Clinical safety and efficacy of microwave ablation for small renal masses

ABSTRACT Purpose: CT-guided MWA is a safe and effective tool that should be utilized in the treatment of small renal masses (SRMs). We aim to clarify the utility of CT-guided MWA by examining patient outcomes such as recurrence, treatment success, changes in renal function, and complications. Methods: A retrospective review of consecutive patients with SRMs who underwent same day renal mass biopsy (RMB) and CT-guided MWA between 2015 and 2022 was performed. Treatment safety was assessed by 30-day complications according to the Clavien-Dindo system and change in eGFR >30 days post-procedure. Treatment efficacy was defined by local recurrence and incomplete treatment rates and calculated using the Kaplan-Meier method. Results: A total of 108 renal masses were found in 104 patients. The overall complication rate was 7.4% (8/108), of which 4 were major complications (3.7%). For those with renal function available >30 days post ablation, the median eGFR was 47.2 (IQR: 36.0, 57), compared to 52.3 (IQR: 43.7, 61.5) pre-ablation, p<0.0001. 5-year local recurrence free survival was 86%. Among those with biopsy proven malignancy (n= 66), there were five local recurrences (7.54%) occurring at a median of 25.1 months (IQR 19.9, 36.2) and one case (1.5%) of incomplete treatment. Conclusions: As the medical field continues to evolve towards less invasive interventions, MWA offers a valuable tool in the management of renal masses. With low major complication and recurrence rates, our findings support the utility of CT-guided MWA as a tool for treatment of SRMs.

Duodenopancreatectomía cefálica con resección vascular laparoscópica / Laparoscopic cephalic pancreaticoduodenectomy with laparoscopic vascular resection

RESUMEN Antecedentes: la duodenopancreatectomía cefálica (DPC) con resección vascular venosa está indicada para el tratamiento del adenocarcinoma ductal y de tumores neuroendocrinos de páncreas, tanto por laparoscopia como por laparotomía. Objetivo: describir los resultados de una serie de pacientes operados de DPC con resección vascular venosa y comparar la morbimortalidad entre los abordados por laparoscopia y por laparotomía. Material y métodos: se realizó un estudio observacional, comparativo, retrospectivo de pacientes con DPC con resección vascular entre enero de 2022 y agosto de 2023. El abordaje laparoscópico fue determinado en menores de 80 años, invasión venosa tumoral igual a 180° o menor en la tomografía, buen performance status, y no haber realizado tratamiento neoadyuvante. Resultados: fueron realizadas 23 DPC con resección vascular venosa: 11 por laparoscopia y 12 por laparotomía. Las 11 realizadas por laparoscopia fueron resecciones laterales, y, en los 12 abordados por laparotomía, se realizó resección total de vena porta en 5 y en el resto, resección lateral. El tiempo de "clampeo" (pinzamiento) portal y la necesidad de transfusiones fue similar en ambos grupos. El estudio patológico reveló R0 en el 78,2% de los pacientes e invasión venosa en el 40.9%. La morbilidad con laparoscopia y con laparotomía consistió, respectivamente, en: fístula pancreática en 7 (4 y 3), vaciamiento gástrico retardado en 4 (1 y 4), fístula biliar en uno (1 y 0), neumonía en dos (1 y 1) e infección de herida en uno (0 y 1). La mortalidad fue de 8,6% por el fallecimiento de dos pacientes, uno en cada grupo. Conclusión: de acuerdo con los criterios empleados, la morbimortalidad de la DPC con resección vascular fue similar por laparoscopia y por laparotomía.

ABSTRACT Background: Cephalic pancreaticoduodenectomy (CPD) with venous resection is indicated for the treatment of ductal adenocarcinoma and neuroendocrine tumors of the pancreas, either through laparoscopy or laparotomy. Objective: The aim of this study was to describe the results of a series of patients undergoing CPD with venous vascular resection and compare morbidity and mortality between the laparoscopic approach and open surgery. Material and methods: We conducted a retrospective, comparative and observational study of patients who underwent CPD with venous vascular resection between January 2022 and July 2023. Criteria for laparoscopic surgery were age < 80 years, interface between tumor and vein of 180° of the circumference of the vessel wall or less on computed tomography, good performance status, and no previous neoadjuvant treatment. Results: A total of 23 CPD procedures with venous vascular resection were performed: 11 by laparoscopy and 12 by laparotomy. The 11 laparoscopic procedures were lateral resections, and in the 12 patients approached by laparotomy, 5 were total portal vein resections and 7 were lateral resections. Portal vein clamping time and need for transfusion was similar in both groups. The pathological examination reported R0 resections in 78.2% and venous invasion in 40.9%. The complications associated with laparoscopy and laparotomy were pancreatic fistula in 4 and 3 patients, respectively, delayed gastric emptying in 1 and 4 patients, respectively, biliary fistula in 1 and 0 patients, respectively, aspiration pneumonia i 1 and 1 patients, respectively and surgical site infection in 0 and 1 patients, respectively. Mortality was 8.6% (n =2), one in each group. Conclusion: According to the criteria used, the morbidity and mortality of CPD with vascular resection were similar for laparoscopy and laparotomy.

