ObjectiveTo investigate the feasibility and safety of endoscopic retrograde cholangiopancreatography （ERCP） combined with oral cholangiopancreatography in the treatment of major duodenal papilla gallbladder polyps. MethodsA retrospective analysis was performed for the clinical data of eight patients with choledocholithiasis and gallbladder polyps who underwent ERCP and combined with oral cholangiopancreatography for major duodenal papilla cholecystectomy in Center of Digestive Endoscopy， Jilin People’s Hospital， from May 2022 to June 2024， and related data were collected， including the success rate of surgery， the technical success rate of gallbladder polyp removal， the superselective method of cystic duct， the time of operation， the time of gallbladder polyp removal， and surgical complications. ResultsBoth the success rate of surgery and the technical success rate of gallbladder polyp removal reached 100%， and of all eight patients， three patients used guide wire to enter the gallbladder under direct view， while five patients received oral cholangiopancreatography to directly enter the gallbladder. The time of operation was 51.88±12.34 minutes， and the time of gallbladder polyp removal was 23.13±10.94 minutes. The diameter of gallbladder polyp was 2‍ ‍—‍ ‍8 mm， and pathological examination showed inflammatory polyps in three patients， adenomatous polyps in one patient， and cholesterol polyps in four patients. There were no complications during or after surgery. The patients were followed up for 2‍ ‍—‍ ‍27 months after surgery， and no recurrence of gallbladder polyp was observed. ConclusionOral cholangiopancreatography is technically safe and feasible in endoscopic major duodenal papilla cholecystectomy.

ObjectiveTo discuss the effects of Cistanches Herba phenylethanoid glycosides （CHPhGs） on the intestinal mucosal barrier and gut microbiota in alcoholic liver disease （ALD） mice were discussed. MethodThe 36 C57BL/6N female mice were randomly divided normal group， normal group of CHPhGs， model group， and low， medium， and high-dose groups （175， 350， 700 mg·kg^-1） of CHPhGs， with six mice in each group. The ALD mouse model was built using Lieber-Decarli alcohol liquid feed. The normal group and low， medium， and high-dose groups of CHPhGs were given CHPhGs by gavage daily. Serum aspartate aminotransferase aminotransferase （ALT）， alanine aminotransferase （AST）， triglycerides （TG）， and total cholesterol （TC） levels were detected by an automatic biochemical analyzer. Serum tumor necrosis factor-α （TNF-α）， interleukin-1β （IL-1β）， lipopolysaccharide （LPS）， lipopolysaccharide-binding protein （LBP）， D-lactic acid （D-LA）， diamine oxidase （DAO）， and LBP of liver were detected by enzyme-linked immunosorbent assay （ELISA）. The levels of TG and TC in the liver were detected by colorimetry. Liver tissue was treated by oil red O and hematoxylin-eosin （HE） staining. The microstructure of jejunum epithelial cells was observed by electron microscope. Jejunum and colon were treated by HE staining and alcian blue-periodate-scheff (AB-PAS) staining staining， and mucin 2 （Muc2） was treated by immunohistochemistry. The intestinal contents of the normal group， normal group of CHPhGs， model group， and high-dose group of CHPhGs were collected and sequenced. ResultThe ALD model was established successfully. Compared with the normal group， the levels of serum ALT， AST， and TG， as well as the levels of liver TG and TC in the model group were significantly increased （P<0.05）. Histopathology showed that compared with the normal group， the liver cells in the model group showed obvious steatosis. Compared with the model group， the levels of serum TG and liver TG and TC in the low， medium， and high-dose groups of CHPhGs decreased significantly （P<0.05）. The serum ALT， AST， TNF-α， IL-1β， LPS， and LBP in the high-dose group of CHPhGs were also significantly decreased （P<0.05）. The number of liver cells with steatosis in the high-dose group of CHPhGs was significantly reduced， and the microvilli structure of jejunum epithelial cells was basically intact. The expression of Muc2 was reduced in the colon， and the gut microbiota of the high-dose group of CHPhGs changed significantly （P<0.05）. Compared with the normal group， the Allobaculum was significantly up-regulated in the model group （P<0.05）. Compared with the model group， the abundance of Akkermansia in the high-dose group of CHPhGs was significantly increased （P<0.01）. The abundance of Akkermansia was negatively correlated with that of Allobaculum （r=-0.701， P<0.01）. ConclusionCHPhGs can reduce the intestinal barrier injury caused by ALD， which may play a protective role by regulating the abundance and structure of Akkermansia and Allobaculum and affecting the homeostasis of intestinal mucus.

