Objective To explore the effect of different ventilation modes during laparoscopic radical resection of colorectal cancer(LRRCC)on respiratory function in patients with complicated mild obstructive ventilatory disorder(OVD).Methods 68 patients with mild OVD who underwent elective LRRCC from June 2022 to March 2024 were randomly divided into a volume controlled ventilation(VCV)group(n=34,with intraoperative VCV)and a pressure controlled ventilation-volume guaranteed(PCV-VG)mode group(n=34,with intraoperative PCV-VG).Changes in hemodynamics[mean arterial pressure(MAP)and heart rate(HR)],blood gas indicators[partial pressure of carbon dioxide in arterial blood(PaCO2)and arterial partial pressure of oxygen(PaO2)],lung exchange function indicators[oxygenation index(OI),alveolar-arterial oxygen partial pressure difference(PA-aO2)],respiratory mechanics indicators[tidal volume,end-tidal carbon dioxide partial pressure(PetCO2),peak airway pressure(Ppeak),and dynamic lung compliance(Cldyn)]before pneumoperitoneum(T1),30 min after establishing pneumoperitoneum(T2),1 h after pneumoperitoneum(T3),and 20 min after the end of pneumoperitoneum(T4)were observed in both groups.And incidence of intraoperative complications and the positive rate of postoperative pulmonary complication(PPC)in both groups were counted.Results There were no statistically significant differences in MAP and HR between the two groups at T1,T2,T3 and T4 time points(P>0.05).The PaCO2 level in both groups at T2,T3,and T4 time points was higher than that at T1 time point,but the PCV-VG group was lower than that in the VCV group,the differences were statistically significant(P<0.05).The PaO2,OI,and Cldyn in the two groups at T2 and T3 time points were lower than those at T1 time point,but the PCV-VG group was higher than that in the VCV group,the differences were statistically significant(P<0.05).The PA-aO2,tidal volume,PetCO2 and Ppeak of the two groups of patients at T2 and T3 time points were significantly higher than those at time point T1,and the differences were statistically significant(P<0.05).At T2 and T3,the PA-aO2 and Ppeak in the PCV-VG group were significantly lower than those in the VCV group,and the differences were statistically significant(P<0.05).The incidence of intraoperative complications and PPC positivity rate in the PCV-VG group were 8.82%and 2.94%,respectively,which were lower than 29.41%and 23.53%in the VCV group,the differences were statistically significant(P<0.05).Conclusion Compared with VCV,implementing PCV-VG mode during LRRCC surgery is more conducive to reducing the impacts of pneumoperitoneum on blood gas analysis,lung ventilation function,and respiratory mechanics,and reducing the incidence of complications such as hypoxemia and hypercapnia rate.It is worthy for clinical application.

Objective To investigate the effect of remimazolam on core body temperature(CBT)and thermoregulatory vasoconstriction in patients undergoing gynecological laparoscopic surgery.Methods 90 gynaecology patients with ovarian or cervical cancer from Jan 2024 to Jun 2024 were randomly divided into experimental group(group R)and control group(group C).45 patients in each group were induced and maintained with remimazolam or propofol.After induction of anesthesia,the CBT and mean skin temperature(MST)were continuously monitored using a nasopharyngeal temperature probe and a skin temperature probe respectively.Record CBT and MST of two groups of patients before surgery(T0),30 min(T1),60 min(T2),90 min(T3),120 min(T4),150 min(T5),180 min(T6)after induction of anesthesia and at extubation(T7),as well as forearm-fingertip temperature gradient(TFOR-FIN).Record vasoconstriction threshold and time to onset of vasoconstriction by TFOR-TIN.Record the changes in mean arterial pressure(MAP),heart rate(HR),and cardiac index(CI)at each time point(T0,T1,T2,T3,T4,T5,T6 and T7 time point);Record the incidence of hypothermia,hypotension and bradycardia and the use of vasoactive drugs.Results Compared with T0 time point,the CBT and TFOR-TIN at T1 to T7 time point decreased significantly,but the MST increased(P<0.05);In group C,the CBT at T1 to T5 decreased significantly than in group R(P<0.05);Compared with group C,MST in group R increased significantly at time T1 to T7(P<0.05).The vasoconstriction threshold in group R was significantly higher than that in group C,and the time to reach the vasoconstriction threshold was significantly less than that in group C(P<0.05).Compared with T0 time point,MAP and CI at T1,T2,T3 time point decreased significantly in two groups,MAP and CI at T1,T2,T3 time point in group R were higher than those in group C(P<0.05);Compared with group R,the incidence of perioperative hypothermia(PH)and hypotension and the utilization rate of ephedirine in group C were increased(P<0.05).Conclusion Remimazolam and propofol for gynecological laparoscopic general anesthesia can cause intraoperative temperature drop in patients,compared with propofol,remimazolam general anesthesia has less influence on CBT,more stable hemodynamics,less influence on thermoregulatory vasoconstriction,less degree of diastolic blood vessels,has better body temperature protection.

