Open reduction and internal fixation via the para-Achilles tendon approach for the treatment of posterior malleolus sandwich fractures / 中国组织工程研究

BACKGROUND:Accurate reduction of ankle fractures under direct vision has become a common understanding among foot and ankle surgeons.How to fully expose free or compressed fragments of the posterior ankle remains one of the most challenging problems. OBJECTIVE:To explore the clinical efficiency of the para-Achilles tendon approach in exposing and repositioning the posterior malleolus sandwich fracture. METHODS:A retrospective study was made for 26 patients with posterior malleolus sandwich fracture treated with open reduction and internal fixation via para-Achilles tendon approach from January to December 2020 in The Second People's Hospital of Dalian.21 of 26 cases were managed with the lateral approach of Achilles tendon and 5 cases were managed with the medial approach of Achilles tendon.There were 19 males and 7 females,with the age of 24-69 years,averagely 38.6 years.The operation time and postoperative complications were recorded.The fracture reduction condition was evaluated by Burwell-Charnley imaging standard.Before operation,3 months after operation and last follow-up,visual analog scale score,ankle plantar flexion and dorsiflexion and American Orthopedic Foot&Ankle Society Ankle Hind Score were used to evaluate the treatment effect. RESULTS AND CONCLUSION:(1)All 26 patients were followed up for an average of 14.6 months(range 13-18 months).The operation time was 52-85 minutes(average 64.2 minutes).(2)Part of the skin edge of the lateral malleolus incision was necrotic in one patient and healed completely after a dressing change.Incision healing of the other patients was in one stage.(3)Through Burwell-Charnley imaging standard,anatomical reductions were obtained in 24 of 26,and good reductions were in 2 of 26,with an excellent and good rate of 100%.(4)At the last follow-up,the visual analog scale score(1.19±0.40)was significantly lower than the preoperative score(6.81±0.80)(P<0.01).Ankle plantar flexion(33.5±5.02)° and ankle plantar back stretch(17.23±0.99)° were significantly increased compared with preoperative data(14.58±2.50)° and(5.81±1.02)°(P<0.01).American Orthopedic Foot&Ankle Society Ankle Hind Score was improved to(89.31±3.62)points compared to preoperative(46.00±5.45)points(P<0.01).The results were excellent in 23 patients and good in 3 patients,with an excellent and good rate of 100%.(5)It is concluded that the open reduction and internal fixation via the para-Achilles tendon approach for the treatment of posterior malleolus sandwich fracture were efficient with decreased operation time,satisfying fracture reduction,fewer complications,satisfactory motion range,and functional recovery.

Research progress of robot-assisted function-preserving pancreatic surgery / 中华消化外科杂志

The application of function-preserving pancreatic surgery as a restrictive resection technique is primarily targeted towards benign or those with borderline or low-grade lesions. This approach has been shown to significantly improve both short-term and long-term quality of life outcomes for patients following surgical intervention. In comparison to conventional laparoscopic procedures, robotic surgical systems have demonstrated superior efficacy and precision when employed in pancreas surgeries, and the safety and reliability are widely recognized within the medical community. Nevertheless, there remains a dearth of research investigating the specific appli-cations of robotic-assisted function-preserving pancreatic surgery. Consequently, the authors compre-hensive review the latest progress on robot-assisted function-preserving pancreatic surgery, while highlighting of surgical scope, techniques utilized during these procedures as well as associated prognostic considerations.

Comparison of the efficacy and safety of inguinal and subinguinal approaches for microsurgical varicocelectomy in the treatment of adolescent varicocele / 现代泌尿外科杂志

【Objective】 To compare the degree, efficacy and safety of testicular catch-up growth after inguinal and subinguinal surgery for adolescent varicocele. 【Methods】 Clinical data of 121 adolescent varicocele patients with secondary testicular atrophy treated during Sep.2014 and Jun.2021 at Huili People’s Hospital were retrospectively analyzed, including 40 cases treated with the inguinal incision approach, and 81 with the subinguinal approach. The characteristics of intraoperative, efficacy, surgical complications and prognosis were compared between the two groups. 【Results】 The inguinal group had significantly shorter microscope usage time (P=0.006), fewer number of preserved internal spermatic arteries (P0.05). Two years after surgery, the bilateral testicular volume of both groups was significantly larger than that before surgery (P0.05). 【Conclusion】 In the treatment of adolescent varicocele patients with secondary testicular atrophy, the subinguinal approach significantly reduces the difficulty of microsurgical varicocele ligation, and has good efficacy and safety, which is worthy of clinical promotion and application.

