Introduction: The acromioclavicular joint is a superficial diarthrodial joint that surrounds the medial articular facet of the acromion and the distal portion of the clavicle. Due to its anatomy and biomechanics, it i...Introduction: The acromioclavicular joint is a superficial diarthrodial joint that surrounds the medial articular facet of the acromion and the distal portion of the clavicle. Due to its anatomy and biomechanics, it is highly susceptible to trauma and in young men who play contact sports, acromioclavicular dislocation is common. This article aimed to systematically review the literature and compare the surgical techniques used in the treatment of acromioclavicular dislocation in patients who practice sports. Methods: This systematic review was conducted according to the International Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Eligible studies for this systematic review included articles in English or Spanish published between 2013 and 2023, which mention the occurrence of acromioclavicular dislocation during sports practices. Additionally, only studies that addressed the surgical treatment of acromion-clavicular dislocation and contained original data on the topic were included. Results: We found 144 eligible studies after searching the LILACS and PubMed databases. Based on the inclusion and exclusion criteria and the reviewers’ consensus, we selected four studies for the systematic review. 133 patients with AC joint displacement were evaluated. Mean Age: approximately 31.90 years. 81.92 of these injuries occurred during sports practice. Surgical Procedures Used: titanium plates fixation (49 patients), arthroscopy (24), single tunnel technique (30) and coracoid sling technique (30). The results of the visual analog scale and Constant-Murley scores varied between the techniques used. Twenty-two complications after surgical treatment were identified. Conclusion: A significant variability of operative techniques can be used in the surgical approach of acromioclavicular dislocation, such as arthroscopy, single tunnel, coracoid sling and titanium plates. Although it presented excellent functional results compared to the other three techniques evaluated by this review, using titanium plates is not the gold standard since other techniques not assessed by this work may be more effective.展开更多
Objective To investigate the changes of perioperative serum levels of interleukin-6(IL-6), C-reactive protein (CRP), and cortisol, as well as gastric intramucosal pH (pHi) and plasma lactate, aiming to compare systemi...Objective To investigate the changes of perioperative serum levels of interleukin-6(IL-6), C-reactive protein (CRP), and cortisol, as well as gastric intramucosal pH (pHi) and plasma lactate, aiming to compare systemic changes and tissue perfusion during colorectal and orthopaedic surgical procedures. Methods Twenty patients were randomly assigned to two groups, 10 cases of operation on vertebral canal, 10 cases of colorectal radical operation.Venous blood was drawn at 1 day before operation, 2, 4, and 6 hours following skin incision, and 1 day after operation, in order to measure serum IL-6, CRP, and cortisol.pHi and plasma lactate were also measured at the same time points.Results Serum concentrations of IL-6 and cortisol increased gradually following operation, reaching the peak value at 6 hours from the beginning of operation.CRP was not detectable until the first day after operation.Peak concentration of IL-6 had positive relationship with CRP.These variables changed more significantly in colorectal group than that in orthopaedic group (P<0.05).pHi decreased gradually, reaching the lowest level at 4 hours from the beginning of operation, and to more extent in colorectal group than that in orthopaedic group (P<0.05).Conclusion IL-6 may reflect tissue damage more sensitively than CRP.Colorectal surgery might induce systemic disorder to more extent, in terms of immuno-endocrinal aspect as well as tissue perfusion, reflected with pHi.展开更多
Introduction: Cancellation of surgical operation is a surgical operation registered in the official schedule the day before or added to the list after and not carried out on the operating day. The purpose of this work...Introduction: Cancellation of surgical operation is a surgical operation registered in the official schedule the day before or added to the list after and not carried out on the operating day. The purpose of this work was to determine the causes of cancellation of elective surgical operations in a major pediatric surgery department in Senegal. Patients and methods: It was a prospective and descriptive study of 278 patients scheduled during a period of 13 weeks. The study took place between April 3<sup>rd</sup>, 2017, and January 31<sup>st</sup>, 2018. Mean age was 2.9 years with extremes of 3 days and 15 years. The age group of 29 days to 30 months was the most represented (62.2%). Sex ratio was 1.41. Causes of cancellation were categorized into administrative and organizational causes, patient-related causes and staff-related causes. Results: Cancellation rate was 29.4%. Patient-related causes were most common (51.2%). Upper Respiratory tract infection (URTI) was commonest reason within this category (57.5%). Organizational causes (28.1%) came second and were mainly represented by the unavailability of the operating room (60.8%) related to breakdowns of anesthesia equipment. Finally, staff-related causes (20.7%) were due for most to the unavailability of the anesthesiologist (12 cases/17). Conclusion: Majority of causes that led to cancellation of elective surgical operations in our Pediatric surgery department are related to intercurrent illnesses affecting the patient, in particular URTI.展开更多
Background:To study the application of management tools such as Plan-Do-Check-Action(PDCA)cycle and fishbone diagram in optimizing surgical procedures to improve the satisfaction of doctor-nurse-patient.Methods:The fu...Background:To study the application of management tools such as Plan-Do-Check-Action(PDCA)cycle and fishbone diagram in optimizing surgical procedures to improve the satisfaction of doctor-nurse-patient.Methods:The fundus surgery nursing team of our hospital began to implement the PDCA cycle management mode to optimize the surgical procedure from July 2017,set up a project activity improvement team,unified the surgical labeling processing plan,and made the fundus surgery procedure,and established the preoperative health education for surgical patients,and standardized the training content of post-rotating doctors and interns.Results:The satisfaction degree to surgical procedure after implementation of doctors and nurses was higher than that before implementation.Conclusions:Using PDCA cycle and fishbone diagram analysis tools to manage the surgical procedure optimization can better integrate doctor-nurse medical care,improve the efficiency and accuracy of the surgical procedure delivery and operation,and optimize the satisfaction of the three parties of doctor-nurse-patient.展开更多