Resección hepática en enfermedad de Caroli unilobar / Liver resection in monolobar Caroli's disease

RESUMEN La enfermedad de Caroli es un trastorno congénito causado por malformación de la placa ductal. Se manifiesta con litiasis intrahepática y colangitis recurrente, habitualmente en personas jóvenes. Los hallazgos imagenológicos incluyen dilatación multifocal y segmentaria de los conductos biliares intrahepáticos. El colangiocarcinoma puede aparecer como complicación a largo plazo debido a la inflamación crónica de los conductos, por lo que debe estar siempre presente dentro de los posibles diagnósticos diferenciales. Se describe el caso infrecuente de una mujer de 52 años que presentó un cuadro de obstrucción biliar poscolecistectomía laparoscópica y requirió en su tratamiento quirúrgico la resección de los segmentos hepáticos II y III por enfermedad de Caroli, con buena evolución.

ABSTRACT Caroli's disease is a congenital disorder caused by a defect of the ductal plate. The clinical picture includes intrahepatic duct lithiasis and recurrent cholangitis usually in young people. The imaging tests reveal the presence of multifocal and segmental dilatation of the intrahepatic bile ducts. Cholangiocarcinoma can develop as a long-term complication of chronic bile duct inflammation and should always be considered as a differential diagnosis. We describe a rare case of a 52-year-old woman who presented with bile duct obstruction after laparoscopic cholecystectomy and required resection of liver segments II and III due to Caroli's disease with a favorable outcome.

Resección de metástasis pancreáticas: análisis de resultados quirúrgicos y oncológicos. Estudio de cohorte retrospectiva / Pancreatic resections for metastases in the pancreas: analysis of surgical and oncologic outcomes. A retrospective cohort study

RESUMEN Antecedentes: las metástasis pancreáticas, si bien son poco frecuentes, representan una entidad clínica cuyo diagnóstico probablemente se incrementará en el futuro por el aumento de los programas de seguimiento oncológico. Objetivo: describir los resultados quirúrgicos y oncológicos de una serie de pacientes operados por metástasis pancreáticas. Materiales y métodos: se realizó un estudio de cohorte retrospectivo, descriptivo, multicéntrico, de los pacientes sometidos a resecciones pancreáticas por metástasis entre enero de 2016 y diciembre de 2022, en tres efectores de salud por el mismo grupo quirúrgico. Resultados: fueron operados 19 pacientes, con una media de edad de 59 años (45-79), 11 de sexo femenino, en buen estado general y sin otra evidencia de enfermedad oncológica. El origen de los tumores primarios fue 14 en riñón (7 diagnosticados durante el seguimiento), uno carcinoma mamario, uno melanoma, uno testicular, uno colorrectal y uno de cuello de útero. Las técnicas quirúrgicas empleada fueron: 7 esplenopancreatectomías (5 videolaparoscópicas y 2 convencionales), 4 enucleaciones (3 convencionales y 1 videolaparoscópica), 3 duodenopancreatectomías cefálicas convencionales, 2 duodenopancreatectomías totales convencionales, 2 pancreatectomías centrales convencionales, y una pancreatectomía corporocaudal con preservación del bazo. No se registró mortalidad operatoria (dentro de los 90 días posoperatorios), y presentaron una supervivencia global y libre de enfermedad de 58 y 53 meses, respectivamente. Conclusión: la resección de metástasis pancreáticas, en casos seleccionados, con un abordaje multidisciplinario, y en centros de alto volumen de patología hepatobiliopancreática, es segura y permite buenos resultados oncológicos y de supervivencia global.

ABSTRACT Background: Pancreatic metastases are rare but are likely to be diagnosed more frequently in the future due to the increase in oncology surveillance programs. Objective: The aim of this study was to describe the surgical and oncologic outcomes of a series of patients undergoing surgery for pancreatic metastases. Materials and methods: We conducted a retrospective, descriptive, and multicenter cohort study on patients who underwent pancreatic resections for metastases in the pancreas by the same surgical group between January 2016 and December 2022 in three healthcare providers. Results: A total of 19 patients were operated on, mean age was 59 years (45-79), and 11 were women with good performance status and no other evidence of oncologic disease. Clear cell renal cell carcinoma was the primary tumor in 14 cases (7 diagnosed during surveillance), and the remaining primary tumors were one case of breast ductal carcinoma, one testicular cancer, one colorectal cancer, one melanoma and one cervical cancer. The surgical techniques used were pancreatectomies and splenectomies in 7 patients (5 via laparoscopy and 2 conventional procedures), 4 enucleations (3 conventional procedures and 1 laparoscopic surgery), 3 conventional cephalic pancreaticoduodenectomies, 2 conventional central pancreatectomies and one spleen-preserving distal pancreatectomy. No deaths were reported within 90 days of surgery, and overall survival and disease-free survival were 58 and 53 months, respectively. Conclusion: Resection of pancreatic metastases is safe and provides good oncologic outcomes and overall survival when performed with a multidisciplinary approach in centers with a high volume of hepatobiliary and pancreatic surgeries and in selected cases.

