Objective To compare the effectiveness of multi-layer compression therapy and biological ice pack in alleviating edema after total knee arthroplasty.Methods 100 patients who underwent total knee arthroplasty in our department from January 2020 to January 2022 were selected.They were randomly divided into two groups,50 cases in each group.The observation group was treated with multi-layer compression therapy,while the control group was treated with biological ice pack.The degree of swelling at 1d,2d,3d and 7d after surgery was evaluated,the time of swelling subtraction was recorded,and the pain and comfort at 1d and 3d after surgery were evaluated.Results On postoperative day 1,3,5 and 7,the circumference of lower limb swelling in the control group was (43.51±1.88)cm、(41.97±1.74)cm、(40.60±1.82)cm and (37.93±1.49)cm,respectively.The circumference of lower limb swelling in the observation group was (42.78±1.29)cm,(40.36±1.62)cm,(38.25±1.51)cm and (37.52±1.18)cm,respectively,which were significantly lower than those in the control group P<0.05).Besides,the swelling degree scores were significantly reduced at 1d,2d and 3d (P<0.05)and the swelling regression time was reduced compared to the control group (P<0.05),while the pain scores and comfort scores of observation group were not significantly different at 1d and 3d after operation (P>0.05).Conclusion Multi-layer compression therapy was more effective than ice pack cold compress in alleviating edema after total knee arthroplasty.

Objective To explore diagnostic strategies and treatment options for gastrointestinal bleeding after aortic dissection surgery.Methods The clinical data and diagnosis and treatment results of patients with gastrointestinal bleeding after aortic dissection surgery admitted from January 2020 to June 2022 in the Affiliated Nanjing Hospital of Nanjing Medical University were analyzed retrospectively.Results A total of 10 cases of 14 patients with gastrointestinal bleeding after aortic dissection surgery were cured,7 cases were mainly based on basic support and drug therapy,1 case was treated with endoscopic therapy,and 2 cases were treated with surgical operations;In the untreated group,3 cases were basic support and medication,and 1 case died due to poor surgical treatment.Conclusion The diagnosis and treatment strategy of gastrointestinal bleeding after aortic dissection surgery should be comprehensively evaluated according to the amount,location and complications of bleeding,and the individualized treatment of patients should be strengthened.Timely surgical treatment is helpful to improve the prognosis and outcome of patients with gastrointestinal bleeding after aortic dissection surgery.

Objective To investigate the effect of remazolam on postoperative delirium,stress response in patients with thyroid-related ophthalmopathy undergoing orbital decompression surgery.Methods A total of 100 patients with thyroid-related ophthalmopathy who were diagnosed in our hospital from January 2021 to December 2021 and underwent orbital wall decompression were selected as the research subjects,and were divided into the intervention group(n=51) and the control group(n=49) according to the random number method.The intervention group received remazolam and propofol anesthesia induction and maintenance during the operation,while the control group received normal saline and propofol anesthesia induction and maintenance during the operation.The incidence of delirium,stress response(epinephrine,norepinephrine,cortisol,blood glucose levels),hemorheology(MAP,HR),adverse reactions and satisfaction were observed and recorded in the two groups of patients at different time points after operation.Results The incidence of delirium in the intervention group within 5 days after surgery(3.92%) was lower than that in the control group(15.67%)(P<0.05),but the incidence of delirium in the intervention group within 7 days after surgery(1.96%) was not statistically different with that in the control group(5.88%)(P>0.05).The epinephrine [(100.52±18.41)ng/ml,(112.20±19.22)ng/ml],norepinephrine [(401.14±30.14)ng/ml,(436.63±32.11)ng/ml],cortisol [(231.29±26.63) ng/ml,(246.25±26.79)ng/ml],blood glucose [(6.33±1.22)mmol/L,(7.15±1.36)mmol/L] levels in the intervention group at 6h and 1d after operation were significantly lower than those in the control group [(120.25±20.22)ng/ml,(135.52±21.63) ng/ml,(452.11±33.20)ng/ml,(560.14±35.16)ng/ml,(286.63±28.52)ng/ml,(310.14±30.10)ng/ml,(7.85±1.52)mmol/L,(8.85±1.89)mmol/L](P<0.05),but the epinephrine,norepinephrine,cortisol  and blood glucose in the two groups at 2d after operation had no significant difference(P>0.05).The rate of postoperative adverse reactions in the intervention group(11.76%) was lower than that in the control group(31.37%)(P<0.05),but there was no statistically significant difference in doctor satisfaction between the two groups(P>0.05).Conclusion  The use of remazolam in orbital wall decompression patients with thyroid-related eye disease does not increase the incidence of postoperative delirium,while reducing stress response and postoperative adverse reactions,and increasing patient and physician satisfaction.

Objective  To report a case of renal clear cell carcinoma metastasis of ipsilateral adrenal after radical nephrectomy,and to analyze its symptoms,signs,diagnosis and treatment process,and discuss in accordance with the latest EUA and CSCO guidelines. Methods  The clinical data,diagnosis and treatment of a patient with renal clear cell carcinoma metastasis of ipsilateral adrenal more than one year after radical nephrectomy were retrospectively analyzed. Results The patient underwent laparoscopic radical left renal resection after renal cancer was found,and robot-assisted laparoscopic left adrenal resection after adrenal metastasis was found.Anti-infection,analgesia,hemostasis,fluid replacement and other treatments were given after the surgery,and the patient recovered well. Conclusion Adrenal metastasis of renal carcinoma is rare and difficult to detect in early stage,resulting in delayed treatment.Mastering comprehensive clinical features combined with authoritative guidelines for the diagnosis and treatment of renal carcinoma is helpful for early diagnosis and treatment of adrenal metastasis of renal carcinoma.

Objective To investigate the difference between the minimally invasive direct anterior approach(DAA) and the SuperPATH approach for early balance and functional recovery after total hip arthroplasty(THA).Methods A total of 82 patients with THA who were admitted to the Eastern Theater General Hospital from August 2016 to August 2020 were divided into DAA group(minimally invasive DAA approach for THA) and SuperPATH group(SuperPATH approach) according to the random number table.THA),41 cases in each group.The acetabular angles(anterior angle,abduction angle) of the two groups of patients were compared with operation related indicators on the 3rd postoperative day.Two groups of patients before operation(T0),1 week after operation(T1),1 month after operation(T2),3 months after operation(T3) and 6 months after operation(T4) Berg Balance Scale(BBS) The score was compared with the Harris score of hip joint function.The postoperative complications of the two groups of patients were compared.Results The length of incision in SuperPATH group [(6.83±0.72) vs(8.06±0.84) cm],intraoperative blood loss [(61.54±10.08)ml vs(80.23±15.74) ml] was shorter(less) than that in DAA group(P<0.05),The operation time [(125.13±11.27)min vs(115.76±10.8 5) min] was longer than that in the DAA group(P<0.05).The postoperative drainage volume [(70.25±11.36)ml vs(65.87±10.43) ml] of the two groups of patients was compared,and the difference was not statistically significant(P>0.05).The anteversion angle of the acetabulum [(15.72±1.76)° vs(15.96±1.85)°] and the abduction angle [(43.28±3.56)° vs(42.75±3.19)°] were compared between the two groups of patients after surgery,and the difference was not statistically significant(P>0.05).There were statistically significant differences in BBS scores between groups,time,and interaction(P<0.05).There was no significant difference in BBS scores between the two groups at T0(P>0.05).Compared with T0,the BBS scores of the two groups of patients at T1,T2 and T3 were reduced(P>0.05),and at T1 [(38.25±5.42)points vs(34.86±6.08) points],T2 time [(41.25±4.96)points vs(37.17±4.03) points],the BBS score of the SuperPATH group was higher than that of the DAA group(P>0.05).There was no significant difference in BBS scores between the two groups at T3 and T4(P>0.05).There were statistically significant differences in the Harris scores of hip joint function between groups,time,and interaction(P<0.05).There was no significant difference in Harris scores of hip joint function between the two groups at T0(P>0.05).Compared with T0,the Harris scores of hip joint function of the two groups of patients at T1,T2,T3,and T4 increased(P>0.05),and T1 [(66.92±3.87)minutes vs(62.35±3.29) minutes],T2 [(77.85±4.06)points vs(75.02±3.75) points] The Harris score of hip joint function in SuperPATH group was higher than that in DAA group(P>0.05).There was no significant difference in Harris scores of hip joint function between the two groups at T3 and T4(P>0.05).The incidence of complications in the SuperPATH group and DAA group were 4.88% and 9.76%,respectively,and the difference was not statistically significant(P>0.05).Conclusion Compared with minimally invasive DAA,the SuperPATH approach for THA has a shorter incision length and less intraoperative blood loss.The two approaches for THA have better early balance and functional recovery,and both are safe and reliable.

