Objective：To evaluate the safety and feasibility of Moses technology 120W holmium laser treated in “Three lines and one layer” method for elderly patients with combined benign prostate hyperplasia(BPH) and bladder stones.Methods：The Moses technology 120W holmium laser treated in “Three lines and one layer” method for 35 elderly patients who had combined BPH and bladder stones during Jun.2018 to Aug.2019.Results：All 35 patients were able to smoothly recover from the operation with no major bleeding,urinary incontinence or other side effects.The average operation time was(54.34±9.88) min,and the average reduction of hemoglobin before and after operation was(5.80±4.04)g/L.Medical measurement follow up after operation within 3 months,like IPSS,QOL and Qmax were noticeably improved and no sign of new growth of bladder stones.Conclusion：The Moses technology120Wholmium laser treated in “Three lines and one layer” method which is more efficient laser lithotripsy for elderly patients combined with BPH and bladder stones.In addition to significantly reduced stone retropulsion,and displayed a margin of safety that may result in a shorter procedural time and safer lithotripsy.

Objective：To explore the feasibility,safety,and effectiveness of transurethral seminal vesiculoscopy(TSV) for the treatment of refractory hematospermia.Methods：31 patients with refractory hematospermia underwent transurethral seminal vesiculoscopy in different approaches between January 2016 and August 2018.Seminal vesicles were lavaged with antibiotics and blood clots,stones,and inflammatory substances were removed from the seminal vesicles.Postoperative followup was conducted for 6 to 12 months to observe the postoperative effect and the occurrence of complications.Results：12 patients underwent TSV successfully through bilateral ejaculatory duct openings,3 patients underwent TSV through unilateral ejaculatory duct openings and contralateral prostatic utricle,11 cases underwent TSV through prostatic utricle,5 patients underwent TSV through resected verumontanum.In 21 cases,hemospermia disappeared completely within 3 months postoperatively.Hemospermia disappeared in 7 cases within 6 months after surgery.Hemospermia did not improve in 3 cases 1year after surgery.Acute epididymitis occurred in one patient after operation.The cure rate was 90.3% and the incidence of complications was 3.2%.Conclusion：Transurethral seminal vesiculoscopy is safe and effective in the treatment of refractory hematospermia,and generally does not cause serious complications.Although the opening of the ejaculatory duct is the preferred approach,the success rate is low.Although the prostatic utricle route and electrocution of verumontanium destroyed the normal anatomical structure of the ejaculatory duct,no adverse consequences were found.

Objective：To observe the therapeutic effects of all seeing needle percutaneous nephroscopy combined with flexible ureteroscopy for the treatment of parapelvic cysts.Methods：A total of 71 patients with parapelvic cyst admitted to our hospital from July 2014 to January 2019 were divided into experimental group and control group.Patients in the test group(n=35) received treatment with allseeing needle percutaneous nephroscopy combined with flexible ureteroscopy,and patients in the control group(n=36) received treatment with laparoscopic parapelvic cyst decortication.The therapeutic effects and complications were observed and compared between the two groups.Results：The duration of surgery of  the test group was(46.83±8.37)min,the bedridden days was(1.86±0.33)d,the days of hospital stay was(6.17±0.82)d,the treatment cost was(1.41±0.09)ten thousand yuan,and the rate of  hemorrhage and infection were both 2.86%.The duration of surgery of the control group was(47.86±6.78)min,the bedridden days was(1.94±0.39)d,the days of hospital stay was(5.86±0.87)d,the treatment cost was(1.37±0.08)ten thousand yuan,and the rate of hemorrhage and infection were both 5.56%.There was no significant difference between the two groups in the above indicators(P>0.05);the postoperative urinary leakage and cyst recurrence rates in the test group were 0 and 2.86%,respectively,which were significantly better than those of the control group(11.11% and 19.44%,P<0.05).Conclusion：Allseeing needle percutaneous nephroscopy combined with flexible ureteroscopy provides a minimally invasive,safe and effective treatment approach for parapelvic cysts.

