Objective  Through retrospective analysis of the case data of infusion port implantation by various approaches,tried to find out the best approach for infusion port implantation. Methods  104 patients who underwent infusion port implantation from January 2019 to December 2021 in our department were retrospectively analyzed.Including internal jugular vein approach in 55 cases (group A),subclavian vein approach in 49 cases (group B),compared the differences in operative time,puncture time,catheter length,intraoperative and postoperative complications.Results  Compared with group B,the puncture time of the group A was shorter[(8.84±3.10)min vs. (11.22±3.86)min],,less bleeding[(12.64±5.63)ml vs (15.71±7.07)ml],the incidence of catheters heterotopia was low(0 vs 8.16%,all P＜0.05).There was no significant difference in intraoperative complications such as pneumothorax and postoperative complications between the two groups（P>0.05). Conclusion  The puncture time of the internal jugular vein is shorter,the success rate is higher,and the incidence of complications such as catheter heterotopia is lower,therefore,the first choice should be the right internal jugular vein.

Objective  Exploring the factors associated with the recovery of early myocardial microcirculatory perfusion after OPCABG.Methods  Retrospective analysis of 100 patients treated with OPCABG in the department of cardiovascular surgery from June 2019 to February 2021.Patients were divided into two groups according to the recovery of myocardial perfusion in each segment in the early postoperative period.Group A:76 patients with improved perfusion in all segments and Group B:24 patients with poor perfusion improvement left in some segments.We compared the pre-procedure gender composition,age,BMI,hypertension,diabetes,dyslipidaemia,smoking,alcohol consumption,metabolic disease,history of PCI,cTnI-T,BNP and cardiac echocardiography results between the two groups.Results  Age[(71.63±5.09)y vs.(64.74±9.45)y],BMI[(29.27±3.56)kg/m² vs.(26.09±3.08)kg/m²],prevalence of diabetes(87.5% vs.21.1%) and incidence of dyslipidemia(70.8% vs.9.2%) were significantly higher in Group B than in Group A,and the difference was statistically significant(P<0.05).No statistically significant differences were seen in the gender composition,prevalence of hypertension,smoking,alcohol consumption,prevalence of metabolic disease,history of PCI,cTnI-T,BNP and cardiac structure between the two groups(P>0.05).Logistic regression modelling showed that age(OR:1.240,95%CI:1.080-1.486),prevalence of diabetes(OR:0.086,95%CI:0.014-0.391) and the occurrence of dyslipidaemia(OR:0.047,95%CI:0.007-0.220) were risk factors for poor improvement of the residual segment in the early postoperative period after OPCABG,and that they were good predictors(AUC=0.934,P<0.001).No significant coefficients were seen between age,dyslipidemia,history of diabetes and BMI(P>0.05). Conclusion  Age,history of diabetes and dyslipidaemia as risk factors for predicting improvement in myocardial microcirculatory perfusion after OPCABG.They can predict the improvement of microcirculation in the early postoperative period in OPCABG patients with high sensitivity and specificity.  

Objective   By comparing the lymph node metastasis of patients with different smoking status,the aim of current research was to investigate the effect of smoking on the LN metastasis rate of clinical stage ⅠA adenocarcinoma patients.  Methods   A total of 156 patients with clinical stage ⅠA lung adenocarcinoma were collected with different smoking stage from December 2013 to December 2017.All patients were grouped into three groups according to current smoking stage as former smoking group (FSG,n=47),smoking group (SG,n=45),and never smoking group (NSG,n=64).And compare the perioperative indexes,tumor size,degree of differentiation and lymph node metastasis rate,as well as prognosis data of different group patients.  Results   The median lymph node metastasis rates in SG, FSG and NSG groups were 24.49%, 22.77% and 10.19%, respectively.The maximum tumor diameters were 2.54cm, 2.62cm and 2.36cm, respectively.The rate of lymph node metastasis in SG and FSG group was higher than that in NSG group(P<0.05).Logistic regression analysis showed that smoking status and differentiation degree were independent influencing factors of lymph node metastasis.In terms of postoperative survival, patients with a history of smoking (SG and FSG) had a greater risk of lymph node metastasis, and smoking history and differentiation were independent prognostic factors(CI:1.297-6.829 and 1.054-1.280,respectively).Conclusion   Patients with a history of smoking have at greater risk of lymph node metastasis than those who never smoking,and smoking and the degree of differentiation are independent influencing factors of lymph node metastasis in patients.