Objective To investigate the characteristics of lymph node sorting and risk factors of metastasis in group No.6 lymph node of lower gastric carcinoma.To provide the data support for standardizing lymph node grouping and harvested in laparoscopic radical distal gastrectomy.Methods This study included 66 patients with lower gastric carcinoma who underwent laparoscopic D2 radical gastrectomy in the department of Gastrointestinal Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2017 to December 2017.Lymph node sorting of each gastric cancer sample was performed according to the scope of D2 dissection.The total number of harvested lymph nodes,total number of metastatic lymph nodes,proportion of patients with lymph node metastasis and lymph node metastasis rate were calculated in each group such as No.1、No.3、No.4sb、No.4d、No.5、No.6、No.7、No.8a、No.9、No.11p and No.12a.Clinicopathological data were recorded:gender,age,depth of invasion,tumor size,degree of differentiation,nerve invasion,vascular invasion,body mass index,HER2 expression,cancer nodule surrounding the tumor and tumor location.The characteristics of lymph node sorting in group No.6 were analyzed and concluded.Univariate and multivariate analysis of risk factors for lymph node metastasis in group No.6 were performed.Results The proportion of patients with lymph node metastasis in group No.6 was 18/66(27.3%),and the rate of lymph node metastasis was 60/233(25.8%).Univariate analysis showed that the depth of invasion(χ2=7.153,P=0.007),nerve invasion(χ2=8.503,P=0.004),vascular invasion(χ2=5.677,P=0.017),HER2 expression(χ2=4.979,P=0.026)and cancer nodule surrounding the tumor(χ2=5.408,P=0.020) were significantly associated with lymph node metastasis in group No.6(P< 0.05).Lymph node metastasis in group No.3(χ2=5.432,P=0.020),group No.7(χ2=12.726,P=0.000),group No.8a(χ2=10.615,P=0.001) and group No.9(χ2=7.787,P=0.005) were closely correlated with lymph node metastasis in group No.6(P<0.05).Multivariate Logistic regression analysis showed that cancer nodule(OR=15.648，95%CI:2.946~83.118)and HER2 expression(OR=11.706，95%CI:2.018~67.890) were independent risk factors for lymph node metastasis in group No.6(P<0.05).Conclusion The attention should be paid to lymph node metastasis and sorting in group No.6 in laparoscopic radical distal gastrectomy.According to the lymph node metastasis of group No.6,the scope of lymph node dissection should be appropriately expanded.

Objective To explore the feasibility of improving the indwelling technique of drainage tube orifice after single-port thoracoscopic lung cancer surgery and analysis of drainage effect.Methods The clinical data of 80 patients who underwent single-port thoracoscopic radical resection of lung cancer who were admitted to Ningbo Huamei Hospital,University of Chinese Academy of Sciences from January to December 2021 were retrospectively analyzed,and they were divided into observation group and control group according to the different drainage tube indwelling techniques.Postoperative drainage tube indwelling time,postoperative hospital stay,postoperative total drainage volume,intraoperative blood loss,operative time,incision infection,postoperative pain score,and drainage port healing.Results The postoperative incision exudation,poor incision healing,incision infection,drainage tube indwelling time,and postoperative hospital stay in the observation group were better than those in the control group,and the differences were statistically significant(P<0.05).There were no significant differences in the total drainage volume,intraoperative blood loss,operation time,and secondary suture rate of the incision(P>0.05).Conclusion The single-port thoracoscopic surgery is beneficial to reduce the incidence of postoperative incision infection and incision exudation,shorten the indwelling time of the drainage tube,improve the safety of extubation,and shorten the hospitalization of patients.time.

Objective To investigate the value of carrelizumab combined with chemotherapy in conversion therapy of primary unresectable locally advanced esophageal cancer.Methods A descriptive case series study was used to retrospectively analyze 22 patients with unresectable locally advanced esophageal squamous cell carcinoma who underwent conversion therapy from February 2020 to December 2021.They were treated with “carrelizumab + albumin paclitaxel+cisplatin” regimen for 3 ~ 4 cycles before operation.The patients who were evaluated as radical surgery after multidisciplinary joint consultation were treated with surgery.The effect,adverse reactions and surgical index during conversion therapy were analyzed.Results After conversion therapy,Among the 22 patients,6 had complete remission and 14 had partial remission.The objective remission rate was 90.91%(20/22);16 patients underwent surgery after transformation.The conversion rate was 72.73%(16/22);The resection rate of R0 was 93.75%(15/16).Conclusion Carrelizumab combined with chemotherapy can achieve better clinical remission and higher R0 resection in the conversion therapy of primary advanced unresectable esophageal cancer.

［Abstract］Hepatocellular Carcinoma(HCC) is one of the most common malignant tumors,which ranks second in the mortality rate of malignant tumors in China.At diagnosis,most patients were in advanced stages already.They have lost surgical opportunities,and also achieved poor response from radiation therapy,chemotherapy,and traditional immunotherapy.In recent years,major advances have been made in anti-PD treatment for HCC,bringing new hope to advanced cancer patients.The anti-PD therapy for HCC has undergone the 1.0 era of anti-PD-1/PD-L1 monoclonal antibody monotherapy,the 2.0 era of combined molecular targeted drug application,and the 3.0 era of clinical application research stage of further combined locoregional therapy.With the development of the PD-1/PD-L1 inhibitors-based immunotherapy,the therapeutic effect of HCC has been further improved.The latest clinical research explores adoptive tumor-infiltrating lymphocytes therapy on the basis of immunotherapy 3.0,and the preliminary research has obtained good clinical efficacy,which also marks the advent of the era of HCC immunotherapy 4.0.

