Recommendations from Annals of Surgical Oncology： Clinical guidelines for extrahepatic cholangiocarcinoma and gallbladder carcinoma / 临床肝胆病杂志

Biliary tract carcinoma （BTC） is a type of gastrointestinal tumor with a low incidence rate and a strong invasive ability， mainly including intrahepatic cholangiocarcinoma （ICC）， extrahepatic cholangiocarcinoma （ECC）， and gallbladder carcinoma （GC）， often accompanied by local progression or distant metastasis. Surgery is often the preferred treatment method for patients with local resectable tumor； however， there is still a high risk of recurrence after radical surgery. Therefore， multiple treatment modalities are often required for BTC patients， including surgical resection， systemic treatment （such as targeted therapy， chemotherapy， and immunotherapy）， and/or a combination of local treatment methods. With the development of the field of BTC， it is critical for surgical oncologists to understand and master the latest surgical strategies and the best patient selection and management systems. In view of the complexity of treatment and the continuous development of diagnosis and treatment techniques， Annals of Surgical Oncology， an authoritative American journal of cancer surgery， recently published the practical diagnosis and treatment guidelines for hepatobiliary tumors， including hepatocellular carcinoma （HCC）， ICC， ECC， and GC， aiming to provide more evidence-based evidence for the clinical management and decision-making of patients with hepatobiliary tumors. Due to the limitations of length and different emphases， this article mainly introduces the recommendations for the evaluation points and clinical treatment of ECC and GC in the guidelines， so as to provide a reference for clinical practice.

Situaciones transoperatorias en pacientes pediátricos con fractura supracondílea del húmero

Introducción: Las fracturas supracondíleas del húmero en el niño, por lo general, son tratadas de manera quirúrgica, durante esa intervención se pueden presentar situaciones específicas en este tipo de enfermos. Objetivo: Actualizar y brindar información sobre algunas de las situaciones transoperatorias en pacientes con fractura supracondílea del húmero. Métodos: La búsqueda y análisis de la información se realizó en un periodo de 61 días (primero de septiembre al 31 de octubre de 2022) y se emplearon palabras de búsqueda relacionadas con la investigación. A partir de la información obtenida, se realizó una revisión bibliográfica de un total de 245 artículos publicados en las bases de datos: PubMed, Hinari, SciELO y Medline, mediante el gestor de búsqueda y administrador de referencias EndNote, de ellos, se utilizaron 29 citas seleccionadas para realizar la revisión, 28 de los últimos cinco años. Resultados: Se hace referencia a cuatro de las situaciones transoperatorias más frecuentes en este tipo de fractura. Se mencionan la conminución de la pared medial, como identificar esta situación y su conducta. En relación a las lesiones asociadas, se recomienda primero estabilizar el antebrazo y luego la fractura supracondílea. Para las fracturas inestables en flexión se recomienda la técnica a emplear. Por su parte, la conversión de la reducción cerrada a abierta está justificada en ciertas circunstancias que de forma detallada se describen en el trabajo. Conclusiones: Las fracturas supracondíleas del húmero en el niño son tratadas en su mayoría mediante tratamiento quirúrgico. Durante el transoperatorio se pueden presentar situaciones para las cuales el médico tratante debe estar preparado.

Introduction: Supracondylar fractures of the humerus in children are generally treated surgically, during surgery intervention may occur specific situations in this type of patient. Objective: To update and provide information on some of the intraoperative situations in patients with supracondylar fracture of the humerus. Methods: The search and analysis of the information was carried out in a period of 61 days (September 1st to October 31st, 2022) and search words related to the investigation were used. Based on the information obtained, a bibliographic review of a total of 245 articles published in the PubMed, Hinari, SciELO and Medline databases was carried out using the EndNote search manager and reference administrator, of which 29 selected citations were used to carry out the review, 28 of the last five years. Results: Reference is made to four of the most frequent intraoperative situations in this type of fracture. Comminution of the medial wall, how to identify this situation and its behavior are mentioned. In relation to associated injuries, it is recommended to first stabilize the forearm and then the supracondylar fracture. For unstable fractures in flexion, the technique to be used is recommended. For its part, the conversion from closed to open reduction is justified in certain circumstances that are described in the article. Conclusions: Supracondylar fractures of the humerus in children are mostly treated by surgical treatment. During the trans-operative period situations may arise for which the treating physician must be prepared.