Objective   To explore the influencing factors of disease-free survival(DFS) in patients with stage Ⅲ non-small cell lung cancer (NSCLC) after neoadjuvant chemotherapy combined with immunotherapy.  Methods   A total of 200 patients with stage Ⅲ NSCLC undergoing radical operation after neoadjuvant chemotherapy combined with immunotherapy in the hospital were enrolled between May 2014 and May 2019.All were followed up for 3 years after neoadjuvant chemotherapy combined with immunotherapy.According to 3-year DFS,they were divided into DFS group (n=76) and non-DFS group (n=124).DFS was analyzed by Kaplan-Meier method,and its influencing factors were analyzed by Cox regression model.  Results   In the 200 patients,there were 96 cases (38.00%) with 3-year DFS,and the median DFS was 21 months.The differences in smoking history,differentiation degree,tumor diameter,EGFR gene mutation,expression of ALK gene,curative effect of neoadjuvant chemotherapy combined with immunotherapy,and postoperative adjuvant chemotherapy between the two groups were statistically significant (P<0.05).The analysis of Cox regression model showed that smoking history (OR=2.016,P=0.004),low differentiation (OR=2.125,P=0.001),tumor diameter >3 cm (OR=1.958,P=0.007),EGFR gene mutation (OR=2.305,P=0.002),positive expression of ALK gene (OR=2.450,P=0.004) and non-remission after neoadjuvant chemotherapy combined with immunotherapy (OR=1.820,P=0.005) were risk factors of DFS,while postoperative adjuvant chemotherapy (OR=1.728,P=0.006) was a protective factor.  Conclusion   In patients with stage III NSCLC undergoing radical operation after neoadjuvant chemotherapy combined with immunotherapy,DFS is related to smoking history,differentiation degree,tumor diameter,EGFR gene mutation,expression of ALK gene,curative effect of neoadjuvant chemotherapy combined with immunotherapy and postoperative adjuvant chemotherapy.

Objective   To investigate the relationship between the level of soluble platelet-derived growth factor receptor β(sPDGFRβ) in cerebrospinal fluid and cognitive impairment in patients with aneurysmal subarachnoid hemorrhage (aSAH). Methods   Cerebrospinal fluid samples from 55 aSAH patients within 72 hours and 20 controls were collected prospectively,and the concentration of sPDGFRβ in cerebrospinal fluid was detected by ELISA.Six months after discharge,aSAH patients were followed up by outpatient visit or telephone,and the cognitive function was evaluated by the Mini-Mental State Examination or the Telephone Interview for Cognitive Status-Modified. Results   The concentration of sPDGFRβ in cerebrospinal fluid was (1.076±0.353)ng/ml in aSAH group and (0.574±0.057)ng/ml in control group,and there was a statistically significant difference between the two groups (P<0.05).Among 55 aSAH patients,19 suffered from cognitive impairment.The concentration of sPDGFRβ in cerebrospinal fluid of patients with cognitive impairment [(1.387±0.280)ng/ml] was significantly higher than that of patients without cognitive impairment [(0.911±0.268)ng/ml] (P<0.05).Multivariate regression analysis showed that Hunt-Hess grade Ⅳ~Ⅴ and sPDGFRβ≥1.347ng/ml were independent risk factors for cognitive impairment in aSAH patients 6 months after discharge (P<0.01). Conclusion   The level of sPDGFRβ in cerebrospinal fluid increases after aSAH,associated with cognitive impairment in patients.

