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BACKGROUND: Minimally invasive surgery is developing rapidly. Robot-assisted minimally invasive transforaminal lumbar interbody fusion and robot-assisted unilateral biportal endoscopic transforaminal/posterior lumbar interbody fusion are important posterior minimally invasive surgical approaches to treat lumbar degenerative diseases. However, it is worth discussing which operation method is more advantageous. OBJECTIVE: To compare the clinical efficacy and imaging examination between different operation groups, and discuss the clinical application value of robotassisted minimally invasive lumbar posterior fusion technology to treat lumbar degenerative diseases. METHODS: Clinical data of 83 patients with lumbar degenerative diseases from January 2018 to June 2022 at the Department of Orthopedics, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital were retrospectively analyzed. Of them, 27 patients received robot-assisted minimally invasive transforaminal lumbar interbody fusion treatment (group A); 30 patients received robot-assisted unilateral biportal endoscopic transforaminal/ posterior lumbar interbody fusion treatment (group B), and 26 traditional minimally invasive transforaminal lumbar interbody fusion patients were selected as the control group (group C). There were no significant differences in gender, age, body mass index, surgical segment, preoperative visual analog scale score and Oswestry Disability Index among the three groups (P > 0.05). The operation time, intraoperative blood loss, complications, fluoroscopic dose, fluoroscopic time, and fluoroscopic frequency were compared among the three groups. Gertzbein-Robbins’ classification was used to evaluate the accuracy of percutaneous pedicle screw. Visual analog scale and Oswestry Disability Index scores were evaluated after surgery. The excellent and good rate of the three surgical options was evaluated using Macnab’s criteria. RESULTS AND CONCLUSION: (1) The operation time of group A was significantly shorter than that of groups B and C (P < 0.05), but there was no significant difference between group B and group C (P > 0.05). The intraoperative blood loss in group B was significantly less than that in group A, and that in group A was significantly less than that in group C (P < 0.05). (2) The fluoroscopic dose, fluoroscopic time, and fluoroscopic frequency of group C were significantly higher than those of groups A and B (P < 0.05). (3) Visual analog scale score and Oswestry Disability Index in the three groups significantly improved after operation when compared with that before operation (P < 0.05), but there was no significant difference among the three groups 1 day and 6 months after surgery (P > 0.05). (4) Postoperative imaging showed that the accuracy of percutaneous pedicle screw placement in groups A and B was better than that in group C (P < 0.05). (5) There was no significant difference in the excellent and good rate of MacNab criteria among the three groups (P > 0.05). (6) There was no significant difference in complications among the three groups (P > 0.05). (7) The results indicated that robot-assisted minimally invasive transforaminal lumbar interbody fusion and robot-assisted unilateral biportal endoscopic transforaminal/posterior lumbar interbody fusion are effective surgery methods for lumbar degenerative diseases. Compared with traditional minimally invasive transforaminal lumbar interbody fusion, robot-assisted minimally invasive transforaminal lumbar interbody fusion surgery has higher efficiency, less intraoperative radiation and higher internal fixation accuracy, which has a good clinical application value. [ABSTRACT FROM AUTHOR]

Objectives The research aimed to determine the effects of different surgical procedures on postsurgical pain and early prognosis. We reviewed the perioperative data of patients who underwent single/two-port television-assisted thoracoscopic pulmonary nodule surgery in the day surgery ward of Nanjing Drum Tower Hospital. Methods The clinical and follow-up data of 693 patients undergoing thoracoscopic for pulmonary nodules in the day surgery ward under the centralized management model of our hospital were retrospectively analyzed during the period of January 2021 to December 2022. The patients were divided into a single-port and a two-port thoracoscopy group. The propensity-matching was used to balance the baseline data and analyze the differences in postoperative pain and prognosis of the patientsin the two groups. Results After propensity score matching, the single-port group had lower intraoperative fentanyl consumption [0.5 (0.35, 0.50) mg vs. 0.5 (0.40, 0.50) mg, P = 0.034], remifentanil consumption [0.48 (0.33, 0.63) mg vs. 0.53 (0.35, 0.73) mg, P = 0.031], intraoperative hemorrhage [20 (10, 50) mL vs. 50 (20, 50) mL, P = 0.001], and Visual Analogue Scale on postoperative third day [2 (2, 4) point vs. 3 (2, 4) point, P = 0.007], which were statistically different. There were no statistically significant differences between the two groups in terms of postoperative rescue analgesia, chest drainage volume, length of hospitalization, pain on postoperative 1st, 5th, 9th, and 30th days, postoperative cough, pulmonary complications within 30 days after surgery, and unplanned hospital visits. Conclusion Compared with two-port thoracoscopy, single-port thoracoscopic day surgery for pulmonary nodules is a safe and feasible procedure that can significantly reduce the use of intraoperative opioid analgesics and the pain level of patients on postoperative 3rd day. [ABSTRACT FROM AUTHOR]

Objective To explore the effect of protective ventilation strategies based on individualized positive end expiratory pressure (PEEP) regulated by driving pressure (Pd) in infants under OLV. Methods Sixty infants undergoing elective thoracoscopic surgery were randomly divided into the control group and driving pressure group, with 30 cases in each group. The two groups were compared in terms of MAP, HR, tidal volume (Vt), PEEP, Pd, airway peak pressure (Pk), and static lung compliance (Cs), and arterial blood gas during OLV before the artificial pneumothorax (T0), 10 min (T,), 30 min (T2), and 60 min (T3) after the artificial pneumothorax, and right at the end of the artificial pneumothorax (T4). Results There were no significant differences in MAP, HR, and Vt between the two groups at all the time points (P > 0.05). Both groups showed the increase in Pd and Pk and decresase in Cs at T,, T2, and T3 (all P < 0.05). PaO2 and OI in both group were decreased and PaCO2 was increased at T2 (all P < 0.05). Compared with the control group, the driving pressure group presented lower Pd and Pk, higher PEEP and Cs at T,, T2, and T3 (P < 0.05), and higher PaO2 and OI (P < 0.05) and no significant differences in PaCO2 and FiO2 at T2 (P < 0.05). The rate of rescue ventilation during OLV was lower in the driving pressure group (2 cases) than in the control group (9 cases) (6.9% versus 32.4%, P < 0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P < 0.05). Conclusion The individualized positive end expiratory pressure (PEEP) regulated by Pd can optimize the PEEP settings upon infant individuals under OLV and improve the compliance and oxygenation of ventilated lung. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical efficacy of preoperative precise rehabilitation on endoscopic spinal decompression （Endo-LOVE） for lumbar spinal stenosis （LSS）. Methods A retrospective study was con⁃ ducted among 52 patients with Endo-LOVE from January 2020 to April 2022. The patients were equally divided into observation group and control group, treated with precision rehabilitation and traditional rehabilitation accord⁃ ing to the different rehabilitation patterns, respectively. The two groups were compared in terms of the score by Visual Analogue Scale （VAS）, Oswestry Disability Index （ODI） and JOA scores as well as the ratio of left and right supporting phases in gait parameters before the operation, 7 days and 3 months after the operation. Results There were no serious surgical complications in all patients. The VAS and ODI scores 7 days and 3 months after the operation were significantly lower （P < 0.05） and the JOA score and the ratio of left and right supporting phases were significantly higher than before the operation（P < 0.05）. The indexes of the observation group were statisti⁃ cally significantly different with those of the control group 7 days and 3 months after the operation （P < 0.05）. Conclusion Preoperative precise rehabilitation in Endo-LOVE for LSS can relieve postoperative residual pain, improve walking function, reduce the degree of lumbar dysfunction, improve the ability of daily living, and shorten the rehabilitation period. It is of value for clinical application. [ABSTRACT FROM AUTHOR]

Objective: A prospective study of the effect of intraoperative intercostal nerve block (IINB) on body stress response, hemodynamics and quality of life in patients with rib fracture (RF). Methods: 70 RF patients who underwent thoracoscopic surgery in the First Affiliated Hospital of Chengdu Medical College from January 2017 to December 2021 were selected and divided into IINB group (n=35) and control group (n=35) according to the random number table. The control group was given intravenous and inhalation combined general anesthesia, and the IINB group was given IINB on the basis of the control group. The hemodynamic indexes such as mean arterial pressure (MAP) and heart rate (HR) before operation (T0), 5 min (T1), 15 min (T2), 30 min (T3) and at the end of operation (T4); Postoperative recovery; Pain at 6 h, 12 h, 24 h and 48 h after operation and pain relief rate; Quality of life at 1 d, 3 d and 7 d after operation; Postoperative complications and other indicators were observed. Results: MAP and HR of IINB group were lower than those of control group at all time points (P<0.05). The feeding recovery time, first time to get out of bed, time of indwelling chest tube and the postoperative hospitalization time in IINB group were shorter than those in the control group(P<0.05). The VAS score of IINB group was lower than that of control group at 6 h, 12 h, 24 h and 48 h after operation (P<0.05); The pain relief rate of IINB group was 20.00% (7/35) lower than that of control group (42.86% (15/35) (P<0.05). The quality of life scores in IINB group were higher than those in the control group on the 1 d, 3 d and 7 d after operation(P<0.05). The incidence of complications in IINB group was 2.86%(1/35) lower than that 22.86%(8/35) in control group(P<0.05). Conclusion: IINB can effectively relieve the pain and body stress response of RF patients, maintain the stability of hemodynamics during operation, effectively relieve postoperative pain,promote postoperative recovery, improve their quality of life and reduce postoperative complications. [ABSTRACT FROM AUTHOR]

