Objective To compare the short-term efficacy and safety of transanal natural orifice specimen extraction surgery(Ta-NOSES)and conventional laparoscopic surgery in left-sided colon cancer.Methods A retrospective analysis was conducted on the clinical data of 35 patients with left-sided colon cancer admitted to the anorectal department of the hospital from January 2018 to December 2019.According to the different surgical methods,the patients were divided into experimental group(15 cases)and control group(20 cases).The observation group underwent Ta-NOSES,and the control group underwent conventional laparoscopic surgery.The perioperative related indicators,postoperative complications,postoperative pain scores,postoperative defecation control,short-term postoperative quality of life scores and 5-year postoperative follow-up of the two groups of patients were compared.Results There was no statistically significant difference in the intraoperative blood loss,stoma status and the number of lymph node dissections between the two groups of patients(P>0.05).Moreover,no permanent stoma occurred in either group of patients.The operation time of the experimental group was longer than that of the control group,the first time to get out of bed and move around,the time of the first anal exhaust,the time of the first diet intake and the hospital stay were shorter than those of the control group,the hospitalization cost was significantly lower than that of the control group,the differences were statistically significant(P<0.05).On 1 and 3 days after operation,the VAS scores of the experimental group were significantly lower than those of the control group.At 3 days after operation,the VAS scores of the two groups were significantly lower than those at 1 day after operation,and the differences were statistically significant(P<0.05).There was a statistically significant difference in postoperative Kirwan anal function grading between two groups of patients(P<0.05),with the experimental group having a better grading(higher proportion of grade Ⅰ),the control group had poor grading(with a higher proportion of grades Ⅱ,Ⅲ,and Ⅳ).There was no statistically significant difference in postoperative complications between the two groups of patients(P>0.05).The scores of each item on the Short Form-36(SF-36)in the experimental group were higher than those in the control group at 10 and 20 days after surgery(P<0.05).There was no statistically significant difference in the scores of each item on the SF-36 between the two groups at 30 days after surgery(P>0.05).The distant recurrence rate after surgery in the experimental group was 26.7％,compared with 25.0％in the control group,the difference was not statistically significant(P>0.05).There were no tumor recurrence cases with the original incision site,rectal and intestinal cavity,pelvic cavity and other specimen removal routes in both groups.The 5-year survival rate of the experimental group was 73.3％,which was not statistically significantly different from that of the control group(70.0％)(P>0.05).Conclusion Ta-NOSES in the treatment of left-sided colon cancer can alleviate postoperative pain compared with conventional laparoscopic surgery,promote the recovery of postoperative gastrointestinal function,improve the utilization rate of medical resources,reduce the economic burden of patients,improve the short-term quality of life after surgery,and does not increase the risks of postoperative complications and tumor metastasis and recurrence.It is worthy of clinical promotion and application.

Objective To explore the clinical efficacy of using 3D patches to repair inguinal hernia in laparoscopic transabdominal preperitoneal inguinal hernia repair(TAPP).Methods A retrospective study was conducted on 102 patients with inguinal hernia.All the patients were treated with laparoscopic TAPP.The patients were divided into two groups based on the different patch methods used after the surgery.The patients who used ordinary patches were in the ordinary patch group(n=50),and the patients who used 3D patches were in the 3D patch group(n=52).The surgery-related conditions,postoperative pain,postoperative complications and recurrence of the two groups of patients were compared.Results The 3D patch group had shorter surgery time,first exhaust time,got out of bed mobility time,less hospital stay and intraoperative bleeding volume than those in the ordinary patch group,the differences were statistically significant(P<0.05).On the 1,3,and 5 d after surgery,the visual analogue scale(VAS)scores of patients in the 3D patch group were lower than those in the ordinary patch group,the differences were statistically significant(P<0.05).The total complications rate in the 3D patch group was 5.77%,which was significantly lower than the 20.00%in the ordinary patch group,the difference was statistically significant(P<0.05).There was no statistically significant difference in the postoperative recurrence rate between the two groups of patients(P>0.05).Conclusion For patients with inguinal hernia,administering 3D hernia patches during laparoscopic TAPP can reduce intraoperative bleeding volume,alleviate postoperative pain,and lower the complications rate such as postoperative urinary retention,scrotal edema,and seroma.It is worthy of clinical promotion and application.

