Objective:To investigate the effect and safety of sufentanil combined with propofol for intravenous anesthesia in chil-dren undergone painless gastroscopy. Methods:Totally 120 cases of children undergone painless gastroscopy were divided into the ob-servation group (60 cases) and the control group (60 cases) according to the random number method. The observation group was given sufentanil combined with propofol for anesthesia, and the control group was given fentanyl and propofol for anesthesia. The hemodynam-ic indices at the period of T0 (before the anesthesia), T1 (1 min after the anesthesia induction), T2 (checking), T3 (2min after the checking) and T4 ( at the end of testing) were compared between the groups, and the anesthesia situation, hospitalization time, dosage of propofol, fine/excellent rate of anesthesia and adverse reactions were also observed. Results:In T1, T2 and T3, the MAP ( mean arterial pressure) , HR ( heart rate) and RR ( respiratory rate) were declined in the two groups when compared with those in T0 ( P<0. 05), and those in the observation group were higher than those in the control group (P<0. 05). The time of consciousness disap-pearance, eyes open, orientation force recovery and hospitalization in the observation group was shorter than that in the control group, and the propofol dosage in the observation group was lower than that in the control group(P<0. 05) . The excellent number and rate of the observation group were better than those of the control group (P<0. 05), and the incidence of apnea of the observation group was lower than that of the control group (P<0. 05). Conclusion: Sufentanil combined with propofol for anesthesia in children undergone painless gastroscopy has the properties of fast onset and recovery, stable hemodynamic indices during the operation and high safety, which is worthy of promoted application.

Objective To review the diagnosis and treatment of primary gallbladder carcinoma in patients older than 70 years.Method The clinical data of 48 patients older than 70 years with primary gallbladder carcinoma treated in our hospital from 2003 to 2010 were retrospectively analyzed.Results The preoperative diagnostic rate was 60.4％.Of 48 patients with primary gallbladder carcinoma,9 received cholecystectomy,18 radical resection,7 extended radical resection,8 palliative operation,while the remaining 6 received biopsy because of metastasis. The 3-year survival rate was 20.8％ and the 5-year survival rate was 8.3％.Conclusions Regular B-ultrasonography,CT-scan and MRI are suggested for elderly patients with chronic diseases of the gallbladder.Radical resection is recommended if clinically possible. Chinese traditional medicine given postoperatively improved the prognosis.

OBJECTIVE:To investigate the effects of lidocaine epidural block combined with general anesthesia on postopera-tive related indexes of lung cancer patients. METHODS:In retrospective analysis,108 patients with lung cancer were divided into observation group (56 cases) and control group (52 cases) according to anesthesia method. Both groups were given intravenous dripping of Propofol injection combined with Fentanyl injection,inhaled 1%sevoflurane for inhalation to assist anesthesia and inter-mittent intravenous drip of Vecuronium for injection to maintain muscle relaxation. On this basis,observation group was treated with epidural infusion of 2.0% Lidocaine hydrochloride injection 5 mL/h to maintain anesthesia;control group was given epidural infusion of 0.9% Sodium chloride injection 5 mL/h to maintain anesthesia. The anesthesia time,operation time,intraoperative bleeding volume,postoperative recovery time,the amount of fentanyl,propofol,vecuronium bromide and sevoflurane,the occur-rence of postoperative anesthesia complications (nausea,vomiting,dizziness,drowsiness,skin itching) and other complications (cardiac function insufficiency,cardiovascular events,atrial fibrillation,infection,transient cerebral ischemia,acute coronary com-prehensive syndrome,cerebral apoplexy)were observed in 2 groups as well as active and calm VAS score 4 h and 1,2,3,4,5 after surgery. RESULTS:The anesthesia time,operation time,intraoperative bleeding volume,postoperative recovery time,the amount of fentanyl,propofol,vecuronium bromide and sevoflurane,calm VAS score 4 h,1 d,2 d after surgery and active VAS score 4 h,1 d,2 d,3 d after surgery,the incidence of drowsiness in observation group were significantly shorter or lower than control group,while the incidence of dizziness was significantly higher than control group,with statistical significance(P<0.05). There was no statistical significance in the amount of vecuronium,calm and active VAS score in other time,the incidence of nau-sea,vomiting,skin itching,cardiac function insufficiency,cardiovascular events,atrial fibrillation,infection,transient cerebral ischemia,acute coronary syndrome and stroke between 2 groups(P>0.05). CONCLUSIONS:Lidocaine epidural block combined with general anesthesia can reduce the perioperation bleeding amount,postoperative pain,shorten postoperative recovery time and do not increase postoperative complications.