Objective：Analyze the composition and clinical characteristics of urinary calculi in Tibetan Plateau area.
Methods：This retrospective analysis explored the composition and clinical characteristics in 129 patients with urolithiasis,who were admitted to Lhasa People's Hospital and surrounding hospitals in Tibet Plateau area,from January 2018 to January 2019.
Results：Of the 129 cases of urolithiasis,78(60.5%) were males and 51(39.5%) were females.The ratio of males to females was 1.5∶1.The average age of the patients was(27.91±13.77)years old.92(71.3%) patients lived in farming or pastoral areas,while 37(28.7%) patients lived in cities.All cases drank water less than 2 000 ml every day.In terms of stone composition,the most common was calcium oxalate stone.47 cases(36.43%) were infection stones while 82 cases(63.57%) were noninfection stones.The incidence of infection stones in women(24 cases,47.06%) was significantly higher than men(23 cases,29.49%)(P＜0.05).
Conclusion：The ratio of infection stones in Tibetan Plateau was significantly higher than flatland areas in China,and this ratio in females was significantly higher than males.The average age of the patients suffered from urinary calculi was younger than other areas.The incidence of calculi was high in children and adolescents.All of these characteristics may be closely related to the specific local environment,climate and dietary habits.

Objective：To investigate the clinical effect of onestage combination therapy laparoscope surgery to perform nephrorrhaphy and ureteroscopic lithotripsy surgery to treat repeated ureteropelvic junction obstruction (UPJO) with renal calculus.Method：The surgical procedure including one double “J” ureteral catheter type F6 placed into renal pelvis was performed on one case of UPJO combined with renal calculus.Result：The surgery was successfully completed without serious complications,such as heavy bleeding and peripheral organ damage.The whole operation lasted 155 minutes including about 65 minutes of removal of renal calculus.There was about 50 ml of bleeding during the procedure.A complete inspection by flexible ureteroscope on repeated renal pelvis showed no blind spots.After the surgery,reviewed KUB showed the removal rate of renal calculus was 100%.After removing the double “J” tube,the examination of the repeated renal showed significantly reduced hydronephrosis.Conclusion：Onestage combination therapy of laparoscope surgery to perform nephrorrhaphy and ureteroscopic lithotripsy is safe and efficacy,it can be adopted as an ideal therapy to treat the case of UPJO combined with renal calculus.

Objective：The pathogenic bacteria and drug resistance of postoperative intracranial infection patients in the department of neurosurgery of our hospital were statistically analyzed,in order to understand the distribution of intracranial infection strains and drug tolerance.Method：A total of 156 patients with postoperative intracranial infection were selected from the Department of neurosurgery in our hospital from 2013.1.1 to 2018.12.31,and the samples of cerebrospinal fluid were collected from the patients.The distribution and drug resistance of the patients in the cerebrospinal fluid culture examination and culture were statistically analyzed.Result：A total of 147 pathogens were cultured in 156 postoperative intracranial infection;62 strains of grampositive bacteria(42.2%),the main strains include staphylococcus aureus,staphylococcus epidermidis,coagulasenegative staphylococcus;84 strains of gramnegative bacteria(57.1%),the main strains include acinetobacter baumannii,pseudomonas aeruginosa,klebsiella pneumonia,enterobacter cloacae;1 strain of fungi(0.68%).The lower resistance rates among grampositive bacteria were piperacillin/tazobactam,linezolid,The drug resistance rate of vancomycin and tigecycline was 0.The rate of drug resistance is generally high in gramnegative,acinetobacter baumannii is resistant to most antibiotics,the resistance rate to polymyxin was 0.〖WTHZ〗Conclusion：Gramnegative bacteria of postoperative intracranial infection accounted for a larger proportion of grampositive bacteria,and the drug resistance rate in gramnegative bacteria is generally higher.Currently,piperacillin/tazobactam,linezolid or vancomycin is still effective against grampositive bacteria.Gramnegative bacteria are resistant to most antibiotics.polymyxin are still highly sensitive to it.