Clinical research of approach selection of extraction of maxillary embedded mesiodens / 安徽医科大学学报

Objective @#To explore the related factors for the unilateral flap and bilateral flap by changing the original operation plan in the extraction of maxillary impacted mesiodens. @*Methods @#81 patients with impacted mesiodens in the middle of the maxillary were retrospectively analyzed. The primary outcome variables were planned surgery (unilateral flap)and unplanned surgery (bilateral flap) . The secondary outcome variables consisted of operation time and postoperative swelling. The predictive variables were as follows:the differential value of the shortest distance from the supernumerary tooth to the labial and palatal bone plates , which was divided into≥1. 5 mm group and < 1. 5 mm group ; the ratio of the distance from the adjacent tooth apex to the nasal floor, compared to the length of the supernumerary teeth , was recorded as≥1 and < 1 . A statistical software SPSS 20 was used to complete the statistical analysis. @*Results @#When the differential value was less than 1. 5 mm , the possibility of unplanned surgery increased , and the probability of planned surgery was 0. 085 times than that of unplanned surgery. With age growing each 1 ⁃year, the probability of planned surgery gradually decreased , HR = 0. 745. The postoperative swelling of the palatal approach was only 0. 374 times than that of the labial approach. With age increasing , the operation time increased gradually , B = 1. 213. The ratio of the distance from the adjacent tooth apex to the nasal floor to the length of the supernumerary teeth did not affect the change of the surgical plan during the operation. @*Conclusion @#The shortest distance difference between the supernumerary teeth and the labial and palatal bone plates can be used as a reference for the selection of surgical approach for the extraction of maxillary impacted mesiodens.

Unilateral parotid gland Simultaneously primary two different pathological tumors: a case report and literature review / 口腔疾病防治

Objective@#To explore the clinical manifestations, histopathological characteristics, diagnosis, treatment, and prognosis of simultaneous unilateral primary tumors of different pathological types in the parotid gland.@*Methods@#A case of simultaneous unilateral primary parotid gland tumors, i.e., adenolymphoma and basal cell adenoma, was reviewed and analyzed in combination with the literature.@*Results@#The patient discovered a lump in the right parotid gland area one month prior to presentation, and a tumor was palpated in the shallow lobe of the right parotid gland before surgery. According to MR images, the initial diagnoses were tumors of the shallow and deep lobes of the right parotid gland. The tumors of the deep and shallow lobes were excised with part of the gland, and the facial nerves were dissected under general anesthesia. Postoperative pathology revealed an adenolymphoma in the shallow lobe of the right parotid gland and a basal cell adenoma with cystic transformation in the deep lobe. The surgical effect was good, with no complications, and there was no recurrence after 1 year of follow-up. A review of the relevant literature showed that multiple primary tumors of the parotid gland can manifest as the simultaneous presence of two or more types of tumors on both sides or on one side, and the disease is mainly treated with surgery.@*Conclusion@#Multiple unilateral primary parotid gland tumors are rare. Imaging examinations need to be combined with clinical evaluations to prevent missed diagnoses. Surgery is the first treatment option, and patients with benign tumors have a good prognosis.

