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
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
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
BACKGROUND Prior studies have shown that preserving the left colic artery(LCA)during laparo-scopic radical resection for rectal cancer(RC)can reduce the occurrence of anasto-motic leakage(AL),without compromising onco...BACKGROUND Prior studies have shown that preserving the left colic artery(LCA)during laparo-scopic radical resection for rectal cancer(RC)can reduce the occurrence of anasto-motic leakage(AL),without compromising oncological outcomes.However,anatomical variations in the branches of the inferior mesenteric artery(IMA)and LCA present significant surgical challenges.In this study,we present our novel three dimensional(3D)printed IMA model designed to facilitate preoperative rehearsal and intraoperative navigation to analyze its impact on surgical safety.AIM To investigate the effect of 3D IMA models on preserving the LCA during RC surgery.METHODS We retrospectively collected clinical dates from patients with RC who underwent laparoscopic radical resection from January 2022 to May 2024 at Fuyang People’s Hospital.Patients were divided into the 3D printing and control groups for sta-tistical analysis of perioperative characteristics.RESULTS The 3D printing observation group comprised of 72 patients,while the control group comprised 68 patients.The operation time(174.5±38.2 minutes vs 198.5±49.6 minutes,P=0.002),intraoperative blood loss(43.9±31.3 mL vs 58.2±30.8 mL,P=0.005),duration of hospitalization(13.1±3.1 days vs 15.9±5.6 days,P<0.001),postoperative recovery time(8.6±2.6 days vs 10.5±4.9 days,P=0.007),and the postoperative complication rate(P<0.05)were all significantly lower in the observation group.CONCLUSION Utilization of a 3D-printed IMA model in laparoscopic radical resection of RC can assist surgeons in understanding the LCA anatomy preoperatively,thereby reducing intraoperative bleeding and shortening operating time,demonstrating better clinical application potential.展开更多
Tumor microenvironment(TME)-activatable probes have been proven to effectively increase signal-tobackground ratios(SBRs)and improve the success rate of complete tumor resection.However,many fluorescence probes have to...Tumor microenvironment(TME)-activatable probes have been proven to effectively increase signal-tobackground ratios(SBRs)and improve the success rate of complete tumor resection.However,many fluorescence probes have to be loaded into a nanocarrier for tumor targeted delivery,which consequently encounters poor drug loading,heterogeneous composition and non-encapsulated drug aggregates occurred during nanoformulation fabrications.Herein,a nitroreductase(NTR)-activated“OFF-ON”near-infrared fluorescence nanoprobe,named Nano Bodipy,was synthesized by the spontaneous self-assembling of NTRresponsive dye-polyethylene glycol(PEG)amphiphilic polymer in water.The NTR-responsive dye acted as the hydrophobic segment in the amphiphilic polymer,yielding a homogeneous composition and a high loading of 12.2 wt%(according to calculation)in the synthesized Nano Bodipy.The synthesized Nano Bodipy can efficiently accumulate in tumors via the enhanced permeability and retention(EPR)effect,enabling non-invasive tumor-targeted fluorescence imaging and guiding complete tumor resection.Once the synthesized Nano Bodipy entered the tumor cells,they dissociated and were activated by overexpressed NTR.With the real-time fluorescence guide of Nano Bodipy,complete tumor resection surgery was performed successfully.展开更多
Objective:Complete resection of malignant gliomas is often challenging.Our previous study indicated that intraoperative contrast-enhanced ultrasound(ICEUS)could aid in the detection of residual tumor remnants and the ...Objective:Complete resection of malignant gliomas is often challenging.Our previous study indicated that intraoperative contrast-enhanced ultrasound(ICEUS)could aid in the detection of residual tumor remnants and the total removal of brain lesions.This study aimed to investigate the survival rates of patients undergoing resection with or without the use of ICEUS and to assess the impact of ICEUS on the prognosis of patients with malignant glioma.Methods:A total of 64 patients diagnosed with malignant glioma(WHO grade HI and IV)who underwent surgery between 2012 and 2018 were included.Among them,29 patients received ICEUS.The effects of ICEUS on overall survival(OS)and progression-free survival(PFS)of patients were evaluated.A quantitative analysis was performed to compare ICEUS parameters between gliomas and the surrounding tissues.Results:The ICEUS group showed better survival rates both in OS and PFS than the control group.The univariate analysis revealed that age,pathology and ICEUS were significant prognostic factors for PFS,with only age being a significant prognostic factor for OS.In multivariate analysis,age and ICEUS were significant prognostic factors for both OS and PFS.The quantitative analysis showed that the intensity and transit time of microbubbles reaching the tumors were significantly different from those of microbubbles reaching the surrounding tissue.Conclusion:ICEUS facilitates the identification of residual tumors.Age and ICEUS are prognostic factors for malignant glioma surgery,and use of ICEUS offers a better prognosis for patients with malignant glioma.展开更多
