The presence of a positive deep surgical margin in tongue squamous cell carcinoma(TSCC)significantly elevates the risk of local recurrence.Therefore,a prompt and precise intraoperative assessment of margin status is i...The presence of a positive deep surgical margin in tongue squamous cell carcinoma(TSCC)significantly elevates the risk of local recurrence.Therefore,a prompt and precise intraoperative assessment of margin status is imperative to ensure thorough tumor resection.In this study,we integrate Raman imaging technology with an artificial intelligence(AI)generative model,proposing an innovative approach for intraoperative margin status diagnosis.This method utilizes Raman imaging to swiftly and non-invasively capture tissue Raman images,which are then transformed into hematoxylin-eosin(H&E)-stained histopathological images using an AI generative model for histopathological diagnosis.The generated H&E-stained images clearly illustrate the tissue’s pathological conditions.Independently reviewed by three pathologists,the overall diagnostic accuracy for distinguishing between tumor tissue and normal muscle tissue reaches 86.7%.Notably,it outperforms current clinical practices,especially in TSCC with positive lymph node metastasis or moderately differentiated grades.This advancement highlights the potential of AI-enhanced Raman imaging to significantly improve intraoperative assessments and surgical margin evaluations,promising a versatile diagnostic tool beyond TSCC.展开更多
Ultrasound plays an important role not only in preoperative diagnosis but also in intraoperative guidance for liver surgery.Intraoperative ultrasound(IOUS)has become an indispensable tool for modern liver surgeons,esp...Ultrasound plays an important role not only in preoperative diagnosis but also in intraoperative guidance for liver surgery.Intraoperative ultrasound(IOUS)has become an indispensable tool for modern liver surgeons,especially for minimally invasive surgeries,partially substituting for the surgeon’s hands.In fundamental mode,Doppler mode,contrast enhancement,elastography,and real-time virtual sonography,IOUS can provide additional real-time information regarding the intrahepatic anatomy,tumor site and characteristics,macrovascular invasion,resection margin,transection plane,perfusion and outflow of the remnant liver,and local ablation efficacy for both open and minimally invasive liver resections.Identification and localization of intrahepatic lesions and surrounding structures are crucial for performing liver resection,preserving the adjacent vital vascular and bile ducts,and sparing the functional liver parenchyma.Intraoperative ultrasound can provide critical information for intraoperative decision-making and navigation.Therefore,all liver surgeons must master IOUS techniques,and IOUS should be included in the training of modern liver surgeons.Further investigation of the potential benefits and advances in these techniques will increase the use of IOUS in modern liver surgeries worldwide.This study comprehensively reviews the current use of IOUS in modern liver surgeries.展开更多
Objective:The role of intraoperative radiation therapy(IORT)in the management of resectable pancreatic cancer(RPC)remains unclear.To date,the application of IORT using a low-energy X-ray source has not been extensivel...Objective:The role of intraoperative radiation therapy(IORT)in the management of resectable pancreatic cancer(RPC)remains unclear.To date,the application of IORT using a low-energy X-ray source has not been extensively investigated.Therefore,this study was conducted to evaluate the safety and efficacy of IORT using a 50 kV X-ray source in treating RPC.Methods:Patients with RPC who underwent radical pancreatectomy and IORT were enrolled.The primary endpoint was time to treatment failure(TTF)survival,whereas the secondary endpoints were safety and overall survival(OS).Results:By November 2023,35 patients with RPC were treated according to the study protocol.The median TTF was 11.67 months,whereas the median OS for the cohort was 22.2 months.The local recurrence rate was 20%.The most common postoperative complication was pancreatic fistula.The incidence of delayed gastric emptying was 20%.Within 30 days after surgery,one patient experienced abdominal pain,another experienced vomiting,and one died because of abdominal infection and a grade C pancreatic fistula.Carcinoembryonic antigen(CEA)and D-dimer levels significantly correlated with TTF and OS in multivariate analyses.The carbohydrate antigen 19-9(CA19-9)level was another prognostic factor significantly associated with OS.Patients with low D-dimer and normal CA19-9 levels showed prolonged OS with an IORT dose≤15 Gy.Conclusions:This study supports use of IORT with a 50 kV X-ray source in treating RPC.IORT using a low-energy X-ray source was well-tolerated and feasible.Additionally,D-dimer,CEA,and CA19-9 levels may help identify patient profiles potentially benefitting from IORT.展开更多
Upper gastrointestinal(UGI)endoscopy has become increasingly popular with the recent advancements in technology and the increase of minimally invasive techniques.UGI endoscopy is indicated for diagnostic,staging,and t...Upper gastrointestinal(UGI)endoscopy has become increasingly popular with the recent advancements in technology and the increase of minimally invasive techniques.UGI endoscopy is indicated for diagnostic,staging,and therapeutic purposes and significantly influences the management of patients with a spectrum of foregut diseases,including esophageal and gastric malignancies,achalasia,and gastroesophageal reflux disease.There is growing evidence that intraoperative UGI endoscopy can be a useful adjunct and a powerful tool to enhance tumor localization,offering a direct evaluation of the surgical reconstruction and identifying potential sources of postoperative complications.However,its widespread utilization has been limited by concerns over cost,accessibility,and sufficient training and expertise.The aim of the current study was to review and elaborate on the available literature while presenting our experience in an academic institution specializing in esophagogastric surgery with intraoperative UGI endoscopy.We focused on the indications,added benefits,and related complications.展开更多
BACKGROUND Sigmoid colon cancer faces challenges due to anatomical diversity,including variable inferior mesenteric artery(IMA)branching and tumor localization complexities,which increase intraoperative risks.AIM To c...BACKGROUND Sigmoid colon cancer faces challenges due to anatomical diversity,including variable inferior mesenteric artery(IMA)branching and tumor localization complexities,which increase intraoperative risks.AIM To comprehensively evaluate the impact of three-dimensional(3D)visualization technology on enhancing surgical precision and safety,as well as optimizing perioperative outcomes in laparoscopic sigmoid cancer resection.METHODS A prospective cohort of 106 patients(January 2023 to December 2024)undergoing laparoscopic sigmoid cancer resection was divided into the 3D(n=55)group and the control(n=51)group.The 3D group underwent preoperative enhanced computed tomography reconstruction(3D Slicer 5.2.2&Mimics 19.0).3D reconstruction visualization navigation intraoperatively guided the following key steps:Tumor location,Toldt’s space dissection,IMA ligation level selection,regional lymph node dissection,and marginal artery preservation.Outcomes included operative parameters,lymph node yield,and recovery metrics.RESULTS The 3D group demonstrated a significantly shorter operative time(172.91±20.69 minutes vs 190.29±32.29 minutes;P=0.002),reduced blood loss(31.5±11.8 mL vs 44.1±23.4 mL,P=0.001),earlier postoperative flatus(2.23±0.54 days vs 2.53±0.61 days;P=0.013),shorter hospital length of stay(13.47±1.74 days vs 16.20±7.71 days;P=0.013),shorter postoperative length of stay(8.6±2.6 days vs 10.5±4.9 days;P=0.014),and earlier postoperative exhaust time(2.23±0.54 days vs 2.53±0.61 days;P=0.013).Furthermore,the 3D group exhibited a higher mean number of lymph nodes harvested(16.91±5.74 vs 14.45±5.66;P=0.030).CONCLUSION The 3D visualization technology effectively addresses sigmoid colon anatomical complexity through surgical navigation,improving procedural safety and efficiency.展开更多