Advances in the internal fixation surgical approach for sacroiliac joint dislocation caused by posterior pelvic ring injury / 局解手术学杂志

Injury of the posterior pelvic ring can easily be caused by high-energy impact,and sacroiliac joint dislocation is the most common.The sacroiliac joint,as the hub of load transfer between the trunk and lower extremities,is essential to maintain the stability of the posterior pelvic ring,and once dislocation occurs,restoring the stability of the posterior pelvic ring by timely surgery is necessary.The current surgical approaches for the internal fixation of sacroiliac joint are mainly divided into anterior approach and posterior approach.The choice of the surgical approach directly affects the exposure of the surgical field,the stability of internal fixation and the prognosis of patients;therefore,it is particularly important to select the appropriate surgical approach and fixation method.In this paper,we briefly review the selection of sacroiliac joint fixation points,surgical approaches and postoperative complications.

Development course and research status of incisions in lung transplantation / 器官移植

Surgical technique of lung transplantation exerts significant impact on clinical prognosis of the recipients. Choosing an appropriate surgical incision determines the exposure of intraoperative visual field, which is the first step of surgical success and directly affects subsequent surgical procedures. Lung transplantation incision is usually considered as primary closure. Nevertheless, for patients with high-risk factors such as oversized lung allografts and primary graft failure after lung transplantation, primary closure cannot be achieved. Hence, delayed chest closure is an effective strategy. The selection of incisions and the adoption of delayed chest closure of lung transplantation exert profound impact upon perioperative prognosis, long-term quality of life and surgical complications of the recipients. Therefore, the development and research status of Clamshell incision, anterolateral incision, posterolateral incision and median sternal incision in lung transplantation were reviewed, highlighting the effect of incision patterns on clinical prognosis of lung transplantation and providing reference for the selection of incisions in clinical lung transplantation.

Fractura de capitellum en el adulto / Capitellum fracture in adults

Introducción: La fractura del extremo distal del húmero afecta la superficie articular y puede provocar incapacidad biomecánica de la articulación si no se trata adecuadamente. Objetivo: Presentar una paciente con fractura del capitellum, tratada mediante osteosíntesis. Presentación del caso: Paciente femenina de 49 años que se cayó sobre su mano en extensión. Presentó dolor intenso en el codo izquierdo y se le diagnosticó una fractura del capitellum desplazada. Se trató con osteosíntesis. Conclusiones: El tratamiento mediante osteosíntesis de la fractura del capitellum constituye la mejor opción para la rápida rehabilitación del paciente(AU)

Introduction: The fracture of the distal end of the humerus affects the articular surface and it can cause biomechanical disability of the joint if it is not treated properly. Objective: To report the case of a patient with capitellum fracture, treated by osteosynthesis. Case report: This is the case of a 49-year-old female patient who fell on her outstretched hand. She complained of severe pain in her left elbow and she was diagnosed with a displaced capitellum fracture. The pateinmet was treated with osteosynthesis. Conclusions: The treatment by osteosynthesis of the capitellum fracture is the best option for the rapid rehabilitation of the patient(AU)

Postauricular Transcanal Posterior Tympanectomy (PT2) Approach - A Modified Surgical Technique for Jugulotympanic Paragangliomas

Abstract Introduction The surgical management of jugulotympanic paragangliomas has remained challenging. They are the second most common type of tumor of the temporal bone after acoustic neuroma. It has been noticed by the authors that the jugulotympanic paragangliomas may have extensions to the epitympanum and aditus in addition to the mesotympanum and hypotympanum. The modified technique could be an alternative to the conventional facial recess technique for complete removal of the tumors. Objective To highlight the modified surgical technique for the surgical treatment of jugulotympanic paragangliomas. Methods This is a retrospective review of 34 cases of jugulotympanic paragangliomas treated in a tertiary center with respect to clinical presentation, diagnosis, and surgical treatment. Tinnitus and hearing loss were predominant symptoms. A modified technique of postauricular transcanal posterior tympanectomy with extended hypo-tympanic access was performed in 29 patients. Only two cases were operated with a classical transcanal approach. A canal wall down the mastoidectomy was required in three patients. Results The patients operated on with the modified technique had complete excision evident by absence of any lesion in computed tomography and the disappearance of tinnitus. However, two patients had recurrence of symptoms and presence of tumor in the follow-up period. These two patients underwent revision surgery. None of the patients required postoperative radiotherapy or gamma knife therapy. Conclusions Jugulotympanic paragangliomas can be effectively managed with the modified technique to ensure complete removal of the lesions. This technique has not been reported earlier in the literature.