Objective A randomized controlled trial was conducted on colonoscopy inpatient and outpatients to compare the efficacy and safety of water exchange(WE)colonoscopy and CO2 convention insufflation colonoscopy in elderly patients.Methods 340 patients underwent fully sedated colonoscopy were randomly divided into two groups according to colonoscopy with either WE colonoscopy group(WE group)and CO2 insufflation colonoscopy group(CO2 group).The two groups were compared in terms of Boston bowel preparation scale(BBPS),withdrawal time,cecal intubation time,cecal intubation success rate,abdominal compression,willingness to repeat,polypdetectionrate(PDR),adenoma detection rate(ADR),and safety.Results The cecal intubation success rate was significantly higher in WE group(100.0%)compared with CO2 group(96.5%),the difference was statistically significant(P=0.013).The average cecal intubation time of WE group was(10.50±1.79)min,which was longer than that of CO2 group(7.55±1.50)min,and the difference was statistically significant(P<0.01).Comparison of withdrawal time and BBPS between the two groups,the differences were not statistically significant(P>0.05).The abdominal pressure rate was lower in WE group(5.9%)compared with CO2 group(13.5%),the difference was statistically significant(P=0.017).The rate of willingness to re-examination in the WE group was 98.2%,which was significantly higher than the 93.5%in the CO2 group.The PDR in WE group(80.6%)was higher than that in CO2 group(70.6%),the ADR in WE group(67.1%)was higher than that in CO2 group(50.6%),the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that WE group was an effective factor in improving ADR(O＾R=2.027,P<0.01).The overall adverse events were less than 3%,with no difference between the two groups(P=1.000).Conclusion The use of WE colonoscopy has a better improved efficacy in elderly patients,and safety should be ensured by individualized assessment of the patient's co-morbidities,bowel preparation tolerance,and willingness prior to the procedure.

Objective To study the clinical efficacy and safety of detachable titanium clip combined with rubber band intracavity dual traction assistance in endoscopic treatment of gastric submucosal tumors(SMT).Methods 52 patients who underwent endoscopic submucosal excavation(ESE)or endoscopic full thickness resection(EFR)for gastric SMT from January 2022 to July 2024 were selected.27 patients using the detachable titanium clip combined with rubber band intracavity dual traction assistance ESE or EFR were selected as experimental group,and 25 patients using the traditional ESE or EFR were selected as control group.Operation time,hospital stay,hospital cost,one time complete excavation rate and complication rates were compared between the two groups.Results The operation time and hospital stay in the experimental group were significantly shorter than those in the control group,and the hospital cost was also significantly lower,with all differences being statistically significant(P<0.05).The comparison of surgical complication rates between the two groups showed a statistically significant difference(P<0.05),with the experimental group having significantly lower total complication rates than that in the control group.However,there was no statistically significant difference(P>0.05)in the rate of one-time complete excavation between the two groups.Conclusion The detachable titanium clip combined with rubber band intracavitary dual-traction-assisted endoscopic treatment for gastric SMT significantly shortens the operation time and hospital stay,reduces hospital costs and surgical complications.It is a simple,effective auxiliary device that worthy for clinical application.

Objective To evaluate the surgical technique and clinical value of laparoscopic bladder diverticulectomy guided by inserting ureteral catheters into the diverticulum under plasmakinetic resectoscope.Methods From December 2018 to May 2024,9 patients underwent laparoscopic bladder diverticulectomy in combination with resectoscope.Each patient had a solitary bladder diverticulum with a median maximum diameter of 6.40(5.70,7.40)cm(range:5.0～8.5 cm).Among the 9 patients,3 patients had concurrent benign prostatic hyperplasia(BPH)and simultaneously underwent transurethral plasmakinetic resection of the prostate;1 patient had concurrent both BPH and bladder calculi,requiring simultaneously underwent plasmakinetic resection of the prostate and bladder calculi removal;2 patients required ureteral reimplantation as the diverticulum was directly involving the ureteral orifice;1 case underwent ureteroscopic double-J stent implantation because the opening of the ipsilateral ureter was adjacent to the entrance of the diverticulum.Results Bladder diverticulectomy was successfully performed in the all patients.Median operative time was 160.00(120.00,317.50)min(range:85～345 min).Median estimated blood loss was 20.00(10.00,150.00)mL(range:10～300 mL).No iatrogenic injuries to adjacent organs were observed.Pelvic drains were removed 1～3 d postoperatively,with no urine leakage.Urinary catheters were maintained for 7～10 d after operation.Follow-up at 3～12 months showed no recurrence or hydronephrosis in any of the patients.Conclusion Laparoscopic resection of bladder diverticula guided by ureteral catheter placed into bladder diverticula by means of resectoscope has the advantages of less trauma,less bleeding and faster recovery,and is an effective measure for the treatment of bladder diverticula.