BACKGROUND Pedicle screw instrumentation is a critical technique in spinal surgery,offering effective stabilization for various spinal conditions.However,the impact of intraoperative imaging quality—specifically the ...BACKGROUND Pedicle screw instrumentation is a critical technique in spinal surgery,offering effective stabilization for various spinal conditions.However,the impact of intraoperative imaging quality—specifically the use of both anteroposterior(AP)and lateral views—on surgical outcomes remains insufficiently studied.Evaluating whether the adequacy of these imaging modalities affects the risk of unplanned returns to theatre(URTT)within 90 days due to screw malplacement is essential for refining surgical practices and improving patient care.AIM To evaluate how intraoperative imaging adequacy influences unplanned returnto-theatre rates,focusing on AP and lateral fluoroscopic views.METHODS This retrospective cohort study analyzed 1335 patients who underwent thoracolumbar and sacral pedicle screw instrumentation between January 2013 and December 2022.Data on intraoperative imaging adequacy,screw placement,and URTT events were collected and statistically analyzed using IBM SPSS v23.Imaging adequacy was assessed based on the presence of both AP and lateral views,and outcomes were compared between imaging groups.RESULTS A total of 9016 pedicle screws were inserted,with 82 screws identified as malplaced in 52 patients.Of these,46 patients required URTT due to screw malplacement,with 37 returning within 90 days(URTT90).Patients with both AP and lateral imaging saved intraoperatively had significantly lower URTT90 rates compared to those with only lateral imaging saved,demonstrating the critical role of imaging adequacy in improving surgical outcomes.CONCLUSION This study underscores that comprehensive intraoperative imaging with both AP and lateral views reduces unplanned returns,improves outcomes,enhances precision,and offers a cost-effective approach for better spinal surgery results.展开更多
Colonoscopy is a cornerstone in the detection and diagnosis of colorectal tumors,playing a critical role in both screening and clinical evaluation. More recently, itsutility has expanded to therapeutic guidance, parti...Colonoscopy is a cornerstone in the detection and diagnosis of colorectal tumors,playing a critical role in both screening and clinical evaluation. More recently, itsutility has expanded to therapeutic guidance, particularly with the advent ofminimally invasive surgical techniques. Preoperative tattoo marking is commonlyused for tumor localization;however, it poses challenges such as intraperitonealink scattering and difficulty in defining dissection planes in the lower rectum. Toaddress these limitations, a new technology utilizing a near-infrared fluorescenceclip placed preoperatively enables accurate intraoperative tumor localization.Intraoperative colonoscopy offers additional advantages, including real-timetumor localization, colonic irrigation, visualization of the proximal colon inobstructive cases, and assessment of anastomosis following colorectal resection.Notably, intraoperative colonoscopy allows for the immediate detection andmanagement of complications, such as anastomotic bleeding and leakage, potentiallyimproving postoperative outcomes. Furthermore, advances in endoscopicresections, including endoscopic mucosal resection, endoscopic submucosal dissection,hybrid endoscopic submucosal dissection, and combined endoscopiclaparoscopic surgery, have broadened the indications for endoscopic and endoscopy-guided full-thickness resection of colorectal tumors. These approaches areincreasingly applicable beyond conventional colorectal neoplasms and showpromise in managing appendiceal tumors as well.展开更多
Laparoscopic or robotic surgery accounts for an increasing proportion of liver surgery.However,the lack of haptic feedback results in a certain amount of risk.The use of laparoscopic ultrasound(LUS)enables the operato...Laparoscopic or robotic surgery accounts for an increasing proportion of liver surgery.However,the lack of haptic feedback results in a certain amount of risk.The use of laparoscopic ultrasound(LUS)enables the operator to observe internal structures of the liver in real time to easily avoid the main blood vessels.It also allows for the detection of tumor boundaries and the extent of tumor thrombi,considerably improving the success rate of the operation.Besides its advantages in detecting small lesions that are not detectable through preoperative imaging,thus assisting diagnosis and staging,the LUS can also be used to monitor ablation therapy,portal vein puncture staining,and lesion blood perfusion.Recent advances in technology like contrast-enhanced intraoperative ultrasound and realtime virtual sonography can help surgeons better perform laparoscopic surgery.For liver surgeons,LUS is an essential technique for safely performing laparoscopic surgery,making their proficiency in the use of LUS vital.This article reviews the application of LUS in laparoscopic hepatic resection of liver tumors and the new technology of LUS to help liver surgeons understand the current application status of LUS and the future research directions.展开更多
BACKGROUND Diabetic foot ulcers(DFUs)in patients with type 2 diabetes(T2D)are associated with heightened risks of infection and amputation and thus require effective surgical interventions to enhance outcomes.Free ant...BACKGROUND Diabetic foot ulcers(DFUs)in patients with type 2 diabetes(T2D)are associated with heightened risks of infection and amputation and thus require effective surgical interventions to enhance outcomes.Free anterolateral thigh(ALT)perforator flap is a promising reconstructive method;however,diabetic vasculopathy challenges optimal perfusion.This study analyzes factors influencing intraoperative blood perfusion in ALT flap repair for DFUs.AIM To identify key factors affecting intraoperative blood perfusion during free ALT perforator flap repair in patients with T2D and DFUs,thereby providing insights to improve surgical outcomes.METHODS This retrospective case-control study included 100 patients with T2D who underwent ALT flap repair at our institution between June 2016 and June 2024.Patients were categorized into normal(n=50)and abnormal(n=50)blood perfusion groups based on intraoperative perfusion assessments.Data on demographics,clinical characteristics,vascular status,metabolic control,and preoperative laboratory parameters were collected.Statistical analyses,including univariate and multivariate logistic regression,were conducted to identify significant predictive factors for perfusion outcomes.RESULTS Old age,high body mass index,long diabetes duration,and presence of diabetic peripheral neuropathy were associated with impaired perfusion.Abnormal perfusion was correlated with poor ankle-brachial index and elevated glycated hemoglobin(HbA1c),creatinine,triglycerides,and partial pressure of carbon dioxide.Conversely,high hemoglobin,albumin,and prealbumin levels and partial pressure of oxygen(PaO_(2))were protective.Multivariate analysis identified diabetes duration,HbA1c,PaCO_(2),PaO_(2),and albumin as independent predictors of perfusion,underscoring the roles of metabolic control and vascular health.CONCLUSION Optimizing metabolic control,vascular health,and nutritional status was crucial to enhance intraoperative blood perfusion in diabetic patients undergoing ALT perforator flap repair for DFUs.展开更多
Objective:This study aims to develop a deep multiscale image learning system(DMILS)to differentiate malignant from benign thyroid follicular neoplasms on multiscale whole-slide images(WSIs)of intraoperative frozen pat...Objective:This study aims to develop a deep multiscale image learning system(DMILS)to differentiate malignant from benign thyroid follicular neoplasms on multiscale whole-slide images(WSIs)of intraoperative frozen pathological images.Methods:A total of 1,213 patients were divided into training and validation sets,an internal test set,a pooled external test set,and a pooled prospective test set at three centers.DMILS was constructed using a deep learningbased weakly supervised method based on multiscale WSIs at 10×,20×,and 40×magnifications.The performance of the DMILS was compared with that of a single magnification and validated in two pathologist-unidentified subsets.Results:The DMILS yielded good performance,with areas under the receiver operating characteristic curves(AUCs)of 0.848,0.857,0.810,and 0.787 in the training and validation sets,internal test set,pooled external test set,and pooled prospective test set,respectively.The AUC of the DMILS was higher than that of a single magnification,with 0.788 of 10×,0.824 of 20×,and 0.775 of 40×in the internal test set.Moreover,DMILS yielded satisfactory performance on the two pathologist-unidentified subsets.Furthermore,the most indicative region predicted by DMILS is the follicular epithelium.Conclusions:DMILS has good performance in differentiating thyroid follicular neoplasms on multiscale WSIs of intraoperative frozen pathological images.展开更多
