were assigned to Group A(94 patients),and those who underwent LC+ERCP in separate sessions during the same hospital stay were assigned to Group B(91 patients).The gender,age,total hospitalization costs,number and size of stones,whether a drainage tube was left in place,intraoperative blood loss,duration of anesthesia,time to postoperative bowel gas passage,length of hospital stay,incidence of postoperative cholangitis,incidence of postoperative pancreatitis(PEP),rate of residual stones in the bile ducts,and changes in preoperative and postoperative neutrophils,neutrophil percentage,total serum bilirubin,indirect serum bilirubin,alanine aminotransferase,aspartate aminotransferase,and γ-glutamyl transferase were recorded for both groups of patients.Results Compared to Group B[(9.7±2.0)d],the hospital stay duration for patients in Group A[(8.6±2.6)d] was significantly reduced(P<0.05).The duration of anesthesia for patients in Group A[(2.5±0.8)h] was also significantly shorter than that for Group B[(3.7±0.5)h],with a statistically significant difference(P<0.05).Similarly,the total hospitalization costs for patients in Group A[(23969±7421)yuan] were lower than those for Group B[(25427±5236)yuan],and this difference was statistically significant(P<0.05).Conclusion The one-stage ERCP combined with LC treatment protocol for common bile duct stones with gallbladder stones is safe and feasible,with the potential advantages of reducing hospital stay,costs,and duration of anesthesia.

Esophageal cancer (EC) is most commonly diagnosed in our country as an advanced esophageal cancer.With the continuous exploration and innovation of treatment methods,the comprehensive treatment scheme based on surgery is gradually improved.Immunotherapy is a new way to treat tumors in recent years.How to make better use of it in neoadjuvant therapy to create a better prognosis for EC is worth discussing.

Prostate cancer is the most prevalent tumor of the urinary system globally and represents the highest incidence of malignant tumors among males in Europe and the United States.For recurrent or metastatic disease,androgen deprivation therapy is currently recognized as the cornerstone of treatment.However,nearly all patients inevitably progress to an incurable castration-resistant prostate cancer stage.Although the approval of several new drugs over the past two decades has enhanced both survival time and quality of life for patients with advanced prostate cancer,there remains an urgent challenge to develop new strategies that can overcome drug resistance and further extend survival duration.Therefore,based on published or ongoing clinical studies,this review will focus on an overview of the significant advancements made in the field of prostate cancer drug therapy,as well as new drugs that are actively undergoing clinical trials to provide a reference for the clinical treatment of advanced prostate cancer.

Prostate cancer (PCa) is the most common malignant tumor of the male urinary and reproductive systems,with its incidence and mortality rates steadily increasing worldwide.Enhancing early detection of PCa and refining surgical treatment methods are crucial for improving cure rates,extending survival,and enhancing quality of life.Prostate biopsy remains the gold standard for diagnosing PCa,utilizing approaches such as transrectal,transperineal,and multi-imaging guided fusion-targeted techniques.Surgical intervention is a key treatment modality for PCa,with radical prostatectomy (RP) serving as the gold standard for managing localized disease.This paper reviews recent advancements in surgical techniques for prostate cancer,aiming to provide clinical practitioners with updated guidance.

In China，more than 80% of patients with hepatocellular carcinoma (HCC) are associated with varying degrees of HBV-related liver cirrhosis.Different from the Western countries,hepatectomy remains as the one of the mainstay choices for HCC with liver cirrhosis.The severity of cirrhosis of HCC patients varies greatly from individual to individual. Although the patients’liver function is at the compensated stage.With the development of liver cirrhosis,both hepatic functional reserve and regenerative capacity are considerably diminished,the incidence of surgical complications and post-hepatectomy liver failure will increase correspondingly.Therefore,maximally preserving the amount of liver parenchyma is crucial to maintaining essential liver function for cirrhotic HCC patients.The insufficient understanding of the relationship between post-hepatectomy liver failure and the severity of liver cirrhosis for patients has led to a lack of agreement on selecting reasonable surgical modalities and preserving sufficient future liver remnant volume.This results in a scarcity of concrete guidance for clinically preventing and treating post-hepatectomy liver failure,substantially compromising the surgical efficacy in HCC patients.Minimizing the incidence of postoperative hepatic insufficiency and mortality rates in cirrhotic HCC patients deserve to be further studied.The Chinese Chapter of the International Hepato-Pancreato-Biliary Association and Hepatic Surgery Group of Surgical Branch of Chinese Medical Association invited well-known experts in liver surgery and hepatology in China,mainly elaborate the role of the severity of liver cirrhosis in the safety evaluation of hepatectomy, and how to improve surgical safety,which may assist liver surgeons to make appropriate surgical decisions for HCC patients with liver cirrhosis.

