Advances in surgical strategies for ossification of posterior longitudinal ligament involving the C 2 segment / 中国修复重建外科杂志

OBJECTIVE@#To evaluate the application of surgical strategies for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL) involving the C 2 segment.@*METHODS@#The literature about the surgery for cervical OPLL involving C 2 segment was reviewed, and the indications, advantages, and disadvantages of surgery were summarized.@*RESULTS@#For cervical OPLL involving the C 2 segments, laminectomy is suitable for patients with OPLL involving multiple segments, often combined with screw fixation, and has the advantages of adequate decompression and restoration of cervical curvature, with the disadvantages of loss of cervical fixed segmental mobility. Canal-expansive laminoplasty is suitable for patients with positive K-line and has the advantages of simple operation and preservation of cervical segmental mobility, and the disadvantages include progression of ossification, axial symptoms, and fracture of the portal axis. Dome-like laminoplasty is suitable for patients without kyphosis/cervical instability and with negative R-line, and can reduce the occurrence of axial symptoms, with the disadvantage of limited decompression. The Shelter technique is suitable for patients with single/double segments and canal encroachment >50% and allows for direct decompression, but is technically demanding and involves risk of dural tear and nerve injury. Double-dome laminoplasty is suitable for patients without kyphosis/cervical instability. Its advantages are the reduction of damage to the cervical semispinal muscles and attachment points and maintenance of cervical curvature, but there is progress in postoperative ossification.@*CONCLUSION@#OPLL involving the C 2 segment is a complex subtype of cervical OPLL, which is mainly treated through posterior surgery. However, the degree of spinal cord floatation is limited, and with the progress of ossification, the long-term effectiveness is poor. More research is needed to address the etiology of OPLL and to establish a systematic treatment strategy for cervical OPLL involving the C 2 segment.

New Thoughts on Surgical Principles of Non-Small Cell Lung Cancer / 肿瘤防治研究

Non-small cell lung cancer (NSCLC) is an important malignancy. Surgery is the earliest treatment and still the main strategy for lung cancer at present. Recently, significant progress has been made in the diagnosis and treatment of lung cancer, covering new theories, knowledge, and methods that urgently require the attention and learning of surgeons. Only by following the new situation and strategies of oncology and making corresponding changes can surgical techniques be perfectly combined with the new developments in oncology, avoiding over-diagnosis/underdiagnosis and over-treatment/undertreatment of lung cancer, and ultimately creating new achievements for patients' long-term cure.

Propensity matching study of mitral valve management strategy during coronary artery bypass grafting in patients with moderate ischemic mitral insufficiency / 中华胸心血管外科杂志

Objective:To explore the surgical strategy of coronary artery bypass grafting(CABG) for moderate ischemic mitral regurgitation(IMR), and to clarify the impact of mitral valve surgical intervention(MVS) on the long-term prognosis of such patients.Methods:The clinical data of 234 consecutive patients with moderate IMR who received CABG from January 2013 to December 2018 were retrospectively included, with 184 males and 50 females. The age ranged from 29 to 78 years, with a mean of(61.5 ± 8.7) years old. According to whether MVS was performed at the same time, they were divided into CABG group(108 cases, CABG alone) and CABG+ MVS group(126 cases, CABG+ MVS at the same time). The long-term cardiac events, all-cause deaths, major cardiovascular and cerebrovascular adverse events(MACCE) and other end events were followed up. A matching queue was established by propensity matching score for statistical analysis.Results:After propensity matching score, a matching queue was established, including 78 pairs of patients. Survival analysis showed that the incidence of long-term cardiac events and postoperative new onset atrial fibrillation in CABG+ MVS group was significantly higher( P<0.05). However, there was no significant difference between the two groups in all-cause mortality, cardiogenic mortality, and the incidence of MACCE events( P>0.05). Cox regression analysis showed that simultaneous CABG+ MVS was a risk factor for long-term cardiac events and new postoperative atrial fibrillation. The results of subgroup studies showed that for patients without tricuspid regurgitation before operation, left ventricular end diastolic diameter>55 mm, and left ventricular ejection fraction(LVEF) ≤0.55, the probability of cardiac events after MVS at the same time of CABG was higher( P<0.05). However, patients with no tricuspid regurgitation before operation, left ventricular end diastolic diameter>55 mm, LVEF≤0.55, and left atrial diameter≥40 mm had a higher probability of atrial fibrillation after MVS at the same time of CABG( P<0.05). Conclusion:CABG can improve left ventricular remodeling in patients with moderate IMR, whether MVS intervention is performed at the same time or not, and the long-term survival rate of both is similar. CABG+ MVS in the same period can maintain a low residual reflux, but the incidence of long-term cardiac events and arrhythmias is high. The longer-term prognosis needs to be further studied. The surgical strategy of such patients should be selected individually according to the specific situation and the surgical quality in medical centers.