Objective   To compare the efficacy of three different surgical methods in the treatment of common bile duct stones after cholecystectomy:open common bile duct exploration (OCBDE),endoscopic retrograde cholangiopancreatography and papillary sphincterotomy (ERCP/EST),and laparoscopic common bile duct exploration (LCBDE). Methods   The clinical data of 109 cases of recurrent choledocholithiasis after cholecystectomy treated in our hospital from July 2016 to July 2020 were analyzed retrospectively.Among them,33 cases were ERCP,40 cases were OCBDE group,and 36 cases were LCBDE.The influence of confounding factors among the groups was balanced by the tendentious score matching method (PSM),and the clinical efficacy and complications of the three groups after matching were compared.  Results   28 patients were included in each group by PSM method,and the baseline data of the three groups were not statistically significant(P>0.05).No statistical difference was found in the success rate of operation and stone clearance rate among three groups (P>0.05).The specific amount of bleeding,specific duration of operation,specific duration of anal exhaust and specific duration of hospitalization after operation in ERCP group were lower/shorter than those in OCBSE group and LCBDE group,with obvious difference (P<0.05),while the specific amount of bleeding,specific duration of operation,specific duration of anal exhaust and specific duration of hospitalization after operation in LCBDE group were lower/shorter than those in OCBSE group,with obvious difference (P<0.05).The incidence rate of perioperative complications of ERCP group showed no obvious difference with that of other 2 groups (P>0.05),while the incidence rate of postoperative complications in LCBDE group was lower than that in OCBDE group,with statistical difference (P<0.05).Postoperative follow-up showed that the recurrence rate of common bile duct stones in ERCP group was higher than OCBDE and LCBDE groups,with statistical difference (P<0.05),while the recurrence rate yielded no statistical difference between OCBDE group and LCBDE group (P>0.05). Conclusion   ERCP,OCBDE and LCBDE can effectively remove common bile duct stones after gallbladder surgery.ERCP surgery is less traumatic,but it is prone to severe complications such as acute pancreatitis and hyperamylasemia after surgery,and the residual rate of stones after surgery is high.LCBDE has the advantage of micro-invasive surgery than OCBDE,but it is not suitable for patients with severe abdominal adhesion.It is recommended that the operator select an appropriate surgical method according to the specific situation of the patient.

Objective   To explore the feasibility and clinical efficacy of laparoscopic subtotal cholecystectomy for cirrhosis combined with acute calculous cholecystitis.  Methods   Ninety-two cases of liver cirrhosis with acute calculous cholecystitis who were hospitalized in the Hospital of Ningxia Hui Autonomous Region from January 2019 to December 2021 were retrospectively analyzed.Fourty-eight patients underwent laparoscopic subtotal cholecystectomy (study group)and fourty-four patients underwent laparoscopic cholecystectomy (control group).The operative time,intraoperative blood loss,postoperative abdominal drainage tube removal time,postoperative hospital stay,hospitalization cost and postoperative complications were compared and analyzed between the two groups. Results  In the laparoscopic subtotal cholecystectomy group,the operative time was （32.13±17.52）min and intraoperative blood loss was （92.52±35.67）ml,while in the laparoscopic total cholecystectomy group,the operative time was （49.11±23.26）min and intraoperative blood loss was （159.18±45.26）ml.The operative time and intraoperative blood loss were significantly different(P＜0.05),while there were no significant differences in postoperative abdominal drainage tube removal time,postoperative length of hospital stay and hospitalization cost between the two groups(P>0.05). Conclusion   Laparoscopic subtotal cholecystectomy is A safe and feasible treatment option for patients with liver cirrhosis (Child A,B) complicated with acute calculous cholecystitis due to its short operation time,less bleeding,fewer complications and faster postoperative recovery.