<strong>Objective:</strong> To compare the clinical efficacy and safety of ultrasound-guided microwave ablation with surgery for the treatment of primary parathyroid adenoma. <strong>Methods:</str...<strong>Objective:</strong> To compare the clinical efficacy and safety of ultrasound-guided microwave ablation with surgery for the treatment of primary parathyroid adenoma. <strong>Methods:</strong> The clinical data of patients with primary parathyroid adenoma admitted to the First Hospital of Yangtze University from January 2010 to May 2020 were retrospectively analyzed, and they were divided into 43 cases in the microwave ablation group (MWA) and 39 cases in the surgical procedure group (SR) according to the different treatment methods. The surgical condition, postoperative complications, and changes in serum parathyroid hormone (PTH) and serum calcium and phosphorus levels were analyzed in both groups. <strong>Results:</strong> The hospital stay and operation time of patients in the microwave ablation group were shorter than those in the surgical group, and the intraoperative bleeding was significantly less than that in the surgical group (P < 0.05);the serum parathyroid hormone (PTH), blood calcium and blood phosphorus levels of patients in both groups were significantly lower than those before treatment (P < 0.05) after surgery of 1, 3 and 6 months respectively, and the differences between groups were not statistically significant (P > 0.05). There was no statistically significant difference in the incidence of postoperative complications between the two groups (P > 0.05). <strong>Conclusion: </strong>Microwave ablation can achieve the same therapeutic effect as surgery. It is a safe and feasible clinical technique worthy of clinical promotion with its short hospitalization time, less bleeding and less trauma.展开更多
Objective To investigate different surgical procedures for treatment of thoracic ossification of ligamentum flavum.Methods From January 1994 to June 2008,56 cases of thoracic ossification of ligamentum flavum underwent
Background:Minimally invasive surgery is the optimal treatment for insulinoma.The present study aimed to compare short-and long-term outcomes of laparoscopic and robotic surgery for sporadic benign insulinoma.Methods:...Background:Minimally invasive surgery is the optimal treatment for insulinoma.The present study aimed to compare short-and long-term outcomes of laparoscopic and robotic surgery for sporadic benign insulinoma.Methods:A retrospective analysis of patients who underwent laparoscopic or robotic surgery for insulinoma at our center between September 2007 and December 2019 was conducted.The demographic,perioperative and postoperative follow-up results were compared between the laparoscopic and robotic groups.Results:A total of 85 patients were enrolled,including 36 with laparoscopic approach and 49 with robotic approach.Enucleation was the preferred surgical procedure.Fifty-nine patients(69.4%)underwent enucleation;among them,26 and 33 patients underwent laparoscopic and robotic surgery,respectively.Robotic enucleation had a lower conversion rate to laparotomy(0 vs.19.2%,P=0.013),shorter operative time(102.0 vs.145.5 min,P=0.008)and shorter postoperative hospital stay(6.0 vs.8.5 d,P=0.002)than laparoscopic enucleation.There were no differences between the groups in terms of intraoperative blood loss,the rates of postoperative pancreatic fistula and complications.After a median follow-up of 65 months,two patients in the laparoscopic group developed a functional recurrence and none of the patients in the robotic group had a recurrence.Conclusions:Robotic enucleation can reduce the conversion rate to laparotomy and shorten operative time,which might lead to a reduction in postoperative hospital stay.展开更多
Background:The superiority of anatomical resection(AR)vs.non-anatomical resection(NAR)in the surgical management of hepatocellular carcinoma(HCC)is debated.ARs are well-defined procedures,whereas the lack of NAR stand...Background:The superiority of anatomical resection(AR)vs.non-anatomical resection(NAR)in the surgical management of hepatocellular carcinoma(HCC)is debated.ARs are well-defined procedures,whereas the lack of NAR standardization results in heterogeneous outcomes.This study aimed to introduce the SegSubTe classification for NAR detailing the appropriateness of the level of surgical section of the Glissonean pedicles feeding the tumor.Methods:A single-center retrospective analysis of pre-and postoperative imaging of consecutive patients treated with NAR for single HCC between 2012 and 2020 was conducted.The quality of surgery was assessed classifying the type of vascular supply and the level of surgical section(segmental,subsegmental or terminal next to the tumor)of vascular pedicles feeding the HCCs;then,the population was divided in“SegSubTe-IN”or“SegSubTe-OUT”groups,and the tumor recurrence and survival were analyzed.Results:Ninety-seven patients who underwent NAR were included;76%were SegSubTe-IN and 24%were SegSubTe-OUT.Total disease recurrence,local recurrence and cut-edge recurrence in the SegSubTe-IN vs.SegSubTe-OUT groups were 50%vs.83%(P=0.006),20%vs.52%(P=0.003)and 16%vs.39%(P=0.020),respectively.SegSubTe-OUT odds ratio for local recurrence was 4.1 at univariate regression analysis.One-,three-,and five-year disease-free survival rates in the SegSubTe-IN vs.SegSubTe-OUT groups were 81%,58%and 35%vs.46%,21%and 11%,respectively(P<0.001).Conclusions:The SegSubTe classification is a useful tool to stratify and standardize NAR for HCC,aiming at improving long-term oncological outcomes and reducing the heterogeneity of quality of NAR for HCC.展开更多
BACKGROUND Cervical necrotizing fasciitis(CNF)is a rare,aggressive form of deep neck space infection with significant morbidity and mortality rates.Serial surgical debridement acts as the cornerstone of CNF treatment;...BACKGROUND Cervical necrotizing fasciitis(CNF)is a rare,aggressive form of deep neck space infection with significant morbidity and mortality rates.Serial surgical debridement acts as the cornerstone of CNF treatment;however,it often results in defects requiring complex reconstructions.CASE SUMMARY We report two cases in which the keystone flap(KF)was used for CNF defect coverage:Case 1,an 85-year-old patient with CNF in the anterior neck,and Case 2,a 54-year-old patient with CNF in the posterior neck.Both patients received empirical intravenous antibiotic therapy and underwent serial debridement,enabling adequate wound preparation and stabilization.The final defect size measured 5.5 cm×12 cm in Case 1 and 6 cm×11 cm in Case 2.For defect coverage,we employed an 8 cm×19 cm type II KF based on perforators from the superior thyroid artery in Case 1 and a 9 cm×18 cm type II KF based on perforators from the transverse cervical artery in Case 2.Both flaps showed complete survival.No postoperative complications occurred in both cases,and favorable outcomes were observed at 7-and 6-month follow-ups in case 1 and 2,respectively.CONCLUSION We effectively treated CNF-associated defects using the KF technique;KF is viable for covering CNF defects in carefully selected cases.展开更多