BACKGROUND Surgical resection remains the primary treatment for hepatic malignancies,and intraoperative bleeding is associated with a significantly increased risk of death.Therefore,accurate prediction of intraoperati...BACKGROUND Surgical resection remains the primary treatment for hepatic malignancies,and intraoperative bleeding is associated with a significantly increased risk of death.Therefore,accurate prediction of intraoperative bleeding risk in patients with hepatic malignancies is essential to preventing bleeding in advance and providing safer and more effective treatment.AIM To develop a predictive model for intraoperative bleeding in primary hepatic malignancy patients for improving surgical planning and outcomes.METHODS The retrospective analysis enrolled patients diagnosed with primary hepatic malignancies who underwent surgery at the Hepatobiliary Surgery Department of the Fourth Hospital of Hebei Medical University between 2010 and 2020.Logistic regression analysis was performed to identify potential risk factors for intraoperative bleeding.A prediction model was developed using Python programming language,and its accuracy was evaluated using receiver operating characteristic(ROC)curve analysis.RESULTS Among 406 primary liver cancer patients,16.0%(65/406)suffered massive intraoperative bleeding.Logistic regression analysis identified four variables as associated with intraoperative bleeding in these patients:ascites[odds ratio(OR):22.839;P<0.05],history of alcohol consumption(OR:2.950;P<0.015),TNM staging(OR:2.441;P<0.001),and albumin-bilirubin score(OR:2.361;P<0.001).These variables were used to construct the prediction model.The 406 patients were randomly assigned to a training set(70%)and a prediction set(30%).The area under the ROC curve values for the model’s ability to predict intraoperative bleeding were 0.844 in the training set and 0.80 in the prediction set.CONCLUSION The developed and validated model predicts significant intraoperative blood loss in primary hepatic malignancies using four preoperative clinical factors by considering four preoperative clinical factors:ascites,history of alcohol consumption,TNM staging,and albumin-bilirubin score.Consequently,this model holds promise for enhancing individualised surgical planning.展开更多
BACKGROUND Partial splenic embolization(PSE)has been suggested as an alternative to splenectomy in the treatment of hypersplenism.However,some patients may experience recurrence of hypersplenism after PSE and require ...BACKGROUND Partial splenic embolization(PSE)has been suggested as an alternative to splenectomy in the treatment of hypersplenism.However,some patients may experience recurrence of hypersplenism after PSE and require splenectomy.Currently,there is a lack of evidence-based medical support regarding whether preoperative PSE followed by splenectomy can reduce the incidence of complications.AIM To investigate the safety and therapeutic efficacy of preoperative PSE followed by splenectomy in patients with cirrhosis and hypersplenism.METHODS Between January 2010 and December 2021,321 consecutive patients with cirrhosis and hypersplenism underwent splenectomy at our department.Based on whether PSE was performed prior to splenectomy,the patients were divided into two groups:PSE group(n=40)and non-PSE group(n=281).Patient characteristics,postoperative complications,and follow-up data were compared between groups.Propensity score matching(PSM)was conducted,and univariable and multivariable analyses were used to establish a nomogram predictive model for intraoperative bleeding(IB).The receiver operating characteristic curve,Hosmer-Lemeshow goodness-of-fit test,and decision curve analysis(DCA)were employed to evaluate the differentiation,calibration,and clinical performance of the model.RESULTS After PSM,the non-PSE group showed significant reductions in hospital stay,intraoperative blood loss,and operation time(all P=0.00).Multivariate analysis revealed that spleen length,portal vein diameter,splenic vein diameter,and history of PSE were independent predictive factors for IB.A nomogram predictive model of IB was constructed,and DCA demonstrated the clinical utility of this model.Both groups exhibited similar results in terms of overall survival during the follow-up period.CONCLUSION Preoperative PSE followed by splenectomy may increase the incidence of IB and a nomogram-based prediction model can predict the occurrence of IB.展开更多