Objective: To investiga te the therapeutic effect of prednisolone on chronic sinusitis and its influence on olfactory function and nasal mucosa morphology in patients with chronic sinusitis. Methods: 80 patients with chronic sinusitis admitted to our hospital from January 2019 to December 2022 were selected as the research objects. All patients were randomly divided into observation group and control group with 40 patients in each group. The patients in the control group were treated with simple endoscopic surgery, while the patients in the observation group were treated with medloratadine before surgery for one month and then underwent endoscopic surgery. The clinical treatment effects, levels of inflammatory factors before and after treatment, quantitative score of endoscopic nasal mucosa morphology, olfactory function and saccharin test time of the two groups were compared. Results: There was no difference in the total effective rate between the two groups (P>0.05); After treatment, IL-6, IL-1 and TNFα were found in the two groups The levels of inflammatory factors in the observation group were lower than those in the control group (P<0.05); Before treatment, there was no difference between the two groups in the quantitative score of endoscopic nasal mucosa morphology (P>0.05) for patients with rhinorrhea, scab, scar, mucosal edema, polyp, purulent secretion, etc. After treatment, the quantitative score of endoscopic nasal mucosa morphology in patients with rhinorrhea, scab, scar, mucosal edema, polyp, purulent secretion, etc. decreased in the two groups, and the observation group was different with control group (P<0.05); There was no difference in the olfactory recognition threshold and saccharin test time between the two groups before treatment (P>0.05). After treatment, the olfactory recognition threshold and saccharin test time of the two groups decreased, and the observation group were different with control group (P<0.05). Conclusion: Lydesloratadine before endoscopic sinus surgery has a significant clinical effect on chronic sinusitis, and can reduce the level of inflammatory factors in patients after surgery, improve the morphology of nasal mucosa, enhance ciliary motor function and olfactory function, which is worthy of clinical application and promotion. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of cold snare polypectomy (CSP) on serum pain factor, stress response, vascular endothelial growth factor (VEGF), thromboxane B2 (TXB2) levels in patients with colorectal polyps ≤1.0 cm in diameter. Methods: 97patients with colorectal polyps ≤1.0 cm in diameter undergoing endoscopic resection who were admitted to the The First Affiliated Hospital of Hunan Normal University from March 2021 to March 2022 were select, and the patients were divided into group A [hot snare polypectomy (HSP), 48 cases] and Group B (CSP, 49 cases) by random number table. The clinical indexes, complication rate, serum pain factor indexes [prostaglandin E2 (PGE2), Substance P (SP)], stress response indexes [epinephrine (E), cortisol (Cor), norepinephrine (NE)],VEGF and TXB2 levels were compared in the two groups. Results: The operation time in the group B was shorter than that in the group A, and the hospitalization cost was less than that in the group A (P＜0.05). The PGE2and SP levels in the group B were lower than those in the group A at 1 d after operation (P＜0.05). The E, Cor and NE levels in the group B were lower than those in the group A at 1 d after operation (P＜0.05). The VEGF and TXB2 levels in the group B were lower than those in the group A at 1 d after operation (P＜0.05).There was no difference in the incidence rate of complications in the two groups (P＞0.05). Conclusion: In the treatment of patients with colorectal polyps ≤1.0 cm in diameter, the complete polypectomy rate and number of polyps removed are equivalent, but CSP can significantly shorten the operation time, reduce hospitalization cost, reduce stress response, and reduce serum pain factor, VEGF and TXB2levels. [ABSTRACT FROM AUTHOR]

Objective: To investigate the efficacy of endoscopic mucosal resection in the treatment of gastric polyps and its effect on the levels of serum gastrin releasing peptide precursor (ProGRP) and pepsinogen I (PGI). Methods: 120 patients with gastric polyps admitted in our hospital from August 2019 to August 2022 were selected as the research objects, and were divided into groups according to different surgical methods. Among them, 60 patients who were treated with conventional endoscopic electrocoagulation were divided into the control group, and 60 patients who were treated with endoscopic mucosal resection were divided into the observation group. The occurrence of adverse effects and treatment costs between the two groups, serum ProGRP, PGI expression levels and inflammatory factors expression levels before and after surgery, and the overall resection rate and complications in the two groups were compared. Results: There was no difference in the total treatment costs between the two groups (P > 0.05) . The incidence of postoperative adverse effects in the observation group was lower than that in the control group (P < 0.05) ; There was no difference in serum ProGRP and PGI levels between the two groups before operation (P > 0.05) After treatment, the ProGRP and PGI levels of the two groups decreased, and the observation group was lower than the matched group (P < 0.05) ; There was no difference in PCT, CRP, IL-6 and IL-2 between the two groups before operation (P > 0.05) After operation, PCT, CRP, IL-6 and IL-2 of the two groups increased, and the observation group was lower than the matched group (P < 0.05) ; The gastric polyps were completely removed in both groups, and the overall resection rate was not different, and the incidence of perforation, delayed bleeding and infection was lower than that of the control group, but the difference was not significant (P > 0.05) Conclusion: Both endoscopic mucosal resection and conventional endoscopic electrocoagulation can completely remove gastric polyps in patients with gastric polyps, and the treatment cost is equivalent. The application of endoscopic mucosal resection can reduce the levels of ProGRP and PGI in patients, reduce the inflammatory reaction of the body, and have a low incidence of complications, which is worthy of clinical application and promotion [ABSTRACT FROM AUTHOR]

In recent years, with persistent development of endoscopic technology, the detection rate of superficial nonampullary duodenal epithelial tumors (SNADETs) has been gradually increased. SNADETs which are identified during early stage rarely metastasize distantly. Consequently, early diagnosis and treatment of SNADETs are of significance. In this article, literature review was conducted at home and abroad, endoscopic resection technologies for SNADETs were analyzed and summarized, aiming to improve endoscopic minimally invasive treatment for SNADETs, enhance clinical efficacy and safety, elevate the quality of life and provide ideas and reference for subsequent in-depth research. [ABSTRACT FROM AUTHOR]

To analyze the risk factors for pulmonary infection after thoracoscopy surgery for lung cancer and to investigate the predictive value of preoperative C-reactive protein/albumin ratio (CRP/Alb), procalcitonin (PCT) and serum amyloid A (SAA) on the risk of infection. 360 patients with lung cancer who were treated by thoracoscopy surgery in the Affiliated Hospital of Xuzhou Medical University from March 2019 to October 2021 were selected, and they were divided into the pulmonary infection group with 57 cases and the non-pulmonary infection group with 303 cases according to whether pulmonary infection occurred 72 h after thoracoscopy surgery. Clinical data were collected from patients, and serum CRP/Alb, PCT and SAA levels of patients were detected 1 day before operation. Univariate and multivariate Logistic regression were used to analyze the risk factors of pulmonary infection after thoracoscopic surgery for lung cancer. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of preoperative serum CRP/Alb, PCT and SAA levels for pulmonary infection after thoracoscopic surgery for lung cancer. Univariate analysis showed that the proportion of age逸60 years, smoking history, diabetes mellitus, operation time≥ 3h, intraoperative blood loss逸200 mL, mechanical ventilation time逸12 h, thoracic drainage time逸5 d, and serum CRP/Alb, PCT and SAA levels in the pulmonary infection group were higher than those in the non-pulmonary infection group (P<0.05). Multivariate Logistic regression analysis showed that age逸 60 years, smoking history, diabetes mellitus, operation time逸3 h, mechanical ventilation time逸12 h, thoracic drainage time逸5 d and elevated serum CRP/Alb, PCT and SAA were independent risk factors for pulmonary infection after thoracoscopy surgery for lung cancer (P<0.05). ROC curve analysis showed that the area under curve of preoperative serum CRP/Alb, PCT and SAA combined in predicting pulmonary infection after thoracoscopy surgery for lung cancer was greater than that of each index alone. Age, smoking history, diabetes mellitus, operation time, mechanical ventilation time, thoracic drainage time and elevated CRP/Alb, PCT and SAA are risk factors for pulmonary infection after thoracoscopy surgery for lung cancer. The combined preoperative serum CRP/Alb, PCT and SAA have a high value in predicting pulmonary infection after thoracoscopy surgery for lung cancer. [ABSTRACT FROM AUTHOR]

Objective To evaluate the efficacy and safety of modified endoscopic retrograde appendicitis therapy (mERAT) for acute uncomplicated appendicitis in children. Methods From October 2018 to May 2021, clinical data were retrospectively reviewed for 228 hospitalized children of acute uncomplicated appendicitis. They were followed up by telephone and outpatient and inpatient electronic information systems in June 2022.The follow-up time was 19(15, 22) months. Clinical profiles, treatment success rate, recurrence within 1 year of cured and discharged children, operative duration, total hospitalization time, hospitalization time after mERAT, hospitalization expense, success rate of intubation, stent implantation rate, stent self-shedding rate, postoperative stent removal time, number of fecal stones, parasites and food seeds detected in appendix cavity and incidence of adverse events during hospitalization were summarized. Results There were 127 boys and 101 girls. Success rate of intubation was 96.9%(221/228), success rate of treatment 96.9%(221/228) and operative duration 40.0(36.0-45.0) min. Rate of stent placement was 83.3%(184/221) and rate of stent shedding 48.4%(89/184).Total hospitalization time was 3(3, 4) day, hospitalization time after mERAT 2(1, 3) day and total hospitalization expense 12787.0(11770.1, 13585.5) yuan. Seventeen cases were lost to follow-ups and recurrence rate within 1 year was 6.9%(14/204).And the incidence of adverse events during hospitalization was 3.5%(8/228). Conclusion mERAT is both safe and effective for acute uncomplicated appendicitis in children. [ABSTRACT FROM AUTHOR]

