Objective Patients suffered ankylosing spondylitis with high risk of general anesthesia were given combined spinal epidural anesthesia（CSEA） under ultrasound guidance.Methods A 51-year-old male for open reduction and internal fixation was scheduled.The patient had a history of ankylosing spondylitis.The lumbar，thoracic and cervical spine has some difficulties in extension and bending.CSEA was conducted with the guidance of ultrasound.Results The pilot ultrasound scanning indicated that the L3/4 intralaminar space existed，and then CSEA was successfully performed with ultrasound guidance.The patient was discharged from hospital one week later and no anesthesia-associated complications occurred.Conclusions CESA under ultrasound guidance greatly facilitates the difficulty of intravertebral puncture in patients with ankylosing spondylitis.

Objective To evaluate the analgesia effects of ultrasound-guided quadratus lumborum block in patients undergoing laparoscopic renal cyst unroofing.Methods Sixty ASA Ⅰ or Ⅱ patients，scheduled for elective laparoscopic unroofing of renal cyst，were randomly divided into two groups（n=30）：ultrasound-guided QLB combined with general anesthesia group（group QLB）and simple general anesthesia group（group C）.In group QLB，QLB was performed with 25ml of 0.4% ropivacaine injection in operation side after induction of general anesthesia ，while group C received simple general anesthesia.Intraoperative sufentanil dosage，visual analogue scores（VAS）at different postoperative time points，first compression time of postoperative analgesia pump，total postoperative sufentanil dosage，number of postoperative analgesia，incidence of nausea and vomiting，and patient satisfaction with analgesia were observed and recorded.Results The consumption of intraoperative and postoperative sufentanil in group QLB were （27.3±5.2）μg and （16.2±6.6）μg;the VAS of 2，4，6，8，12，24h of post-operation were 1.4±0.7，1.6±0.6，1.6±0.6，2.0±0.7，2.1±1.0，2.1±1.1，respectively;first compression time of analgesic pump was （684.3±162.7）min;the times of remedial analgesia and nausea or vomiting was 5 and 3;patient satisfaction with postoperative analgesia was 7.7±1.3.While in group C was（32.8±3.6）μg，（61.9±22.9）μg，2.1±0.9，2.8±0.9，3.6±0.8，3.0±1.2，3.0±1.5，2.9±1.2，（56.6±14.9）min，12 cases，10 cases，6.9±1.4，respectively.The difference between the two groups was statistically significant（P<0.05）.Conclusion Ultrasound-guided QLB with 0.4% ropivacaine can reduce the opioid consumption and enhance the efficacy of postoperative analgesia for patients under going laparoscopic renal cyst unroofing.It can improve the patient's comfort and satisfaction.

Objective To evaluate effects of transcutaneous electrical acupoint stimulation on postoperative recovery after laparoscopic nephrectomy.Methods 60 cases of female patients undergoing laparoscopic nephrectomy were selected and randomized into stimulation group and control group.The stimulation group received transcutaneous electrical acupoint stimulation 30min at neiguan point，hegu point，zusanli point and sanyinjiao point once a day.The routines of the control group were the same as that of the stimulation group except for switch off.Time of first exhaust，time of water intake，time of getting out of bed，time of urinary catheter indwelling，nausea and vomiting within 2 days after surgery，use of patient-controlled intravenous analgesia pump and total hospitalization were recorded.Results Compared with the control group，Patients in the stimulation group had less time of first exhaust（15.0±4.1）h，getting out of bed（30.7±9.0）h and urinary catheter indwelling（30.7±6.9）h（P<0.05），The difference of water intake time was not statistically significant.The incidence of nausea and vomiting was 20% and 13.3% in the stimulation group，and 33.3% and 30.3% in the control group.The number of analgesic pump compression（12.4±5.8）was reduced，and the total amount of drugs（69±43.6）ml was decreased in the stimulation group（P<0.05）.There was no statistically significant difference in hospital stay between the two groups.Conclusion Transcutaneous electrical acupoint stimulation can accelerate postoperative rehabilitation of patients undergoing laparoscopic nephrectomy.