1470nm laser transurethral modified bladder neck incision for the treatment of female bladder neck obstruction / 中国现代医生

Objective To investigate the treatment of female bladder neck obstruction by 1470nm laser transurethral modified enlarged female bladder neck obstruction(FBNO).Methods The clinical data of 34 patients with FBNO from January 2019 to November 2021 were retrospectively analyzed.The patient underwent a 1470nm laser transurethral modified enlarged bladder neck incision.The 1470nm laser was used to vaporise the bladder neck at 12 o'clock(lithotomy),and the incision site was expanded along the bladder neck to 9 o'clock and 3 o'clock to form a semi-circular surgical wound.The patients were followed up for complications,scored form of Bristol female lower urinary tract symptoms questionnaire(BFLUTS-SF)urination symptom subscale,quality of life(QoL)score and the maximum urinary flow rate(Qmax),detrusor pressure at maximum flow rate(PdetQmax),post-void residual(PVR)were reviewed at 1,4,and 10 months after operation.Results After 10 months of follow-up,the subjective indexes of BFLUTS-SF and QoL scores were significantly improved compared with those before operation(P<0.001),and the objective indexes of Qmax,PdetQmax,and PVR were significantly improved compared with those before operation(P<0.001).Two patients had mild urgency urinary incontinence and urinary tract infection symptoms half a month after operation,and the symptoms were improved after anti-infection and pelvic floor rehabilitation treatment.During the follow-up period,there were no complications such as vesicovaginal fistula,stress urinary incontinence,or recurrent bladder neck obstruction.Conclusion 1470nm laser transurethral modified enlarged bladder neck resection can effectively relieve bladder neck obstruction without significant postoperative complications,with high safety and good patient satisfaction.

Comparison of anesthetic effects between ESPB and ICNB in thoracoscopic lung wedge resection guided by surgical pleth index / 中国现代医生

Objective To compare anesthetic effects between erector spinae plane block(ESPB)and intercostal nerve block(ICNB)in thoracoscopic lung wedge resection guided by surgical pleth index(SPI).Methods A total of 46 patients who underwent thoracoscopic lung wedge resection in Wenzhou People's Hospital from July 2020 to June 2022 were selected and divided into ICNB group and ESPB group according to random number table method,with 23 cases in each group.Remifentanil infusion rate,propofol dosage and intraoperative vital signs were compared between two groups.Results The intraoperative remifentanil infusion rate in ESPB group was significantly lower than that in ICNB group(P<0.05).There was no significant difference in intraoperative propofol dosage between two groups(P>0.05).The SPI,bispectral index and mean arterial pressure in ESPB group during lung wedge resection were significantly lower than those in ICNB group(P<0.05).There was no significant difference in heart rate between two groups(P>0.05).Conclusion Under the guidance of SPI,patients undergoing thoracoscopic lung wedge resection with preoperative ESPB had low opioid consumption and stable vital signs.

Effectiveness of rhomboid intercostal and sub-serratus plane block in improving early recovery quality after thoracoscopic radical surgery for lung cancer / 中国现代医生

@#Objective Verify the improvement effect of rhomboid intercostal and sub-serratus plane block on the quality of early postoperative recovery in patients undergoing thoracoscopic radical resection of lung cancer;Comparison of the differences in the effect of regional block at different timing on improving the quality of early postoperative recovery.Methods A total of 75 patients,aged 18 to 75 years,with ASA gradeⅠ-Ⅱ,who were scheduled to undergo thoracoscopic radical resection of lung cancer from January 2022 to January 2023 were selected.Randomly divided into three groups:blank control group(Group C),preoperative block group(PR group),and postoperative block group(PO group).The PR group and the PO group received ultrasound guided rhomboid intercostal and sub-serratus plane block in the preoperative anesthesia preparation room and postoperative anesthesia recovery room,respectively,with a dosage of 0.375％ropivacaine 30ml.Evaluate the postoperative recovery quality of patients at 24 and 48 hours using the postoperative recovery quality rating scale(QoR-40)scoring scale.Record numeric rating scale(NRS)pain scores in resting and active states at 0.5h,1h,2h,4h,8h,12h,24h,and 48h after surgery.Record the consumption of opioid drugs during and after surgery,the effective number of postoperative patient-controlled intravenous analgesia(PCIA)compressions,and the incidence of nausea and vomiting.Results Compared with Group C,the consumption of opioids during surgery in the PR group was significantly reduced.The QoR-40 score at 24 hours after surgery was significantly higher in the PR and PO groups.Significant reduction in NRS scores between 1-8 hours of rest and 1-12 hours of activity after surgery,and the effective times of PCIA compressions and opioid consumption were significantly reduced(P<0.05).Compared with the PR group,the PO group consumed more opioids during surgery and had a higher NRS score at 0.5 hours after surgery(P<0.05).There was no significant difference in postoperative QoR-40 scores,PCIA effective compressions,and opioid consumption;There was no statistically significant difference in the incidence of postoperative nausea and vomiting among the three groups.Conclusion Rhomboid intercostal and sub-serratus plane block can improve the early recovery quality of patients undergoing thoracoscopic radical resection of lung cancer,reduce the postoperative pain level of patients,and reduce the amount of opioids used in perioperative period,and its effectiveness has nothing to do with the blocking time.