BACKGROUND Intraoperative persistent hypotension(IPH)during pancreaticoduodenectomy(PD)is linked to adverse postoperative outcomes,yet its risk factors remain unclear.AIM To clarify the risk factors associated with IP...BACKGROUND Intraoperative persistent hypotension(IPH)during pancreaticoduodenectomy(PD)is linked to adverse postoperative outcomes,yet its risk factors remain unclear.AIM To clarify the risk factors associated with IPH during PD,ensuring patient safety in the perioperative period.METHODS A retrospective analysis of patient records from January 2018 to December 2022 at the First Affiliated Hospital of Nanjing Medical University identified factors associated with IPH in PD.These factors included age,gender,body mass index,American Society of Anesthesiologists classification,comorbidities,medication history,operation duration,fluid balance,blood loss,urine output,and blood gas parameters.IPH was defined as sustained mean arterial pressure<65 mmHg,requiring prolonged deoxyepinephrine infusion for>30 min despite additional deoxyepinephrine and fluid treatments.RESULTS Among 1596 PD patients,661(41.42%)experienced IPH.Multivariate logistic regression identified key risk factors:increased age[odds ratio(OR):1.20 per decade,95%confidence interval(CI):1.08-1.33](P<0.001),longer surgery duration(OR:1.15 per additional hour,95%CI:1.05-1.26)(P<0.01),and greater blood loss(OR:1.18 per 250-mL increment,95%CI:1.06-1.32)(P<0.01).A novel finding was the association of arterial blood Ca^(2+)<1.05 mmol/L with IPH(OR:2.03,95%CI:1.65-2.50)(P<0.001).CONCLUSION IPH during PD is independently associated with older age,prolonged surgery,increased blood loss,and lower plasma Ca^(2+).展开更多
BACKGROUND Intraoperative fluid management is an important aspect of anesthesia mana-gement in gastrointestinal surgery.Intraoperative goal-directed fluid therapy(GDFT)is a method for optimizing a patient's physio...BACKGROUND Intraoperative fluid management is an important aspect of anesthesia mana-gement in gastrointestinal surgery.Intraoperative goal-directed fluid therapy(GDFT)is a method for optimizing a patient's physiological state by monitoring and regulating fluid input in real-time.AIM To evaluate the efficacy of intraoperative GDFT in patients under anesthesia for gastrointestinal surgery.METHODS This study utilized a retrospective comparative study design and included 60 patients who underwent gastrointestinal surgery at a hospital.The experimental group(GDFT group)and the control group,each comprising 30 patients,received intraoperative GDFT and traditional fluid management strategies,respectively.The effect of GDFT was evaluated by comparing postoperative recovery,com-plication rates,hospitalization time,and other indicators between the two patient groups.RESULTS Intraoperative blood loss in the experimental and control groups was 296.64±46.71 mL and 470.05±73.26 mL(P<0.001),and urine volume was 415.13±96.72 mL and 239.15±94.69 mL(P<0.001),respectively.The postoperative recovery time was 5.44±1.1 days for the experimental group compared to 7.59±1.45 days(P<0.001)for the control group.Hospitalization time for the experimental group was 10.87±2.36 days vs 13.65±3 days for the control group(P<0.001).The visual analogue scale scores of the experimental and control groups at 24 h and 48 h INTRODUCTION Gastrointestinal surgery is one of the most common procedures in the field of general surgery[1],involving the stomach,intestines,liver,pancreas,spleen,and other internal abdominal organs[2,3].With advancements in surgical technology and anesthesia methods,the safety and success rates of surgery have significantly improved[4,5].However,intraop-erative fluid management remains a critical challenge[6].Traditional fluid management strategies often rely on experience and basic physiological parameters,which may lead to excessive or insufficient fluid input,thereby affecting postoperative recovery and complication rates.Intraoperative goal-directed fluid therapy(GDFT)is an emerging fluid management strategy that dynamically adjusts fluid input volume by monitoring the patient's hemodynamic parameters in real-time to optimize the patient's physiological state[7,8].GDFT has shown superiority in many surgical fields;however,its application in gastrointestinal surgery requires further research and verification[9,10].The application of intraoperative GDFT in clinical settings has gradually increased in recent years[11,12].Studies have demonstrated that GDFT can optimize tissue perfusion and oxygenation by precisely controlling fluid input and reducing the occurrence of postoperative complications[13,14].For example,in cardiac and major vascular surgeries,GDFT significantly reduced the incidence of postoperative acute kidney injury and cardiovascular events[15,16].Similarly,in abdominal surgery,GDFT effectively reduced postoperative infections and expedited recovery[17].However,studies on the utilization of GDFT in gastrointestinal surgery are relatively limited and they are confounded by contradictory findings[18].Traditional fluid management strategies typically rely on estimating fluid input volume based on the patient's weight,preoperative status,and basic physiological parameters[19].However,this method lacks real-time dynamic adjustment,which may