Timing of surgical operation for patients with intra-abdominal infection:A systematic review and meta-analysis

BACKGROUND Intra-abdominal infections(IAIs)is the most common type of surgical infection,with high associated morbidity and mortality rates.In recent years,due to the use of antibiotics,various drug-resistant bacteria have emerged,making the treatment of abdominal infections more challenging.Early surgical exploration can reduce the mortality of patients with abdominal infection and the occurrence of complications.However,available evidence regarding the optimal timing of IAI surgery is still weak.In study,we compared the effects of operation time on patients with abdominal cavity infection and tried to confirm the best timing of surgery.AIM To assess the efficacy of early vs delayed surgical exploration in the treatment of IAI,in terms of overall mortality.METHODS A systematic literature search was performed using PubMed,EMBASE,Cochrane Central Register of Controlled Trials,Ovid,and ScienceDirect.The systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses method.Based on the timing of the surgical operation,we divided the literature into two groups:Early surgery and delayed surgery.For the early and delayed surgery groups,the intervention was performed with and after 12 h of the initial surgical intervention,respectively.The main outcome measure was the mortality rate.The literature search was performed from May 5 to 20,2021.We also searched the World Health Organization International Clinical Trials Registry Platform search portal and ClinicalTrials.gov on May 20,2021,for ongoing trials.This study was registered with the International Prospective Register of Systematic Reviews.RESULTS We identified nine eligible trial comparisons.Early surgical exploration of patients with IAIs(performed within 12 h)has significantly reduced the mortality and complications of patients,improved the survival rate,and shortened the hospital stay.CONCLUSION Early surgical exploration within 12 h may be more effective for the treatment of IAIs relative to a delayed operation.

Hepatolithiasis and surgical operation

Reply to the Editor: With the development of the treatment hepatolithiasis, I, as the responsible author of the article, has discussed the merits of the new operation dealing with regional hepatolithiasis-subcutaneous tunnel and hepatocholangioplasty with the use of the gallbladder (STHG).

The Popularization and Application of Cold Storage Red Blood Cells or Whole Blood at -80 ℃ of the Rh(D) Negative Patients in Surgical Operation

Summary: The efficiency of cold storage red blood cells (CSRBC) or whole blood at -80 ℃ used in 27 Rh(D) negative patients during surgical operation was reported. The Rh(D) negative patients received the transfusion of CSRBC or whole blood stored at -80 ℃ for 180 to 360 days. The changes in the indexes, such as blood TB, DB, K +, Na +, BUN, Cr, urine protein (URPO), UOB, Hb, HCT, serum total protein, relative to hemolytic reaction and blood volume before and after transfusion were observed. The results showed that after transfusion of CSRBC or whole blood 27 cases were negative for urine protein and UOB, and the levels of BUN and Cr were normal (P>0.05). Blood TB, DB, Hb, and HCT were increased, while pH, blood K + and blood Na + was normal with the difference being not significant before and after operation (P>0.05). Plasma protein was decreased, but there was no significant difference before and after operation (P>0.05). It was suggested that CSRBC or whole blood at -80 ℃ could be safely infused to the Rh(D) negative patients without side effects during the surgical operation.

Cardiac surgical operation after renal transplantation

Several studies reported the impact of cardiac surgical operation on morbidity and mortality in renal transplant recipients as well as on renal graft function and safety and effect of immunosuppressant medication.1-3 However,few data are available about the risk and immunosuppressant medication in patients who undergo cardiac surgical operation after successful renal transplantation,especially in patients who underwent offpump coronary artery bypass grafting （CABG） with previous renal transplantation.This research provides important insights into the immunosuppressive management of a patient requiring valve replacement or CABG after renal transplantation during the perioperative period.