Twenty five patients with incarcerated stone in distal common bile duct were treated with mini-blasting lithotrite under choledochoscope from June 2008 to September 2010.The clinical data of patients were retrospectively analyzed.The successful rate of surgery was 100％.The clearance rate of first procedure was 92％ (23/25),2 cases underwent second procedure and all were successful.There were no severe operative complications including bile duct injury,perforation,hemorrhage or bile leakage.Miniblasting lithotrite is a safe and effective method for treating incarcerated stone in distal common bile duct.

Objective:To explore the characters of CDU imaging anatomy and results of clinical application of perforating branch of median cubital vein, and to find the evidence of utilizing perforating vein to establish high level hemodialysis access.Methods:From November, 2016 to October, 2019, 150 median cubital veins in 75 persons were observed by CDU. And the inner diameter and length of the perforating branch were measured Perforating branches of median cubital vein were categorized with ultrasonic imaging anatomy. Thirty-eight chronic kidney failure patients who can not build forearm fistulas were operated by end-to-side anastomosis between perforating branch vein and brachial artery to build hemodialysis access. The blood flow of fisultas was measured,the mature period of fisultas was recorded. The length of available vessels of fisultas was measured and the long-term utilization rate of fisultas was counted.Results:Perforating branch of median cubital vein was always located in a little below elbow near brachial artery, the rate of occurrence was 94.0%. It was sent out at intersection of veins. There were 4 types of perforating vein in image-anatomy. There was no significant difference in vessel length and vessel inner diameter between different types ( P>0.05) ; All the 38 patients with mature fistulas could meet the needs of hemodialysis. The available vascular length of fistulas in type I and type II patients was better than that in type III ( P<0.01), and the long-term utilization rates of fistulas in type I, type II and type III were 84.6%, 85.7% and 72.7%, respectively. There was no significant difference in blood flow and mature period between different types ( P>0.05) . Conclusion:It is most safe and reliable to use the type I and type II of perforating branch of median cubital vein to make the high level fistulas , which can provide a safe and efficient hemodialysis access for the patients with forearm vascular drain, elderly diabetes patients and difficult fistulas with repeatedly thrombosis.

Objective To study the diagnostic value of endoscopic ultrasonography (EUS) in patients with cholangiopancreatic duct dilatation (CPDD).Methods Forty-five patients with CPDD and without any visual or detected obstructive lesions after traditional uhrasonography (US) were re-examined by EUS,CT and MRI.The diagnostic rates of EUS and the other imaging technologies were compared.Results All the 45 patients underwent successful EUS examination.Among them,there were 18 patients with periampullary tumor,10 patients with lower common bile duct stones,1 patient with pancreatic duct stones,3 patients with chronic pancreatitis,1 patient with an intrapancreatic choledochal cyst,4 patients with inflammatory strictures of papilla of duodenum and 2 patients with terminal bile duct inflammatory stenosis.However,1 patient with a lower common bile duct tumor,1 patient with a small pancreatic head carcinoma and 1 patient with sphincter of Oddi dysfunction (SOD) were not diagnosed.The diagnostic rates of obstructive lesions by US,EUS,CT and MRI were 7.1％,92.9％,33.3％,31.0％,respectively.The diagnostic rates of tumor were 10.0％,90.0％,35.0％,25.0％,respectively.As compared with the other examination methods,EUS was best in detecting small carcinoma.Conclusion EUS plays an important role in the diagnosis of lesions causing cholangiopancreatic duct dilatation.