Objective:To study the feasibility and safety of left semiprone position in 3D laparoscopic liver resection for tumor in segment Ⅶ.Methods:Clinical data of 60 patients with liver tumors treated at Jinhua Central Hospita from January 2018 to September 2022 were retrospectively collected, including 40 males and 20 females, aged (51.5±4.5) years. Perioperative data on operative time, intraoperative blood loss, postoperative time of ambulation, postoperative time to flatulate, duration of hospital stay, pathological type, complications (bile leakage, pleural effusion, etc.) were analyzed. Postoperative follow-ups were conducted through telephone reviews, outpatient visits.Results:Of 57 patients (95.0%) successfully underwent the surgery, while three cases (5.0%) were converted to open surgery due to excessive intraoperative bleeding. The operative time was (210.5±20.5) min. The intraoperative blood loss was (220.5±50.5) ml. The postoperative time of ambulation was (1.5±0.5) d, and the postoperative time to flatulate was (2.0±0.8) d. The postoperative hospital stay was (7.2±1.5) d. Bile leakage occurred in four cases (6.7%) after surgery, which was managed by conservative treatment, and pleural effusion occurred in eight cases (13.3%), which recovered after puncture and drainage. Postoperative pathology included 40 cases (66.7%) of hepatocellular carcinoma, three cases (5.0%) of intrahepatic cholangiocarcinoma, five cases (8.3%) of liver metastases, seven cases (11.7%) of hepatic hemangioma, two case (3.3%) of angiomyolipoma, and three case (5.0%) of focal hepatic nodular hyperplasia. No tumor recurrence was observed during follow-up (median 26 months; range 18-40 months).Conclusion:The application of left semiprone position in 3D laparoscopic liver resection for tumor in segment Ⅶ is safe and feasible.

Objective To investigate the safety and clinical efficacy of the Laennec membrane left side hepatic parenchymal transection-first approach combined with APR triangle in laparoscopic anatomical central hepatectomy.Methods 24 patients underwent laparoscopic anatomical central hepatectomy via Laennec membrane left side hepatic parenchymal transection-first approach combined with APR triangle from January 2023 to June 2024 were selected.Statistical analysis of patients with operation time,intraoperative blood loss,postoperative complications,and postoperative hospital stay.Results All the 24 patients underwent laparoscopic anatomical central hepatectomy without perioperative death.The operation time was(210.2±75.6)minutes(range:95～295 min),and the intraoperative blood loss was(358.9±118.4)mL(range:150～1 100 mL).There was no intraoperative blood transfusion and no conversion to open surgery.The abdominal drainage tube was removed on the average of(5.5±0.5)d(range:4～10 d)after operation,and the average postoperative hospital stay was(7.5±1.5)d(range:5～16 d).There were 5 cases of Clavien-Dindo grade Ⅰ and Ⅱ complications,including 4 cases of abdominal effusion and 1 case of pleural effusion.Postoperative pathology:all patients were hepatocellular carcinoma.Patients with liver malignant tumor were followed up for 1 month to 1.5 years.All the patients survived during the follow-up period,and 2 patients had tumor recurrence.Conclusion For central hepatic segment tumors,laparoscopic anatomical central hepatectomy can be performed using the left hepatic parenchyma via Laennec membrane priority approach combined with APR triangle method,which is safe and feasible.

Objective To investigate the safety and clinical efficacy of the Laennec membrane left side hepatic parenchymal transection-first approach combined with APR triangle in laparoscopic anatomical central hepatectomy.Methods 24 patients underwent laparoscopic anatomical central hepatectomy via Laennec membrane left side hepatic parenchymal transection-first approach combined with APR triangle from January 2023 to June 2024 were selected.Statistical analysis of patients with operation time,intraoperative blood loss,postoperative complications,and postoperative hospital stay.Results All the 24 patients underwent laparoscopic anatomical central hepatectomy without perioperative death.The operation time was(210.2±75.6)minutes(range:95～295 min),and the intraoperative blood loss was(358.9±118.4)mL(range:150～1 100 mL).There was no intraoperative blood transfusion and no conversion to open surgery.The abdominal drainage tube was removed on the average of(5.5±0.5)d(range:4～10 d)after operation,and the average postoperative hospital stay was(7.5±1.5)d(range:5～16 d).There were 5 cases of Clavien-Dindo grade Ⅰ and Ⅱ complications,including 4 cases of abdominal effusion and 1 case of pleural effusion.Postoperative pathology:all patients were hepatocellular carcinoma.Patients with liver malignant tumor were followed up for 1 month to 1.5 years.All the patients survived during the follow-up period,and 2 patients had tumor recurrence.Conclusion For central hepatic segment tumors,laparoscopic anatomical central hepatectomy can be performed using the left hepatic parenchyma via Laennec membrane priority approach combined with APR triangle method,which is safe and feasible.