Objective  To investigate the clinical effect of elastic fixation of Endobutton plate with loop in the treatment of lower tibiofibular combined injury.Methods A total of 326 patients with lower tibiofibular joint injury combined with ankle fracture underwent surgical treatment from June 2019 to June 2021 were randomly divided into experimental group (163 cases) and control group (163 cases) by using a random number table. The control group was fixed with traditional steel plate screw, and the experimental group was fixed with elastic steel plate with loop Endobutton.Hospitalization and operation related indexes were compared between the two groups. The American Association of Foot and Ankle Surgery Ankle Function Score (AOFAS) was performed on the two groups at 2 and 6 months after surgery, respectively, and the reseparation rate of the lower tibiofibular union was evaluated and compared between the two groups at 6 months after surgery.Results There were no significant differences in operation time, blood loss, incision length, getting out of bed time and hospital stay between experimental group and control group (P>0.05). The incidence of postoperative complications in experimental group was 2.45%, lower than that in control group (7.98%), and the difference between the two groups was statistically significant (P<0.05).The incidence of postoperative complications in experimental group was 2.45%, lower than that in control group (7.98%), and the difference was statistically significant between the two groups (P<0.05). The AOFAS scores of control group were (74.5±9.2) and (81.3±4.3) at 2 months and 6 months, respectively, and the excellent and good rate was 76.0%.AOFAS of experimental group were (82.3±5.3) points and (91.2±3.8) points at 2 months and 6 months after surgery, respectively, and the excellent and good rate was 93.2%, the above indexes of experimental group were higher than those of control group, and the difference between the two groups was statistically significant (P<0.05).Reexamination 6 months after surgery the reseparation rate of lower tibiofibular combination was 12.8% in the control group and 2.4% in the experimental group, and the risk of reseparation in the experimental group was lower than that in the control group, with statistical significance (P<0.05).Conclusion Elastic fixation using Endobutton plate with loop could be used in the treatment of ankle fracture with distal tibiofibular syndesmosis injury,which has a better effect of traditional internal fixation with plate and screws.

Objective  To investigate the  short-term and long-term effect of intersphincter approach to protect external anal sphincter via intersphincter sulcus approach in perianal abscess.Methods A total of 376 patients with perianal abscess were admitted from March 2020 to June 2022,including 298 patients in the control group and 78 patients in the observation group.The propensity score matching method was used to obtain baseline data balance in 45 patients in each group.The control group received traditional incision and thread drawing,while the observation group received external anal sphincter protection.Evaluate the short-term and long-term efficacy of both groups of patients based on postoperative pain scores,wound healing time,average hospital stay,anal function score at 1 month after surgery,and recurrence rate within 1 year.Results After matching,there was no statistically significant difference in baseline data between the two groups of patients (all P＞0.05).On the first day after surgery,there was a statistically significant difference in pain scores between the two groups of patients (3.51±1.547 VS 4.33±1.871,P<0.05),while there was no statistically significant difference in pain scores between the two groups on the 7th (5.07±1.250 vs 4.87±1.236)and 14th days (1.18±0.490 vs 1.22±0.599)after surgery (P＞0.05).There were significance among wound healing time(31.89±2.197 VS 35.60±3.934),average hospital stay(10.64±2.442 vs 12.16±3.548),and anal function score at 1 month after surgery(3.44±1.765 vs 6.00±3.303) (all P<0.05).The one-year recurrence rate in the observation group was 15.6%,while the control group was 8.9%,without statistically significant difference(P＞0.05).Conclusion To protect the external sphincter during the operation of perianal abscess can reduce the muscle injury during the operation,reduce the postoperative pain,accelerate the wound healing and protect the anal function on the premise of ensuring the cure rate.

