Objective To explore the effects of micro channel (mPCNL)and standard channel percutaneous lithotripsy (sPCNL)on hemodynamics and blood gas analysis in patients with renal calculi.Methods From March 2007 to June 2015,180 patients with kidney stones were selected as the research subjects,through digital said method,the patients were randomly divided into MPCNL group and sPCNL group,the former F16 plastics through established channels of percutaneous nephrolithotomy.The latter F24 plastics through established channels of percuta-neous nephrolithotomy.The changes of hemodynamics and blood gas analysis were observed and compared in the two groups during perioperative period .Results In MPCNL group ,theoperation time was significantly shorter in sPCNL group(t =-6.018),the perfusion fluid was higher than that of sPCNL group(t =20.506,P <0.05).The perfusion of MAP and CVP of the two groups were significantly lower than those before anesthesia,and irrigation flow after dif-ferent time and postoperative were significantly higher than those before hemoperfusion,60 min,120min,after opera-tion MAP value of MPCNL group,test value was as follows(t60min =5.878,t120min =6.802,tpostoperative =7.070,all P <0.05);60min,120min,after operation CVP value of MPCNL group,test value was as follows (t60min =5.987,t120min =6.505,tpostoperative =7.180,all P <0.05).60min,120min,postoperative MAP value of sPCNL group,test value was as follows (t60min =5.613,t120min =7.238,tpostoperative =7.170,all P <0.05);60min,120min,postoperative the CVP value of sPCNL group,test value was as follows (t60min =7.682,t120min =7.135,t[postoperative]=9.218,all P <0.05). Blood gas analysis showed that the two groups of postoperative Na +,Cl - compared with before anesthesia had no sta-tistically significant difference(P >0.05).Two groups of postoperative K +,pH,BE,Hb were lower than before anes-thesia,the differences were statistically significant (P <0.05).The two groups of patients with no postoperative urina-ry sepsis and other serious complications.Conclusion With the increase of operation time filling fluid absorption on hemodynamics and arterial blood gas analysis of influence gradually increased;in heart,lung and normal renal function patients,due to the compensatory organ function,caused by MPCNL and sPCNL irrigation fluid absorption differences in the amount is not enough to cause different hemodynamics and blood gas analysis.

Objective To identify the routes and branches of the proper plantar digital nerves(PPDN) in the medial of the great toe and its adjoining relationship among the surrounding fascia tissues and organs,which was expected to provide accurate localization of the nerve impingement and possible relevant of anatomical basis for the treatment of nerve entrapment in clinical utility.Methods From December,2016 to January,2019,a total of 54 formalin fixed feet were collected.Fifty of them were performed conventional anatomical procedure,the other 4 were prepared with sectional anatomical technique.The seats and branches of the PPDN in the medial of the great toe were observed;The width and thickness of the nerve were measured at the first metatarpophalangeal joint(FMPJ),along with its proximal and distal sides 0.5 cm.The origin and origin of fascia were observed by foot dissection.Masson staining was used to observe the tissue changes of the nerves in the FMPJ.Results The PPDN of the medial great toe run between the flexor pollicis longus tendon and the abductor pollicis tendon at the proximal,issued (4.21±0.12) final branches.And governed the sensation of the medial half of the great toe.The width of the nerve at the FMPJ was (3.50±0.09) mm,which was significantly increased compared with that of the near [(1.58±0.04) mm] and far [(1.56± 0.03) mm] from the joint.The difference was statistically significant (P＜0.05);The thickness of the nerve in the proximal segment was (0.83±0.04) mm,and that in the distal segment was (0.82±0.03) mm.Compared with that in the FMPJ [(0.67±0.02) mm],the difference was statistically significant (P＜0.05).A deep fascia was observed on the superficial surface of the PPDN at medial great toe,which was stretched between the tendon sheath of the flexor pollicis longus tendon and the tendon of the abductor pollicis muscle.Masson staining showed obvious proliferation of nerve outer mem brane fibers at the metatarpophalangeal joint,the number of nerve fiber bundles increased,and obvious thickening of nerve fiber bundles and nerve fascia.Conclusion Long-term compression can lead to thickening of the epineurium and perineurium,and the superficial fascia is an important factor of thumb pain and numbness caused by the compression of the PPDN at medial of the great toe.

Objective To investigate the anatomical structure of the first plantar lumbrical muscle in the foot and to measure the relevant data which could provide anatomical basis for repairing thumb and finger defects with the transplantation of toes accompanied with the first lumbrical muscle,and to explore the marphological function of the first lumbrical muscle of the foot.Methods From March,2016 to January,2018,a systematic and detailed dissection of the 50 formalin-fixed feet was performed to observe the exact position of the starting and ending points of the first lumbrical muscle,and a Vernier caloper was used to measure the relevant record data.Results The first lumbrical muscle originates from the medial portion of the flexor digitorum lungus tendon of the second toe,and the length of the ventral muscle was [55.87±8.67(79.30-41.16] mm.There were 2 endpoints in the tendon.The first one was in the medial tubercle of the proximal phalanges.The second one was aponeurosis of the dorsal toe and the tendon was divided into proximal and distal segments with the medial tubercle as the mark point.The length of the proximal segment was [15.34±4.81(5.52-25.18] mm,the width of the proximal segment was [2.31±1.12(3.28-1.21)] mm,the thickness was [0.44±0.14(0.28-0.68)] mm;the length of the distal segment was [11.51±4.06(3.46-14.90)] mm,the width was [6.10±1.44(9.36-3.70)] mm,and the thickness was [0.18±0.09(1.10-0.38)] mm.The length and thickness of the proximal segment was signifantly larger than those of the distal segment (P＜0.05).Conclusion The first lumbrical muscle has the function of maintaining the balance and stability of both the toe and the arch during movement,flexuring the metatarsophalangeal joint,extending the interosseous joint of the extensor phalangeal,adducting the second toe;also the function of preventing the second toe from pronation during foots' movement.