Objective   To investigate the value of arterial priority approach combined with radical anterograde modular pancreaticosplenectomy in the resection of pancreatic body and tail cancer combined with multiple organs． Methods   The clinical data of 12 patients with pancreatic body and tail cancer combined with multiple organ resection in Taizhou People’s Hospital Affiliated to Nanjing Medical University from December 2014 to January 2022 were analyzed retrospectively.Preoperative evaluation was based on CT or MRI plain scan plus enhancement.During the operation,arterial priority approach combined with radical anterograde modular pancreaticosplenectomy was used,and combined with multiple organ resection.Postoperative complications were treated in time. Results   All patients were successfully completed surgery,no perioperative death.The operation time was (375±43) min and the amount of intraoperative bleeding was (280±40) ml.Postoperative pathology showed that the cutting edges of all specimens were negative,nerves were involved,lymph nodes were cleaned (23±6),and lymph node metastasis occurred in 10 of 12 cases.The incidence of postoperative complications was 50%,including 3 cases of grade A pancreatic fistula,no grade B and C pancreatic fistula,1 case of gastric emptying disorder,1 case of lymphatic fistula and 1 case of adhesive intestinal obstruction,which were cured by conservative treatment.No colonic anastomotic leakage and renal cortical crisis occurred.All patients were cured and discharged,with an average hospitalization of 18.6 days. Conclusions   Using the method of arterial priority approach combined with radical anterograde modular pancreaticosplenectomy,pancreatic body and tail cancer combined with multi organ resection ensures the radical resection of the tumor,less intraoperative bleeding,safe and feasible.

Objective   To analyze the etiology,diagnosis and treatment of liver abscess(LPA) after laparoscopic pancreaticoduodenectomy(LPD) in single center. Methods   From January 2017 to January 2021,4 patients with secondary liver abscess who received LPD in the Second Department of General Surgery of Handan Central Hospital were collected,and their clinical data were collected to analyze the etiology and treatment of liver abscess.  Results   All the 4 cases were secondary liver abscess after LPD.The etiology was retrospectively analyzed according to medical records and imaging data.Case 1 was the main branch of right hepatic artery injured during operation.The right hepatic artery in case 2 originated from superior mesenteric artery and was accidentally injured and ligation during operation.The superior mesenteric vein was narrowed after wedge resection in case 3.Case 4 was a case of recurrent biliary retrograde infection.All 4 cases recovered after antibiotic therapy combined with interventional therapy.Case 1 died 16 months after surgery due to multiple liver metastases and ascites.Patient 2 survived healthy for 19 months after LPD without recurrence and metastasis.Case 3 died of jaundice 26 months after surgery due to multiple liver metastases and lymph node metastasis in the pancreatic head region.Patient 4 died of recurrent retrograde biliary tract infection 13 months after surgery.  Conclusion   Liver abscess after LPD is mainly related to hepatic artery and vein injury and recurrent biliary tract retrograde infection.Rational antibiotic use combined with interventional therapy is the preferred effective treatment.

Objective   To investigate the value of serum albumin(ALB) and alkaline phosphatase(ALP) levels in predicting lymph node metastasis in patients with colorectal cancer(CRC) after laparoscopic radical surgery,and to find a method to predict lymph node metastasis in patients with CRC. Methods   The prospective analysis method was used in this study to include 115 CRC patients admitted to the hospital from September 2017 to September 2019.All patients were treated with laparoscopic radical surgery,and were followed up for 3 years.The last follow-up was until September 2022.The clinical data and related laboratory indicators of CRC patients were investigated,and the clinical data and serum ALB and ALP levels of patients in the metastatic group and non metastatic group were compared.The correlation between serum ALB,ALP and postoperative lymph node metastasis of CRC patients was tested by point binary correlation test,bivariate Pearson correlation coefficient and Logistic regression.ROC curve was drawn to analyze the value of serum ALB and ALP in predicting postoperative lymph node metastasis. Results   Of the 110 patients with CRC,29 had lymph node metastasis after operation,with an incidence of 26.36%.The levels of serum carcinoembryonic antigen(CEA),carbohydrate antigen(CA) 199 and ALP and the proportion of differentiation degree(low differentiation) in the developing group were higher than those in the non-developing group,and the level of serum ALB was lower than that in the non-developing group,the difference was statistically significant(P＜0.05).Serum CEA,CA199 and ALP levels were positively correlated with lymph node metastasis in CRC patients(r=0.348,0.469,0.470,P＜0.001),while ALB levels were negatively correlated with lymph node metastasis in CRC patients(r=-0.426,P＜0.001).There was a negative correlation between serum ALB and ALP(r=-0.250,P=0.009).Serum CA199,CEA,ALB,ALP and differentiation degree were related to lymph node metastasis in CRC patients after operation.The AUC(0.839,95% CI:0.758-0.919) of serum ALB and ALP in predicting postoperative lymph node metastasis in CRC patients was higher than that of serum ALB and ALP alone(0.789,95% CI:0.701-0.876),(0.748,95% CI:0.639-0.858),and the value of combined prediction was the highest.Conclusion   Serum ALB and ALP have a certain value in predicting lymph node metastasis in CRC patients after laparoscopic radical surgery,and the value of combined prediction is the highest.