AIM:To evaluate the detection and differentiation ability of contrast-enhanced intraoperative ultrasonography(CE-IOUS) in hepatocellular carcinoma(HCC) operations.METHODS:Clinical data of 50 HCC patients were retrospe...AIM:To evaluate the detection and differentiation ability of contrast-enhanced intraoperative ultrasonography(CE-IOUS) in hepatocellular carcinoma(HCC) operations.METHODS:Clinical data of 50 HCC patients were retrospective analyzed.The sensitivity,specificity,false negative and false positive rates of contrast enhanced magnetic resonance imaging(CE-MRI),IOUS and CEIOUS were calculated and compared.Surgical strategy changes due to CE-IOUS were analyzed.RESULTS:Lesions detected by CE-MRI,IOUS and CEIOUS were 60,97 and 85 respectively.The sensitivity,specificity,false negative rate,false positive rate of CEMRI were 98.2%,98.6%,98.6%,60.0%,respectively;for IOUS were 50.0%,90.9%,1.8%,1.4%,respectively;and for CE-IOUS were 1.4%,40.0%,50.0%,9.1%,respectively.The operation strategy of 9(9/50,18.0%) cases was changed according to the results of CE-IOUS.CONCLUSION:Compared with CE-MRI,CE-IOUS performs better in detection and differentiation of small metastasis and regenerative nodules.It plays an important role in the decision-making of HCC operation.展开更多
Objective:To investigate the value of routine intraoperative ultrasound(IU)and intraoperative contrast-enhanced ultrasound(ICEUS)in the surgical treatment of brain tumors,and to explore the utilization of ICEUS for th...Objective:To investigate the value of routine intraoperative ultrasound(IU)and intraoperative contrast-enhanced ultrasound(ICEUS)in the surgical treatment of brain tumors,and to explore the utilization of ICEUS for the removal of the remnants surrounding the resection cavity.Methods:In total,51 patients who underwent operations from 2012 to 2018 due to different tumors in the brain were included in this study.The clinical data were evaluated retrospectively.IU was performed in all patients,among which 28 patients underwent ICEUS.The effects of IU and ICEUS on tumor resection and recurrence were evaluated.展开更多
Objective: To evaluate the effectiveness of intraoperative radiotherapy (IORT) in combination with regional chemotherapy in the treatment of advanced pancreatic carcinoma.Methods: 17 patients with advanced pancreatic ...Objective: To evaluate the effectiveness of intraoperative radiotherapy (IORT) in combination with regional chemotherapy in the treatment of advanced pancreatic carcinoma.Methods: 17 patients with advanced pancreatic adenocarcinoma were treated with IORT and regional chemotherapy with 5-FU, Epirubucin and Mitomycin, and 6 cases accepted external radiotherapy postoperatively.Results: 35.29% (6/17) of the patients were clinical benefit responders and 23.53% (4/17) had a partial response. The median survival time was 11 months and the 1-year survival rate was 35.29% (6/17)Conclusion: IORT in combination with regional chemotherapy had a good impact on clinical benefit without severe side effects in locally advanced pancreatic carcinoma and led to a significant prolongation of the survival time. Key words pancreatic cancer - intraoperative radiotherapy - chemotherapy展开更多
To assess the role of laparoscopic ultrasound (LUS) as a substitute for intraoperative cholangiography (IOC) during cholecystectomy. METHODSWe present a MEDLINE and PubMed literature search, having used the key-words ...To assess the role of laparoscopic ultrasound (LUS) as a substitute for intraoperative cholangiography (IOC) during cholecystectomy. METHODSWe present a MEDLINE and PubMed literature search, having used the key-words “laparoscopic intraoperative ultrasound” and “laparoscopic cholecystectomy”. All relevant English language publications from 2000 to 2016 were identified, with data extracted for the role of LUS in the anatomical delineation of the biliary tract, detection of common bile duct stones (CBDS), prevention or early detection of biliary duct injury (BDI), and incidental findings during laparoscopic cholecystectomy. Data for the role of LUS vs IOC in complex situations (i.e., inflammatory disease/fibrosis) were specifically analyzed. RESULTSWe report data from eighteen reports, 13 prospective non-randomized trials, 5 retrospective trials, and two meta-analyses assessing diagnostic accuracy, with one analysis also assessing costs, duration of the examination, and anatomical mapping. Overall, LUS was shown to provide highly sensitive mapping of the extra-pancreatic biliary anatomy in 92%-100% of patients, with more difficulty encountered in delineation of the intra-pancreatic segment of the biliary tract (73.8%-98%). Identification of vascular and biliary variations has been documented in two studies. Although inflammatory disease hampered accuracy, LUS was still advantageous vs IOC in patients with obscured anatomy. LUS can be performed before any dissection and repeated at will to guide the surgeon especially when hilar mapping is difficult due to fibrosis and inflammation. In two studies LUS prevented conversion in 91% of patients with difficult scenarios. Considering CBDS detection, LUS sensitivity and specificity were 76%-100% and 96.2%-100%, respectively. LUS allowed the diagnosis/treatment of incidental findings of adjacent organs. No valuable data for BDI prevention or detection could be retrieved, even if no BDI was documented in the reports analyzed. Literature analysis proved LUS as a safe, quick, non-irradiating, cost-effective technique, which is comparatively well known although largely under-utilized, probably due to the perception of a difficult learning curve. CONCLUSIONWe highlight the advantages and limitations of laparoscopic ultrasound during cholecystectomy, and underline its value in difficult scenarios when the anatomy is obscured.展开更多
AIM:To elucidate the potential impact of intraoperative blood loss(IBL)on long-term survival of gastric cancer patients after curative surgery.METHODS:A total of 845 stageⅠ-Ⅲgastric cancer patients who underwent cur...AIM:To elucidate the potential impact of intraoperative blood loss(IBL)on long-term survival of gastric cancer patients after curative surgery.METHODS:A total of 845 stageⅠ-Ⅲgastric cancer patients who underwent curative gastrectomy between January 2003 and December 2007 in our center were enrolled in this study.Patients were divided into 3groups according to the amount of IBL:group 1(<200mL),group 2(200-400 mL)and group 3(>400 mL).Clinicopathological features were compared among the three groups and potential prognostic factors were analyzed.The Log-rank test was used to assess statistical differences between the groups.Independent prognostic factors were identified by the Cox proportional hazards regression model.Stratified analysis was used to investigate the impact of IBL on survival in each stage.Cancer-specific survival was also compared among the three groups by excluding deaths due to reasons other than gastric cancer.Finally,we explored the possible factors associated with IBL and identified the independent risk factors for IBL≥200 mL.RESULTS:Overall survival was significantly influenced by the amount of IBL.The 5-year overall survival rates were 51.2%,39.4%and 23.4%for IBL less than 200mL,200 to 400 mL and more than 400 mL,respectively(<200 mL vs 200-400 mL,P<0.001;200-400 mL vs>400 mL,P=0.003).Age,tumor size,Borrmann type,extranodal metastasis,tumour-node-metastasis(TNM)stage,chemotherapy,extent of lymphadenectomy,IBL and postoperative complications were found to be independent prognostic factors in multivariable analysis.Following stratified analysis,patients staged TNMⅠ-Ⅱand those with IBL less than 200 mL tended to have better survival than those with IBL not less than 200mL,while patients staged TNMⅢ,whose IBL was less than 400 mL had better survival.Tumor location,tumor size,TNM stage,type of gastrectomy,combined organ resection,extent of lymphadenectomy and year of surgery were found to be factors associated with the amount of IBL,while tumor location,type of gastrectomy,combined organ resection and year of surgery were independently associated with IBL≥200 mL.CONCLUSION:IBL is an independent prognostic factor for gastric cancer after curative resection.Reducing IBL can improve the long-term outcome of gastric cancer patients following curative gastrectomy.展开更多