Objective：To explore the establishment and verification of a risk prediction model for recurrence after trigeminal neuralgia decompression.Methods：260 cases of trigeminal neuralgia patients undergoing microvascular decompression in the Department of Neurosurgery of our hospital from June 2016 to December 2018 were analyzed.The model group(n=200) and the verification group(n=60) were divided according to the sequence of the cases,and the recurrence group and the routine group were divided according to the postoperative pain recurrence.Multivariate Logistic regression was used to analyze the related factors affecting postoperative recurrence of trigeminal neuralgia,and a prediction model was established and verified.Results：Among the patients in the modeling group,9 cases fell off,35 cases had postoperative recurrence as the recurrence group,and the remaining 156 cases were in the conventional group,with a surgical recurrence rate of 18.32%.The proportion of the recurrent group with a history of tooth extraction,no clearly responsible vessels,arteriovenous compression,3 or more vessels involved,and second decompression was higher than that of the conventional group(P<0.05).Multivariate Logistic regression analysis showed that undefined responsibility vessels(OR=3.320),arteriovenous compression(OR=5.932) and 3 or more vessels involved(OR=3.799) were independent risk factors affecting the risk of recurrence after decompression of trigeminal neuralgia.The cindex of the risk of recurrence after decompression of trigeminal neuralgia was 0.917(95%Cl 0.854~0.949).Conclusion：This study constructed a simple risk prediction model for recurrence after trigeminal neuralgia decompression,which can accurately predict the recurrence after trigeminal neuralgia decompression,and is helpful for early treatment adjustment.

Objective：To investigate the effects of total thoracoscopic surgery on tumor specific neuron specific enolase(NSE),procalcitonin(PCT),immune markers CD3+,CD4+ and CD8+ in lung cancer patients and their correlation with prognosis.Methods：A total of 85 patients with lung cancer who underwent total thoracoscopic surgery in our hospital from October 2016 to February 2018 were selected as the observation group.102 healthy people who were enrolled in our hospital for the same period were selected as control group.The levels of serum NSE and PCT in the observation group before and after operation and in the control group were measured by electrochemiluminescence method.The levels of CD3+,CD4+ and CD8+ in the observation group before and after operation and in the control group were detected by automatic flow cytometry.Results：The NSE and PCT levels in the observation group were significantly higher than those in the control group before and after surgery,while the NSE and PCT levels after operation were significantly lower than those before surgery(P＜0.05).The proportion of CD8+ before and after operation was significantly higher than that of the control group,while the proportions of CD3+,CD4+ and CD4+/CD8+ were significantly lower than those of the control group.Compared with preoperative,the proportions of CD3+,CD4+,and CD4+/CD8+ were significantly increased after surgery(P＜0.05).The logistic regression analysis showed that NSE(OR=3.32,95%CI=1.88~6.02,P=0.023),PCT(OR=8.12,95%CI=3.25~20.12,P=0.012),CD3+(OR=2.33,95%CI=1.52~7.92,P=0.021),CD4+(OR=5.53,95%CI=3.20~8.65,P=0.018) and CD4+/CD8+(OR=4.82,95%CI=1.57~8.51,P=0.015) were independent risk factor for the prognosis of lung cancer patients undergoing thoracoscopic surgery.Conclusion：The total thoracoscopic surgery can effectively reduce the levels of NSE and PCT,improve postoperative immune function,and monitor the levels of NSE,PCT,CD3+,CD4+ and CD8+ after operation has an important role in assessing the prognosis of lung cancer.

Objective:To observe the clinical features of patients with cryptogenic multifocal ulcerative ulcerous stenosing enteritis(CMUSE),and to improve the diagnosis and treatment strategy of CMUSE combined with literature review.Methods:The clinical and followup data of 8 patients with CMUSE who received medical and surgical treatment in our center from January 2018 to December 2019 were reviewed retrospectively.The observation indexes included clinical symptoms,laboratory examination,imaging or endoscopy(enteroscopy / capsule endoscopy),pathological examination and therapeutic effect.Results：7 patients were treated by operation and 1 patient was treated conservatively.Laboratory tests showed varying degrees of anemia and occult blood positive,and the average ESR was not significantly abnormal.Abdominal CT/MRI showed that the intestinal wall was thickened obviously.Circular stenosis of intestine could be seen in the surgical treatment group.The time of hormone reduction in the drug treatment group were 1 month,2 months and 4 months after discharge,respectively.The average followup time was 8 months.The conservative treatment patients had no obvious symptoms of abdominal pain,diarrhea and adverse reactions of drug treatment,and the surgical patients had no obvious shortterm complications.Conclusion：The misdiagnosis rate of CMUSE is high,and the clinical significance of endoscopy is more significant than that of inflammation,and the inclusion criteria should be more stringent than other inflammatory bowel diseases.Partial small bowel resection with sidetoside anastomosis is a higher priority for patients with recurrent attacks.