Objective To investigate the clinical effect of oxycodone on tracheal catheter tolerance during awake period after general anesthesia in patients with tongue cancer.Methods 90 patients with radical surgery for tongue cancer were randomly divided into three groups（Q group，S group and Y group），30 patients in each group，all under routine anesthesia induction and anesthesia maintenance.Oxycodone 0.1mg/kg（Q group），sulfentanil 0.1μg/kg（S group），and normal saline 5ml（Y group）were intravenously administered 30min before the end of the operation.The sedation-agitation score after recovery and the postoperative events（cough frequency，hemodynamic changes and adverse reaction）of the three groups of patients were quantified.Results The hemodynamic changes in Q group and S group were more stable than those in group Y（P<0.05）;The sedation-agitation scores in Q group（4.1±0.2）and S group（4.2±0.3）were significantly lower than those in Y group（5.7±0.3）（P<0.05）.And the postoperative cough frequency in the Q group and S group were both less than that in the Y group（P<0.05）.The number of cough（2.1±0.6）in Q group within 6 hours after operation was reduced compared with that in S group（3.6±1.3）（P<0.05）.There was no significant difference in the patient's adverse reactions（Y group：8 cases，Q group：10 cases，S group：9 cases）（P>0.05）.Conclusion Oxycodone displayed improved effects compared to sulfentanil in reducing the number of postoperative coughs which makes the patient better tolerate the tracheal tube.

Objective To investigate the application of indocyanine green in the surgery of ultrasoundguided laparoscopic hepatic hemangioma ablation.Methods We analyed the clinical and follow-up data of one case that using indocyanine green dye in the surgery of  ultrasound-guided laparoscopic hepatic hemangioma ablation.In this case，indocyanine green was injected into peripheral veins during operation to observe the fluorescence staining and the boundary of hepatic hemangioma.Results There was no fluorescent observed on the surface of hepatic hemangioma.There was a clear boundary between hepatic hemangioma and normal liver tissue that dyeing green fluorescence.The ablation was performed according to the boundary.The hepatic hemangioma collapsed after the ablation and the whole liver surface was observed green fluorescence.Conclusion Indocyanine green is effective in determining the boundary of hepatic hemangioma，and can be used to evaluate the effect of ablation in real time.

Objective To explore the complications of laparoscopic cholecystectomy combined with endoscopic sphincterotomy in the treatment of gallbladder and analyze the influencing factors.Methods A retrospective analysis of 136 patients with biliary summary stones admitted to our hospital from April 2015 to April 2016 were divided into groups according to the actual treatment.The control group（n=76）underwent laparoscopic cholecystectomy（LC），the observation group（n=60）underwent LC combined with endoscopic sphincterotomy（EST）.All the patients were followed up for 2 years.The complications were observed，Oddi sphincter pressure and bile were detected，screening and analysis may affect postoperative Factors of complications.Results The incidence of complications in the control group was higher than that in the observation group，but the incidence of complications was not significant（P>0.05）.There was no significant difference in the incidence of liver dysfunction between the two groups（P>0.05）.There was no significant change in CBD pressure and SO base pressure（P>0.05），amplitude of SO contractions（SOCA）and frequency of SO contractions（SOF）.The incidence of the control group was significantly lower than that of the observation group（P<0.05），but the difference of bacterial infection rate between the two groups was not significant（P>0.05）.The course of disease and gallstones，CBD internal diameter，maximum stone diameter and bacterial infection were single factors affecting the complications of LC combined with EST in patients with choledocholith（P<0.05）; disease duration greater than 5 years，with gallstones，CBD internal diameter greater than 15 mm，maximum stones Diameter greater than 15 mm and bacterial infection were independent risk factors for the complications of LC combined with EST in patients with choledocholith（P<0.05）.Conclusion The combined therapy of LC and EST did not increase the risk of postoperative complications in patients with choledocholith，and the disease duration was greater than 5 years，with gallstones，CBD internal diameter greater than 15 mm and maximum stone diameter greater than 15 mm and bacterial infection were independent risk factors for the complications of LC combined with EST in patients with choledocholith.