Weber approach for retromolar adenoid cyst carcinoma: case report and literature review

Adenoid cyst carcinoma (ACC) is an uncommon facial tumor and challenging to treat; surgical treatment is challenging due to its localization. A 49-year-old Latin female patient with a one-year history of soft tissue-depending mass of slow growth in the right maxillary region. Laboratory tests reported normal. Contrast-enhanced computed tomography showed a maxillary tumor. Patient underwent to surgical resection by Weber-Fergusson approach. The patient received postoperative adjuvant radiotherapy. ACC is a challenging entity to treat, surgical resection, and radiotherapy is required. The combination of surgery and radiotherapy represents the definitive treatment for ACC. Chemotherapy remains controversial and is reserved for palliation in selected cases.

Evidencia de la efectividad del uso de aparatología ortopédica prequirúrgica en pacientes con labio y paladar hendido: revisión sistemática / Evidence of the effectiveness of the use of presurgical orthopedic appliances in patients with cleft lip and palate: a systematic review

Resumen El objetivo de este artículo fue evaluar la evidencia sobre el uso de una aparatología ortopédica prequirúrgica (AOP) en pacientes con labio y paladar hendido. Se realizó una búsqueda en las siguientes bases de datos: Medline/PubMed, Google Scholar, Clinical Trails.gov, ProQuest y Web of Science. En la búsqueda, se encontraron 7.926 registros, de los cuales se analizaron 105 artículos de texto completo; de éstos se incluyeron 23 estudios en pacientes con uso de AOP, asi como su grupo control sin el uso del AOP, previo al mismo tipo de cirugía. Los aparatos más utilizados para la AOP en el manejo de LPH fueron: el paladar pasivo (Paladar de Hotz), el modelador nasolaveolar (NAM), aparato McNeil y por último el T-traction; los principales desenlaces evaluados fueron: la estética facial y apariencia nasal; la evaluación de medidas cefalométricas, de vías aéreas superiores, nasales, del ancho de la fisura y así como puntos de referencia anatómicos como la distancia inter-canina e inter-tuberosidad. Además, se encontraron estudios que evaluaron oclusión y la fonación. La evidencia de esta literatura sugiere que el uso de aparatos activos tiene un mejor efecto que la placa pasiva, en términos de estética facial y aproximación de los segmentos maxilares para el cierre de la fisura. Sin embargo, la heterogeneidad, el riesgo de sesgo y la baja calidad de los estudios no permite tener conclusiones sólidas.

Abstract This review article aimed to evaluate the evidence on the use of a presurgical orthopedic appliance (POP) in patients with cleft lip and palate. The search was conducted using Medline/PubMed, Scholar Google, Clinical Trails, ProQuest, Scopus, and Web of Science databases. During the search, 7,926 records were found, of which 105 full-text articles were analyzed, and 23 studies included analysis in patients with the use of POP, and their control groups without the use of POP prior to the same type of surgery. The devices most used for POP in the management of LPH were: the passive palate (Hotz palate), the nasolaveolar moulding (NAM), the McNeil device, and finally, the T-traction. The primary outcomes evaluated were: facial aesthetics and nasal appearance; the evaluation of cephalometric measurements, upper airways, nasal fissure width, as well as anatomical references such as inter-canine and intertuberosity distances. In addition, studies that evaluated occlusion and phonation were found. The evidence from this literature suggests that the use of active appliances had a better effect than passive appliances in terms of facial aesthetics and approximation of the maxillary segments for the closure of the fissure. However, the heterogeneity, the risk of bias, and the low quality of the studies do not allow to state firm conclusions.