低温等离子射频消融联合下鼻甲骨折外移术治疗阻塞性睡眠呼吸暂停低通气综合征的疗效观察

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者接受低温等离子射频消融联合下鼻甲骨折外移术后睡眠及经鼻持续气道正压通气(nasal continuous positive airway pressure,nCPAP)治疗耐受性的改善情况。方法选择40例OSAHS合并双侧下鼻甲肥大的患者作为研究对象,均在局麻下接受下鼻甲低温等离子射频消融联合骨折外移术。术前及术后2周分别采用多导睡眠监测(PSG)、鼻阻力仪、autoCPAP呼吸机及视觉模拟量表(VAS)测定睡眠呼吸暂停低通气指数(AHI)、最低血氧饱和度(lowest oxygen saturation,LSaO_(2))、鼻气道阻力及nCPAP治疗耐受性。结果与术前比较,术后2周时患者AHI降低至(35.17±9.72)次/h,LSaO_(2)提高至(83.21±6.58)%,鼻气道阻力降低至(0.55±0.09)kPa·s/cm^(3),VAS评分升高至8.32±1.17,差异比较均有统计学意义(P均<0.05)。结论低温等离子射频消融联合下鼻甲骨折外移术能有效降低OSAHS患者的鼻阻力,提高nCPAP治疗的耐受性,改善OSAHS患者的睡眠情况。

Surgical spacer placement and proton radiotherapy for unresectable hepatocellular carcinoma

Few potentially curative treatment options exist apart from hepatic resection for patients with huge hepatocellular carcinoma (HCC). Proton radiotherapy is a promising new modality which has an inherent antitumor effect against HCC. However, the application of proton radiotherapy for tumors adjacent to the gastrointestinal tract is restricted because the tolerance dose of the intestine is extremely low. A novel two-step treatment was developed with surgical spacer placement and subsequent proton radiotherapy to administer proton radiotherapy with curative intent. This report presents a case of a patient with a huge unresectable HCC treated by this method who achieved disease-free survival of more than 2 years. This new strategy may potentially be an innovative and standard therapy for unresectable HCC in the near future.