Objective To investigate the risk factors of thrombus head shedding and bleeding during endoscopic treatment of patients with esophageal varices veins,and build a risk prediction model.Methods 209 cases of esophageal varices with thrombus head found by endoscopy from February 2009 to July 2024 were retrospectively analyzed,and divided into non-shedding group(n=186)and shedding group(n=23)according to whether thrombus head shedding bleeding occurred during endoscopic treatment.Clinical and endoscopic data of the two groups were compared.Statistically significant factors were included in multivariate Logistic regression analysis and their independent risk factors were explored.A nomogram risk prediction model was constructed by R software,and its prediction efficiency was evaluated.Results Multivariate Logistic regression analysis showed that red thrombus head((O＾R)=6.231,95%CI:1.748～22.208),thrombus head diameter≥3 mm((O＾R)=4.355,95%CI:1.341～14.144),conical thrombus head((O＾R)=8.555,95%CI:2.427～30.154),and the presence of hematoma in the stomach((O＾R)=7.079,95%CI:1.665～30.103)were risk factors for bleeding after thrombus head shedding during endoscopic diagnosis and treatment.A nomogram prediction model was constructed with a sensitivity of 0.870(95%CI:0.732～1.000)and a specificity of 0.887(95%CI:0.842～0.933).Conclusion The thrombus head being red,conical in shape,with a diameter of≥3 mm and the presence of hematoma in the stomach are independent risk factors for thrombus head shedding and bleeding during endoscopic diagnosis and treatment.Timely intervention should be made for the above factors to benefit patients.

Objective To evaluate and compare the long-term efficacy of endoscopic radiofrequency ablation(RFA)and photodynamic therapy(PDT)combined with biliary stenting for the treatment of unresectable extrahepatic cholangiocarcinoma.Methods Clinical data of patients with cholangiocarcinoma who received endoscopic RFA or PDT treatment from February 2018 to February 2023 were retrospectively collected.The patients were divided into RFA group(n=30,received endoscopic RFA combined with biliary stent placement)and PDT group(n=20,received PDT combined with biliary stent placement).The frequency of treatment,stent patency time,overall survival time and adverse events incidence were counted.The factors affecting the survival time of patients were analyzed.Results The overall survival time was 14.0(95%CI:11.8～16.2)months in RFA group and 18.0(95%CI:15.4～20.6)months in PDT group,the median patency time of stent was 4.0(95%CI:2.7～5.3)months in RFA group and 3.5(95%CI:2.3～4.7)months in PDT group,the differences were not statistically significant(P>0.05).Multivariate Cox regression analysis showed that the H＾R of patients with≥2 endoscopic RFA or PDT treatments was 2.417,which was a protective factor affecting overall survival(P=0.018),while the H＾R of TNM stage Ⅲ to Ⅳ was 0.300,which was a risk factor affecting the overall survival period(P=0.002).No significant difference was found in clinical success rate(both 100.00%)and adverse events incidence between the two groups[28.13%(9/32)vs.23.81%(5/21)],the difference was not statistically significant(P>0.05).Conclusion The long-term efficacy of endoscopic RFA or PDT combined with biliary stenting in the treatment of unresectable extrahepatic cholangiocarcinoma is comparable,while the sequential treatment of endoscopic RFA or PDT≥2 times can effectively prolong the overall survival of patients.

Objective To compare the colonoscopy results of patients with positive fecal SDC2,ADHFE1,and PPP2R5C gene methylation tests to those with positive fecal occult blood tests,and analyze the effectiveness of colorectal cancer(CRC)screening.This study aims to provide a scientific basis for risk assessment in CRC screening.Methods From December 2023 to May 2024,9 284 combined test kits for SDC2,ADHFE1,and PPP2R5C gene methylation were distributed to high-risk individuals aged 40～80 years.Among them,841 patients(9.1％)tested positive.These patients were encouraged via telephone to undergo colonoscopy,with colonoscopy combined with pathological diagnosis as the gold standard,a total of 495 positive patients completed electronic colonoscopy.Among them,the 251 patients who tested positive for fecal SDC2,ADHFE1,and PPP2R5C gene methylation and completed electronic colonoscopy were the observation group;concurrently,244 patients who tested positive for fecal occult blood tests and underwent electronic colonoscopy were selected as the control group.Compare two groups of patients with polyp,number,shape,pathological changes and pathological types.Results There was no statistically significant difference in number and lesion location of polyps between the two groups of patients(P>0.05).The proportion of Yamada type Ⅰ in the observation group was lower than that in the control group,while the proportion of Yamada type Ⅱ was higher than that in the control group.The difference was statistically significant(P<0.05).In the observation group,1 case(0.4％)of CRC,62 cases(24.7％)of advanced adenomas,78 cases(31.1％)of non-advanced adenomas,20 cases(8.0％)of hyperplastic polyps,and 90 cases(35.9％)with no dysplastic lesions were identified.In the control group,6 cases(2.5％)of CRC,38 cases(15.6％)of advanced adenomas,53 cases(21.7％)of non-advanced adenomas,19 cases(7.8％)of hyperplastic polyps,and 128 cases(52.5％)with no dysplastic lesions were identified.The proportions of non-advanced adenomas and advanced adenomas were lower in the control group than those in the observation group,while the no dysplastic lesions rate was higher in the control group,the differences were statistically significant(P<0.05).Conclusion The detection rate of colorectal non-advanced adenomas and advanced adenomas is higher with fecal SDC2,ADHFE1,and PPP2R5C gene methylation testing compared to the fecal occult blood test.