ObjectiveTo investigate the safety and efficacy of endoscopic retrograde cholangiopancreatography （ERCP） combined with electrohydraulic lithotripsy under the direct view of eyeMax biliary-pancreatic imaging system in the treatment of difficult choledocholithiasis. MethodsA retrospective analysis was performed for the clinical data of 12 patients with difficult choledocholithiasis who underwent ERCP and electrohydraulic lithotripsy under the direct view of eyeMax biliary-pancreatic imaging system in Department of Gastroenterology， Jilin People’s Hospital， from May to November 2022. The clinical effect of lithotripsy and lithotomy was observed， and postoperative complications and time of surgical operation were assessed. ResultsAmong the 12 patients， 11 （91.67%） were successfully treated by electrohydraulic lithotripsy under direct view， 9 （75.00%） achieved first-attempt success in lithotripsy， and 11 （91.67%） had complete removal of calculi； 1 patient was found to have stenosis of the bile ducts caused by multiple biliary tract surgeries， and grade Ⅱ intrahepatic bile duct stones above the sites of stenosis were removed under direct view， but there were still residues of grade Ⅲ intrahepatic bile duct stones， which led to the fact that complete calculus removal was not achieved. The mean time of ERCP operation was 91.3±26.2 minutes， including a time of 41.8±22.2 minutes for energy lithotripsy. There were 2 cases of postoperative biliary tract infection which were improved after anti-infective therapy， 2 cases of hyperamylasemia which were not given special treatment， and 3 cases of mild pancreatitis which were improved after symptomatic medication， and there were no complications such as bleeding and perforation. ConclusionERCP combined with electrohydraulic lithotripsy under the direct view of eyeMax biliary-pancreatic imaging system is safe， effective， and feasible in the treatment of difficult choledocholithiasis.

Objective:To explore the clinical effect of laparoscopic anatomical hepatic segment Ⅷ (S8) resection.Methods:Of 16 patients with liver cancer who underwent laparoscopic anatomical hepatic S8 resection at the National Cancer Center from October 2020 to October 2022 were were enrolled, including 13 males and 3 females, aged (59.1±10.9) years. The operation time, intraoperative blood loss, occurrence of intraoperative blood transfusion, and postoperative complications were retrospectively analyzed. Recurrence and survival were followed up by outpatient and telephone reviews.Results:Laparoscopic anatomical hepatic S8 resection was successfully performed in 16 patients without conversion to laparotomy. Among them, 10 patients underwent the intraoperative ultrasound guided hepatic parenchymal approach, and 6 underwent laparoscopic Glissonean pedicle puncture for the positive staining of S8 using indocyanine green. The operation time was (274.8±82.8) min, and the intraoperative blood loss was [ M( Q1, Q3)] 100.0 (50.0, 200.0) ml. There were no intraoperative blood transfusion or postoperative complication. The drainage tube was successfully removed and the patients were discharged 5 to 7 days after surgery. The patients were followed up for 5 to 24 months and all survived. Two patients had tumor recurrence. Conclusion:Laparoscopic anatomical S8 resection is safe and feasible.