Objective   To analyze the risk factors for the prognosis of Periampullary carcinoma and establish a prognostic model. Methods   Clinical data of periampulla carcinoma patients from SEER database were retrospectively analyzed.According to the set criteria,1775 patients were included and divided into the modeling group(1 242 case) and the validation group(533 case) in a 7∶3 ratio.In the modeling group,Cox proportional risk regression model was used to screen the risk factors influencing the survival and prognosis of periampullary carcinoma,and a Nomogram was constructed based on the regression analysis results.The predictied efficiency of the model was verified in the modeling group and the verification group respectively. Results   Age,T stage,N stage,degree of tumor differentiation,pathological type and operation were found to be risk factors for periampullary carcinoma by Cox regression model.The above six variables were included in the prediction model and a Nomogram was drawn to predict 1year,3year and 5year survival rates.C index in modeling group and verification group was 0.7047(95%CI：0.6854,0.7241) and 0.7001(95%CI：0.6689,0.7314),respectively.The AUC values of 1year,3year and 5year ROC curves in the modeling group were 0.766、0.756 and 0.757,respectively,and those of 1year,3year and 5year ROC curves in the verification group were 0.736、0.733 and 0.742,respectively.The correction curve showed that the predictors of survival rate was consistent with the actual survival rate,and the decision curve showed that the prediction model had certain clinical value.Conclusion   The prognostic model of periampullary carcinoma has good predictive value.

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.

Objective   To explore the surgical method and clinical effect of repairing the finger C-shape soft tissue defect by free transverse wrist crease flap with preserved cutaneous nerve. Methods   6 patients with finger C-shape soft tissue defect were repaired with free transverse wrist crease flap with preserved cutaneous nerve in the department between March 2019 and January 2021.The skin flap was cut with an area of 1.8cm×2.6cm3.5cm×4.8cm,and the donor site wound was directly sutured.The defect of palmar digital nerve was repaired by superficial palmar branch of radial nerve and the postoperative recovery status of recipient site and donor site were observed. Results   All flaps survived in 6 cases after surgery,and the donor site of the flap and the wound healed in primary stage without muscle adhesion and vascular crisis.All patients were followed up for 6 to 12 months,with an average of 8 months.Follow-up showed that the skin flaps of patients were with normal color,no obvious pigmentation,soft texture,good appearance and protective sensory recovery.There was only a linear scar left in the wrist donor site,and the wrist function was not affected.The sensory function of the affected finger recovered,the finger body was not atrophied,the flexion and extension function of the finger joint returned to normal,and the activity was free.According to the trial standard of upper limb function evaluation of Chinese Medical Association,there were 4 excellent cases,1 good case and 1 fair case. Conclusion Free transverse wrist crease flap with preserved cutaneous nerve is an ideal method on repairing finger C-shape soft tissue defect,and its design and incision of the flap are flexible and simple,which is beneficial to the revascularization and sensory function recovery of finger C-shape soft tissue defect site.