Surgical treatment of rectourethral fistula / 现代泌尿外科杂志

Rectourethral fistula (RUF) has been difficult to manage in urology due to its special anatomical location,complicated condition and uncertain prognosis. With the increasing incidence of prostate cancer,the incidence of RUF as a serious complication is also rising. Major treatment methods of RUF include conservative treatment and surgical treatment such as transabdominal approach,trans-perineal approach,trans-sphincter approach and trans-anal approach. However,there is no explicit treatment protocol. In recent years,the application of modified York-Mason technique has achieved good results. This article details the key steps and surgical experience of the technique.

Efficacy of modified anterior robot-assisted laparoscopic radical prostatectomy with preservation of Retzius space in 10 cases / 现代泌尿外科杂志

【Objective】 To investigate the safety, feasibility and clinical efficacy of modified anterior robot-assisted laparoscopic radical prostatectomy (RALRP) with preservation of Retzius space. 【Methods】 The clinical data of 10 patients who underwent RALRP using the modified anterior approach to preserve the Retzius space in our hospital during June 2021 and March 2022 were retrospectively analyzed, including the preoperative, intraoperative, postoperative and follow-up data. 【Results】 All operations were successful without conversion to open surgery. The average operation time (robotic arm operation time) was (98.6±47.7) min, blood loss (105.0±57.3) mL, postoperative drainage tube indwelling time (5.3±1.3) d, postoperative urinary catheter indwelling time (7.2±0.8) d, and postoperative hospital stay (9.2±2.2) d. Urinary continence was achieved immediately after removal of the urinary catheter in 6 patients, 2 patients recovered 2 weeks after extubation, and 2 patients recovered 3 months after extubation. Postoperative pathology showed pT2a stage in 1 case, pT2b stage in 2 cases, and pT2c stage in 7 cases; Gleason score was 6-7 points; all postoperative resection margins were negative. During the follow-up of 3-12 months, no tumor recurrence was observed, and no patient was readmitted due to surgical complications. 【Conclusion】 RALRP with modified anterior approach to preserve the Retzius space is safe and feasible, with no serious complications during and after surgery, and the early postoperative urinary continence effect is comparable to that of the posterior approach.

Clinical application of a digital positioning guide template during the extraction of maxillary wholly impacted supernumerary teeth / 口腔疾病防治

Objective@#To evaluate the clinical efficacy of positioning guide templates for maxillary wholly impacted supernumerary teeth to provide technological solutions for clinical applications. @*Methods @#After approval by the hospital ethics committee and informed consent given by the patients. Data from 136 patients with maxillary wholly impacted supernumerary teeth from January 2016 to April 2022 were analyzed retrospectively. The patients were divided into two groups according to the usage of the positioning guide template. The experimental group included patients using the positioning guide template (71 cases), and the control group did not use the positioning guide template (65 cases). The operation time and complications were statistically analyzed to evaluate the clinical efficacy after surgery. @*Results @# All operations were successfully completed. The average operation time in the experimental group was (21.5 ± 3.4) min, significantly shorter than that in the control group (27.2 ± 4.9) min. There were statistically significant differences between the experimental and control groups (t = 7.599, P<0.001). One week after the operation, there were no complications in the experimental group, and there were 2 cases of adjacent tooth injury and 3 cases of gingival numbness in the control group.@* Conclusion @# A digital positioning guide template can effectively shorten the time of maxillary wholly impacted supernumerary teeth extraction and is an effective means to assist clinical maxillary wholly impacted supernumerary teeth extraction.

Treatment of stable degenerative lumbar spondylolisthesis with percutaneous endoscopic surgery through two different approaches / 中国骨伤