Objective To compare the efficacy and complications of cupric ion electrochemical therapy and selective suprahemorrhoid resection and stapling surgery for the treatment of grade Ⅲ-Ⅳ hemorrhoids.Methods 204 patients with grade Ⅲ-Ⅳ mixed hemorrhoids admitted to our hospital from September 2022 to October 2023 were included as the study subjects.They were divided into two groups using numerical method,with 102 cases in each group.The observation group received copper ion electrochemical therapy,while the control group received selective hemorrhoid mucosal resection and stapling surgery.Compare the surgical outcomes,efficacy,pain scores,anal function scores,quality of life index scores,and incidence of complications between two groups.Results There was no statistically significant difference in gender,age,hemorrhoid grade,surgical time,and hospitalization period between the observation group and the control group(P＞0.05),but the intraoperative blood loss in the observation group was less than that in the control group [(11.37±5.32)ml and (26.72±14.24)ml], and the difference between the two groups was statistically significant (P<0.05).The severity of pain in the observation group was lower than that in the control group on the 1st and 7th day after surgery(P＜0.05);There was no statistically significant difference in the Wexner anal incontinence scores between the two groups at 1 and 8 weeks after surgery(P＞0.05).The observation group had a better gastrointestinal quality of life index(GIQLI) score than the control group at 2 weeks after surgery[(20.92±4.63) and (26.77±5.03) scores,P<0.05],and there was no statistically significant difference between the two groups at 8 weeks[(4.38±0.90) and (4.68±1.41)mm, P>0.05].The total incidence of postoperative complications in both groups was statistically significant(8.8% vs 20.6%,P＜0.05).An average follow-up of six months showed no recurrence.Conclusion Cupric ion electrochemical therapy for mixed hemorrhoids is safe,effective,and has no serious complications,providing a more convenient and minimally invasive treatment method.

[Abstract] Objective To explore the influencing factors of Barrett’s esophagus after endoscopic submucosal dissection (ESD) in patients with early esophageal cancer.Methods 110 patients with esophageal cancer who received ESD therapy in our hospital from January 2022 to March 2023 were divided into two groups according to whether they had Barrett’s esophagus (n=20) and no Barrett’s esophagus (n=90).The general clinical data,esophageal cancer related characteristics and ESD related treatment characteristics of the two groups were compared.Multivariate regression analysis were used to screen the risk factors of Barrett’s esophagus in patients with esophageal cancer after ESD.Results The proportion of male,former drinking,former smoking,prevalence of peptic ulcer,multiple tumors,maximum diameter of tumors,the rate of postoperative lymph node metastasis,postoperative distant metastasis and the proportion of muscularis propria injury in patients with Barrett’s esophagus were significantly higher( P<0.05).Multivariatelogistic regression analysis showed that alcohol drinking,smoking,peptic ulcer,postoperative lymph node metastasis,postoperative distant metastasis and injury of muscularis propria were the risk factors for Barrett’s esophagus ( P<0.05).Conclusion Patients with a history of drinking,smoking,peptic ulcer,postoperative lymph node metastasis,postoperative distant metastasis and injury of muscularis propria are more likely to develop Barrett’s esophagus after ESD.

[Abstract] Objective To investigate the expression of X-linked inhibitor of apoptosis associated factor 1 (XAF1) and phosphoenolpyruvate carboxykinase 1 (PCK1) in Luminal type B breast cancer and their relationship with the prognosis of patients.Methods From January 2016 to January 2018, 95 patients with Luminal B breast cancer underwent surgical treatment. Cancer tissues and adjacent tissues > 5 cm from the cancer tissues were collected during the operation.The positive expressions of XAF1 and PCK1 proteins were detected by immunohistochemistry.The relationship between XAF1 and PCK1 protein expression and clinicopathological features of breast cancer was analyzed, and the survival curves of breast cancer patients with different XAF1 and PCK1 protein expression were plotted by KaplanMeier method,the survival rate was compared by Log-rankn test. Multi-factor Cox-regression analysis was used to analyze the prognostic factors of breast cancer.Results GEPIA database analysis showed that the expression levels of XAF1 and PCK1 mRNA in breast cancer tissues were lower than those in normal tissues ( P<0.05).The positive expression rates of XAF1 and PCK1 proteins in cancer tissue were lower than adjacent tissues ( P<0.05).The positive expression of XAF1 in breast cancer tissue was related to clinical stage,lymph node metastasis and histological grade,Ki-67 expression status,while the positive expression of PCK1 was related to clinical stage,lymph node metastasis and Ki-67 expression status ( P<0.05).The 5-year overall survival rate of XAF1 positive expression patients was higher than that of negative expression patients (Log-rank χ²=5.101， P=0.024),and the 5-year overall survival rate of PCK1 positive expression patients was higher than that of negative expression patients (Log-rank ^χ2=6.515, P=0.011).Clinical stage Ⅲ,negative expression of XAF1,and negative expression of PCK1 were risk factors for poor prognosis ( P<0.05).Conclusion The positive expression rates of XAF1 and PCK1 in Luminal B type breast cancer tissue are reduced,which is related to some clinicopathological characteristics and 5-year survival rate after surgery.The 5-year survival rate was lower in patients with negative XAFI and PCKI expression.

