Objectives  To investigate the clinical outcomes of Hybrid Ⅱ and total arch replacement in acute type A aortic dissection(ATAAD) with malperfusion. Methods From January 2016 to January 2020, 127 ATAAD patients with malperfusion who underwent surgical repair were enrolled in this study.There were 56 patients in hybrid debranching group and 71 in total arch replacement group.Their baseline characteristics,perioperative data,and early and mid-term outcomes were compared.Results Compared with the total arch replacement surgery group,the postoperative ventilator assistance time[(32.6±26.7）h vs（61.8±31.1）h],intensive care unit length of stay[(75.3±30.6)h vs (104.4±34.1)h],postoperative renal insufficiency(21.4% vs 46.5%),mortality within 30 days(1.8% vs 12.7%),mortality within 1 year(5.4% vs 18.3%) and permanent neurological dysfunction(8.9% vs 22.5%) in the hybrid debranching group were all statistically significant(P<0.05).There were no differences in re-exploration,hepatic insufficiency,tracheotomy,temporary neurological dysfunction,mortality within 3 years and endoleak.Conclusion Hybrid debranching had better advantages in improving the short-term prognosis of ATAAD patients with malperfusion,but the long-term prognosis needed further study.

Objective To investigate the value of 3D printing technology in locating the transverse sinus-sigmoid sinus in retrosigmoid sinus approach surgery. Methods 47 patients who underwent microvascular decompression surgery from January 2021 to January 2023 in the Department of Neurosurgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology were selected to enter the study,and were divided into 2 groups according to whether 3D printing technology was applied to assist in transverse sinus-sigmoid sinus positioning:23 patients in the 3D printing group applied 3D printing technology to guide transverse sinus-sigmoid sinus;24 patients in the control group performed conventional craniotomy.The length of surgery,intraoperative blood loss and the accuracy of transverse sinus-sigmoid sinus migration(keyhole) localization were compared between the two groups. Results The accuracy of transverse sinus-sigmoid shift localization was significantly higher in the 3D printing group than in the control group(95.7% vs.71.0%),and the operative time was significantly less than in the control group[(120.8±9.1)min vs.(131.5±19.7 min)],and the intraoperative bleeding was also significantly less than in the control group[(28.3±32.4)ml vs.(67.5±76.0)ml],with statistically significant differences(P<0.05). Conclusion The application of 3D printing technology to assist in transverse sinus-sigmoid sinus positioning in the retrosigmoid sinus approach can help improve positioning accuracy,surgical efficiency and reduce intraoperative bleeding.

Objective To investigate the effects of early enteral nutrition support with different energy ratios on nutritional indices and immune function in patients with severe brain injury. Methods 71 patients with severe craniocerebral injury admitted to our hospital from November 2018 to November 2021 were selected as the research objects.According to the different energy of enteral and intralteral nutrient solution,they were divided into low energy group (n=36) and high energy group (n=35).Patients in the low energy group received early 50% low energy enteral and intralteral nutrition support.Patients in the high energy group received early 100% high energy parenteral nutrition support.Nutritional indexes hemoglobin (Hb),total protein (PA),serum albumin (Alb),transferrin (TF),immune indexes [(immunoglobulin A (IgA),immunoglobulin M (IgG),immunoglobulin M (IgM),T lymphocyte subsets CD3+,CD4+,CD8+ and CD4+/CD8+)]] were compared between the two groups.,infection and prognosis. Results After treatment,the levels of Hb,TF,Alb and PA in the low energy group were higher than those in the high energy group (P<0.05).IgA,IgG,IgM,CD3+,CD4+,CD8+ and CD4+/CD8+ in low energy group were higher than those in high energy group (P<0.05).The total infection rate in low energy group was lower than that in high energy group (5.56% vs 25.71%) (P<0.05).The good prognosis rate of low energy group was higher than that of high energy group (83.33% vs 60.00%) (P<0.05). Conclusion Compared with early high-energy parenteral nutrition support,early low-energy parenteral nutrition support has a more significant effect on patients with severe intracranial brain injury,which can significantly improve the nutritional status and immune function of patients,reduce infection rates.