BACKGROUND Colorectal cancer is the third most common cancer and the second highest cause of cancer-related mortality worldwide.About 5%-10%of patients are diagnosed with locally advanced rectal cancer(LARC)on present...BACKGROUND Colorectal cancer is the third most common cancer and the second highest cause of cancer-related mortality worldwide.About 5%-10%of patients are diagnosed with locally advanced rectal cancer(LARC)on presentation.For LARC invading into other structures(i.e.T4b),multivisceral resection(MVR)and/or pelvic ex-enteration(PE)remains the only potential curative surgical treatment.MVR and/or PE is a major and complex surgery with high post-operative morbidity.Minimally invasive surgery(MIS)has been shown to improve short-term post-operative outcomes in other gastrointestinal malignancies,but there is little evi-dence on its use in MVR,especially so for robotic MVR.This is a single-center retrospective cohort study from 1st January 2015 to 31st March 2023.Inclusion criteria were patients diagnosed with cT4b rectal cancer and underwent MVR,or stage 4 disease with resectable systemic metastases.Pa-tients who underwent curative MVR for locally recurrent rectal cancer,or me-tachronous rectal cancer were also included.Exclusion criteria were patients with systemic metastases with non-resectable disease.All patients planned for elective surgery were enrolled into the standard enhanced recovery after surgery pathway with standard peri-operative management for colorectal surgery.Complex sur-gery was defined based on technical difficulty of surgery(i.e.total PE,bladder-sparing prostatectomy,pelvic lymph node dissection or need for flap creation).Our primary outcomes were the margin status,and complication rates.Cate-gorical values were described as percentages and analysed by the chi-square test.Continuous variables were expressed as median(range)and analysed by Mann-Whitney U test.Cumulative overall survival(OS)and recurrence-free survival(RFS)were analysed using Kaplan-Meier estimates with life table analysis.Log-rank test was performed to determine statistical significance between cumulative estimates.Statistical significance was defined as P<0.05.Meier estimates with life table analysis.Log-rank test was performed to determine statistical significance between cumulative estimates.Statistical significance was defined as P<0.05.RESULTS A total of 46 patients were included in this study[open MVR(oMVR):12(26.1%),miMVR:36(73.9%)].Patients’American Society of Anesthesiologists score,body mass index and co-morbidities were comparable between oMVR and miMVR.There is an increasing trend towards robotic MVR from 2015 to 2023.MiMVR was associated with lower estimated blood loss(EBL)(median 450 vs 1200 mL,P=0.008),major morbidity(14.7%vs 50.0%,P=0.014),post-operative intra-abdominal collections(11.8%vs 50.0%,P=0.006),post-operative ileus(32.4%vs 66.7%,P=0.04)and surgical site infection(11.8%vs 50.0%,P=0.006)compared with oMVR.Length of stay was also shorter for miMVR compared with oMVR(median 10 vs 30 d,P=0.001).Oncological outcomes-R0 resection,recurrence,OS and RFS were comparable between miMVR and oMVR.There was no 30-d mortality.More patients underwent robotic compared with laparoscopic MVR for complex cases(robotic 57.1%vs laparoscopic 7.7%,P=0.004).The operating time was longer for robotic compared with laparoscopic MVR[robotic:602(400-900)min,laparoscopic:Median 455(275-675)min,P<0.001].Incidence of R0 resection was similar(laparoscopic:84.6%vs robotic:76.2%,P=0.555).Overall complication rates,major morbidity rates and 30-d readmission rates were similar between la-paroscopic and robotic MVR.Interestingly,3-year OS(robotic 83.1%vs 58.6%,P=0.008)and RFS(robotic 72.9%vs 34.3%,P=0.002)was superior for robotic compared with laparoscopic MVR.CONCLUSION MiMVR had lower post-operative complications compared to oMVR.Robotic MVR was also safe,with acceptable post-operative complication rates.Prospective studies should be conducted to compare short-term and long-term outcomes between robotic vs laparoscopic MVR.展开更多
Introduction: Treatments for cardiovascular diseases have increasingly evolved with the tendency to offer minimally invasive or transcatheter procedures instead of conventional sternotomy surgery. In this context, we ...Introduction: Treatments for cardiovascular diseases have increasingly evolved with the tendency to offer minimally invasive or transcatheter procedures instead of conventional sternotomy surgery. In this context, we highlight minimally invasive mitral valve surgery (MIMVS), which has been shown to be an increasingly solid option with some superior results when compared to the conventional technique: better pain control, shorter hospital stays, shorter recovery time, shorter readmission rate in the first postoperative year, better aesthetic results, and lower overall cost. Aim: This study aims to evaluate the stages of MIMVS, by primary mitral valve consultation, in our service and compare these results with data from the literature. Methods: All electronic medical records of patients who underwent MIMVS for primary mitral valve injury in the Encore Hospital from January 2020 to February 2023 were analyzed. Tabulation and statistical analysis were performed using the Microsoft Excel<sup>®</sup> program. Quantitative variables were presented as means, standard deviations. Results: 46 patients were enrolled in our study (Age: 59.1 ± 12.4 years old;60.8% Female, BMI: 26 ± 4.4 Kg/m<sup>2</sup>, Low risk STS score: 82.6%). The observed 30-day mortality was 2.1%, plastic rate of 23.9%, blood transfusion rate of 41.3%, length of stay in an intensive care bed (ICB) of 3.3 ± 3.3 days and hospital stay of 6.4 ± 5.1 days. Conclusions: We noticed that the MIMVS results carried out in our service agree with data from national and international literature with approximately 1.3 days more hospitalization in ICB.展开更多