Early or Delay? The Most Suitable Rehabilitation Protocol for "No Man's Land" Injury: Meta-Analysis with Trial Sequential Analysis - 20 Years Trends / Precoce ou tardio? O protocolo de reabilitação mais adequado para lesão na região 'terra de ninguém': Metanálise com análise sequencial de ensaios - Tendências de 20 anos

Abstract Objective The aim of this study is to analyze various rehabilitation protocol and determine which methods will yield a better outcome. Methods The database reports were searched within 1990 until 2020, using PubMed, Cochrane library database, Ovid, Medline, and the other several published trials. A statistical analysis was made from Review Manager and Trial Sequential Analysis (TSA). Result The mean of re-rupture rate is 3.3% (n= 8) in the combination protocol until 8% (n= 48) in CAM protocol. Meta-analyses found no significant difference between Kleinert vs CAM in re-rupture rate. Also no significant difference in Duran vs CAM in rerupture rate. In Trial Sequential Analysis (TSA), the z-curve does not cross both of the trial sequential boundaries, a further trial with larger sample will be required. The TSA of flexion contracture CAM vs Kleinert was indicated that CAM protocol may be superior than Kleinert to reduce the incidence of flexion contracture. For the range of mean flexion contracture 6.6% (n= 18) in CAM to 23.6% (n= 76) in Kleinert protocol. Conclusion Current meta-analysis proposed that the combination technique will result less re-rupture incidence and better functional outcome in flexor zone II injuries than other techniques. The CAM method also results less flexion contracture than others. However, a further meta-analyses with larger sample trials will be required to confirm this review's conclusion.

Resumo Objetivo O objetivo deste estudo é analisar vários protocolos de reabilitação e determinar quais métodos produzem um melhor resultado. Métodos Os relatórios dos bancos de dados foram pesquisados entre 1990 e 2020, usando PubMed, banco de dados da biblioteca Cochrane, Ovid, Medline e vários outros ensaios publicados. Uma análise estatística foi feita a partir do Review Manager e Trial Sequential Analysis (TSA). Resultado A taxa média de re-ruptura é de 3,3% (n = 8) no protocolo combinado, e até 8% (n = 48) no protocolo de Movimento Ativo Controlado (MAC). As metanálises não encontraram diferença significativa entre Kleinert vs MAC na taxa de re-ruptura. Também não há diferença significativa entre Duran e MAC na taxa de re-ruptura. Na Trial Sequential Analysis (TSA), a curva z não cruza ambos os limites sequenciais de ensaio, será necessário um ensaio adicional com amostra maior. A TSA de contratura em flexão MAC vs Kleinert indicou que o protocolo MAC pode ser superior ao Kleinert para reduzir a incidência de contratura em flexão. Para a faixa de contratura média em flexão de 6,6% (n = 18) no MAC a 23,6% (n = 76) no protocolo Kleinert. Conclusão A metanálise atual propôs que a técnica combinada resultará em menor incidência de re-ruptura e melhor resultado funcional em lesões da zona flexora II do que outras técnicas. O método MAC também resulta em menos contratura em flexão do que outros. No entanto, serão necessárias mais metanálises com estudos com amostras maiores para confirmar a conclusão desta revisão.

Riesgo de accidente cerebrovascular en pacientes con aterosclerosis carotídea asintomática: ¿se debe tratar médicamente o quirúrgicamente?

Los desórdenes cerebrovasculares siguen siendo la primera causa de morbilidad y mortalidad neurológica en el mundo, representando una de las entidades patológicas que genera mayor carga de enfermedad a nivel global. La aterosclerosis, o estenosis carotídea, es un potencial factor de riesgo para el ictus isquémico. La identificación y seguimiento estricto de esta condición son esenciales en la prevención secundaria de complicaciones a través de la atención primaria y el manejo especializado del riesgo cardiometabólico. No obstante, dependiendo de este riesgo y/o la presencia de sintomatología, es necesario realizar un manejo definitivo. Actualmente, existe controversia sobre si es mejor tratar la estenosis carotídea asintomática, ya sea médica o quirúrgicamente. Teniendo en cuenta la relevancia de esta entidad, el objetivo de esta revisión consiste en analizar la evidencia reciente sobre el riesgo de ictus isquémico en la aterosclerosis carotídea asintomática en adultos, y el potencial beneficio del manejo quirúrgico vs. farmacológico de esta condición. Para esto, se llevó a cabo una búsqueda bibliográfica en las bases de datos PubMed, ScienceDirect, Web of Science y MEDLINE, hasta el año 2023. Se evidenció que el riesgo de ictus asociado a estenosis carotídea asintomática es significativo (>10 %, aproximadamente), incluso en aquellos con terapia antiplaquetaria e hipolipemiante activa. En aquellos con manejo médico, la supervivencia a cinco años es alrededor del 80 %. Sin embargo, la progresión de la estenosis sucede en promedio en más del 60 % de los casos, y es significativa. Por el contrario, el stent carotídeo y la endarterectomía son intervenciones resolutivas. Pero existe un riesgo mayor comparado con la terapia médica, el cual se atribuye al periodo periy posoperatorio, así como a 30 días de aparición o recurrencia del ictus, infarto agudo de miocardio o muerte por cualquier causa; aunque el uso de la endarterectomía ha demostrado beneficios superiores a largo plazo en cuanto a estos mismos desenlaces. Entonces, la evidencia es heterogénea en cuanto a la superioridad del tratamiento quirúrgico comparado con la terapia farmacológica en el manejo de la aterosclerosis o estenosis carotídea asintomática. Sin embargo, parece ser que el manejo quirúrgico, específicamente la endarterectomía, podría impactar significativamente sobre la aparición o recurrencia del ictus ipsilateral y muerte a largo plazo, pero con resultados controversiales periy postoperatorios.