Effect of"corresponding compensation"massage on rehabilitation of shoulder joint function afterradical resection of breast cancer / 重庆医学

Objective To explore the effect of massage therapy guided by"corresponding compensa-tion"theory on the rehabilitation of shoulder joint function after radical resection in the patients with breast cancer.Methods Forty female patients with breast cancer after radical resection in Chongqing Municipal Hos-pital of Traditional Chinese Medicine during 2020-2022 were selected and divided into the group A and B ac-cording to the random number table method,20 cases in each group.The group A conducted the progressive functional exercise,and the group B received"corresponding compensation"massage combined with progres-sive functional exercise.Both of the two groups were treated for 20 d.Before treatment,on 20 d of treatment and after 3 months follow-up,the peak torque and total work of elbow joint flexor and extensor on the affected side were measured for evaluating the muscle force and endurance of the affected limb;the initiative joint mob-ility of anterior flexion,posterior extension,abduction and adduction of the affected shoulder joint was meas-ured to evaluate the shoulder joint mobility;the disabilities of the arm,shoulder and hand scale(DASH)was used to evaluate the degree of upper limb dysfunction;the swelling recovery of the upper limb was evaluated by measuring the difference of the circumference of the upper arm.The comparative analysis was conducted.Results On 20 d of treatment and after 3 months follow-up,the elbow flexion,extensor peak torque and total work on the affected side,and shoulder mobility in all directions on the affected side were improved in both groups,moreover these indicators in the group B were higher than those in the group A with statistically sig-nificant differences(P＜0.05);the DASH score and the circumference difference of the upper arm on the af-fected side all were decreased,moreover these indicators in the group B were lower than those in the group A with statistically significant differences(P＜0.05).Conclusion"Corresponding compensation"massage com-bined with progressive functional exercise could promote the rehabilitation of shoulder joint function after rad-ical resection in the patients with breast cancer.

Significance and techniques of pelvic floor reconstruction in laparoscopic low anterior resection for rectal cancer / 国际外科学杂志

The residual pelvic floor cavity formed by laparoscopic low anterior resection for rectal cancer can result in some complications, such as spread of pelvic infection following anastomotic leakage, adhesive intestinal obstruction, and may increase the probability of radiation intestinal injury in case of postoperative radiotherapy. Reconstructing the pelvic floor can prevent the small intestine from entering the residual cavity, reduce the risk of intestinal obstruction and radiation induced intestinal injury; prevent or reduce the occurrence and severity of anastomotic leakage. Reconstructing the pelvic floor can also improve the anal function after low anterior resection to a certain extent and enhance the quality of life of patients. Direct suturing of the pelvic floor peritoneum and pedicled greater omentum flap graft transplantation are currently two commonly used pelvic floor reconstruction methods, which are relatively simple to operate, easy to promote, and worthy of routine application.

Effect of midazolam on postoperative delirium in elderly patients with preoperative moderate-severe anxiety undergoing radical resection of colorectal cancer / 临床麻醉学杂志

Objective To investigate the effect of preoperative oral midazolam on postoperative de-lirium in elderly patients with preoperative moderate-severe anxiety undergoing radical resection of colorectal cancer.Methods Eighty elderly patients undergoing laparoscopic surgery for radical resection of colorectal cancer,32 males and 48 females,aged 65-79 years,BMI 21-27 kg/m2,ASA physical status Ⅱ or Ⅲ,the state-trait anxiety inventory(STAI-S)≥38 scores at admission were selected.Patients were divided into two groups using random number method:control group and midazolam group,40 patients in each group.The midazolam group were administrated midazolam 7.5 mg per night till one day before surgery,while the placebo was administrated in the control group.The incidence of delirium 3 days after surgery and the STAI-S scores of one day before surgery were evaluated.The HR and MAP at entry,30 minutes after an-esthesia induction,1 hour,2 hours after anesthesia induction,and 30 minutes after extubation were recor-ded.The total dose of propofol,remifentanil and dexmedetomidine and the using rate of metaraminol were recorded.The visual analog scale scores 30 minutes after extubation,24 and 72 hours after surgery,the u-sing rate of tramadol,and the extubation time were recorded.Results Compared with the control group,the STAI-S scores of one day before surgery,and the incidence of postoperative delirium,the rate of using metaraminol,the VAS scores 30 minutes after extubation and 24 hours after surgery,the rate using of tram-adol were significantly decreased in the midazolam group(P＜0.05).There were no significant differences in total dose of propofol,remifentanil,and dexmedetomidine,extubation time between the two groups.Conclusion Preoperative oral midazolam can effectively reduce the incidence of postoperative delirium in elderly patients with preoperative moderate-severe anxiety undergoing radical resection of colorectal cancer.