Objective To investigate the clinical effect of bedside fiberoptic bronchoscopy on patients with traumatic brain injury complicated with pulmonary infection undergoing mechanical ventilation. Methods From July 2018 to July 2022, 82 patients with traumatic craniocerebral injury complicated with pulmonary infection treated in our hospital were enrolled,42 patients with routine sputum aspiration were set as the control group,and 40 patients with bedside fiber bronchoscopy were set as the experimental group.Sputum samples were collected from both groups for examination and culture,and clinical data such as chest CT lesion absorption time,mechanical ventilation time,anti-infection course,ICU stay time were recorded.Driving pressure (△P),oxygenation index (OI),respiratory mechanical index and detection rate of effective pathogens were calculated.GOS-E score was followed up 6 months after injury. Results The total effective rate of the experimental group (95.00%) was higher than that of the control group (78.57%)(P<0.05).The ICU stay time,mechanical ventilation time,focus absorption time,driving pressure (△P),oxygenation index (OI),respiratory mechanics index and GOS-E score of the experimental group were significantly improved compared with the control group,and the differences were statistically significant (P<0.05). Conclusions  The implementation of bronchoscopy in ICU patients with traumatic craniocerebral injury and pulmonary infection can effectively improve pulmonary ventilation,lung dynamic compliance,and cerebral blood perfusion,which is helpful for clinical brain-lung conflict management and neurological prognosis.

Objective To detect the level of purinergic receptor P2X,ligandgated ion channel 7 (P2X7R) and the degree of cerebral edema in patients with cerebral hemorrhage,and to analyze the correlation between the two and the cognitive function of patients with cerebral hemorrhage. Methods Prospectively,115 patients with cerebral hemorrhage admitted to our hospital from July 2019 to July 2021 were regarded as the study group.Another 90 healthy subjects who underwent physical examination were regarded as the healthy control group.The serum P2X7R level and the volume of cerebral edema were detected;Pearson correlation was used to analyze the correlation between P2X7R and brain edema volume;the patients were grouped into a no cognitive dysfunction group (78 cases) and a cognitive dysfunction group (37 cases) according to whether cognitive dysfunction occurred,multivariate Logistic regression was performed to analyze the cognitive function factors of patients with cerebral hemorrhage,receiver operating characteristic (ROC) curve of serum P2X7R level and brain edema volume in the assessment of cognitive function in patients with intracerebral hemorrhage was drawn. Results On the first day of onset,the serum P2X7R level in the study group were higher than those in the healthy control group (P<0.05),the serum P2X7R level and the volume of cerebral edema in patients with cerebral hemorrhage gradually increased during 1-5d,and reached the peak on the 5th day and then decreased (P<0.05);there were a positive correlation between serum P2X7R levels and brain edema volume in patients with cerebral hemorrhage on the 1st,3rd,5th,and 7th day of onset (r=0.712,0.583,0.589,0.472,P<0.05);the serum P2X7R level and brain edema volume in the Cognitive dysfunction group were higher than those in the no cognitive dysfunction group (P<0.05);serum P2X7R levels and brain edema volume are risk factors for cognitive dysfunction in patients with cerebral hemorrhage (P<0.05).The area under the curve of serum P2X7R level and cerebral edema volume alone and in combination was 0.763,0.750 and 0.829,respectively. Conclusion The level of serum P2X7R in patients with cerebral hemorrhage increases,and the volume of cerebral edema increases,and the two are positively correlated.Combined detection can predict the occurrence of cognitive dysfunction in patients.

Objective To investigate the effects of long noncoding RNA(lncRNA) SLC26A4 antisense RNA 1(SLC26A4-AS1) on proliferation,migration and invasion of breast cancer cell and the underlying mechanisms. Methods From June 2017 to December 2020, there were 40 cases of breast cancer tissue and corresponding paracancer tissue (more than 5cm away from the margin of cancer tissue).The expression levels of SLC26A4-AS1 in breast cancer tissues and cell lines were determined by quantitative real-time PCR(qRT-PCR).MCF7 cell was selected and allocated into:control group,pcDNA3.1 group,pcDNA3.1-SLC26A4-AS1 group and pcDNA3.1-SLC26A4-AS1+Notch activator group.The effects of SLC26A4-AS1 on expressions of Notch1 and Hes1 in Notch signaling pathway were examined by qRT-PCR.Cell viability(Proliferation),migration and invasive were determined by MTT assay,Scratch and Transwell assay. Results SLC26A4-AS1 was significantly down-regulated in breast cancer tissues and cell lines.The expressions of Notch1 and Hes1 in pcDNA3.1-SLC26A4-AS1 group were lower than pcDNA3.1 group(P<0.01).The cell viability,wound healing rate and number of transmembrane cells of pcDNA3.1-SLC26A4-AS1 group were inhibited compared with pcDNA3.1 group(P<0.01).The cell viability,wound healing rate and number of transmembrane cells of pcDNA3.1-SLC26A4-AS1+Notch activator group were promoted compared with pcDNA3.1-SLC26A4-AS1 group(P<0.01). Conclusions SLC26A4-AS1 was down-regulated in breast cancer,and overexpression of SLC26A4-AS1 curtailed proliferation,migration and invasion of breast cancer cells.SLC26A4-AS1 provides a novel epigenetic mechanism involved in deactivation of Notch signaling pathway.

