Objective To explore the clinical application value of non-inflatable mediastinoscopy combined with laparoscopic radical resection for esophageal cancer patients complicated with cardiovascular and pulmonary diseases.Methods A retrospective analysis was made on clinical data of 20 patients with esophageal cancer complicated with cardiovascular and pulmonary diseases treated with non-inflatable mediastinoscopy combined with laparoscopic radical resection in our hospital from January 2021 to October 2024.The cervical and abdominal surgical teams worked simultaneously.During the operation,a left neck incision was made to free the cervical esophagus.After inserting a mediastinoscope,an ultrasonic knife was used to free the thoracic esophagus from top to bottom and clean the lymph nodes adjacent to the esophagus.The laparoscopic procedure(freeing the stomach and esophagus from bottom to top)was connected in the mediastinum to complete the esophageal freedom,and a tubular stomach was made and anastomosed at the neck.Results All the 20 operations were successfully completed without conversion to thoracotomy.The operation time was(130.5±25.5)min,the intraoperative blood loss was(60.5±32.5)ml,a total of 3-11 mediastinal lymph nodes and1-5 abdominal lymph nodeswerecleared,andthe postoperative hospital stay was(20.0±6.0)d.There were 2 cases of anastomotic leakage,2 cases of anastomotic stenosis,2 cases of pleural effusion,2 cases of pulmonary infection,1 case of chylothorax,and 1 case of recurrent laryngeal nerve injury.After conservative treatment,all of which were cured.Postoperative pathology showed 18 cases of squamous cell carcinoma and 2 cases of adenocarcinoma.Postoperative TNM staging was 6 cases in stage Ⅰ,10 cases in stage Ⅱ,and 4 cases in stage Ⅲ,consistent with preoperative evaluation.All the20 cases were followed up for1-24 months,with a median follow-up time of 12 months.CT re-examinations showed no recurrence,and no death case was recorded.Conclusion Non-inflatable mediastinoscopy combined with laparoscopic radical resection is safe and feasible for esophageal cancer patients complicated with cardiovascular and pulmonary diseases.

Objective To investigate the short-term efficacy of arthroscopic total internal suture combined with platelet-rich plasma(PRP)in the treatment of lateral meniscal popliteal hiatus area injuries.Methods Forty-eight patients diagnosed with lateral meniscal popliteal hiatus area injuries in our hospital from January 2020 to December 2022 were selected and divided into Fast-Fix total internal suture group(FF group,n=23)and Fast-Fix total internal suture combined with PRP group(PRP group,n=25)according to treatment methods.The positive rate of McMurray test at 6 and 12 months after surgery,the preoperative and postoperative visual analogue scale(VAS)of pain,the International Knee Documentation Committee(IKDC)scores,the Lysholm Knee Function Scores,and the Knee Society Scores(KSS)were compared between the two groups.Results No adverse events such as vascular and nerve injury,fever and infection occurred in both groups.There was no significant difference between the two groups in the positive rates of McMurray test at 6 and 12 months(χ2=0.880,P=0.348;Fisher's exact test,P=0.479).In the PRP group,25 cases were followed up for11-14 months,with an average of(12.2±0.8)months;in the FF group,23 cases were followed up for11-14 months,with an average of(12.8±0.8)months.The VAS scores at 6 months and 12 months after surgery were significantly lower than those before surgery in both groups(all P=0.000).The VAS scores of the PRP group at 6 and 12 months after surgery were significantly lower than those of the FF group(P<0.05).Both groups showed significant improvements in IKDC,Lysholm,and KSS scores at 6 and 12 months after surgery compared to preoperative levels(all P=0.000).The IKDC,Lysholm,and KSS scores of the PRP group at 6 and 12 months after surgery were significantly higher than those of the FF group(P<0.05).Conclusion Compared to Fast-Fix total internal suture alone,PRP joint cavity adjuvant therapy based on Fast-Fix total internal suture surgery could reduce the postoperative pain of patients,and promote the functional recovery of the knee joint,which is more recommended in clinical practice.

Objective To explore the feasibility and safety of robotic-assisted laparoscopic Boari flap reconstruction for middle and distal ureteral stricture.Methods A retrospective study was made on 22 cases of middle and distal ureteral stricture between February 2019 and September 2022 in our department.The patients underwent DaVinci robotic-assisted laparoscopic middle and distal ureterectomy.Then flap of bladder was released and excised to perform Boari flap reconstruction for recuperating ureteral patency.Results The length of ureteral stricture ranged 7-10 cm(mean,9.3 cm).The operation time was 110-190 min(mean,132 min)and the intraoperative blood loss was50-150 ml(mean,87 ml).All the 22 cases were followed up for 12-44 months(mean,28 months).None of patients suffered from postoperative surgical side ureteral obstruction or vesicoureteral reflux.Conclusion Robotic-assisted laparoscopic Boari flap reconstruction for middle and distal ureteral stricture is safe and feasible,having definite therapeutic efficacy.