Surgical strategy for cerebral arteriovenous malformation with acute hemorrhage

BACKGROUND： Presently, there have been craniocerebral operation, interventional embolization,stereotactic radiotherapy and other methods in treating cerebral arteriovenous malformation （AVM）.However, the standard of different therapeutic regimens of cerebral AVM at the acute stage of hemorrhage has not been completely identified.OBJECTIVE： To observe the clinical characteristics and therapeutic effects of AVM at the acute stage of hemorrhage in patients, and to analyze corresponding therapeutic strategies.DESIGN： Non-randomized clinical observation.SETTING： Department of Neurosurgery, Foshan First People＇s Hospital, Sun Yat-sen University.PARTICIPANTS： Forty-six patients with cerebral AVM complicated by hemorrhage admitted to Department of Neurosurgery, Foshan First People＇s Hospital between January 1999 and December 2006,were involved in this study. All the patients were confirmed as cerebral AVM complicated by hemorrhage by brain angiography or/and postoperational pathology. The involved patients, 32 males and 14 females,averaged 25 years old, ranging from 6 to 62 years. Informed consents of therapeutic items were obtained from the relatives of all the patients.METHODS： ①On admission, skull CT and brain angiography were conducted in the involved subjects. ②The therapeutic method was confirmed according to the consciousness, hematoma region, hematoma volume,imageological results following comprehensive analysis： DSA examination was permitted to identify the size and position of abnormal vessel mass, and the distribution of feeding artery and draining vein. Craniocerebral operation was carried out as early as possible in patients with severe or progressive conscious disturbance, in which most of hematoma with obvious occupied effect or cerebral hernia was located in lobe of brain. The primary thing was to clean intracerebral hematoma for in time decompression. According to different situations, corresponding therapeutic measures were used for resecting abnormal vessel mass, and the treatments of patients were observed. ③The therapeutic effects were assessed following Glasgow outcome scale（GOS） at 3 months after hemorrhage.MAIN OUTCOME MEASURES： ①The examination results of skull CT and brain angiography of patients on admission. ②Treatment of patients. ③GOS results at 3 months after hemorrhage.RESULTS： Forty-six patients were involved, and all of them participated in the final analysis. ① Examination results of skull CT and brain angiography： Bleeding part： frontal lobe in 7 cases, parietal lobe 15, temporal lobe 19, occipital lobe 3, cerebellar hemisphere 2, and hemorrhage rupturing into ventricle 10. Haematoma volume： small volume of hematoma （〈20 mL） in 4 cases, moderate volume of hematoma （20 - 50 mL） 14, large volume of hematoma （ 50 - 80 mL） 21, great volume of hematoma （〉80 mL） 7; Abnormal vessel mass： Among 17 patients undergoing aortocranial angiography, abnormal vessel mass was found in 16 patients, including cortex 13 patients, basal ganglia and thalamencephalon（deep part） 2 patients, and posterior cranial fossa 1 patient. The size of abnormal vessel mass： small （〈3 cm） 4 patients, moderate （3 -6 cm） 9 patients, and large （〉6 cm） 3 patients. The type of feeding artery： perforating branch blood-supply 1 patient, cortical branch blood supply 13 patients, mixed branch blood supply 2 patients. The type of draining vein： cortical draining （superficial part） 10 patients, deep part draining 2 patients, and mixed draining 4 patients. ② Treatment condition： Among 17 patients undergoing brain angiography followed by craniocerebral operation, hematoma was removed and AVM was completely resected in 12 patients, hematoma was removed and AVM was partially resected in 3 patients, and only hematoma was resected in 2 patients; Among 24 patients undergoing emergent craniocerebral operation, hematoma was removed and AVM was completely resected in 5 patients, hematoma was removed and AVM was partially resected in 9 patients, and only hematoma was resected in 10 patients; Expectant treatment was carried out in the early stage in 5 patients. When disease condition was stable, AVM resection was separately or complicatedly conducted in 13 patients, embolization in 4 patients, and γ - radiotherapy in 5 patients. ③GOS： 5 patients died in postoperative complications, and among the other patients, 19 had moderate or had not functional impairment, 13 had moderate disability, 6 had severe disability, 2 were vegetative state, and 2 died. ④Post-operative re-examination of brain angiography： Among 16 patients undergoing AVM, vessel mass disappeared in 9 patients.CONCLUSION： Good therapeutic effects can be obtained by choosing proper therapeutic regimen according to clinical and imageological characteristics of patients with arteriovenous malformation complicated by hemorrhage at the acute stage.

颈部多间隙感染12例临床分析

目的总结颈部多间隙感染患者的临床特点和治疗经验。方法回顾性分析吉林市人民医院耳鼻咽喉头颈外科收治的12例颈部多间隙感染患者的详细临床资料,对其感染来源、实验室结果、影像学检查、治疗方式、疗效等进行总结和分析。结果男10例,女2例,2例牙源性感染,白细胞及C反应蛋白均不同程度升高,颈部增强CT可见局部软组织肿胀、密度不均,部分患者可见气体影或边缘及分隔样强化。6例保守治疗,6例手术治疗,所有患者均治愈出院,无死亡病例。结论颈部多间隙感染患者根据病情轻重选择保守或手术治疗,手术治疗的关键在于彻底清创引流,合理应用抗生素和规律控制血糖,必要时多科联合治疗以提高治愈率。

颈交感链神经鞘瘤的诊断和治疗

目的探讨术中是否保留颈交感链对颈交感链神经鞘瘤(cervical sympathetic chain neurilemmoma,CSCL)患者预后的影响。方法回顾性分析2018年4月~2022年5月首都医科大学附属北京友谊医院诊治的5例CSCL患者病例资料,分析临床表现、诊断要点、手术经验、术后并发症及转归情况。结果5例CSCL患者术中均先试行包膜内核除术,4例成功保留颈交感链,术后4~14 d出现霍纳综合征(Horner syndrome,HS),术后1~3个月恢复正常,患者未有第一口综合征(first bite syndrome,FBS)并发症;1例切断颈交感链,术后3 d出现HS,随访21个月未恢复,患者出现严重的FBS并发症,随访21个月无明显减轻。所有患者中位随访时间14个月,未发现复发。结论CSCL手术时应首先尝试包膜内核除,如果能成功保留颈交感链,可以避免FBS并发症,尽管术后会出现HS,但仍可恢复。