Objective：To study the expression of stc2 in AFP positive gastric cancer and its prognostic value.Methods：Taking 112 AFP positive gastric cancer patients admitted to our hospital from March 2018 to June 2019 as the research object, another 112normal gastric cancer patients in the same period of physical examination in our hospital as the control group, respectively, to compare the expression of stc2 in cancer tissues, cancer tissues and normal mucosa, analyze the difference between the expression of stc2 in cancer tissues with different disease states, and compare the expression of stc2 with the expression of stc2 The correlation among the degree of differentiation, infiltration, lymph node metastasis and peritoneal metastasis was analyzed.Results：By comparing the expression of stc2 in three groups of tissues, the positive rate of stc2 from high to low was cancer tissue, paracancer tissue and normal mucosa tissue. By comparing the expression of stc2 in different pathological state of cancer tissue, there were statistically significant differences between the differentiation degree, infiltration degree（P＜0.05）; lymphatic metastasis and abdominal metastasis of different tumor tissue by correlation analysis, the positive expression of TC2 was positively correlated with the differentiation degree, infiltration degree, lymph metastasis and abdominal metastasis of different tumor tissues.Conclusion：The expression of stc2 in AFP positive gastric cancer tissue is significantly related to the prognosis of the patients.

Objective：To investigate the application effect of compound panimage dextramine in the diagnosis and treatment of intestinal obstruction.Methods：Retrospective analysis of 415 cases of intestinal obstruction admitted in general surgery of Hubei Provincial Integrated Chinese and Western Medicine Hospital from June 2011 to June 2020.207 cases receiving routine treatment were treated as control groups.The observation group included 208 cases, on the basis of conventional treatment combined with 76% generic shadow meglumine 100ml of oral or stomach tube injection. The time to complete remission of intestinal obstruction, the time to gastrointestinal decompression, the flow of gastrointestinal decompression, the total length of hospital stay and the rate of conversion to surgery were compared between the two groups.Results：The complete remission time of intestinal obstruction in the observation group was(21.2±8.6)h,significantly lower than that in the control group(48.2±6.5)h.The time of gastrointestinal decompression was(36.2±6.3)h,significantly lower than that of the control group(96.2±12.3)h,The Gastrointestinal decompression drainage was(867±123)ml,was significantly lower than that of that of the control group(1 800±126),Total length of stay was(6.3±2.3)d,was significantly lower than the control group(14.3±3.2)d,The transit surgery rate of 10.1%,also significantly lower than the control group 21.7%,the difference between the two groups was statistically significant（all P＜0.05）.Conclusion：The compound panimage dextramine is safe,convenient,economical and effective to the diagnosis and treatment of intestinal obstruction.

Objective：To explore the effect and safety of different anastomosis methods of BⅡ+Braun and Uncut RouxenY during radical laparoscopic radical gastrectomy.Methods：A retrospective analysis of 95 patients undergoing radical laparoscopic radical gastrectomy from January 2017 to January 2019 in our hospital was divided into the BⅡ+Braun group according to the intraoperative anastomosis method(BⅡ+Braun anastomosis was performed,50 cases) and the Uncut RouxenY group(uncut RouxenY anastomosis,45 cases).The complications,surgery,hospitalization costs,recurrence and metastasis between the two groups were compared.Results：The recovery time of gastrointestinal function in the RouxenY group[(3.3±1.4)d] and the time of first exhaustion[(2.4±0.7)d] were shorter than the BⅡ+Braun group[(4.0±1.8)d,(2.9± 0.8)d],the difference was statistically significant(P<0.05).There was no statistically significant difference in operation time,intraoperative blood loss,number of lymph node dissection,digestive tract reconstruction time,incision length,first time out of bed activity,postoperative extubation time and hospital stay between the two groups(P>0.05).There was no significant difference in hospitalization costs and the number of staplers used between the two groups(P>0.05).The incidence of complications in the Uncut RouxenY group was lower than that in the BⅡ+Braun group(4.44% vs.18.0%,P<0.05).Conclusion：Both methods of anastomosis are safe and feasible,but the Uncut RouxenY method has less effect on gastrointestinal function and is safer.