result in either insufficient or excessive fluid input,consequently affecting postoperative recovery.Insufficient fluid input can lead to hypovolemia and inadequate tissue perfusion,whereas excessive fluid input can cause tissue edema and postoperative complications,such as pulmonary edema and heart failure.GDFT involves dynamically adjusting fluid input volume by monitoring the patient's hemodynamic parameters in real-time,such as cardiac output,pulse pressure variability,and central venous pressure.Commonly used monitoring equipment include esophageal Doppler and pulse wave profile analyzers[20].These devices provide real-time hemo-dynamic data to assist anesthesiologists in tailoring fluid therapy to a patient's specific condition.Firstly,the patient's volume responsiveness is assessed by preloading fluid;secondly,fluid input volume is dynamically adjusted based on real-time monitoring data;finally,vasoactive and inotropic drugs are administered in combination to further optimize the patient’s hemodynamic status.Through personalized fluid management,GDFT can more accurately maintain intraop-erative hemodynamic stability and reduce complications[21].Gastrointestinal surgery involves procedures on multiple organs,often requiring prolonged operative times and extensive tissue trauma,which presents challenges for intraop-erative fluid management.Surgical procedures can lead to significant bleeding and fluid loss,requiring prompt and effective fluid replenishment.In addition,the slow recovery of gastrointestinal function after surgery and susceptibility to complications such as intestinal obstruction and delayed gastric emptying elevate the necessity for postoperative fluid management.展开更多
Background: We present a compelling case fitting the phenomenon of cortical spreading depression detected by intraoperative neurophysiological monitoring (IONM) following an intraoperative seizure during a craniotomy ...Background: We present a compelling case fitting the phenomenon of cortical spreading depression detected by intraoperative neurophysiological monitoring (IONM) following an intraoperative seizure during a craniotomy for revascularization. Cortical spreading depression (CSD, also called cortical spreading depolarization) is a pathophysiological phenomenon whereby a wave of depolarization is thought to propagate across the cerebral cortex, creating a brief period of relative neuronal inactivity. The relationship between CSD and seizures is unclear, although some literature has made a correlation between seizures and a cortical environment conducive to CSD. Methods: Intraoperative somatosensory evoked potentials (SSEPs) and electroencephalography (EEG) were monitored continuously during the craniotomy procedure utilizing standard montages. Electrophysiological data from pre-ictal, ictal, and post-ictal periods were recorded. Results: During the procedure, intraoperative EEG captured a generalized seizure followed by a stepwise decrease in somatosensory evoked potential cortical amplitudes, compelling for the phenomenon of CSD. The subsequent partial recovery of neuronal function was also captured electrophysiologically. Discussion: While CSD is considered controversial in some aspects, intraoperative neurophysiological monitoring allowed for the unique analysis of a case demonstrating a CSD-like phenomenon. To our knowledge, this is the first published example of this phenomenon in which intraoperative neurophysiological monitoring captured a seizure, along with a stepwise subsequent reduction in SSEP cortical amplitudes not explained by other variables.展开更多
Objective: To explore the necessity and strategy of intraoperative freezing to identify primary and metastatic adenocarcinoma of the lung. Methods: This study retrospectively analyzes the impact of failing to make a d...Objective: To explore the necessity and strategy of intraoperative freezing to identify primary and metastatic adenocarcinoma of the lung. Methods: This study retrospectively analyzes the impact of failing to make a definitive diagnosis of metastatic adenocarcinoma of the lung on the clinical surgical approach in four cases of intraoperative freezing. It also examines the reasons for this failure and reviews the relevant literature. Results: All 4 cases of intraoperative freezing were diagnosed as invasive adenocarcinoma, and none of them made a definitive diagnosis of metastatic adenocarcinoma. Conclusion: It is difficult to confirm the diagnosis of metastatic adenocarcinoma of the lung by intraoperative frozen section, and the combination of patient history, rapid immunohistochemistry, and histological morphology of intraoperative frozen section for its identification can guide the surgeon to adjust the surgical approach in time and provide evidence for the establishment of surgical protocols for reference.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
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
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 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.