AIM： To assess the clinical value of contrast-enhanced intraoperative ultrasound （CE-IOUS） as a novel tool in partial hepatectomy for cirrhotic patients with hepatocellular carcinoma （HCC）. METHODS： From January...AIM： To assess the clinical value of contrast-enhanced intraoperative ultrasound （CE-IOUS） as a novel tool in partial hepatectomy for cirrhotic patients with hepatocellular carcinoma （HCC）. METHODS： From January 2007 to September 2007, a total of 20 consecutive cirrhotic patients with HCC scheduled to undergo partial hepatectomy were studied. Preoperative contrast enhanced computer tomography （CT） and/or magnetic resonance （MR） scans were performed within 1-2 wk before operation. Intraoperative ultrasound （IOUS） and CE-IOUS were carried out after mobilization of the liver. Lesions on precontrast and postcontrast scans were counted and mapped. CE-IOUS was performed with intravenous injection of ultrasound contrast agents SonoVue （Bracco Imaging, Milan, Italy）. Arterial, portal and late phases of contrast enhancement were recorded and analyzed. Nodules showing arterial phase hyper-enhancing and/or hypo-enhancing in late parenchymal phase were considered malignant and removed surgically. Ultrasound-guided biopsy and ethanol ablation would be an option if the nodule could not be removed surgically. Newly detected nodules on IOUS showing iso-enhancement in both arterial and late phases were considered benign. These nodules were either removed surgically if they were close to the main lesion or followed by examinations of alpha-fetoprotein （AFP） level and ultrasound and/or CT/MR every 3 too. RESULTS： IOUS found 41 nodules in total, among which 17 （41.46%） were newly detected compared to preoperative imaging. Thirty-three nodules were diagnosed malignant by CE-IOUS, including one missed by IOUS. The sensitivity and specificity of CE-IOUS on detecting HCC nodules are 100% （33/33 and 100% （9/9）, respectively. Nine nodules were considered benign by CE-IOUS, four was confirmed at histology and five by follow-up. CE-IOUS changed the surgical strategy in 35% （7/20） of patients and avoid unnecessary intervention in 30% （6/20） of patients. CONCLUSION： CE-IOUS is a useful means to characterize the nodules detected by IOUS in cirrhotic liver, to find isoechoic HCC nodules which can not be shown on IOUS and to improve the accuracy of conventional IOUS, thus it can be used as an essential tool in the surgical treatment of cirrhotic patients with HCC.展开更多
Recently, many surgeons have been using intraoperative neurophysiological monitoring(IOM) in spinal surgery to reduce the incidence of postoperative neurological complications, including level of the spinal cord, caud...Recently, many surgeons have been using intraoperative neurophysiological monitoring(IOM) in spinal surgery to reduce the incidence of postoperative neurological complications, including level of the spinal cord, cauda equina and nerve root. Several established technologies are available and combined motor and somatosensory evoked potentials are considered mandatory for practical and successful IOM. Spinal cord evoked potentials are elicited compound potentials recorded over the spinal cord. Electrical stimulation is provoked on the dorsal spinal cord from an epidural electrode. Somatosensory evoked potentials assess the functional integrity of sensory pathways from the peripheral nerve through the dorsal column and to the sensory cortex. For identification of the physiological midline, the dorsal column mapping technique can be used. It is helpful for reducing the postoperative morbidity associated with dorsal column dysfunction when distortion of the normal spinal cord anatomy caused by an intramedullary cord lesion results in confusion in localizing the midline for the myelotomy. Motor evoked potentials(MEPs) consist of spinal, neurogenic and muscle MEPs. MEPs allow selective and specific assessment of the functional integrity of descending motor pathways, from the motor cortex to peripheral muscles. Spinal surgeons should understand the concept of the monitoring techniques and interpret monitoring records adequately to use IOM for the decision making during the surgery for safe surgery and a favorable surgical outcome.展开更多
Diabetogenic traits in patients undergoing liver transplantation(LT) are exacerbated intraoperatively by exogenous causes, such as surgical stress, steroids,blood transfusions, and catecholamines, which leadto intraop...Diabetogenic traits in patients undergoing liver transplantation(LT) are exacerbated intraoperatively by exogenous causes, such as surgical stress, steroids,blood transfusions, and catecholamines, which leadto intraoperative hyperglycemia. In contrast to the strict glucose control performed in the intensive care unit, no systematic protocol has been developed for glucose management during LT. Intraoperative blood glucose concentrations typically exceed 200 mg/dL in LT, and extreme hyperglycemia(> 300 mg/dL) is common during the neohepatic phase. Only a few retrospective studies have examined the relationship between intraoperative hyperglycemia and posttransplant complications, with reports of infectious complications or mortality. However, no prospective studies have been conducted regarding the influence of intraoperative hyperglycemia in LT on post-transplant outcome. In addition to absolute blood glucose values,the temporal patterns in blood glucose levels during LT may serve as prognostic features. Persistent neohepatic hyperglycemia(without a decline) throughout LT is a useful indicator of early graft dysfunction. Moreover,intraoperative variability in glucose levels may predict the need for reoperation for hemorrhage after LT.Thus, there is an urgent need for guidelines for glucose control in these patients, as well as prospective studies on the impact of glucose control on various posttransplant complications. This report highlights some of the recent studies related to perioperative blood glucose management focused on LT and liver disease.展开更多
Intraoperative blood salvage autotransfusion (IBSA) is used in various surgical procedures. However, because of the risk of reinfusion of salvaged blood contaminated by tumor cells, the use of IBSA in hepatocellular c...Intraoperative blood salvage autotransfusion (IBSA) is used in various surgical procedures. However, because of the risk of reinfusion of salvaged blood contaminated by tumor cells, the use of IBSA in hepatocellular carcinoma (HCC) patients undergoing liver transplantation (LT) is controversial. The critical points include whether tumor cells can be cleared by IBSA, whether IBSA increases the risk of recurrence or metastasis, and what are the indications for IBSA. Moreover, is it warranted to take the risk of tumor dissemination by using IBSA to avoid allogeneic blood transfusion? Do the remaining tumor cells after additional filtration by leukocyte depletion filters still possess potential tumorigenicity? Does IBSA always work well? We have reviewed the literature and tried to address these questions. The available data indicate that IBSA is safe in LT for HCC, but randomized, controlled and prospective trials are urgently required to clarify the uncertainty.展开更多
In the treatment of patients with symptomatic cholelithiasis and choledocholithiasis (CBDS) detected during intraoperative cholangiography (IOC),or when the preoperative study of a patient at intermediate risk for CBD...In the treatment of patients with symptomatic cholelithiasis and choledocholithiasis (CBDS) detected during intraoperative cholangiography (IOC),or when the preoperative study of a patient at intermediate risk for CBDS cannot be completed due to the lack of imaging techniques required for confirmation,or if they are available and yield contradictory radiological and clinical results,patients can be treated using intraoperative endoscopic retrograde cholangiopancreatography (ERCP) during the laparoscopic treatment or postoperative ERCP if the IOC finds CBDS.The choice of treatment depends on the level of experience and availability of each option at each hospital.Intraoperative ERCP has the advantage of being a single-stage treatment and has a significant success rate,an easy learning curve,low morbidity involving a shorter hospital stay and lower costs than the two-stage treatments (postoperative and preoperative ERCP).Intraoperative ERCP is also a good salvage treatment when preoperative ERCP fails or when total laparoscopic management also fails.展开更多
基金supported by the National Natural Science Foundation of China(Grant Nos.82272955 and 22203057)the Natural Science Foundation of Fujian Province(Grant No.2021J011361).