成人鳃裂畸形患者临床分析

目的探讨成人鳃裂畸形的临床特征、检查手段及疗效。方法回顾性分析2011年11月~2021年12月宁波大学附属第一医院手术的25例成人鳃裂畸形患者,分析治疗疗效及术后并发症情况。结果成人鳃裂畸形男女比例为7∶18,病程(113.92±154.20)个月。囊肿型16例,瘘管型9例。第一鳃裂来源5例,第二鳃裂来源17例,第三鳃裂来源3例。就诊于耳鼻咽喉头颈外科18例、口腔科6例、甲状腺外科1例。MRI检查可显示病变及走行。术后复发7例(28%),其中囊肿型者1例,瘘管型者6例。3例累及腮腺、面神经;2例累及同侧甲状腺、颈鞘、喉返神经。所有患者均手术治愈,无面瘫、声嘶等并发症。结论成人鳃裂畸形就诊科室分布广,涉及解剖复杂,相关科室提高对该病的认知程度和外科处理能力,避免漏诊误诊,减少疾病复发及相关并发症的出现。

药物诱导睡眠内镜定位辅助下手术治疗阻塞性睡眠呼吸暂停低通气综合征的效果及对摄氧情况的影响

目的 探讨分析药物诱导睡眠内镜(drug-induced sleep endoscopy,DISE)定位辅助下手术治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的效果及对摄氧情况的影响。方法 2017年6月~2022年6月六安市中医医院收治的OSAHS患者100例,以数字表法随机分2组,对照组50例和观察组50例,对照组根据Müller检查结果进行手术,观察组根据DISE定位辅助进行手术,比较分析两组治疗情况。结果 观察组较对照组治疗总有效率更高[94.00%(47/50)vs.78.00%(39/50)](χ2=5.316,P<0.05);治疗后观察组呼吸暂停低通气指数(AHI)低于对照组[(9.38±2.94)次/h vs.(13.45±3.68)次/h],最低血氧饱和度(LSaO2)[(85.72±3.17)%vs.(79.63±2.47)%]、△VE/△SaO2[(-0.25±0.04)L/(min·%)vs.(-0.31±0.06)L/(min·%)]均高于对照组(t=6.110、10.716、5.883,P<0.05);治疗后观察组匹兹堡睡眠质量指数(PSQI)量表评分较对照组低(2.32±0.35 vs.4.19±0.48),Calgary睡眠呼吸暂停生活质量指数(SAQLI)量表评分(6.09±0.53vs.4.84±0.49)高于对照组(t=22.259、12.245,P<0.05);治疗后观察组超敏C反应蛋白(hs-CRP)低于对照组[(0.49±0.08)mg/L vs.(0.78±0.11)mg/L],胰岛素样生长因子1(IGF-1)较对照组高[(72.58±9.63)mmol/L vs.(64.82±11.57)mmol/L](t=15.076、3.645,P<0.05)。结论 DISE定位辅助下手术治疗OSAHS能提高治疗效果,促进患者摄氧情况、睡眠状态及生活质量改善,也能进一步调节血清相关因子水平,值得推广。

保留扁桃体的茎突截短术治疗茎突综合征

茎突综合征是因茎突过长或形态异常导致周围血管、神经或其他组织受刺激引起的咽部不适、异物感、咽痛、反射性耳痛及头颈痛等症状的一组综合征,易误诊及误治。我科自2010年以来采用保留扁桃体手术治疗茎突综合征共45例,取得满意疗效,现报道如下。

紧急环甲膜切开术救治急性喉梗阻临床分析

急性喉梗阻病情凶险,必须迅速紧急开放气道改善呼吸才能缓解病情及挽救生命,如处理不及时或方法不当,患者可因缺氧窒息死亡。我院自1995年以来,因急性喉梗阻导致的窒息昏迷患者做紧急环甲膜切开术4例,效果显著,现报道如下。