Objective To evaluate the effect of Helicobacter pylori(H.pylori)infection on colorectal adenoma(CRA)recurrence after polypectomy and to study other potential prognosis factors associated with CRA recurrence.Methods This single-centered retrospective cohort study included 808 patients with CRA who underwent colonoscopy,polypectomy,and gastroscopy between January 2005 and October 2022.The patients were classified into three groups based on H.pylori infection status:persistently negative(group A,n=626),initially positive but turned negative(group B,n=141),and persistently positive(group C,n=41).The CRA recurrence and high-risk CRA or colorectal cancer(CRC)occurrence were assessed,and potential prognosis factors for recurrence were analyzed.Results During a median follow-up period of 1.6(1.1,2.4)years,the recurrence rate was 56.4%(456/808),including 124 cases(15.3%)of high-risk CRA/CRC[of which 5 cases(0.6%)were CRC]and 332 cases(41.1%)of low-risk CRA.The recurrence rates in the three groups were 55.4%(347/626),60.3%(85/141),and 58.5%(24/41),respectively,with no statistically significant difference(log-rank χ2=0.525,P=0.769).The high-risk CRA/CRC recurrence rates in the three groups were 14.9%(93/626),17.7%(25/141),and 14.6%(6/41),respectively,showing no significant intergroup differences(log-rank χ2=0.340,P=0.844).Multivariate analysis identified increasing age(HR=1.011,95%CI:1.002-1.021,P=0.020)and baseline high-risk CRA(HR=1.428,95%CI:1.183-1.724,P<0.001)as independent prognosis factors for CRA recurrence.Conclusions This study did not find a significant correlation between H.pylori infection and CRA recurrence after polypectomy.Increasing age and baseline high-risk CRA are prognosis factors for CRA recurrence.

Objective To compare the efficacy and safety of flexible ureteral lithotripsy(FURL)and non-retrograde percutaneous nephrolithotomy(NR-PCNL)for treating1.5-2.0 cm upper ureteral stones.Methods We retrospectively analyzed clinical data of 130 patients with upper ureteral stones treated between October 2022 and October 2024.Sixty-two patients underwent FURL and 68 underwent NR-PCNL.Comparisons included operative time,pre-and postoperative changes in white blood cells(WBC),hemoglobin(Hb),and creatinine(Cr),postoperative C-reactive protein(CRP)levels,stone-free rate after primary surgery,postoperative hospitalization duration,pain scores,complications,and need for auxiliary treatments.Results Compared to the FURL group,the NR-PCNL group demonstrated advantages in operative time[54.0(44.3,69.3)min vs.82.5(66.0,101.0)min,Z=-5.565,P<0.001],WBC elevation[1.9(0.5,3.5)×109/L vs.4.5(3.0,6.0)×109/L,Z=-4.528,P<0.001],and secondary surgery rate[0%(0/68)vs.14.5%(9/62),P<0.001].The FURL group showed lower Hb reduction[3.0(2.0,6.3)g/L vs.8.0(5.0,11.0)g/L,Z=-4.262,P<0.001],less postoperative Visual Analogue Scale(VAS)pain scores[1.0(1.0,2.0)points vs.2.0(1.0,2.0)points,Z=-2.840,P=0.005],and shorter hospitalization duration[2.0(1.0,2.0)d vs.3.0(2.0,3.0)d,Z=-5.815,P<0.001].No significant differences were observed in Cr elevation,CRP levels,stone-free rate after primary surgery,complications,or analgesic requirements(P≥0.05).Conclusions Both NR-PCNL and FURL are safe and effective for 1.5-2.0 cm upper ureteral stones.FURL offers better patient comfort,while NR-PCNL shows superior overall safety.