Objective To explore the relationship between long-chain non-coding RNA MIR205HG (LncRNA MIR205HG) and microRNA-299-3p (miR-299-3p) and its molecular mechanism affecting proliferation and apoptosis of lung cancer cells. Methods  The expressions of MIR205HG and miR-299-3p in lung cancer tissue and cell lines were detected.The H1299 cells were grouped into:si-MIR205HG group,si-NC group,miR-299-3p group,miR-NC group,si-MIR205HG+anti-miR-299-3p group,si-MIR205HG+anti-miR-NC group.The interaction of MIR205HG with miR-299-3p was detected.Proliferation, apoptosis and protein expression were detected. Results The expression level of MIR205HG in lung cancer tissues and cell lines was increased (P<0.05),and the expression level of miR-299-3p was decreased (P<0.05).MIR205HG can specifically bind to miR-299-3p and regulate the expression and activity of miR-299-3p.Interference with MIR205HG expression or miR-299-3p overexpression reduced lung cancer cell proliferation and promoted apoptosis,and the expressions of CyclinD1 and p21 decreased,while the expressions of Bcl-2 and Bax increased (P<0.05).Inhibition of miR-299-3p reversed the effect of MIR205HG expression on proliferation and apoptosis of lung cancer cells. Conclusion Interfering with the expression of MIR205HG could inhibit lung cancer cell proliferation and induce cell apoptosis,and its mechanism of action was related to the negative regulation of miR-299-3p.

Objective To detect the correlation between the clinical imaging features and the degree of invasion of pulmonary pure ground-glass nodules (pGGNs) (≤ 3cm). Methods The  clinical data of 886 patients who underwent minimally invasive surgery from June 2013 to June 2016 for pulmonary nodules were collected. Among these, 72 patients had complete clinical data and isolated pulmonary GGN resection, and the  diameter of the pulmonary GGN was ≤ 3cm.Logistic regression analysis was used to analyze the independent risk factors for invasiveness of pure ground glass  nodules. Receiver operating characteristic curve (ROC curve) was used to determine the optimal cut-off value for preinvasive and invasive lesions. Results Univariate analysis demonstrated that there were significant differences in carcinoembryonic antigen,maximum diameter,and area of pGGNs in patients with pre-invasive and invasive lesions (P<0.05).Multivariate logistic regression analysis showed that there were only statistical differences in the maximum diameter of nodule pre-invasive and invasive lesions.The optimal cut-off value for CT-maximal diameter to predict pre-invasive lesions or invasive lesions was 1.08cm. Conclusion Therefore,predicting the pathological types of nodules (pre-invasive or invasive) by measuring the maximum diameter of pGGNs is reliable,with the most reliable cut-off value as 1.08cm.