Basic principles and quality control of surgical treatment for giant thoracic tumors / 中国胸心血管外科临床杂志

@#Giant thoracic tumor is currently one of the diagnostic and therapeutic challenges of thoracic surgery, with no established guideline or standard for diagnosis and treatment. The quality control of individualized surgical strategy and perioperative management with multi-disciplinary participation is the key to ensure the safety and improve the prognosis of patients. Based on the clinical experience of our institution and others, we hereby discussed and summarized the basic principles, surgical strategies and perioperative management of giant thoracic tumor, aiming to provide a reference of quality control.

Feasibility study of one-stage surgery of intracardiac leiomyomatosis through an abdominal approach / 中国实用外科杂志

OBJECTIVE: To investigate the feasibility of abdominal surgical resection of intracardiac leiomyomatosis.METHODS: The clinical data of 4 cases of intracardiac leiomyomatosis performed in zhongshan Hospital,Fudan University from December 2015 to August 2017 were analyzed retrospectively. RESULTS: Four patients underwent onestage surgery through an abdominal approach,without death. The operative time was 185-420(315.3 ± 86.4) min.Extracorporeal circulation time was 22-175(71.8±60.4)min and blood loss was 600-3000(1475.0±941.7)mL. Acute renal failure occurred in one of the patients after operation,the rest had no surgical complications. After 8-26 months of follow-up,there was no sign of recurrence and metastasis. CONCLUSION: One-stage surgery of intracardiac leiomyomatosis through an abdominal approach is feasible. But,how to determine the indications of surgery remains to be further explored and studied.

Difficulties and countermeasures in the diagnosis and treatment of medullary thyroid carcinoma / 中国实用外科杂志

Prognosis of medullary thyroid carcinoma(MTC)is worse,and occurrence of early metastasis is easy. Hereditary and sporadic MTC have different clinical characteristics and prognosis. The diagnostic value of ultrasound,CT,MRI and bone scintigraphy is special. Calcitonin(Ctn)is found to have diagnostic specificity,while carcinoembryonic antigen(CEA)is useful for evaluating disease progression. Whether hereditary or sporadic MTC,surgeons should pay attention to the subsequent genetic detection. Different surgical strategies are required for hereditary and sporadic MTC. Active surgery is necessary for patients with regional recurrence and nodal metastasis. Advanced progressive MTC could be treated by palliative surgery,external radiotherapy or systemic treatment with the tyrosine kinase inhibitor. Measurement of doubling times of serum Ctn and CEA can evaluate recurrence and metastasis after surgery.