OBJECTIVE@#To assess the clinical effects of percutaneous endoscopic surgery through two different approaches for stable degenerative lumbar spondylolisthesis.@*METHODS@#Sixty-four patients with stable degenerative lumbar spondylolisthesis who underwent percutaneous endoscopic procedures between January 2016 and December 2019 were divided into transforaminal approach group and interlaminar approach group according to surgical approaches, 32 patients in each group. There were 16 males and 16 females in transforaminal approach group, aged from 52 to 84 years old with an average of (66.03±9.60) years, L2 slippage in 4 cases, L3 slippage in 5, and L4 slippage in 23. There were 17 males and 15 females in interlaminar approach group, aged from 46 to 81 years old with an average of (61.38±9.88) years, L3 slippage in 3 cases, L4 slippage in 15, and L5 slippage in 14. Operative time, intraoperative fluoroscopy times, and postoperative bedtime were compared between two groups. Anteroposterior displacement values, interbody opening angles, and the percentage of slippage were measured on preoperative and postoperative 12-month dynamic radiographs. Visual analogue scale (VAS) of low back pain and lower extremity pain, and the Japanese Orthopaedic Association (JOA) score before and after surgery were observed, and clinical effects were evaluated according to the modified MACNAB criteria.@*RESULTS@#All operations were successfully completed, and patients in both groups were followed up for more than 1 year, and without complications during follow-up period. ①There was no significant difference in operation time between two groups(P>0.05). Intraoperative fluoroscopy times were longer in transforaminal approach group than that in intervertebral approach group(P<0.05). Postoperative bedtime was shorter in transforaminal approach group than that in intervertebral approach group (P<0.05).② No lumbar instability was found on dynamic radiography at 12 months postoperatively in both groups. There were no significant differences in anteroposterior displacement values, interbody opening angles, and the percentage of slippage between two groups postoperative 12 months and preoperative 1 day(P>0.05). ③There was no significant difference between two groups in VAS of low back pain at 3 days and 1, 12 months after the operation compared with the preoperative(P>0.05), but the VAS of the lower extremity pain was significantly improved compared with the preoperative(P<0.05). Both of groups showed significant improvement in JOA score at 12 months compared with preoperatively(P<0.05). There was no significant difference in VAS of low back pain, lower extremity pain and JOA scores between two groups during the same period after surgery(P>0.05). According to modified Macnab criteria, excellent, good, fair and poor outcomes were 21, 7, 3 and 1 in transforaminal approach group respectively, and which in intervertebral approach group were 20, 7, 5 and 0, there was no significant difference in clinical effect between the groups(P>0.05).@*CONCLUSION@#Intervertebral approach may reduce intraoperative fluoroscopy times and transforaminal approach can shorten postoperative bedtime, both approaches achieve satisfactory results in the treatment of stable degenerative lumbar spondylolisthesis with no progression of short-term slippage.

Application value of the anatomically oriented "six steps with six windows" approach in laparoscopic radical total gastrectomy / 中华消化外科杂志

Objective:To investigate the application value of the anatomically oriented "six steps with six windows" approach in laparoscopic radical total gastrectomy.Methods:The retros-pective cohort study was conducted. The clinicopathological data of 121 patients who underwent laparoscopic radical total gastrectomy in Henan Provincial People′s Hospital from January 2019 to February 2022 were collected. There were 53 males and 68 females, aged (68±12)years. Of the 121 patients, 72 patients using the traditional approach in the surgery were divided into the control group, and 49 patients using the "six steps with six windows" approach in the surgery were divided into the experiment group. Observation indicators: (1) surgical situations; (2) postoperative situations. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Count data were described as absolute numbers or percen-tages, and comparison between groups was conducted using the chi-square test. Results:(1) Surgical situations. All 121 patients underwent laparoscopic radical total gastrectomy successfully, without laparotomy conversion. The operation time, volume of intraoperative blood loss, number of lymph nodes dissected were (250±50)minutes, (150±34)mL, 41±6 in the control group, versus (180±16)minutes, (55±13)mL, 51±5 in the experiment group, showing significant differences in the above indicators between the two groups ( t=11.04, 21.47, 9.42, P<0.05). (2) Postoperative situations. The times of postoperative analgesic injection, time to postoperative ?rst ?atus, duration of postoperative hospital stay, postoperative pathological staging (stage Ⅰ, stage Ⅱ, stage Ⅲ), incidence of postoperative complication were 3.4±1.6, (4.0±1.4)days, (13.1±2.0)days, 9, 32, 31, 15.3%(11/72) in the control group, versus 3.5±1.7, (4.1±1.5)days, (13.1±1.7)days, 6, 25, 18, 16.3%(8/49), showing no significant difference in the above indicators between the two groups ( t=0.35, 0.18, 0.03, Z=0.55, χ2=0.02, P>0.05). There was no perioperative death in both groups of patients. Conclusion:Appli-cation of the anatomically oriented "six steps with six windows" approach in laparoscopic radical total gastrectomy is safe and feasible.