Objective: To investigate the risk factors of olfactory dysfunction in patients with chronic sinusitis and its effect on mental health and quality of life of patients. Methods: 120 patients with chronic sinusitis who were admitted to Beijing Tongren Hospital Affiliated to Capital Medical University from September 2017 to September 2020 were selected for olfactory function test. The incidence of olfactory dysfunction was analyzed, and patients were divided into olfactory dysfunction group (n=64) and olfactory normal group (n=56) according to the olfactory function test. The basic data, clinical data, mental health status and quality of life of patients in the two groups were compared and analyzed. The influencing factors of olfactory dysfunction in patients with chronic sinusitis were analyzed by univariate analysis, and risk factors of olfactory dysfunction in patients with chronic sinusitis were analyzed by multivariate Logistic regression. Results: According to the olfactory function test results, 64 of the 120 patients showed olfactory dysfunction, and the prevalence rate of olfactory dysfunction was 53.33%, included 36 cases (56.25%) of male patients, and 28 cases (43.75%) of female patients. 46 cases (38.33%) had hypoolfactory, and 18 cases (15.00%) had anosmia. Univariate analysis showed that nasal endoscopic surgery history, concomitant nasal polyp, asthma history, proportion of eosinophils and nasal endoscopic Lund-Kennedy score were the influential factors for the occurrence of anosmia in chronic sinusitis (all P<0.05). Multivariate Logistic regression analysis showed that nasal endoscopic surgery history, concomitant nasal polyp, asthma history, proportion of eosinophil ＞5%, and nasal endoscopic Lund-Kennedy score ≥2 scores were independent risk factors for olfaction of chronic sinusitis. The scores of anxiety self-rating Scale (SAS) and depression self-rating Scale (SDS) in the olfactory normal group were lower than those in the olfactory dysfunction group (P<0.05). The score of quality of life (SF-36) for each dimension in the olfactory normal group was higher than that in the olfactory dysfunction group (P<0.05). Conclusion: The incidence of anosmia is higher in patients with chronic sinusitis, and the risk factors for anosmia are nasal endoscopic surgery history, concomitant nasal polyp, asthma history, proportion of eosinophilia ＞5% and Lund-Kennedy score ≥2 scores. At the same time, olfactory disorder can also cause depression and anxiety and other adverse emotions, reducing the quality of life of patients. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To probe into the clinical efficacy of Xiangju capsules combined with budesonide in the treatment of chronic sinusitis complicated with nasal polyps (CRSwNP) after functional endoscopic sinus surgery (FESS) and its effects on serum interleukin 2 (IL-2), IL-6 and C-reactive protein levels. METHODS: Totally 90 patients with CRSwNP undergoing FESS admitted into the Second Affiliated Hospital of Hebei University of Chinese Medicine from Mar. 2019 to Mar. 2020 were selected and divided into the control group and observation group via the random number table method, with 45 cases in each group. The control group was given budesonide nasal spray after FESS, the observation group was treated with Xiangju capsules orally based on the observation group. The efficacy and safety were compared between two groups after 12 weeks of treatment; changes of subjective symptom visual analog (VAS) scores, nasal endoscopic Lund-Kennedy scores and serum IL-2, IL-6 and CRP levels in the two groups were observed and analyzed before and after surgery; the recurrence rates of the two groups were compared at 1 year after surgery. RESULTS: The total effective rate of observation group was 95. 6% (43/45), which was significantly higher than that of the control group (82. 2%, 37/45), with statistically significant difference (P<0. 05). The subjective symptom VAS scores and nasal endoscopic Lund-Kennedy scores of both groups at 4, 8 and 12 weeks after surgery were significantly lower than those before surgery, and the decrease was more significant in the observation group, with statistically significant differences (P <0. 05). At 3 d after surgery, the serum IL-2, IL-6 and CRP levels of both groups were significantly higher than those before surgery (P <0. 05); compared with 3 d after surgery, the serum IL-2, IL-6 and CRP levels of both groups were significantly lower at 7 and 15 d after surgery (P<0. 05); the serum IL-2, IL-6 and CRP levels were significantly lower in the observation group at 3, 7 and 15 d after surgery than in the control group at the same time (P<0. 05), all with statistically significant differences. No drug-related adverse events occurred in both groups. At 1 year after surgery, the recurrence rate of the observation group was significantly lower than that of the control group [8. 9% (4/45) vs. 26. 7% (12/45)], with statistically significant difference (P < 0. 05). CONCLUSIONS: The efficacy of Xiangju capsules combined with budesonide in the treatment of CRSwNP after FESS is definite, which can reduce the recurrence rate, and its mechanism may be related to the significant down-regulation of expression levels of serum IL-2, IL-6 and CRP. [ABSTRACT FROM AUTHOR]

Objective: To compare the clinical efficacy of microscope or neuroendoscope transsphenoidal approach surgery for patients with pituitary adenomas, and to analyze the risk factors of cerebrospinal fluid leakage during operation. The clinical data of 178 patients with pituitary adenomas who underwent surgery in our hospital from March 2018 to February 2022 were retrospectively selected. 178 patients were divided into group A (microscope, n=91) and group B (neuroendoscope, n=87) according to different surgical instruments. The effective tumor resection rate, clinical indicators, the incidence of cerebrospinal fluid leakage during operation and the incidence of postoperative complications were compared between the two groups. According to whether cerebrospinal fluid leakage occurred during operation, it was divided into cerebrospinal fluid leakage group and no cerebrospinal fluid leakage group. The risk factors of cerebrospinal fluid leakage during operation were analyzed by univariate and multivariate Logistic regression. The operation time and hospital stay of the group B were shorter than those of the group A, and the amount of intraoperative bleeding was less than that of the group A (P<0.05). There was no significant difference in the effective tumor resection rate between group A and group B (P>0.05). The incidence of cerebrospinal fluid leakage during operation and postoperative complications of the group B were lower than those of the group A (P<0.05). Cerebrospinal fluid leakage during operation in patients with pituitary adenoma was related to reoperation, tumor size, age, tumor texture, American Association of anesthesiologists (ASA) grade (P<0.05). The tumor size was huge adenoma, reoperation, and the tumor texture was tough were the risk factors for cerebrospinal fluid leakage during operation in patients with pituitary adenoma (P<0.05). Microscopeand neuroendoscope transsphenoidal surgery for pituitary adenomas has the same therapeutic effect, but neuroendoscope surgery can shorten the operation time, hospital stay, reduce the amount of intraoperative bleeding, reduce the incidence of cerebrospinal fluid leakage during operation and postoperative complications. In addition, the tumor size is huge adenoma, reoperation, and the tumor texture is tough are the risk factors of cerebrospinal fluid leakage during operation in patients with pituitary adenoma. [ABSTRACT FROM AUTHOR]

Objective　To investigate the application of pneumoperitoneum transvaginal natural orifice endoscopic surgery in ectopic pregnancy and the related factors affecting the operation time in the initial stage. Methods　A total of 23 patients who were admitted to Kunming First People’s Hospital from July 2020 to November 2021， with stable vital signs， indicating for ectopic pregnancy surgery， and estimated internal bleeding < 800 mL， were selected as the study subjects. v-NOTES pregnancy tubal resection without air was performed. Another 23 patients who underwent peritoneal porous peritoneoscope tubal resection were selected as the control group. Results　23 patients in observation group were successfully resected without complications such as infection and rectal injury. The operation time of observation group was significantly longer than that of control group （P < 0.001）. There was no significant difference in postoperative exhaust time and hospital stay between the observation group and the control group （P > 0.05）. The NRS score and the first time out of bed after operation in the observation group were lower than those in the control group， and the differences were statistically significant （ P < 0.05） . Further analysis of the operation time of pregnancy tubal resection under v-NOTES showed that the operation time under the laparoscope was significantly longer than the time of establishing the approach and suturing the vaginal mucosa， and the difference was statistically significant （ P < 0.001）， and the time of laparoscopic operation gradually shortened with the increase of the number of cases undergoing surgery. The time to establish the approach and suture the vaginal mucosa was different according to the previous delivery mode，and those with a history of vaginal delivery had the shortest time，（P > 0.05）and the difference was not statistically significant. Conclusion　v- NOTES salpingectomy is safe and effective for the surgical treatment of ectopic pregnancy. Patients with stable vital signs，less pelvic effusion，and no severe pelvic adhesions should be selected for surgery. Pneumoperitoneum v- NOTES reduces the difficulty of surgery by avoiding the risk of pneumoperitoneum， and is beneficial to intraoperative anesthesia management. It increases the safety of surgery by avoiding the use of disposable port， which does not increase the economic burden of patients，and is suitable for primary hospitals. The initial operation time was correlated with the patient’s previous delivery history，the volume of pelvic effusion，and the number of surgical cases. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical value and safety of enhanced recovery after surgery ( ERAS) plus colonoscopy for colorectal polypi in children. Methods Clinical data were retrospectively reviewed for 200 children undergoing endoscopic resection of colorectal polypi. They were randomized into two groups of ERAS plus colonoscopic polypectomy ( n = 100 ) and conventional perioperative management plus colonoscopic polypectomy ( n = 100) . Perioperative treatment, clinical symptoms, surgical parameters, biochemical indices and postoperative adverse reactions were recorded. Results Operative duration of ERAS and control groups was [ ( 27. 77 ± 8. 76) vs. ( 33. 88 ± 6. 58) min], postoperative defecation time [ ( 1. 50 ± 0. 50) vs. ( 3. 50 ± 1. 00) days] and hospitalization duration [ ( 3. 00 ± 1. 00) vs. ( 6. 00 ± 1. 00) days]. In ERAS children, blood glucose post-operation was significantly higher than that pre-operation[ 5. 75 (5. 15, 6. 08) vs. 5. 10 ( 4. 80, 5. 90), z = - 3. 807, P < 0. 001], blood insulin spiked significantly post-operation[ 16. 30 ( 15. 70, 16. 90) vs. 7. 55(6. 30,9. 05), z = - 8. 682,P < 0. 001], insulin resistance index post-operation was significantly higher than that pre-operation[ 4. 07 (3. 77, 4. 34) vs. 1. 72( 1. 46,2. 02), z = - 8. 682, P < 0. 001], blood glucose post-operation in control group was significantly higher than that in ERAS group [ 9. 60 ( 8. 90, 10. 80) vs. 5. 75(5.15, 6. 08), U =21. 000, P <0. 001], blood insulin was significantly higher in control group than that in ERAS group[22. 80(21. 73, 23. 68) vs. 16. 30( 15. 70, 16. 90), P <0. 001] and insulin resistance index was significantly higher in control group than that in ERAS group[9. 77(8. 89,10. 77) vs. 4. 07(3. 77, 4. 34), P < 0. 001]. Two group are no aspiration during operation and abdominal pain was ( 6 vs. 21), diarrhea ( 4 vs. 5), vomiting ( 5 vs. 24) and dizziness ( 23 vs. 5) . VAS was significantly higher in control group than that in ERAS group[ (6. 00 ± 1. 00) vs. (3.50 ± 1. 00), X² =38. 000,P <0.001]. Conclusion After colonoscopy for colorectal polypi, ERAS can accelerate the rehabilitation and lower postoperative complications in children. It is both safe and feasible in the management of endoscopic smgery. [ABSTRACT FROM AUTHOR]

Nasopharyngeal carcinoma (NPC) is a common malignant tumor in China. Radiotherapy is the firstline treatment. After appropriate radiotherapy, about 5%-15% patients experience recurrence. In view of the poor efficacy and high incidence of severe late toxicities associated with re-irradiation, salvage surgery by the transnasal endoscopic approach is recommended for recurrent NPC (rNPC). Compared with reirradiation, endoscopic surgery can better prolong survival, improve the quality of life, and reduce complications and medical expenses of patients with rNPC. However, the complexity of the nasopharyngeal skull base enhances the difficulty and risk of surgery. Expanding the boundary of surgical resection remains a clinical challenge for otolaryngologists. In this regard, to help more advanced patients with rNPC, the surgical innovative system of NPC needs to be established by multi-disciplinary cooperation, involving skull base anatomy-based investigation, appropriate administration of the internal carotid artery (ICA), repair of skull base defect, and establishment of various types of endoscopic endonasal nasopharyngectomy. [ABSTRACT FROM AUTHOR]