Cerebrovascular disorders remain the leading cause of neurological morbidity and mortality in the world, representing one of the pathological entities responsible for the greatest burden of disease worldwide. Carotid atherosclerosis or stenosis is a potential risk factor for ischemic stroke. The identification and strict follow-up of this condition are essential in the secondary prevention of complications through primary care and the specialized treatment of cardiometabolic risk. However, depending on this risk and/or presence of symptoms, definitive treatment is necessary. Currently, there is controversy as to whether asymptomatic carotid stenosis is better to be treated medically or surgically. Considering the significance of such entity, this review aims to analyze recent evidence on the risk of ischemic stroke in the case of asymptomatic carotid atherosclerosis among adults, as well as the potential benefit of the surgical vs. pharmacological treatment for this condition. For this purpose, a literature search for publications up to 2023 was carried out in PubMed, ScienceDirect, Web of Science and MEDLINE databases. It was shown that there is a significant risk of stroke associated with asymptomatic carotid stenosis (> 10 % approximately), even in patients with active antiplatelet and lipid-lowering therapy. Out of all those who receive medical treatment, around 80 % had a five-year survival rate. However, stenosis progression occurs on average in more than 60 % of the cases and is significant. On the other hand, carotid stenting and endarterectomy are curative interventions. Nevertheless, these procedures involve a higher risk compared to the medical therapy during the periand postoperative period, as well as 30 days afterwards, due to the occurrence or recurrence of stroke, acute myocardial infarction or death from any cause. Despite this, the use of endarterectomy has shown superior long-term benefits concerning these same outcomes. Thus, evidence regarding the superiority of surgical treatment compared to pharmacological treatment for asymptomatic carotid atherosclerosis or stenosis is heterogeneous. However, it seems that surgical treatment, specifically endarterectomy, could have a significant impact on the occurrence or recurrence of ipsilateral stroke and death in the long term but with controversial periand postoperative outcomes.

Desenlaces negativos y mortalidad en el anciano frágil sometido a cirugía mayor: ¿qué factores de riesgo impactan más?

El adulto mayor, con frecuencia frágil, es un paciente susceptible a un sinnúmero de complicaciones, tanto inmediatas como a corto, mediano y largo plazo, posterior a una intervención quirúrgica. En función de las comorbilidades presentadas, se debe hacer un abordaje integral para alcanzar el mejor estado orgánico previo a la cirugía e intentar mantenerlo durante y posterior a la intervención. Considerar la fuerza estadística de los desenlaces negativos y, específicamente, de la mortalidad en adultos mayores sometidos a cirugía mayor, es verdaderamente un reto. Incluso, esto trasciende a otros campos como la bioética, al plantearse un dilema sobre la distanasia, cuando se recurre a ciertas intervenciones riesgosas en aquellos con un pronóstico de vida temeroso. Recientemente, se ha publicado evidencia interesante que ha estimado la incidencia, riesgo de mortalidad y factores asociados a desenlaces negativos en adultos mayores sometidos a cirugía mayor, planteando posibles modificaciones en los algoritmos de toma de decisiones en futuras guías de práctica clínica en cirugía. El objetivo de esta revisión consiste en analizar evidencia actualizada sobre qué factores de riesgo impactarían más sobre desenlaces negativos y mortalidad en el adulto mayor sometido a cirugía mayor. Se realizó una búsqueda bibliográfica utilizando los términos de búsqueda "Cirugía Mayor" y "Adulto Mayor", además de sinónimos, en las bases de datos PubMed, ScienceDirect, Web of Science y MEDLINE. En cirugía general y subespecialidades, es muy complejo determinar factores de riesgo precisos y extrapolables a todos los escenarios quirúrgicos, debido a la complejidad y especificidad de ciertos órganos y procedimientos. Existe evidencia sobre adultos frágiles que son sometidos a cirugía por cáncer colorrectal, metástasis hepática, cáncer de pulmón, enfermedad pancreática y cáncer esofágico, en donde se registra una mayor estancia hospitalaria; y de forma general, la mortalidad es mayor en aquellos sometidos a cirugía oncológica. No obstante, tanto la integridad física como mental se asocian con peores desenlaces, y la prehabilitación quirúrgica podría impactar de manera positiva sobre esta situación, al mejorar la reserva funcional y tiempo de recuperación posquirúrgico.