Objective  To explore the predictive value of postoperative drainage volume and lung function for pulmonary complications (PPCs) after thoracoscopic lobectomy (VATSL) in patients with non-small cell lung cancer (NSCLC). Methods The clinical data of 80 NSCLC patients with VATSL treated in Suzhou Hospital of Integrated Traditional Chinese and Western Medicine from June 2017 to June 2022 were collected.According to the occurrence of postoperative PPCs,patients were divided into the occurrence group and the non-occurrence group.Lung function indexes of all NSCLC patients were examined one week before surgery,and postoperative drainage volume of 3 days after operation was recorded.The influencing factors of PPCs after VATSL were analyzed by Logistic regression,and the predictive value of postoperative drainage volume and lung function on PPCs after VATSL in NSCLC patients was analyzed according to ROC curve. Results After VATSL,there were 57 cases without PPCs and 23 cases with PPCs,the incidence of PPCs was 28.75%.There was no significant differencein gender,age,BMI,operation time,intraoperative blood loss,length of hospital stay,clinical stage,history of diabetes,history of hypertension,smoking history and lung function between the two groups [vital capacity (VC),forced vital capacity (FVC),forced expiratory volume in the first second (FEV1),FEV1/FVC,maximum volume of gas (MVV)] (P>0.05).The peak expiratory flow (PEF) level in the occurrence group was lower than that in the non-occurrence group,and the drainage flow of 3 days after operation was higher than that in the non-occurrence group (P<0.05).Logistic regression analysis showed that PEF and drainage volume of 3 days after operation were independent risk factors for PPCs after VATSL in NSCLC patients (P<0.05).ROC analysis showed that the AUC values of PPCs after PEF and drainage volume of 3 days after operation assessment of VATSL in NSCLC patients were 0.788 and 0.815,respectively,and 95%CI were 0.682-0.871 and 0.713-0.893.The combined prediction of AUC was 0.908 and 95%CI was 0.823-0.961. Conclusion Both postoperative drainage volume and PEF have certain reference value for predicting the occurrence of PPCs after VATSL in NSCLC patients,and the combined value is higher for predicting the occurrence of PPCs after VATSL.

Objective To detect the expression levels of long non-coding RNA BSN-AS2 (lncRNA BSN-AS2) and hsa-miR-4782-3p in serum of patients with liver cancer,and to analyze their clinical diagnostic value in liver cancer.Methods A total of 100 patients with liver cancer who were diagnosed and treated in our hospital from March 2018 to March 2020 were taken as the research group.Another 90 healthy subjects who underwent physical examination were included as the control group.Quantitative real-time polymerase chain reaction (qRT-PCR) was applied to detect the expression levels of lncRNA BSN-AS2 and hsa-miR-4782-3p in serum of patients;Spearman rank correlation was applied to analyze the correlation between the expression of lncRNA BSN-AS2 and hsa-miR-4782-3p in serum,meantime,the relationship between the two and clinicopathological characteristics was analyzed;receiver operating characteristic (ROC) curve was applied to analyze the diagnostic efficacy of serum lncRNA BSN-AS2 and hsa-miR-4782-3p expression levels for liver cancer. Results The results of qRT-PCR showed that the expression level of serum lncRNA BSN-AS2 in the study group (2.02±0.59) was obviously higher than that in the control group (1.05±0.25),the expression level of serum hsa-miR-4782-3p in the study group (0.69±0.15) was obviously lower than that in the control group (1.08±0.29) (P<0.05).The expression levels of serum lncRNA BSN-AS2 and hsa-miR-4782-3p were related to TNM staging, alpha-fetoprotein (AFP) and degree of differentiation (P<0.05).Spearman rank correlation analysis showed that serum lncRNA BSN-AS2 was negatively correlated with the expression of hsa-miR-4782-3p in patients with liver cancer (r=-0.536,P<0.05).The AUC of serum lncRNA BSN-AS2 and hsa-miR-4782-3 alone and in combination for diagnosing liver cancer was 0.890,0.856 and 0.937,respectively,the sensitivity was 87.00%,93.00% and 86.00%,and the specificity was 78.89%,70.00%and 92.22%,respectively;the combination of the two was better than the prediction of lncRNA BSN-AS2 and hsa-miR-4782-3p,respectively (the combination of the two-lncRNA BSN-AS-=2.481,P=0.013the combination of the two-hsa-miR-4782-3P= 3.503,P=0.001).Conclusion The expression level of serum lncRNA BSN-AS2 in patients with liver cancer is obviously increased,and the level of hsa-miR-4782-3p is obviously decreased,both can be used as potential molecular markers for the diagnosis of liver cancer.