Background and purpose: In recent years, the incidence of rectal neuroendocrine neoplasm (R-NEN) has been on the rise. However, its treatment remains controversial, especially for tumors of 10-20 mm in diameter. In this study, the clinicopathological characteristics of R-NEN were analyzed, the risk factors for lymph node metastasis were discussed, and the effects of different endoscopic resection were compared, so as to ascertain the indications and methods of endoscopic treatment of R-NEN. Methods: Clinical data of patients with R-NEN treated in the Fourth Hospital of Hebei Medical University from February 2007 to December 2020 were collected and retrospectively analyzed. The risk factors of lymph node metastasis were analyzed, and the safety and effectiveness of different endoscopic resection methods were compared. Results: The clinicopathological features of 190 patients with R-NEN were analyzed, suggesting that tumor size ≥12.5 mm (OR= 69.081, 95% CI: 11.385-419.155, P＜ 0.001) and lymphovascular invasion (OR= 11.732, 95% CI: 1.028-84.567, P= 0.015) were independent risk factors for lymph node metastasis. The clinical data of 114 patients with R-NEN treated with endoscopic mucosal resection with cap (EMR-c) and endoscopic submucosal dissection (ESD) respectively were compared. The results showed that the duration of operation was significantly shorter in EMR-c group than in ESD group ［(10.23±1.99) min vs (24.78±8.09) min, P＜0.001］. There was no significant difference in rate of endoscopic en bloc resection, pathological complete resection rate and complication rate between the two groups (P＞0.05). Conclusion: Tumor size ≥12.5 mm in diameter and presence of lymphovascular invasion are independent risk factors for lymph node metastasis in patients with R-NEN. Both EMR-c and ESD are safe and effective treatments for R-NEN of  ＜12.5 mm in diameter and without lymph node metastasis. [ABSTRACT FROM AUTHOR]

Objective To introduce the repair application in medium-flow cerebrospinal fluid leakage during transsphenoidal pituitary tumor resection by using autologous material from the surgical site in situ， combined with dural suture and bone-mucosa embedding technique， and evaluate its effect. Methods We conducted a retrospective case analysis of medium-flow cerebrospinal fluid leakage during endoscopic transsphenoidal approach pituitary tumor resection in our hospital from September 2016 to March 2020. All the collected cases were divided into two groups. In situ material harvest group：dural suture + in situ bone-mucosa embedding， avoiding additional trauma to the thigh and nasal cavity， referred to as in situ group. Traditional multi-layer reconstruction group：fat + fascia lata + pedicled nasoseptal flap （PNSF），referred to as traditional group. The important indexes related to repair were compared and analyzed between the two groups. Results The in situ group and the traditional group consisted of 108 and 63 cases，respectively. The baseline data of the two groups were comparable. For the incidence of postoperative cerebrospinal fluid leakage［（1/108，0. 9%）vs. （1/63，1. 6%），P>0. 05］and intracranial infection rate［（2/108，1. 9%）vs. （2/63，3. 2%），P>0. 05］，no statistical difference was shown between the groups. While compared with that in the traditional group，the mean postoperative bed stay time［（3. 7±1. 6）vs. （4. 4±1. 5）days， P<0. 001］and the mean postoperative hospital stay［（5. 8±1. 8）vs. （6. 5±1. 7）days， P<0. 001］of the in situ group were significantly shorter. The in situ group had significantly lower incidences of postoperative olfactory disturbance［（0/108，0%）vs.（3/63，4. 8%），P<0. 05］and nasal discomfort［（3/108， 2. 8%）vs. （7/63， 11. 1%）， P<0. 05］. Follow-up imaging and endoscopic examination showed that the reconstructed structure of the in situ group was stable， and there was no delayed cerebrospinal fluid leakage. Conclusion This technique showed a reliable effect in repairing medium-flow leaks during transsphenoidal pituitary tumor resection by restoring the anatomical structure while avoiding the additional trauma. It is beneficial to shortening bed stay and hospitalization time and improving the subjective experience of patients，thus having a great value in clinical application. [ABSTRACT FROM AUTHOR]

Digestive endoscopy in children has been developed over the last four decades and its diagnostic and treatment techniques are constantly refined. With a growing popularization of digestive endoscopy in adults, various endoscopic techniques are gradually applied in children. And surgical trend of internal medicine is becoming more and more apparent. Recent studies have successively reported that digestive endoscopy could safely and effectively treat children with benign esophageal stenosis, congenital hypertrophic pyloric stenosis, duodenal diaphragm, acute/chronic appendicitis, giant polyps in gastrointestinal tract and massive gastrointestinal hemorrhage that previously requiring surgical interventions. However, due to small cavity and handling difficulties of digestive tract, wider pediatric applications still require further explorations and improvements. [ABSTRACT FROM AUTHOR]

Objective: To retrospectively compare the efficacy of neuroendoscopic surgery and small bone window craniotomy in the treatment of hypertensive intracerebral hemorrhage (HICH). Methods: The clinical data of 83 patients with HICH who were treated in the 909th Hospital of Joint Logistics Support Force from July 2018 to March 2021 were retrospectively selected. According to the different surgical methods, the patients were divided into group A(n=41) and group B(n=42). Patients in group A were treated with small bone window craniotomy and patients in group B were treated with neuroendoscopic surgery. The perioperative indexes, incidence of complications, neurological function, living ability, nerve injury indexes and prognosis of the two groups were compared. Results: Compared with group A, group B significantly shortened the operation time and hospital stay, reduced the amount of intraoperative bleeding and increased the clearance rate of hematoma(P<0.05). One week after operation, the National Institutes of Health Stroke Scale (NIHSS) score in group B was lower than that in group A, and the Barthel index score was higher than that in group A (P<0.05). The levels of neuron specific enolase (NSE), S100B protein (S100B), myelin basic protein (MBP) and glial fibrillary acidic protein (GFAP) in group B were lower than those in group A one week after operation (P<0.05). The incidence of complications in group B was lower than that in group A(P<0.05). The rate of good prognosis in group B was higher than that in group A (P<0.05). Conclusion: Neuroendoscopic surgery and small bone window craniotomy can obtain good curative effects in the treatment of HICH. Among them, neuroendoscopic surgery has a more significant effect in shortening the operation time and hospital stay, reducing the amount of intraoperative bleeding and the incidence of complications, improving the clearance rate of hematoma, reducing the damage of nerve function, promoting the improvement of patients' living ability and improving patients' prognosis. [ABSTRACT FROM AUTHOR]

Objective To evaluate and compare the effect of flurbiprofen axetil，parecoxib sodium and propacetamol on postoperative analgesia in patients undergoing otoendoscopic surgery under general anesthesia． Methods A total of 140 patients scheduled for ear endoscopic surgery from Oct 2019 to Oct 2020 in Eye，Ear，Nose and Throat Hospital，Fudan University were recruited. The patients were randomly divided into 4 groups（n=35 each）：flurbiprofen axetil group（Group Flu），parecoxib sodium group（Group Par），propacetamol group（Group Pro）and sufentanil group（Group Suf）by random number table. In the non steroidal drug groups，flurbiprofen axetil （50 mg），parecoxib sodium （40 mg） or propanthamol（2 g）were given intravenously 15-30 minutes before the end of the operation；Group Suf was given 0.2 μg/kg sufentanil 15-30 minutes before the end of operation. We measured visual analogue scale（VAS）of patients in static state at post anesthsia care unit（PACU）interval，postoperative 6 and 24 h.The recovery profiles，incidence and severity of side-effects（nausea，vomiting，dizzy，drowsiness and respiratory depression）were evaluated. Results Postoperative analgesia in this study was effective with the median value of VAS score<2 at 3 time points in the 4 groups.There were no significant difference in VAS scores between the whole Non-steroidal groups（Group Flu，Par，Pro）and Group Suf at PACU（H= 2.160，P=0.540）and postoperative 24 h（H=3.493，P=0.322）；While the VAS scores at postoperative 6 h of Group Par was lower than Group Pro（P=0.039）and Group Suf（P=0.015）；The extubation time in Group Suf［（23.83±5.73）min］was longer than Group Flu［（18.71±5.99）min，P=0.001］and Group Pro ［（19.69±6.97）min，P=0.009］；The incidence of all adverse reactions in the 4 group was not statistically significant（χ²=6.269，P=0.099）. Conclusion The simple application of nonsteroidal drugs can provide adequate pain relief for patients undergoing otoendoscopic surgery with no impact on duration of recovery and side-effect incidence ． [ABSTRACT FROM AUTHOR]

Spinal endoscopic surgery is a minimally invasive technique that has developed rapidly in recent years. As spinal endoscopic techniques continue to develop, their indications are expanding and they are beginning to gradually replace traditional open spine surgery. This article compares the differences between various spinal endoscopic procedures and other open and minimally invasive spine procedures, summarizes the current state of development of the main common techniques of spinal endoscopic surgery, and provides an overview of the advantages, disadvantages, and future developments of this technique. [ABSTRACT FROM AUTHOR]

Objective: To investigate the clinical effect of simultaneous and staging endoscopic sinus surgery for chronic dacryocystitis combined with chronic rhinosinusitis. Methods: 76 cases of chronic dacryocystitis complicated with chronic rhinosinusitis in our hospital from January 2017 to October 2019 were selected retrospectively, and divided into group A and group B according to operation method, with 38 cases in each group. The group A underwent staged surgery(the nasal cavity and sinus lesions were treated to control the inflammation of the nasal cavity and sinus, and then underwent endoscopic dacryocystorhinostomy). The group B underwent simultaneous surgery(treatment of nasal cavity and sinus lesions immediately underwent endoscopic dacryocystorhinostomy). The perioperative indicators, clinical efficacy and postoperative complications were compared between the two groups. Chronic dacryocystitis Quality of Life Scale (DQOLS) was used to evaluate the quality of life of patients before and 6 months after surgery. Results: The total effective rate was 94.74%(36/38) in the group B, and 92.11%(35/38) in the group A, and there was no significant difference in the total effective rate between the two groups (P>0.05). The total incidence rate of postoperative complications in the group B was 13.16% (5/38), with no significant difference compared with 10.53% (4/38) in the group A (P>0.05). DQOLS scores of all dimensions and total scores of patients in both groups at 6 months after surgery were higher than those before surgery (P<0.05), but there was no statistically significant difference between the two groups (P>0.05). The operation time and hospital stay of patients in the group B were shorter than those in the group A, and the total cost of hospitalization was less than that in the group A(P<0.05). There was no significant difference in intraoperative blood loss between the two groups (P>0.05). Conclusions: Simultaneous surgery and staged surgery for patients with chronic dacryocystitis combined with chronic rhinosinusitis have considerable clinical efficacy and safety, and there is no significant difference in the improvement degree of patients' quality of life, but the former can shorten the operation time, hospital stay and reduce the cost of hospitalization. [ABSTRACT FROM AUTHOR]

Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) has flourished in the past decade. Compared with traditional laparoscopic surgery or laparoendoscopic single-site surgery, vNOTES has the advantages of scarfree, mild pain and fast recovery. Nowadays it is mostly used for gynecological benign diseases, and its application in gynecological malignant tumors is still controversial. Therefore, domestic and foreign scholars have made many beneficial attempts for the treatment of gynecological malignant tumors, initially confirming the feasibility of this operation. In this paper, the current situation, advantages, difficulties and technical skills of vNOTES surgery in gynecological malignant tumors are discussed. [ABSTRACT FROM AUTHOR]

BACKGROUND: Percutaneous lumbar endoscopy is in full swing in China and even in the world. Transforaminal lateral approach is one of the most commonly used approaches in percutaneous lumbar endoscopic surgery, but the biomechanical effects of the relevant segments are rarely reported. OBJECTIVE: To investigate the biomechanical effects of different sizes (7.5 mm, 10 mm, 15 mm) of facet arthroplasty on related segments of lumbar spine by three-dimensional finite element simulation. METHODS: A three-dimensional finite element model of L3-L5 was established to verify its effectiveness. The arthroplasty of L4/5 lumbar vertebrae in percutaneous endoscopic surgery was simulated. The angle between the needle and the horizontal plane and the coronal plane was taken as the puncture target, and the base of L5 superior articular process was taken as the puncture target. According to the puncture path, the circular saw with the diameter of 7.5 mm, 10 mm and 15 mm was made respectively, so as to obtain three-dimensional finite element model formed at different diameters of the base of L5 superior articular process. The normal model, 7.5 mm, 10 mm and 15 mm diameter forming finite element models were loaded in six directions to calculate the von Mises stress extremum and range of motion of the operating segments (L4/5) and adjacent segments (L3/4) of the three models under six states of flexion, extension, left flexion, right flexion, left rotation and right rotation. Relevant comparative studies were conducted to determine the effect of different sizes of facet arthroplasty on the biomechanical stability of lumbar spine. RESULTS AND CONCLUSION: (1) The effect on the operating segment (L4/5): The maximum stress of L4/5 disc with 15 mm diameter of L5 superior articular process was significantly increased under six working conditions of flexion, extension, left-right lateral bending and left-right rotation compared with that of 7.5 mm and 10 mm diameter of L4/5. The maximum stress of L4/5 disc with 15 mm diameter of L5 superior articular process was increased by 110%, 95% and 97% respectively. The range of motion of L4/5 segment of L5 with 15 mm diameter was greater than that of 7.5 mm and 10 mm diameter, which increased by 8.6%, 21.8%, 8.9%, 17.6%, 35.7% and 21.4% respectively. (2) Effect on adjacent segment (L3/4): The maximum stress of adjacent segment L3/4 disc with 15 mm diameter of L5 superior articular process increased compared with 7.5 mm and 10 mm diameter of L5 superior articular process in six working conditions, in which flexion was the most obvious, and the maximum stress of L3/4 disc increased by 29.3% compared with normal model. The range of motion of adjacent segment L3/4 of different sizes (7.5 mm, 10 mm, 15 mm) of zygapoplasty in flexion, extension, leftright lateral bending and left-right rotation was not significantly increased compared with normal model. (3) It is concluded that compared with 7.5 mm and 10 mm in diameter, 15 mm in diameter has a greater mechanical effect on the operating segment, and even has a corresponding effect on the stress of adjacent segments. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of ultrafast channel anesthesia on hemodynamics and serum interferon-γ (IFN-γ) in patients undergoing thoracoscopic surgery. Methods: A total of 62 patients undergoing thoracoscopic surgery in the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine from January 2018 to October 2020 were selected and divided into two groups according to the treatment method (n=31). All patients underwent thoracoscopic surgery, the control group were given traditional intravenous combined anesthesia, and the experimental group were given ultra-fast channel anesthesia. The changes in hemodynamics and serum IFN-γ expression were recorded. Results: There was no difference in the mean arterial pressure (MAP) and heart rate (HR) values between the two groups at T0, T1, T2 and T3 (P>0.05), and they were all within the normal range. There was no difference in operation time and intraoperative blood loss between the two groups (P>0.05). The postoperative chest tube indwelling time and hospital stay in the experimental group were shorter than those in the control group (P<0.05). The complication rate of the experimental group was lower than that of the control group (6.5% vs 25.8 %, P<0.05). Serum IFN-γ values of the two groups at 7 days after operation were higher than those at 1 day before operation, and the experimental group was higher than the control group (P<0.05). Conclusion: The application of ultrafast channel anesthesia in patients undergoing thoracoscopic surgery does not affect the patient’s hemodynamics and surgical process, and is beneficial to inhibit the release of serum IFN-γ, reduce postoperative complications, and promote patient recovery. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To probe into the effects of Jinqi lavage liquid on nasal ventilation in patients with chronic rhinosinusitis after functional endoscopic sinus surgery. METHODS: Totally 120 patients with chronic rhinosinusitis after functional endoscopic sinus surgery admitted into Affiliated Hospital of Traditional Chinese Medicine, Xinjiang Medical University from Jun. 2019 to Mar. 2021 were extracted to be divided into the study group (n = 60) and the control group (n = 60) via the random number table. The control group was treated with with 0. 9% sodium chloride injection for nasal irrigation, while the study group received Jinqi lavage liquid. Both groups were treated for 3 months. Changes of nasal airway resistance and time of operative cavity epithelialization were observed. RESULTS: There was no significant difference in nasal airway resistance between two groups before treatment (P > 0. 05). On the 7th day, 1 month, 2 months and 3 months after surgery, the nasal airway resistance in the study group was significantly lower than that in the control group, with statistically significant difference (P<0. 05). The time of operative cavity epithelialization in the study group was significantly shorter than that in the control group, the difference was statistically significant ( P < 0. 01). No adverse reactions occurred in both groups of patients. CONCLUSIONS: Compared with the conventional nasal irrigation with 0. 9% sodium chloride injection, Jinqi lavage liquid is more helpful to the improvement of nasal ventilation status in patients with chronic rhinosinusitis after functional endoscopic sinus surgery, and does not increase the incidence of adverse drug reactions. [ABSTRACT FROM AUTHOR]

Objective: To study the clinical efficacy of endoscopic mucosal resection (EMR) in the treatment of large intestine polyps and the influencing factors of postoperative bleeding. Methods: 500 patients with large intestine polyps admitted to our hospital from January 2016 to December 2019 were included in the study. All patients were treated with EMR. The clinical efficacy and postoperative bleeding were analyzed. Single factor and multivariate Logistic regression analyses were performed for the influencing factors of postoperative bleeding. Results: The total effective rate of clinical treatment was 97.80% (489/500). Postoperative bleeding occurred was 17 cases, and the incidence of bleeding was 3.40% (17/500). The quality of life scores of the patients after treatment were all higher than those before treatment (all P<0.05). Single factor analysis showed that the number of resected polyps, postoperative feeding time, appearance of polyps, and lobulation of polyps were all associated with bleeding after EMR treatment (all P<0.05). Age, sex, polyp site and pathological type were not associated with postoperative bleeding (all P>0.05). Multivariate Logistic regression analysis showed that the number of polyps resected ≥ 4 pieces, feeding within 48 days after surgery, polyp appearance flushing/erosion and polyp lobulation were risk factors for bleeding after EMR treatment (all P<0.05). Conclusion: EMR treatment of patients with colorectal polyps has a better clinical effect, which can improve their quality of life. The number of resected polyps, the postoperative feeding time, the appearance of the polyps and the lobulation of polyp are related to the postoperative bleeding, which deserves clinical attention. [ABSTRACT FROM AUTHOR]

Objective: To study the clinical efficacy of endoscopic mucosal resection (EMR) in the treatment of large intestine polyps and the influencing factors of postoperative bleeding. Methods: 500 patients with large intestine polyps admitted to our hospital from January 2016 to December 2019 were included in the study. All patients were treated with EMR. The clinical efficacy and postoperative bleeding were analyzed. Single factor and multivariate Logistic regression analyses were performed for the influencing factors of postoperative bleeding. Results: The total effective rate of clinical treatment was 97.80% (489/500). Postoperative bleeding occurred was 17 cases, and the incidence of bleeding was 3.40% (17/500). The quality of life scores of the patients after treatment were all higher than those before treatment (all P<0.05). Single factor analysis showed that the number of resected polyps, postoperative feeding time, appearance of polyps, and lobulation of polyps were all associated with bleeding after EMR treatment (all P<0.05). Age, sex, polyp site and pathological type were not associated with postoperative bleeding (all P>0.05). Multivariate Logistic regression analysis showed that the number of polyps resected ≥4 pieces, feeding within 48 days after surgery, polyp appearance flushing/erosion and polyp lobulation were risk factors for bleeding after EMR treatment (all P<0.05). Conclusion: EMR treatment of patients with colorectal polyps has a better clinical effect, which can improve their quality of life. The number of resected polyps, the postoperative feeding time, the appearance of the polyps and the lobulation of polyp are related to the postoperative bleeding, which deserves clinical attention. [ABSTRACT FROM AUTHOR]

Objective To explore the method and effect of skull base reconstruction in the repair of cerebrospinal fluid ( CSF) leakage in endoscopic sinus surgery. Methods The clinical data of 341 patients underwent endoscopic sinus surgery were retrospectively analyzed. According to the classification of CSF leakage, different methods of skull base reconstruction were used, such as gelatin sponge, artificial dural packing, or autologous fascia, mucosal flap, fat packing and dural suture. Results In this group, 92 patients had intraoperative CSF leakage, of which 69 ( 75 % ) were Kelly grade 2 - 3 CSF leakage. CSF leakage occurred in 4 cases (4.3%), of which 1 was cured after lumbar puncture and drainage, and 3 were cured by repair operation. All patients were followed up for 6 - 12 months, and no recurrence of CSF leakage occurred. Conclusions Skull base reconstruction technique can significantly reduce the incidence of CSF leakage after endoscopic skull base surgery, which is a safe and reliable method to prevent CSF leakage. [ABSTRACT FROM AUTHOR]