Objective：To summarize the clinical experience of laparoscopic transabdominal preperitoneal hernia repair(TAPP).
Methods：Retrospective analysis was made on the clinical data of 102 inpatients with inguinal hernia who underwent laparoscopic transabdominal preperitoneal hernia repair(TAPP) in the first ward of general Surgery department,the First Affiliated Hospital of Baotou Medical College from November 2016 to November 2019.
Results：All the 102 cases of TAPP were successfully completed without transferring to open surgery.The operative time was(46.87±4.94)min,the intraoperative blood loss was(5.4±1.64)ml,and the postoperative hospital stay was(4.18±1.09)d.Postoperative analgesics were used in 18 patients(17.65%),with pain score(0.93±1.53) and abdominal incision satisfaction score(4.58±0.62).Postoperative followup(6～42 months) showed good recovery and no recurrence.8 cases of postoperative inguinal seroma,accounting for 7.8%,were relieved after treatment.There were no longterm chronic pain,mesh infection,incision infection,intestinal obstruction and other serious complications.TAPP puncture site has small scar,high incision satisfaction,low postoperative pain,and short postoperative hospital stay.Conclusion：Laparoscopic transabdominal preperitoneal hernia repair(TAPP) in the treatment of inguinal hernia is minimally invasive,safe and effective,without obvious scar and other characteristics,is one of the reliable clinical treatment options for inguinal hernia.

Objective：To explore and compare the curative effect of Tshaped plate combined with reconstruction of plate elastic fixation and parallel double anatomical locking plate internal fixation on posterior acetabular wall fractures.Methods：A retrospective analysis of the clinical data of patients with acetabular posterior wall fractures and surgical treatments admitted from January 2013 to January 2019.A total of 31 patients were included.Among them,17 cases underwent elastic fixation with Tshaped steel plate combined with reconstruction,and 14 cases underwent internal fixation with parallel double anatomical locking plates.Modified pain visual analogue scale(VAS),Map score and Harris score were used to evaluate the clinical results,and the quality of fracture reduction was evaluated by the imaging modified Matta grading standard.Results：31 patients successfully completed the operation.The operation time[(123.06±18.38)min] and intraoperative blood loss[(184.12±55.12)ml] of patients with combined steel plates were significantly less than those of patients with parallel steel plates[(139.29±22.61)min,(230.71±43.58)ml],and the differences were statistically significant(P<0.05).The pain in both groups was gradually reduced and the function improved.The parallel steel plate group's complete weight bearing time in parallel steel plates group[(13.71±1.31)w] was better than that of the combined steel plate group[(15.50±2.10)w],and the difference was statistically significant(P<0.05).With the passage of time after surgery,the VAS scores of the two groups were significantly reduced[(3.06±0.75，2.29±0.69，1.24±0.44)vs(3.71±1.07，2.50±0.65，1.36±0.50)],while the Harris score[(59.71±4.75，81.94±8.74，91.82±3.17)vs(57.14±8.47，79.71±7.21，90.57±5.30)] and the Map scores[(8.29±1.31，14.53±1.59，17.53±1.23)vs(7.79±0.80,13.71±1.64,16.57±1.55)] were significantly increased.At the same time point,the VAS and Map scores of the combined steel plate group were better than those of the parallel steel plate group,and there was no statistical difference(P> 0.05).Conclusion：Tshaped plate elastic fixation combined with reconstruction plate and parallel double acetabular anatomical locking plate fixation of posterior acetabular wall fractures have achieved good results in terms of stability and hip function recovery.However,the operation time using the combined steel plate method is shorter and the postoperative recovery is better.