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.
基金Supported by the Health Commission of Fuyang City,No.FY2021-18Bengbu Medical College of Bengbu City,No.2023byzd215the Health Commission Anhui Provence,No.AHWJ2023BAa20164.
文摘BACKGROUND Prior studies have shown that preserving the left colic artery(LCA)during laparo-scopic radical resection for rectal cancer(RC)can reduce the occurrence of anasto-motic leakage(AL),without compromising oncological outcomes.However,anatomical variations in the branches of the inferior mesenteric artery(IMA)and LCA present significant surgical challenges.In this study,we present our novel three dimensional(3D)printed IMA model designed to facilitate preoperative rehearsal and intraoperative navigation to analyze its impact on surgical safety.AIM To investigate the effect of 3D IMA models on preserving the LCA during RC surgery.METHODS We retrospectively collected clinical dates from patients with RC who underwent laparoscopic radical resection from January 2022 to May 2024 at Fuyang People’s Hospital.Patients were divided into the 3D printing and control groups for sta-tistical analysis of perioperative characteristics.RESULTS The 3D printing observation group comprised of 72 patients,while the control group comprised 68 patients.The operation time(174.5±38.2 minutes vs 198.5±49.6 minutes,P=0.002),intraoperative blood loss(43.9±31.3 mL vs 58.2±30.8 mL,P=0.005),duration of hospitalization(13.1±3.1 days vs 15.9±5.6 days,P<0.001),postoperative recovery time(8.6±2.6 days vs 10.5±4.9 days,P=0.007),and the postoperative complication rate(P<0.05)were all significantly lower in the observation group.CONCLUSION Utilization of a 3D-printed IMA model in laparoscopic radical resection of RC can assist surgeons in understanding the LCA anatomy preoperatively,thereby reducing intraoperative bleeding and shortening operating time,demonstrating better clinical application potential.
基金supported by the National Natural Science Foundation of China(Nos.51903201,82172798)the Natural Science Foundation of Shaanxi Province(No.2023-YBSF-270)+1 种基金the Open Program of NHC Key Laboratory of Nuclear Medicine and Jiangsu Key Laboratory of Molecular Nuclear Medicine(No.KF202203)Horizontal Project of the First Affiliated Hospital of Xi'an Jiaotong University(No.202304174)。
文摘Tumor microenvironment(TME)-activatable probes have been proven to effectively increase signal-tobackground ratios(SBRs)and improve the success rate of complete tumor resection.However,many fluorescence probes have to be loaded into a nanocarrier for tumor targeted delivery,which consequently encounters poor drug loading,heterogeneous composition and non-encapsulated drug aggregates occurred during nanoformulation fabrications.Herein,a nitroreductase(NTR)-activated“OFF-ON”near-infrared fluorescence nanoprobe,named Nano Bodipy,was synthesized by the spontaneous self-assembling of NTRresponsive dye-polyethylene glycol(PEG)amphiphilic polymer in water.The NTR-responsive dye acted as the hydrophobic segment in the amphiphilic polymer,yielding a homogeneous composition and a high loading of 12.2 wt%(according to calculation)in the synthesized Nano Bodipy.The synthesized Nano Bodipy can efficiently accumulate in tumors via the enhanced permeability and retention(EPR)effect,enabling non-invasive tumor-targeted fluorescence imaging and guiding complete tumor resection.Once the synthesized Nano Bodipy entered the tumor cells,they dissociated and were activated by overexpressed NTR.With the real-time fluorescence guide of Nano Bodipy,complete tumor resection surgery was performed successfully.
基金funded by grants from the Natural Science Foundation of Hubei Province,China(No.2022CFB307)and the Foundation of Tongji Hospital(No.2020JZKT292).