文摘The presence of a positive deep surgical margin in tongue squamous cell carcinoma(TSCC)significantly elevates the risk of local recurrence.Therefore,a prompt and precise intraoperative assessment of margin status is imperative to ensure thorough tumor resection.In this study,we integrate Raman imaging technology with an artificial intelligence(AI)generative model,proposing an innovative approach for intraoperative margin status diagnosis.This method utilizes Raman imaging to swiftly and non-invasively capture tissue Raman images,which are then transformed into hematoxylin-eosin(H&E)-stained histopathological images using an AI generative model for histopathological diagnosis.The generated H&E-stained images clearly illustrate the tissue’s pathological conditions.Independently reviewed by three pathologists,the overall diagnostic accuracy for distinguishing between tumor tissue and normal muscle tissue reaches 86.7%.Notably,it outperforms current clinical practices,especially in TSCC with positive lymph node metastasis or moderately differentiated grades.This advancement highlights the potential of AI-enhanced Raman imaging to significantly improve intraoperative assessments and surgical margin evaluations,promising a versatile diagnostic tool beyond TSCC.
基金Supported by a grant from Japan China Sasakawa Medical Fellowship。
文摘Ultrasound plays an important role not only in preoperative diagnosis but also in intraoperative guidance for liver surgery.Intraoperative ultrasound(IOUS)has become an indispensable tool for modern liver surgeons,especially for minimally invasive surgeries,partially substituting for the surgeon’s hands.In fundamental mode,Doppler mode,contrast enhancement,elastography,and real-time virtual sonography,IOUS can provide additional real-time information regarding the intrahepatic anatomy,tumor site and characteristics,macrovascular invasion,resection margin,transection plane,perfusion and outflow of the remnant liver,and local ablation efficacy for both open and minimally invasive liver resections.Identification and localization of intrahepatic lesions and surrounding structures are crucial for performing liver resection,preserving the adjacent vital vascular and bile ducts,and sparing the functional liver parenchyma.Intraoperative ultrasound can provide critical information for intraoperative decision-making and navigation.Therefore,all liver surgeons must master IOUS techniques,and IOUS should be included in the training of modern liver surgeons.Further investigation of the potential benefits and advances in these techniques will increase the use of IOUS in modern liver surgeries worldwide.This study comprehensively reviews the current use of IOUS in modern liver surgeries.
基金supported by the Tianjin Science and Technology Commission key project(Grant No.21JCZDJC00980)Tianjin Science and Technology Commission project(Grant No.22ZXJBSY00030)Tianjin Health Research project(Grant No.TJWJ2022MS007)。
文摘Objective:The role of intraoperative radiation therapy(IORT)in the management of resectable pancreatic cancer(RPC)remains unclear.To date,the application of IORT using a low-energy X-ray source has not been extensively investigated.Therefore,this study was conducted to evaluate the safety and efficacy of IORT using a 50 kV X-ray source in treating RPC.Methods:Patients with RPC who underwent radical pancreatectomy and IORT were enrolled.The primary endpoint was time to treatment failure(TTF)survival,whereas the secondary endpoints were safety and overall survival(OS).Results:By November 2023,35 patients with RPC were treated according to the study protocol.The median TTF was 11.67 months,whereas the median OS for the cohort was 22.2 months.The local recurrence rate was 20%.The most common postoperative complication was pancreatic fistula.The incidence of delayed gastric emptying was 20%.Within 30 days after surgery,one patient experienced abdominal pain,another experienced vomiting,and one died because of abdominal infection and a grade C pancreatic fistula.Carcinoembryonic antigen(CEA)and D-dimer levels significantly correlated with TTF and OS in multivariate analyses.The carbohydrate antigen 19-9(CA19-9)level was another prognostic factor significantly associated with OS.Patients with low D-dimer and normal CA19-9 levels showed prolonged OS with an IORT dose≤15 Gy.Conclusions:This study supports use of IORT with a 50 kV X-ray source in treating RPC.IORT using a low-energy X-ray source was well-tolerated and feasible.Additionally,D-dimer,CEA,and CA19-9 levels may help identify patient profiles potentially benefitting from IORT.
文摘Upper gastrointestinal(UGI)endoscopy has become increasingly popular with the recent advancements in technology and the increase of minimally invasive techniques.UGI endoscopy is indicated for diagnostic,staging,and therapeutic purposes and significantly influences the management of patients with a spectrum of foregut diseases,including esophageal and gastric malignancies,achalasia,and gastroesophageal reflux disease.There is growing evidence that intraoperative UGI endoscopy can be a useful adjunct and a powerful tool to enhance tumor localization,offering a direct evaluation of the surgical reconstruction and identifying potential sources of postoperative complications.However,its widespread utilization has been limited by concerns over cost,accessibility,and sufficient training and expertise.The aim of the current study was to review and elaborate on the available literature while presenting our experience in an academic institution specializing in esophagogastric surgery with intraoperative UGI endoscopy.We focused on the indications,added benefits,and related complications.
基金Supported by the Health Commission of Fuyang City,Anhui,China,No.FY2023-45Fuyang Municipal Science and Technology Bureau,Anhui,China,No.FK20245505+1 种基金Anhui Provincial Health Commission,No.AHWJ2023Baa20164Bengbu Medical University,No.2023byzd215.