Objective To investigate the expressions of Receptor-interacting protein 2（RIP2）in tissues of rectal cancer（RC）and adjacent tissues，and the relationship with the clinicopathologic factors of RC.Methods The clinicopathological data of 77 patients with rectal?cancer who admitted to the Renmin Hospital of Wuhan University from January 2016 to January 2017 were collected.The expressions of RIP2 in cancer and adjacent tissues were detected using immunohistochemical assay.Semi-quantitative data of immunohistochemical assay was analyzed within independent T test.The relationship between the expression of RIP2 and clinicopathologic factors was then analyzed within the chi-square test.Results In these 77 cancer cases，RIP2 is positively expressed in 44 samples，accounted for 57.1%，and 50 cases in adjacent tissues，totally accounted for 64.9%.The difference is not statistically significant（χ2 =0.983，P>0.05）.The positive expression rate of RIP2 in poorly differentiated and undifferentiated cases ，stage Ⅲ and stage Ⅳ cases，cases with lymph node metastasis and cases with vein invasion was higher than that in cases of high and middle differentiation ，stageⅠand stageⅡ，no lymph node metastasis and no vein invasion（P<0.05）.However，the positive expression of RIP2 has nothing with sex，age and tumor size（P>0.05）.Besides，semi-quantitative analysis shows that the expression of RIP1 and RIP3 in rectal cancer is less than normal tissue（t=-4.305，P<0.05）.Conclusion The expression of RIP2 in rectal cancer is up regulated，and may be a potential reference designator to judge the prognosis of patients with rectal cancer.

Objective To explore the left colic artery（LCA）during laparoscopic radical resection of rectal cancer Efficacy and risk factors of postoperative anastomotic leakage in patients with inferior mesenteric artery（IMA）type 3 rectal cancer.Methods 102 patients with IMA3 rectal cancer were divided into the study group（52 cases）and the control group（50 cases）according to different surgical treatment methods.The study group was treated with LCA in laparoscopic radical resection of rectal cancer，while the control group was treated with LCA without laparoscopic radical resection of rectal cancer，and the clinical efficacy of the two groups was compared.Results The operation time of the study group and the control group were（149.2±25.）minutes and（145.8±22.5）minutes，and the hospitalization time was（11.8±2.4）days and（12.2±2.8）days，respectively.The number of lymph node dissections was（14.6±2.5）The sum of（14.8±2.6）pieces of IMA root lymph node dissection was（3.2±1.3）and（3.0±1.5），respectively.The 1-year overall survival rate was 88.1% and 83.3%，respectively.The recurrence or metastasis rate were respectively.For 14.3% and 11.9%，there was no significant difference between the two groups（P>0.05），and the anal exhaust time was（35.6±5.4）hours and（45.3±8.6）hours，respectively.The incidence of postoperative anastomotic leakage was 1.9% and 14.0%，respectively.The difference between the two groups was statistically significant（P<0.05）.The incidence of intestinal obstruction，urinary retention and urinary tract infection were 9.6% and 12.0%，1.9% and 4.0%，5.8% and 8.0%，respectively.Preoperative life quality was（56.2±9.2）and（56.5±10.5），and postoperative life quality was（78.8±12.2）and（78.4±12.0），respectively，with no statistically significant difference between the two groups（P>0.05）.Conclusions〖WTBZ〗〓In the case of clinical safety and efficacy，the retention of LCA in laparoscopic radical resection of the rectum can effectively reduce the incidence of postoperative anastomotic leakage in patients with IMA3.Therefore，in the future clinical work，these patients should be paid attention to.