Throughout the twenty-first century, robotic surgery has been used in multiple oral surgical procedures for the treatment of head and neck tumors and non-malignant diseases. With the assistance of robotic surgical sys...Throughout the twenty-first century, robotic surgery has been used in multiple oral surgical procedures for the treatment of head and neck tumors and non-malignant diseases. With the assistance of robotic surgical systems, maxillofacial surgery is performed with less blood loss, fewer complications, shorter hospitalization and better cosmetic results than standard open surgery.However, the application of robotic surgery techniques to the treatment of head and neck diseases remains in an experimental stage, and the long-lasting effects on surgical morbidity, oncologic control and quality of life are yet to be established. More well-designed studies are needed before this approach can be recommended as a standard treatment paradigm. Nonetheless,robotic surgical systems will inevitably be extended to maxillofacial surgery. This article reviews the current clinical applications of robotic surgery in the head and neck region and highlights the benefits and limitations of current robotic surgical systems.展开更多
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 effe...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.展开更多
BACKGROUND: Carcinoma of the hepatic duct confluence is the most common site of bile duct malignancies. Although hilar cholangiocarcinoma has been characterized as a slow-growing and late metastasizing tumor, post-the...BACKGROUND: Carcinoma of the hepatic duct confluence is the most common site of bile duct malignancies. Although hilar cholangiocarcinoma has been characterized as a slow-growing and late metastasizing tumor, post-therapeutic prognosis has remained poor. The study was undertaken to analyze factors influencing the surgical curative effect of hilar cholangiocarcinoma. METHODS: A retrospective clinical analysis was made of 198 patients with hilar cholangiocarcinoma who had been surgically treated at our hospital from 1997 to 2002. Jaundice (94.5%, 187 patients), pruritus (56.6%, 112) and abdominal pain (33.8%, 67) were the main symptoms. According to the Bismuth-Corlette classification, there were 14 type Ⅰ patients, 19 type Ⅱ patients, 12 type Ⅲa patients, 15 type Ⅲb patients, 112 type Ⅳ patients, and 26 unclassified patients. 144 patiens received laparotomy, and 120 tumor resection including radical resection (59 patients) and palliative resection (61). Fifty-four patients were treated by endoscopic surgery and 16 patients by postoperative adjuvant radiation. RESULTS: Occupation, preoperative level of total serum bilirubin, operative procedure and postoperative adjuvant radiation affected postoperative survival of the patients. The postoperative suvivals of endoscopic nose-biliary drainage (ENBD) group, endoscopic retrograde biliary drainage (ERBD) or endoscopic metal biliary endoprosthesis (EMBE) group, biliary exploration and drainage group, palliative resection group and radical resection group differed (x2 =87.0489, P<0.01). CONCLUSION: Early diagnosis and radical resection are important to improve the prognosis of hilar cholangiocarcinoma.展开更多
Objective: To evaluate the procedures and timing of operation as well as long-term postoperative effect of congenital choledochal cysts (CCC) in adults. Methods: The procedures and timing of operation, effective rate,...Objective: To evaluate the procedures and timing of operation as well as long-term postoperative effect of congenital choledochal cysts (CCC) in adults. Methods: The procedures and timing of operation, effective rate, re-operation rate and incidence of car- cinoma after operation for 70 adult patients with CCC from January 1980 to June 1999 were analyzed retrospectively. Results: The re-operation rate of external drainage was 86% (6/7). The effective rate of internal drain- age was significantly lower than that of cyst resection (3/10 vs 45/49, X^2=20. 94, P<0.001). The re-op- eration rate and incidence of carcinoma of internal drainage were higher than those of cyst resection (5/ 10 vs 3/49, X^2=13. 64, P<0. 001 and 3/10 vs 3/49, X^2=5. 18, P<0. 025). The reoperation rate of e- mergency surgery was higher than that of selective operation (8/10 vs 6/56, X^2=24. 37, P<0.001). Conclusions: External drainage should be the first- aid measure and the therapy of choice on emergency basis. Internal drainage should never be attempted. Cyst resection with Roux-en-Y hepaticojejunostomy is recommended as the treatment of choice in selective operation.展开更多
BACKGROUND: The role of aggressive surgery for end-stage gallbladder carcinoma is controversial. This retrospective study was designed to evaluate the outcome of surgical treatment for Nevin stage Ⅳ and Ⅴ gallbladde...BACKGROUND: The role of aggressive surgery for end-stage gallbladder carcinoma is controversial. This retrospective study was designed to evaluate the outcome of surgical treatment for Nevin stage Ⅳ and Ⅴ gallbladder carcinoma at a single institution. METHODS: A retrospective analysis was made on 70 patients with Nevin stage Ⅳ and Ⅴ gallbladder carcinoma undergoing surgical treatment from January 1993 to June 2004. RESULTS: There were 22 cases of stage Ⅳ and 48 of stage V. Cholecystectomy was performed in 37 cases with a resection rate of 53%,9 cases received radical resection, 13 extended radical resection, and 15 palliative resection. The curative resection rate was 31% and the morbidity rate was 36%. Postoperative 1-, 3-, 5-year survival rates of curative and palliative resection were 69%, 33%, 8% and 27%, 13%, 0, respectⅣely (P <0.01). The 1- and 3-year survival rates of patients undergoing exploratory laparotomy only were 3% and 0, respectively. CONCLUSIONS: Nevin stage Ⅳ and Ⅴ gallbladder carcinoma should be treated by aggressive surgery. Curative resection is promising in the improvement of long-term survⅣal rate.展开更多
Colorectal cancers comprise a large percentage of tumors worldwide,and transverse colon cancer(TCC)is defined as tumors located between hepatic and splenic flexures.Due to the anatomy and embryology complexity,and lac...Colorectal cancers comprise a large percentage of tumors worldwide,and transverse colon cancer(TCC)is defined as tumors located between hepatic and splenic flexures.Due to the anatomy and embryology complexity,and lack of large randomized controlled trials,it is a challenge to standardize TCC surgery.In this study,the current situation of transverse/extended colectomy,robotic/laparoscopic/open surgery and complete mesocolic excision(CME)concept in TCC operations is discussed and a heatmap is conducted to show the evidence level and gap.In summary,transverse colectomy challenges the dogma of traditional extended colectomy,with similar oncological and prognostic outcomes.Compared with conventional open resection,laparoscopic and robotic surgery plays a more important role in both transverse colectomy and extended colectomy.The CME concept may contribute to the radical resection of TCC and adequate harvested lymph nodes.According to published studies,laparoscopic or robotic transverse colectomy based on the CME concept was the appropriate surgical procedure for TCC patients.展开更多