The elderly, often frail, are patients susceptible to numerous complications, both immediate and in the short, medium and long term, following surgical interventions. Depending on their comorbidities, a comprehensive approach should be taken to achieve the best condition of the organs prior to surgery and attempt to maintain it during and after the intervention. Considering the statistical strength of negative outcomes, specifically mortality in elderly patients undergoing major surgery, is truly a challenge. This even extends to other fields such as bioethics, raising a dilemma about dysthanasia when resorting to certain risky interventions in those with a fearful life prognosis. Recently, interesting evidence estimating the incidence, mortality risk and factors associated with negative outcomes in elderly patients undergoing major surgery has been published, suggesting possible modifications in decision-making algorithms for future clinical practice guidelines in surgery. The objective of this review is to analyze updated evidence on which risk factors would have the greatest impact on negative outcomes and mortality in elderly patients undergoing major surgery. A literature search was conducted using the search terms "Major Surgery" and "Elderly," in addition to synonyms, in the PubMed, ScienceDirect, Web of Science and MEDLINE databases. In general surgery and subspecialties, it is very complex to determine precise risk factors that can be extrapolated to all surgical scenarios due to the complexity and specificity of certain organs and procedures. Evidence has found that frail adults undergoing surgery for colorectal cancer, liver metastasis, lung cancer, pancreatic disease and esophageal cancer have the longest hospital stays, and overall mortality is higher in those undergoing oncologic surgery. However, both physical and mental integrity are associated with worse outcomes, and surgical prehabilitation could positively impact this situation by improving functional reserve and post-surgical recovery time.

The influence of 3D renal reconstruction on surgical planning for complex renal tumors: An interactive case-based survey

ABSTRACT Objectives To evaluate the role of three-dimensional (3D) reconstruction in preoperative planning for complex renal tumors. Materials and Methods A well-planned questionnaire was distributed among the attending urologists at an international meeting. The questionnaire inquired about demographic data, surgical experience, partial nephrectomy (PN) versus radical nephrectomy (RN), surgical approach, time of ischemia, probability of postoperative urine leakage and positive surgical margins after viewing computed tomography (CT) scans and their respective 3D models of six complex renal tumors. Following the CT scans, attendees were asked to view randomly selected reconstructions of the cases. Results One hundred expert urologists participated in the study; 61% were aged between 40 and 60 years. Most of them (74%) were consultants. The overall likelihood of PN after viewing the 3D reconstructions significantly increased (7.1±2.7 vs. 8.0±2.2, p<0.001), the probability of conversion to RN significantly decreased (4.3±2.8 vs. 3.2±2.5, p<0.001), and the likelihood of urine leakage and positive surgical margins significantly decreased (p<0.001). Preference for the open approach significantly decreased (21.2% vs. 12.1%, p<0.001), while selective clamping techniques significantly increased (p<0.001). After viewing the 3D models, low expected warm ischemia time and estimated blood loss were significantly preferred by the respondents (p<0.001). Surgical decision change was significantly associated with performance or participation in more than 20 PNs or RNs annually [3.25 (1.98-5.22) and 2.87 (1.43-3.87), respectively]. Conclusions 3D reconstruction models play a significant role in modifying surgeons' strategy and surgical planning for patients with renal tumors, especially for patients with stronger indications for a minimally invasive and/or nephron-sparing approach.

Outcomes of the Carlson Approach in the Treatment of Posterior Tibial Plateau Fractures / Resultados da abordagem de Carlson para o tratamento de fraturas no platô tibial posterior

Abstract Objectives To describe a series of cases of tibial fractures surgically treated using the posterior approach as described by Carlson, focusing on evaluating its functional results and complication rate. Methods Eleven patients with tibial plateau fractures, who underwent surgical treatment using the Carlson approach from July to December 2019, were followed-up. The minimum follow-up period was defined as 6 months. The American Knee Society Score (AKSS), American Knee Society Score/Function (AKSS/Function) and the Lysholm score were used to check treatment results at 6 months after the fracture. The patients underwent standard anteroposterior and lateral radiographs to assess fracture healing, and clinical healing was determined by the absence of pain during full weight-bearing. Results The mean follow-up period was 12 months (9-16 months). The primary mechanism of trauma was motorcycle accident, and the most prevalent side of fracture was the right side. Eight participants were male. The mean age of the patients was 28 years. All fractures healed, and none of the patients presented complications. The AKSS was excellent in 11 patients, with a mean AKSS/Function of 99.1±3, and Lysholm scores with a median of 95.0±5.6. Conclusions The Carlson approach for posterior fractures of the tibial plateau can be considered safe, presenting a low complication rate and satisfactory functional results.

Resumo Objetivos O objetivo deste trabalho é descrever uma série de casos de fraturas de tíbia submetidas ao tratamento cirúrgico pela via posterior de Carlson para avaliação de resultados funcionais e frequência de complicações. Métodos Onze pacientes com fraturas do platô tibial foram submetidos a tratamento cirúrgico pela via de Carlson de julho a dezembro de 2019 e acompanhados por um período mínimo de 6 meses. As pontuações American Knee Society Score (AKSS), American Knee Society Score/Function (AKSS/Função) e de Lysholm verificaram os resultados do tratamento 6 meses após a fratura. Os pacientes foram submetidos a radiografias comuns em incidência anteroposterior e de perfil para avaliação da consolidação da fratura e a cicatrização clínica foi determinada pela ausência de dor à descarga total de peso. Resultados O período médio de acompanhamento foi de 12 meses (9 a 16 meses). O principal mecanismo de trauma foi acidente motociclístico e a fratura foi mais prevalente no lado direito. Oito pacientes eram do sexo masculino. A média de idade dos pacientes foi de 28 anos. Todas as fraturas cicatrizaram e nenhum paciente apresentou complicações. A AKSS foi excelente em 11 pacientes, com AKSS/Função média de 99,1 ±3, e a mediana das pontuações de Lysholm foi de 95,0 ±5,6. Conclusões Nas fraturas posteriores do platô tibial, a abordagem de Carlson pode ser considerada segura, apresentando baixo índice de complicações e resultados funcionais satisfatórios.