Objective：To investigate the effect of preoperative hemoglobin A1c(HbA1c) level on the clinical prognosis of hip fracture in elderly patients with type 2 diabetes mellitus.Methods：The clinical data of 97 elderly patients with hip fracture complicated with type 2 diabetes mellitus who underwent surgery in our hospital from January 2014 to October 2019 were retrospectively analyzed.They were divided into group A(HbA1c<6.5%，n=47) and group B(HbA1c≥6.5%，n=50) according to their preoperative HbA1c level,VAS score of pain at 2,7 and 14 days after operation，Harris score of postoperative hip joint function,incidence of postoperative complications,operation time,hospital stay,suture removal time and intertrochanteric fracture healing time were analyzed and compared between the two groups.〖WTHZ〗Results〓〖WTBZ〗The VAS score of pain at 2,7 and 14 days after operation,postoperative complication rate,hospitalization time,suture removal time and complete intertrochanteric fracture healing time in group B were significantly higher than those in group A after operation,while the Harris scores at 1,3 and 6 months after operation in group B were significantly lower than those in group A(P＜0.05),but there was no significant difference in operation time between the two groups(P>0.05).Conclusion：For the elderly hip fracture patients with type 2 diabetes mellitus,the preoperative high level of HbA1c may indicate a poor clinical prognosis.Paying attention to the preoperative HbA1c level and taking relevant measures can promote the recovery of hip joint function,reduce the incidence of postoperative complications.

Objective：Ankylosing spondylitis(AS)and diffuse idiopathic skeletal hyperostosis(DISH) are both spinal ankylosing conditions.Simultaneous occurrence of both conditions is rare,and the present of  lumbar spinal stenosis(LSS) had not been reported at the same time.We encountered a patient with this diagnosis whose initial operation had failed through analyzing the characteristics of the this example patient,review of the literature,So as to improve the understanding of clinicians to such rare diseases,improve the level of diagnosis and treatment ，and improve the level of diagnosis and treatment.Methods：The clinical and imaging data of this patient before and after the initial operation and during the followup were collected.Combined with relevant literature,the reasons for the failure of the initial operation were analyzed，to guide reoperation plan；reoperation was completed  according to the preoperative plan,followed up for a short time after surgery to observe the clinical efficacy of the patients and whether there were implantsrelated complications,so as to provide preliminary guidance for the diagnosis and treatment of such diseases.Results：In this case,the diagnosis was wrong during the first operation and the operation plan was not made properly,so the first operation failed and the internal plants loose.the failure of the was internal plants related to the stress concentration in the surgical stage,the short fixation stage,the absence of intervertebral fusion and many other factors.The long stage fixation in revision surgery,after intervertebral fusion,had satisfactory clinical efficacy,and no implantrelated complications in the following up.Conclusion：AS and DISH  should not be seen as mutually exclusive.DISH is associated with lumbar spinal stenosis requiring surgery.Decompression and shortsegment fixation in LSS patients with DISH was characterized by high rate of reoperation，longsegment fixed fusion is recommended.

Objective:To preliminarily investigate the difference of knee joint function recovery of perforated metal bone needle combined with titanium cable and internal fixation of patella ring in patients suffering from the comminuted patella fracture.
Methods:We enrolled 52 comminuted patellar fracture patients from January 2016 to January 2018 who underwent needle cable or patellar ring,26 patients were in needle cable group and 26 patients were in patellar ring group.The differences between the two groups in the recovery of knee function after internal fixation were compared. The patients in the two groups were followed up for 3 months to compare the complications of postoperative knee stiffness, contracture, disuse of flexion and extension function and loosening of internal fixation devices.
Results:We found that there were significant differences among the score of straight legraising training,limb muscle strength,rate of knee flexion and walking ability after a week,the recovery rate of knee joint efficacy after a month,complications such as knee stiffness,contracture,deactivation of flexion and extension function and loosening of internal fixation device in 3 months.Compared with the patellar ring group,the score of straight legraising training,limb muscle strength,rate of knee flexion and walking ability after a week of needle cable group was higher(P＜0.05),the recovery rate of knee joint efficacy after a month was better(P＜0.05),and complications such as knee stiffness,contracture,deactivation of flexion and extension function and loosening of internal fixation device in 3 months were less(P＜0.05).Conclusion:For patellar comminuted fracture,the treatment of perforated metal bone needle combined with titanium cable has strong internal fixation to the fracture ends,at the same time,it can provide help to the perioperative patients with postoperative knee early functional exercise.As for perioperative postoperative knee joint stiffness,contracture,expand function disuse loose loss and internal fixation devices such as the occurrence of complications,it has also obtained the satisfactory curative effect in clinical.