文摘BACKGROUND Sigmoid colon cancer faces challenges due to anatomical diversity,including variable inferior mesenteric artery(IMA)branching and tumor localization complexities,which increase intraoperative risks.AIM To comprehensively evaluate the impact of three-dimensional(3D)visualization technology on enhancing surgical precision and safety,as well as optimizing perioperative outcomes in laparoscopic sigmoid cancer resection.METHODS A prospective cohort of 106 patients(January 2023 to December 2024)undergoing laparoscopic sigmoid cancer resection was divided into the 3D(n=55)group and the control(n=51)group.The 3D group underwent preoperative enhanced computed tomography reconstruction(3D Slicer 5.2.2&Mimics 19.0).3D reconstruction visualization navigation intraoperatively guided the following key steps:Tumor location,Toldt’s space dissection,IMA ligation level selection,regional lymph node dissection,and marginal artery preservation.Outcomes included operative parameters,lymph node yield,and recovery metrics.RESULTS The 3D group demonstrated a significantly shorter operative time(172.91±20.69 minutes vs 190.29±32.29 minutes;P=0.002),reduced blood loss(31.5±11.8 mL vs 44.1±23.4 mL,P=0.001),earlier postoperative flatus(2.23±0.54 days vs 2.53±0.61 days;P=0.013),shorter hospital length of stay(13.47±1.74 days vs 16.20±7.71 days;P=0.013),shorter postoperative length of stay(8.6±2.6 days vs 10.5±4.9 days;P=0.014),and earlier postoperative exhaust time(2.23±0.54 days vs 2.53±0.61 days;P=0.013).Furthermore,the 3D group exhibited a higher mean number of lymph nodes harvested(16.91±5.74 vs 14.45±5.66;P=0.030).CONCLUSION The 3D visualization technology effectively addresses sigmoid colon anatomical complexity through surgical navigation,improving procedural safety and efficiency.
文摘BACKGROUND Pedicle screw instrumentation is a critical technique in spinal surgery,offering effective stabilization for various spinal conditions.However,the impact of intraoperative imaging quality—specifically the use of both anteroposterior(AP)and lateral views—on surgical outcomes remains insufficiently studied.Evaluating whether the adequacy of these imaging modalities affects the risk of unplanned returns to theatre(URTT)within 90 days due to screw malplacement is essential for refining surgical practices and improving patient care.AIM To evaluate how intraoperative imaging adequacy influences unplanned returnto-theatre rates,focusing on AP and lateral fluoroscopic views.METHODS This retrospective cohort study analyzed 1335 patients who underwent thoracolumbar and sacral pedicle screw instrumentation between January 2013 and December 2022.Data on intraoperative imaging adequacy,screw placement,and URTT events were collected and statistically analyzed using IBM SPSS v23.Imaging adequacy was assessed based on the presence of both AP and lateral views,and outcomes were compared between imaging groups.RESULTS A total of 9016 pedicle screws were inserted,with 82 screws identified as malplaced in 52 patients.Of these,46 patients required URTT due to screw malplacement,with 37 returning within 90 days(URTT90).Patients with both AP and lateral imaging saved intraoperatively had significantly lower URTT90 rates compared to those with only lateral imaging saved,demonstrating the critical role of imaging adequacy in improving surgical outcomes.CONCLUSION This study underscores that comprehensive intraoperative imaging with both AP and lateral views reduces unplanned returns,improves outcomes,enhances precision,and offers a cost-effective approach for better spinal surgery results.
文摘Colonoscopy is a cornerstone in the detection and diagnosis of colorectal tumors,playing a critical role in both screening and clinical evaluation. More recently, itsutility has expanded to therapeutic guidance, particularly with the advent ofminimally invasive surgical techniques. Preoperative tattoo marking is commonlyused for tumor localization;however, it poses challenges such as intraperitonealink scattering and difficulty in defining dissection planes in the lower rectum. Toaddress these limitations, a new technology utilizing a near-infrared fluorescenceclip placed preoperatively enables accurate intraoperative tumor localization.Intraoperative colonoscopy offers additional advantages, including real-timetumor localization, colonic irrigation, visualization of the proximal colon inobstructive cases, and assessment of anastomosis following colorectal resection.Notably, intraoperative colonoscopy allows for the immediate detection andmanagement of complications, such as anastomotic bleeding and leakage, potentiallyimproving postoperative outcomes. Furthermore, advances in endoscopicresections, including endoscopic mucosal resection, endoscopic submucosal dissection,hybrid endoscopic submucosal dissection, and combined endoscopiclaparoscopic surgery, have broadened the indications for endoscopic and endoscopy-guided full-thickness resection of colorectal tumors. These approaches areincreasingly applicable beyond conventional colorectal neoplasms and showpromise in managing appendiceal tumors as well.
基金Supported by Liaoning Province People's Livelihood Science and Technology(Health)Plan Joint Project,No.2021JH2/10300127the State Scholarship Funding of CSC,No.201908865001。
文摘Laparoscopic or robotic surgery accounts for an increasing proportion of liver surgery.However,the lack of haptic feedback results in a certain amount of risk.The use of laparoscopic ultrasound(LUS)enables the operator to observe internal structures of the liver in real time to easily avoid the main blood vessels.It also allows for the detection of tumor boundaries and the extent of tumor thrombi,considerably improving the success rate of the operation.Besides its advantages in detecting small lesions that are not detectable through preoperative imaging,thus assisting diagnosis and staging,the LUS can also be used to monitor ablation therapy,portal vein puncture staining,and lesion blood perfusion.Recent advances in technology like contrast-enhanced intraoperative ultrasound and realtime virtual sonography can help surgeons better perform laparoscopic surgery.For liver surgeons,LUS is an essential technique for safely performing laparoscopic surgery,making their proficiency in the use of LUS vital.This article reviews the application of LUS in laparoscopic hepatic resection of liver tumors and the new technology of LUS to help liver surgeons understand the current application status of LUS and the future research directions.
文摘BACKGROUND Diabetic foot ulcers(DFUs)in patients with type 2 diabetes(T2D)are associated with heightened risks of infection and amputation and thus require effective surgical interventions to enhance outcomes.Free anterolateral thigh(ALT)perforator flap is a promising reconstructive method;however,diabetic vasculopathy challenges optimal perfusion.This study analyzes factors influencing intraoperative blood perfusion in ALT flap repair for DFUs.AIM To identify key factors affecting intraoperative blood perfusion during free ALT perforator flap repair in patients with T2D and DFUs,thereby providing insights to improve surgical outcomes.METHODS This retrospective case-control study included 100 patients with T2D who underwent ALT flap repair at our institution between June 2016 and June 2024.Patients were categorized into normal(n=50)and abnormal(n=50)blood perfusion groups based on intraoperative perfusion assessments.Data on demographics,clinical characteristics,vascular status,metabolic control,and preoperative laboratory parameters were collected.Statistical analyses,including univariate and multivariate logistic regression,were conducted to identify significant predictive factors for perfusion outcomes.RESULTS Old age,high body mass index,long diabetes duration,and presence of diabetic peripheral neuropathy were associated with impaired perfusion.Abnormal perfusion was correlated with poor ankle-brachial index and elevated glycated hemoglobin(HbA1c),creatinine,triglycerides,and partial pressure of carbon dioxide.Conversely,high hemoglobin,albumin,and prealbumin levels and partial pressure of oxygen(PaO_(2))were protective.Multivariate analysis identified diabetes duration,HbA1c,PaCO_(2),PaO_(2),and albumin as independent predictors of perfusion,underscoring the roles of metabolic control and vascular health.CONCLUSION Optimizing metabolic control,vascular health,and nutritional status was crucial to enhance intraoperative blood perfusion in diabetic patients undergoing ALT perforator flap repair for DFUs.
