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.

吸入性烧伤导致的喉气管狭窄疗效分析

目的探讨成年人吸入性烧伤导致喉气管狭窄的外科治疗方法和效果。方法回顾性分析2008年9月~2022年3月就诊于西安交通大学附属红会医院,由吸入性烧伤导致的16例喉气管狭窄患者临床资料,男10例,女6例,年龄17~57岁,平均38.4岁。支撑喉镜下喉剪或激光切除瘢痕并球囊扩张4例;气道前壁加宽喉气管重建术9例,其中肋软骨加宽4例,肌皮瓣2例,甲状软骨翼板3例;气管-气管端端吻合1例,环气管吻合1例,甲状软骨气管吻合1例。结果拔管13例,拔管率81.25%(13/16),失败3例,失败率为18.75%(3/16)。T型硅胶管放置时间为9~24个月,平均12.5个月。随访3个月~10年,所有拔管者均未见复发,进食、呼吸正常。结论对于成年人吸入性烧伤导致的喉气管狭窄患者进行气道重建选择好恰当的手术时机及对应的手术方法,效果满意,T型管放置时间要长。

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。

声门下异位甲状腺1例

1临床资料患者,女,62岁,以气喘8个月,加重1个月有余为主诉就诊。患者于入院前8个月无明显诱因出现气喘、呼吸困难、气短,无咳嗽、咳痰,无胸闷、胸痛、咯血,无发热、乏力等不适,活动后加重,自行服用“感冒药”(具体不详)后缓解,未予以重视。入院前1个余月,患者新冠病毒感染后感觉气喘明显加重,伴低热。于2023-01-28就诊于联勤保障部队第九〇〇医院耳鼻咽喉头颈外科。

Clinical analysis of surgical treatment of portal hypertension

AIM： To review the experience in surgery for 508 patients with portal hypertension and to explore the selection of reasonable operation under different conditions. METHODS： The data of 508 patients with portal hypertension treated surgically in 1991-2001 in our centers were analyzed. Of the 508 patients, 256 were treated with portaazygous devascularization （PAD）, 167 with portasystemic shunt （PSS）, 62 with selective shunt （SS）, 11 with combined portasystemic shunt and portaazygous devascularization （PSS＋PAD）, 9 with liver transplantation （LT）, 3 with union operation for hepatic carcinoma and portal hypertension （HCC＋PH）. RESULTS： In the 167 patients treated with PSS, free portal pressure （FPP） was significantly higher in the patients with a longer diameter of the anastomotic stoma than in those with a shorter diameter before the operation （P〈0.01）. After the operation, FPP in the former patients markedly decreased compared to the latter ones （P〈0.01）. The incidence rate of hemorrhage in patients treated with PAD, PSS, 55, PSS＋PAD, and HCC＋PH was 21.09% （54/256）, 13.77 （23/167）, 11.29 （7/62）, 36.36% （4/11）, and 100% （3/3）, respectively. The incidence rate of hepatic encephalopathy was 3.91% （10/256）, 9.58% （16/167）, 4.84% （3/62）, 9.09% （1/11）, and 100% （3/3）, respectively while the operative mortality was 5.49% （15/256）, 4.22% （7/167）, 4.84% （3/62）, 9.09% （1/11）, and 66.67% （2/3） respectively. The operative mortality of liver transplantation was 22.22% （2/9）. CONCLUSION： Five kinds of operation in surgical treatment of portal hypertension have their advantages and disadvantages. Therefore, the selection of operation should be based on the actual needs of the patients.

Recent advances in the surgical treatment of pancreatic cancer

INTRODUCTIONPancreatic cancer remains the fourth commonest cause of cancer related death in the western world[1]. The prognosis remains dismal due partly to late presentation, with associated low resectability rates, and the aggressive biological nature of these tumors. The median survival time from diagnosis in unresectable tumors remains only 4 6 months.For those patients amenable to surgical resection over the last 20 years have seen marked improvements in postoperative mortality and morbidity, especially in specialist pancreatic centres 23. Despite these changes long-term survival remains low. with a total 5-year survival rate remaining less than 5%.Patients with ampullary cancer have a better 5-year survival of 40°%-60°%.