Objective:To investigate the safety and efficacy of percutaneous patent ductus arteriosus(PDA) occlusion for ambulatory surgery.Methods:102 cases of ambulatory surgery and 83 cases of nonambulatory surgery for transcatheter PDA occlusion under fluoroscopy were selected from the Department of Cardiovascular Surgery,Xijing Hospital of Air Force Medical University from June 2017 to June 2018.Echocardiographic data of the immediate,1month and 6month followup after surgery was collected to compare the clinical outcomes and hospitalization costs between the two groups.Results:Ductus arteriosus of the patients in both groups was successfully occluded.There was no significant difference in operative time and occluder diameter between the two groups.Complications such as residual leakage,hemolysis,and peripheral vascular injury showed no significant difference between the two groups.The total hospitalization cost and hospitalization days in the ambulatory surgery group were significantly lower than those in the nonambulatory surgery group(P<0.05).Conclusion:Shortterm clinical outcomes of percutaneous patent ductus arteriosus occlusion for ambulatory surgery are safe and effective,with significantly reducing days and costs of the hospitalization.

Objective:To investigate the analysis of Curative effect and prognosis of two suture methods of laparoscopic common bile duct exploration in the treatment of gallbladder and CBD stone patients.Methods:To screening 68 cases of gallbladder and CBD stone patients as research subjects,it will be divided into study group with 34 cases and control group with 34 cases，patients in control group were given vicryl interrupted suture of laparoscopic common bile duct exploration,patients in study group were given Barbed wire continuous suture of laparoscopic common bile duct exploration,then the two groups were compared in terms of clinical efficacy and so on.Results:In addition to intraoperative blood loss,the operation time,indwelling drainage tube time and hospital stay time of the study group were all better than those of the control group(P<0.05).The serum IL6,CRP and EP of the patients in the study group were better than those in the control group(P<0.05).The incidence of total complications in the study group was significantly lower than that in the control group(P<0.05).There was no difference between the two groups in stone recurrence rate after half a year(P>0.05).Conclusion:The Barbed wire continuous suture of laparoscopic common bile duct exploration in the treatment of gallbladder and CBD stone patients is significant and safe, reduce the incidence of bile leakage, reduce the degree of inflammatory reaction.

Objective:To investigate the feasibility of retroperitoneal laparoscopic debridement therapy for patients with infected severe acute pancreatitis(SAP).Methods:The clinical data of 4 SAP patients undergoing retroperitoneal laparoscopic debridement in the First Hospital of Huai'an,Nanjing Medical University and the diagnosis,treatment process and postoperative recovery were retrospectively analyzed.Results:All 4 patients successfully completed debridement without death in the perioperative period with an average operation time of (180±78)minutes and a mean hospital stay time after surgery of 42.75(1889)days.Postoperative imagings showed that pancreatic necrosis tissue and fluid accumulation were obvious improve.Conclusion:Retroperitoneal laparoscopic debridement therapy can achieve satisfactory results for infected SAP patients.

