Objective To evaluate the efficacy of the thoracic approach to thoracic paravertebral blockade ( PVB) performed via video-assisted thoracoscope on postoperative analgesia in patients undergoing lobectomy. Methods A total of 84 patients of both sexes, aged 44-64 yr, with body mass index of 19. 7-24. 9 kg∕m2 , of American Society of Anesthesiologists physical statusⅡorⅢ, scheduled for elective vide-o-assisted thoracoscopic unilateral lobectomy, were divided into 2 groups ( n=42 each) using a random number table method: thoracic PVB group (TP group) and control group (C group). In TP group, the thoracic approach to thoracic PVB was performed on the affected side via video-assisted thoracoscope before closing the chest, and 0. 375％ ropivacaine hydrochloride 20 ml was injected. Then patient-controlled intra-venous analgesia ( PCIA) was performed in both groups. PCIA solution contained dezocine 0. 6 mg∕kg, flurbiprofen axetil 200 mg, palonosetron 0. 5 mg and dexamethasone 10 mg in 120 ml of normal saline. The PCA pump was set up with a 0. 5 ml bolus dose, a 15 min lockout interval and background infusion at a rate of 2 ml∕h after a loading dose of 5 ml. Duration of operation was recorded. The peak expiratory flow rate ( PEFR) was recorded before surgery and at 6, 24 and 48 h after surgery. The amount of dezocine and pressing times of PCA were recorded at 24 and 48 h after surgery. The occurrence of drowsiness, dizziness, nausea and vomiting was recorded after surgery. Tramadol 2 mg∕kg was intravenously injected as rescue an-algesic when visual analog scale score≥4 points. Results Compared with group C, the amount of dezo-cine and pressing times of PCA were significantly reduced at 24 and 48 h after surgery, the requirement for rescue analgesia and incidence of nausea and vomiting were decreased, and the PEFR was increased at 6 h after operation in group TP ( P<0. 05) . Conclusion The thoracic approach to PVB performed via video-assisted thoracoscope can enhance the efficacy of postoperative analgesia in patients undergoing lobectomy.

[Objective] To summarize the clinical manifestations, pathological characteristics, treatment options and prognosis of the world's first case of prostate ductal adenocarcinoma (PDA) complicated with prostate mucinous adenocarcinoma (PMA). [Methods] The clinical and follow-up data of a patient with PDA and PMA treated in Zhongnan Hospital of Wuhan University were retrospectively analyzed, and relevant literature in PubMed and CNKI databases was retrieved. [Results] The patient sought medical attention due to dysuria, frequent urination, urinary urgency and urinary pain for more than half a year, and was admitted to hospital 3 times in total.The initial diagnosis upon the first admission was benign prostatic hyperplasia complicated with prostatic abscess.After 2 months, the patient was readmitted due to worsening symptoms, received transurethral bladder neck incision+ cystoscopy+ transurethral plasma resection of the prostate, and postoperative diagnosis confirmed PDA with local PMA.Three months after surgery, the patient had bleeding.After auxiliary examinations revealed extensive metastasis, he received hormonal therapy.After 9 months, the patient died due to multiple lung metastases. [Conclusion] Early diagnosis has a significant impact on the treatment and prognosis, but there have been no previous reports of PDA combined with PMA, so the lack of specific biomarkers in the early stage has led to missed diagnosis or misdiagnoses.There is no specific treatment for PDA with PMA. Radical prostatectomy was not satisfactory in the treatment of this case.