Surgical Treatment of Carcinoma of Esophagus and Gastric Cardia—A 34—year Investigation

Objective To understand the progress in surgical treatment of 12 970 patients with carcinoma of esophagus and gastric cardiac during 1965-1998.Methods The patients were divided into A, B and C groups: 3 155 patients (group A) were treated surgically in the first 14 years, 5952 patients (group B) in the next 10 years, and 3 863 patients (group C) in the last 10 years. The early stage lesions (Tis, Tl) were assigned as a separate group. The results of these groups were compared.Results The resectability for esophageal and gastric cardiac carcinoma was 94.0% and 84.4% respectively, and the overall resectability was 91.3% . The resectabih'ty for groups A, B, C and the early stage group was 82.1% , 85.1% , 90.2% and 100% , respectively. The overall operative mortality was 1.8%, it was 4.4% for group A, 1.6% for group B, and 0.5% for group C. The overall 5-year survival was 31.6% . The 5-year survival for groups A, B, C and the early stage group was 27.0% , 29.1%, 32.0% and 92.6%, respectively . Among the 3 temporal groups, differences were observed in terms of lesion stage, location and size, surgery with or without combined therapy and postoperative complications.Conclusion Best results were achieved in the early cases, with a resectability of 100% and a 5-year survival of 92.6% . The indications for surgical treatment were extended with increased resectability and decreased mortality. Subtotal esophagectomy combined with cervical esophagogastrostomy was advocated as the procedure of first choice for esophageal carcinoma in attempt to diminish the chance of recurrence, and to achieve better outcomes by using combined therapy for patients with e" stage b! lesion.

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.

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.

Open surgical treatment of choledochocele: A case report and review of literature

Choledochocele （also known as type？Ⅲ？ choledochal cyst according to Todani’s classifcation） is a cystic dilation of the distal segment of the common bile duct protru-ding into the duodenal lumen. Cases are rare and the etiology remains unclear. It is usually misdiagnosed as peptic ulcer, as in the patient whose case is described here. Multislice spiral computed tomography and magnetic resonance cholangiopancreatography may be comparable to endoscopic retrograde cholangiogra-phy for diagnosis of choledochocele. Both endoscopic therapy and open surgical management are safe options, and size of the cyst plays a role in the decision-making for which approach to apply. A 50-year-old woman admitted to our hospital with upper abdominal pain caused by choledochocele with large size was successfully treated by open surgical management. We present the details of her case in this case report and discuss the recent literature on such cases and their therapeutic management.

Radiotherapy combined with surgical treatment for gastric cancer:a meta-analysis

Objective:We carried out a meta-analysis to assess the effectiveness and safety of radiotherapy combined with surgery for gastric cancer.Methods:Randomized Clinical Trials (RCTs) in which radiotherapy (preoperative,intraoperative and postoperative),was compared with surgery alone in resectable gastric cancer were identified by searching Cochrane Library (Issue 2,2009),PubMed (Jan 1966-Jun 2009),EMBASE (Jan 1974-Jun 2009),Chinese Biomedical Literature Database (Jan 1978-Jun 2009),Chinese Science and Technology Periodicals Database (Jan 1989-Jun 2009),China National Knowledge Infrastructure (Jan 1994-Jun 2009) and Wanfang database (Jan 1997-Jun 2009) in English and Chinese languang.Two researchers assessed the quality of included randomized controlled trials (RCT) extracted data independently.The RevMan 5.0 software was used for meta-analysis.Our researchers assessed the quality of included randomized controlled trials (RCT) extracted data independently.The RevMan 5.0 software was used for meta-analysis.Results:Nine randomized controlled trials of 1 548 patients were selected for meta-analysis.Five randomized controlled trials were related with comparison of preoperative radiotherapy plus surgery with single surgery.Two randomized controlled trials were the comparative studies between surgery plus postoperative and single surgery.The meta-analysis results showed that:(1) compared with surgery alone,preoperative radiotherapy combined with surgery can increase 3 years (OR=1.78;95% CI 1.14-2.78,P=0.01),5 years (OR=1.67;95% CI 1.22-2.29,P=0.001),10 years (OR=1.64;95% CI 1.03-2.60,P=0.04) survival rate and resection rate (OR=2.15;95% CI 1.31-3.54,P=0.003);reduce the of tumor recurrence rate (OR=0.59;95% CI 0.37-0.92,P=0.02) and metastasis rate (OR=0.44;95% CI 0.27-0.73,P=0.001);(2) The tumor recurrent rates (OR=0.19,95% CI 0.03-1.14,P=0.07) and tumor metastasis rate (OR=0.09;95% CI 0.00-1.77,P=0.11) had no difference between single surgery group and peri-operative radiotherapy plus surgery group;(3) Postoperative radiotherapy compared with surgery alone had no significant effects on 1 year (OR=0.83;95% CI 0.60-1.15,P=0.26) and 3 years (OR=0.75;95% CI 0.51-1.11,P=0.15) survival rate compared with single surgery,but the 5-year survival rates (OR=0.57;95% CI 0.34-0.95,P=0.03) of the patients who received surgery alone was higher than those who received combined therapy.No difference of the tumor recurrence rate (OR=0.59;95% CI 0.33-1.05,P=0.07),tumor metestasis rate (OR=0.90;95% CI 0.51-1.59,P=0.71) and anastomotic leak (OR=0.98;95% CI 0.25-3.65,P=0.98) were observed between the two groups.Conclusion:Preoperative radiotherapy combined surgery is more rational and effective than surgery alone of gastric cancer.However,in terms of the clinical effects of perioperarive or postoperative radoiotherapy combined with surgery,much multicenter,largescale,high-quality,double-blind and rigorously designed studies would be needed than currently available in the future.