Objective:The effect of VSD combined with autologous free skin graft on wound healing and VLUQoL score in patients with venous leg ulcers.Methods:62 cases of VLU patients admitted to our hospital from May 2018 to November 2019 were selected as subjects.They were divided into two groups by random number table,31 cases in each group.The control group was treated with simple autologous skin graft.The observation group was treated with VSD combined with autologous free skin graft,and the VSD drainage device was removed 5～7 days after surgery.Wound healing,postoperative infection,dressing times,wound healing time,total hospital stay,and VLUQoL score were analyzed.Results:The good rate of wound healing was 93.55% in the observation group and 70.97% in the control group(P<0.05).The skin infection rate,dressing change times,wound healing time and total hospitalization time of the observation group were 3.23%,(8.70±1.69),(17.32±3.30)d,(13.61±2.20)d,respectively,which were significantly lower than those of the control group[(22.58%,(15.79±2.58),(25.39±4.88)d,(22.13±2.68)d] with significant difference(P<0.05).The total score of vlu QOL,daily life,subjective feelings and local symptoms of the two groups were[(36.87±7.92),(13.56±4.18),(13.01±3.24) and(10.30±2.36) VS(53.05±14.82),(19.72±4.96),(18.55±3.26) and(14.78±2.90),respectively],which were significantly lower than those before operation.Comparison between groups,12 weeks after surgery to observe group VLUQoL scores and the subjective feeling of daily life,the three dimensions,local symptoms score lower than the control group,the difference was statistically significant(P<0.05).Conclusion:VSD combined with autologous free skin graft treatment for patients with venous leg ulcers can promote wound healing,reduce the rate of skin infection,reduce the number of dressing changes,reduce wound healing time,total hospital stay,and improve quality life of VLU QoL score.

Objective:To observe the effect of ultrasoundguided suprainguinal fascia iliaca compartment block on analgesia of unilateral great saphenous vein stripping surgery.Methods:Sixty patients who underwent elective unilateral great saphenous vein stripping operation from May 2019 to September 2020 were selected and divided into two groups according to the random number table(RNT) method,30 cases in each group.The operations in both groups were completed under general anesthesia.The observation group received a single ultrasoundguided suprainguinal fascia iliaca compartment block before the induction of general anesthesia;While the control group was not treated.Patient controlled intravenous sufentanil administration was used for postoperative analgesia.VAS pain scores,PCIA compression times,cumulative sufentanil consumption,salvage analgesia and related adverse reactions were recorded at 1h,4 h,8h,24h and 48h after operation.Results:The VAS scores of the observation group at 1h,4h,8h,24h and 48h after operation was 1.5±0.9,1.6±0.9,1.8±0.9,1.5±0.8,1.3±0.8,respectively.There were all significantly lowerthan control group（3.1±0.9,3.2±0.8,2.6±0.7,2.4±0.6,2.3±0.7 ） (P<0.05).The times of PCIA pressing at 1h,4h,8h,and 24h in the observation group were 0.6±0.8,1.3±1.1,1.6±1.3,0.9±1.1,respectively,while in control group were 2.2±0.9,3.2±1.4,3.4±1.5,2.6±1.7,respectively.There were significantly difference in the two groups(P<0.05).During 48h after the operation,the cumulative sufentanil consumption in the observation group [(98.5±2.2)μg] compared with control group [(102.3±1.9)μg] was significantly difference(P<0.05).There were no significant difference in terms of the incidence of adverse reactions between the two groups(P>0.05).Conclusion:Ultrasoundguided suprainguinal fascia iliaca compartment block has a good analgesic effect for great saphenous vein stripping operation,and significantly reduces the amount of post operation opioid drugs consumption,which indicates that this block can be used as a good choice for multimode analgesia fo rgreat saphenous vein stripping surgery.

Laparoscopic partial nephrectomy (LPN) has matured in the treatment of early localized renal carcinoma, but it still has limitations in complex renal tumors. Since the successful implementation of LPN in hilar renal tumors was reported in 2005, with the improvement of surgical techniques, the success rate of kidney-preserving surgery for hilar renal tumors has been increasing continuously. Since 2015, our center has significantly improved the safety and feasibility of surgery by combining various technologies and methods such as preoperative IQQA intelligent 3D and 3D imaging, preoperative scoring, intraoperative suture technology, renal artery occlusion technology and so on. In this paper, preoperative evaluation planning, intraoperative techniques and improvement of difficulties in hilar renal tumor LPN were briefly reviewed.