Nursing Care Related with Surgical Position / Cuidados de enfermería relacionados con la posición quirúrgica / Cuidados de enfermagem relacionados à posição cirúrgica

The patient's correct position is necessary to conduct a safe and effective surgical procedure. This position depends on the access route, duration of the procedure, kind of anesthesia, devices to use, among other factors. This procedure requires planning and effort by the surgical team where they share responsibility to establish and maintain the correct positions for patients. Each surgical position fulfills an objective and implies risks to patients, which is why nursing professionals must be very attentive to provide the necessary care and ensure reliable practices in each position during the perioperative, the importance of the documentation, and the NANDA, NIC, and NOC taxonomy to consider.

La correcta posición del paciente es necesaria para el desarrollo de un procedimiento quirúrgico seguro y eficaz. Esta posición depende de la vía de acceso, la duración del procedimiento, el tipo de anestesia, los dispositivos a utilizar entre otros factores. Este procedimiento requiere planeación y esfuerzo del equipo quirúrgico donde se comparten responsabilidad para establecer y mantener las posiciones correctas para los pacientes. Cada posición quirúrgica cumple un objetivo e implica un riesgo para el paciente, por lo que los profesionales de enfermería deben estar muy atentos para brindar los cuidados necesarios y asegurar prácticas confiables en cada posición durante el perioperatorio, la importancia de la documentación y la taxonomía NANDA, NIC y NOC a tener en cuenta.

A posição correta do paciente é necessária para o desenvolvimento de um procedimento cirúrgico seguro e eficaz. Essa posição depende da via de acesso, da duração do procedimento, do tipo de anestesia, dos aparelhos a serem utilizados, entre outros fatores. Este procedimento requer planejamento e esforço da equipe cirúrgica onde a responsabilidade é compartilhada para estabelecer e manter as posições corretas dos pacientes. Cada posição cirúrgica cumpre um objetivo e implica um risco para o paciente, por isso os profissionais de enfermagem devem estar muito atentos para prestar os cuidados necessários e garantir práticas confiáveis em cada posição durante o período perioperatório, a importância da documentação e taxonomia NANDA, NIC e NOC para levar em conta.

Application of body temperature rinse in percutaneous transforaminal endoscopic lumbar discectomy through intervertebral approach / 中国骨伤

OBJECTIVE@#To investigate the effects of two types of temperature rinses on body temperature, inflammatory cytokine levels, and bleeding volume in percutaneous endoscopic lumbar discectomy.@*METHODS@#Eighty patients underwent percutaneous endoscopic lumbar discectomy from January 2018 to December 2020 were selected and divided into experimental group (40 cases) and control group(40 cases). In experimental group, there were 19 males and 21 females, aged (38.8±9.8) years old;7patients on L4,5 and 33 patients on L5S1;Body msss index(BMI) was (27.8±7.2) kg·m-2. In contral group, there were 18 males and 22 females, aged (41.5±10.9) years old, 5 patients on L4,5 and 35 patients on L5S1;BMI was (26.4±6.2) kg·m-2. The patients in the control group were received normal saline rinse at room temperature, and the patients in the experimental group were received normal saline rinse heated to 37 ℃. Body temperature, chills, nausea, vomiting, and other adverse reactions were recorded. The levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and interleukin-10 (IL-10) in two groups were recorded before and 2 hours after operation. Visual analogue scale (VAS) was used to evaluate the degree of lumbar pain in two groups before and 2 hours after surgery. Fibrinolytic-coagulation indexes with preoperative and 2 hours after surgery, including the D-dimer (DD), fibrinogen degradation products (FDP), activated partial thrombin time (APTT) and prothrombin time (PT) were recorder. Operation time and blood loss in two groups were recorded.@*RESULTS@#The body temperature of both groups showed a downward trend, while the body temperature of the control group was lower than that of the experimental group. The levels of TNF-α, IL-6 and IL-10 in two groups were increased 2 hours after surgery compared with those before surgery(P<0.05), while the levels in experimental group were lower than those in control group(P<0.05). Postoperative VAS in experimental group 2.19±1.13 was significantly lower than that in the control group 3.38±1.35(P<0.05). The levels of DD and FDP at 2 hours after surgery in both groups were higher than those before surgery (P<0.05), while the levels of DD and FDP in the experimental group were higher than those in the control group (P<0.05). There was no significant difference in APTT and PT levels between two groups after operation (P>0.05). The blood loss in the experimental group of (45.2±14.1) ml was lower than that in the control group of (59.52±15.6) ml. The operation time of experimental group (46.7±13.8) min was less than that of control group (58.3±15.2) min(P<0.05).@*CONCLUSION@#Body temperature rinse can reduce the incidence of adverse reactions, alleviate local inflammatory reactions, reduce intraoperative blood loss and shorten the operation time.