基金supported by the Taishan Scholar Project(No.ts20190991,tsqn202211378)the Key R&D Project of Shandong Province(No.2022CXPT023)the General Program of National Natural Science Foundation of China(No.82371933)。
文摘Objective:This study aims to develop a deep multiscale image learning system(DMILS)to differentiate malignant from benign thyroid follicular neoplasms on multiscale whole-slide images(WSIs)of intraoperative frozen pathological images.Methods:A total of 1,213 patients were divided into training and validation sets,an internal test set,a pooled external test set,and a pooled prospective test set at three centers.DMILS was constructed using a deep learningbased weakly supervised method based on multiscale WSIs at 10×,20×,and 40×magnifications.The performance of the DMILS was compared with that of a single magnification and validated in two pathologist-unidentified subsets.Results:The DMILS yielded good performance,with areas under the receiver operating characteristic curves(AUCs)of 0.848,0.857,0.810,and 0.787 in the training and validation sets,internal test set,pooled external test set,and pooled prospective test set,respectively.The AUC of the DMILS was higher than that of a single magnification,with 0.788 of 10×,0.824 of 20×,and 0.775 of 40×in the internal test set.Moreover,DMILS yielded satisfactory performance on the two pathologist-unidentified subsets.Furthermore,the most indicative region predicted by DMILS is the follicular epithelium.Conclusions:DMILS has good performance in differentiating thyroid follicular neoplasms on multiscale WSIs of intraoperative frozen pathological images.
文摘AIM:To evaluate the detection and differentiation ability of contrast-enhanced intraoperative ultrasonography(CE-IOUS) in hepatocellular carcinoma(HCC) operations.METHODS:Clinical data of 50 HCC patients were retrospective analyzed.The sensitivity,specificity,false negative and false positive rates of contrast enhanced magnetic resonance imaging(CE-MRI),IOUS and CEIOUS were calculated and compared.Surgical strategy changes due to CE-IOUS were analyzed.RESULTS:Lesions detected by CE-MRI,IOUS and CEIOUS were 60,97 and 85 respectively.The sensitivity,specificity,false negative rate,false positive rate of CEMRI were 98.2%,98.6%,98.6%,60.0%,respectively;for IOUS were 50.0%,90.9%,1.8%,1.4%,respectively;and for CE-IOUS were 1.4%,40.0%,50.0%,9.1%,respectively.The operation strategy of 9(9/50,18.0%) cases was changed according to the results of CE-IOUS.CONCLUSION:Compared with CE-MRI,CE-IOUS performs better in detection and differentiation of small metastasis and regenerative nodules.It plays an important role in the decision-making of HCC operation.
基金This work was supported by the foundation of Tongji Hospital(No.2020JZKT292).
文摘Objective:To investigate the value of routine intraoperative ultrasound(IU)and intraoperative contrast-enhanced ultrasound(ICEUS)in the surgical treatment of brain tumors,and to explore the utilization of ICEUS for the removal of the remnants surrounding the resection cavity.Methods:In total,51 patients who underwent operations from 2012 to 2018 due to different tumors in the brain were included in this study.The clinical data were evaluated retrospectively.IU was performed in all patients,among which 28 patients underwent ICEUS.The effects of IU and ICEUS on tumor resection and recurrence were evaluated.
文摘Objective: To evaluate the effectiveness of intraoperative radiotherapy (IORT) in combination with regional chemotherapy in the treatment of advanced pancreatic carcinoma.Methods: 17 patients with advanced pancreatic adenocarcinoma were treated with IORT and regional chemotherapy with 5-FU, Epirubucin and Mitomycin, and 6 cases accepted external radiotherapy postoperatively.Results: 35.29% (6/17) of the patients were clinical benefit responders and 23.53% (4/17) had a partial response. The median survival time was 11 months and the 1-year survival rate was 35.29% (6/17)Conclusion: IORT in combination with regional chemotherapy had a good impact on clinical benefit without severe side effects in locally advanced pancreatic carcinoma and led to a significant prolongation of the survival time. Key words pancreatic cancer - intraoperative radiotherapy - chemotherapy
文摘To assess the role of laparoscopic ultrasound (LUS) as a substitute for intraoperative cholangiography (IOC) during cholecystectomy. METHODSWe present a MEDLINE and PubMed literature search, having used the key-words “laparoscopic intraoperative ultrasound” and “laparoscopic cholecystectomy”. All relevant English language publications from 2000 to 2016 were identified, with data extracted for the role of LUS in the anatomical delineation of the biliary tract, detection of common bile duct stones (CBDS), prevention or early detection of biliary duct injury (BDI), and incidental findings during laparoscopic cholecystectomy. Data for the role of LUS vs IOC in complex situations (i.e., inflammatory disease/fibrosis) were specifically analyzed. RESULTSWe report data from eighteen reports, 13 prospective non-randomized trials, 5 retrospective trials, and two meta-analyses assessing diagnostic accuracy, with one analysis also assessing costs, duration of the examination, and anatomical mapping. Overall, LUS was shown to provide highly sensitive mapping of the extra-pancreatic biliary anatomy in 92%-100% of patients, with more difficulty encountered in delineation of the intra-pancreatic segment of the biliary tract (73.8%-98%). Identification of vascular and biliary variations has been documented in two studies. Although inflammatory disease hampered accuracy, LUS was still advantageous vs IOC in patients with obscured anatomy. LUS can be performed before any dissection and repeated at will to guide the surgeon especially when hilar mapping is difficult due to fibrosis and inflammation. In two studies LUS prevented conversion in 91% of patients with difficult scenarios. Considering CBDS detection, LUS sensitivity and specificity were 76%-100% and 96.2%-100%, respectively. LUS allowed the diagnosis/treatment of incidental findings of adjacent organs. No valuable data for BDI prevention or detection could be retrieved, even if no BDI was documented in the reports analyzed. Literature analysis proved LUS as a safe, quick, non-irradiating, cost-effective technique, which is comparatively well known although largely under-utilized, probably due to the perception of a difficult learning curve. CONCLUSIONWe highlight the advantages and limitations of laparoscopic ultrasound during cholecystectomy, and underline its value in difficult scenarios when the anatomy is obscured.
文摘AIM:To elucidate the potential impact of intraoperative blood loss(IBL)on long-term survival of gastric cancer patients after curative surgery.METHODS:A total of 845 stageⅠ-Ⅲgastric cancer patients who underwent curative gastrectomy between January 2003 and December 2007 in our center were enrolled in this study.Patients were divided into 3groups according to the amount of IBL:group 1(<200mL),group 2(200-400 mL)and group 3(>400 mL).Clinicopathological features were compared among the three groups and potential prognostic factors were analyzed.The Log-rank test was used to assess statistical differences between the groups.Independent prognostic factors were identified by the Cox proportional hazards regression model.Stratified analysis was used to investigate the impact of IBL on survival in each stage.Cancer-specific survival was also compared among the three groups by excluding deaths due to reasons other than gastric cancer.Finally,we explored the possible factors associated with IBL and identified the independent risk factors for IBL≥200 mL.RESULTS:Overall survival was significantly influenced by the amount of IBL.The 5-year overall survival rates were 51.2%,39.4%and 23.4%for IBL less than 200mL,200 to 400 mL and more than 400 mL,respectively(<200 mL vs 200-400 mL,P<0.001;200-400 mL vs>400 mL,P=0.003).Age,tumor size,Borrmann type,extranodal metastasis,tumour-node-metastasis(TNM)stage,chemotherapy,extent of lymphadenectomy,IBL and postoperative complications were found to be independent prognostic factors in multivariable analysis.Following stratified analysis,patients staged TNMⅠ-Ⅱand those with IBL less than 200 mL tended to have better survival than those with IBL not less than 200mL,while patients staged TNMⅢ,whose IBL was less than 400 mL had better survival.Tumor location,tumor size,TNM stage,type of gastrectomy,combined organ resection,extent of lymphadenectomy and year of surgery were found to be factors associated with the amount of IBL,while tumor location,type of gastrectomy,combined organ resection and year of surgery were independently associated with IBL≥200 mL.CONCLUSION:IBL is an independent prognostic factor for gastric cancer after curative resection.Reducing IBL can improve the long-term outcome of gastric cancer patients following curative gastrectomy.