Risk factors of postoperative pulmonary complications in children after video-assisted thoracoscopic lung resection / 临床麻醉学杂志

Objective To investigate risk factors of postoperative pulmonary complications(PPCs)in children after video-assisted thoracoscopic lung resection.Methods Retrospective analysis of clinical data of 566 children,334 males and 232 females,aged≤6 years,ASA physical statusⅠorⅡ,enrolled for video-assisted thoracoscopic lung resection.The children were divided into two groups based on whether they developed PPCs within 7 days after surgery:the PPCs group and the non-PPCs group.Factors with P≤0.2 and perceived as potentially clinically meaningful,were included in the binary logistic regression model.The receiver operating characteristic(ROC)curve was drawn and the area under the curve(AUC)was calculated.Results A total of 123 children(21.7%)developed postoperative pulmonary compli-cations(PPCs).Multivariate logistic regression analysis showed longer duration of one-lung ventilation(OLV),faster respiratory rate during OLV and inexperienced surgeon were found to be independently risk factors of PPCs.Higher PEEP level was protective factors of PPCs(The maximum PEEP was 7 cmH2 O).The prediction model was Logit(P)=-4.41+0.006×OLV duration+0.063×OLV respiratory rate+0.569×inexperienced surgeon(yes = 1)-0.16×maximum PEEP value.The ROC curve showed a good accuracy with an area under the curve of 0.682(95%CI 0.631-0.734),and sensitivity was76.4%,and specificity was 69.6%.Conclusion Longer OLV duration,faster repiratory rate and less surgeon experience are found to be independently risk factors of PPCs.Higher PEEP level is protective factor of PPCs.

Prediction model of uroschesis rate after radical cervical cancer resection based on machine learning / 中国实用护理杂志

Objective:To construct a risk prediction model for urinary retention in patients undergoing radical cervical cancer surgery based on machine learning, and the prediction effect of the model was internally verified and evaluated, in order to provide reference for the early prevention and treatment of urinary retention in patients undergoing radical cervical cancer surgery.Methods:A total of 981 patients who underwent radical cervical cancer surgery in the First Affiliated Hospital of Anhui Medical University from June 2017 to February 2022 were selected and divided into the training set (687 cases) and the test set (294 cases) according to a ratio of 7∶3. Through literature review and risk factor analysis, the influencing factors of urinary retention after radical treatment of cervical cancer were explored, and the risk prediction model of urinary retention was constructed by using XGBoost, random forest, support vector machine and decision tree in machine learning. The accuracy rate, recall rate, F1 value and AUC of four machine learning algorithms were calculated by using the method of 10-fold cross-validation, and the model with the highest predictive efficiency was selected.Results:Among the 981 patients included, the incidence of urinary retention after radical cervical cancer surgery was 18.86% (185/981). The median age of urinary retention group was 51 years old, and that of non urinary retention group was 50 years old. Statistically significant variables in the univariate analysis and influencing factors summarized by literature review were featured, including patient age, intraoperative blood loss, body mass index (BMI), cancer stage, surgical method, surgical resection scope, whether pelvic lymph node dissection was performed, comorbidities and residual urine. Among the four model building methods of machine learning, the random forest model has the best effect, its training set F1 value was 0.94, the test set F1 value was 0.77, the ROC was plotted and the AUC was calculated to be 0.73. Age, intraoperative blood loss, BMI, cancer stage and surgical method contributed significantly to the classification of random forest model.Conclusions:The prediction model of urinary retention risk after radical cervical cancer surgery based on random forest method has the best efficacy. It is useful to help nursing personnel evaluate the risk of the uroschesis for a patient and then take targeted nursing interventions to actively prevent postoperative urinary retention.

Prediction of risks of early anastomotic recurrence following primary bowel resection in patients with Crohn's disease based on preoperative magnetic resonance enterography / 实用医学杂志

Objective To develop a nomogram for predicting the risks of early anastomotic recurrence(EAR)after primary bowel resection in patients with Crohn's disease(CD).Methods The patients with CD under-going preoperative magnetic resonance enterography(MRE)and primary bowel resection were enrolled in this retrospective study and divided into an EAR group(18 patients)and EAR-free group(12 patients).The EAR group included the patients having an endoscopic Rutgeerts score of≥I2 month or the need for anastomotic resection within 12 months after surgery.All the 38 indexes including preoperative demographic characteristics,laboratory examina-tions,multi-parameter MRE features of the resected intestine and its adjacent mesentery,histological findings,and postoperative pharmacotherapy were analyzed.Least absolute shrinkage and selection operator(LASSO)regression and multivariate binary logistic regression analysis were performed to identify independent risk factors to be incorpo-rated into the nomogram for predicting the risks of early anastomotic recurrence and the prediction performance was evaluated.Results Mesenteric creeping fat index on MRE and comb sign were independent risks of EAR,with a concordance index of 0.882(95%CI:0.764～1).The calibration plot revealed a strong relationship between actual observation and predicted probability of EAR.Conclusions The preoperative MRE-based nomogram may be a potential tool for predicting EAR following surgery in patients with CD,which is beneficial to individual management in those patients.It provides reference for the formulation of early postoperative individualized drug adjuvant therapy in patients at high risk of EAR.