A correspondence between the "meso" of the rectum and of the pancreas has recently been reported. Here we highlight the differences between mesorectum and mesopancreas. Based on anatomical findings from a series of ...A correspondence between the "meso" of the rectum and of the pancreas has recently been reported. Here we highlight the differences between mesorectum and mesopancreas. Based on anatomical findings from a series of 89 consecutive pancreaticoduodenectomies and 71 consecutive total mesorectal excisions, we observed that in contrast to the mesorectum, the mesopancreas did not have well-defined anatomic boundaries and was continuous and connected through its components with the para-aortic area. In rectal cancer,tumor deposits and nodal involvement could be confined to the mesorectum(i.e., within the mesorectal fascia), whereas in pancreatic carcinoma, tumor deposits and nodal metastases occurred in the boundless mesopancreatic area. Total mesorectal excision was made en bloc with the rectum by dissecting along the mesorectal fascia; this was not the case for mesopancreatic excision since anatomical demarcation of the mesopancreas did not exist. Moreover, the growth pattern of pancreatic cancer showed greater dispersion, which was more prominent at the invasive front of the tumor and could potentially affect the status of the resection margin. These findings indicate that the mesorectum and mesopancreas are completely distinct from the pathological, surgical, and oncological standpoints.展开更多
文摘Introduction: The acromioclavicular joint is a superficial diarthrodial joint that surrounds the medial articular facet of the acromion and the distal portion of the clavicle. Due to its anatomy and biomechanics, it is highly susceptible to trauma and in young men who play contact sports, acromioclavicular dislocation is common. This article aimed to systematically review the literature and compare the surgical techniques used in the treatment of acromioclavicular dislocation in patients who practice sports. Methods: This systematic review was conducted according to the International Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Eligible studies for this systematic review included articles in English or Spanish published between 2013 and 2023, which mention the occurrence of acromioclavicular dislocation during sports practices. Additionally, only studies that addressed the surgical treatment of acromion-clavicular dislocation and contained original data on the topic were included. Results: We found 144 eligible studies after searching the LILACS and PubMed databases. Based on the inclusion and exclusion criteria and the reviewers’ consensus, we selected four studies for the systematic review. 133 patients with AC joint displacement were evaluated. Mean Age: approximately 31.90 years. 81.92 of these injuries occurred during sports practice. Surgical Procedures Used: titanium plates fixation (49 patients), arthroscopy (24), single tunnel technique (30) and coracoid sling technique (30). The results of the visual analog scale and Constant-Murley scores varied between the techniques used. Twenty-two complications after surgical treatment were identified. Conclusion: A significant variability of operative techniques can be used in the surgical approach of acromioclavicular dislocation, such as arthroscopy, single tunnel, coracoid sling and titanium plates. Although it presented excellent functional results compared to the other three techniques evaluated by this review, using titanium plates is not the gold standard since other techniques not assessed by this work may be more effective.
文摘Objective To investigate the changes of perioperative serum levels of interleukin-6(IL-6), C-reactive protein (CRP), and cortisol, as well as gastric intramucosal pH (pHi) and plasma lactate, aiming to compare systemic changes and tissue perfusion during colorectal and orthopaedic surgical procedures. Methods Twenty patients were randomly assigned to two groups, 10 cases of operation on vertebral canal, 10 cases of colorectal radical operation.Venous blood was drawn at 1 day before operation, 2, 4, and 6 hours following skin incision, and 1 day after operation, in order to measure serum IL-6, CRP, and cortisol.pHi and plasma lactate were also measured at the same time points.Results Serum concentrations of IL-6 and cortisol increased gradually following operation, reaching the peak value at 6 hours from the beginning of operation.CRP was not detectable until the first day after operation.Peak concentration of IL-6 had positive relationship with CRP.These variables changed more significantly in colorectal group than that in orthopaedic group (P<0.05).pHi decreased gradually, reaching the lowest level at 4 hours from the beginning of operation, and to more extent in colorectal group than that in orthopaedic group (P<0.05).Conclusion IL-6 may reflect tissue damage more sensitively than CRP.Colorectal surgery might induce systemic disorder to more extent, in terms of immuno-endocrinal aspect as well as tissue perfusion, reflected with pHi.
文摘Introduction: Cancellation of surgical operation is a surgical operation registered in the official schedule the day before or added to the list after and not carried out on the operating day. The purpose of this work was to determine the causes of cancellation of elective surgical operations in a major pediatric surgery department in Senegal. Patients and methods: It was a prospective and descriptive study of 278 patients scheduled during a period of 13 weeks. The study took place between April 3<sup>rd</sup>, 2017, and January 31<sup>st</sup>, 2018. Mean age was 2.9 years with extremes of 3 days and 15 years. The age group of 29 days to 30 months was the most represented (62.2%). Sex ratio was 1.41. Causes of cancellation were categorized into administrative and organizational causes, patient-related causes and staff-related causes. Results: Cancellation rate was 29.4%. Patient-related causes were most common (51.2%). Upper Respiratory tract infection (URTI) was commonest reason within this category (57.5%). Organizational causes (28.1%) came second and were mainly represented by the unavailability of the operating room (60.8%) related to breakdowns of anesthesia equipment. Finally, staff-related causes (20.7%) were due for most to the unavailability of the anesthesiologist (12 cases/17). Conclusion: Majority of causes that led to cancellation of elective surgical operations in our Pediatric surgery department are related to intercurrent illnesses affecting the patient, in particular URTI.