Objective To explore the high-risk factors and prevention strategies for rebleeding in patients with upper gastrointestinal hemorrhage(UGIH)treated with endoscopy,and construct a predictive model.Methods 97 patients with UGIH who experienced rebleeding after endoscopic treatment from January 2020 to December 2023 were selected as the observation group,and another 178 patients with UGIH who did not experience rebleeding after endoscopic treatment admitted during the same period were selected as the control group,both groups were followed up for 1 year after endoscopic treatment.Clinical data of the two groups was compared,the high-risk factors for rebleeding after endoscopic treatment in patients with UGIH were analyzed by multivariate Logistic regression analysis,a predictive model was constructed,and the predictive value of the model for rebleeding after endoscopic treatment in patients with UGIH was analyzed by plotting a receiver operator characteristic curve(ROC curve)to analyze.Results The proportions of patients in the observation group with liver cirrhosis,shock,endoscopic active bleeding,Forrest classification of Ia to Ib,level of blood hemoglobin≤90 g/L,and level of blood platelet≤100×109/L were 55.67%,14.43%,37.11%,62.89%,23.71%,and 23.71%,respectively,which were higher than the control group's 41.57%,2.25%,18.54%,44.38%,3.37%,and 7.87%.The level of serum D-dimer(D-D)of the observation group was higher than that of the control group,and the bleeding volume of the observation group was more than that of the control group,the prothrombin time(PT)of the observation group was longer than that of the control group(P<0.05).Multivariate Logistic regression analysis showed that:cirrhosis((O＾R)=2.423,95%CI:1.124～5.224),shock((O＾R)=6.897,95%CI:1.487～31.995),endoscopic active bleeding((O＾R)=2.604,95%CI:1.109～6.118),Forrest grading of Ia to Ib((O＾R)=2.494,95%CI:1.162～5.354),level of blood hemoglobin≤90 g/L((O＾R)=5.270,95%CI:1.797～15.442),level of blood platelet≤100×109/L((O＾R)=5.018,95%CI:1.733～14.531),bleeding volume>189.61 mL((O＾R)=1.025,95%CI:1.016～1.034),PT>15.99 s((O＾R)=1.996,95%CI:1.618～2.460)were both risk factors for rebleeding in UGIH patients after endoscopic treatment(P<0.05).Regression equation model:logit(P)=-18.551+cirrhosis×0.885+shock×1.931+endoscopic active bleeding×0.957+Forrest grading×0.914+level of blood hemoglobin×1.662+level of blood platelet×1.613+bleeding volume×0.025+PT×0.691.The ROC curve for predicting rebleeding in UGIH patients after endoscopic treatment was plotted according to the diagnostic probability logit(P).When logit(P)>0.30,the 95%CI was 0.891～0.955,and the diagnostic sensitivity and specificity were 88.66%and 83.15%,respectively.The area under the curve(AUC)value was 0.923.Conclusion The cirrhosis,shock,endoscopic active bleeding,Forrest grade Ia to Ib,level of blood hemoglobin≤90 g/L,level of blood platelet≤100×109/L,bleeding volume>189.61 mL,and PT>15.99 s are independent risk factors for rebleeding after endoscopic treatment in patients with UGIH.The model constructed based on this has high predictive value,which can be used clinically to provide personalized intervention and treatment for high-risk patients to reduce or avoid the occurrence of rebleeding.