文摘Objective:Complete resection of malignant gliomas is often challenging.Our previous study indicated that intraoperative contrast-enhanced ultrasound(ICEUS)could aid in the detection of residual tumor remnants and the total removal of brain lesions.This study aimed to investigate the survival rates of patients undergoing resection with or without the use of ICEUS and to assess the impact of ICEUS on the prognosis of patients with malignant glioma.Methods:A total of 64 patients diagnosed with malignant glioma(WHO grade HI and IV)who underwent surgery between 2012 and 2018 were included.Among them,29 patients received ICEUS.The effects of ICEUS on overall survival(OS)and progression-free survival(PFS)of patients were evaluated.A quantitative analysis was performed to compare ICEUS parameters between gliomas and the surrounding tissues.Results:The ICEUS group showed better survival rates both in OS and PFS than the control group.The univariate analysis revealed that age,pathology and ICEUS were significant prognostic factors for PFS,with only age being a significant prognostic factor for OS.In multivariate analysis,age and ICEUS were significant prognostic factors for both OS and PFS.The quantitative analysis showed that the intensity and transit time of microbubbles reaching the tumors were significantly different from those of microbubbles reaching the surrounding tissue.Conclusion:ICEUS facilitates the identification of residual tumors.Age and ICEUS are prognostic factors for malignant glioma surgery,and use of ICEUS offers a better prognosis for patients with malignant glioma.
文摘BACKGROUND Surgical resection remains the primary treatment for hepatic malignancies,and intraoperative bleeding is associated with a significantly increased risk of death.Therefore,accurate prediction of intraoperative bleeding risk in patients with hepatic malignancies is essential to preventing bleeding in advance and providing safer and more effective treatment.AIM To develop a predictive model for intraoperative bleeding in primary hepatic malignancy patients for improving surgical planning and outcomes.METHODS The retrospective analysis enrolled patients diagnosed with primary hepatic malignancies who underwent surgery at the Hepatobiliary Surgery Department of the Fourth Hospital of Hebei Medical University between 2010 and 2020.Logistic regression analysis was performed to identify potential risk factors for intraoperative bleeding.A prediction model was developed using Python programming language,and its accuracy was evaluated using receiver operating characteristic(ROC)curve analysis.RESULTS Among 406 primary liver cancer patients,16.0%(65/406)suffered massive intraoperative bleeding.Logistic regression analysis identified four variables as associated with intraoperative bleeding in these patients:ascites[odds ratio(OR):22.839;P<0.05],history of alcohol consumption(OR:2.950;P<0.015),TNM staging(OR:2.441;P<0.001),and albumin-bilirubin score(OR:2.361;P<0.001).These variables were used to construct the prediction model.The 406 patients were randomly assigned to a training set(70%)and a prediction set(30%).The area under the ROC curve values for the model’s ability to predict intraoperative bleeding were 0.844 in the training set and 0.80 in the prediction set.CONCLUSION The developed and validated model predicts significant intraoperative blood loss in primary hepatic malignancies using four preoperative clinical factors by considering four preoperative clinical factors:ascites,history of alcohol consumption,TNM staging,and albumin-bilirubin score.Consequently,this model holds promise for enhancing individualised surgical planning.
基金Supported by National Natural Science Foundations of China,No.82174160and Anhui Natural Science Foundation,No.2008085QH389。
文摘BACKGROUND Partial splenic embolization(PSE)has been suggested as an alternative to splenectomy in the treatment of hypersplenism.However,some patients may experience recurrence of hypersplenism after PSE and require splenectomy.Currently,there is a lack of evidence-based medical support regarding whether preoperative PSE followed by splenectomy can reduce the incidence of complications.AIM To investigate the safety and therapeutic efficacy of preoperative PSE followed by splenectomy in patients with cirrhosis and hypersplenism.METHODS Between January 2010 and December 2021,321 consecutive patients with cirrhosis and hypersplenism underwent splenectomy at our department.Based on whether PSE was performed prior to splenectomy,the patients were divided into two groups:PSE group(n=40)and non-PSE group(n=281).Patient characteristics,postoperative complications,and follow-up data were compared between groups.Propensity score matching(PSM)was conducted,and univariable and multivariable analyses were used to establish a nomogram predictive model for intraoperative bleeding(IB).The receiver operating characteristic curve,Hosmer-Lemeshow goodness-of-fit test,and decision curve analysis(DCA)were employed to evaluate the differentiation,calibration,and clinical performance of the model.RESULTS After PSM,the non-PSE group showed significant reductions in hospital stay,intraoperative blood loss,and operation time(all P=0.00).Multivariate analysis revealed that spleen length,portal vein diameter,splenic vein diameter,and history of PSE were independent predictive factors for IB.A nomogram predictive model of IB was constructed,and DCA demonstrated the clinical utility of this model.Both groups exhibited similar results in terms of overall survival during the follow-up period.CONCLUSION Preoperative PSE followed by splenectomy may increase the incidence of IB and a nomogram-based prediction model can predict the occurrence of IB.