Objective To retrospectively analyze the incidence and influencing factors of proximal femoral shortening after intertrochanteric fracture surgery. Methods The clinical data of 97 patients with intertrochanteric fracture treated from January 2017 to February 2020 were retrospectively analyzed.There were 31 cases with the dynamic hip screw(DHS),41 cases with the proximal femoral nail antirotation(PFNA),25 cases with Intertan.They were divided into normal group(59 cases) and PFS group(38 cases) according to the shortening of proximal femur after operation.The differences of age,gender,body mass index(BMI),bone mineral density,fracture type,internal fixation method,reduction quality,TAD value and complete weight-bearing time between the two groups were observed.Results In this group,the proportion of proximal femoral shortening was 38/97(39.18%).In PFS group,the shortening of femoral neck main screw was (5.43±1.72)mm,including 2 cases(2.06%) with internal fixation penetrating the femoral head and 5 cases(5.14%) with nonunion； The proportion of type Ⅲ and type Ⅳ fractures in the normal group was 40.68%,and that in the PFS group was 76.32%,the difference was statistically significant(P<0.05).The proportion of PFNA /Intertan was 76.27% in the normal group and 65.79% in the PFS group(P<0.05).There were 26 cases of positive reduction,18 cases of neutral support and 15 cases of negative support in the normal group,while there were 8 cases,13 cases and 17 cases in the PFS group,the difference was statistically significant(P<0.05).The complete weight-bearing time of normal group was (8.54±2.37)weeks,which was significantly later than that of PFS group(4.15±1.83)weeks(P<0.001).Conclusions  Internal fixation,reduction quality and complete weight-bearing time were important factors affecting the proximal femoral shortening after intertrochanteric fracture.

The development of the popularity of chest CT has led to an increasing number of lung cancer patients being detected at an early stage.Early lung cancer is often presented in the form of small lung nodules on chest CT,and small lung nodules are often clinically wedge-shaped or pulmonary segment resection.Because small lung nodules are small in diameter and low in density,surgeons cannot determine whether the resection range is sufficient.With the development of science and technology,the technology of localization of small lung nodules has also been greatly developed,but the specific role of each method in lung cancer surgery is not clear.We review the clinically relevant studies such as computed tomography-guided percutaneous puncture localization technique,bronchoscopic assisted positioning technology,computed tomography virtual 3D assisted positioning technology and intraoperative anatomical localization technique and summary the application progress of various localization techniques in lung cancer surgery.

Objective To count and analyze the composition of pathogenic bacteria inabdominal pus and drug sensitivity test results of patients with acute appendicitis.Methods From January 1, 2020 to January 1, 2021, 280 patients with acute appendicitis received laparoscopic appendectomy. Intraoperatively, abdominal fluid was taken from the patients, and bacterial culture and drug sensitivity tests were performed.Bacteria were identified by VTEK-MS mass spectrometer; drug susceptibility tests were performed by VITEK2-Compact automatic microbiological analyzer or disk diffusion.Result In terms of the composition of pathogenic bacteria,Escherichia coli was the main pathogenic bacteria,accounting for 59.7%,followed by pseudomonas aeruginosa (11.2%) and klebsiella pneumoniae (6.6%).In drug susceptibility test,the five antibiotics with the highest sensitivity to Escherichia coli  were:carbapenems(100%),amikacin(98.3%),piperacillin/tazobactam(97.4%),cefoxitin(95.7%),amoxicillin/clavulanate potassium (85.5%).Conclusion The sensitivity rates of piperacillin/tazobactam,cefoxitin,amoxicillin/clavulanate potassium,amikacin and carbapenems to Escherichia coli in patients with acute appendicitis are all above 70% ,which can be preferred according to clinical situation.

Objective To analyze the effects of end-to-side ileocolon and side-to-side ileocolon on diarrhea after radical resection of right colon cancer.Methods Total 90 right colon cancer subjects from Jingzhou First People's Hospital between June 2019 and June 2021 were recruited.According to different surgical anastomosis methods,patients were divided into group A(30 cases):ileocolonic anastomosis was performed by end-to-side anastomosis with A 25 mm circular stapler,and the colon stump was 5 cm;Group B(30 cases):ileocolonic anastomosis was performed end-to-side anastomosis with a 25 mm circular stapler,and the colon stump was 10 cm;Group C(30 cases):ileocolon anastomosis was performed side-to-side with a 75 mm linear cutter and closure device.Multivariate Logistic regression was used to analyze the risk factors of postoperative diarrhea and compare the effects of different surgical anastomosis methods. Results The results showed that 35 patients developed postoperative diarrhea, univariate analysis showed that age(P=0.033)，club ratio(P=0.015)，anastomosis(P=0.014)，recovery time(P=0.024)，postoperative antibiotic time(P=0.033) had statistical significance between diarrhea group and non-diarrhea group.Multivariate analysis showed that club ratio(P=0.012,OR=0.195) was an independent factor influencing the occurrence of diarrhea after right colon cancer.There were statistically significant differences between group A and group C(P<0.01,OR=0.181) and group B and group C(P=0.021,OR = 2.243).There was no statistical significance in group A compared with group B(P=0.661,OR=1.339).Therefore,the anastomosis method is also an independent factor influencing the occurrence of postoperative diarrhea in right colon cancer.There were statistical differences in the number of postoperative daily diarrhea(P=0.028),duration of postoperative diarrhea(P=0.045),intestinal sIgA(P=0.018) and blood D-lactic acid(P= 0.019) between the end-to-side anastomosis group and the side-to-side anastomosis group.
 Conclusion 1.Age,club ratio,anastomosis method,recovery time of liquid food and postoperative antibiotic time were correlated with the occurrence of diarrhea after right colon cancer radical resection.2.Club ratio and anastomosis were independent risk factors for diarrhea after radical resection of right colon cancer.3.The incidence and degree of postoperative diarrhea were both lower in the end-to-side anastomosis group than in the side-to-side anastomosis group,and the effects of simulated cecum 5 cm and simulated cecum 10 cm on postoperative diarrhea were similar.4.The changes of intestinal sIgA and blood D-lactic acid may be the mechanism of end-to-side anastomosis and side-to-side anastomosis affecting postoperative diarrhea.

Objective To explore the effect of thoracoscopic-assisted tricuspid valve surgery with minimally invasive right thoracotomy after left heart valve replacement. Methods A retrospective analysis of 28 patients with tricuspid valve surgery with minimally invasive right thoracotomy after left heart valve replacement was conducted in the First Affiliated Hospital with Nanjing Medical University from May 2018 to July 2020.Nine patients underwent tricuspid valve repair and 19 patients underwent tricuspid valve replacement.All the patients underwent double-lumen tracheal intubation under general anesthesia,with the right chest elevated,the main operating hole of 5cm from the right midclavicular line to the right midaxillary line at the 4th intercostal space,and the observation hole of 1cm at the 5th intercostal incision at the right midaxillary line.Cardiopulmonary circulation was established through right femoral artery and vein cannulation,and tricuspid valve surgery was completed under heart beating. Results Only one patient died during the perioperative period,the patient developed acute renal failure combined with pulmonary infection,and the rest patients recovered well after the operation.All the operations were performed under cardiopulmonary bypass with continuous heart beating,no patients were converted to sternotomy,and there was no intraoperative complication.The cardiopulmonary bypass time was (78±15)min,postoperative ICU extubation time (20.3±8.6)h,postoperative hospital stay (8.5±3.0)days,no postoperative third-degree atrioventricular block,postoperative echocardiography showed no paravalvular leakage.The patients were followed up for 12 to 30 months,no death was found,and the cardiac function was improved compared with that before the operation. Conclusion Tricuspid valve surgery with thoracoscopic-assisted minimally invasive right thoracotomy after left heart valve replacement is a safe and feasible surgical method,which can significantly simplify the surgical process and reduce postoperative mortality and complications.