Objective To investigate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP)+SpyGlass system versus percutaneous transhepatic gallbladder drainage (PTGD)+ERCP in the treatment of acute cholecystitis secondary to choledocholithiasis. Methods A retrospective analysis was performed for the clinical data of the patients with acute cholecystitis secondary to choledocholithiasis who were treated in Department of Gastroenterology, Jilin City People's Hospital, from December 2019 to September 2021, among whom there were 23 patients in the ERCP+SpyGlass group and 19 patients in the PTGD+ERCP group. The two groups were compared in terms of the indicators such as surgical technical success, surgical operation time, surgical clinical success, postoperative recovery, length of hospital stay, and complications. The two-independent-samples t test was used for comparison of normally distributed continuous data between groups, and the Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between groups; the chi- square test or the Fisher's exact test was used for comparison of categorical data between groups. Results Compared with the PTGD+ERCP group, the ERCP+SpyGlass group had a significant reduction in C-reactive protein after surgery ( Z =2.999, P =0.003). There were no significant differences between the two groups in technical success rate ( χ 2 =1.735, P =0.188), clinical success rate ( χ 2 =0.846, P =0.358), total time of operation ( t =1.667, P = 0.113), white blood cell count on day 1 after surgery ( t =1.075, P = 0.289), length of postoperative hospital stay ( t =1.560, P =0.127), and incidence rate of complications (all P > 0.05). Conclusion In the treatment of acute cholecystitis secondary to choledocholithiasis, the ERCP+SpyGlass system has a comparable clinical effect to PTGD+ERCP and is safe and effective, without increasing surgery-related adverse events and risks, and it can also solve the problems of the biliary tract and the gallbladder at one time through natural orifices, with no scars on body surface and convenient postoperative nursing. Therefore, it holds promise for clinical application.

Objective:To compare the efficacy of pericapsular nerve group (PENG) block combined with lateral femoral cutaneous nerve (LFCN) block versus fascia iliaca compartment block (FICB) in elderly patients undergoing total hip arthroplasty under general anesthesia.Methods:Fifty-eight patients of both sexes, aged 65-85 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, scheduled for elective direct anterior approach to total hip arthroplasty, were divided into 2 groups ( n=29 each) using a random number table method: PENG block plus LFCN block group (PL group) and FICB group (F group). In group PL, the mixture (20 ml) of 0.375% ropivacaine hydrochloride and dexamethasone 3.3 mg was injected around the nerve innervating the hip joint capsule under ultrasound guidance.In group F, the mixture (30 ml) of 0.375% ropivacaine hydrochloride and dexamethasone 5 mg was injected around the nerve innervating the fascia iliaca compartment under ultrasound guidance.All the patients received patient-controlled intravenous analgesia with oxycodone after surgery.When visual analogue scale scores≥4 points, oxycodone 1 mg was intravenously injected as rescue analgesic.The intraoperative consumption of remifentanil was recorded.First time to ambulation, discharge destination, length of hospital stay, and effective pressing times of analgesic pump, requirement for rescue analgesia and the incidence of quadriceps weakness, nausea and vomiting and nerve block related complications within 48 h after surgery were recorded. Results:Compared with F group, intraoperative consumption of remifentanil was significantly decreased, effective pressing times of analgesic pump and incidence of quadriceps weakness were decreased, first time to ambulation and length of hospital stay were shortened, and first discharge destination was prolonged ( P<0.05), and no significant change was found in the requirement for rescue analgesia and the incidence of nausea ( P>0.05) in group PL. Conclusion:PENG block combined with LFCN block can reduce intraoperative consumption of opioids, be helpful for inhibiting postoperative pain sensitivity, and improve early recovery than FICB when used for total hip arthroplasty under general anesthesia.

Objective To investigate the effect of ultrasound-guided quadratus lumborum block on cognitive function after laparoscopic colorectal surgery.Methods Seventy-six patients, there is no restriction on gender, aged 50-75 years, falling into ASA physical statusⅡorⅢ, who provided informed consent for their participation in this study and underwent colorectal surgery under general anesthesia were divided into two groups (groups Q and C).Induction of anesthesia was induced by intravenous midazolam 0.03 mg/kg, sufentanil 0.5μg/kg, etomidate 0.3 mg/kg and rocuronium 1 mg/kg in the two groups.Remifentanil 0.2-0.3μg·kg-1·min-1 and propofol 0.10-0.15 mg·kg-1·min-1 were maintained intravenously during anesthesia.0.375％ropivacaine 20 ml was injected between the psoas quadratus muscle and psoas major muscle under ultrasound guidance before extubation in group Q, only equal volume saline was given in group C.Neuropsychological tests were performed preoperatively as well as postoperative day 7.The postoperative pain was evaluated by VAS after surgery.The postoperative sleep quality was measured using a BIS-vista monitor.The changes of serum IL-6, IL-1β, TNF-αand CGRP levels were detected by ELISA at immediately after operation (T0), 1 hour (T1), 2 days (T2), 4 days (T3) and 7 days (T4) after operation.Results Seventy-six patients finished cognitive function tests (38 cases in group Q and 38 cases in group C), 12 cases (31.6％) were diagnosed as POCD in group C, 4 cases (10.5％) in group Q.Compared with group C, the incidence of POCD, VAS scores at 24 and 48 hours after operation in group Q were significantly lower (P<0.05), the sleeping time at night was longer, the serum levels of IL-6, IL-1βand TNF-αwere significantly lower at T2 and T3, and the serum levels of CGRP were significantly higher at T2-T4 (P<0.05 or P<0.01).Conclusion QLB treatment repaired the surgery induced early cognitive dysfunction by inhibiting the postoperative pain, excessive inflammatory response and improving the quality of sleep.