Objective   To explore the predictive value of platelet lymphocyte ratio (PLR) combined with systemic inflammatory response index (SIRI) in the recurrence of non muscle invasive bladder tumor after plasma resection. Methods   From January 2020 to June 2021,108 patients with nonmuscular invasive bladder tumor were treated in Hai’an People’s Hospital.The levels of neutrophils,lymphocytes,platelets,and monocytes were detected within 24 hours before plasma electroresection,and the SIRI and PLR levels were calculated.The patients were followed up for 12 months and divided into relapse group and non relapse group according to the recurrence outcome.To analyze the influencing factors of postoperative recurrence of patients with nonmuscular invasive bladder tumor,draw the ROC,and use the area under the curve (AUC) to evaluate the predictive efficacy of PLR and SIRI on postoperative recurrence of patients with nonmuscular invasive bladder tumor. Results   By the end of follow-up,7 of 108 patients with nonmuscular invasive bladder tumors had lost follow-up,with a follow-up rate of 93.52%.16 cases recurred,the recurrence rate was 15.84%,and 85 cases (84.16%) had no recurrence detected.The age,SIRI,PLR,tumor stage T1,multiple tumors,and high risk ratio in the recurrence group were higher than those in the non recurrence group (P<0.05).Logistic analysis showed that older age,tumor stage T1,multiple tumors,high risk degree,elevated SIRI and PLR levels were all risk factors for postoperative recurrence of patients with nonmuscular invasive bladder tumor (P<0.05).ROC analysis showed that AUC of patients with nonmuscular invasive bladder tumor predicted by single and combined SIRI and PLR levels were 0.748 (95%CI:0.640～0.855),0.790 (95%CI:0.669～0.911) and 0.819 (95%CI:0.713～0.925) respectively. Conclusion   SIRI and PLR can be used to predict the risk of postoperative recurrence in patients with nonmuscular invasive bladder tumor,and the prediction effect is good.

Objective   To investigate the effect of Qijin mixture on residual stone rate and stone recurrence after ureteroscopic holmium laser lithotripsy. Methods   A total of 108 patients with upper ureteral calculi treated in our hospital from October 2015 to October 2020 were randomly divided into control group(n=54) and study group(n=54).Patients in both groups were treated with Ureteroscopic holmium laser lithotripsy,the control group was treated with traditional natural stone removal,and the study group was treated with Qijin mixture on the basis of the control group.All patients were reexamined 3 days,1 month and 6 months after the end of treatment.The postoperative residual stone rate and postoperative complications were compared between the two groups. Results   After treatment,hematuria,abdominal pain,frequency and urgency of urination,burning sensation of urination,and the total score of TCM symptoms in the two groups were significantly lower than those before treatment (P<0.05).The symptoms of the study group were slighter than those of the control group,and the total score of TCM symptoms was lower than that of the control group (P<0.05).The total effective rate of the study group was 96.30%,which was higher than 85.19% of the control group (P<0.05).The stone clearance rate of the study group was higher than that of the control group (P<0.05).The total incidence of complications such as low back pain,fever,infection and urinary tract irritation was lower than that of the control group (P<0.05).There was no significant difference in the residual stone rate between the two groups at 3 days after operation (P>0.05).Abdominal X-ray examination 1 month after operation showed no residual stones in the study group,while 8 patients in the control group still had residual stones (P<0.05).CT examination of urinary system 6 months after operation showed no recurrence of calculi in the study group.In the control group, 5 of the 8 patients with residual stones had increased stone diameter and stone recurrence was visible, and 2 of the 46 patients without residual stones found new stones.The recurrence rate of stone in the study group was lower than that in the control group, the difference was statistically significant(P<0.05). Conclusion   Qijin mixture has a significant effect on stone removal after Ureteroscopic holmium laser lithotripsy,which can accelerate the discharge of residual stone,and reduce the incidence of complications.