Objective To investigate the clinical value of body mass index(BMI) in guiding femoral artery incision or puncture for aortic dissection. Methods From January 2020 to December 2020, 449 patients with aortic dissection were admitted to our hospital. Clinical data and imaging data were collected.The correlation between BMI and subcutaneous fat thickness at cross section under femoral artery branch and intra-femoral artery track was analyzed.Results There was a relatively strong positive correlation between BMI and bilateral femoral subcutaneous fat thickness,as the correlation coefficient was 0.654 on the left and 0.635 on the right.The results were statistically significant(P<0.05).The correlation between BMI and bilateral femoral artery diameter was very weak with the correlation coefficient 0.11 on the left side and 0.108 on the right side.The results were statistically significant(P<0.05). Conclusion There was a relatively strong correlation between BMI and bilateral femoral subcutaneous fat thickness.Thus,BMI can act as an important reference for intraoperative femoral artery incision or puncture,that suitable for predicting femoral artery depth in patients who suffer aortic dissection.

Objective   To compare the efficacy and safety of single pig-tail biliary stent placement under choledochoscopy followed by primary common bile duct closure with traditional T-tube drainage after laparoscopic common bile duct exploration.   Method  A total of 98 cases who underwent laparoscopic common bile duct exploration in our hospital from June 2019 to June 2022 were included retrospectively.They were divided into bile duct stents group (BD-stent group,40 cases) and the T-tube drainage group (TTD group,58 cases) according to the surgery type.The general conditions,intraoperative indicators,postoperative recovery and complications in two groups were statistically compared.   Result   In terms of surgery,the BD-stent group had significantly less surgery time,bile-duct-operation time,bleeding volume,postoperative VAS index and Caprini score than the TTD group (P<0.05).Both groups had no mortality or reoperation.There were no significant differences in first-day serum total bilirubin,γ-GT and total analgesia usage between two groups(P>0.05).But the first-day serum albumin,anal ventilation time,antibiotic usage,leukocyte recovery days,drain-tube removal days,bile duct drainage days,postoperative hospital stay and total costs in BD-stent group were significantly better than those in TTD group (P<0.05).As for postoperative complications,the rate in BD-stent group and TTD group were respectively 5.0% and 6.9%,without significant differences (P>0.05).  Conclusion   Single pig-tail biliary stent placement under choledochoscopy followed by primary common bile duct closure has unique advantages in safety and rapid recovery.It avoids long-term drainage.

Objective During the anesthesia of ankle fractures,ultrasound-guided sciatic nerve block with different approaches is used to analyze the safety and effectiveness of anesthesia.Methods A retrospective analysis of 176 patients with ankle fractures admitted to our hospital from June 2020 to June 2021,patients in group P received sciatic nerve block(PA) in the superior popliteal approach(PA，92 cases),and patients in group G received The sciatic nerve block of the greater trochanteric plane approach(GTA)(84 cases).The operation time, onset time, sciatic nerve depth and pain score of nerve block were compared between the two groups.Results The operation time of nerve block[(3.16±0.68)min vs (6.07±0.94)min],onset time[(1.46±0.36)min vs (2.18±0.43)min] and sciatic nerve depth[(2.76±0.32)cm vs (3.45±0.58)cm] of patients between group P and group G were significant(P<0.05),the maintenance time of nerve blockin group P[(571.27±37.43)min vs (440.42±31.16)min] was significantly better than that in group G(P<0.05).The ankle pain score of patients in group P was significantly lower than that in group G(1.21±0.36 vs 2.26±0.46)(P<0.05);the proportion of muscle strength of grade Ⅲ and above patients in group P was significantly better than that in group G(97.83% vs 8.33%)(P<0.05).Conclusion The use of ultrasound-guided PA sciatic nerve block in patients with ankle fracture is satisfactory in relieving pain symptoms,maintaining muscle strength,and avoiding motor block.It can also effectively simplify surgical operations and avoid surgical trauma to rehabilitation influence.

Objective To evaluate the effects of different loading doses of Sketamine on postoperative cognitive dysfunction in elderly patients with hip replacement.Methods This was a prospective case control study.120 patients who underwent hip replacement surgery from September 2020 to September 2021 were randomly divided into three groups(n=40) by random number table method:low load dose Sketamine(group L,0.3mg/kg),highload dose of Sketamine(group H,0.5mg/kg) and control group(group C),After the level of anesthesia was stabilized,each group was given intravenous injection of corresponding doses of drugs.At the beginning of operation,both group L and group H were given 0.1mg/(kgoh) Sketamine by pump,and group C was given 0.1ml/(kgoh) normal saline pump until the end of the operation.To evaluate the patients' preoperative and postoperative Mini mental Status Examination(MMSE) scores,postoperative 3minute Delirium Diagnostic Scale(3D CAM) scores,sleep scores,intraoperative sedation assessment scale(RASS) scores and ICU non verbal communication patient pain assessment scale(COPT) score,assess patients for the occurrence of POCD.Results Compared with group C,the incidence of POCD and the analgesia score at 24 hours after operation were decreased in groups L and H(P<0.05).The incidence of POCD:13 cases in group C,5 cases in group L,and 4 cases in group H,analgesia scores:group C(3.15±0.81),group L(2.1±0.96),group H(1.9±0.96)(P<0.05);the incidence of adverse reactions in group H(13 cases) was higher than group C(5 cases) and group L(3 cases)(P<0.05).Conclusion The application of low dose Sketamine in elderly hip replacement patients can improve there postoperative cognitive cognition,reduce the occurrence of postoperative complications.

Objective To investigate the efficacy of different Uncut Roux-en-y surgical approaches on patients with gastric cancer and the effect on their test indicators and prognosis.Methods 96 patients with distal gastric cancer admitted to our hospital from March 2018 to February 2021 received laparoscopic assisted radical gastrectomy for distal gastric cancer.According to surgical methods,96 patients were divided into 2 groups.Among them,46 patients in the study group were treated with modified U-RY anastomosis,while 50 patients in the control group were treated with U-RY anastomosis.Perioperative indicators (operation time,intraoperative blood loss,first ventilation time,hospital stay and drainage volume on the first day after operation),tumor-related indicators (CEA,CA199) before and after operation,postoperative complications and prognosis one year after operation were compared between the two groups.Results Except for the drainage volume on the first day after surgery, the other indexes (operation time, intraoperative blood loss, first ventilation time and hospital stay) of the study group were better than those of the control group（P<0.05）.The tumor-related indexes (CA199,CEA) were not different between the two groups before surgery (P>0.05),while the tumorrelated indexes (CA199,CEA) were lower in both groups after surgery compared with those before surgery (P<0.05);after surgery,the overall complication rate was lower in the study group than in the control group (8.7% vs.30.0%,P<0.05);one year after surgery,there was no difference in the survival and recurrence rates between the two groups (97.8% vs.96.0%;4.3% vs.6.0%;P>0.05).Conclusion The application of modified U-RY anastomosis in LADG significantly shortens the operative time of patients,accelerates their recovery,and reduces their postoperative complication rate,which ultimately does not affect their prognosis.