Objective To investigate the effects of low-dose esketamine on catheter-related bladder discomfort(CRBD)in elderly male patients after ureteroscopic lithotripsy(URL).Methods 90 elderly male patients with URL from October 2023 to Jun 2024 were selected and randomly divided into group A(esketamine group)and group B(control group),45 cases in each.After induction of general anesthesia,group A received intravenous infusion of 0.15 mg/kg esketamine hydrochloride diluted with saline to 10 mL,while group B received an equal volume of saline.The occurrence and severity of CRBD were recorded at T0(immediately after catheter removal),T1(30 min after catheter removal),T2(2 h after catheter removal),and T3(6 h after catheter removal)time points.The neurocognitive status and the incidence of perioperative neurocognitive disorder(PND)were assessed using the mini-mental state examination(MMSE)score one day before surgery and 6 h after surgery.Relevant indicators during the perioperative period and in the postanesthesia care unit(PACU)observation period were recorded for both groups.Results There were no statistically significant differences in anesthesia duration,recovery time,dosages of propofol and remifentanil between the two groups(P>0.05).Compared with group B,group A showed significantly lower CRBD incidence rate at T0,T1,T2 and T3 time points,and the severity rate of CRBD at T0,and T1 time points in group A was significantly lower than that in group B,the differences were statistically significant(P<0.05).Group A also had higher MMSE scores and lower PND incidence rate 6 h after surgery compared to group B,the differences were statistically significant(P<0.05).Compared with group B,group A required fewer tramadol hydrochloride administrations at T0,exhibited higher Ramsay sedation scale(RASS)scores,and lower Visual analog the scale(VAS)scores and Richer agitation-sedation Scale(SAS)scores,the differences were statistically significant(P<0.05).No adverse reactions were observed in either group after surgery.Conclusion Low-dose esketamine can effectively reduce the incidence and severity of early CRBD in elderly male patients after URL,which may be related to its minimal impact on postoperative cognitive function and better sedative and analgesic effects.

Objective To investigate the effect of the use of glycopyrrolate before anesthesia on the perioperative circulation of patients undergoing laparoscopic cholecystectomy(LC).Methods 88 patients undergoing LC from March to June in 2024 were enrolled and randomly divided into two groups:the glycopyrrolate group(group G)and the control group(group C),with 44 patients in each.Three patients from group G and four from group C were excluded,leaving 41 patients in group G and 40 patients in group C.Ten minutes before anesthesia induction,group G received an intravenous dose of 4 μg/kg glycopyrrolate diluted to 5 mL with normal saline.The control group received an equal volume of normal saline.Both groups then received an intravenous infusion of dexmedetomidine at 1 μg/kg over 10 minutes.Heart rate(HR)and mean arterial pressure(MAP)were monitored immediately before infusion of glycopyrrolate/saline(T0),5 min after infusion(T1),10 min after infusion(T2),1 min after tracheal intubation(T3),immediately at skin incision(T4),2 min after pneumoperitoneum(T5),dissociating the cholecyst(T6),and 1 min after tracheal tube drawing(T7).Intraoperative amounts of propofol,rocuronium bromide,sufentanil,remifentanil,oral secretion score,PACU stay time,first postoperative flatus time and the occurrence of perioperative adverse reactions were observed.Results HR at T2,T3,T4,T5,and T6 time points was significantly higher in group G than in group C,while MAP at T1,T2,T3,T4,T5 time points was also significantly higher in group G(P<0.05).HR at T2 time points in Group G was significantly lower than that at T0,while T7 was significantly higher than that at T0 time points.In Group C,HR at T1,T2,T4,T5,and T6 time points was significantly lower than that at T0 time points,while T7 time points was significantly higher than that at T0 time points,with the differences being statistically significant(P<0.05).In Group G,MAP at T1 and T2 time pointswas significantly higher than that at T0,and MAP at T6 was significantly lower than that at T0 time points,and in Group C,MAP at T4,T5 and T6 time points was significantly lower than that at T0 time points,and the differences were all statistically significant(P<0.05);Oral secretion was lower in group G compared to group C,with a significant difference(P<0.05).The incidence of bradycardia was significantly lower in group G compared to group C(P<0.05).The incidence of oral dryness within 24 h postoperatively was higher in group G compared to group C(P<0.05).There were no significant differences of HR at T0,T1,and T7 time points,MAP at T0,T6,and T7 time points between the two groups(P>0.05);There were no significant differences of operation time,propofol usage,sufentanil usage,remifentanil usage,rocuronium bromide usage during operation,rate of atropine use,incidence of intraoperative hypotension,PACU stay time,first postoperative flatus,and nausea vomiting rate between the two groups(P>0.05);No delirium occurred in either group of patients 24 h after the operation.Conclusion Use of glycopyrrolate before anesthesia can be effectively applied to patients undergoing LC,is beneficial in reducing the incidence of bradycardia,maintaining the stability of intraoperative circulation,and has no significant effect on the incidence of postoperative delirium and nausea and vomiting.It is a worthy clinical application.