Laparoscopic surgery strategies for adenocarcinoma of the esophagogastric junction / 中华消化外科杂志

The incidence of adenocarcinoma of the esophagogastric junction (AEG) has been raised in recently years.Comprehensive treatment based on surgical treatment is currently a general strategy for the treatment of AEG.As a minimally invasive treatment,laparoscopic surgery has been gradually applied to the treatment of AEG.Because of the particularity of the anatomy and pathology of AEG,laparoscopic radical resection still has many difficulties and controversies.Up to now,there are a few high-level evidences for the range of lymph node dissection and gastrectomy and the selection of digestive tract reconstruction,and the treatment strategy of total laparoscopic surgery for AEG has not reached a consensus.Therefore,laparoscopic surgery for AEG has gradually become a hot topic in clinical research.Here,combined with the experience of laparoscopic surgery for AEG and the latest guidelines and literatures,authors presented the general strategies for the laparoscopic treatment of AEG in our center.

Mid-term outcome of coronary artery bypass graft surgery in patients aged≤40 years with coronary heart disease / 复旦学报（医学版）

Objective To investigate the clinical characteristics,surgical experience and mid-term outcome of coronary artery bypass graft surgery in patients aged ≤ 40 years.Methods From Jan.,2009 to Dec.,2015,12 patients with median age of (37.9 ± 2.5) years (range 32-40 years,10 males) were diagnosed with coronary artery disease and underwent coronary artery bypass graft surgery at Zhongshan Hospital,Fudan University.The clinical characteristics included five cases with hypertension,three cases with diabetes mellitus,four cases with hyperlipemia,eight cases with smoking history,seven cases with myocardial infarction.Six cases had at least one branch totally occluded.Two cases once underwent percutaneous coronary intervention surgery and implanted with five and three stents respectively.The perioperative data and follow-up results were retrospectively analysed.Results There was no in-hospital death and no death during follow-up period.Surgical techniques included bilateral internal mammary arteries combined with radial artery were operated in six cases,bilateral internal mammary arteries combined with great saphenous vein in two cases,left internal mammary arteries combined with great saphenous vein in four cases,off-pump in nine cases and on-pump in three cases.The mean follow-up time was (47.8 ± 24.3) months.During the follow-up one case suffered with saphenous vein graft restenosis 5 years after the surgery and underwent percutaneous coronary intervention.Other cases were all alive and assessed New York Heart Association's function class Ⅰ-Ⅱ.Conclusions Younger patients usually suffer with severe coronary artery disease when diagnosed because they often have excellent compensative capacity and the pathogenesis is concealed.The mid-term results of coronary artery bypass graft surgery in patients aged ≤40 years are satisfactory.

Thoughts on enacting and carrying out for reoperative procedures in thyroid surgery / 中华外科杂志

In recent years, with the improvement of the incidence of thyroid tumors and the extensive development of thyroid surgery in primary hospitals, the proportion of thyroid cancer patients requiring reoperation has continued to increase. In spite of different reasons of reoperation, the risk of serious complications will increase after reoperation compared with first operation. Undoubtedly, the doctors will have to face new challenges to make more appropriate surgery program. Before reoperation, both the operation benefits and the corresponding risks should be considered comprehensively. As far as possible, the individual treatment should be recommended on the basis of standardized treatment, and it will be better to strike a balance between radical surgery and function protection. Consequently, low-grade doctors should be cautious to perform these reoperations.

Surgical Strategies for Successful Minimally Invasive Transforaminal Lumbar Interbody Fusion

STUDY DESIGN: Literature review. OBJECTIVES: The aim of this study was to demonstrate surgical strategies for successful minimally invasive transforaminal lumbar interbody fusion (TLIF). SUMMARY OF LITERATURE REVIEW: Although many studies have reported the benefits and disadvantages of minimally invasive TLIF, few have described surgical strategies to improve the success rate or to reduce complications. MATERIALS AND METHODS: We searched for studies reporting the clinical and radiological outcomes of minimally invasive TLIF, and analyzed the optimal indications, technical pitfalls, and tips for successful surgical outcomes. RESULTS: The ideal candidate for minimally invasive TLIF is a patient with single or 2-level low-grade adult degenerative or isthmic spondylolisthesis. Incomplete decompression, dura tearing, nerve root injury, and implant-related complications were found to be the most commonly reported adverse events, especially in the early periods of a surgeon's experience. Precise positioning for skin incision and tube insertion, complete neural decompression, proper interbody preparation for bone graft and cage insertion, and the correct placement of percutaneous pedicle screws are critical strategies for successful surgical outcomes. Fully understanding the surgical pitfalls and tips described in this review is also important to avoid potential complications. CONCLUSIONS: It is imperative not only to carry out a comprehensive preoperative evaluation and proper patient selection, but also to perform meticulous surgical procedures with thoughtful considerations of potential pitfalls, in order to improve the success rate and to reduce the complications of minimally invasive TLIF.