[Abstract] Objective To evaluate the perioperative safety and long-term efficacy of preoperative in patients with simultaneous colorectal peritoneal metastasis before CRS+HIPEC.Methods This study retrospectively analyzed patients who received preoperative chemotherapy combined with CRS+HIPEC for simultaneous colorectal peritoneal metastasis in National Cancer Center and Huanxing Cancer Hospital from June 2017 to June 2019.A total of 52 patients were included in this study,and they were divided into preoperative chemotherapy group(n=20) and non-preoperative chemotherapy group(n=32) according to whether or not they had received preoperative chemotherapy.Results In the preoperative chemotherapy group,the proportion of patients with a peritoneal carcinomatosis index(PCI) >12 was significantly higher than in the non-preoperative chemotherapy group(80.0% vs.50.0%,P=0.031),while more patients achieved complete cytoreductives(80.0% vs 46.9%,P=0.018).There were no significant differences in the incidence of grade Ⅲ/Ⅳ complications,reoperation rates and mortality rates between the two groups(P>0.05).Platelet counts(151.9 ×10⁹/L和197.7×10⁹/L,P=0.036) and white blood cell count(4.7 ×10⁹/L和7.2×10⁹/L,P=0.030) were significantly lower on the first day after surgery in patients receiving preoperative chemotherapy.Patients in the preoperative group survived more than 2 years significantly more than those in the nonpreoperative group(67.4% vs 32.2%,P=0.044).Multivariate analysis showed that completeness of the cytoreduction score(HR,2.99;95% CI,1.14~7.84;P=0.026) was an independent risk factor for overall survival,but not preoperative chemotherapy.Conclusion For patients with peritoneal metastasis of colorectal cancer,preoperative chemotherapy before CRS+HIPEC is safe and feasible,with a relatively low incidence of complications and mortality.

Objective To investigate the effect of preoperative non-biliary drainage related invasive procedures on postoperative complications of pancreaticoduodenectomy, and to evaluate the benefits of preoperative non-biliary drainage related invasive procedures on patients.  Methods From January 2016 to July 2020, 163 patients with ampullary mass underwent pancreaticoduodenectomy. The patients were divided into the invasive operation group and the control group according to whether they underwent non-biliary drainage related invasive procedures before operation. Both groups underwent open or laparoscopic pancreaticoduodenectomy. The incidence of postoperative complications and its relationship with clinical factors were analyzed.  Results The incidence of postoperative complications in invasive group was 59.70% (40/67), including pancreatic leakage 52.24% (35/67), bile leakage 11.94%(8/67), intra-abdominal or gastrointestinal bleeding 17.91% (12/67), intra-abdominal infection 13.43% (9/67). The incidence of Clavien-Dindo grade Ⅰ~Ⅱ minor complications was 46.27% (31/67), and the incidence of Clavien-Dindo gradeⅢ~Ⅴ severe complications was 13.43% (9/67). The incidence of postoperative complications in the control group was 57.29% (55/96), including pancreatic leakage (52.08%, 50/96), bile leakage (12.50%, 12/96), abdominal or gastrointestinal bleeding (19.79%, 19/96), and abdominal infection (14.58%, 14/96). The incidence of Clavien-Dindo gradeⅠ~Ⅱ minor complications was 42.71% (41/96), and the incidence of Clavien-Dindo gradeⅢ~Ⅴ severe complications was 14.58% (14/96). There were no significant differences in the incidence of pancreatic leakage, bile leakage, intra-abdominal or gastrointestinal bleeding, intra-abdominal infection, minor and severe complications between the two groups.  Conclusion  Preoperative non-biliary drainage related invasive procedures have no significant effect on postoperative complications of pancreaticoduodenectomy. It is safe and feasible to perform preoperative non-biliary drainage related invasive procedures in patients with ampullary space occupying lesions.

Objective  To explore the expression change and clinical implication of apolipoprotein H(ApoH) in aortic dissection(AD).Methods Fifteen patients with Stanford type A aortic dissection(TAAD) in Tongji Hospital from August 2015 to January 2020 were included,and the ascending aortic tissue extracted during the operation was used as the TAAD group.Normal ascending aortic wall clipped during heart transplantation or cardiopulmonary transplantation was selected as the control group（9 cases）.The protein levels of ApoH were detected in the two groups,and Pearson correlation analysis was used to analyze the relationship between the protein levels of ApoH and the aortic diameters of patients with TAAD.Results Western blot and immunohistochemical staining showed that the expression levels of ApoH in the aortic wall of TAAD group was significantly higher than that of the control group(P<0.05).However,there was no significant correlation between the protein levels of ApoH and the aortic diameters of TAAD(P>0.05).Conclusion The protein expression of ApoH is significantly upregulated in aortic wall of patients with TAAD,suggesting that ApoH may be involved in the pathogenesis of AD.Targeting ApoH may be a potential new strategy for delaying AD.

Objective To explore risk factors of high activity delirium after laparoscopic radical nephrectomy combined with inferior vena cava tumor removal under general anesthesia in elderly patients with renal cell carcinoma.Methods 115 elderly patients with renal cell carcinoma who were underwent laparoscopic radical nephrectomy combined with inferior vena cava tumor thrombectomy were divided into N group (86 cases) and PHTD group(29 cases) from January 2019 to January 2021.They.Statistic and analyze the clinical data,operation and anesthesia conditions and postoperative conditions of patients in each group.Results The multiple factors Logistic regression analysis showed that age,ASA grade,anesthesia time,anesthetic dosage,extubation time,PACU residence time,sleep interference,intraoperative hypotension,postoperative pethidine dosage and postoperative body temperature were independent risk factors for the occurrence of highly-active delirium in elderly patients with cell carcinoma (P<0.05).The Nomogram analysis prediction model shows that the higher total risk of each factor,the high risk of delirium in elderly patients with cell carcinoma after kidney cancer surgery.The receiver operating characteristic（ROC）curve analysis showed performed,and the results showed that the area under the curve (AUC) of the prediction performance of the nomogram prediction model was 0.911（95%CI：0.847-0.975）（P<0.01）.Conclusion Age,ASA grade,anesthesia time,anesthetic dosage,extubation time,PACU residence time,sleep interference,intraoperative hypotension,postoperative pethidine dosage and postoperative body temperature are all independent risk factors for the occurrence of high-activity delirium during the recovery period after renal cancer surgery.

Surgical treatment is still the most important means of breast cancer treatment,but in recent years,with the continuous development of systemic treatment level of breast cancer,the surgical treatment concept of breast cancer is also changing.Including surgical treatment strategy of ductal carcinoma in situ,sentinel lymph node micrometastases or macro metastasis of axillary processing strategy,Safety of sentinel lymph node biopsy and breast conserving after neoadjuvant therapy,the timing of surgery after neoadjuvant therapy,surgical treatment of young breast cancer，Surgical treatment of stage Ⅳ breast cancer,radiation time to implant breast reconstruction,etc.,in the face of these problems, Breast surgeons are often confused.In this paper,ten hot issues in the surgical treatment of breast cancer are summarized based on the latest progress in the surgical treatment of breast cancer in recent years and guidelines at home and abroad,so as to make the surgical treatment of breast cancer more standardized and individualized. 