文摘Background:To study the application of management tools such as Plan-Do-Check-Action(PDCA)cycle and fishbone diagram in optimizing surgical procedures to improve the satisfaction of doctor-nurse-patient.Methods:The fundus surgery nursing team of our hospital began to implement the PDCA cycle management mode to optimize the surgical procedure from July 2017,set up a project activity improvement team,unified the surgical labeling processing plan,and made the fundus surgery procedure,and established the preoperative health education for surgical patients,and standardized the training content of post-rotating doctors and interns.Results:The satisfaction degree to surgical procedure after implementation of doctors and nurses was higher than that before implementation.Conclusions:Using PDCA cycle and fishbone diagram analysis tools to manage the surgical procedure optimization can better integrate doctor-nurse medical care,improve the efficiency and accuracy of the surgical procedure delivery and operation,and optimize the satisfaction of the three parties of doctor-nurse-patient.
文摘<strong>Objective:</strong> To compare the clinical efficacy and safety of ultrasound-guided microwave ablation with surgery for the treatment of primary parathyroid adenoma. <strong>Methods:</strong> The clinical data of patients with primary parathyroid adenoma admitted to the First Hospital of Yangtze University from January 2010 to May 2020 were retrospectively analyzed, and they were divided into 43 cases in the microwave ablation group (MWA) and 39 cases in the surgical procedure group (SR) according to the different treatment methods. The surgical condition, postoperative complications, and changes in serum parathyroid hormone (PTH) and serum calcium and phosphorus levels were analyzed in both groups. <strong>Results:</strong> The hospital stay and operation time of patients in the microwave ablation group were shorter than those in the surgical group, and the intraoperative bleeding was significantly less than that in the surgical group (P < 0.05);the serum parathyroid hormone (PTH), blood calcium and blood phosphorus levels of patients in both groups were significantly lower than those before treatment (P < 0.05) after surgery of 1, 3 and 6 months respectively, and the differences between groups were not statistically significant (P > 0.05). There was no statistically significant difference in the incidence of postoperative complications between the two groups (P > 0.05). <strong>Conclusion: </strong>Microwave ablation can achieve the same therapeutic effect as surgery. It is a safe and feasible clinical technique worthy of clinical promotion with its short hospitalization time, less bleeding and less trauma.
文摘Objective To investigate different surgical procedures for treatment of thoracic ossification of ligamentum flavum.Methods From January 1994 to June 2008,56 cases of thoracic ossification of ligamentum flavum underwent
文摘Background:Minimally invasive surgery is the optimal treatment for insulinoma.The present study aimed to compare short-and long-term outcomes of laparoscopic and robotic surgery for sporadic benign insulinoma.Methods:A retrospective analysis of patients who underwent laparoscopic or robotic surgery for insulinoma at our center between September 2007 and December 2019 was conducted.The demographic,perioperative and postoperative follow-up results were compared between the laparoscopic and robotic groups.Results:A total of 85 patients were enrolled,including 36 with laparoscopic approach and 49 with robotic approach.Enucleation was the preferred surgical procedure.Fifty-nine patients(69.4%)underwent enucleation;among them,26 and 33 patients underwent laparoscopic and robotic surgery,respectively.Robotic enucleation had a lower conversion rate to laparotomy(0 vs.19.2%,P=0.013),shorter operative time(102.0 vs.145.5 min,P=0.008)and shorter postoperative hospital stay(6.0 vs.8.5 d,P=0.002)than laparoscopic enucleation.There were no differences between the groups in terms of intraoperative blood loss,the rates of postoperative pancreatic fistula and complications.After a median follow-up of 65 months,two patients in the laparoscopic group developed a functional recurrence and none of the patients in the robotic group had a recurrence.Conclusions:Robotic enucleation can reduce the conversion rate to laparotomy and shorten operative time,which might lead to a reduction in postoperative hospital stay.
文摘Background:The superiority of anatomical resection(AR)vs.non-anatomical resection(NAR)in the surgical management of hepatocellular carcinoma(HCC)is debated.ARs are well-defined procedures,whereas the lack of NAR standardization results in heterogeneous outcomes.This study aimed to introduce the SegSubTe classification for NAR detailing the appropriateness of the level of surgical section of the Glissonean pedicles feeding the tumor.Methods:A single-center retrospective analysis of pre-and postoperative imaging of consecutive patients treated with NAR for single HCC between 2012 and 2020 was conducted.The quality of surgery was assessed classifying the type of vascular supply and the level of surgical section(segmental,subsegmental or terminal next to the tumor)of vascular pedicles feeding the HCCs;then,the population was divided in“SegSubTe-IN”or“SegSubTe-OUT”groups,and the tumor recurrence and survival were analyzed.Results:Ninety-seven patients who underwent NAR were included;76%were SegSubTe-IN and 24%were SegSubTe-OUT.Total disease recurrence,local recurrence and cut-edge recurrence in the SegSubTe-IN vs.SegSubTe-OUT groups were 50%vs.83%(P=0.006),20%vs.52%(P=0.003)and 16%vs.39%(P=0.020),respectively.SegSubTe-OUT odds ratio for local recurrence was 4.1 at univariate regression analysis.One-,three-,and five-year disease-free survival rates in the SegSubTe-IN vs.SegSubTe-OUT groups were 81%,58%and 35%vs.46%,21%and 11%,respectively(P<0.001).Conclusions:The SegSubTe classification is a useful tool to stratify and standardize NAR for HCC,aiming at improving long-term oncological outcomes and reducing the heterogeneity of quality of NAR for HCC.
文摘BACKGROUND Cervical necrotizing fasciitis(CNF)is a rare,aggressive form of deep neck space infection with significant morbidity and mortality rates.Serial surgical debridement acts as the cornerstone of CNF treatment;however,it often results in defects requiring complex reconstructions.CASE SUMMARY We report two cases in which the keystone flap(KF)was used for CNF defect coverage:Case 1,an 85-year-old patient with CNF in the anterior neck,and Case 2,a 54-year-old patient with CNF in the posterior neck.Both patients received empirical intravenous antibiotic therapy and underwent serial debridement,enabling adequate wound preparation and stabilization.The final defect size measured 5.5 cm×12 cm in Case 1 and 6 cm×11 cm in Case 2.For defect coverage,we employed an 8 cm×19 cm type II KF based on perforators from the superior thyroid artery in Case 1 and a 9 cm×18 cm type II KF based on perforators from the transverse cervical artery in Case 2.Both flaps showed complete survival.No postoperative complications occurred in both cases,and favorable outcomes were observed at 7-and 6-month follow-ups in case 1 and 2,respectively.CONCLUSION We effectively treated CNF-associated defects using the KF technique;KF is viable for covering CNF defects in carefully selected cases.