Surgical Strategy for Papillary Thyroid Microcarcinoma / 대한갑상선학회지

It is generally agreed that papillary thyroid microcarcinoma (PTMC) demonstrates indolent biological behavior. But PTMCs include at least two biologically distinct subpopulations: indolent tumors with minimal or no potential for progression, and tumors with the propensity for aggressive behavior and dissemination. The ability to stratify those relatively few patients with aggressive PTMC from the vast majority who are low-risk is crucial to offer most appropriate clinical management. Risk factors such as tumor size, age, sex, tumor multifocality, vascular or capsular invasion, extrathyroidal extension, lymph node metastases, histological variants of papillary thyroid cancer (PTC), the presence of mutational markers, and incidentalness need to be considered for a risk-adapted algorithmic approach that would hope to achieve minimal morbidity while still anticipating optimal outcomes at less cost to the patient and to society. But risk factors for recurrence have not been confirmed because of such low recurrence rates, rare mortality rate, and several selection (or therapeutic) biases present in any retrospective series. Larger scale cohort studies showed that recurrence rates did not differ statistically between patients treated with unilateral lobectomy and those treated with bilateral resection, so long as complete tumor resection was achieved. Similarly, more aggressive nodal dissection failed to yield the anticipated reduction in recurrence rates. In conclusion, selection of the minority of PTMC who deserves more aggressive surgery is important, reserving less aggressive treatments for the other, the large majority cases. The ability to stratify those relatively few patients with aggressive PTMC from the vast majority who are low-risk is crucial to offer most appropriate surgical strategy.

Surgical strategy of osteoarthritis secondary to acetabular dysplasia by total hip arthroplasty / 中国医师进修杂志

Objective To investigate the experiences of total hip replacement in the treatment of different types of osteoarthritis secondary to acetabular dysplasia, and evaluate its effect. Methods From January 1999 to December 2006, 37 hips in 35 cases with osteoarthritis secondary to acetabular dysplasia undergoing total hip replacement were included in this study. Preoperative Harris score was 30-64 points, with an average score of 45 points. Undergoing total hip replacement with complete release, of soft tissue, original acetabular, and no femoral osteotomy. Crowe Ⅰ , Ⅱ-type acetabular dysplasia chose conventional cementless press-fit prosthesis;Crowe Ⅲ,Ⅳ-type,chose the appropriate trumpet,Zweymüller system cementless acetabular biconical spiral surface and thin and straight SL rectangular hip stems. Results The duration of follow-up ranged from 12 to 60 months (average 24 months). No case appeared dislocation, periprosthetic fractures, femoral nerve and sciatic nerve injury and other complications, no clinical and X-ray findings of prosthesis loosening occurred. Postoperative Harris score was 60-95 points, and average was 85 points. Conclusion Adequate preoperative preparation, intraoperative complete release, is the key of the treatment and restoration of limb length.

Strategy & Pitfalls of Internal Carotid Artery Aneurysm Surgery / 대한뇌혈관외과학회지

Saccular aneurysms of the subarachnoid segment of the internal carotid artery(ICA) are among the most common aneurysms encountered by neurosurgeons. Surgical strategy and techniques to deal with such aneurysms arising from the ophthalmic artery to the ICA bifurcation are described. Intimate understanding of the anatomy and proper surgical technique improve surgical result.