Objective To explore the surgical techniques and therapeutic effects of hematoma evacuation for hypertensive cerebral hemorrhage(HCH)with different bleeding sites under neuroendoscopy.Methods This study enrolled 101 patients with HCH treated in our hospital from May 2022 to January 2024.Based on CT imaging results,patients were divided into lobar cerebral hemorrhage group(n=43)and basal ganglia hemorrhage group(n=58).The Pearson was used to analyze the correlations between cerebral microcirculation indicators and the scores of national institutes of health stroke scale(NIHSS),mini mental state examination(MMSE),and the Barthel index(BI)of activities of daily living.The generalized estimating equation was employed to analyze the improvement effects of neuroendoscopic hematoma evacuation on cerebral microcirculation indicators in patients with different hemorrhage locations.A difference-in-differences equation model with full specifications was applied to analyze the improvement effects of neuroendoscopic hematoma evacuation on NIHSS score,MMSE score,and BI score in patients with different hemorrhage locations,incorporating baseline indicators as control variables.Results The operative time of basal ganglia hemorrhage group was significantly longer than those of lobar cerebral hemorrhage group,and the differences of NIHSS,MMSE,BI,mean transit time(MTT),cerebral blood flow(CBF),cerebral blood volume(CBV)and mean arterial pressure(MAP)before and after treatment were significantly smaller than those of lobar cerebral hemorrhage group,the differences were statistically significant(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).The correlation analysis results showed that MTT was positively correlated with NIHSS,and negatively correlated with BI and MMSE;CBF,CBV and MAP were negatively correlated with NIHSS,but positively correlated with BI and MMSE,the differences were statistically significant(P<0.05).The result of generalized estimating equation analysis showed that the improvement of MTT,CBF,CBV and MAP in patients with lobar cerebral hemorrhage group was better than those in patients with basal ganglia hemorrhage group,the differences were statistically significant(P<0.05).The result of difference-in-differences equation model analysis showed that increase of age,prolongation of MTT and prolongation of the time from onset to operation had positive effects on NIHSS score(B=0.884,1.291,0.758,P<0.05),and had negative effects on MMSE score(B=-1.014,-1.569,-0.821,P<0.05).The prolongation of MTT had a negative effect on BI score(B=-0.973,P<0.05).The increase of CBV,CBF and MAP had a negative effect on NIHSS score(B=-0.841,-0.767,-1.213,P<0.05),and had a positive effect on MMSE and BI score(MMSE:B=0.932,0.738,0.874;BI:B=0.897,0.751,0.842,P<0.05).Conclusion Neuroendoscopic hematoma evacuation can improve the NIHSS score,MMSE score,BI score of patients with HCH by adjusting MTT,CBF,CBV and MAP,and the improvement effect of patients with lobar cerebral hemorrhage is significantly better than that of patients with basal ganglia hemorrhage.

Objective To explore the therapeutic effect of microsurgical vascular decompression(MVD)under complete neuroendoscopy combined with nerve combing surgery in the treatment of primary trigeminal neuralgia(TN),and its impacts on prognosis.Methods 108 primary TN patients from November 2021 to November 2023 were retrospectively selected and grouped into combined group and control group based on the surgical plan,with 54 cases in each group.The control group received MVD treatment under the microscope,while the combined group received complete neuroendoscopic MVD combined with nerve combing surgery.The total effective rate,pain degree,stress indicators,quality of life,and complications were compared between the two groups.Results The total effective rate of the combined group(96.30%)was greatly higher than that of the control group(83.33%),the difference was statistically significant(P<0.05).The visual analogue scale(VAS)scores of both groups after surgery were significantly lower than those before surgery,and the combined group was lower than the control group,the differences were statistically significant(P<0.05).After surgery,the levels of norepinephrine(NE),superoxide dismutase(SOD),and cortisol(Cor)increased in both groups compared with those before surgery,but the combined group was greatly lower than that of the control group,the differences were statistically significant(P<0.05).The generic quality of life inventory-74(GQOL-74)scores in both groups after surgery were significantly higher than those before surgery,and the combined group was higher than the control group,the differences were statistically significant(P<0.05).There was no difference of the total complication rate between the two groups(P>0.05).Conclusion MVD under complete neuroendoscopy combined with nerve combing surgery in the treatment of primary TN,can relieve pain,reduce stress response and improve the quality of life of patients.It is worthy of clinical promotion and application.