Objective To investigate the clinical efficacy of wrapping the hepatic artery with the hepatogastric ligament for preventing bleeding of the hepatic artery and its branches following pancreaticoduodenectomy(PD).Methods 194 patients who underwent PD in Xiangyang Central Hospital from January 2017 to November 2024 were enrolled and categorized into two groups based on whether the hepatic artery was enwrapped with the hepatogastric ligament during the operation.The wrapped group consisted of 95 cases where the hepatic artery was wrapped,while the non-wrapped group had 99 cases without such wrapping.Intraoperative parameters(intraoperative blood loss and operative time) and postoperative complications(pancreatic fistula,abdominal cavity infection,biliary fistula,delayed gastric emptying,postoperative bleeding,and bleeding of the hepatic artery and its branches) were compared between the two cohorts.Univariate and multivariate Logistic regression analyses were conducted to identify the independent risk factors for postoperative bleeding.Results PD was accomplished successfully in both groups.There was no remarkable difference in intraoperative indices like blood loss and operative time between the two groups(P>0.05).Similarly,no significant disparities were noted in postoperative complications such as pancreatic fistula,abdominal infection,biliary fistula,and delayed gastric emptying(P>0.05).Nevertheless,the incidence of postoperative bleeding in the wrapped group was lower than that in the non-wrapped group(3.16% vs. 12.12%,P=0.019),and the incidence of bleeding of the hepatic artery and its branches after surgery was also significantly decreased in the wrapped group(0 vs. 10.10%,P=0.004).Logistic regression analysis revealed that the operation time (OR=1.013,P=0.011), pancreatic fistula (OR=9.006,P=0.006) and celiac infection (OR=7.930,P=0.014) are independent risk factors of postoperative bleeding, Hepatogastric ligament encapsulation of hepatic artery was an independent protective factor for postoperative hemorrhage of PD (OR=0.084,P=0.006).Conclusion Wrapping the hepatic artery with the hepatogastric ligament reduces PD postoperative bleeding,especially that of the hepatic artery and its branches,without adding other complications.

Objective To explore the clinical application effects of Chen's pancreatojejunostomy in laparoscopic pancreaticoduodenectomy.Methods Clinical data of 176 patients who underwent laparoscopic pancreaticoduodenectomy in Xiangyang Central Hospital from January 2019 to December 2024 were retrospectively analyzed.According to the methods of intraoperative pancreatojejunostomy,the patients were divided into two groups,the research group(102 cases) using Chen's pancreatojejunostomy,and the control group(74 cases) using duct-to-mucosa pancreatojejunostomy.The two groups were compared on clinical indicators,including operation time,pancreatojejunostomy time,intraoperative blood loss,incidence of postoperative complications,length of hospital stay,and 30-day postoperative mortality rate.Results All 176 patients successfully underwent laparoscopic pancreaticoduodenectomy.There were no statistically significant differences between the two groups in intraoperative blood loss,biochemical leakage,abdominal bleeding,upper gastrointestinal bleeding,delayed gastric emptying,bile leakage,abdominal infection,and 30-day postoperative mortality rate(P>0.05).The pancreatojejunostomy time[(22.33±5.95)min] and operation time[(334.60±66.42)min] in the study group were significantly shorter than those in the control group[(30.70±5.50)min] and [(414.46±60.96)min],with statistically significant differences(P<0.05).Two groups of patients did not develop grade C pancreatic fistula.The incidence of grade B pancreatic fistula in the study group(5.88%) was significantly lower compared to the control group(16.22%),and this difference was statistically significant(P<0.05).Additionally,The postoperative hospital stay of the study group patients[(17.10±6.89)days] was significantly shorter than in the control group[(20.88±8.40)days],with a statistically significant difference(P<0.05).Conclusion Chen's pancreatojejunostomy is a feasible,safe,and effective procedure in laparoscopic pancreaticoduodenectomy,which can shorten the pancreatojejunostomy time,reduce the incidence of postoperative pancreatic fistula,and decrease the length of hospital stay.