Objective:To study the feasibility and safety of left semiprone position in 3D laparoscopic liver resection for tumor in segment Ⅶ.Methods:Clinical data of 60 patients with liver tumors treated at Jinhua Central Hospita from January 2018 to September 2022 were retrospectively collected, including 40 males and 20 females, aged (51.5±4.5) years. Perioperative data on operative time, intraoperative blood loss, postoperative time of ambulation, postoperative time to flatulate, duration of hospital stay, pathological type, complications (bile leakage, pleural effusion, etc.) were analyzed. Postoperative follow-ups were conducted through telephone reviews, outpatient visits.Results:Of 57 patients (95.0%) successfully underwent the surgery, while three cases (5.0%) were converted to open surgery due to excessive intraoperative bleeding. The operative time was (210.5±20.5) min. The intraoperative blood loss was (220.5±50.5) ml. The postoperative time of ambulation was (1.5±0.5) d, and the postoperative time to flatulate was (2.0±0.8) d. The postoperative hospital stay was (7.2±1.5) d. Bile leakage occurred in four cases (6.7%) after surgery, which was managed by conservative treatment, and pleural effusion occurred in eight cases (13.3%), which recovered after puncture and drainage. Postoperative pathology included 40 cases (66.7%) of hepatocellular carcinoma, three cases (5.0%) of intrahepatic cholangiocarcinoma, five cases (8.3%) of liver metastases, seven cases (11.7%) of hepatic hemangioma, two case (3.3%) of angiomyolipoma, and three case (5.0%) of focal hepatic nodular hyperplasia. No tumor recurrence was observed during follow-up (median 26 months; range 18-40 months).Conclusion:The application of left semiprone position in 3D laparoscopic liver resection for tumor in segment Ⅶ is safe and feasible.

Objective To investigate the safety and clinical efficacy of the combined gallbladder plate approach using Laennec membrane based on APR triangle in laparoscopic anaphylactic right lobe hepatectomy.Methods Clinical data of 27 patients underwent laparoscopic anaphylactic of right lobe hepatectomy based on the APR triangle combined with the gallbladder plate approach using Laennec membrane were collected from January 2021 to December 2023.The relevant data of patients were statistically analyzed,including operation time,intraoperative blood loss,postoperative complications,and postoperative hospital stay.Results All the 27 patients underwent laparoscopic anatomic hepatectomy,and no perioperative death occurred.Among them,segment Ⅴ was resected in 4 cases,segment Ⅵ in 3 cases,segment Ⅴ+Ⅷ in 6 cases,segment Ⅴ+Ⅵ in 4 cases,segment Ⅵ+Ⅶin 5 cases,segment Ⅴ+Ⅵ+Ⅶ in 3 cases,and segment Ⅴ+Ⅵ+Ⅷ in 2 cases.All cases belonged to the China Liver Cancer(CNLC)clinical staging,stage Ⅰa in 15 cases,stage Ⅰb in 8 cases and stage Ⅱa in 4 cases.The operative time was(258.3±62.3)min,the intraoperative blood loss was(168.8±48.1)mL,and there was no transfusion.The patients were given liquid diet on the first day after surgery,and were active in bed on the second day after surgery.The mean postoperative length of hospital stay was(6.5±1.7)d after removal of abdominal drainage tube.There were 5 cases of Clavien-Dindo Ⅰ and Ⅱ complications(3 cases of abdominal effusion,1 case of pleural effusion,1 case of pulmonary infection),and no complications such as bile leakage and abdominal hemorrhage occurred.Postoperative pathology:21 cases of hepatocellular carcinoma,4 cases of hepatociliary duct carcinoma,2 cases of liver metastasis.Patients with liver malignant tumor were followed up for 2 months to 2 years,and all patients survived during the follow-up period without tumor recurrence.Conclusion The gallbladder plate approach based on APR triangle combined with Laennec membrane is a safe and effective surgical method for laparoscopic anaphylactic right lobe hepatectomy,which is worthy of clinical application.