New progress in the diagnosis and treatment of biliary tract tumors / 国际外科学杂志

Biliary tract cancers (BTC) is a type of digestive tract malignant tumors that originate from biliary epithelial cells, is characterized by strong occult and highly invasive, and has a high mortality rate. Early detection and diagnosis are considered to be the key to obtaining radical surgical treatment. R0 resection is an effective measure to benefit patients with BTC. However, most of the patients present with local progression or associated distant metastasis, making it impossible to undergo radical surgical treatment. With existing diagnosis and treatment methods, the 5-year survival rate of patients is still very low. Therefore, how to improve the level of diagnosis and treatment of BTC, prolong survival, and improve the quality of life has become an urgent problem to be solved. In view of the characteristics of BTC and the continuous deepening of clinical pathological molecular research, adjuvant therapy, precisely targeted therapy, immunotherapy, and comprehensive treatment are currently considered to be standardized diagnosis and treatment models and research directions beyond surgery. Therefore, this article systematically analyzes the current research progress of BTC both domestically and internationally, aiming to provide strategies for the diagnosis and treatment of patients with BTC.

Clinical effect analysis of en-bloc low-power holmium laser enucleation of prostate in the treatment of benign prostatic hyperplasia / 国际外科学杂志

Objective:To investigate the efficacy and safety of en-bloc low-power (22.5 W) holmium laser for enucleation of prostate (LP-HoLEP) in the treatment of benign prostatic hyperplasia (BPH).Methods:The clinical data of 98 patients with BPH who underwent surgical treatment in the Department of Urology, Beijing Friendship Hospital, Capital Medical University from January 2020 to October 2022 were retrospectively analyzed. They were divided into LP-HoLEP group ( n=53) and TURP group ( n=45) according to different treatment methods. Patients in the LP-HoLEP group were treated with en-bloc holmium laser enucleation of prostate, and patients in the TURP group were treated with transurethral resection of prostate (TURP). Perioperative indexes of the two groups were compared, including operation time, postoperative hemoglobin changes, tissue resection amount, postoperative catheter indentation time, postoperative hospital stay, complications, and international prostate symptom score (IPSS), quality of life (Qol) score, maximum urine flow rate (Qmax), postvoid residual volume (PVR) and other indicators were obtained at 3 and 6 months after surgery. The measurement data were tested by Shapiro-Wilk normality test. The measurement data conforming to normal distribution were expressed as mean ± standard deviation ( ± s), independent sample t-test was used for comparison between groups, measurement data of skewness distribution were expressed as median (interquartile distance)[ M( Q1, Q3)], and Mann-Whitney U test was used for comparison between groups. The Chi-square test was used to compare the count data between groups. Results:In the LP-HoLEP group, the operative time was (65.74±22.82) min, the hemoglobin decreased 5.71(3.97, 9.01) g/L, the tissue resection volume was (60.59±24.40) g, and the catheter indinduration time was (3.03±0.91) d. The length of postoperative hospitalization was (4.14±1.05) d. TURP group was (77.04±27.33) min, 11.02(8.89, 16.51) g/L, (39.49±11.32) g, (4.80±0.91) d, (5.98±1.03) d, respectively. All the indexes of LP-HoLEP group were better than TURP group. The differences were statistically significant ( P<0.05). Compared with preoperative, IPSS, Qol score, Qmax and PVR of two groups were significantly improved at 3 months after surgery, but there were no statistical significance between groups ( P>0.05). Conclusion:En-bloc LP-HoLEP is safe and reliable in the treatment of BPH, and has advantages over TURP in terms of tissue resection volume, shortening hospitalization and indwelling catheter time, and reducing intraoperative bleeding.

Propensity score matching study of outcomes of elderly patients over 80 years of age with preoperative combined type 2 diabetes mellitus following laparoscopic colorectal cancer resection / 国际外科学杂志