Objective  To investigate the predictors of chronic pain after inguinal hernia surgery.Methods A total of 400 patients with inguinal hernia surgery in our hospital from August 2018 to May 2023 were selected as the study objects.Visual analog scoring (VSA) was used to evaluate postoperative acute pain within 24 h after surgery.The patients were divided into chronic pain group and nonchronic pain group according to whether chronic pain occurred after surgery.Thirty-seven patients with postoperative pain lasting more than 3 months were in the chronic pain group, and the remaining 363 patients were in the non-chronic pain group.Lasso-Logistic regression was used to analyze the predictors of acute and chronic pain after inguinal hernia surgery.ResultsUnivariate analysis showed that there were significant differences in age,BMI,smoking history,preoperative groin pain,intraoperative nerve tension or injury,wound infection and postoperative acute pain between the chronic pain group and the non-chronic pain group (P<0.05).The data were regularized by Lasso regression,and three representative risk factors of chronic postoperative pain,namely preoperative groin pain,intraoperative nerve pulling or injury,and postoperative acute pain,were selected.Multivariate Logistic regression analysis showed that:Preoperative groin pain (OR=2.548,95%CI1.150~5.647),intraoperative nerve tension OR injury (OR=4.435,95%CI2.084~9.436) and postoperative acute pain (OR=2.242,95%CI1.041~4.829) was the factor of chronic pain after operation (P<0.05).Conclusion  Preoperative groin pain,intraoperative nerve pulling or injury,and postoperative acute pain are the factors affecting chronic pain after inguinal hernia.Identifying high-risk groups and taking targeted measures are helpful to prevent and treat chronic pain after inguinal hernia.

ObjectiveTo investigate the influencing factors of postoperative complications with Clavien-Dindo grade ≥Ⅲ in elderly patients with esophageal cancer and construct a line graph prediction model.Methods 376 esophageal cancer patients who underwent radical esophagectomy in our hospital from January 2021 to December 2022 were selected as the study subjects.According to the Claven Mindo surgical complication grading system,the groups were divided into two groups:Clavien Mindo grading ≥ Grade Ⅲ group (93 cases) and Clavien Mindo gradingLogistic regression were used to analyze the influencing factors of postoperative complications of esophageal cancer with Clavien-Dindo grade ≥Ⅲ,and establish a risk prediction column chart model using R 3.5.1 software; The discrimination and calibration of the area verification model under the ROC curve; Use calibration curves and Hosmer Lemeshoe goodness of fit tests to evaluate the fit of the column chart model.Results 376 patients with esophageal cancer,93 patients with Clavien-Dindo grade ≥Ⅲ had complications,accounting for 24.73%.The results of univariate analysis showed that chronic respiratory disease,intraoperative blood loss,surgical time,ASA grading,prognostic nutritional index,and Charlson comorbidities index were significantly correlated with postoperative complications in elderly esophageal cancer patients with Clavien Dundo grading ≥ grade Ⅲ (P<0.05).The results of the logistic multiple regression model showed that intraoperative bleeding volume,surgical time,ASA grading,prognostic nutritional index,and Charlson Comorbidity Index were independent risk factors for postoperative complications in elderly esophageal cancer patients with Clavien Dundo grading ≥ grade Ⅲ (all P<0.05)，Based on five variables,a nomogram prediction model for postoperative complications in elderly patients with esophageal cancer with Clavien-Dindo grade ≥Ⅲ was constructed.ROC curve analysis verified that the area under ROC curve was 0.835 (0.794~0.876),indicating a good differentiation of the model.The calibration curve is drawn.The slope of the calibration curve is close to 1,and the predicted probability is basically consistent with the actual probability.Hosmer-Lemeshow goodness of fit test,χ²=5.737,df=8,P=0.676.The analysis results of decision curve show that the threshold probability is less than 0.8 and the net benefit rate is greater than 0.Conclusion The prediction model based on 5 independent risks can reliably predict the probability of postoperative complications with Clavien-Dindo grade ≥Ⅲ,which is helpful to provide targeted preventive measures for high-risk patients and reduce the occurrence of complications with Clavien-Dindo grade ≥Ⅲ.