Objective This research assessed the impact of incorporating choledochoscopy with laparoscopic left hepatectomy on stress response and bile duct stone removal in patients presenting with complex intrahepatic biliary stones.Methods Clinical data of 194 patients with complex intrahepatic biliary stones from June 2020 to June 2024 were retrospectively analyzed.The patients were divided into control group (n=97) and observation group (n=97) according to different operation methods.The control group received laparoscopic left hepatectomy,while the observation group received choledochoscopic lithotomy combined with laparoscopic left hepatectomy.The changes of stress indexes[cortisol (Cor),adrenaline (AD)],inflammatory factors[C-reactive protein (CRP),interleukin-6 (IL-6),tumor necrosis factor-α (TNF-α)]in the two groups before and 3 days after operation were compared.The liver function indexes[alanine transaminase (ALT),total bilirubin (TBiL),glutamyl transferase (GGT)]of the two groups before and 7 days after operation were compared.The treatment effect levels of the two groups were evaluated 3 months after operation.The incidence of postoperative complications (bile leakage,infection,residual stones and pleural effusion) was recorded and compared between the two groups.Results Three days before and after operation,the levels of Cor,AD,CRP,IL-6 and TNF-α in the two groups had no significant difference (P>0.05),but the postoperative level in two groups were significantly higher than those before surgery,and the differences were statistically significant (P<0.05).Before operation,there was no significant difference in ALT,TBiL and GGT between the two groups (P>0.05).On the 7th day after operation,ALT,TBiL and GGT of the two groups decreased,and the observation group was lower than those of the control group (P<0.05).There was no significant difference in visual analogue scale (VAS),postoperative anal exhaust time and postoperative ambulation time between the two groups (P>0.05).The hospitalization time of the observation group was shorter than that of the control group,the difference was statistically significant (P<0.05).The therapeutic effect of the observation group at 3 months after operation was significantly better than that of the control group,the difference was statistically significant (P<0.05).The total incidence of postoperative complications in the observation group was significantly lower than that in the control group,the difference was statistically significant (P<0.05).Conclusion The combination of laparoscopic left hepatectomy and choledochoscopy effectively addresses complex intrahepatic biliary stones,minimally impacting patient stress responses,enhancing liver function,and reducing complication risks,thereby holding promising clinical applicability.

Objective This research assessed the impact of incorporating choledochoscopy with laparoscopic left hepatectomy on stress response and bile duct stone removal in patients presenting with complex intrahepatic biliary stones.Methods Clinical data of 194 patients with complex intrahepatic biliary stones from June 2020 to June 2024 were retrospectively analyzed.The patients were divided into control group (n=97) and observation group (n=97) according to different operation methods.The control group received laparoscopic left hepatectomy,while the observation group received choledochoscopic lithotomy combined with laparoscopic left hepatectomy.The changes of stress indexes[cortisol (Cor),adrenaline (AD)],inflammatory factors[C-reactive protein (CRP),interleukin-6 (IL-6),tumor necrosis factor-α (TNF-α)]in the two groups before and 3 days after operation were compared.The liver function indexes[alanine transaminase (ALT),total bilirubin (TBiL),glutamyl transferase (GGT)]of the two groups before and 7 days after operation were compared.The treatment effect levels of the two groups were evaluated 3 months after operation.The incidence of postoperative complications (bile leakage,infection,residual stones and pleural effusion) was recorded and compared between the two groups.Results Three days before and after operation,the levels of Cor,AD,CRP,IL-6 and TNF-α in the two groups had no significant difference (P>0.05),but the postoperative level in two groups were significantly higher than those before surgery,and the differences were statistically significant (P<0.05).Before operation,there was no significant difference in ALT,TBiL and GGT between the two groups (P>0.05).On the 7th day after operation,ALT,TBiL and GGT of the two groups decreased,and the observation group was lower than those of the control group (P<0.05).There was no significant difference in visual analogue scale (VAS),postoperative anal exhaust time and postoperative ambulation time between the two groups (P>0.05).The hospitalization time of the observation group was shorter than that of the control group,the difference was statistically significant (P<0.05).The therapeutic effect of the observation group at 3 months after operation was significantly better than that of the control group,the difference was statistically significant (P<0.05).The total incidence of postoperative complications in the observation group was significantly lower than that in the control group,the difference was statistically significant (P<0.05).Conclusion The combination of laparoscopic left hepatectomy and choledochoscopy effectively addresses complex intrahepatic biliary stones,minimally impacting patient stress responses,enhancing liver function,and reducing complication risks,thereby holding promising clinical applicability.