Diagnosis and treatment of complications and surgical improvements on simultaneous pancreas-kidney transplantation / 中华器官移植杂志

The number of Chinese adults with diabetes mellitus (DM) ranks first in the world.Diabetic nephropathy (DN) has surpassed chronic glomerulonephritis as a leading cause of end-stage renal disease (ESRD). Simultaneous pancreas-kidney (SPK) transplantation remains an effective treatment for DM plus ESRD.Type 1/2 DM has a similar efficacy.During the last 50 years, pancreas transplantation is gaining popularity with constant improvements and innovations in surgical approaches.However, high rates of complications and reoperation after SPK lower graft survival and it has hampered the widespread implementation of SPK transplantation.It is imperative to diagnose and treat complications early and further improve the surgical approach for minimizing the occurrence of complications.This review summarized the managements of postoperative complications post-SPK and ongoing evolutions of surgical approaches.With continuous modifications of vascular anastomosis and intestinal anastomosis and adoptions of new surgical approaches, survival rates of SPK recipients and grafts shall further improve.

Surgical approaches and clinical outcomes of endoscopic endonasal resection for trigeminal schwannomas / 中华显微外科杂志

Objective:To investigate the surgical approaches and clinical outcomes of endoscopic endonasal approaches (EEA) for trigeminal schwannomas(TSs).Methods:Clinical data, surgical videos and outpatient follow-up notes of 41 patients with TSs and underwent EEA between January 2013 to October 2022 in the Department of Neurosurgery of the First Affiliated Hospital of Nanchang University were retrospectively studied. The patients were 19 males and 22 females, with an average age of 45.3 (22-63) years old. Twenty-four patients had TSs on the left and 17 on the right. According to Jeong's classification, for 6 TSs with type MP, 2 tumours were resected by trans-Meckel's cave approach (TMCA) alone, and the remaining 4 TSs were resected by combined transclival approach (TCA). For the 4 tumours that involved infratemporal fossa(2 of type E3, 1 of type mE3 and 1 of type Mpe3), the surgery were performed via a trans-prelacrimal recess approach(TPRA), of which the operation for type Mpe3 was combined with a TMCA. The trans-laminal papyracea approach (TLPA) was applied to remove 2 tumours of type E1. The rest of 29 patients received the surgery by TMCA alone to remove tumours including 15 of types M, 10 of type Mp, 1 of type ME2, 2 of type E2 and 1 of type MpE2. Gross total tumour resection was achieved in 40 patients(97.6%), with only 1 patient (2.4%) had a subtotal tumour resection.Results:A total of 40 patients had completed the long-term follow-up, with 1 patient lost in follow-up. The average follow-up period was 34(3-101) months; No tumour recurrence or progression was observed over follow-up. After the surgery, preoperative symptoms were improved in 34 patients(89.5%). The main improved symptoms were: facial numbness(78.9%), facial pain(70.0%), headache(88.2%), mastication weakness (50.0%), poor vision (60.0%), diplopia (83.3%), and abducens nerve palsy (100%). Transient and permanent neurological deficits occurred in 8 (19.5%) and 9 (22.0%) patients, respectively. Cerebrospinal fluid leakage and internal carotid artery injury occurred in 1 patient each.Conclusion:According to the location of a tumour, an appropriate EEA should be selected and satisfactory results can be achieved for all types of tumours, except the TSs that has the main body of the tumour located in the posterior cranial fossa.