[Abstract] Objective Exploring the efficacy and prognostic analysis of open reduction and internal fixation combined with ligament repair in the treatment of ankle joint fractures with anterior tibiofibular ligament rupture.Methods Ninety-two patients with ankle fracture combined with lower tibiofibular anterior ligament rupture admitted to our hospital from January 2020 to August 2022 were selected to implement the prospective study,and they were divided into 46 cases in the study group and 46 cases in the control group according to the different treatment modalities.The control group only received open reduction and internal fixation surgery,while the research group received open reduction and internal fixation surgery combined with ligament repair treatment.The differences in surgical indicators and recovery,pain level (VAS score),ankle joint function recovery (AOFAS score,ankle ROM),bone metabolism indicators,postoperative complications,and long-term prognosis between the two groups were compared.Results Compared with the control group,the study group had longer operation time,shorter hospitalization time,and shorter fracture healing time ( P<0.05).Repeated measures showed that there were differences in the comparison of timepoint effects,between-group effects,and interaction effects of VAS scores ( P<0.05),and VAS scores were lower in both groups at 1 month and 3 months postoperatively compared with preoperatively,and were better in the study group than in the control group ( P<0.05).Compared with preoperative,AOFAS score and ankle ROM were increased in both groups at 6 months postoperatively,and the study group was better than the control group ( P<0.05).Compared with preoperative,collagen type Ⅰ N-terminal peptide (PINP),osteocalcin (BGP),bone alkaline phosphatase (BALP) were elevated in both groups at 6 months postoperatively,and the level of β-collagen degradation product (β-CTX) β-CTX was reduced in the former ( P<0.05);and the study group was better than the control group ( P<0.05).Compared with the control group,there was no significant difference in the comparison of postoperative complication status ( P>0.05),but the study group had a better long-term prognosis ( P<0.05).Conclusion The combination of open reduction and internal fixation surgery with ligament repair for the treatment of ankle fracture combined with anterior tibiofibular ligament rupture has good clinical efficacy,can effectively reduce pain,improve ankle function,regulate bone metabolism level,promote fracture healing,and has good safety and long-term prognosis.

Objective To evaluate the effect of target oriented infusion guided by stroke volume variation (SVV) in elderly lumbar surgery.Method  From January to December 2023, 80 elderly patients undergoing elective general anesthesia for prone lumbar surgery were divided into two groups by random number table method: SVV guidance target-oriented infusion group (SVV group) and conventional infusion group (conventional group), with 40 cases in each group.The amount of infusion, blood loss, urine volume and use of vasoactive drugs in the two groups were recorded. MAP, HR, blood lactate concentration (Lac), base residual value (BE), and PaO-2 were recorded at the time of entry (T₁), before cuticle (T₂), 1- hour after prone position (T₃), and after surgery (T₄).Pulmonary ultrasound examinations were performed at 4, 8, 12 and 24 hours after surgery, and Bline scores were calculated, as well as the incidence of cardiac insufficiency, nausea, vomiting, delirium and hospital stay at 24 hours after surgery.Result Compared with normal group, in group SVV, intraoperative infusion volume [(1123 + 532)ml], vascular active drug utilization rate (15.0%), postoperative each point B line score [(1.55±1.32), (1.22±0.94), (1.01±0.93), (1.07±0.90)] were reduced (P<0.05).HR at T₂～T₄ [(67±8,71±11,73±12) times/min]、PaO₂ at T₃,T₄ [(438±41,423±44) mmHg] were increased,Lac and BE at T₂～T₄ were (0.3±0.5,1.4±0.5,1.4± 0.3) mmol/L.(0.3±0.6,0.3±1.0,0.3± 1.1)was decreased (P<0.05).There were no significant differences between the two groups in cardiac dysfunction,nausea,vomiting,delirium and hospital stay after a 24-hour postoperative period (P>0.05).Conclusion SVV guided target oriented infusion in elderly lumbar surgery is beneficial to circulation stability and tissue perfusion, and reduces the production of lung water.