Objective To analyze the short-term effects of one anastomosis gastric bypass as revision surgery following sleeve gastrectomy. Methods The patients who underwent one anastomosis gastric bypass as revision surgery after sleeve gastrectomy in the First Affiliated Hospital of Soochow University from January 2018 to November 2021 were included.The body weight,body mass index,percent excess weight loss,percent total weight loss and remission of obesity complications were compared at 1,3,6 and 12 months after revision surgery. Results A total of 15 patients underwent one anastomosis gastric bypass at(36.67 ± 25.79) months after sleeve gastrectomy.The average body weight before revision surgery was(97.05 ± 16.62) kg,and the average body mass index was(35.35 ± 4.88) kg/m2.Four patients(27%) each had diabetes and gastroesophageal reflux disease.Patients with hypertension and hyperlipidemia were 3(20%) each.12 months after revision surgery,the average weight of the patients was(70.76 ± 8.65) kg,and the average body mass index was(25.82 ± 2.46) kg/m2.Except for one diabetic patient,the obesity complications of the other patients were improved or remitted. Conclusion As revision surgery of sleeve gastrectomy,one anastomosis gastric bypass is feasible and effective,which can significantly reduce weight and improve obesity complications

Objective To investigate the factors related to the complications of laparoscopic radical gastrectomy after neoadjuvant chemotherapy and its influence on the prognosis. Methods The clinical data of 102 patients who underwent laparoscopic radical gastrectomy after neoadjuvant chemotherapy from May 2017 to May 2019 were retrospectively analyzed,Clavien Dindo method was used to evaluate the incidence of postoperative complications.Single factor and multi factor logistic regression analysis were used to explore the influencing factors of postoperative complications;Kaplan Meier survival curve was used to observe the 3 year overall survival rate of patients with or without complications. Results Postoperative complications occurred in 23 of 102 patients (22.55%),including 13 cases of Clavien Dindo grade Ⅱ,5 cases of grade Ⅲa and Ⅲb,3 cases of grade Ⅳ and 2 cases of grade Ⅴ.Univariate analysis showed that age,body mass index (BMI),operation time and scope of gastrectomy were related to postoperative complications (P<0.05);Multivariate logistic regression analysis showed that age≥60 (OR=2.395,95%CI=1.270-4.516),BMI≥24kg/m2 (OR=3.487,95%CI=1.037-11.725),operation time≥3.5h (OR=1.781,95%CI=1.064-2.982),and total gastrectomy (OR=1.709,95%CI=1.125-2.596) were independent risk factors for postoperative complications (P<0.05);Kaplan Meier survival curve analysis showed that the 3 year overall survival rate of patients with complications was 43.48%,which was lower than that of patients without complications (Log Rank χ2＝5.532,P＝0.019). Conclusion The occurrence of complications of laparoscopic radical gastrectomy after neoadjuvant chemotherapy is closely related to the patient’s age,BMI,operation time and scope of gastrectomy,and the prognosis of patients with postoperative complications is poor.Clinical attention should be paid to the prevention of postoperative complications.

Objective To analyze the effect of Brown anastomosis and Roux-en-Y anastomosis in laparoscopic distal gastrectomy on the curative effect and gastrointestinal function of patients with gastric cancer.Methods 120 patients with gastric cancer who underwent laparoscopic distal gastrectomy in our hospital from 08-2015 to 05-2017 were divided into group A and group B;The patients in group A were treated with Brown’s anastomosis,and the patients in group B were treated with Roux-en-Y anastomosis;The perioperative clinical related indicators of 2 groups were recorded;Enterococcus,Enterobacteriaceae,Bifidobacterium and Lactobacillus in intestinal flora before and 6 months after operation were analysed quantitatively;The serum CCK level was detected before operation and 6 months after operation;The patients were followed up for more than 5 years to record the 1 year postoperative complications and 5 year survival. Results There was no significant difference between group A and group B in operation time,intraoperative blood loss,postoperative exhaust time,gastric tube removal time,feeding time,drainage tube removal time and postoperative hospital stay (P>0.05); 6 months after operation,Enterococcus and Enterobacteria in group B were lower,while Lactobacillus and Bifidobacteria were higher than those in group A (P<0.05);6 months after operation,the level of CCK in group B was lower than that in group A (P<0.05);The incidence of gastric stump inflammation,gastric stump ulcer,gastric stump canceration,reflux esophagitis and cholecystolithiasis in group B was lower than that in group A (P<0.05);The 5 year survival rate of group B was higher than that of group A (P<0.05). Conclusion Laparoscopic distal gastrectomy Brown anastomosis and Roux-en-Y anastomosis have a higher clinical application effect on gastric cancer patients after intervention,and Roux-en-Y anastomosis has a lower impact on gastrointestinal function of patients,which improves the clinical efficacy of patients.