Objective   To summarize the etiology,clinical features,treatment and prevention of internal abdominal hernia after gastric surgery(Petersen hernia) and improve the understanding of Petersen hernia.  Methods   A retrospective analysis in January 2018 to December 2021 jilin university fellowship between China and Japan hospital for treatment of 9 cases after gastrectomy Petersen hernia patients,7 cases underwent open Bie-ⅱ anastomosis and 2 cases underwent Roux-en-Y anastomosis due to the primary disease.The median duration of onset was 2 days.The percentage of neutrophils in blood routine was increased to varying degrees.Preoperative abdominal CT showed anastomotic wall thickening,proximal small bowel obstruction sign 4 cases,small intestine torsion signs in 2 cases,no special signs only 3 cases of small intestinal obstruction,has not been in patients with preoperative diagnosis for Petersen hernia,all patients underwent surgical treatment,intraoperative see output section of the small intestine to shift into the Petersen clearance and hernia in 5 cases,There were 3 cases without torsional herniation into Petersen space in the output segment and 1 case with torsional herniation into Petersen space in the input segment.Among them,4 patients underwent intestinal resection and anastomosis due to intestinal necrosis.  Results   One patient developed pleural and abdominal effusion after operation,and all patients were cured and discharged after treatment.  Conclusions   Petersen’s hernia is a relatively rare complication after gastrectomy.Preoperative abdominal CT can help to determine the criticality of the patient’s condition and can be the first choice of examination.A small number of patients with acute pancreatitis should pay attention to preoperative and postoperative amylase changes,and once the diagnosis is confirmed,surgery should be performed as soon as possible.

Objective   To study the effect of double plate fixation through inverted L approach combined with lateral approach on the range of motion of knee joint in patients with three column fracture of tibial plateau. Methods   Retrospectively,88 patients with tibial plateau triple column fractures admitted in the orthopedic department of Beijing Tongren Hospital affiliated to Capital Medical University from November 2017 to December 2,2020 were selected as the study subjects and divided into control group and study group according to the treatment methods.The control group,44 patients had lateral approach double plate fixation,and 44 patients had lateral approach double plate fixation combined with inverted L approach.Compare the surgical efficacy and postoperative recovery between the two groups;compare the preoperative and postoperative knee function scores and quality of life scores between the two groups. Results   After operation,the operation time of the study group was (90.12±11.30) min,the intraoperative bleeding volume was (463.20±70.10) ml,and the hospital stay was (3.08±1.12) d,the time of knee joint exercise was (3.08±1.12) days,the time of complete fracture healing was (14.58±2.64) weeks and the time of complete weight-bearing was (16.27±3.65) weeks,which were shorter than those in the control group [(98.42±12.18) min,(502.41±77.10) ml,(20.36±3.12) d,(5.54±1.69) d,(16.06±3.27) weeks,(18.67±4.21) weeks] (P<0.05).In study group,the scores of the American Special Surgery Hospital (HSS)  were (87.06±10.06) points,the scores of the health survey summary (SF36)  was (82.69±10.30) points,the rate of excellent and good healing (93.18%),and the range of motion of the knee joint [knee extension (9.54±2.36),flexion (135.28±28.48)],which were higher than those of the control group [(80.26±9.20),(74.12±9.20),(77.27%),(8.06±2.06) and (121.64±22.61)] (P<0.05).There was no significant difference in the total incidence of postoperative complications between the two groups (P>0.05).  Conclusion   The treatment of patients with three column fracture of tibial plateau with lateral approach double plate fixation combined with inverted L approach can improve the range of motion of knee joint,promote fracture healing and improve the quality of life.

Many studies abroad have shown that surgical elective surgery for patients infected with COVID-19 may lead to a significant increase in postoperative mortality and complications.At present,the proportion of COVID-19 infection in China is high,and in the face of cases of COVID-19 infection,there is still a lot of confusion about how to perform elective surgery.Therefore,we review and analyze the latest research progress in this field abroad,combined with the guidelines and statements issued by relevant academic organizations in the United Kingdom and the United States,summarize the relevant experience of how to conduct preoperative assessment and how to choose the timing of surgery for patients infected with COVID-19,aiming to avoid and prevent the high complication rate of surgical operations in China under the COVID-19 epidemic.

Objective To investigate the changes and clinical significance of microalbumin(mAlb),transferrin(TRF),immunoglobulin G(IgG),α1-MG and β2-MG in the drainage fluid of renal pelvis after percutaneous nephrostomy(PCN) for adult severe hydronephrosis.Methods The clinical data of 33 adults with unilateral severe hydronephrosis before and after PCN with glomerular filtration rate(GFR) ≤ 10ml / min were analyzed retrospectively.Including the biochemical indexes of renal GFR,PCN and drainage fluid before and 1 month after operation.Based on the recovery of GFR in the affected kidney one month after operation,33 subjects were divided into improved renal function group(n=18) and non improved renal function group(n=15).The contents of mAlb,TRF,IgG,α1-MG and β2-MG in drainage fluid between the two groups were analyzed whether there were differences during and after operation,and whether there was correlation with GFR in the affected kidney.Results One month after PCN,the contents of mAlb,TRF,IgG,α1-MG and β2-MG in the renal function improvement group were lower than those during operation(P＜0.05),and the postoperative GFR was higher than that before operation(P＜0.05).There were significant differences in intraoperative α1-MG,β2-MG and preoperative and postoperative GFR between the two groups(P＜0.05).There was a negative correlation between α1-MG,β2-MG,mAlb,IgG,TRF and GFR in the drainage fluid of renal pelvis retained by PCN.The r values were -0.86、-0.83、-0.75、-0.79、-0.72，respectively.Conclusion Severe hydronephrosis leads to the recovery of renal function in varying degrees after the damaged kidney is drained through PCN.PCN can improve the glomerular filtration function of adults with severe hydronephrosis and restore the reabsorption function of renal tubules to a certain extent.The contents of mAlb,TRF,IgG,α1-MG andβ2-MG in the drainage fluid of renal pelvis have a good correlation with the GFR measured by ect.Among them,α1-MG andβ2-MG can be used as sensitive indexes to evaluate the recovery of renal tubular function.The patient measured the protein content through PCN and retained the renal pelvis drainage fluid,evaluated the improvement of renal function,reduced unnecessary imaging examinations,and saved medical expenses.

Objective To investigate the effect of using Kirschner wire tension band plus titanium cable ring tie on the limb function and short-term efficacy of patients with complex patella fracture.Methods A total of 100 patients who underwent patella fracture surgery from December 2018 to December 2020 were selected and divided into the observation group and the control group,50 patients in each group according to the treatment method.The observation group was treated with Kirschner wire tension band plus titanium cable ring ligating,and the control group was treated with Kirschner wire tension band.The surgical conditions of the two groups were compared.Fracture healing;Excellent rate of joint function;The incidence of complications,pain score and satisfaction were compared between the two groups.Results The average postoperative length of hospital stay in the observation group was(8.62±2.69) d,shorter than the (10.54±3.54) d in the control group,and the average pain score was (2.51±0.24) points,which was less than the (5.52±0.72) points(P<0.05) in the control group.The average fracture healing time in the observation group was (10.74±1.58) weeks,which was shorter than that of the control group at (13.54±2.69) weeks,and the overall good rate of fracture healing was 88.00%,which was higher than that of the control group of 60.00%(P<0.05).The excellent rate of joint function in the observation group was 92.00%,which was higher than that of the control group(P<0.05).The complication rate in the observation group was 4.00%,lower than the 20.00(P<0.05) in the control group.The total satisfaction rate of the observation group was 86.00%,which was higher than that of the control group of 72.00%(P<0.05).Conclusion Kirschner wire tension band plus titanium cable ring ligating is effective in the treatment of complex patella fracture,which can improve the limb function of patients with less complications.

