Objective To explore the causes,management and prevention of major blood vessel injury during urological laparoscopic surgery.Methods Six cases of major blood vessel injuries happened in 1700 laparoscopic surgeries from January 2007 to July 2011.All of the cases were males.Patient age was (53 ± 14) years.There were 4 extraperitoneal and 2 transperitoneal procedures including 3 adrenalectomies,1 radical cystectomy,1 radical prostatectomy and 1 radical nephrectomy.There were lacerations in 3 cases of vena cava,2 cases of external iliac vein and one case of renal vein.The length of laceration was (0.68 ±0.29) cm and blood lost was (114 ++ 79) ml.Results Five of the patients were managed with laparoscopic techniques by suction compressing bleeding sites,dissecting related vessels,adding extra trocar and repairing laceration by suturing in four cases and clipping bleeding site in one case.The bleeding control management lasted (21.0 ± 5.6) min.One laparoscopic adrenalectomty for the treatment of pheochromocytoma converted to open surgery because of increasing blood pressure.All the patients were followed up for (4 ± 2) months.No more related complication occurred.Conclusions Lymph node dissection,local adhesion and energy source are the main causes for blood vascular injuries.This kind of injuries may occur at any stages during a laparoscopic surgery and laparoscopic repairing is safe and feasible.

Objective:To explore the influence of patient-controlled intravenous analgesia(PCIA)with morphine on early post-operative cognitive function in the elderly patients undergoing abdominal surgery with target control infusion(TCI)/total intra-venous anesthesia(TIVA).Methods:A total of 120 patients matched with the inclusion criteria were randomly divided into PCIA group with morphine(n=60)and control group(n=60).All the patients underwent abdominal operation with TCI/TI-VA.Pain intensity at 24 h and 48 h after the operation were evaluated by visual analogue scale(VAS).Mini-mental state examination(MMSE)scores were recorded at 24 h before the operation and 24 h,48 h,72 h after the operation,in order to as-sess cognitive function and incidence of POCD.Results:Scores of VAS in PCIA group were significantly lower than those in control group at 24 h and 48 h after the operation(P <0.01).The incidence of postoperative cognitive dysfunction(POCD)at 72 h after the operation in PCIA group was lower than that in the control group (P <0.05),and recovery of postoperative cog-nitive function in PCIA group was better than that in the control group(P <0.05).Conclusions:PCIA with morphine could re-duce the incidence of POCD in the elderly patients undergoing abdominal surgery and improve postoperative cognitive function.