基金Informed consent was obtained from patients included(No.SDB-2023-0069-TTSH-01).
文摘BACKGROUND Colorectal cancer is the third most common cancer and the second highest cause of cancer-related mortality worldwide.About 5%-10%of patients are diagnosed with locally advanced rectal cancer(LARC)on presentation.For LARC invading into other structures(i.e.T4b),multivisceral resection(MVR)and/or pelvic ex-enteration(PE)remains the only potential curative surgical treatment.MVR and/or PE is a major and complex surgery with high post-operative morbidity.Minimally invasive surgery(MIS)has been shown to improve short-term post-operative outcomes in other gastrointestinal malignancies,but there is little evi-dence on its use in MVR,especially so for robotic MVR.This is a single-center retrospective cohort study from 1st January 2015 to 31st March 2023.Inclusion criteria were patients diagnosed with cT4b rectal cancer and underwent MVR,or stage 4 disease with resectable systemic metastases.Pa-tients who underwent curative MVR for locally recurrent rectal cancer,or me-tachronous rectal cancer were also included.Exclusion criteria were patients with systemic metastases with non-resectable disease.All patients planned for elective surgery were enrolled into the standard enhanced recovery after surgery pathway with standard peri-operative management for colorectal surgery.Complex sur-gery was defined based on technical difficulty of surgery(i.e.total PE,bladder-sparing prostatectomy,pelvic lymph node dissection or need for flap creation).Our primary outcomes were the margin status,and complication rates.Cate-gorical values were described as percentages and analysed by the chi-square test.Continuous variables were expressed as median(range)and analysed by Mann-Whitney U test.Cumulative overall survival(OS)and recurrence-free survival(RFS)were analysed using Kaplan-Meier estimates with life table analysis.Log-rank test was performed to determine statistical significance between cumulative estimates.Statistical significance was defined as P<0.05.Meier estimates with life table analysis.Log-rank test was performed to determine statistical significance between cumulative estimates.Statistical significance was defined as P<0.05.RESULTS A total of 46 patients were included in this study[open MVR(oMVR):12(26.1%),miMVR:36(73.9%)].Patients’American Society of Anesthesiologists score,body mass index and co-morbidities were comparable between oMVR and miMVR.There is an increasing trend towards robotic MVR from 2015 to 2023.MiMVR was associated with lower estimated blood loss(EBL)(median 450 vs 1200 mL,P=0.008),major morbidity(14.7%vs 50.0%,P=0.014),post-operative intra-abdominal collections(11.8%vs 50.0%,P=0.006),post-operative ileus(32.4%vs 66.7%,P=0.04)and surgical site infection(11.8%vs 50.0%,P=0.006)compared with oMVR.Length of stay was also shorter for miMVR compared with oMVR(median 10 vs 30 d,P=0.001).Oncological outcomes-R0 resection,recurrence,OS and RFS were comparable between miMVR and oMVR.There was no 30-d mortality.More patients underwent robotic compared with laparoscopic MVR for complex cases(robotic 57.1%vs laparoscopic 7.7%,P=0.004).The operating time was longer for robotic compared with laparoscopic MVR[robotic:602(400-900)min,laparoscopic:Median 455(275-675)min,P<0.001].Incidence of R0 resection was similar(laparoscopic:84.6%vs robotic:76.2%,P=0.555).Overall complication rates,major morbidity rates and 30-d readmission rates were similar between la-paroscopic and robotic MVR.Interestingly,3-year OS(robotic 83.1%vs 58.6%,P=0.008)and RFS(robotic 72.9%vs 34.3%,P=0.002)was superior for robotic compared with laparoscopic MVR.CONCLUSION MiMVR had lower post-operative complications compared to oMVR.Robotic MVR was also safe,with acceptable post-operative complication rates.Prospective studies should be conducted to compare short-term and long-term outcomes between robotic vs laparoscopic MVR.
文摘Introduction: Treatments for cardiovascular diseases have increasingly evolved with the tendency to offer minimally invasive or transcatheter procedures instead of conventional sternotomy surgery. In this context, we highlight minimally invasive mitral valve surgery (MIMVS), which has been shown to be an increasingly solid option with some superior results when compared to the conventional technique: better pain control, shorter hospital stays, shorter recovery time, shorter readmission rate in the first postoperative year, better aesthetic results, and lower overall cost. Aim: This study aims to evaluate the stages of MIMVS, by primary mitral valve consultation, in our service and compare these results with data from the literature. Methods: All electronic medical records of patients who underwent MIMVS for primary mitral valve injury in the Encore Hospital from January 2020 to February 2023 were analyzed. Tabulation and statistical analysis were performed using the Microsoft Excel<sup>®</sup> program. Quantitative variables were presented as means, standard deviations. Results: 46 patients were enrolled in our study (Age: 59.1 ± 12.4 years old;60.8% Female, BMI: 26 ± 4.4 Kg/m<sup>2</sup>, Low risk STS score: 82.6%). The observed 30-day mortality was 2.1%, plastic rate of 23.9%, blood transfusion rate of 41.3%, length of stay in an intensive care bed (ICB) of 3.3 ± 3.3 days and hospital stay of 6.4 ± 5.1 days. Conclusions: We noticed that the MIMVS results carried out in our service agree with data from national and international literature with approximately 1.3 days more hospitalization in ICB.
文摘Throughout the twenty-first century, robotic surgery has been used in multiple oral surgical procedures for the treatment of head and neck tumors and non-malignant diseases. With the assistance of robotic surgical systems, maxillofacial surgery is performed with less blood loss, fewer complications, shorter hospitalization and better cosmetic results than standard open surgery.However, the application of robotic surgery techniques to the treatment of head and neck diseases remains in an experimental stage, and the long-lasting effects on surgical morbidity, oncologic control and quality of life are yet to be established. More well-designed studies are needed before this approach can be recommended as a standard treatment paradigm. Nonetheless,robotic surgical systems will inevitably be extended to maxillofacial surgery. This article reviews the current clinical applications of robotic surgery in the head and neck region and highlights the benefits and limitations of current robotic surgical systems.