Objective:To investigate the clinical effect of respiratory intervention training in feeding of preterm infants, so as to provide reference for feeding interventions in preterm infants.Methods:From March 2021 to October 2021, the 80 preterm infants hospitalized in the Neonatal Intensive Care Unit of Xuzhou Central Hospital were selected and divided into intervention group (40 cases) and control group (40 cases) according to the random table method in a prospective study. The common nursing was given in the control group, the respiratory intervention training was given on this basis in the intervention group, once a day for two weeks. The intervention effect was evaluated by the time of indwelling gastric tube, hospital stay, feeding reaction, feeding related complications and satisfaction rate of catch-up growth. The oral feeding ability of preterm infants was evaluated by the non-nutritive sucking (NNS) score and preterm infants oral feeding readiness assessment scale (PIOFRAS) score.Results:The time of indwelling gastric tube and hospital stay was (15.3 ± 8.7), (28.9 ± 9.8) d in the intervention group and (21.7 ± 9.8), (34.6 ± 12.2) d in the control group, the difference was significant ( t=3.12, 2.32, both P<0.05). After intervention, the differences of respiratory number, heart rate and pulse oxygen saturation were (6.5 ± 1.3) beats/min, (11.2 ± 1.5) beats/min, 0.048 ± 0.015 in the intervention group and (11.2 ± 1.2) beats/min, (16.5 ± 1.3) beats/min, 0.082 ± 0.018 in the control group, the differences were significant ( t=16.39, 16.40, 9.35, all P<0.05). The incidence of feeding-related complications was 25.0% (10/40) in the intervention group and 55.0% (22/40) in the control group, the difference was significant ( χ2=7.50, P<0.05). The satisfaction rate of catch-up growth was 77.5%(31/40) in the intervention group and 40.0%(16/40) in the control group, the difference was significant ( χ2=12.78, P<0.05). The scores of NNS and PIOFRAS at 7 d, 10 d and 14 d after intervention were (13.73 ± 2.24), (29.98 ± 6.67), (49.08 ± 16.37) points and (15.28 ± 1.41), (25.08 ± 3.10), (31.03 ± 3.00) points in the intervention group and (10.30 ± 2.18), (15.68 ± 2.42), (28.60 ± 3.61) points and (12.60 ± 1.22), (17.15 ± 1.51), (23.75 ± 3.87) points in the control group, the differences were significant ( t values were -14.53--6.94, all P<0.05). Conclusions:The respiratory intervention training can effectively shorten the transition time from tube feeding to complete oral feeding in preterm infants, reduce feeding reaction and the incidence of feeding-related complications, and promote the coordination of feeding behavior, so as to improve oral feeding ability and catch-up growth of preterm infants.