Simultaneous operative treatment of patients with primary liver cancer associated with portal hypertension

Objective: To explore the operative procedure for pa-tients with primary liver cancer associated with portalhypertension (PLCPH).Methods: We analyzed retrospectively the effect of op-erative procedure for 9 patients with PLCPH compli-cated by severe esophageal varicosity and hyper-splenism.Results: All patients underwent liver resection andpericardiac devascularization with splenectomy. Of the9 patients, 2 died from liver cancer recurrence sepa-rately 13 and 16 months after operation, and 1 diedfrom massive duodenal ulcer bleeding and multipleorgans failure. Six patients survived 3, 4, 8, 10, 12 and25 months after operation.Conclusions: The patients with PLCPH undergoing si-multaneous operation could acquire curative effect ascompared with those who underwent liver resec-tion. This operation is beneficial to the patients withpoor liver function.

成人复发性甲状舌管囊肿临床分析

甲状舌管囊肿及瘘是颈部常见的先天性疾病,是由于甲状舌管未闭合或退化不全所致。如果感染自行溃破或切开引流后经久不愈,则会形成继发囊肿表面的皮下瘘管,偶有恶变倾向。手术切除是其有效的治疗方法,手术切除不彻底易致复发。

Occlusion of the middle cerebral artery Guidance by screen imaging using an EDA-H portable medium-soft electronic endoscope

The present study aimed to verify the practicability of performing screen-based surgical operations under the guidance of a real-time viewing and recording system （RTVRS） using a portable medium-soft electronic endoscope （pmsEE）. The middle cerebral artery in rats was occluded under screen-imaging guidance using a pmsEE RTVRS to reproduce an animal model of human cerebral infarction. The screen imaging of the pmsEE RTVRS was clear, life-like, stereoscopic and synchronous with the actual operation. Screen-imaging guidance led to an accurate, smooth, minimally invasive and comparatively easy surgical procedure. The surgical success rate, time of model establishment, neurological function scores, and infarct volume were similar to those using an operating microscope. These results indicate that the self-designed pmsEE RTVRS could be utilized for portable endoscopic screen-based surgical operations.

In vivo fiber photometry of neural activity in response to optogenetically manipulated inputs in freely moving mice

In vito fber photometry is a powerful technique to analyze the dy namics of population neurons during fiunctional study of neuroscience.Here,we introduced a detailed protocol for fiber photometry-based calciun reording in freely moving mice,covering from virus injection,fiber stub insertion,optogenetical stimulation to data procurement and analysis.Furthemnore,we applied this protocol to explore neuronal activity of mice latenal-posterior(LP)thalaric nucleus in response to optogenetical stimulation of primary visual cortex(V1)neurons,and explore axon clusters activity of optogenetically evoked V1 neurons.Final confirmation of virus-based protein expression in V1 and precise fber insertion indicated that the surgery procedure of this protocol is reliable for functional calcium recording.The scripts for data analysis and some tips in our protocol are provided in details.Together,this protocol is simple,low-cost,and effective for neuronal activity detection by fiber photometry,which will hep neuroscience researchers to carry out fiunctional and behavioral study in vivo.

The relation of laparotomy timing to prognosis in patients with acute necrotizing pancreatitis

Objective: To evaluate the relation of laparotomy timing to the prognosis in patients with acute necro- tizing pancreatitis (ANP). Methods: The laparotomy timing, morbidity, mor- tality and reoperation rate were reviewed in 78 pa- tients with ANP at our hospital from 1988 to 2001. Results: The morbidity rates of early operation, de- layed operation and non-operation groups were 68.7%, 34.2% and 29.1%, respectively, and their mortality rates were 37.5%, 10.5% and 12.5%. The reoperation rates in early operation and delayed ope- ration groups were 87.5% and 18.4%, respectively. Conclusions: The strategy for the management of ANP is an important factor influencing the prognosis of ANP patients. For ANP, delayed operation if nec- essary is more preferable than early operation in terms of better prognosis, and surgery should be simple and free from severe trauma.