Objective   To investigate the effect of sevoflurane and isoflurane in radical resection of lung cancer and their effects on the expression of serum matrix metalloproteinases(MMPs),inflammatory factors,E-selectin(E-selectin)and cyclooxygenase-2(COX-2)level effect. Methods   Lung cancer patients who underwent three-hole thoracoscopic radical resection for lung cancer from May 2017 to December 2020 were selected as the study objects,and were divided into observation group(intraoperative anesthesia maintained by sevoflurane)and control group(intraoperative anesthesia maintained by isoflurane)according to random number table,with 43 cases in each group.The level changes of matrix metalloproteinase-2(MMP-2),matrix metalloproteinase-9(MMP-9),E-selectin,COX-2,interleukin-4(IL-4),interleukin-10(IL-10) and interleukin-6(IL-6) of the two groups were compared before surgery(T0),1h after surgery(T1),after surgery(T2),and 6h after surgery(T3).Recovery time,extubation time,recovery of spontaneous respiration,and length of hospital stay were evaluated. Results   At T1,T2 and T3,the MMP-2 levels of the observation group were (328.11±23.15)ng/L,(335.41±23.85)ng/L,(342.52±25.52)ng/L,respectively.MMP-9 was (357.01±24.02)ng/L,(365.85±25.69)ng/L,(375.01±27.01)ng/L,respectively.E-selectin values were (59.11±6.02)ng/ml,(65.18±6.15)ng/ml,(57.25±5.69)ng/ml,respectively.COX-2 was (21.15±2.11)ng/ml,(22.05±2.18)ng/ml,(22.35±2.02)ng/ml,respectively.IL-4 was (14.11±2.65)ng/ml,(17.23±3.21)ng/ml,(22.01±3.96)ng/ml,respectively.IL-10 was (5.96±0.32)ng/ml,(7.25±0.58)ng/ml,(11.02±1.32)ng/ml,respectively.IL-6 was (44.12±3.41)ng/ml,(56.23±4.02)ng/ml,(57.14±4.09)ng/mlrespectively.In control group,MMP-2 was (341.52±25.45)ng/L,(368.78±28.74)ng/L,(381.02±31.03)ng/L,respectively.MMP-9 was (369.78±26.45)ng/L,(387.45±29.65)ng/L,(410.52±34.02)ng/L,respectively.E-selectin values were (64.12±7.25)ng/ml,(72.36±8.45)ng/ml,(62.15±6.45)ng/ml,respectively.COX-2 was (25.26±3.33)ng/ml,(25.35±3.28)ng/ml,(25.75±3.36)ng/ml,respectively.IL-4 was (15.96±3.12)ng/ml,(22.69±4.52)ng/ml,(27.41±4.32)ng/ml,respectively.IL-10 was (7.12±0.55)ng/ml,(9.96±1.02)ng/ml,(15.21±1.96)ng/ml,respectively.IL-6 was (59.78±4.85)ng/ml,(77.65±5.32)ng/ml,(62.65±5.05)ng/ml,respectively.The levels of MMP-2,MMP-9,E-selectin,COX-2,IL-4,IL-10 and IL-6 at T1,T2 and T3 in observation group were lower than those in control group(P<0.05).The recovery time of observation group and control group was (20.21±2.32)min and (27.12±3.15)min,respectively.The extubation time was (24.23±2.85)min and (30.15±3.14)min,and the recovery of spontaneous respiration was (10.25±1.23)min and (14.45±2.47)min,respectively.The observation group was shorter than the control group(P<0.05). Conclusion   Compared with isoflurane,sevoflurane has a better anesthesia effect in patients undergoing radical resection of lung cancer.It can inhibit inflammatory factors and reduce the stress response to MMP-2,MMP-9,The influence of E-selectin and COX-2.