文摘AIM： To assess the clinical value of contrast-enhanced intraoperative ultrasound （CE-IOUS） as a novel tool in partial hepatectomy for cirrhotic patients with hepatocellular carcinoma （HCC）. METHODS： From January 2007 to September 2007, a total of 20 consecutive cirrhotic patients with HCC scheduled to undergo partial hepatectomy were studied. Preoperative contrast enhanced computer tomography （CT） and/or magnetic resonance （MR） scans were performed within 1-2 wk before operation. Intraoperative ultrasound （IOUS） and CE-IOUS were carried out after mobilization of the liver. Lesions on precontrast and postcontrast scans were counted and mapped. CE-IOUS was performed with intravenous injection of ultrasound contrast agents SonoVue （Bracco Imaging, Milan, Italy）. Arterial, portal and late phases of contrast enhancement were recorded and analyzed. Nodules showing arterial phase hyper-enhancing and/or hypo-enhancing in late parenchymal phase were considered malignant and removed surgically. Ultrasound-guided biopsy and ethanol ablation would be an option if the nodule could not be removed surgically. Newly detected nodules on IOUS showing iso-enhancement in both arterial and late phases were considered benign. These nodules were either removed surgically if they were close to the main lesion or followed by examinations of alpha-fetoprotein （AFP） level and ultrasound and/or CT/MR every 3 too. RESULTS： IOUS found 41 nodules in total, among which 17 （41.46%） were newly detected compared to preoperative imaging. Thirty-three nodules were diagnosed malignant by CE-IOUS, including one missed by IOUS. The sensitivity and specificity of CE-IOUS on detecting HCC nodules are 100% （33/33 and 100% （9/9）, respectively. Nine nodules were considered benign by CE-IOUS, four was confirmed at histology and five by follow-up. CE-IOUS changed the surgical strategy in 35% （7/20） of patients and avoid unnecessary intervention in 30% （6/20） of patients. CONCLUSION： CE-IOUS is a useful means to characterize the nodules detected by IOUS in cirrhotic liver, to find isoechoic HCC nodules which can not be shown on IOUS and to improve the accuracy of conventional IOUS, thus it can be used as an essential tool in the surgical treatment of cirrhotic patients with HCC.
文摘Recently, many surgeons have been using intraoperative neurophysiological monitoring(IOM) in spinal surgery to reduce the incidence of postoperative neurological complications, including level of the spinal cord, cauda equina and nerve root. Several established technologies are available and combined motor and somatosensory evoked potentials are considered mandatory for practical and successful IOM. Spinal cord evoked potentials are elicited compound potentials recorded over the spinal cord. Electrical stimulation is provoked on the dorsal spinal cord from an epidural electrode. Somatosensory evoked potentials assess the functional integrity of sensory pathways from the peripheral nerve through the dorsal column and to the sensory cortex. For identification of the physiological midline, the dorsal column mapping technique can be used. It is helpful for reducing the postoperative morbidity associated with dorsal column dysfunction when distortion of the normal spinal cord anatomy caused by an intramedullary cord lesion results in confusion in localizing the midline for the myelotomy. Motor evoked potentials(MEPs) consist of spinal, neurogenic and muscle MEPs. MEPs allow selective and specific assessment of the functional integrity of descending motor pathways, from the motor cortex to peripheral muscles. Spinal surgeons should understand the concept of the monitoring techniques and interpret monitoring records adequately to use IOM for the decision making during the surgery for safe surgery and a favorable surgical outcome.
文摘Diabetogenic traits in patients undergoing liver transplantation(LT) are exacerbated intraoperatively by exogenous causes, such as surgical stress, steroids,blood transfusions, and catecholamines, which leadto intraoperative hyperglycemia. In contrast to the strict glucose control performed in the intensive care unit, no systematic protocol has been developed for glucose management during LT. Intraoperative blood glucose concentrations typically exceed 200 mg/dL in LT, and extreme hyperglycemia(> 300 mg/dL) is common during the neohepatic phase. Only a few retrospective studies have examined the relationship between intraoperative hyperglycemia and posttransplant complications, with reports of infectious complications or mortality. However, no prospective studies have been conducted regarding the influence of intraoperative hyperglycemia in LT on post-transplant outcome. In addition to absolute blood glucose values,the temporal patterns in blood glucose levels during LT may serve as prognostic features. Persistent neohepatic hyperglycemia(without a decline) throughout LT is a useful indicator of early graft dysfunction. Moreover,intraoperative variability in glucose levels may predict the need for reoperation for hemorrhage after LT.Thus, there is an urgent need for guidelines for glucose control in these patients, as well as prospective studies on the impact of glucose control on various posttransplant complications. This report highlights some of the recent studies related to perioperative blood glucose management focused on LT and liver disease.
文摘Intraoperative blood salvage autotransfusion (IBSA) is used in various surgical procedures. However, because of the risk of reinfusion of salvaged blood contaminated by tumor cells, the use of IBSA in hepatocellular carcinoma (HCC) patients undergoing liver transplantation (LT) is controversial. The critical points include whether tumor cells can be cleared by IBSA, whether IBSA increases the risk of recurrence or metastasis, and what are the indications for IBSA. Moreover, is it warranted to take the risk of tumor dissemination by using IBSA to avoid allogeneic blood transfusion? Do the remaining tumor cells after additional filtration by leukocyte depletion filters still possess potential tumorigenicity? Does IBSA always work well? We have reviewed the literature and tried to address these questions. The available data indicate that IBSA is safe in LT for HCC, but randomized, controlled and prospective trials are urgently required to clarify the uncertainty.
文摘In the treatment of patients with symptomatic cholelithiasis and choledocholithiasis (CBDS) detected during intraoperative cholangiography (IOC),or when the preoperative study of a patient at intermediate risk for CBDS cannot be completed due to the lack of imaging techniques required for confirmation,or if they are available and yield contradictory radiological and clinical results,patients can be treated using intraoperative endoscopic retrograde cholangiopancreatography (ERCP) during the laparoscopic treatment or postoperative ERCP if the IOC finds CBDS.The choice of treatment depends on the level of experience and availability of each option at each hospital.Intraoperative ERCP has the advantage of being a single-stage treatment and has a significant success rate,an easy learning curve,low morbidity involving a shorter hospital stay and lower costs than the two-stage treatments (postoperative and preoperative ERCP).Intraoperative ERCP is also a good salvage treatment when preoperative ERCP fails or when total laparoscopic management also fails.