Minimally invasive surgery is the mainstream direction of today's surgical development. The transformation of surgical procedures from traditional open surgery to endoscopic surgery has brought tremendous benefits to patients. Income. However, surgeons have never stopped exploring from multi-port laparoscopy to single-port or even through natural cavity laparoscopic surgery, seeking a more minimally invasive method. Surgery has always been the pursuit of clinicians. Single-port laparoscopy is a minimally invasive technique with increasing clinical application. Its achievements and difficulties are as follows: Further research to guide the direction of development. This article reviews the clinical application of single port laparoscopy in recent years, and reviews its development status. [ABSTRACT FROM AUTHOR]

Objective: To observe the effect of dezocine combined with low-dose dexmedetomidine on oxidative stress levels and inflammatory factors in patients undergoing functional endoscopic sinus surgery. Methods: From June 2013 to June 2018, 130 patients who received functional endoscopic sinus surgery in our hospital were selected, and patients were divided into control group(n=65, given general anesthesia only) and experimental group(n=65, given dezocine combined with low-dose dexmedetomidine assisted general anesthesia) according to the envelope lottery method. Hemodynamics, oxidative stress and inflammatory factors levels were compared in the two groups, restlessness during awakening and incidence rate of cough in two groups were recorded. Results: The heart rate(HR) and mean arterial pressure(MAP) of the two groups before intubation(T1) ～ 5 min after extubation(T4) increased and then decreased, while the blood oxygen saturation(SpO2) decreased and then increased(P<0.05). HR and MAP of the experimental group were lower than those of the control group, and SpO2 was higher than that of the control group(P<0.05). Superoxide dismutase(SOD) of the two groups at 1 d after operation and 3 d after operation was increased than that before operation, and the experimental group was higher than the control group(P<0.05). The malondialdehyde(MDA) was decreased than that before operation, and the experimental group was lower than the control group(P<0.05). The interleukin-6(IL-6), tumor necrosis factor-α(TNF-α) and C-reactive protein(CRP) of the two groups at 1 d after operation and 3 d after operation showed a decrease trend, and the experimental group was lower than the control group(P<0.05). The Riker agitation score(SAS) scores of the two groups at extubation～10 min after extubation showed a decreased trend, and the experimental group was lower than the control group(P<0.05). The incidence rate of cough of experimental group was lower than control group(P<0.05). Conclusion: Dezocine combined with low-dose dexmedetomidine assisted general anesthesia in patients undergoing functional endoscopic sinus surgery, reduce restlessness during recovery period, can effectively prevent cough, maintain stable hemodynamics, and reduce body oxidative stress and inflammatory stress. [ABSTRACT FROM AUTHOR]

To investigate the effect of atomization inhalation of Jinlianhua liquid on nasal ventilation function, quality of life and serum inflammatory factors in patients with chronic rhinosinusitis (CRS) after functional endoscopic surgery. From October 2017 to August 2019, 160 patients with CRS functional endoscopy who were admitted to our hospital were selected, they were randomly divided into control group (n=80) and study group (n=80) by random number table method. The control group was treated with nasal normal saline atomization inhalation on the basis of conventional treatment, and the study group was treated with Jinlianhua liquid atomization inhalation on the basis of conventional treatment. The nasal ventilation function [minimum nasal area (NMCSA), nasal volume (NV)], quality of life, serum inflammatory factors [interleukin-5 (IL-5), tumor necrosis factor-琢levels (TNF-琢), procalcitonin (PCT)] and prognostic indicators were compared between the two groups. The NMCSA and NV increased in the two groups at 10 days after treatment, and those in the study group were higher than those in the control group(P<0.05). The scores of emotional function, physical pain, social function, physiological function, mental health, vitality, physiological function and overall health of the patients in the two groups at 10 days after treatment were higher, and those in the study group were higher than those the control group (P<0.05). The serum levels of IL-5, TNF-琢and PCT in the two groups at 10 days after treatment were lower than those before treatment, and those in the study group were lower than those the control group (P<0.05). The cleaning time of the operation cavity and epithelialization time in the study group were shorter than those in the control group (P<0.05). The nasal mucociliary transport speed in the study group was higher than that in the control group(P<0.05). The treatment of patients with CRS after functional endoscopy by atomization inhalation of Jinlianhua liquid, it can effectively improve the nasal ventilation function and quality of life, inhibit the inflammatory response, and it can promote the recovery of patients. [ABSTRACT FROM AUTHOR]

Objective: To explore the effects of sufentanil combined with dexmedetomidine in the treatment of intervertebral foraminal surgery under local anesthesia on the sleep quality of middle-aged and elderly patients. Methods: 178 cases of middle-aged and elderly patients with lumbar disc herniation were selected for diagnosis and treatment in our hospital from December 2018 to October 2019, and were equally divided into the sufentanil dexmedetomidine combined group and the saline control group, with 89 cases each accorded to the random number table method. All patients were underwent intervertebral foramen surgery and were given 0.5 % lidocaine mixtured 0.25 % ropivacaine under local anesthesia. On the basis of this, the combination group was given sufentanil and dexmedetomidine to induce sleep, and investigated the sleep quality of patients during and after surgery. Results: There was no significant difference in surgical mouth size, intraoperative blood loss, and postoperative hospital stay between the two groups (P>0.05), and the operation time in the combined group was significantly shorter than that in the control group (P<0.05). The incidence of complications such as incision infection, nausea and vomiting at the 14 d in the combined group was 1.12%, which was significantly lower than the control group's 8.87 % (P<0.05). The visual analogue scales (VAS) scores of the combined group at 1 d, 7 d and 14 d after surgery were significantly lower than those of the control group (P<0.05). The PSQI at 7 days after surgery in both groups was lower than that at 1 day after surgery, and the difference was statistically significant (P<0.05). The Pittsburgh Sleep Quality Index (PSQI) of the combined group was significantly lower than that of the control group at intraoperative and postoperative 1 d and 7 d(P<0.05). Conclusion: It has good sleep quality, good analgesia, haemodynamically stable, fewer postoperative complications and faster recovery in the treatment of local subanaesthesia intervertebral foraminal endoscopic surgery for lumbar disc herniation in middle-aged and elderly patients by used of sufentanil combined with dexmedetomidine. [ABSTRACT FROM AUTHOR]

Objective : To investigate the effect of plasma low-temperature radiofrequency ablation combined with nasal endoscopy on olfactory function and serum inflammatory mediators in patients with chronic sinusitis (CRS). Methods : 127 patients with CRS who were admitted to our hospital from March 2016 to July 2018 were selected, they were divided into group A (n=62, endoscopic surgery) and group B (n=65, plasma low-temperature hypothermia radiofrequency ablation combined with endoscopic surgery) according to different surgical methods. Postoperative follow-up was 1 year. The clinical efficacy, symptom score, olfactory function, serum inflammatory mediators and complications of the two groups were compared. Results : The total clinical effective rate of group B at 1 year after surgery was 87.69% (57/65), which was higher than that of group A 72.58% (45/62) (P<0.05). The distribution of olfactory function in group B was better than that in group A 3 months after operation (P<0.05). The scores of nasal congestion, head and facial distemper, runny nose, nasal reflux, headache and other symptoms in the two groups at 3 months after operation were all decreased, and those in group B were lower than those in group A (P<0.05). The serum levels of interleukin-5 (IL-5), interleukin-17 (IL-17) and tumor necrosis factor-α (TNF-α) in the two groups at 1 weeks after operation were decreased, and those in group B were lower than those in group A (P<0.05). There was no difference in the incidence of postoperative complications between the two groups (P<0.05). Conclusion : On the basis of nasal endoscopic therapy, CRS combined with plasma low-temperature radiofrequency ablation has a significant effect, which can effectively improve the olfactory function and clinical symptoms of patients, inhibit the inflammatory response of the body without increasing the incidence of complications. [ABSTRACT FROM AUTHOR]

Objective : To provide experience for clinical operation, we compared the clinical indexes of different thoracoscopic operation methods in the treatment of early non-small cell lung cancer after radical operation. Method : From January 2017 to December 2019, a total of 100 patients with early non-small cell lung cancer who underwent radical resection of lung cancer in our hospital were collected. Single hole thoracoscopy (40 cases), two hole thoracoscopy (32 cases) and three hole thoracoscopy (28 cases) were used,and compared the intraoperative and postoperative indicators of the three groups. Results :The intraoperative blood loss and postoperative thoracic drainage in the single hole group were significantly less than those in the two hole group and the three hole group (P<0.05), while those in the two hole group were significantly less than those in the three hole group (P<0.05); the postoperative chest tube indwelling time and postoperative hospital stay in the single hole group were shorter than those in the two hole group and the three hole group (P<0.05), while those in the two hole group were significantly shorter than those in the three hole group (P<0.05). The pain score at postoperative 24h of the three groups was lower than postoperative 12h, and postoperative 48h lower than postoperative 24h, the difference was statistically significant (P<0.05). The results showed that the pain score of single hole group was lower than that of two hole group and three hole group (P<0.05), while two hole group was lower than three hole group (P<0.05). There was no significant difference in the number of lymph nodes, the number of lymph node stations and the incidence of postoperative complications between three groups (P>0.05). Conclusion : Compared with two hole and three hole thoracoscopic surgery, single hole thoracoscopic surgery for early non-small cell lung cancer has obvious advantages,and does not significantly increase postoperative complications, so it can be used as the clinical first choice. [ABSTRACT FROM AUTHOR]

