Objective: To improve the safety of anesthesia of the neonates at high risk during surgical operation. 　Methods:Before the operation, Anisodamine, Ketamine and Vecuronium bromide were injected intravenously with dosage of 0.06mg, 2mg*kg-1 and 0.08-0.1mg*kg-1, respectively. Tracheal cannula or topical anesthesia using 1% of lidocaine hydrochloride was performed. The tracheal cannulation was performed after administration of sodium hydroxybutyrate and Ketamine by injection with dosages of 50-80 mg*kg-1 and 2mg*kg-1 body weight. Anesthesia apparatus and combinative anesthesia were used. The concentrations of SpO2 were monitored during the operation. A dosage of 1-2mg*kg-1 body weight was used for resuscination of the patients after the operation. 　Results: A total of 100 cases of operation were performed using the regime of anesthetic intervention described above. A 100% of success rate was achieved and no death occurred during the operation. 　Conclusion:Significant improvement of safety in anesthesia of the neonates at high risk during surgical operation can be achieved with sufficient preoperational preparation, adequate monitoring during the operation and rational use of anesthetics as well as restrict selection of suitable anesthetical interventions.

Objective To explore the value of application of choledochofiberscopy in the diagnosis and treatment of the extrahepatic bile duct disease, and the effect on reducing the incidence of the postoperative residual stone in biliary ducts. Methods According to the case history and ultrasonography,if the common bile duct(CBD) diseases suspected,the CBD was explored by intraoperative choledochofiberscope(IOCF). During the procedure,a biliary passage mirror inducer apparatus and biliary tract probe which were manufactured by ourselves were used. Results During LC,IOCF was performed on 385 cases of the 10 396 LC cases,and possitive findings were dicovered in 102 cases(26.49%). Among those positive patients, 67 cases belonged to stricture of the lower biliary tract; 5 cases were Mirizzi syndrome; 2 cases were carcinoma of the periampulla; 1 case was primarily carcinoma of the bile duct; 1case was ascarisis of the biliary system. Conclusions IOCF is a good inspect technique with high success rate and clear image of bile duct, it can discover the common duct diseases which are difficult to be diagnosed through the routine examination.At the same time, it can provide the locative and qualitive diagnosis, determine reasonable methods of operation,and effectively provent postoperative complications.

With the aim of further understanding of the nerve supply of the Iumbodorsal region,and its relation to the pathogenesis of lumbago and lumbocrural pain,the superior chnial nerves of lilty adult Chinese cadavers were dissected. In the present study,it was shown that the superior clunial nerve consists of lateral branches of the posterior rami of spinal nerves rarying from T_(12)L_(1～5)and S_1 segments. The contribution of these branches to this nerve is as follows,T_(12):40 cases,L_1 and L_2: 100 cases each,L_3:96 cases,L_4:48 cases,L_5:11 cases,and S_1:4 cases.Our observation revealed the fact that the posterior rami of L_(4,s)spinal nerves consist of a lot of lateral cutaneous branches,which is not in accordance with embroyological descriptions cited in literature which deny their existence. Basing on our data,we classify the superior clunial nerve into 4 types,Viz:one- branched:1 case;two-branched:15 cases;three-branched:66 cases;and four-branched:18 cases. More than one half of the medial and the most medial branches of the superior clunial nerves perforate through the deep surface of the attachment of the posterior layer of the lumbodorsal fascia on to the iliac crest,and enter the superficial fascia of the buttock.During acute wriggle of the loin,the firm fixation and tight stretching of the perforating branches by this attachment may cause partly the injury of the branches. The crossing point of the lateral margin of the sacrospinalis muscle and iliac crest or the area slightly medial to this point is the site where the perforating superior clun- ial nerve could be localized supeficialiy.

A total of 120 patients with Ⅲ/Ⅳ degree hemorrhoids were randomly divided into 3 groups.Self-made drainage(A group),traditional device(B group)and stuffing(C group) were used at the end of operation.The patient postoperative complications and satisfaction were observed and compared.The results showed that postoperative abdominal distension,pain,medical dressing dampness and satisfaction were better in A group than those in B and C groups(all P ＜0.01).Postoperative abdominal distention in B group was lighter than that in C group and medical dressing dampness less in C group than that in B group (all P ＜ 0.01).Thus the self-made drainage device may reduce the levels of postoperative abdominal distension,pain and medical dressing dampness and increase postoperative patient satisfaction.

Objective To investigate the clinical features of patients with multiple sclerosis (MS) and restless legs syndrome (RLS) and to further examine relevant factors that may contribute to the co-occurrence of MS and RLS.Methods Seventy MS patients were recruited in the present study.The RLS screen was further performed in MS patients based on the diagnostic criteria for RLS.MS patients with RLS were designated as the case group and MS patients without RLS served as the control group.The clinical data including age of MS onset,MS duration and clinical disability by the expanded disability status scale (EDSS) were analyzed.Results There were 12 MS patients with RLS in total 70 MS patients and the incidence rate was 17.1％.The average age of MS onset in the RLS group was (47.6 ± 10.0) years,and (40.1 ± 10.4 ) years in the control group.The difference of average age of MS onset was found to be significant (t =2.29,P =0.030).The average history of MS in the RLS group was ( 12.6 ± 6.8 ) years,and ( 8.2 ± 6.6) years in the control group ( t =2.10,P =0.039).The average EDSS of the RLS group was 4.5 ±2.5,and 2.5 ±2.0 in the control group (t =3.02,P =0.004).There was no significant association between RLSRS and EDSS in MS patients with RLS (P =0.15).Conclusion The incidence rate of RLS in MS patients was high.Among patients with MS,RLS was associated with older age,longer MS duration,and more severe disability.