Objective To evaluate the effect of ultrasound-guided continuous anterior quadratus lumborum block (QLB) on postoperative analgesia in total hip arthroplasty.Methods Fifty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes,aged 65-80 yr,weighing 45-80 kg,scheduled for elective total hip arthroplasty under subarachnoid block,were divided into 2 groups (n =25 each) using a random number table method:ultrasound-guided continuous anterior quadratus lumborum block group (group Q) and routine analgesia group (group R).Anterior QLB was performed at the end of operation in group Q.Patient-controlled intravenous analgesia was performed with sufentanil after operation in two groups.Dezocine was given as rescue analgesic.Ramsay sedation score and the maximum angle for hip flexion and abduction of hip joint were recorded after operation,and the total consumption of sufentanil,requirement for dezocine and occurrence of adverse reactions were recorded within 72 h after operation.The occurrence of QLB-related complications was also recorded.Results Compared with group R,Ramsay sedation score was significantly decreased and the maximum angle for hip flexion and abduction of hip joint were increased at each time point after operation,and the total consumption of sufentanil,requirement for dezocine and incidence of nausea and vomiting were decreased in group Q (P ＜ 0.05).No QLB-related complications were found in group Q.Conclusion Ultrasound-guided continuous anterior QLB can produce better postoperative analgesia and reduce postoperative consumption of opioids with fewer adverse reactions in the patients undergoing total hip arthroplasty.

Objective To evaluate the effect of ultrasound-guided quadratus lumborum block (QLB) on the efficacy of postoperative analgesia after caesarean section.Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ parturients,aged 20-39 yr,weighing 50-80 kg,scheduled for elective cesarean section under subarachnoid block,were divided into 2 groups (n =30 each) using a random number table:QLB group (group Q) and control group (group C).Ultrasound-guided bilateral QLBs were performed at the end of surgery,the solution was injected into the compartment between quadratus muscle and psoas major muscles,and 0.25％ ropivacaine 1.25 mg/kg was injected to each side in group Q.The parturients in both groups received patient-controlled intravenous analgesia after surgery to maintain the visual analog scale score ≤ 3,and dezocine 5 mg was intramuscularly injected as a rescue analgesic when the visual analog scale score≥4.Bruggrmann comfort scale (BCS) and Ramsay sedation scores were evaluated at 2,4,6,12,24 and 48 h after operation.The consumption of sufentanil during patient-controlled intravenous analgesia,requirement for rescue analgesia,satisfaction score of analgesia,the number of successfully delivered doses (D1) and the number of attempts (D2) were recorded within 24 h after surgery.D1/D2 was calculated.The development of respiratory depression and over-sedation was recorded.The development of QLB-related adverse reactions and postoperative nausea,vomiting,chest tightness and pruritus was also recorded.Results Compared with group C,BCS scores were significantly increased,the consumption of sufentanil was reduced,D1/D2 was increased,the requirement for rescue analgesia was decreased,and the satisfaction score of analgesia was increased (P＜0.05),and no significant change was found in Ramsay sedation score in group Q (P＞0.05).Adverse reactions such as respiratory depression,over-sedation,nausea,vomiting,chest tightness and pruritus were not found in two groups.Adverse reactions such as hematoma and infection at the puncture site or local anesthetic intoxication were not observed after surgery in group Q.Conclusion Ultrasound-guided QLB can enhance the efficacy of postoperative analgesia after caesarean section,reduce postoperative consumption of opioids and raise the comfort degree for parturients.