A Comparative Study of Ultrasound-Guided Microwave Ablation, Surgery and Rotational Adenomammectomy for Benign Breast Nodules

Objective: To explore the clinical effects of conventional surgery, ultrasound-guided microwave ablation and rotational adenomammectomy on the prognosis of benign breast nodules. Methods: 232 cases of patients with benign breast nodules confirmed by pathological examination who received surgical treatment in the breast surgery department of our hospital from December 2016 to December 2020 were included. According to the surgical methods, they were divided into microwave ablation group (n = 48), conventional surgery group (n = 105) and rotational adenomammectomy group (n = 79). The clinical parameters were compared and analyzed between the three groups, and the postoperative pain, residual tumor, breast beauty and complication rate of the patients were evaluated. Results: Operative time, intraoperative blood loss, healing time and postoperative pain in microwave ablation group were lower than those of rotational adenomammectomy group (P < 0.05) and those of conventional surgery group (P < 0.05). Besides, those in the rotational adenomammectomy group were lower than those in the conventional surgery group (P < 0.05). The residual tumor rates in microwave ablation group and rotational adenomammectomy group were 4.17% and 3.80%, respectively. And the difference was not statistically significant (P > 0.05). Both of them were lower than 6.66% in conventional surgery group, with statistically significant differences (P < 0.05). The effective rates of breast beauty were 91.67%, 82.28% and 68.58% in the microwave ablation group, the rotational adenomammectomy group and the conventional surgery group, respectively. And the difference between groups was statistically significant (P < 0.05). The rate of postoperative complications in microwave ablation group and rotational adenomammectomy group were 4.17% and 3.80% respectively, both of which were significantly lower than 6.66% in conventional surgery group (P < 0.05). Conclusion: Microwave ablation, rotational adenomammectomy and conventional surgery are effective for the treatment of benign breast tumors. Among them, microwave ablation is the best option with many advantages of shorter operative time, less intraoperative blood loss, more beautiful breast shape, less postoperative pain, a lower residual rate after surgery, and a lower complication rate.

Duodenal giant stromal tumor combined with ectopic varicose hemorrhage:A case report

BACKGROUND Gastrointestinal stromal tumors(GISTs)are mesenchymal tissue tumors originating from Cajal cells,presenting diverse clinical manifestations due to the different sizes,locations,and growth patterns of the lesions.Duodenum is an uncommon site of GISTs,more with gastrointestinal obstruction and bleeding as the first symptoms.Ectopic duodenal varix,as a rare varix occurring outside the gastroesophageal region,is the main type of heterotopic varices and an unusual cause of gas-trointestinal hemorrhage.The etiology is mainly seen in liver cirrhosis,portal hypertension,vasculitis,portal vein embolism and obstruction caused by various factors.Reports of duodenal stromal tumor combined with ectopic variceal hemorrhage are rarely seen;however,when it occurs,the situation can sometimes be urgent and life-threatening,especially when traditional endoscopy and imaging fail to detect the lesion timely.CASE SUMMARY We report a 52-year-old female patient who had no obvious inducement to develop black stool.Gastroscopy in a local hospital revealed that the duodenal horizontal ectopic varices were ruptured and bleeding.After metal clamping hemostasis,she still had gastrointestinal bleeding and was transferred to our hospital.Gastroscopy showed that active bleeding was still seen in the horizontal part of duodenum,and suspicious submucosal eminence was seen in the bleeding part.Abdominal computed tomography showed a huge stromal tumor of duodenum,specimens were pathologically confirmed after surgery.After a 3-mo follow-up,no gastrointestinal hemorrhage and complications occurred.CONCLUSION Ectopic variceal hemorrhage is rare but sometimes fatal.It may be combined with stromal tumor,which can be diagnosed by multiple methods.Endoscopic and surgical treatment are effective.