Objective To study the application effect of combined midline approach and caudal midline approach in laparoscopic right colon cancer D3 radical surgery.Methods From December 2016 to December 2021,98 patients with right colon cancer in general surgery department of Rugao People’s Hospital were randomly divided into two groups with 49 patients in each group.Both groups underwent laparoscopic D3 radical resection of right colon cancer.The control group adopted the midline approach,and the observation group adopted the caudal combined midline approach.The operation indexes (operation time,intraoperative bleeding,number of lymph nodes cleaned) and postoperative recovery indexes (time of first exhaust,time of first defecation,and hospital stay) were compared between the two groups.The levels of tumor markers [carcinoembryonic antigen (CEA),carbohydrate antigen 125 (CA125)] and gastrointestinal hormones [gastrin (GAS),motilin (MTL)] before and 2 weeks after the operation were analyzed,and the postoperative complications were counted. Results Operation time [(131.58±8.96) min], first exhaust time [(2.81±0.42) days] and first defecation time [(3.42±0.55) days] in observation group were shorter than those in control group [(142.15±9.51) min, (3.54±0.48) days, (3.99±0.61) days](P < 0.05).Two weeks after surgery, CEA and CA125 were decreased in both groups, and CEA [(9.25±1.12)ng/ml] and CA125[(28.26±2.57)U/ml] in observation group were lower than those in control group [(15.87±1.56)ng/ml, (35.98±3.13)U/ml](P< 0.05).Two weeks after operation, GAS and MTL were decreased in both groups, but GAS[(105.26±9.15)μmol/L] and MTL[(253.21±14.58)ng/L] in observation group were higher than those in control group [(100.47±8.24)μmol/L, (244.69±13.25)ng/L](P < 0.05).There was no significant difference in the total incidence of complications between the two groups (P>0.05). Conclusion Compared with the midline approach,the caudal combined midline approach can shorten the operation time,promote postoperative recovery,reduce the level of tumor markers,improve gastrointestinal function,and have high safety.

Objectives To investigate the effectiveness of actively select the pull force anastomosis for procedure for prolapse and hemorrhoids (PPH) in treating severe hemorrhoids. Methods We retrospectively analyzed 92 patients with severe hemorrhoids treated by author,between January 2020 and January 2023.The 92 cases were randomly divided into control group and observationgroup,with 46 cases each group.The control group was treated with regular PPH,while the observation group was treated with actively select the pull force anastomosis for PPH.We compared the surgical parameters,clinical effectiveness,postoperative complications in the two groups.Results There was no significant difference in length of hospital stay,intraoperative hemorrhage,postoperative bleeding,postoperative anorectal sensation abnormalities(P＞0.05).The operation time(25.8±6.4)min,intraoperative submucosal hematoma 2.17%,the width and integrity of rectal mucosa (3.4±0.46) cm,the retraction of hemorrhoids with grade Ⅲ and grade Ⅳ(96.77%、88.67%) in the observation group were better than control group(P<0.05).The pain scores of the observation group at 24h,48h,7 day was significantly lower than that of the control group(P<0.05). Conclusion Actively select the pull force anastomosis for PPH has favorable effectiveness for severe hemorrhoids.The effect of anal cushion lifting was satisfactory,the retraction rate of hemorrhoids was high,the occurrence of submucosal hematomas was small,and the postoperative pain was light.

Objective To summarize the clinical characteristics of patients with Petersen’s hernia after gastrectomy and gastrointestinal reconstruction for gastric cancer,to explore the diagnosis and treatment methods of Petersen’s hernia. Methods Eleven patients diagnosed with Petersen’s hernia admitted to our hospital from January 2019 to December 2021 were collected,and all patients underwent emergency surgery.The clinical manifestations,imaging features,perioperative conditions and post-treatment follow-up of these patients were analyzed and summarized. Results Seven of the 11 patients underwent small bowel reduction and blood supply was restored without bowel resection.One case was confirmed with small bowel necrosis and underwent partial small bowel resection with a length of 80cm.All 8 cases were sutured to close the Petersen space again.The patient was discharged smoothly after the operation,and no acute gastrointestinal symptoms or acute abdomen have occurred during the follow-up so far.Intraoperative exploration confirmed extensive necrosis of the small intestine in 3 cases,of which 1 case underwent subtotal small bowel resection,and the other 2 cases gave up further surgery.All three patients died within 24 hours after surgery. Conclusion Petersen’s hernia after gastric cancer surgery has acute onset,rapid progress and poor prognosis.When patients with acute abdomen are suspected of having the disease,enhanced abdominal CT and early laparotomy should be performed as soon as possible to avoid the occurrence of intestinal necrosis.