文摘BACKGROUND Intraoperative persistent hypotension(IPH)during pancreaticoduodenectomy(PD)is linked to adverse postoperative outcomes,yet its risk factors remain unclear.AIM To clarify the risk factors associated with IPH during PD,ensuring patient safety in the perioperative period.METHODS A retrospective analysis of patient records from January 2018 to December 2022 at the First Affiliated Hospital of Nanjing Medical University identified factors associated with IPH in PD.These factors included age,gender,body mass index,American Society of Anesthesiologists classification,comorbidities,medication history,operation duration,fluid balance,blood loss,urine output,and blood gas parameters.IPH was defined as sustained mean arterial pressure<65 mmHg,requiring prolonged deoxyepinephrine infusion for>30 min despite additional deoxyepinephrine and fluid treatments.RESULTS Among 1596 PD patients,661(41.42%)experienced IPH.Multivariate logistic regression identified key risk factors:increased age[odds ratio(OR):1.20 per decade,95%confidence interval(CI):1.08-1.33](P<0.001),longer surgery duration(OR:1.15 per additional hour,95%CI:1.05-1.26)(P<0.01),and greater blood loss(OR:1.18 per 250-mL increment,95%CI:1.06-1.32)(P<0.01).A novel finding was the association of arterial blood Ca^(2+)<1.05 mmol/L with IPH(OR:2.03,95%CI:1.65-2.50)(P<0.001).CONCLUSION IPH during PD is independently associated with older age,prolonged surgery,increased blood loss,and lower plasma Ca^(2+).
文摘BACKGROUND Intraoperative fluid management is an important aspect of anesthesia mana-gement in gastrointestinal surgery.Intraoperative goal-directed fluid therapy(GDFT)is a method for optimizing a patient's physiological state by monitoring and regulating fluid input in real-time.AIM To evaluate the efficacy of intraoperative GDFT in patients under anesthesia for gastrointestinal surgery.METHODS This study utilized a retrospective comparative study design and included 60 patients who underwent gastrointestinal surgery at a hospital.The experimental group(GDFT group)and the control group,each comprising 30 patients,received intraoperative GDFT and traditional fluid management strategies,respectively.The effect of GDFT was evaluated by comparing postoperative recovery,com-plication rates,hospitalization time,and other indicators between the two patient groups.RESULTS Intraoperative blood loss in the experimental and control groups was 296.64±46.71 mL and 470.05±73.26 mL(P<0.001),and urine volume was 415.13±96.72 mL and 239.15±94.69 mL(P<0.001),respectively.The postoperative recovery time was 5.44±1.1 days for the experimental group compared to 7.59±1.45 days(P<0.001)for the control group.Hospitalization time for the experimental group was 10.87±2.36 days vs 13.65±3 days for the control group(P<0.001).The visual analogue scale scores of the experimental and control groups at 24 h and 48 h INTRODUCTION Gastrointestinal surgery is one of the most common procedures in the field of general surgery[1],involving the stomach,intestines,liver,pancreas,spleen,and other internal abdominal organs[2,3].With advancements in surgical technology and anesthesia methods,the safety and success rates of surgery have significantly improved[4,5].However,intraop-erative fluid management remains a critical challenge[6].Traditional fluid management strategies often rely on experience and basic physiological parameters,which may lead to excessive or insufficient fluid input,thereby affecting postoperative recovery and complication rates.Intraoperative goal-directed fluid therapy(GDFT)is an emerging fluid management strategy that dynamically adjusts fluid input volume by monitoring the patient's hemodynamic parameters in real-time to optimize the patient's physiological state[7,8].GDFT has shown superiority in many surgical fields;however,its application in gastrointestinal surgery requires further research and verification[9,10].The application of intraoperative GDFT in clinical settings has gradually increased in recent years[11,12].Studies have demonstrated that GDFT can optimize tissue perfusion and oxygenation by precisely controlling fluid input and reducing the occurrence of postoperative complications[13,14].For example,in cardiac and major vascular surgeries,GDFT significantly reduced the incidence of postoperative acute kidney injury and cardiovascular events[15,16].Similarly,in abdominal surgery,GDFT effectively reduced postoperative infections and expedited recovery[17].However,studies on the utilization of GDFT in gastrointestinal surgery are relatively limited and they are confounded by contradictory findings[18].Traditional fluid management strategies typically rely on estimating