Objective To detect the changes of cellular immune level in patients with different grades of glioma in perioperative period, and to investigate its relationship with the postoperative intracranial infection. Methods A total of 53 patients with glioma newly diagnosed by pathology who underwent the surgical treatment in the First Hospital of Shanxi Medical University from September 2017 to September 2018 were collected. According to the World Health Organization (WHO) classification criteria, the patients were divided into the low-grade group (grade Ⅰ-Ⅱ, 21 cases) and the high-grade group (grade Ⅲ-Ⅳ, 32 cases). The peripheral blood at the time of 1 day before the operation, 1 day and 7 days after the operation was drawn to detect the T lymphocyte subsets, and then the differences of cell immunity indexes from different grade gliomas were analyzed. The relationship between immune level and postoperative intracranial infection was analyzed. SPSS 22.0 statistical software was used to analyze the data. Results The levels of CD3+, CD4+, CD8+, CD4+CD25+Foxp3+and CD4+/CD8+in the high-grade group at the time of 1 day before the operation were (54.09±4.25)％, (31.93±3.08)％, (34.23±2.48)％, (9.66±1.47)％, 0.93±0.06, respectively; the levels at the time of 1 day after the operation were (48.84±3.69)％, (27.49±2.41)％, (34.99±2.96)％, (11.09±1.70)％, 0.84± 0.05, respectively; the levels at the time of 7 days after the operation were (59.45 ±3.47)％, (33.59 ±2.66)％, (31.99±1.97)％, (7.45±1.48)％, 1.05±0.07, respectively. The levels of CD3+, CD4+, CD8+, CD4+CD25+Foxp3+and CD4+/CD8+in the low-grade group at the time of 1 day before the operation were (62.37±6.57)％, (34.88± 4.43)％, (30.16 ±3.75)％, (6.30 ±1.29)％, 1.16 ±0.11, respectively; the levels at the time of 1 day after the operation were (55.44 ±7.25)％, (29.05 ±4.04)％, (31.66 ±3.13)％, (7.95 ±1.67)％, 0.92 ±0.11, respectively; the levels at the time of 7 days after the operation were (67.73 ±7.18)％, (35.55 ±4.95)％, (28.10 ±3.12)％, (5.50 ± 1.25)％, 1.27±0.12, respectively. The levels of CD3+, CD4+, CD4+/CD8+before and after the operation in the high-grade group were lower than those in the low-grade group (all P< 0.05), while the levels of CD8+and CD4+CD25+Foxp3+were higher than those in the low-grade group (all P<0.05). Compared with the levels at the time of 1 day before the operation, the levels of CD3+, CD4+, CD4+/CD8+at the time of 1 day after the operation of both groups were decreased, while the levels of CD8+and CD4+CD25+Foxp3+were increased (all P< 0.05). The levels of CD3+, CD4+and CD4+/CD8+ at the time of 7 days after the operation in the both groups were increased, while the levels of CD8+ and CD4+ CD25+ Foxp3+ were decreased (all P< 0.05). Among 53 patients, 8 cases had postoperative intracranial infection, and the infection rate was 15.09％. Age, duration of surgery, pathological stage, and intraoperative blood transfusion were the independent affecting factors of postoperative intracranial infection of cerebral glioma (OR= 1.513, P= 0.024; OR= 1.722, P<0.01; OR= 1.365, P= 0.001; OR= 1.262, P< 0.01). Conclusions The peripheral blood cellular immune level of glioma patients is related with the malignancy of glioma. The inhibition degree of the cellular immunity could be relieved after the resection of glioma. The detection of T lymphocyte subsets could be considered as an evaluating index for the malignancy and prognosis in patients with glioma. The clinical detection of cellular immune can play a positive role in predicting and preventing the postoperative intracranial infection in patients with glioma.

Objective To assess the clinical effect of Percutaneous transforaminal endoscopic spinal surgery for central lumbar spinal stenosis.Methods Total 92 patients (44 males and 48 females with average age of 68.6± 12.4 years) with central lumbar spinal stenosis were enrolled in our study during February 2012 and July 2016.All patients were treated with Percutaneous transforaminal endoscopic spinal surgery.Clinical and Radiographic evaluation were investigated on 1 week,3 months,6 months,12 months postoperatively and final follow-up.Visual analogue scale (VAS) for low back pain and leg pain,Oswestry disability index(ODI) for low back pain were used to evaluate the clinical efficacy of surgery.Pre and postoperative Dural sac cross sectional area(DSCA) was measured.And the correlation between changes of DSCA and clinical efficacy was analyzed.Results The operation time was 45-1 15 min.The mean operation time was 75±15 min.the mean blood loss was 15±5 ml (range 8-50 ml).All patients were followed for 12-46 months (24.5±5.3 months).VAS for low back pain,VAS for leg pain,and OD1 were significantly improved from 6.75± 1.28,7.79± 1.15 and 39.82％ ±5.06％ preoperatively to 2.21± 1.08,2.16± 1.14 and 9.82％ ±3.69％ at the latest follow-up.Dural sac cross sectional area significantly increased from 55.35±12.18 mm2 preoperatively to (102.36±15.38) mm2 at the latest follow-up.Correlation coefficient with DSCA change was-0.480 for ODI change,-0.612 for VAS(low back pain) change,-0.637 for VAS (leg pain)(P ＜ 0.05);obvious positive correlation existed between the change of DSCA and patient's clinical efficacy.It showed that the change of DSCA was positively correlated with the patient's clinical efficacy.The clinical results were excellent in 56 cases.good in 29,fair in 4,and poor in 3 based on the MacNab criteria.92.39％ demonstrated a good-to-excellent outcome.One case occurred cauterizing syndrome,3 cases of recurrence,and 2 cases of Dural tear.There was no severe vascular or nerve injury.Conclusion Percutaneous transforaminal endoscopic spinal surgery provides a new minimally invasive treatment for central lumbar spinal stenosis.It is safe and effective.It is found that the change of DSCA is positively correlated with the clinical efficacy of surgery.