Objective To compare the clinical effect of percutaneous minimally invasive surgery with open surgery for lumbar fracture.Methods A total of 62 patients with thoracolumbar fracture who received surgical intervention in our hospital from April 2018 to April 2022 were selected and divided into percutaneous minimally invasive approach group and traditional open group according to random number table method,with 31 cases in each group.Patients in the traditional open group were treated with open surgery,that is,traditional open internal fixation,and patients in the percutaneous minimally invasive approach group were treated with minimally invasive percutaneous approach.Surgical indexes such as operation time,incision length,intraoperative blood loss,length of hospital stay and so on were compared between the two groups.Visual Analog Scale (VAS) scores of the two groups were observed 1,3 and 7 days after surgery.Changes in ESR and D-dimer factor indexes before and after surgery were compared between the two groups.The vertebral space height,kyphotic Cobb Angle imaging indicators before and after surgery were compared between the two groups,and the total incidence of postoperative complications was compared between the two groups.Results The surgical time, incision length,intraoperative bleeding volume,and hospital stays of the minimally invasive percutaneous approach group were (65.25±13.76) minutes, (8.31±1.44) cm, (91.37±11.09) ml and (8.59±1.35)d,respectively,which were significantly lower than those of the traditional open group [(110.37±20.43) minutes, (13.17±2.02) cm, (475.38±18.36) ml, and (11.93±2.91) d] (all P<0.05).The postoperative VAS scores of both groups of patients gradually decreased with time (P<0.05), but the VAS scores of the percutaneous minimally invasive approach group on the 1st day (7.12±1.13), 3rd day (3.27±0.75), and 7th day (2.47±0.78) after surgery were significantly lower than those of the traditional open group (8.36±1.64, 5.48±1.27, 4.26±1.36) (all P<0.05).Three days after surgery, two groups of serum factors including erythrocyte sedimentation rate (ESR), and D-dimer (D-D) levels were significantly higher than before surgery, but the levels of various indicators in the minimally invasive percutaneous approach group were significantly lower than those in the traditional open group (all P<0.05).Seven days after surgery, the height of the intervertebral space (92.66±5.72 vs 83.17±5.04) and the kyphotic Cobb angle (7.37±2.85 vs 9.72±3.18) in the minimally invasive percutaneous approach group were significantly higher than those in the traditional open group (all P<0.05).The total incidence of complications in the minimally invasive percutaneous approach group was significantly lower than that in the traditional open group (6.45% vs 35.48%)  (P<0.05). Conclusion For lumbar patients,the application of minimally invasive percutaneous approach has positive effects on promoting rapid postoperative recovery,reducing pain and reducing the risk of postoperative complications.

Objective To explore the short-term and long-term value of hemiarthroplasty and internal fixation in elderly patients with Garden Ⅰ ~ Ⅱ femoral neck fracture. Methods The general data of 102 elderly patients with femoral neck fracture diagnosed and treated by Haikou People’s Hospital from January 2019 to June 2020 were analyzed retrospectively.They were divided into control group (51 cases) and observation group (51 cases) according to different surgical treatment methods.The control group was treated with hemiarthroplasty,and the observation group was treated with internal fixation.The operation related indexes,hip joint function,muscle injury around the hip,bone metabolic indicators and occurrence of complications. Results The operation time and hospitalization time in the observation group were significantly shorter than those in the control group ,and the intraoperative blood loss  was significantly less than those in the control group.The score of Harris Hip Rating Scale (HHS)  in the observation group was significantly lower than that in the control group  3 and 6 months after operation;The HHS scores  of the two groups had no significant difference 1 and 2 years after operation.Three days after operation,creatine kinase (CK),C-reactive protein (CRP),interleukin-6 (IL-6)  in the observation group were significantly lower than those in the control group at the same time (P＜0.05).Three months after operation,serum osteocalcin (BGP),bone alkaline phosphatase (ALP) and bone morphogenetic protein 2 (BMP-2)  in the observation group were significantly lower than those in the control group（P＜0.05）.One year after operation,there was no significant difference between the two groups in BGP,ALP,BMP-2 .There was no significant difference between the two groups in the incidence of postoperative complications (9.80% vs 15.69%) （P＞0.05）.Conclusion The long-term effect of internal fixation for elderly Garden Ⅰ~Ⅱ femoral neck fracture patients is equivalent to that of hemiarthroplasty,and the former has more advantages in terms of operation time,trauma,etc.