Objective To compare the curative effect of postoperative sphincter fistula ligation and incision and suture for postoperative pain，anal function and wound healing time of sphincter anal fistula.Methods The date of 124 patients with sphincter anal fistula were retrospectively analyzed.Among them，60 patients who underwent sphincter fistula ligation were set as the study group，and 64 patients who underwent incision and suture were set as the control group.Anal incontinence score，anal function，postoperative pain，wound healing time and clinical efficacy were compared between two groups.Results The total score of anal incontinence in the control group（8.68±1.65）was significantly higher than that（7.03±1.46）in the study group，and the difference was statistically significant（P<0.05）.The total anal function score of the control group（6.71±0.93）was significantly lower than the total anal function score of the experimental group（8.04±1.11），and the difference was statistically significant（P<0.05）.The postoperative pain score of the control group（6.22±1.24）was significantly higher than that of the experimental group（3.52±1.06），the difference was statistically significant（P<0.05）.The wound healing time of the control groupand the test There was no significant difference in the wound healing time（5.78±1.43）between control group [（5.31±1.32）d]  and study group[（5.78±1.43）d](P>0.05）.The total effective rate of the control group was 95.31%，which was not significantly different from the total clinical effective rate of the experimental group（88.33%）（P>0.05）.Conclusion Ligation of sphincter fistula can significantly alleviate postoperative pain in patients with sphincter anal fistula and promote the improvement of anal function.There is no significant difference between clinical efficacy and incision and suture.It can flexible used as an ideal procedure for anal fistula in clinical practice.

Objective To introduce the combination of two kind of minimally invasive osteotomy in treatment of severe hallux valgus.Methods The clinical data of 2123 patients（3865 feet）who had hallux valgus between January 2007 and June 2017 were reviewed.There were 2082 females and 41 males with an average age of 56.39 years.Among these patients，207 patients（253 feet）had severe hallux valgus.124 patients（163 feet）who had severe hallux valgus had received the combination of two kind of minimally invasive osteotomy which in the first proximal phalanx and metatarsal.83 patients（90 feet）who had severe hallux valgus had just received one kind of minimally invasive osteotomy which in the first metatarsal.1916 patients（3612 feet）who had mild and moderate hallux valgus had just received one kind of minimally invasive osteotomy which in the first metatarsal.Results All patients were followed for 3～30 months.In the combined surgery group，HVA after surgery was（2.8±1.11）°，IMA after surgery was（5.68±1.62）°.The difference between combined surgery group and uncombined surgery group has statistical significance（P=0.044）in HVA after surgery among severe hallux valgus patients.In the combined surgery group，84.67% of patients had excellent results，14.52% good，and 0.81% bad.In the uncombined surgery group of severe hallux valgus，79.52% of patients had excellent results，19.82% good，and 1.20% bad.In the uncombined surgery group of mild and moderate hallux valgus，82.83% of patients had excellent results，17.07% good，and 0.10% bad.Conclusion the combination of two kind of minimally invasive osteotomy in treatment of severe hallux valgus had the better HVA，less complication，higher satisfaction degree after surgery.

Objective The study was the quantitative relationship between the D-dimer（DD）and C-reactive protein（CRP）levels and the geometric parameters of the false lumen in the DeBakey III aortic dissection aneurysm（ADA）patients to understand the patient's condition and make a preliminary judgment on the prognosis.Methods 35 patients were diagnosed as DeBakey type ⅢADA in Northern Jiangsu People's Hospital from January 2012 to January 2018 were selected，and clinical data such as DD and CRP values before and after surgery were collected，and aorta CTA data were measured with GE Healthcare Volume ViewerTM post-processing software to obtain the values of false lumen volume（FLV），false lumen length （FLL），and maximum false lumen diameter（MFLD）before and after surgery，and then correlation studies were carried out. Results The analysis showed that the proportion of DD and CRP values above the upper limit of normal after surgery was higher than before（94.3% vs 100% and 40% vs 94.3%）and the postoperative average value was also higher than before（3.76±3.88 vs 5.14±3.68 and 35.35±54.92 vs 56.98±34.16）The DD and CRP values of the type DeBakeyⅢ ADA patients decreased after operations（74.3%），but the FLL，MFLD and FLV values decreased in the vast majority（94.3%）of type DeBakey III ADA patients; The changes of CRP，FLL，MFLD and FLV after operation were significant（P<0.05），but the DD value before and after surgery did not change significantly（P＞0.05）; Preoperative DD level was weakly associated with preoperative FLL，and postoperative CRP level was weakly associated with postoperative FLV.Conclusion DD and CRP value could reflect the trend of geometric parameters of type DeBakey III ADA false lumen to a certain extent，and make a preliminary judgment on the prognosis.