Efficacy comparison between modified two-window iliofemoral approach and ilioinguinal approach for reduction and internal fixation of composite acetabular fracture / 中华创伤杂志

Objective:To compare the effect of reduction and internal fixation of composite acetabular fracture with the modified two-window iliofemoral approach and ilioinguinal approach.Methods:A retrospective cohort study was used to analyze the clinical data of 160 patients with composite acetabular fracture admitted to First Affiliated Hospital of Nanjing Medical University from January 2016 to August 2021, including 117 males and 43 females, aged 15-78 years [(44.1±16.0)years]. According to the Letournel classification system, there were 101 patients with both-column fracture, 5 with anterior wall/column combined with posterior semi-transverse fracture and 24 with T-shaped fracture. A total of 80 patients were treated using the modified iliofemoral incision combined with limited Pfannstiel incision (modified two-window iliofemoral approach group) and the other 80 patients were treated using the ilioinguinal approach (ilioinguinal approach group). The fracture healing was observed. The operation time and intraoperative bleeding volume were compared between the two groups. The quality of fracture reduction was evaluated by Matta scoring standard at 1 day and 6 months after operation. The modified Merle d′Aubigne & Postel scoring standard was used to evaluate the function of the affected hip joint at the last follow-up. The incidence of complications such as neurovascular injury, iatrogenic bladder injury, heterotopic ossification and femoral head necrosis were compared between the two groups.Results:All patients were followed up for 12-78 months [(43.3±17.9)months], with bony union of the fracture. The operation time and intraoperative bleeding volume in modified two-window iliofemoral approach group were 150.0 (123.8, 180.0)minutes and 600.0 (500.0, 787.5)ml when compared to 190.0 (150.0, 240.0)minutes and 700.0 (562.5, 887.5)ml in ilioinguinal approach group (all P<0.01). There was no significant difference between the two groups in the quality of fracture reduction at 1 day and 6 months after operation, function of hip joint at the last follow-up and incidence of complications (all P>0.05). Conclusions:For reduction and internal fixation of composite acetabular fracture, the modified two-window iliofemoral approach has advantages over the ilioinguinal approach in reducing operation time and intraoperative bleeding, although both methods yield similar results in fracture reduction quality, postoperative hip function and complication rate.

A clinical comparative study on the Laennec’s approach versus the two-step separation stylized approach in laparoscopic left lateral sectionectomy / 中华肝胆外科杂志

Objective:To compare the clinical outcomes of the Laennec’s approach versus the two-step separation stylized approach in laparoscopic left lateral sectionectomy (LLLS).Methods:A total of 60 patients who underwent LLLS at the Department of Hepatobiliary and Pancreatic Surgery, the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University from March 2019 to April 2022 were prospectively entered into this study. There were 40 males and 20 females, aged (49.1±9.3) years, with 31 patients suffering from liver cancer, 14 patients hepatic hemangioma and 15 patients hepatolithiasis. A randomized number table was used to assign the patients into two groups: the Laennec’s approach group ( n=30) and the two-step separation stylized approach group ( n=30). The age, gender, liver function, operation time, intraoperative blood loss, abdominal drainage amount, drainage tube retention time, postoperative hospital stay, total hospital costs and postoperative complications were compared between the two groups. Results:There were no significant differences between the two groups in gender, age and Child-Pugh grading of liver function (all P>0.05). Comparison of intraoperative bleeding, postoperative hospital stay, postoperative complications, postoperative recurrence between the two groups showed there were no significant differences between the two groups (all P>0.05). The operative time [(85.6±24.5) min vs (99.1±30.7) min, P<0.05] was significantly less in the stylized group than the Laennec’s group, while the Laennec’s group were superior to the stylized group in the amount of draining [(144.1±38.3) ml vs (290.9±59.5) ml], drainage tube retention time [(2.7±1.5) d vs (4.3±1.9) d] and total hospital costs [(35 100.7±13 200.6) yuan vs (44 700.1±11 800.8) yuan](all P<0.05). Conclusions:Both the Laennec’s and stylized approaches for LLLS were safe and feasible. The stylized approach for LLLS could be performed more quickly, while the Laennec’s approach could more accurately dissect and handle intrahepatic and extrahepatic ducts, thus resulting in decreased postoperative exudation and treatment costs.