Objective:To investigate the outcome after laparoscopic radical surgery for colorectal cancer in patients over 80 years of age with preoperative combined type 2 diabetes (T2DM).Methods:Clinical data of 919 patients who underwent colorectal cancer laparoscopic resection surgery in Shaanxi Provincial People′s Hospital from January 2015 to January 2019 were retrospectively analyzed. The propensity score matching (PSM) method was used for 1∶1 matching of gender, ASA score, preoperative serum albumin level, body mass index(BMI), preoperative haemoglobin level, clinical tumour pathology TNM staging, tumour location, other medical comorbidities and history of abdominal surgery and finally group of 104 elderly diabetic patients aged ≥80 years with combined T2DM were successfully matched with another 104 non-elderly non-diabetic patients <80 years without combined diabetes group. (1) To compare the differences in operating time, intraoperative bleeding, number of intraoperative blood transfusions, number of lymph nodes dissected, number of ICU treatments, postoperative time to exhaustion and postoperative hospital stay, and postoperative adjuvant chemotherapy between the two groups after matching. (2)To observe the difference in major postoperative complications between the two groups. (3) Patients in both groups were observed for three years post-operative survival rate during the follow-up period. SPSS 25.0 statistical software was used for data analysis. The survival analysis was carried aut by the Kaplan-Meier curve method in parallel and the Log-Rank test.Results:Both groups were balanced in terms of baseline variable after PSM ( P>0.05). There was no difference between the two groups in terms of operative time, intraoperative bleeding, number of intraoperative blood transfusions, number of lymph nodes dissected, or time to postoperative evacuation ( P>0.05). There was a statistically significant difference between two groups in the number of people admitted to the ICU for treatment ( χ2=4.04, P=0.042), and ≥80 years diabetic group was higher. The difference in the incidence of postoperative complications between the two groups was not statistically significant [34.6% (36/104) vs 25.0% (26/104), χ2=2.30, P=0.130]; according to the Clavien-Dindo classification of postoperative complications, the incidence of Clavien-Dindo grade Ⅲ complications in the group ≥80 years with diabetes mellitus were was higher than that in the group <80 years without diabetes [12.5% (13/104) vs 4.8% (5/104), χ2=3.89, P=0.049]. For local surgical complications, the incidence of postoperative anastomotic leak was significantly higher in the ≥80 years diabetic group than in the <80 years non-diabetic group ( χ2=4.70, P=0.030), and the incidence of postoperative wound infection was no statistical significance in the two group. For non-surgical local complications, there was a statistically significant difference in pulmonary infection in the ≥80 years diabetic group compared to the <80 non-diabetic group ( χ2=4.68, P=0.031) and in acute coronary syndrome ( χ2=4.02, P=0.045). Compared with the <80 years non-diabetic group, patients in the ≥80 years diabetic group had significantly longer postoperative hospital stay [(13.3±4.4)d vs (9.2±3.2) d, t=3.41, P=0.019]. The difference in adjuvant chemotherapy after surgery between the two groups was not statistically significant (67.3% vs 76.0%, χ2=1.92, P=0.166). The survival rate at 3 years after surgery was not statistically significant in both groups [68.9% vs 74.2%, χ2=4.34, P=0.085]. Conclusions:The short-term and long-term outcomes of colorectal cancer in advanced age with type 2 diabetes are satisfactory. Adequate preoperative assessment of the patient's physical condition should be carried out, close intraoperative control of blood glucose, and close postoperative monitoring and regulation of blood glucose should be performed, except for patients with severe comorbidities and coexisting diseases that cannot tolerate surgery and advanced tumours that have lost their surgical significance.

Application of laparoscopic surgery for gastric stromal tumor in unfavorable sites / 国际外科学杂志

Gastrointestinal stromal tumor (GIST) is a kind of mesenchymal tumor, most commonly found in the stomach, with unique immunophenotype and molecular genetic characteristics. Gastric GIST mostly originates from the musculi propria of the stomach wall. It often grows expansively with clear boundaries and is relatively easy to separate. Surgery is still the preferred treatment for gastric GIST. With the rapid development of laparoscopic technique, laparoscopic surgical treatment for gastric GIST has been gradually recognized. However, it still remains unclear whether laparoscopic surgery can be applied in gastric gastrointestinal stromal tumors located in unfavorable sites. Here, this paper will combine author center′s exploration and clinical application on laparoscopic surgery for gastric GIST located in unfavorable sites and make a brief summary in order to choose a better way for treatment of gastric GIST located in unfavorable sites.

Clinical efficacy of ultrasound-guided vacuum-assisted excision in the treatment of breast benign phyllode tumor and the risk factors of local recurrence after operation / 国际外科学杂志

Objective:To investigate the clinical efficacy of ultrasound-guided vacuum-assisted excision (VAE) in the treatment of breast benign phyllode tumor and the risk factors of local recurrence after operation.Methods:A total of 256 cases of patients with breast benign phyllode tumor admitted to Yuncheng Central Hospital from January 2012 to January 2020 were included in the retrospective study, they were all female, of which 160 cases received ultrasound-guided VAE surgical treatment and 96 cases received open surgical treatment. Measurement data were expressed as mean ± standard deviation ( ± s), and t-test was used for comparison between groups. The Chi-square test or Fisher exact probability method was used to compare the data groups. Univariate analysis was performed on the factors related to the local recurrence of benign phyllode tumor after surgery, and then the factors with statistically significant differences in the univariate analysis were further incorporated into multivariate Logistic regression analysis. Results:Univariate analysis results showed that the maximum diameter of tumor ≥25 mm and the history of ipsilateral breast fibroadenoma were associated with postoperative local recurrence of breast benign phyllodes tumor ( P<0.05). Multivariate Logistic regression analysis results showed that tumor diameter ≥25 mm was an independent risk factor for postoperative local recurrence of breast benign phyllodes tumor ( P<0.05). Conclusion:Ultrasound-guided VAE in the treatment of breast benign phyllodes tumor patients with maximum diameter less than 25 mm can reduce the postoperative local recurrence rate, and patients with tumor maximum diameter greater than 25 mm should have the higher local recurrence risk.