Objective To investigate the relationship between colposcopy findings and the progression of cervical intraepithelial neoplasia(CIN)and analyze the factors of missed diagnosis in the evaluation of high-grade lesions.Methods 304 cases who underwent colposcopy-guided biopsy and were diagnosed with CIN from January 2020 to November 2023 were selected.Based on colposcopic biopsy results,patients were classified into CIN Ⅰ(103 cases),CIN Ⅱ(137 cases),CIN Ⅲ(59 cases),and early invasive carcinoma(5 cases).By comparing with postoperative pathological results from loop electrosurgical excision procedure of cervix(LEEP of cervix),high-grade cases(CIN Ⅱ and above)were further subdivided into the detected group and the missed diagnosis group.Logistic regression analysis was performed to identify factors influencing the underdiagnosis of high-grade CIN by colposcopy.Results Abnormal blood vessels and acetowhite epithelium observed during colposcopy were helpful in differentiating various grades of CIN.Although the overall concordance rate of CIN diagnosis by colposcopy-guided biopsy was relatively high,21 cases of high-grade CIN(including 14 CIN Ⅱ,5 CIN Ⅲ,and 2 early invasive carcinoma)were missed.Factors independently associated with the underdiagnosis of high-grade CIN included parity,menopause,non-staining areas with iodine<2 cm,cytological examination of low-grade squamous intraepithelial lesion(LSIL),lesion size<1/2,single biopsy specimen,and poor-quality colposcopic images(P<0.05).Conclusion Colposcopic biopsy shows a high concordance rate for diagnosing CIN across different grades.However,parity,menopause,non-staining areas with iodine<2 cm,cytological examination of LSIL,lesion size<1/2,single biopsy specimen,and colposcopic image poor-quality are identified as independent factors influencing the underdiagnosis of high-grade CIN.These factors should be considered in clinical practice to improve diagnostic accuracy.

Objectives To investigate the clinical efficacy on combined application of ear canal injected administration dispenser and triamcinolone acetonide econazole nitrate cream in the treatment of mycosis externa.Methods Clinical data of 130 patients(166 ears)diagnosed with mycosis externa from January 2023 to December 2023 were collected and randomly divided into two groups.In the observation group,65 cases(86 ears)were treated with ear canal injected administration dispenser combined with triamcinolone acetonide econazole nitrate cream,while in the control group,65 cases(80 ears)applied clean cotton swabs with triamcinolone acetonide econazole nitrate cream to the external auditory canal by themselves to treat mycosis externa.All the patients were treated for 4 weeks and followed up for half a year.The clinical efficacy,recurrence rate and adverse reactions were statistically analyzed and compared.Results The total effective rate of the observation group was 97.67%,which was significantly higher than that of the control group was 73.75%,there was a significant difference between the two groups(P<0.05).There were no obvious adverse reactions in either group.No obvious recurrence was observed in the recovered patients of both groups during the follow-up period.Conclusion The efficacy of combined of ear canal injected administration dispenser and triamcinolone acetonide econazole nitrate cream in the treatment of mycosis externa is significant.Compared with the traditional way of medicine application,the adverse reactions are less.It can improve the cure rate and reduce the recurrence rate,which is worthy in clinical application.

Objective To explore the effect of 3D printing auxiliary stent on the operation of laryngeal microsurgery instrument.Methods Auxiliary stent of suspension laryngoscope was design and 3D printed.30 standardized training residents as experimental participants were randomly divided into conventional group and auxiliary stent group(15 in each group).The pig's larynx was used as a specimen,and the vocal folds were marked with localized staining.Participants performed operation on the stained areas of the vocal folds under suspension laryngoscope(60 times of grasping in 1 h).The conventional group performed operation unaided;The auxiliary stent group performed operation with the auxiliary stent as a support.Two senior chief physicians scored the participants'stability and accuracy.Results The operational stability scale score of the conventional group and the auxiliary stent group were(5.03±4.33)and(8.99±3.42),respectively;The operation accuracy rates were 58.4%(526/900)and 78.9%(710/900),respectively.The operation accuracy rate,operation stability of the auxiliary stent group were significantly higher than those in the conventional group,and the differences were significant(P<0.01).Conclusion The auxiliary stent can significantly improve the stability and accuracy of operation,which has highly application value.