Objective The aim of this study is to explore the impact of early enteral nutrition (EN) on postoperative prognosis of patients with hypertensive intracerebral hemorrhage (HICH),with a special focus on postoperative secondary hydrocephalus.
Methods The clinical data of 46 HICH patients who underwent surgical treatment in our department between Jan 2018 and Dec 2020 were retrospectively analyzed.Patients were divided into two groups: early EN group (EN administration within 48 h after operation) and delayed EN group (EN administration later than 48h after operation).The incidence of postoperative hydrocephalus was evaluated according to postoperative imaging data,and the postoperative Glasgow coma score (GCS) and Glasgow Outcome score (GOS) were used to comprehensively evaluate the prognosis of patients.Besides,the age,gender and other relevant clinical data were collected to analyze the risk factors of postoperative hydrocephalus in patients with HICH.Results Of 46 patients,8 patients  suffered from acute hydrocephalus,while 6 cases  experienced chronic hydrocephalus.Compared with the delayed EN group,patients in the early EN group had a lower incidence of chronic hydrocephalus (4.3% vs.33.3%,P=0.029),higher postoperative GCS score (10.8±2.1 vs.9.4±2.0,P<0.05) and GOS score (4.1±0.5 vs.3.6±1.1,P<0.05).The incidence of acute hydrocephalus had no significant difference between two groups (8% vs.28.6%,P<0.05.In addition,chronic hydrocephalus was also closely associated with low preoperative GCS score and intraventricular hemorrhage (P<0.05),while acute hydrocephalus was only associated with intraventricular hemorrhage (P<0.05).Conclusion Early EN administration could remarkably decrease the occurrence of postoperative chronic hydrocephalus and improve the prognosis of HICH patients.

Objective To investigate the application value of combined ultrasound and CT diagnosis of mesh infection after open inguinal hernia tensionless repair.Methods 83 patients admitted to our hospital with confirmed patch infection after tension-free repair of open inguinal hernia were studied,all of whom underwent preoperative ultrasound and abdominal CT examination,and intraoperative confirmation was the diagnostic criteria.To compare the value of ultrasonography, CT and combined examination in the diagnosis of mesh infection after open tension-free inguinal hernia repair. Results Among the 83 patients,the compliance rate of ultrasound diagnosis of mesh infection was 75.90%(63/83 cases);the compliance rate of CT diagnosis of mesh infection was 86.74%(72/83 cases);and the compliance rate of ultrasound combined with CT diagnosis of mesh infection was 87.95%(73/83 cases).The accuracy,sensitivity,specificity,and kappa values of ultrasound,CT,and ultrasound combined with CT in predicting the depth of mesh infection compared with the results confirmed during surgery were 88.76%,75.73%,90.58%,and 0.695;91.16%,80.96%,93.06%,and 0.774;and 91.97%,83.52%,93.64%,and 0.795.The combined examination was better than ultrasonography alone and CT alone in the diagnosis of postoperative mesh infection after open inguinal hernia repair(P<0.05). Conclusion Ultrasound combined with CT is better than ultrasound alone and CT alone in diagnosing mesh infection after open inguinal hernia repair without tension.

Glioma is the most common intracranial malignant tumor,among which glioblastoma is the most malignant and still incurable.The main reasons for its recurrence include high heterogeneity of tumor,invasive growth,resistance to existing treatments,etc.Many genetic changes promote the occurrence and malignant progression of glioma.At present,great progress has been made in the molecular research of glioma.Individualized and precise treatment for genetic changes may be the hope of curing glioma in the future,but the results of many basic trials and clinical studies are still not ideal.In this article,based on relevant literature,we reviewed the progress of molecular research and targeted therapy of glioma.

Objective To explore the application of extended isthmus resection combined with lymph node dissection in the central area of the affected side in the treatment of thyroid micro papillary carcinoma with length ≤1cm.Methods The data of 164 patients with thyroid papillary carcinoma treated in Huai'an First Hospital Affiliated to Nanjing Medical University from January 2015 to January 2017 were analyzed retrospectively.According to the operation method,they were divided into control group(74 cases) and observation group(90 cases).The control group received thyroidectomy + isthmus resection on the affected side,and the observation group received thyroidectomy + isthmus resection + central lymph node dissection on the affected side.The operation situation,pharyngeal reflux symptom index (RSI),voice disturbance index (VHI),complication rate and follow-up of the two groups were counted.Results There was no significant difference in blood loss,length of hospital stay,incidence of temporary recurrent laryngeal nerve injury,incidence of hypocalcemia and incidence of parathyroid gland dysfunction between the two groups (P>0.05).There was no significant difference in RSI scores and VHI scores between the two groups before operation and 1 week after operation (P>0.05).The RSI scores and VHI scores of the two groups after 1 week of operation were lower than those before operation (P<0.05).The operation time of the observation group was longer than that of the control group(P<0.05).The 6 month recurrence rate,1 year recurrence rate and 1 year lymph node metastasis rate of the observation group were lower than those of the control group The 3 year survival rate was higher than that in the control group (P<0.05).Conclusion The implementation of isthmus extended resection + central lymph node dissection on the affected side has no effect on the pharynx and sound of patients with thyroid micro papillary carcinoma with length ≤1cm.It can reduce the incidence of complications and recurrence rate without increasing intraoperative blood loss,and can significantly improve the survival rate of patients.

Objective To investigate the effect of ureteroscopic lithotripsy on renal function and inflammatory factors in patients with renal stones with diameter of 2-3cm.Methods A total of 68 patients with nephrolithiasis admitted to Chongming Branch of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from June 2020 to January 2022 were selected and divided into microchannel percutaneous nephroscopy group and flexible ureteroscopy group by digital parity method,with 34 cases in each group.The operation time,intraoperative blood loss,postoperative hospital stay,renal function indexes [blood urea nitrogen(BUN),serum creatinine(sCr),24h urinary protein(24h Upro)],inflammatory factors [C-reactive protein(CRP),interleukin 6(IL-6),procalcitonin(PCT)] level and postoperative complications were compared between the two groups.Results There was no significant difference in the operation time between the two groups [(58.75±10.23)min vs(53.82±11.65)min](P＞0.05).The intraoperative blood loss in the flexible ureteroscope group was less than that in the percutaneous nephroscope group,which was(5.07±1.32)ml and(12.84±2.18)ml,respectively.The difference between the two groups was statistically significant(P＜0.05).The postoperative hospital stay of the the flexible ureteroscope group was shorter than that in the percutaneous nephroscope group[(2.94±0.87)days and(5.21±1.03)days,respectively],with a statistically significant difference between the two groups(P＜0.05).The BUN [(3.16±1.65)mmol/L vs(4.82±1.83)mmol/L],sCr [(60.48±12.74)μmol/L vs(72.85±15.36)μmol/L] and 24h Upro [(0.12±0.02)g vs(0.18±0.05)g] were lower than those in the percutaneous nephroscopy group(P＜0.05).Three days after operation,the flexible ureteroscopy group CRP [(21.65±4.63)mg/L vs(32.86±4.87)mg/L],IL-6 [(25.45±5.86)ng/L vs(32.21±7.21)ng/L] and PCT [(2.15±0.94)μg/L vs(3.68±1.32)μg/L] levels were lower than those in the percutaneous nephroscopy group(P＜0.05).There was no significant difference in the total incidence of postoperative complications between the two groups(5.88% vs 14.71%)(P＞0.05).Conclusion Flexible ureteroscopic lithotripsy for patients with 2-3cm kidney stones can reduce intraoperative blood loss,shorten hospital stay,improve renal function,and reduce the level of inflammatory factors.