Rediscussion of the reoperation of differentiated thyroid cancer / 国际外科学杂志

The treatment concept and standardization of primary surgery for patients with differentiated thyroid cancer vary among different regions and different treatment centers in the same region, resulting in different reoperation rates for patients. Intraoperative experience, preoperative evaluation, surgical approach, and procedure may all influence the success rate of reoperation. In order to reduce the risk of surgery and complications, reoperation should be treated standardized, while combining the current diagnosis and treatment techniques to provide individualized treatment options for reoperation patients, under the premise of ensuring efficacy, to broaden the indications of surgery, make large incisions into small incisions, and change traditional open surgery into minimally invasive surgery, improve the quality of life of patients and confidence in coping with social stress. This paper will summarize the main content of preoperative assessment at the time of reoperation in patients with differentiated thyroid cancer, analyze the notes and rationally developing a surgical plan for patients, in the hope of attracting the same emphasis and normalizing the reoperation treatment, so as to achieve reoperation of the tumor R0 resection.

Advances in the application of three-dimensional visualization technique in hepatic alveolar echinococcosis / 临床肝胆病杂志

Hepatic alveolar echinococcosis (HAE) is a parasitic disease caused by Echinococcus multilocularis infection and has wide distribution and great harm in China. At present, ultrasound, CT, and MRI are the main radiological examination methods for HAE, with certain limitations in preoperative diagnosis and evaluation. This article introduces the guiding effect of three-dimensional visualization technique and its derivative technologies in the accurate diagnosis and preoperative evaluation of HAE, so as to provide help for the clinical diagnosis and treatment of HAE in the future.

Da-vinci robot-assisted surgery vs laparoscopic repair for the treatment of hiatal hernia repair / 中华普通外科杂志

Objective:To compare Da-vinci robotic surgical system with laparoscopic surgery for the repair of hiatal hernia.Methods:The clinical data of 115 patients undergoing minimally invasive Nissen fundoplication at the Department of Hernia and Abdominal Wall Surgery, the Affiliated Hospital,Xuzhou Medical University from Dec 2019 to May 2022 were retrospectively studied. After propensity score matching (PSM), 46 cases in each group were included:Robot-assisted surgery (RS group) and laparoscopic surgery (LS group). Postoperative complications were collected and GERD Questionnaire (GERDQ) were used as the standard in evaluation of the results.Results:Patients in RS group had less intraoperative bleeding ( P<0.001), shorter postoperative gastrointestinal recovery time ( P<0.001), and shorter postoperative hospital stay ( P=0.002). The LS group had a shorter operative time ( P<0.001) and lower total hospital cost ( P<0.001). GERD-Q scores decreased significantly in both groups at 3 and 6 months postoperatively compared with preoperative scores ( P<0.001). There was no statistically significant difference between the two groups in the incidence of postoperative complications ( P>0.05). No recurrence was seen in both groups during postoperative follow-up. Conclusion:Da-vinci robot-assisted repair of hiatal hernia is as safe and feasible as laparoscopic procedures, with less intraoperative trauma and quicker, earlier recovery.

A preliminary experience of retroperitoneal approach by partial resection of the tenth rib for repairing Crawford type Ⅳ thoracoabdominal aortic aneurysm and complex abdominal aortic aneurysm / 中华普通外科杂志

Objective:To evaluate a surgical approach for partial resection of the tenth rib through a retroperitoneal approach for the exposure of Crawford type IV thoracoabdominal aortic aneurysm and complex abdominal aortic aneurysm from 2014 to 2019.Methods:A retrospective analysis was conducted on clinical data and follow-up results of 7 patients who underwent treatment for Crawford type IV thoracoabdominal aortic aneurysm and complex abdominal aortic aneurysm through partial resection of the tenth rib via a retroperitoneal approach.Results:One case (14.3%) had associated Marfan syndrome, and 5 cases (71.4%) underwent left renal artery reconstruction. None of the patients experienced severe complications such as cardiopulmonary complications or renal failure postoperatively, and there was no statistically significant difference in serum creatinine levels between preoperative and postoperative stages during hospitalization ( P=0.205). Follow-up examinations showed no long-term vascular stenosis. Conclusions:Partial resection of the tenth rib through a retroperitoneal approach can avoid incisions of the pleura and diaphragm. It allows for the exposure of the aorta below the diaphragm and has the ability to treat aortic diseases below the diaphragm with smaller incisions and lower complication risks.