Objective To investigate the effects of cardiopulmonary bypass（CPB）and off-circulation coronary artery bypass grafting（CABG）on visceral injury in elderly patients with coronary heart disease.Methods 144 elderly patients with coronary heart disease admitted in our hospital from July 2013 to June 2017 were divided into two groups：the control group（n=72）and the control group（n=72）treated with coronary artery bypass grafting（CCABG），）under cardiopulmonary bypass（CPB）.Off-pump coronary artery bypass grafting（OPCAB）was performed to compare the clinical indexes，complications，CK-MB，cTnI，（IO），kidney（BUN，SCr）of lung，liver（AST，ALT）and brain（S100B protein）injury between the two groups.The improvement of cardiac function（LVEF，LVEDD）was recorded 12 months after operation and the quality of life was evaluated with SF-36 scale.Results there was no significant difference in the operation time，the number of bypass grafts and the drainage volume within 24 hours after operation between the two groups（P>0.05）.The complications were significantly lower than those in the control group（P<0.05），and the protein of AST，ALT，BUN，CK-MB，SCr，cTn Igni S100B in the observation group was significantly lower than that in the control group at the end of operation（T2），24 hours（T3）and 48 hours（T4）after operation（P<0.05）.There was no significant difference in LVEF，LVEDD between the two groups at 12 months after operation（P>0.05）.The GH，RE，MH scores in the observation group were significantly higher than those in the control group（P<0.05）.Conclusion both CCABG and VOPCAB can cause visceral tissue injury in elderly patients with CHD.The degree of OPCAB injury to lung，myocardium，kidney，liver and craniocerebral tissue is smaller and the prognosis is better than that of CCABG.

Objective To evaluate the clinical efficacy of scorpion venom active polypeptide gel in managing venous ulceration of lower extremities after stage C6 varicose vein surgery.Methods Thirty-six stage C6 varicose vein patients with lower limbs venous ulceration were randomly divided into two groups.All of which underwent varicose vein surgery.18 cases were in the control group，and the venous ulceration wound after surgery was managed with routine dressing change.The other 18 cases were in the scorpion venom active polypeptide gel group，the venous ulceration wound after surgery was covered with scorpion venom active polypeptide gel before changing dressings every other day.The size of the wound，wound infections and visual analogue score were evaluated at different time points during the treatment.Results There was no significant difference between two groups on general conditions（P>0.05）.The visual analogue scores related to venous ulceration wound showed no significant differences between two groups at 24 hours，48 hours and 72 hours after surgery（P>0.05）.Scorpion venom active polypeptide gel reduced wound infections markedly after surgery（P<0.05）.Meanwhile，the healing time in scorpion venom active polypeptide gel group was significantly shorter when compared with control group（21.7±7.9 d vs 29.4±8.6 d，P<0.01）.Conclusion Scorpion venom active polypeptide gel application accelerates wound healing process and inhibits infection when treating venous ulceration of lower limbs after stage C6 varicose vein surgery.

ObjectiveThis study aimed to evaluate clinical effects and related issues of subdermal excision of apocrine glands through small incisions for axillary osmidrosis.Methods From March 2016 to February 2018，42 cases of moderate-to-severe axillary osmidrosis were treated with subdermal excision of apocrine glands through small incisions along underarm creases.Follow-up was performed in 1，3，6 months.Results All 42 cases were followed up for an average of 5 months.In 2 cases（3 sides），the incision was not well healed.The maximum area of the wound was about 1×1.5 cm， which was healed after dressing and debridement.The rest were all healed naturally.At follow-up，3 males and 1 female relapsed with unilateral subgingival odor，which was mild; no hematoma，flap necrosis and nerve injury occurred.Conclusion After subdermal excision of apocrine glands for axillary osmidrosis，the incision along underarm creases was concealed，the wound was relatively small，and the treatment was thorough.The postoperative scar was small and concealed，and the effect was satisfactory.

