Objective:To explore the effects of ropivacaine ultrasound-guided serratus anterior plane block anesthesia on analgesia, oxygen metabolism and postoperative cognitive function in patients undergoing radical mastectomy.Methods:The study subjects were 110 patients with breast cancer treated in hospital from Sep. 2020 to Dec. 2023. They were divided into the control group ( n=55, general anesthesia) and the study group ( n=55, general anesthesia + ultrasound-guided serratus anterior plane block anesthesia) by random odd-even criteria. The analgesic effect, the level of oxygen metabolism index before and after operation, postoperative cognitive function and the occurrence of adverse reactions were compared. Results:The intraoperative dosage of sufentanil, remifentanil and propofol, and the number of analgesic pump compression within 48h in the study group were lower [ (241.82±19.82) μg, (581.42±52.77) mg, (107.22±9.81) μg, (3.47±1.02) times vs. (271.22±24.87) μg, (638.91±63.79) mg, (121.48±10.84) μg, (5.81±1.35) ], and the first time of postoperative analgesia pump was higher [ (7.59±1.44) h vs. (5.05±1.24) h], with statistically significant differences ( t=6.86, 5.15, 7.23, 10.26, 9.80; P<0.05). The visual analog scores in the study group were lower at 1h, 4h and 8h after surgery [ (1.11±0.25) points, (1.89±0.54) points, (1.65±0.45) points vs. (2.17±0.49) points, (2.68±0.64) points, (2.33±0.64) points], with statistically significant differences ( t=14.29, 7.00, 6.45, P<0.05). The difference of arterial-carotid vein oxygen content between the time of the beginning of operation and 1h after surgery in the study group was lower [ (37.22±2.22) ng/L, (34.89±1.86) ng/L vs. (42.77±2.05) ng/L, (42.77±2.05) ng/L], while carotid venous blood oxygen content and cerebral oxygen uptake rate were higher [ (94.32±2.78) ng/L, (97.39±2.64) ng/L, (37.26±2.31) %, (44.76±2.54) % vs. (81.82±1.35) ng/L, (89.53±2.04) ng/L, (42.86±2.06) %, (47.58±2.15) %], with statistically significant differences ( timmediately after the surgery =6.81, 8.12, 10.26, t1h after the surgery =12.54, 7.34, 10.54; P<0.05) ; The cognitive function scores in the study group at 1 and 7 days after surgery were higher [ (24.78±2.59) points, (26.35±1.84) points vs. (20.36±2.14) points, (24.66±1.57) points], with statistically significant differences ( t=9.76, 5.18, P<0.05). The incidence of adverse reactions was 5.46% in the study group and 18.18% in the control group, and the difference was statistically significant ( χ2 value=4.27, P<0.05) . Conclusion:Ropivacaine ultrasound-guided serratus anterior plane block anesthesia can improve the analgesic effect of breast cancer patients, ensure the balance of oxygen metabolism in brain tissue, and reduce the cognitive function damage of patients, and has excellent clinical application value.

Objective:To investigate the clinical efficacy of laparoscopic radical resection of hilar cholangiocarcinoma (LRHCCA).Methods:The retrospective and descriptive study was constructed. The clinicopathological data of 211 patients who under LRHCCA in the Second Hospital of Hebei Medical University from May 2014 to June 2022 were collected. There were 135 males and 76 females, aged (63±8)years. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M( Q1, Q3) or M(range). Count data were described as absolute numbers or percentages. The Kaplan-Meier method was used to calculate survival rate and draw survival curve. Results:(1) Surgical situations. All 211 patients underwent LRHCCA successfully, with the operation time as 350 (300,390)minutes, volume of intraoperative blood loss as 400(200,800)mL, and intraoperative red blood cell transfusion as 2.0(range, 0-15.0)U, respectively. As partial portal vein invasion, 10 of 211 patients underwent portal vein resection and reconstruction. Results of intraoperative histopathology examination showed negative margin of portal vein. The operation time, volume of intraoperative blood loss, intraopera-tive red blood cell transfusion of the 10 patients was (400±53)minutes, 1 200(range, 800-3 000)mL, 5.5(range, 4.0-15.0)U, respectively. (2) Postoperative situations. Of the 211 patients, there were 63 cases of the Bismuth type Ⅰ, 65 cases of the Bismuth type Ⅱ, 22 cases of the Bismuth type Ⅲa, 26 cases of the Bismuth type Ⅲb, 35 cases of the Bismuth type Ⅳ. The R 0 resection rate was 95.73%(202/211). There were 202 patients identified as adenocarcinoma of the bile duct, including 7 cases with poorly differentiated tumor, 189 cases with moderate to poorly differentiated tumor, 3 cases with moderate to well differentiated tumor, 3 cases with well differentiated tumor. There were 8 patients with poorly differentiated biliary mucinous adenocarcinoma, 1 patient with intraductal papillary neoplasm with high-grade epithelial dysplasia. There were 24 cases of stage Ⅰ, 98 cases of stage Ⅱ, 30 cases of stage ⅢA, 34 cases of stage ⅢB, 19 cases of stage ⅢC, 6 cases of stage ⅣA. Of the 211 patients, there were 25 cases with postoperative biliary fistula, 11 cases with postoperative abdominal infection, 3 cases with postoperative bleeding as anastomotic bleeding after biliary fistula, 2 cases with postoperative gastric emptying disability, 1 case with postoperative acute liver failure. There were 7 patients undergoing postoperative unplanned reoperation, including 3 cases with emergency operation for hemostasis, 4 cases with abdominal exploration debridement and drainage for severe abdominal infection. There were 3 cases dead during perioperative period, including 1 case of acute liver failure, 1 case of systemic infection and multiple organ failure, 1 case of exfoliated deep venous thrombosis of lower extremities and acute pulmonary embolism. The postoperative duration of hospital stay was (15±5)days of the 211 patients and (17±4)days of patients undergoing portal vein resection and reconstruction. The cost of hospital stay of the 211 patients was (11.7±1.7)ten thousand yuan. (3) Follow-up. Of the 211 patients, 188 patients were followed up for 21(range, 4?36)months. The median survival time of 188 patients was 22 months, and the postoperative 1-, 2- and 3-year survival rate was 90.9%, 43.1% and 18.7%, respectively. Conclusion:LRHCCA is safe and feasible, with satisfactory short-term effect, under the coditions of clinicians with rich experience in laparoscopic surgery and patients with strict surgical evaluation.