Objective : To study The effect of functional endoscopic sinus surgery on Total immunoglobulin (TIgE), eosinophil (Eos) and nasal cilia transport in patients with chronic sinusitis. Method : 120 patients with chronic sinusitis treated in our hospital from December 2015 to December 2019 were selected and divided into the observation group (n=61) and the control group (n=59) by lottery. The control group was treated with traditional adenoidectomy and the observation group was treated with functional endoscopic sinus surgery. The clinical efficacy, serum TIgE, Eos, interleukin-4 (IL-4), interleukin-8 (IL-8), tumor necrosis factor (TNF-α) levels, nasal mucociliary clearance rate, clearance rate, transmission rate and complications were compared between the two groups before and after treatment. Result : After treatment, the total effective rate of observation group was 95.08%, which was significantly higher than that of the control group (77.97%, P<0.05). Before treatment, there was no significant difference in the serum TIgE and Eos levels between the two groups. After treatment, the serum TIgE and Eos levels in both groups were significantly lower than those before treatment, which were lower than those in the control group (P<0.05). Before treatment, there was no significant difference in clearance rate, clearance speed and transmission speed between the two groups. After treatment, the above indexes in both groups were significantly increased, and those in the observation group were higher than those in the control group (P<0.05). Before treatment, there was no significant difference in the serum IL-4, IL-8 and TNF-α levels between the two groups. After treatment, the serum IL-4, IL-8 and TNF-α levels in both groups were significantly lower than those before treatment, and the above indicators in the observation group were significantly lower than those in the control group (P<0.05). The total incidence of complications in the two groups was 4.92% and 20.34%, respectively, which was significantly lower in the observation group than that of the control group (P<0.05). Conclusion : The clinical effect of functional endoscopic sinus surgery in patients with chronic sinusitis is significantly better than that of traditional adenoid curettage with higher safety. It can effectively improve the nasal ciliary transport function in patients, which may be related to the reduction of serum TIgE and Eos levels. [ABSTRACT FROM AUTHOR]

Endoscopic retrograde cholangiopancreatography( ERCP) and its derivative technologies have become the first-line treatment methods for bile duct stones. Most stones can be removed by conventional endoscopic techniques,while the treatment of large common bile duct stones requires a combination with endoscopic lithotripsy. This article summarizes the current research advances in endoscopic mechanical lithotripsy,electrohydraulic lithotripsy/laser lithotripsy,extracorporeal shockwave lithotripsy for bile duct stones in the treatment of large common bile duct stones,so as to provide recommendations and bases for the clinical treatment of large common bile duct stones. [ABSTRACT FROM AUTHOR]

To investigate the efficacy evaluation and prognostic prediction value of Coagulation function for the non-small cell lung cancer patients with thoracoscopic surgery. 50 patients with non-small cell lung cancer who underwent thoracoscopic surgery in our hospital were selected as subjects. The relationship between coagulation function index and clinicopathological features was analyzed. The changes of coagulation function index before and after treatment were compared, and the prognosis of patients was evaluated. Statistically significant differences were found in the coagulation function indexes between patients with different gender, pathological type, pathological stage and lymph node metastasis(P<0.05). The level of coagulation function was significantly changed after thoracoscopic surgery (P<0.05). Log-Rank one-way survival analysis showed that the survival rate of non-small cell lung cancer patients whose with fibrinogen (Fib) and D-dimer (DD) levels were higher than average was significantly lower (P<0.05). Logistic multivariate regression analysis showed that increased Fib and D-D were independent risk factors affecting the survival and prognosis of patients with non-small cell lung cancer (P<0.05). Coagulation function is correlated with the efficacy and prognosis of patients with non-small cell lung cancer treated by thoracoscopic surgery. Fib and D-D are independent risk factors for the prognosis of patients. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of central venous catheter drainage on postoperative thoracic drainage in patients with lung cancer undergoing single hole thoracoscopic surgery. Methods: The clinical data of 80 patients with lung cancer who were treated by single hole thoracoscopic radical surgery from January 2019 to December 2019 were retrospectively selected. According to the different drainage methods, they were divided into group A (n=40, traditional drainage) and group B (n=40, central venous catheter drainage). The clinical indicators, quality of life, inflammatory factors and complications of the two groups were compared. Results: The operation time and postoperative hospitalization time of group B were shorter than that of group A (P<0.05). The scores of quality of life (SF-36) in the two groups were higher than those before operation at 3 months after operatiob, and those in group B were higher than those in group A (P<0.05). The levels of interleukin-6 (IL-6), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) in the two groups increased first and then decreased at 3d and 7d after operation, and the group B were lower than those in the group A(P<0.05). There was no difference in the incidence of postoperative complications between the two groups (P>0.05). Conclusion: Compared with the traditional drainage, the central venous catheter drainage can reduce the inflammatory stimulation and improve the quality of life. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between the expression of long non-coding RNA (lncRNA) zinc finger DHHC-type containing 8 pseudogene 1(ZDHHC8P1), maternally expressed gene 3(MEG3), taurineup-regulated gene 1(TUG1) and the clinicopathological characteristics and prognosis in gastric cancer. Methods: Paraffin specimens of gastric cancer tissues and adjacent tissues from 83 patients with gastric cancer who underwent surgical resection or endoscopic biopsy were selected from January 2013 to January 2016 collected by the pathology department of our hospital. The expression of ZDHHC8P1, MEG3 and TUG1 in gastric cancer and paracancerous tissues were detected. The relationship between the expression of ZDHHC8P1, MEG3 and TUG1 and the clinicopathological characteristics of gastric cancer were analyzed. All patients were followed up and the relationship between the expression of ZDHHC8P1, MEG3 and TUG1 and the prognosis of patients was analyzed. Results: The expression of ZDHHC8P1 and TUG1 in gastric cancer tissues were higher than those in adjacent tissues (P<0.05) and the expression of MEG3 was lower than that in adjacent tissues (P < 0.05). The expression of ZDHHC8P1 were related to tumor diameter, differentiation degree, invasion depth, TNM stage, lymph node metastasis and distant metastasis (P<0.05). The expression of MEG3 and TUG1 were related to differentiation degree, invasion depth and lymph node metastasis (P<0.05). Kaplan-Meier survival curve analysis showed that the progression-free survival (PFS) and overall survival (OS) rates of patients with high expression of ZDHHC8P1 and TUG1 were lower than those of patients with low expression of ZDHHC8P1 and TUG1 (P<0.05) and the PFS and OS rates of patients with low expression of MEG3 were lower than those of patients with high expression of MEG3 (P<0.05). Cox risk regression analysis showed that lymph node metastasis, high expression of ZDHHC8P1 and TUG1 and low expression of MEG3 were risk factors of gastric cancer patients'poor prognosis (HR=1.613, 1.956, 2.512, -0.824; P＜0.05). Conclusion: ZDHHC8P1, TUG1 are high express in gastric cancer tissues and MEG3 is low express, the expression of ZDHHC8P1, TUG1 and MEG3 are related to the clinicopathological characteristics and prognosis of gastric cancer, which can be used auxiliary indexs for prognosis evaluation of gastric cancer patients. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of desloratadine citrate disodium combined with endoscopic sinus surgery on clinical symptoms and inflammatory response in patients with chronic sinusitis. Methods: 116 patients with chronic sinusitis admitted to our hospital from March 2017 to July 2018 were selected as the research objects. They were divided into traditional group and combined group according to random number table method, 58 cases in each group. The traditional group were treated with endoscopic sinus surgery. The combined group were treated with desloratadine citrate disodium on the basis of endoscopic sinus surgery. The clinical efficacy, symptom visual analogue scale (VAS) scores, clearance function of nasal mucociliary, levels of inflammatory factors and adverse reactions were compared between the two groups. Results: The total effective rate of the combined group were higher than that of the traditional group, and the VAS scores of headache, nasal obstruction, facial pain and olfactory disturbance in the combined group were lower than those in the traditional group (P<0.05). The clearance rate and clearance speed of the two groups after treatment were higher than those before treatment, and the clearance time was shorter than that before treatment (P<0.05). Compared with the traditional group, the clearance rate and clearance speed of the combined group increased and clearance time shortened after treatment (P<0.05). After treatment, the levels of tumor necrosis factor-α (TNF-α), interleukin-5 (IL-5), interleukin-12 (IL-12) and high-sensitivity C-reactive protein (hs-CRP) in the two groups were lower than those before treatment, and those in the combined group were lower than those in the traditional group(P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion: On the basis of endoscopic sinus surgery, combined use of desloratadine citrate in the treatment of chronic sinusitis patients has a definite effect, effectively alleviating inflammatory response, alleviating the clinical symptoms of patients. [ABSTRACT FROM AUTHOR]

Objective: To investigate the occurrence of neuropathic pain and related risk factors after thoracic surgery. Method(s): The clinical data of patients who underwent thoracic surgery in our hospital from 2015 to 2016, including patients' age, gender, smoking history, BMI, preoperative use of hypnotics, preoperative diagnosis, surgical side, surgical approach, whether it was minimally invasive, the use of epidural analgesia pump, intraoperative blood loss, duration of surgery, tube drainage time and whether neuropathic pain occurred were retrospectively collected. The clinical data of patients with neuropathic pain and without were comparably analyzed. Multivariate logistic regression analysis was performed on the differential clinical data to explore the risk factors of neuropathic pain. Result (s): A total of 123 patients were enrolled in the study. 33 patients (26.8%) had postoperative neuropathic pain. 6 patients (4.9%) had persistent neuropathic pain for one year after surgery. The time for postoperative neuropathic pain was on the 7th day after surgery and the duration was 75 days. The smoking proportion (81.8%), the proportion of hypnotics before surgery (57.6%), the proportion of thoracotomy (81.8%), and the amount of intraoperative blood loss ( 185 mL), operative time (196 minutes), and postoperative drainage time (2.5 days) of patients with neuropathic pain were higher than those without neuropathic pain. Multivariate analysis showed that preoperative use of hypnotics (OR=2.322, P<0.001 ), prolonged operative time (OR=3.703, P<0.001), and prolonged postoperative drainage time (OR=2.675, P=0.002) were the risk factors of neuropathic pain. Conversely, Video-assisted thoracoscopic surgery is a protective factor (OR=0.453, P=0.002). Conclusion (s): Preoperative use of hypnotics, and prolonged operative time and postoperative drainage time increase the risk of neuropathic pain. Video-assisted thoracoscopic techniques can reduce the incidence. [ABSTRACT FROM AUTHOR]