3D printed guide template technique combined with multiple derotation for severe rigid scoliosis / 中国组织工程研究

BACKGROUND:In recent years,with the development of 3D printing,surgical surgery has become personalized and accurate.3D printed guide template technique can realize preoperative planning and intraoperative navigation,making surgery more accurate.In clinical orthopedic surgery for moderate and severe stiff scoliosis,there is still a problem that the accuracy of screw placement is not high,resulting in screw loosening and even nerve complications.There are few studies on 3D printed guide template technique to guide screw placement in surgery for severe stiff scoliosis. OBJECTIVE:To evaluate the clinical effect of the 3D printed guide template technique combined with multiple posterior derotation in the treatment of severe rigid scoliosis. METHODS:The clinical data of six patients with severe scoliosis undergoing 3D printed guide template technique of pedicle screw combined with multiple posterior derotation were retrospectively analyzed.There were 3 males and 3 females,with a mean age of(18.17±3.49)years(range,15-23 years).The changes of parameters related to lateral bending were analyzed at postoperative 2 weeks and 18 months,and the results were obtained by statistical analysis. RESULTS AND CONCLUSION:(1)The operation time was 280-540 minutes(mean 340.83±102.20 minutes).The intraoperative blood loss was 1 000-4 000 mL(mean 2 000.00±1 073.70 mL).The fixed segments were 9-14 vertebral bodies(mean 11.83±1.72),and no screw loosening occurred during the operation.(2)All patients were followed up.At postoperative 2 weeks,the anteroposterior and lateral radiography of the whole spine showed that the cobb angle,the distance between the vertical line of C7 on the coronal plane and the median line of S1,the distance between the vertical line of C7 in the sagittal plane and the posterior edge of S1,apical vertebral translation,thoracic kyphosis,and lumbar lordosis were significantly corrected.The average correction rate of the cobb angle in the main curve was 62.22%.After 18 months of follow-up,there was no significant change in all parameters compared with 2 weeks after operation;the orthopedic effect was satisfactory,and there was no infection or internal fixation fracture.(3)There was one case of delayed wound healing;scar healing appeared after dressing change treatment;no neurological complications occurred.(4)The results show that the 3D print-guide template combined with multiple posterior rod derotation technique is safe and effective in the treatment of severe rigid scoliosis,and the correction effect is satisfactory.

Re-understanding of surgical resection techniques for liver cancer / 中华消化外科杂志

Liver cancer is still a major disease threatening the lives and health of the Chinese people. For early liver cancer with good liver functional reserve, surgical resection remains as the preferred treatment option. In the past several decades, great advances have been made in hepatectomy because of the refinement of surgical theories, advancements in surgical techniques, and improvements in surgical equipment. However, there are still different understandings in the academic community regarding whether to choose anatomic liver resection, how to choose the surgical margin, the design of surgical methods under the liver "territory theory", and the use of indocyanine green fluorescence imaging technology in liver cancer resection. The authors comprehensively review the current researches on the above issues and the research progress in hepatectomy for liver cancer, aiming to provide references for clinicians to optimize the surgical procedure.

Analysis of influencing factors for early tumor recurrence and efficacy of adjuvant chemotherapy in gallbladder carcinoma patients after curative-intent resection: a nationwide, multicenter clinical study / 中华消化外科杂志