Objective To investigate the application effect of the anterolateral thigh perforator flap (ALTPF) with end-to-side anastomosis of non-primary source vessels in repairing soft tissue defects in the hands and feet.Methods Ninety-six patients with soft tissue defects in the hands and feet of the Third People's Hospital of Xinjiang Uygur Autonomous Region from March 2021 to June 2023 were randomly divided into two groups using a random number table method,with 48 cases in each group.The control group was treated with a conventional subcutaneous artery perforator flap,while the observation group was treated with an end-to-side anastomosis of non-primary source vessels using an ALTF.The repair indicators of tissue defects,the recovery of sensory function,the recovery of hand and foot function,and the incidence of complications were compared between the two groups at 1 month and 3 months after surgery.Results The wound healing time in the observation group and the control group was (19.35±3.89) days and (23.72±4.76) days,respectively,with a statistically significant difference (P<0.05).There was no significant difference in the preparation time,survival rate,and stage I healing rate of the two groups of skin flaps (P>0.05).At 1 month and 3 months after surgery,the proportions of patients with pain sensation in the observation group and control group were 70.83% and 50.00%,respectively,and 100.00% and 79.17%,respectively.The proportions of patients with cold and hot sensation were 66.67% and 45.83%,respectively,and 97.92% and 72.92%,respectively.The distance of two-point discrimination was (30.69±6.10) mm and (34.40±7.36) mm,respectively,and (15.23±3.72) mm and (22.36±5.28) mm,respectively,with a statistically significant difference (P<0.05).There was no significant difference in the excellent and good rate of hand and foot function between the two groups 3 months after surgery (P>0.05).The incidence of complications in the observation group was 4.17%,which was lower than that in the control group (22.91%),and the difference was statistically significant (P<0.05).Conclusion ALTPF repair of soft tissue defects in the hands and feet with end-to-side anastomosis of non-primary source vessels can improve wound healing rates,improve sensory function,and reduce the incidence of complications.

Objective To evaluate the effects of thoracoscopic intercostal nerve block and incision infiltration block on postoperative recovery quality and analgesia in patients with partial pulmonary resection.Methods From July 2023 to December 2023, 60 patients scheduled for elective thoracoscopic partial lung resection were divided into two groups by random number table method, with 30 cases in each group.The observation group underwent thoracoscopic vision intercostal nerve block,and the control group underwent incision local infiltration block.Intravenous patient-controlled analgesia was adopted in all cases after the operation.The 15-item Recovery Quality Scale (QOR-15) score was recorded 1 day before surgery,24 hours and 48 hours after surgery.The visual analogue pain scores (VAS) at rest and cough at 2,4,8,24,and 48 hours after surgery,consumption of sufentanil within 24 hours and 48 hours after surgery,remedial analgesia and related adverse reactions were recorded.Results The QOR-15 scores of the observation group at 24 hours and 48 hours after operation were (103.4±14.2) and (111.2±6.9),which were higher than those of the control group (91.3±21.4) and (101.8±14.8),and the differences were statistically significant (P<0.05).At rest,the VAS scores of the observation group at 2,4,8 and 24 hours after surgery were (2.0±0.9),(2.1±0.9),(2.5±1.2) and (2.4±1.2).Compared with the control group (3.1±1.2),(3.4±1.7),(3.5±1.7) and (3.2±1.3),the differences were statistically significant (P<0.05).When coughing,the VAS scores of the observation group at 2,4 and 8 hours after operation were (2.4±0.6),(2.5±0.6) and (3.0±1.2),which were lower than (3.2±1.2),(3.7±1.7) and (4.0±2.1) of the control group.The difference was statistically significant (P<0.05).The consumption of sufentanil within 24 hours and 48 hours after surgery in the observation group was (58.1 ± 7.5)μg and (116.5 ± 14.9)μg,respectively,which were lower than those in the control group (63.2 ± 8.5)μg and (125.0 ± 16.7)μg,and the difference was statistically significant (P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05).Conclusion Compared with incision infiltration block,thoracoscopic intercostal nerve block has better postoperative analgesic effect and higher postoperative recovery quality.