Objective To study the clinical study of single hole laparoscopic percutaneous extraperitoneal ligation（LPEC）in the treatment of children with traffic hydrocele.Methods The clinical data of 76 children with traffic hydrocele were retrospectively analyzed.The postoperative condition of end-diastolic phase of single-hole LPEC，peak systolic blood flow velocity（PSV），enddiastolic flow velocity（EDV），testicular artery resistance index（RI）were analyzed.Results All the 76 children successfully completed single-hole LPEC surgery，and no patients were transferred to open surgery during the operation.No spermatic cord，vas deferens，testicle，testicular artery and other gonadal vessels were damaged after operation.Local infection was found in 1 case（1.32%）and mild scrotal edema in 2 cases（2.63%）.After 6 months of follow-up，the scar was basically dissipated in 76 children，and there was no incisional hernia formation or recurrence of hydrocele，no vasectomy torsion or testicular atrophy.The preoperative PSV，EDV and RI of 64 children with unilateral communicating hydrophilia were（65.26±6.23）min/ml，（48.06±4.68）min/ml，（0.55±0.09）ml·min·m2，respectively;the data of 1 month after surgery was（79.21±7.10）min/ml，（55.29±5.61）min/ml，（0.59±0.12）ml/min·m2，respectively;the dataof 3 month after surgery was（104.59±8.72）min/ml，（72.59±6.45）min/ml，（0.83±0.14）ml/min·m2，respectively;the data of 6 month after surgery was（135.92±10.46）min/ml，（87.39±7.32） min/ml，（1.02±0.16）ml/min·m2，respectively.There was significantly difference in children with unilateral traffic hydrocele at 6 months after operation than preoperative，postoperative，1 month，3 months（P<0.05）; the RI of 1 month after operation had not significantly different than that before surgery（P>0.05）.The preoperative PSV，EDV and RI of 12 children with bilateral communicating hydrocele were（60.14±6.05）min/ml，（44.52±4.50）min/ml，RI（0.54±0.08）ml/min·m2，respectively;the data of 1 month after surgery was（75.13±6.92）min/ml，（49.78±5.11）min/ml，（0.57±0.10）ml/min·m2，respectively;the data of 3 month after surgery was（98.76±8.15）min/ml，（62.19±6.33）min/ml，（0.81±0.12）ml/min·m2，respectively;the data of 6 month after surgery was（129.48±9.82）min/ml，（80.16±7.05）min/ml，（0.96±0.13）ml/min·m2，respectively.There was significantly difference in children with unilateral traffic hydrocele at 6 months after operation than preoperative，postoperative，1 month，3 months（P<0.05）; the RI of 1 month after operation had not significantly different than that before surgery（P>0.05）.Conclusion Pediatric traffic hydrocele is treated with single-hole LPEC，which can significantly improve the blood supply of the testis，and the incidence of complications is low，the surgical incision is small，and it has high clinical efficacy and safety.

The ultrasonic guided injection technique has been widely used in the diagnosis and treatment of pain management，and it can provide objective basis for pain doctors to choose appropriate treatment technique in clinical practice.The ultrasonic guided injection technique can be used to support almost all of the common interventional procedures in pain management.The success rate of puncture and safety can be elevated markedly compared with the traditional techniques.But the efficacy still need to be identified in some kind of ultrasonic guided injection procedures.

Peripheral nerve block（PNB）is an anesthetic techniques with a long history and has been widely applied in variety kinds of surgical anesthesia and pain management.With nerve stimulator adoption，especially the application of ultrasonic visualization，PNB began to be recognized and got more extensive application.PNB was an invasive procedure，which inevitably leads to some complications or unnoticed complications.By retrieving recent published articles，we elaborated the mechanism and factors of nerve injury associated with PNBs and provided solution for decreasing the rate of nerve injury as well as the diagnosis and treatment.

Congenital scoliosis is a failure of vertebral formation，segmentation，or a combination of the 2 arising from abnormal vertebral development.Hemivertebral deformity caused by the former is the main cause of congenital scoliosis.Its etiology is complex and may be related to genetic and environmental factors.The diagnosis depends on clinical manifestations and imaging findings.Currently，imaging examinations include fetal spinal ultrasound and MRI，postnatal spinal ultrasound in infants，whole spine X-rays，CT，and MRI.At the same time，the genitourinary and cardiac ultrasound should be performed.Conservative treatment includes plaster，brace，the therapeutic effect is not good enough to completely correct deformity，so early surgical treatment is needed.The operative methods include in situ fusion，convex epiphysis arrest，hemivertebral resection，spinal fusion and spinal non-fusion.