Objective:To investigate the influencing factors for early tumor recurrence and the efficacy of adjuvant chemotherapy in gallbladder carcinoma (GBC) patients after curative-intent resection.Methods:The retrospective case-control study was conducted. The clinicopathological data of 506 patients with GBC in 11 medical centers, including The First Affiliated Hospital of Xi'an Jiaotong University et al, from January 2016 to December 2020 were collected. There were 168 males and 338 females, aged (62±11)years. All patients underwent curative-intent resection of GBC, and they were divided into patients with and without early recurrence based on time to postoperative recurrence. Observation indicators: (1) treatment; (2) follow-up and survival of patients; (3) analysis of influencing factors for early tumor recurrence after curative-intent resection of GBC; (4) efficacy of postoperative adjuvant chemotherapy. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data was conducted using the Mann-Whitney U test. Univariate analysis was conducted using the corresponding statistical methods based on data type. Multivariate analysis was conducted using the Logistic regression model with forward method. The Kaplan-Meier method was used to draw survival curve and calculate survival rate, and Log-Rank test was used for survival analysis. Results:(1) Treatment. Of 506 patients, there were 112 cases with postoperative adjuvant chemotherapy, and 394 cases without postopera-tive adjuvant chemotherapy. They underwent 5(range, 3-9)cycles of postoperative adjuvant chemo-therapy. (2) Follow-up and survival of patients. All 506 patients underwent postoperative follow-up, with the follow-up time of 55(range, 34-93)months. During the follow-up, there were 248 patients with tumor recurrence, including 158 cases of early recurrence and 90 cases of late recurrence, and there were 258 patients without tumor recurrence. Of 506 patients, 275 cases survived, and 231 cases died of multiple organ failure caused by tumor recurrence and metastasis. The postoperative recurr-ence-free survival time, overall survival time were 52(range,1-93)months, 62(range, 2-93)months. The 1-, 3-, 5-year disease-free survival rates and 1-, 3-, 5-year overall survival rates of the 506 pati-ents were 68.8%, 53.8%, 47.9% and 78.3%, 58.7%, 51.6%, respectively. Results of survival analysis showed that the median overall survival time of 158 patients with postoperative early recurrence and 348 patients without postoperative early recurrence (including 90 cases of late recurrence and 258 cases of no tumor recurrence) were 9(range, 2-73)months and unreached, showing a significant difference between them ( χ2=456.15, P<0.05). (3) Analysis of influencing factors for early tumor recurrence after curative-intent resection of GBC. Results of multivariate analysis showed that carcinoembryonic antigen (CEA) >5.0 μg/L, poorly differentiated tumor, liver invasion, and tumor N staging as stage N1-N2 were independent risk factors influencing early tumor recurrence after cura-tive-intent resection of GBC ( odds ratio=2.74, 6.20, 1.81, 2.93, 4.82, 95% confidence interval as 1.62-4.64, 1.82-21.12, 1.15-3.08, 1.68-5.09, 1.91-12.18, P<0.05), while postoperative adjuvant chemo-therapy was an independent protect factor ( odds ratio=0.39, 95% confidence interval as 0.21-0.71, P<0.05). (4) Efficacy of postoperative adjuvant chemotherapy. The median overall survival time of 394 patients without postoperative adjuvant chemotherapy and 112 patients with postoperative adjuvant chemotherapy were 57(range, 2-93)months and unreached, showing a significant differ-ence between them ( χ2=9.38, P<0.05). Of the 158 patients with postoperative early recurrence after curative-intent resection of GBC, 135 cases didn't receive adjuvant chemotherapy and 23 cases received adjuvant chemotherapy, with the overall survival time of 8(range, 2-73)months and 17(range, 8-61)months, respectively, showing a significant difference between them ( χ2=7.68, P<0.05). Conclusions:CEA >5.0 μg/L, poorly differentiated tumor, liver invasion, and tumor N staging as stage N1-N2 are independent risk factors influencing early tumor recurrence after curative-intent resection of GBC, while postoperative adjuvant chemotherapy is an independent protect factor. Postoperative adjuvant chemotherapy can prolong the overall survival time of patients with post-operative tumor early recurrence.

Current status and prospects of postoperative adjuvant therapy for hepatocellular carcinoma / 中华消化外科杂志

The high recurrence and metastasis rate of hepatocellular carcinoma (HCC) in patients after hepatectomy significantly impact the prognosis. Exploring effective strategies and indications of postoperative adjuvant therapy for HCC is of great clinical significance in reducing postoperative recurrence rate and improving long-term survival. Traditional local treatment modalities, including transcatheter arterial chemoembolization, hepatic artery infusion chemotherapy, and radiotherapy, continue to play a crucial role in postoperative adjuvant therapy. Recently, the emergence of novel systemic therapy agents, including molecular targeted drugs and immune checkpoint inhibitors, has transformed the landscape of postoperative adjuvant therapy, making the selection of adjuvant therapy more intricate and diverse. The author combines the latest progress in adjuvant therapy to explore the strategies and challenges of postoperative adjuvant therapy for HCC.

Effect of ropivacaine combined with dexmedetomidine for ultrasound-guided erector spinae plane block in elderly thoracoscopic radical surgery for lung cancer / 新乡医学院学报