Objective To explore the surgical treatment experience of primary giant gastrointestinal stromal tumors（GIST）(with isolated lesions with a maximum diameter ＞ 10cm).Methods A retrospective analysis was conducted on the clinical and pathological data of 67 patients with primary giant GIST admitted from January 2018 to December 2024.Among them, 35 cases underwent surgical operations after preoperative neoadjuvant therapy (25 effective cases and 10 ineffective cases) (neoadjuvant therapy group).Due to the initial diagnosis assessment expecting radical (R0) resection (13 cases), or preoperative complications (12 cases), or difficulty in obtaining a pathological diagnosis through puncture biopsy (7 cases), 32 cases underwent direct surgery without neoadjuvant therapy (direct surgery group).Compare the general information,tumor condition,surgical condition,postoperative recovery,postoperative pathology,postoperative adjuvant therapy,and recurrence between two groups.Results Comparative analysis revealed that there was no statistically significant difference(P>0.05) between the neoadjuvant therapy group and the direct surgery group in terms of gender,age,primary tumor location,initial maximum diameter,growth type,localized or locally advanced stage,and postoperative follow-up time.The maximum diameters of the tumors before surgery in the neoadjuvant therapy group and the direct surgery group were (12.4±7.1)cm and (18.2±5.0) cm respectively, and the operation times were (125.4±30.6) minutes and (153.0±31.7) minutes respectively. The intraoperative blood loss was (228.3±76.4)ml and (300.3±67.2)ml, respectively. The postoperative hospital stay was (9.1±2.6) days and (11.1±3.2) days, respectively. There was a statistically significant difference between the two groups (P < 0.05).The proportion of laparoscopic surgery in the neoadjuvant therapy group was 17.1%, which was higher than that in the direct surgery group (0), and the difference was statistically significant (P < 0.05). There was no statistically significant difference between the two groups in terms of the proportion of tumor rupture, combined organ resection, postoperative complications and postoperative recurrence (P>0.05).Conclusion Primary giant gastrointestinal stromal tumors can mostly be reduced in size and progression through neoadjuvant therapy,improving the chances of minimally invasive surgery.However,there is also a risk of tumor progression during neoadjuvant therapy leading to increased surgical difficulty or even loss of curative surgical opportunities.

Objective To compare the clinical effects of improved rivet double pulley fixation method and traditional Kirschner wire tension band in the treatment of patellar lower pole fractures.Methods 78 patients with patellar inferior pole fractures who underwent surgery in our department between January 2020 and January 2024 and met the inclusion criteria were collected.Divided into two groups according to different fixing methods,the observation group(39 cases) were fixed by modified rivet double pulley,the control group(39 cases) were fixed by steel wire tension band.The operation time, hospital stay, medical expenses, knee motion of the two groups at 1.5 months, 3 months and 6 months after surgery, and knee lyshom function score at 3 months and 6 months after surgery were compared between the two groups.Results The observation group had a surgery time of (62.58±6.37) minutes compared to the control group [(60.20±11.18) minutes],and the observation group had a hospital stay of (6.45±1.35) days compared to the control group[(6.40±1.30) days].There was no significant difference in surgical time and hospitalization time between the two group (P>0.05).The total medical expenses of the observation group were significantly lower than those of the control group (P<0.05).Knee joint activity in observation group was higher than that in control group at 1.5 months, 3 months and 6 months after surgery (P<0.05), and knee lyshom function scores in observation group at 3 months and 6 months after surgery were significantly higher than those in control group (P<0.05).Conclusion Compared with Kirschner wire tension band fixation for the treatment of patellar lower pole fractures,the improved riveting double pulley surgery does not require secondary surgery to remove internal fixation,resulting in lower overall medical costs,better postoperative knee joint mobility,and better postoperative knee joint function scores.The improved riveting double pulley surgery has more advantages in treating patellar lower pole fractures compared to traditional Kirschner wire tension band fixation.