Objective To investigate clinical efficacy of single-port thoracoscopy combined with small incision surgical stabilization of rib fractures(SSRF)in the treatment of multiple rib fractures.Methods A retrospective comparison was carried out on clinical data of 73 patients who underwent multiple rib fractures surgery in our hospital from August 2023 to November 2024.Among them,31 patients underwent single-port thoracoscopy combined with small incision SSRF(thoracoscopic group),while 42 patients underwent traditional open SSRF by using small incision muscle-preserving technique(open group).The two groups were compared in terms of intraoperative blood loss,operation time,total chest tube drainage volume,pain relief time,postoperative hospital stay,postoperative complications,incision healing grade,and stability of internal fixation.Results Both groups successfully completed the surgery and were discharged.Compared to the open group,the thoracoscopic group had less intraoperative blood loss[(67.9±26.7)ml vs.(96.1±38.3)ml,t=-3.508,P=0.001],shorter pain relief time[(59.5±12.7)h vs.(67.9±13.9)h,t=-2.647,P=0.010],shorter postoperative hospital stay[(9.0±2.2)d vs.(10.3±2.5)d,t=-2.332,P=0.023],and better incision healing grade(Z=-2.867,P=0.004).The open group was superior to the thoracoscopic group in terms of operation time[(82.7±20.4)min vs.(116.6±30.6)min,t=5.350,P=0.000],total drainage volume of the chest tube[(417.5±116.5)ml vs.(575.2±191.4)ml,t=4.064,P=0.000],and incidence of encapsulated pleural effusion(2.4%vs.22.6%,χ2=5.532,P=0.019).There was no significant difference in the incidence of atelectasis and pulmonary infection between the two groups(P>0.05).All the patients were followed up for3-12 months after surgery,with an average of 6 months.They all recovered their ability to work within 3 months after surgery,with no obvious symptoms such as chest pain or tightness,no chest collapse or deformity,and no displacement or detachment of internal fixation devices.Conclusion Single-port thoracoscopy combined with small incision SSRF is safe and feasible,and is especially suitable for posterior rib fractures that are difficult to expose and covered by the scapula or deep paraspinal rib fractures of the erector spinae muscle.

Objective To explore the safety and feasibility of extracorporeal suture traction of round ligament of the uterus assisted two-port laparoscopic internal ring closure in the treatment of pediatric ovarian sliding hernia.Methods From September 2019 to September 2024,57 children with ovarian sliding hernia underwent extracorporeal suture traction of round ligament of the uterus assisted two-port laparoscopic internal ring closure.Under the guidance of single-port umbilical laparoscopic monitoring,a 2-0 suturing needle with thread was inserted through the opposite internal ring and used to suture the round ligament of the uterus at the affected side's internal ring.The needle was passed through and exited near the entry point,and the extracorporeal suture traction was used to pull the ovary(and part of the fallopian tube)back into the abdominal cavity from the inguinal canal,maintaining the suture tension to prevent the ovary and fallopian tube from re-entering the internal ring.The internal ring was fully exposed.A 2-0 suturing needle with thread was inserted at the affected side(2-3 cm from the internal ring)to perform a circular suture of the peritoneum at the internal ring.The internal ring was closed at the level of internal ring orifice.Results All the 57 cases of ovarian sliding hernia were confirmed to be unilateral,with 18 cases on the right side(including 12 cases of pure ovarian sliding hernia and 6 cases of ovarian and fallopian tube sliding hernia)and 39 cases on the left side(including 22 cases of pure ovarian sliding hernia and 17 cases of ovarian and fallopian tube sliding hernia).The average surgery time was(22.5±2.5)min.All the patients were discharged within 6 h postoperatively and no complications were noted.A total of 49 patients were followed up for6-20 months(mean 9.5 months),with 21 cases followed for more than 12 months.No complications such as incision infection,recurrence of hernia,or Nuck's cyst were observed.Ultrasonic examinations showed normal bilateral ovarian blood flow.Conclusion For pediatric ovarian sliding hernia,extracorporeal suture traction of round ligament of the uterus assisted two-port laparoscopic internal ring closure can effectively retract the ovary(and part of the fallopian tube)from the inguinal canal back into the abdominal cavity,fully exposing the normal anatomical form of the internal ring,with the characteristics of safety and feasibility.

Objective To explore the effect of hysteroscopy combined with laparoscopy in the diagnosis and treatment of intramural pregnancy.Methods A retrospective analysis was conducted on clinical data of 10 patients with intramural pregnancy treated with hysteroscopy and laparoscopy from January 2010 to December 2024.Among them,2 were diagnosed as tubal pregnancy,2 as cornual pregnancy,and 6 as intramural pregnancy before surgery.All the patients underwent a combination of hysteroscopy and laparoscopy,and intraoperative exploration confirmed the diagnosis of intramural pregnancy.The hysteroscopic or laparoscopic resection of the intramural pregnancy lesion was successfully performed.Results There were no perioperative complications.Follow-up visits were conducted at 1-3 months after surgery,and the postoperative hCG decreased to negative level.Conclusions Intramural pregnancy is easy to be misdiagnosed as tubal or cornual pregnancy,and the location of the gestational sac needs to be located based on imaging examinations before the operation.A combination of hysteroscopy and laparoscopy can be used to clarify the location of pregnancy,followed by pregnancy lesion resection.