fluid input volume based on the patient's weight,preoperative status,and basic physiological parameters[19].However,this method lacks real-time dynamic adjustment,which may result in either insufficient or excessive fluid input,consequently affecting postoperative recovery.Insufficient fluid input can lead to hypovolemia and inadequate tissue perfusion,whereas excessive fluid input can cause tissue edema and postoperative complications,such as pulmonary edema and heart failure.GDFT involves dynamically adjusting fluid input volume by monitoring the patient's hemodynamic parameters in real-time,such as cardiac output,pulse pressure variability,and central venous pressure.Commonly used monitoring equipment include esophageal Doppler and pulse wave profile analyzers[20].These devices provide real-time hemo-dynamic data to assist anesthesiologists in tailoring fluid therapy to a patient's specific condition.Firstly,the patient's volume responsiveness is assessed by preloading fluid;secondly,fluid input volume is dynamically adjusted based on real-time monitoring data;finally,vasoactive and inotropic drugs are administered in combination to further optimize the patient’s hemodynamic status.Through personalized fluid management,GDFT can more accurately maintain intraop-erative hemodynamic stability and reduce complications[21].Gastrointestinal surgery involves procedures on multiple organs,often requiring prolonged operative times and extensive tissue trauma,which presents challenges for intraop-erative fluid management.Surgical procedures can lead to significant bleeding and fluid loss,requiring prompt and effective fluid replenishment.In addition,the slow recovery of gastrointestinal function after surgery and susceptibility to complications such as intestinal obstruction and delayed gastric emptying elevate the necessity for postoperative fluid management.
文摘Background: We present a compelling case fitting the phenomenon of cortical spreading depression detected by intraoperative neurophysiological monitoring (IONM) following an intraoperative seizure during a craniotomy for revascularization. Cortical spreading depression (CSD, also called cortical spreading depolarization) is a pathophysiological phenomenon whereby a wave of depolarization is thought to propagate across the cerebral cortex, creating a brief period of relative neuronal inactivity. The relationship between CSD and seizures is unclear, although some literature has made a correlation between seizures and a cortical environment conducive to CSD. Methods: Intraoperative somatosensory evoked potentials (SSEPs) and electroencephalography (EEG) were monitored continuously during the craniotomy procedure utilizing standard montages. Electrophysiological data from pre-ictal, ictal, and post-ictal periods were recorded. Results: During the procedure, intraoperative EEG captured a generalized seizure followed by a stepwise decrease in somatosensory evoked potential cortical amplitudes, compelling for the phenomenon of CSD. The subsequent partial recovery of neuronal function was also captured electrophysiologically. Discussion: While CSD is considered controversial in some aspects, intraoperative neurophysiological monitoring allowed for the unique analysis of a case demonstrating a CSD-like phenomenon. To our knowledge, this is the first published example of this phenomenon in which intraoperative neurophysiological monitoring captured a seizure, along with a stepwise subsequent reduction in SSEP cortical amplitudes not explained by other variables.
文摘Objective: To explore the necessity and strategy of intraoperative freezing to identify primary and metastatic adenocarcinoma of the lung. Methods: This study retrospectively analyzes the impact of failing to make a definitive diagnosis of metastatic adenocarcinoma of the lung on the clinical surgical approach in four cases of intraoperative freezing. It also examines the reasons for this failure and reviews the relevant literature. Results: All 4 cases of intraoperative freezing were diagnosed as invasive adenocarcinoma, and none of them made a definitive diagnosis of metastatic adenocarcinoma. Conclusion: It is difficult to confirm the diagnosis of metastatic adenocarcinoma of the lung by intraoperative frozen section, and the combination of patient history, rapid immunohistochemistry, and histological morphology of intraoperative frozen section for its identification can guide the surgeon to adjust the surgical approach in time and provide evidence for the establishment of surgical protocols for reference.
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.
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.