Objective To study the clinical efficacy of bilateral double Z plasties for correction of the webbed neck defects, and to explore its principle and superiority to other reported methods. Methods We designed a small Z plasty over the mastoid with a rhomboidal skin resection of infra-hairline, and another large Z plasty transposition skin flap in superior-acromion. The tight band of fibrous webbing was separately cut and undermined at infra-mastoid and midclavicular line, wherein the middle part of the band retracted medially.Results It involved narrow tunneled anterolateral skin undermining and minimal skin resections from the nape of the neck, and posterior rhomboidal skin excision avoided the unnatural and noticeable lateral scars with normal skin extended in the middle of the webbing.The resultant scar was hidden and mild with no hypertrophic scars. A total of 5 cases were repaired, in which 1 case was male, 4 others were females. Follow-up for 1 to 11 years showed that the appearance and function in the repaired sites by using the bilateral double Z-plasties for repair of webbed neck deformity were very satisfactory. Conclusion We propose the use of this technique for correction of webbed neck deformities with simplified manipulation and cosmetic effect.

Objective To investigate the value of oral and intravenous contrast enhanced ultrasonography-double contrast ultrasonography (DCUS) in the evaluation of differentiation degree of gastric cancer. Methods Fifty-three patients who had been diagnosed as gastric cancer by gastroscope and confirmed by pathology after operation were examined by DCUS, and they were divided into moderately to well differentiated group and poorly differentiated group. The correlation of size and enhancement features of the lesions was compared with differentiation degree of gastric cancer. Results The size and enhancement distribution of lesions were markedly correlated with the degree of differentiation. The baseline intensity(BI)in poorly differentiated group was lower than that in well and moderately differentiated group[(0.52±1.12)dB vs (1.53±1.87) dB, P<0.05], but enhanced intensity(EI) was higher than that in the second group [(26.22±3.69)dB vs (23.69±5.02)dB, P<0.05]. Conclusions DCUS could initial evaluate the degree of differentiation of gastric cancer before operation.

Objective To observe the changes of serum potassium concentration in rectal cancer patients from the admission to before the operation,to provide clinical evidence for preventing serum potassium disorder during and after their operation.Methods Monitoring of the changes of serum potassium concentration of 40 cases of rectal cancer patients according to three time points including the first day of admission,before taking of cathartics and the morning before operation.They were divided into different groups according to their age(young,middle age and elderly group),gender(male and female group),diet(normal,decreased slightly and serious decline group) and course(long,middle and short course group) of disease.The serum potassium concentration was observed between each time point of each group and SPSS13.0 statistical software was used to analyze the changes above.Results The mean of all patients' serum potassium concentration was (4.09 ± 0.62) mmol/L on the first day of admission,was (3.83 ± 0.46) mmoL/L before taking of cathartics that was decreased compared to the former and there was significant difference (P ＜ 0.01),it was (3.36 ±0.40) mmol/L on the morning of operation and had significant difference with the above two groups (P ＜ 0.01).It hadn't significant difference between different gender and age groups at different time points (P ＞ 0.05) except between the young group and the elderly group in the morning of the operation (P ＜ 0.05).There were statistically significant differences between the different diet condition and different course at anytime point (P ＜ 0.01).Conclusions The rectal cancer patients were possiblely in hypokalemia before operation,the causes might be relative to the long course of disease,the decreased diet,the aged and infirm,the diet structure change after admission and taking cathartics cleaning intestinal tract.

Objective In order to provide clinical evidence of reducing postoperative complications of procedure for prolapse and hemorrhoids and observe the effects of constipation on postoperative complications of procedure for prolapse and hemorrhoids.Methods One hundred and sixty cases of hemorrhoid were divided into two groups according to whether suffering from constipation:there were eihgty cases who were suffered from constipation in the experimental group and eighty cases who were not suffered from constipation in the control group.All patients' postoperative bleeding,anal edema,stool impaction and satisfaction were observed within 30 days and these data were compared and analysed by using SPSS 13.0 software.Results In the experimental group,the postoperative bleeding incidence was 37.5 ％ (30/80),the anal edema incidence was 31.3 ％ (25/80),the stool impaction inci dence was 8.6％ (7/80),and the patients' satisfaction rate was 88.6％ (71/80).In the control group,the postoperative bleeding incidence was 18.6％ (15/80),the anal edema's incidence was 15.0％ (12/80),the stool impaction incidence was 1.3％ (1/80),and the patients' satisfaction rate was 97.5％ (78/80).All the indexes above were different statistically in the two groups (P ＜ 0.05).Conclusion constipation could increase complications and reduce the degree of satisfaction after procedure for prolapse and hemorrhoids.

Objective To compare the efficacy of ureteroscopic lithotripsy(URL)combined with occlusion device and the supine and lithotomy position mini-invasive percutaneous nephrolithotomy(mPCNL)in the treatment of upper incarcerated ureteral stones. No difference could be found in age,sex and size of stones between the two groups. Method From Jan. 2014 to Dec. 2016 in our hospital,all cases of upper incarcerated ureteral stones were diviede into two groups:52 in ureteroscopic lithotripsy combined with occlusion device group and 45 in mini-inva-sive percutaneous nephrolithotomy group. Result The hospitalization and operation time in URL group were(5.5 ± 1.4)days and(53.3 ± 12.4)mins,which were significantly shorter than that in mPCNL group with(9.1 ± 3.2)days and(78.2 ± 14.1)mins,(P<0.05). There were no differences between mPCNL and URL groups in the success rate of operation(97.8% vs 94.2%,P > 0.05),stone clearance rate(100% vs 91.8,P > 0.05)and complication rate (4.4%vs 3.9%,P>0.05). Conclusion URL combined with occlusion device can obtain satifactory results as well as the supine and lithotomy position mPCNL in the treatment of upper incarcerated ureteral stones.