Objective:To study the correlation between pneumoperitoneum pressure, level of blood uric acid (UA) and postoperative cognitive function in elderly patients undergoing laparoscopic cholecystectomy (LC).Methods:One hundred and one patients from December 2018 to December 2019 in Wuhu First People′s Hospital of Anhui Province were selected. According to average value of intraoperative pneumoperitoneum pressure, the patients were divided into low pressure group (intraoperative pneumoperitoneum pressure<11.2 mmHg, 1 mmHg = 0.133 kPa; 50 cases) and standard pressure group (intraoperative pneumoperitoneum pressure ≥ 11.2 mmHg, 51 cases). According to preoperative average level of preoperative blood UA, the patients were divided into low-level UA group (UA<324.1 mmol/L, 50 cases) and high-level UA group (UA≥324.1 mmol/L, 51 cases). The cognitive function 24 h after surgery was assessed by mini-mental state examination (MMSE) scale and Loewenstein occupational therapy cognitive assessment (LOTCA) scale. The correlation between pneumoperitoneum pressure, level of blood UA and cognitive function was analyzed by Pearson correlation analysis.Results:There were no statistical differences in recovery time of spontaneous breathing, recovery time and extubation time between standard pressure group and low pressure group ( P>0.05); the recovery time of orientation in low pressure group was significantly shorter than that in standard pressure group: (12.54 ± 2.41) min vs. (14.65 ± 2.88) min, the postoperative MMSE score and LOTCA score were significantly higher than those in standard pressure group: (25.12 ± 2.03) scores vs. (20.84 ± 2.42) scores and (96.24 ± 6.54) scores vs. (85.15 ± 5.12) scores, and there were statistical differences ( P<0.01). The postoperative MMSE score and LOTCA score in high-level UA group were significantly higher than those in low-level UA group: (24.76 ± 2.53) scores vs. (21.12 ± 2.06) scores and (94.86 ± 6.18) scores vs. (86.34 ± 5.27) scores, and there were statistical differences ( P<0.01). The Pearson correlation analysis result showed that pneumoperitoneum pressure was negative correlation with MMSE score and LOTCA score ( r = -0.544 and - 0.615, P<0.01); while UA level was positive correlation with MMSE score and LOTCA score ( r = 0.433 and 0.405, P<0.01). Conclusions:The carbon dioxide pneumoperitoneum pressure and UA level are related to postoperative cognitive function in elderly LC patients. The postoperative cognitive function is relatively better in patients with lower intraoperative pneumoperitoneum pressure and higher preoperative UA level.

Objective The purpose of this study is to explore the clinical efficacy of laparoscopic transabdominal anterior peritoneal hernia repair(TAPP)in the treatment of inguinal hernia in elderly male patients,and to analyze the factors influencing postoperative recurrence.Methods A retrospective analysis was conducted on the clinical data of 93 elderly male patients admitted to our hospital for TAPP from January 2020 to June 2023.They were divided into a recurrence group and a non-recurrence group based on postoperative recurrence.Risk factors for postoperative recurrence of TAPP were analyzed through univariate analysis and logistic regression analysis.Results The proportion of hernia sac diameter≥3 cm,lower abdominal surgery history,severe hernia ring adhesion and surgery time ≥60 min in the recurrent group were significantly higher than those in the non-recurrence group(P＜0.05).Multivariate logistic analysis showed that hernia sac diameter≥3 cm,history of lower abdominal surgery,and severe hernia ring adhesion were independent risk factors for postoperative recurrence of TAPP(P＜0.05).Conclusion TAPP is a safe and reliable treatment for inguinal hernia in elderly male patients.The diameter of the hernia sac≥3 cm,a history of lower abdominal surgery,and severe hernia ring adhesion may increase the risk of postoperative recurrence in elderly male patients with TAPP.