Objective   To explore the effect of application of ultrasound-guided lateral approach combined with iliohypogastric/ilioinguinal transversus abdominis plane(TAP) two-point block in laparoscopic inguinal hernia repair. Methods   88 patients who underwent unilateral inguinal hernia repair in our hospital from January 2021 to April 2022 were enrolled as the study subjects.The patients were divided into observation group (n=44) and control group (n=44) according to the random number table.In the control group,lateral TAP block was used after general anesthesia,and in the observation group,lateral combined iliohypogastric/ilioinguinal TAP two-point block was used after general anesthesia.The volatility of heart rate and mean arterial pressure were  analyzed and compared between the two groups at five time points:skin incision (T1),3 hours after surgery (T2),6 hours after surgery (T3),12 hours after surgery (T4),and 24 hours after surgery (T5),and visual analogue scale (VAS) scores were used to compare the degree of pain at T2-T5 between the two groups,and the satisfaction of anesthetic effect was compared between the two groups. Results   The two groups of patients were successfully completed the operation.In the observation group,the VAS scores at rest at T2-T4 were (2.04±0.55),(2.41±0.57) and (2.95±0.70) points,the VAS scores at activity were (2.82±0.59),(3.16±0.68) and (3.80±0.77) points,in the control group,the VAS scores at rest were (2.32±0.69),(3.29±0.77) and (3.54±1.08) points,and (3.55±0.83),(4.07±0.91) and (4.34±1.05) points at activity,respectively.The VAS scores in the observation group were significantly lower than those in the control group,and the proportion of VAS≥4 points at rest was lower (20.45% VS.47.73%).At T2-T5,the hemodynamics in the observation group were more stable,and the satisfaction rate of anesthetic effect was significantly better than that in the control group (93.18% VS.70.45%),and the above differences were statistically significant (P<0.05). Conclusion   In laparoscopic inguinal hernia repair,the use of TAP two-point block anesthesia has better postoperative analgesia,more stable hemodynamics,and better anesthesia than lateral TAP block.

Objective   To explore the effect of laparoscopic or robotic-assisted Duhamel pull-through procedure postoperative rectal tube indwelling time on recovery of children with long segment Hirschsprung disease (HD) and intestinal neuronal dysplasia (IND-B). Method   The clinical data of 29 cases with long segment HD and 56 cases with IND-B failed to conservative treatment,received minimallly invasive external anal transection rectum Duhamel pull-through procedure from January,2019 to December,2021 were retrospectively analyzed.Postoperative routine indwelling rectal tube.According to actual rectal tube indwelling time,the patients were divided into 3 groups to analyzed：Group A, catheterization time ≤3 days, 8 cases; Group B, catheterization time 4-6 days, 15 cases; Group C, catheterization time ≥7 days, 62 cases，and compared intraoperative and postoperative clinical data. Result   There were statistical differences among three groups in terms of the incidence of enterocolitis occured within 1 year after surgery,postoperative abdominal distension and perianal discomfort (P<0.05). Conclusion   In children with long segment Hirschsprung disease (HD) and intestinal neuronal dysplasia (IND-B),longer rectal tube indwelling time after minimallly invasive external anal transection rectum Duhamel pull-through procedure,which is beneficial to reduce the incidence of postoperative abdominal distention and perianal discomfort and enterocolitis.

Pancreatic cancer is one of the most malignant solid tumors with an increasing incidence and poor prognosis.In recent years,neoadjuvant therapy has gradually become one of the research hotspots in the field of pancreatic cancer,which is aimed at eliminating tumor micrometastases,improving the radical resection rate and improving the prognosis of patients.However,there is a great controversy in the selection of suitable population,treatment options,efficacy evaluation and resectability prediction of neoadjuvant therapy for pancreatic cancer.This article reviews the current status and controversial issues of neoadjuvant therapy for pancreatic cancer,aiming to promote the standardized treatment of pancreatic cancer.

Prolonged Postoperative Ileus (PPOI) often occurs after abdominal surgery,and it is still one of the common complications in the field of surgery,which not only results in the prolongation of postoperative recovery time and hospital stays but also one of the main reasons for the increase of patients’ economic burden and the waste of medical resources.It has been paid more and more attention by scholars because of its special clinical manifestations and the lack of recognized treatment and preventive measures.This review intends to make a summary and prospect of the related mechanisms of PPOI,the auxiliary diagnostic methods of PPOI,and the treatment methods that show a certain curative effect on PPOI.