A SURVEY OF ELECTIVE SURGICAL PATIENTS' ATTITUDES TOWARD ANESTHESIA IN PUMC HOSPITAL

Objective.To assess patients’ knowledge,attitudes,and concerns regarding anesthetic management.Method.A survey of 55items was developed and administered preoperatively to 500patients including 190men and 310women in our hospital.Patients were interviewed on their know ledge of the role of anesthesiolo-gists,their preferences regarding anesthetic management,and also their concernaboutpotential anesthetic complica-tions.Results.Patients’ perceptions ofanesthesiologists’ training androle have reacheda certainlevel.Mostsignifi-cant preoperative concerns regardi ng the anesthesiologists focused on experience,qualifications,and pr esence or absence during the anesthesia.Patients’ concerns also included the possibility of not being waken up following anesthesia,experiencing postoperative pain,and becoming paralyzed.The variations of concerns depended partial-ly on patients’ sex,type of anesthesia,and propose d surgical procedure,partially on t heir education and living environments.Conclusion.It is suggested that anesthesiologists address significant patient con cerns during the preopera-tive visit to enhance their effectiv eness in patient care.Efforts to educate the public on the anesthesiologists’ role in preoperative care would improve p atients’ confidence.

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.

Surgical treatment effects in cancer of the cardia and esophagogastric junction

Objective： To evaluate the treatment effects of total gastrectomy （TG） and proximal gastrectomy （PG） for cancer of the cardia and esophagogastric junction. Methods： forty-five patients with cancer of the cardia and esophagogastric junction underwent surgical resection. Of them, 29 were treated using proximal gastrectomy and 16 total gastrectomy. The 3-year and 5-year survival rate and the postoperative complication rate and mortality rate were followed up and compared between the two groups. Results： The 3-year and 5-year survival rates of group PG were 44.8% and 20.7%, of group TG were 37.5% and 18.8%, respectively, and the differences were not statistically significant （X^2= 3.84, P 〉 0.05; X^2= 3.89, P 〉 0.05）. The postoperative complication and mortality rate of group PG were 13.7% and 6.8%, of group TG was all 6%, respectively. Conclusion： Proximal and total gastrectomy treatment effects can not significantly influence the prognosis of patients in progressive stage of cancer of cardia and esophagogastric junction.

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 Use of 3D laparoscopy in Surgical Operation

Purpose： studying and analyzing the application effect of three dimensional （3D） laparoscopy m surgical operation. Method： We select 126 patients who were diagnosed celiac disease in our hospital between May 2015 and April 2016 as our research subjects. All of these patients have indications for laparoscopic surgery, and we divide them into two groups randomly （observation and control group）. While the observation group is treated by 3D laparoscopic operation system, and the control group is treated by 2D laparoscopic system. During the treatment ,we observe the operation time, intra-operative bleeding and hospitalization time between the two different methods. Result： During the operation, the operation time of observation is （135.5±23.84） minutes and intra-operative bleeding time is （130.2±20. 11） milliliters, which both them are significantly lower than control group （163.8±25.22）min, （146.3±27.42）ml. This difference is statistically significant （P 〈0.05）. On the other hand, there is no obvious difference between observation and conlrol about indwelling catheter time, postoperative hospitalization time and postoperative exhaust time. For the observation, the datum were （2.3±0.31） d, （8.1±1. 32） d, （3.2±0.58） d and they were no statistical significance. Conclusion： Compared with traditional laparoscopic surgery, the image of 3D laparoscopic surgery is more clear and stereoscopic. What＇s more, operators can have a good command of it easily to shorten operation time, which avoid surgery vascular damage and reduce bleeding amounts to some extent. It is a good assistant for clinical use.

Analysis of the therapeutic effect of surgical treatment for the gastrointestinal tumor

The gastrointestinal tumor is a disease with the high incidence in our country, and the researches in our country currently on the treatment of the disease are increasingly deep-going. The disease has gradually received widespread attention in the medical field, and the treatment program of the disease and the operational program also made a lot of experts devoted into the relevant researches. This paper cites some practical examples to briefly elaborate the curative effect of the surgical operations on the gastrointestinal tumors and has carried out the summary, hoping to provide certain references for the related researches.

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。