Objective To evaluate the clinical analgesic effect of different doses of dexmedetomidine(DEX) mixed with ropivacaine in hip surgery in children.Method 60 children aged 2-8 years(inclusive) were selected with developmental dysplasia of the hip(DDH) diagnosed,who needed open reduction of hip joint and osteotomy of pelvis and femur.Ultrasonicguided lumbar plexus block combined with general anesthesia was used.According to the composition of local anesthetics,children were randomly divided into three groups:simple 0.2% ropivacaine group(R group),0.2% ropivacaine+0.5μg/kg DEX group(0.5DEX group) and 0.2% ropivacaine+1μg/kg DEX group(1DEX group).The dosage of sufentanil used during operation,the dosage of sufentanil used in Post anesthesia care unit(PACU),postoperative Children's Hospital of Eastern Ontario Pain Scale(CHEOPS),intraoperative hypotension,bradycardia,postoperative excessive sedation,nausea and vomiting were observed. Result There was no significant difference in general information,operation time,intraoperative bleeding volume and blood transfusion rate among the three groups（P>0.05）.The dosage of sufentanil used during operation and the scores of CHEOPS 12 and 24 hours after operation in 0.5DEX group and 1DEX group were significantly lower than those in R group(P<0.05),but there was no significant difference between the two DEX groups（P>0.05）.There was no significant difference in the dosage of sufentanil used in PACU,intraoperative hypotension,bradycardia,postoperative excessive sedation,nausea and vomiting among the three groups（P>0.05）.Conclusion A certain dose of DEX combined with ropivacaine for lumbar plexus block provides better postoperative analgesia than ropivacaine alone in children undergoing hip surgery,and there is no obvious dose dependent effect and no obvious side effects.

Objective To investigate the feasibility of pancreaticoduodenectomy in elderly patients over 80 years old. Methods A retrospective analysis of 58 patients with pancreaticoduodenectomy performed in Songjiang Hospital Affiliated to Shanghai Jiaotong University School of Medicine from March 2017 to October 2020.Taking 80 years old as the classification standard,28 people aged 80 and above belong to the senior group,and 30 people aged 80 and below belong to the non-elderly group.The preoperative complications,surgery-related conditions and postoperative complications were compared between the two groups. Results The preoperative comorbidities of the two groups were compared.There were 13 cases of hypertension,7 cases of heart disease,9 cases of diabetes mellitus and 16 cases of hypoalbuminemia in the elderly group,and 7 cases,4 cases,3 cases and 7 cases in the non-senior age group,respectively.The difference was statistically significant(P<0.05).Comparison of operation-related indicators between the two groups,the operation time in the elderly group was(172.4±33.2) minutes,and the intraoperative blood loss was(160.0±84.4) ml,while the non-elderly group was(160.6±35.8) minutes and(156.6±84.8) ml,respectively.There was no significant difference between groups(P>0.05).The postoperative hospital stay days in the elderly group were(22.6±9.0) days and in the non-elderly group(18.9±2.8) days,there was a statistically significant difference between the two groups(P<0.05).The postoperative complications,including pancreatic fistula,bile leakage,intra-abdominal infection,delayed gastric emptying and intra-abdominal hemorrhage,showed no significant difference between the two groups(P>0.05).In the comparison of prognostic indicators,there was 1 case of severe pancreatic fistula-induced hemorrhage death in the elderly group,and no death in the non-elderly group,and the difference was not statistically significant(P>0.05).Conclusion Pancreaticoduodenectomy in elderly patients requires adequate preoperative preparation,meticulous intraoperative operation,and effective postoperative management to prevent complications.Even for elderly patients over 80 years old,the operation is safe and feasible.

Objective To explore the short-term and long-term efficacy of sentinel lymph node biopsy combined with breast conserving surgery and modified radical mastectomy in the treatment of stage Ⅰ-Ⅱ breast cancer and its impact on post-traumatic stress disorder(PTSD).Methods Between January 2016 and may 2019,220 breast cancer patients admitted to Qidong people's hospital were divided into two groups according to the treatment scheme,of which 135 patients in the radical cure group received modified radical surgery and 85 patients in the breast conservation group received sentinel lymph node biopsy combined with breast conservation surgery.The surgical indexes,breast aesthetic effect,PTSD level,serum tumor marker level,postoperative complications,3year overall survival rate and recurrence rate were compared between the two groups.Results The operation time,intraoperative bleeding volume,postoperative drainage volume and hospital stay in the breast conserving group were less than those in the radical group(P<0.05).The cosmetic effect of breast conserving group was better than that of radical mastectomy group(P<0.05).One week after operation,the levels of serum carcinoembryonic antigen(CEA) and carbohydrate antigen 153(CA153) in both groups were lower than those before operation(P<0.05).The scores of PTSD checklist version(PCL-C) in breast conserving group and radical therapy group were [(33.67±7.89) points and [(46.82±6.15) points],respectively,the PCL-C of the breastconserving group were lower than those of the radical treatment group in a week after operation,and both groups were higher than those before operation(P<0.05).There were no serious complications such as severe infection and flap necrosis in both groups.The incidence of postoperative complications in radical group was higher than that in breast conserving group(P<0.05).The 3-year survival rates of breast conserving group and radical operation group were 98.78% and 100.00% respectively,and the recurrence rates were 6.10% and 3.10% respectively,there was no significant difference in the 3-year survival rate and recurrence rate between the two groups(P>0.05).Conclusion The application of sentinel lymph node biopsy combined with breast conserving surgery in the treatment of stage Ⅰ-Ⅱ breast cancer patients is more helpful to shorten the operation time,hospital stay and other operation indicators,improve the postoperative breast aesthetic effect,reduce the incidence of postoperative complications and PTSD level,and the adjustment level of short-term tumor markers,long-term survival rate and recurrence rate after operation are equivalent to that of modified radical mastectomy.

Objective This study aims to assess the feasibility,safety and analgesic efficacy of paravertebral blockade(PVB) for percutaneous nephrolithotomy(PCNL).Methods The clinical data of 45 patients with upper urinary calculi treated by Shanghai Fourth People's Hospital affiliated to Tongji University from March 2019 to December 2020 were retrospectively analyzed.Intraoperative hemodynamic changes were observed.Through visual analog pain scale(VAS) questionnaire survey were corded the  degree of pain for establishing gravel channel,after 6 hours,and after 24 hours postoperatively,postoperative analgesic usage,hospitalization duration,postoperative complications and stone clearance rate，perioperative important parameters，adverse reactions during the operation.
Results Of all the 45 patients,the mean diameter of the stones was 2.2cm.The mean operative time was 47.6min.The mean laser lithotripsy time was 18.6min.The average VAS scores of intraoperatively and at 6 and 24 hours postoperatively were 2.7,3.5,and 2.2,respectively.No additional opioid drugs were needed 6 and 24 hours after the operation.The average hospital -in time was 6.4 d.Postoperative low fever occurred in 2 patients and amild bleeding wound appeared in 1 patient,and one had mild nausea.All of whom were cured by conservative treatment.One month after the operation,the stone clearing rate was 95.6%.Two patient had residual stone in the renal calyces after the operation,and the second stage flexible ureteroscope lithotripsy was performed to achieve stone-free.
Conclusion For patients with increased risk of complications after general anesthesia or epidural anesthesia,ultrasound guided paravertebral block anesthesia in PCNL has an ideal analgesic effect with high safety and few adverse reactions.This method reduces the need for opioids in patients undergoing PCNL,improves pain experience.