Objective To compare the safety and adverse effects of esketamine alone or fentanyl combined with propofol for interventional occlusion of congenital heart disease in children,so as to provide a more suitable sedation and analgesia plan for these patients.Methods A prospective randomized controlled study was adopted.A total of 104 cases of congenital heart disease,including 53 cases of atrial septal defect(ASD),31 cases of ventricular septal defect(VSD),and 20 cases of patent ductus arteriosus(PDA),who underwent interventional occlusion under general anesthesia while preserving spontaneous breathing from January to March 2025,were taken as the research subjects.The children were divided into two groups by random number table method:esketamine group(group ES)and fentanyl+propofol group(group AP),with 52 cases in each group.The children in the group ES and the group AP were anesthetized by esketamine 0.5 mg/kg and fentanyl 2 ug/kg+propofol 2.5 mg/kg,respectively,and sevoflurane inhalation anesthesia was maintained during the operation.The mean arterial pressure(MAP),heart rate(HR),respiratory rate(RR)and pulse oxygen saturation(SpO2)were recorded at the time of entry(T0),1 min after induction of general anesthesia(T1),femoral artery puncture(T2),occluder insertion(T3),recovery(T4),and 10 min after recovery(T5).The operation time,dosage of sevoflurane,anesthesia induction time and recovery time of the two groups were recorded.The occurrence of adverse events during general anesthesia was recorded,including hypoxemia after general anesthesia induction,respiratory depression and intraoperative body movement,restlessness during the recovery period,and increased secretion during the recovery period.Results There were significant differences in MAP,HR,SpO2 and RR in time points within each group,between two groups,and across the time×group interaction(P<0.05).There was no significant difference in operation time,dosage of sevoflurane,anesthesia induction time,and recovery time between the two groups(P>0.05).The incidence of hypoxemia in the group ES was significantly lower than that in the group AP[1.9%(1/52)vs.28.9%(15/52),χ2=14.477,P=0.000],the incidence of respiratory depression in the group ES was significantly lower than that in the group AP[0.0%(0/52)vs.11.5%(6/52),P=0.027],and the incidence of intraoperative body movement in the group ES was significantly lower than that in the group AP[0.0%(0/52)vs.11.5%(6/52),P=0.027].Conclusions During the three interventional occlusion procedures for congenital heart disease in children,compared with fentanyl combined with propofol injection,esketamine can better maintain the stability of respiratory circulation,and has a lower incidence of adverse events such as intraoperative hypoxemia,respiratory depression and intraoperative body movement.Compared with traditional anesthetic drugs,eketamine can be used as a better choice for sedation and analgesia during interventional occlusion for the three types of congenital heart diseases in children.

Objective To explore the clinical efficacy of membrane anatomy in laparoscopic radical resection of rectal cancer.Methods A retrospective cohort study was conducted,involving 33 patients who underwent laparoscopic radical resection of rectal cancer guided by membrane anatomy(observation group)from April 2023 to April 2024,compared with 35 patients who underwent traditional total mesorectal excision(control group)from March 2022 to March 2023.Surgical indicators(duration of surgery,intraoperative blood loss,and number of lymph nodes dissected)and postoperative recovery were compared between the two groups.Results There was no statistically significant difference in the operation time between the two groups[(173.8±14.7)min in the observation group vs.(179.1±15.3)min in the control group,t=-1.437,P=0.156].There were also no statistically significant differences in the postoperative hospital stay[(9.4±1.4)d vs.(9.8±2.4)d,t=-0.859,P=0.394]and in the incidence of various complications[12.1%(4/33)vs.20.0%(7/35),χ2=0.778,P=0.378].The intraoperative blood loss in the observation group was significantly less than that in the control group[(34.6±10.8)ml vs.(81.0±14.3)ml,t=-15.156,P=0.000].The number of lymph nodes dissected in the observation group was significantly higher than that in the control group(19.8±1.3 vs.12.4±1.9,t=18.684,P=0.000).The time to first flatus after surgery in the observation group was shorter than that in the control group[(50.4±6.5)h vs.(55.2±8.9)h,t=-2.557,P=0.013].The postoperative drainage time in the observation group was shorter than that in the control group[(5.9±1.1)d vs.(6.5±1.0)d,t=-2.532,P=0.014].A total of 66 cases were followed up for 8-39 months,with a median time of 25 months.The observation group had no metastasis,local recurrence,or death,while the control group had 1 case of liver metastasis,1 case of local recurrence,and 1 case of death from other systemic diseases.Conclusions The application of membrane anatomy in laparoscopic radical resection of rectal cancer can ensure complete mesorectal excision,expand the surgical field of view,minimize intraoperative bleeding,and enhance the thoroughness of lymph node dissection,thereby improving surgical quality.However,it fails to shorten the operation time.