文摘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.
文摘BACKGROUND: Carcinoma of the hepatic duct confluence is the most common site of bile duct malignancies. Although hilar cholangiocarcinoma has been characterized as a slow-growing and late metastasizing tumor, post-therapeutic prognosis has remained poor. The study was undertaken to analyze factors influencing the surgical curative effect of hilar cholangiocarcinoma. METHODS: A retrospective clinical analysis was made of 198 patients with hilar cholangiocarcinoma who had been surgically treated at our hospital from 1997 to 2002. Jaundice (94.5%, 187 patients), pruritus (56.6%, 112) and abdominal pain (33.8%, 67) were the main symptoms. According to the Bismuth-Corlette classification, there were 14 type Ⅰ patients, 19 type Ⅱ patients, 12 type Ⅲa patients, 15 type Ⅲb patients, 112 type Ⅳ patients, and 26 unclassified patients. 144 patiens received laparotomy, and 120 tumor resection including radical resection (59 patients) and palliative resection (61). Fifty-four patients were treated by endoscopic surgery and 16 patients by postoperative adjuvant radiation. RESULTS: Occupation, preoperative level of total serum bilirubin, operative procedure and postoperative adjuvant radiation affected postoperative survival of the patients. The postoperative suvivals of endoscopic nose-biliary drainage (ENBD) group, endoscopic retrograde biliary drainage (ERBD) or endoscopic metal biliary endoprosthesis (EMBE) group, biliary exploration and drainage group, palliative resection group and radical resection group differed (x2 =87.0489, P<0.01). CONCLUSION: Early diagnosis and radical resection are important to improve the prognosis of hilar cholangiocarcinoma.
文摘Objective: To evaluate the procedures and timing of operation as well as long-term postoperative effect of congenital choledochal cysts (CCC) in adults. Methods: The procedures and timing of operation, effective rate, re-operation rate and incidence of car- cinoma after operation for 70 adult patients with CCC from January 1980 to June 1999 were analyzed retrospectively. Results: The re-operation rate of external drainage was 86% (6/7). The effective rate of internal drain- age was significantly lower than that of cyst resection (3/10 vs 45/49, X^2=20. 94, P<0.001). The re-op- eration rate and incidence of carcinoma of internal drainage were higher than those of cyst resection (5/ 10 vs 3/49, X^2=13. 64, P<0. 001 and 3/10 vs 3/49, X^2=5. 18, P<0. 025). The reoperation rate of e- mergency surgery was higher than that of selective operation (8/10 vs 6/56, X^2=24. 37, P<0.001). Conclusions: External drainage should be the first- aid measure and the therapy of choice on emergency basis. Internal drainage should never be attempted. Cyst resection with Roux-en-Y hepaticojejunostomy is recommended as the treatment of choice in selective operation.
文摘BACKGROUND: The role of aggressive surgery for end-stage gallbladder carcinoma is controversial. This retrospective study was designed to evaluate the outcome of surgical treatment for Nevin stage Ⅳ and Ⅴ gallbladder carcinoma at a single institution. METHODS: A retrospective analysis was made on 70 patients with Nevin stage Ⅳ and Ⅴ gallbladder carcinoma undergoing surgical treatment from January 1993 to June 2004. RESULTS: There were 22 cases of stage Ⅳ and 48 of stage V. Cholecystectomy was performed in 37 cases with a resection rate of 53%,9 cases received radical resection, 13 extended radical resection, and 15 palliative resection. The curative resection rate was 31% and the morbidity rate was 36%. Postoperative 1-, 3-, 5-year survival rates of curative and palliative resection were 69%, 33%, 8% and 27%, 13%, 0, respectⅣely (P <0.01). The 1- and 3-year survival rates of patients undergoing exploratory laparotomy only were 3% and 0, respectively. CONCLUSIONS: Nevin stage Ⅳ and Ⅴ gallbladder carcinoma should be treated by aggressive surgery. Curative resection is promising in the improvement of long-term survⅣal rate.
文摘Colorectal cancers comprise a large percentage of tumors worldwide,and transverse colon cancer(TCC)is defined as tumors located between hepatic and splenic flexures.Due to the anatomy and embryology complexity,and lack of large randomized controlled trials,it is a challenge to standardize TCC surgery.In this study,the current situation of transverse/extended colectomy,robotic/laparoscopic/open surgery and complete mesocolic excision(CME)concept in TCC operations is discussed and a heatmap is conducted to show the evidence level and gap.In summary,transverse colectomy challenges the dogma of traditional extended colectomy,with similar oncological and prognostic outcomes.Compared with conventional open resection,laparoscopic and robotic surgery plays a more important role in both transverse colectomy and extended colectomy.The CME concept may contribute to the radical resection of TCC and adequate harvested lymph nodes.According to published studies,laparoscopic or robotic transverse colectomy based on the CME concept was the appropriate surgical procedure for TCC patients.
文摘A correspondence between the "meso" of the rectum and of the pancreas has recently been reported. Here we highlight the differences between mesorectum and mesopancreas. Based on anatomical findings from a series of 89 consecutive pancreaticoduodenectomies and 71 consecutive total mesorectal excisions, we observed that in contrast to the mesorectum, the mesopancreas did not have well-defined anatomic boundaries and was continuous and connected through its components with the para-aortic area. In rectal cancer,tumor deposits and nodal involvement could be confined to the mesorectum(i.e., within the mesorectal fascia), whereas in pancreatic carcinoma, tumor deposits and nodal metastases occurred in the boundless mesopancreatic area. Total mesorectal excision was made en bloc with the rectum by dissecting along the mesorectal fascia; this was not the case for mesopancreatic excision since anatomical demarcation of the mesopancreas did not exist. Moreover, the growth pattern of pancreatic cancer showed greater dispersion, which was more prominent at the invasive front of the tumor and could potentially affect the status of the resection margin. These findings indicate that the mesorectum and mesopancreas are completely distinct from the pathological, surgical, and oncological standpoints.