Objective To explore the role of motivational interviewing (MI) in preventing lower limb vein thrombosis after total hip arthroplasty. Methods Selected 50 patients with total hip arthroplasty in our hospital from March 2022 to June 2022,and randomly divided into the control group(23 cases) and intervention group(27 caes).Routine thromboprophylaxis in the control group were performed.On the basis of this,in the intervention group,Four times of motivational interviewing were carried out before surgery,at 3 days after surgery,at 2 weeks after surgery,and at 4 weeks after surgery.The incidence of lower limb intravenous embolism of the two groups,nursing satisfaction and quality of life were evaluated. Result No lower limb deep venous thrombosis (DVT) was observed in both two groups,but the cumulative incidence rate of lower limb intramuscular venous thrombosis (MCVT) at 2nd and 4th week of the intervention group was significantly lower than that of the control group (P<0.05 ).There was no significant difference in the scores of the two groups of satisfaction;the quality of life scores of psychological,social,physiological,environment,independence,and beliefs at 4 weeks after surgery in intervention group are higher than that of the control group (P<0.05).Groups were significantly improved compared to preoperative  Harris scores (P<0.05), and the postoperative Harris scores of the intervention group were higher than those of the control group (P<0.05). Conclusion Motivational interviewing can effectively prevent the incidence of lower limb vein thrombosis after total hip arthroplasty,promote postoperative function rehabilitation,and improve the patients’ quality of life.

Objective To observe the effect of modified transabdominal total laparoscopic surgery in patients with upper tract urothelial carcinoma (UTUC).〖WTHZ〗Methods〓〖WTBZ〗84 patients with UTUC were divided into improved group (n=43) and conventional group (n=41) according to different surgical methods.The modified group underwent modified transabdominal total laparoscopic surgery (modified single position transabdominal total laparoscopic nephroureterectomy + bladder sleeve resection).In the conventional group,laparoscopic nephrectomy was performed by retroperitoneal approach in the lateral decubitus position,and then ureterectomy + bladder sleeve resection was performed by oblique incision in the lower abdomen in the supine position.The perioperative condition,visual analogue scale (VAS) score at each time point after operation,postoperative complications and trauma response index before and after operation were compared between the two groups;The tumor recurrence and metastasis rate of the two groups at 1 year after operation were counted.Results The operations of 84 patients were successfully completed.The intraoperative blood loss and postoperative drainage in the modified group were (118.29±36.41) mL and (127.36±24.75) mL,respectively,which were lower than those in the conventional group (142.54±30.68) mL and (251.49±39.50) mL.The operation time,postoperative first exhaust time and hospitalization time were (107.35±15.62) min,(22.19±3.74) h and (7.32±0.58) d respectively,which were shorter than (139.57±21.09) min,(29.25±5.06) h and (9.68±0.62) d in the conventional group (P<0.05);The VAS scores of the modified group at 6 h,12 h,24 h and 48 h after operation were lower than those of the conventional group (P<0.05);The levels of serum IL-6 and CRP in the modified group at 12 h and 24 h after operation were (9.17±1.86) ng / L,(6.74±1.35) ng / L,(10.37±1.95) mg / L and (7.26±1.34) mg / L respectively,which were lower than those in the conventional group (14.20±3.04) ng / L,(9.36±2.17) ng / L,(15.46±2.69) mg / L and (10.72±1.82) mg / L (P<0.05);There was no difference in the incidence of postoperative complications between the modified group (9.30 %) and the conventional group (24.39 %) (P>0.05);There was no difference in the rate of tumor recurrence and metastasis between the two groups 1 year after operation(P>0.05). Conclusion Modified transabdominal total laparoscopic surgery for UTUC has the advantages of less bleeding,convenient operation,rapid postoperative recovery,less pain and less trauma.It has good application effect and high safety.