Objective To explore the efficacy of ropivacaine combined with dexmedetomidine for ultrasound-guided erector spinae plane block(ESPB)in elderly patients undergoing thoracoscopic radical surgery for lung cancer.Methods A total of 119 lung cancer patients who underwent thoracoscopic radical resection of pulmonary carcinoma at the First Affiliated Hospital of Henan Polytechnic University from October 2020 to October 2022 were selected and randomly divided into the observation group(n=59)and the control group(n=60),with 3 patients excluded from the observation group and 4 patients excluded from the control group.Finally,56 patients were included in each group.Patients in the control group received ultrasound-guided ESPB with ropivacaine,while patients in the observation group received ultrasound-guided ESPB with both ropivacaine and dexmedetomidine.The pre-anesthesia preparation,anesthesia induction,and anesthesia maintenance were the same for patients in both groups,and patients in both groups used patient-controlled intravenous analgesia to relieve pain after surgery.The heart rate(HR)and mean arterial pressure(MAP)of patients in the two groups after entry(T1),successful block(T2),skin incision(T3),and end of surgery(T4),as well as the visual analogue scale(VAS)scores at rest and activity 6,12,24,and 48 hours after surgery were recorded.The amount of analgesic medication used,the number of analgesia pump presses,and the incidence of delirium and adverse reactions were compared between the two groups 48 hours after surgery.Results The MAP and HR of patients in the two groups at T2 and T3 were significantly higher than those at T1 and T4(P＜0.05).However,there was no significant difference in MAP and HR between the two groups at T4 and T1(P＞0.05),and there was also no significant difference in MAP and HR between the two groups at T2 and T3(P＞0.05).The patients in both groups showed no significant difference in MAP and HR at T1(P＞0.05),while at T2,T3,and T4,the MAP and HR in the observation group were significantly lower than those in the control group(P＜0.05).The patients in both groups had lower VAS scores at rest and activity 12,24,and 48 hours postope-ratively compared to 6 hours postoperatively(P＜0.05).The patients in both groups had lower VAS scores at rest and activity 24 and 48 hours postoperatively compared to 12 hours postoperatively(P＜0.05).The patients in both groups had lower VAS scores in both resting and active states 48 hours after surgery compared to 24 hours after surgery(P＜0.05).There was no significant difference in VAS scores at both rest and activity 6 hours after surgery between the two groups(P＞0.05).At 12,24,and 48 hours after surgery,the patients in the observation group had lower VAS scores in both resting and active states compared to the control group(P＜0.05).Compared with the control group,the observation group used fewer analgesic drugs and pressed analgesia pumps less 48 hours after surgery(P＜0.05).The incidence of overall adverse reactions within 48 hours after surgery was 5.36％(3/56)and 8.93％(5/56),respectively;there was no significant difference in the incidence of overall adverse reactions between the two groups(x2=0.135,P＞0.05).The incidence of delirium within 48 hours after surgery in the control and observation groups was 14.29％(8/56)and 3.57％(2/56),respectively.The incidence of delirium in the observation group was significantly lower than that in the control group(x2=3.953,P＜0.05).Conclusion The use of ropivacaine combined with dexmedetomidine for ultrasound-guided ESPB in elderly patients undergoing thoracoscopic radical surgery for lung cancer can maintain perioperative hemodynamic sta-bility,improve analgesic effect,and reduce the dosage of analgesic drugs,the number of analgesia pump presses,and the inci-dence of postoperative delirium.

Treatment of thoracoscopic subsegmental resection under the guidance of 3D reconstruction of bronchial blood vessels of pulmonary for pulmonary nodule / 中国医学装备

Objective:To analyze the effect of thoracoscopic subsegmental resection under the guidance of three dimensional(3D)computed tomography bronchography and angiography(3D-CTBA)for resection of pulmonary nodules.Methods:A total of 40 patients who underwent 3D-CTBA-guided thoracoscopic subsegmental resection in Nanjing Jiangbei Hospital of Nantong University from January 2020 to October 2021 were selected as the observation group,and other 35 patients who underwent 3D-CTBA-guided thoracoscopic pulmonary segmentectomy were selected as the control group.The intraoperative and postoperative conditions,and the incidence of postoperative complications of the two groups were observed.Results:The differences of amount of intraoperative blood loss,average margin width,postoperative drainage,retention time of drainage tube between observation group and control group were significant(t=8.644,2.862,10.03,3.277,P<0.05),respectively.The numbers of occurring postoperative chest leakage,pulmonary infection and hemoptysis in observation group and control group were respectively"3,1,1"and"2,1,2".The incidences of complications of two groups were respectively 12.5%and 14.29%,without statistical significance between the two groups(P>0.05).Conclusion:3D-CTBA-guided thoracoscopic subsegmental resection can shorten the operation time,and reduce intraoperative blood loss and the injury of tracheas and blood vessels,and improve the postoperative recovery of patients.

Application of new concepts of endoscopic minimally invasive surgery in the treat-ment of gastrointestinal tumors / 中国肿瘤临床

Gastrointestinal tumors are a serious and threatening public health concern.Endoscopic minimally invasive treatment is an im-portant way to achieve early diagnosis and treatment of gastrointestinal tumors.Here,we summarize the history and current status of en-doscopic minimally invasive resection of early-stage gastrointestinal tumors,and explain the application of the new ERBEC concepts of endo-scopic minimally invasive surgery for the treatment of gastrointestinal tumors,which include elements,reservation-resection,bilateral-bene-fit,expansion,and collaboration.We also discuss the future direction of endoscopic minimally invasive resection for gastrointestinal tumors.