Objective To evaluate the clinical outcomes of 514 cases of anterior cruciate ligament(ACL)reconstruction using hamstring tendon autograft and to observe postoperative changes and recovery of the grafts through second-look arthroscopy.Methods This retrospective study collected data from 514 patients who underwent ACL reconstruction with hamstring tendon autograft between May 2015 and June 2018,with a follow-up of at least one year.Knee function recovery and stability were assessed using the Lysholm score,International Knee Documentation Committee(IKDC)score,and Tegner score,along with the pivot shift test and Lachman test.During the second-look arthroscopy,key observations included the synovial coverage,continuity of the reconstructed ligament,and any intra-articular abnormalities.Results The time interval between ACL reconstruction and second-look arthroscopy ranged from 12 to 28 months,with an average of 20 months.Postoperative infection occurred in 2 cases,both of which were successfully treated with arthroscopic debridement and drainage.No other patients experienced infections,graft resorption,or other complications.At the second-look arthroscopy,the Lysholm score significantly improved from(43.56±9.89)preoperative to(92.21±6.12)postoperatively,the difference was statistically significant(P<0.05);The IKDC score increased from(20.32±7.87)to(85.67±10.43),the difference was statistically significant(P<0.05);The Tegner score improved from(4.31±0.82)to(6.61±1.21),the difference was statistically significant(P<0.05).Second-look arthroscopy revealed that the ligament remained intact in 375 patients,with partial tears in 139 patients,ligament tension was maintained in 447 patients,while 67 patients had laxity,the reconstructed ACL graft was deemed to be in good condition in 435 patients and suboptimal in 79 patients,there were significant differences observed in pre-and post-pivot shift test and Lachman test(P<0.05);Among the 514 patients,188(36.58%)successfully returned to sport.Conclusion ACL reconstruction using hamstring tendon autograft effectively restores knee function and stability.In patients followed for more than one years,the grafts show good vascularization and synovial coverage.Emphasis should be placed on systematic postoperative rehabilitation to optimize recovery.

Objective To explore the changes in cervical curvature and their influencing factors after percutaneous posterior cervical endoscopic treatment for single segment cervical spondylotic radiculopathy.Methods 200 patients with single segment cervical spondylotic radiculopathy from January 2021 to March 2024 was selected,then divide them into control group and study group according to the random number table method.The control group received traditional open anterior cervical surgery,while the study group received percutaneous posterior cervical endoscopic treatment.Compare the treatment outcomes,surgical related conditions,cervical curvature and other sagittal parameters,pain levels,and cervical function between the two groups of patients.Using the generalized estimation equation(GEE)model to analyze the improvement degree of cervical curvature and other cervical sagittal parameters by two methods,and analyze the risk factors affecting changes in cervical curvature.Results The study group had significantly shorter surgical time,incision length,and hospitalization time compared to the control group.The intraoperative blood loss and hospitalization costs were also significantly lower than those of the control group,and the differences were statistically significant(P<0.05).The excellent rate of the study group was significantly higher than that of the control group,and the difference was statistically significant(P<0.05).The C2-7 Cobb angle and T1 tilt angle in the study group were significantly higher than those in the control group,the intervertebral height was significantly higher than that in the control group,and the C2-7 sagittal vertical axis(C2-7 SVA)was significantly smaller than that in the control group,with statistically significant differences(P<0.05).At three months after surgery and the last follow-up,the visual analogue scale(VAS)scores and neck disability index(NDI)of the two groups of patients were significantly lower than those before treatment,and the study group was significantly lower than the control group.At three months after surgery and the last follow-up,the Japanese Orthopaedic Association(JOA)scores of the two groups of patients were significantly higher than those before treatment,and the study group was significantly higher than the control group,with statistically significant differences(P<0.05).Intervertebral height≤8 mm(OR＾=1.627,95%CI:1.401～1.938,P=0.020),T1 tilt angle≤25°(OR＾=1.598,95%CI:1.381～1.934,P=0.027),and no percutaneous cervical endoscopic treatment(OR＾=2.591,95%CI:1.673～3.998,P=0.000)were independent risk factors affecting changes in cervical curvature.C2-7 SVA≤20 cm(OR＾=0.748,95%CI:0.601～0.928,P=0.007)was a protective factor for changes in cervical curvature.According to GEE,the improvement of C2-7 Cobb angle,intervertebral height,T1 tilt angle,and C2-7 SVA in the study group was significantly better than that in the control group,and the differences were statistically significant(P<0.05).Conclusion Percutaneous posterior cervical endoscopic treatment can significantly improve the cervical cervical curvature and cervical sagittal plane parameters of patients with single segment cervical spondylotic radiculopathy,and the treatment effect is better than traditional open anterior cervical surgery.The surgical trauma is smaller,the cost is lower,the hospital stay is shorter,and the postoperative recovery is faster.It is worthy for clinical application.