BACKGROUND: The incidence of lumbar spinal stenosis with vertebral instability is increasing year by year, which can cause symptoms such as waist and leg pain, lower limbs feeling numbness and intermittent claudication. In recent years, scholars have tried various minimally invasive treatment methods to further reduce the trauma and complications of surgery. The improvement of the clinical effect of minimally invasive surgery for lumbar spinal stenosis with vertebral instability is an important issue to be solved. OBJECTIVE: To evaluate the mid-long-tenn effect of only placed expandable interbody fusion cage in the treatment of lumbar spinal stenosis with vertebral instability using micro-endoscopic discectomy system. METHODS: A retrospective, self-control clinical trial was conducted in the First Affiliated Hospital of Zhengzhou University from 2012 to 2014. Totally 35 patients with lumbar spinal stenosis combined with vertebral instability were treated by only placed expandable interbody fusion cage using micro-endoscopic discectomy system. This study was approved by the Ethics Committee of the First Affiliated Hospital of Zhengzhou University. RESULTS AND CONCLUSION: (1) All 35 patients were followed-up for 60-85 months, mean (70.17±5.40) months. Among these patients, lumbar interbody fusion in 1 segment, 2 segments and 3 segments was performed in 6, 20 and 9 cases, respectively. A total of 73 intervertebral spaces were fused. (2) The mean operation time was 53.49±9.13 minutes (range, 35-75 minutes). The mean blood loss was 114.86±54.23 ml (range, 50-250 ml). (3) Dural rupture occurred in one case during operation and then hypotensive cranial pressure headache occurred after operation. Headache gradually eased after the patient received rehydration and analgesic treatment for 3 days. Poor incision healing occurred in one case after operation and then healed well after one-week vacuum sealing drainage technique. (4) The Visual Analogue Scale scores, Oswestry Disability Index, and height of intervertebral space were significantly decreased at 1 week, 6 months, 1 year, 2 years after surgery and the final follow-up compared to the preoperative ones. At 6 months after the operation, 31 (42.5%) intervertebral spaces reached a strong fusion, 25(34.2%) possible fusion, and 17(23.3%) did not reach fusion. At 1 year after surgery, 51(69.9%) intervertebral spaces achieved a strong fusion and 22(30.1%) achieved possible fusion. At 2 years after surgery, 57(78.1%) intervertebral spaces achieved a strong fusion and 16(21.9%) achieved possible fusion. During final follow-up, 62(84.9%) intervertebral spaces achieved a strong fusion and 11(15.1%) achieved possible fusion. (5) At the last follow-up, cage migration was found in one case. The patient was not treated because of symptomless. (6) Unilateral approach only placed expandable interbody fusion cage by using micro-endoscopic discectomy system is a safe and reliable minimally surgical method, which has a good mid-long-term effect on lumbar spinal stenosis with vertebral instability. [ABSTRACT FROM AUTHOR]

BACKGROUND: With the rapid development of intervertebral disc interventional technology, surgical treatment of lumbar disc herniation has made great progress, but at the same time, surgeons and patients have more choices. Therefore, it is particularly important to compare the efficacy and safety of new surgical methods and traditional widely accepted treatment methods. Traditional meta-analysis cannot classify the advantages and disadvantages of various surgical methods. OBJECTIVE: To evaluate the efficacy and safety of seven surgical interventions for the treatment of lumbar disc herniation using network meta-analysis. METHODS: We performed a Bayesian-framework network meta-analysis of randomized controlled trials to compare seven surgical interventions for people with lumbar disc herniation, including percutaneous endoscopic lumbar discectomy, standard open discectomy, standard open microsurgical discectomy, chemonucleolysis, microendoscopic discectomy, percutaneous laser disc decompression, and automated percutaneous lumbar discectomy. The eligible randomized controlled trials were identified by searching the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase and Google scholar. Data from three outcomes (success rate, complication rate, and reoperation rate) were independently extracted by two assessors. RESULTS AND CONCLUSION: (1 ) A total of 29 randomized controlled trials (31 literatures) including 3 146 participants were finally included into this article. (2) Our Meta-analysis provides hierarchies of these seven interventions. For the success rate, the rank probability is as follows (from best to worst}: percutaneous endoscopic lumbar discectomy > standard open discectomy >standard open microsurgical discectomy > chemonucleolysis > microendoscopic discectomy > percutaneous laser disc decompression> automated percutaneous lumbar discectomy. (3) For the complication rate, the rank probability is as follows (from best to worst}: percutaneous endoscopic lumbar discectomy > standard open microsurgical discectomy > standard open discectomy > microendoscopic discectomy > percutaneous laser disc decompression > chemonucleolysis >automated percutaneous lumbar discectomy. (4) For the reoperation rate, the rank probability is as follows (from best to worst): standard open microsurgical discectomy > standard open discectomy > microendoscopic discectomy > percutaneous laser disc decompression > percutaneous endoscopic lumbar discectomy > chemonucleolysis > automated percutaneous lumber discectomy. (5) This meta-analysis provides evidence that percutaneous endoscopic lumbar discectomy might be the best choice to increase the success rate and decrease the complication rate. Moreover, standard open microsurgical discectomy might be the best option to drop the reoperation rate. Automated percutaneous lumbar discectomy might lead to the lowest success rate and the highest complication rate. It is hoped that one-to-one randomized controlled trials of high quality will further validate the results of this study. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of single-hole video-assisted thoracoscopic surgery(VATS) on pulmonary function and immunoglobulin in elderly patients with solitary pulmonary nodules. Methods: The clinical data of 78 elderly patients with SPN who were admitted to Wuxi People’s Hospital Affiliated to Nanjing Medical University from February 2016 to January 2019 were retrospectively selected. The patients were divided into control group(n=43) and study group(n=35) according to different surgical methods. The control group was treated with traditional porous VATS pulmonary nodule resection, while the study group was treated with single-hole VATS pulmonary nodule resection. The clinical indicators, pulmonary function, immunoglobulin, visual analogue pain scale(VAS),complications and recurrence were compared between the two groups. Results: There was no difference in operation time between the two groups(P>0.05). The hospitalization time in the study group was shorter than that in the control group. Postoperative drainage, hospitalization expenses and intraoperative bleeding were less than those in the control group(P<0.05). No serious complications were found in both groups, and no recurrence occurred in both groups. The forced expiratory volume(FEV1), maximum ventilation volume per minute(MVV) and forced vital capacity(FVC) of the two groups decreased at the 1 st second of 1 month after operation, but those in the study group were higher than those in the control group(P<0.05). Immunoglobulin A(IgA), immunoglobulin M(IgM), and immunoglobulin G(IgG) decreased in both groups at 3 days after operation, but thosel in the study group were higher than those in the control group(P<0.05). The VAS scores of the study group were lower than those of the control group at the 1st, 3rd and 5th day after operation(P<0.05).Conclusion: Single-hole VATS treatment of elderly patients with SPN can effectively improve perioperative indicators, improve immunity,reduce lung function damage, and it has good safety, it has a high clinical value. [ABSTRACT FROM AUTHOR]

Objective To observe the application effect of the patient controlled epidural analgesia in the transforaminal endoscopic operations. Methods 60 patients, aged 38 ~ 64 years，18 kg/cm2≤BMI≤26 kg/cm2， were chosen for the transforaminal endoscopic operations, regardless of gender. Patients' physical status were I or II by ASA，They were randomly assigned into 3 groups(n = 20 each) : local anesthesia group(LA group), epidural anesthesia group(EA group)，and patient controlled epidural analgesia (PCEA group). In the LA group，0.5% ropivacaine 100 mg was locally injected into the surgical site. In the EA group and PCEA group，puncture and catheter putting outside of epidural was performed 2 intervertebral space above the surgical site. Both groups were injected with 1%lidocaine 3ml by epidural catheter at the beginning of the anesthesia. When no anesthetic poison was observed，5 minutes later，the PCEA group was injected with 0.2%ropivacaine at a speed of 1 mL/5s. The operation was performed in the prone position after the anesthesia plane was fixed. The EA group was injected with 5 ~ 8 mL of 0.2% ropivacaine per 30min. The patients in the PCEA group were connected to an electric self-control pump which continuously pumped 0.2%ropivacaine at a continuous infusion speed of 8ml/h, and a single infusion of 3ml，with a locked time of 20 min. Sufentanil was given as auxiliary analgesia according to intraoperative conditions，and VAS score was maintained ≤4. MAP，HR、SpO2，Bromage scores were recorded at the following times: the beginning of skin incision (T0)，muscle and ligment separation (T1)， nerve root stimulation in the operation (T2)，nucleus pulposus removal (T3)，skin suture(T4). The dosages of Sufentanil, respiratory depression in the operation, nausea and vomiting，skin itch and uroschesis were all recorded. As well as the patients' comfort levels for the whole operation's analgesia were recorded. Results When the EA group and PCEA group patients'anesthesia plane got to T1~T3，their MAP and HR were lower than those in the LA group，showing statistical significance(P<0.05). Compared with the EA group，MAP and HR in the PCEA group were more stable，with statistical significance(P<0.05). The EA group and PCEA group used less sufentanil than the LA group did during the whole operation, with statistical significance(P<0.05). the PCEA group's Bromage scores were higher than those in the EA group, with less blocked motor nerves and a better coordination in completing the body movements commanded by the doctors(P<0.05). Besides，The patients' comfort and satisfaction degree was the highest in the three groups. Conclusion The patient controlled epidural analgesia shows an effective pain relieving effect during the whole transforaminal endoscopic surgery，and makes it easier to observe the patients' motor nerve functions during the operation. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of endoscopic submucosal resection (EMR) assisted by endoscopic ultrasonogra-phy (EUS) on tumor markers and stress response indexes in patients with esophageal precancerous lesions. Methods: A total of 137 patients with esophageal precancerous lesions, who were admitted to Gastroenterology Department of Qilu Hospital Qingdao District of Shandong University from March 2016 to April 2018, were selected. The patients were divided into routine group (n=68, routine gastroscopy EMR) and EUS group (n=69, EUS-assisted EMR). The clinical indicators, the serum tumor markers and stress response indexesbefore operation and after operation, and the genetic molecules levels before operation and 1 weeks after operation were compared be-tween the two groups. Results: The operation time and the fluid diet time of EUS group were shorter than those of routine group (P<0.05),and the number of small perforation of esophageal mucosa and hemostasis with titanium clip were less than those of routine group(P<0.05).The levels of tumor specific growth factor (TSGF), cytokeratin 19 serum fragment 21-1 (CYFRA21-1) and squamous cell carcinoma anti-gen (SCC-Ag) in both groups were higher than those before operation, but the above indexes in EUS group were lower than those in routine group(P<0.05). Postoperative levels of epinephrine (E), norepinephrine (NE), renin (R), angiotensin II (Ang II) and aldosterone in both groups were higher than those before operation, but the above indexes in EUS group were lower than those in routine group(P<0.05).The cyclin E (Cyclin E) and transforming growth factor-α(TGF-α) 1 week after operation in the two groups were lower than before operation, and the above indexes in EUS group were lower than those in routine group (P<0.05). Conclusion: Compared with routine gastroscopy, EMR assisted by EUS, in the treatment of esophageal precancerous lesions, can effectively improve the clinical indicators, alleviate the stress response of patients, and reduce the level of serum tumor markers and genetic molecules. [ABSTRACT FROM AUTHOR]