BACKGROUND Robotic resection using the natural orifice specimen extraction surgery I-type F method(R-NOSES I-F)is a novel minimally invasive surgical strategy for the treatment of lower rectal cancer.However,the curre...BACKGROUND Robotic resection using the natural orifice specimen extraction surgery I-type F method(R-NOSES I-F)is a novel minimally invasive surgical strategy for the treatment of lower rectal cancer.However,the current literature on this method is limited to case reports,and further investigation into its safety and feasibility is warranted.AIM To evaluate the safety and feasibility of R-NOSES I-F for the treatment of low rectal cancer.METHODS From September 2018 to February 2022,206 patients diagnosed with low rectal cancer at First Affiliated Hospital of Nanchang University were included in this retrospective analysis.Of these patients,22 underwent R-NOSES I-F surgery(RNOSES I-F group)and 76 underwent conventional robotic-assisted low rectal cancer resection(RLRC group).Clinicopathological data of all patients were collected and analyzed.Postoperative outcomes and prognoses were compared between the two groups.Statistical analysis was performed using SPSS software.RESULTS Patients in the R-NOSES I-F group had a significantly lower visual analog score for pain on postoperative day 1(1.7±0.7 vs 2.2±0.6,P=0.003)and shorter postoperative anal venting time(2.7±0.6 vs 3.5±0.7,P<0.001)than those in the RLRC group.There were no significant differences between the two groups in terms of sex,age,body mass index,tumor size,TNM stage,operative time,intrao-perative bleeding,postoperative complications,or inflammatory response(P>0.05).Postoperative anal and urinary functions,as assessed by Wexner,low anterior resection syndrome,and International Prostate Symptom Scale scores,were similar in both groups(P>0.05).Long-term follow-up revealed no significant differences in the rates of local recurrence and distant metastasis between the two groups(P>0.05).CONCLUSION R-NOSES I-F is a safe and effective minimally invasive procedure for the treatment of lower rectal cancer.It improves pain relief,promotes gastrointestinal function recovery,and helps avoid incision-related complications.展开更多
BACKGROUND The number of population-based studies on unclassified inflammatory bowel disease(IBD-U)is very limited.AIM To evaluate the long-term incidence,disease course and surgery rates of IBD-U in a prospective pop...BACKGROUND The number of population-based studies on unclassified inflammatory bowel disease(IBD-U)is very limited.AIM To evaluate the long-term incidence,disease course and surgery rates of IBD-U in a prospective population-based cohort.METHODSThe present study is a continuation of the well-established Veszprem IBD cohort with patient inclusion between1977 and 2018. Both in-hospital and outpatient records were collected. The source of age- and gender-specificdemographic data was derived from the Hungarian Central Statistical Office. Medical therapy, surgery and changein disease phenotype were analyzed.RESULTSData of 119 incident IBD-U patients were analyzed [male/female: 55/64;median age at diagnosis: 34 years(interquartile range: 24-47.5)]. Adjusted mean incidence rate was 0.76 (95%CI: 0.63-0.9)/105 person-years in the totalstudy period. Disease extent at diagnosis was extensive (pancolitis) in 56.3%. Twenty-two of 119 (18.5%) patientswere reclassified to Crohn’s disease during follow up, the probability of developing terminal ileum involvementwas 6.8%, while perianal disease developed in 5% (n = 6). The probability of receiving biological therapy in patientsdiagnosed after the year 2000 (n = 62), was 15.5% (SD: 4.8) at 5 years. The overall resective surgery rate was 16.8%.Segment resection was performed in 5.0% of the patients, and 11.8% underwent subtotal or total colectomy. Thecumulative probability of resective surgery was 7.6% (SD: 2.4) at 1 year, 9.3% (SD: 2.7) at 5 years, 13.5% (SD: 3.3) at10 years, and 18.5% (SD: 3.9) at 20 years.CONCLUSIONThese data extend our knowledge on the overall burden of IBD-U. Colonic involvement was extensive in a highproportion of IBD-U. Disease reclassification to Crohn’s disease was relatively high. High rates of biologicaltherapy and surgery rates support a relatively severe disease course of IBD-U.展开更多
Many patients with Crohn’s disease (CD) require surgery. Indications for surgery include failure of medical treatment, bowel obstruction, fistula or abscess formation. The most common surgical procedure is...Many patients with Crohn’s disease (CD) require surgery. Indications for surgery include failure of medical treatment, bowel obstruction, fistula or abscess formation. The most common surgical procedure is resection. In jejunoileal CD, strictureplasty is an accepted surgical technique that relieves the obstructive symptoms, while preserving intestinal length and avoiding the development of short bowel syndrome. However, the role of strictureplasty in duodenal and colonic diseases remains controversial. In extensive colitis, after total colectomy with ileorectal anastomosis (IRA), the recurrence rates and functional outcomes are reasonable. For patients with extensive colitis and rectal involvement, total colectomy and end-ileostomy is safe and effective; however, a few patients can have subsequent IRA, and half of the patients will require proctectomy later. Proctocolectomy is associated with a high incidence of delayed perineal wound healing, but it carries a low recurrence rate. Patients undergoing proctocolectomy with ileal pouch-anal anastomosis had poor functional outcomes and high failure rates. Laparoscopic surgery has been introduced as a minimal invasive procedure. Patients who undergo laparoscopic surgery have a more rapid recovery of bowel function and a shorter hospital stay. The morbidity also is lower, and the rate of disease recurrence is similar compared with open procedures.展开更多
Background: In patients undergoing pneumonectomy, intraoperative pulmonary and cardiac complications are the major cause of morbidity and mortality. Protective lung ventilation strategies may decrease the overall lung...Background: In patients undergoing pneumonectomy, intraoperative pulmonary and cardiac complications are the major cause of morbidity and mortality. Protective lung ventilation strategies may decrease the overall lung injury. Right, ventricular dysfunction may occur during the surgery and after the pneumonectomy, in the early postoperative period, with reduced RV ejection fraction and increased RV end-diastolic volume index, caused by increased RV afterload. Case report: We describe the case of a 28-year-old non-smoker female who underwent to a right pneumonectomy. The patient presented intraoperative hemodynamic instability and signs of RV dysfunction, requiring vasoactive amines and nitric oxide. Discussion: This article is intended to provide an overview of the anesthetic management for pneumonectomy including the hemodynamic management and considerations of the causes and management of right ventricular dysfunction.展开更多
Aim:To evaluate the perioperative outcomes and postoperative survival of applying staging laparoscopy(SL)in intrahepatic cholangiocarcinoma(ICC)patients undergoing surgical resection.Methods:A retrospective analysis w...Aim:To evaluate the perioperative outcomes and postoperative survival of applying staging laparoscopy(SL)in intrahepatic cholangiocarcinoma(ICC)patients undergoing surgical resection.Methods:A retrospective analysis was performed on all selected ICC patients who underwent curative-intent resection with/without applying staging laparoscopy from January 2010 to August December 2021.Perioperative outcomes and postoperative survival were analyzed.Propensity score matching(PSM)and inverse probability of treatment weighting(IPTW)were performed to reduce the bias due to confounding variables in the SL group and the non-SL group.Multivariate Cox analysis was used to ascertain the independent predictor of survival for ICC patients.Results:A total of 279 patients(24.1%)were included in the SL group,while 881 patients(75.9%)were included in the non-SL group.Compared with the non-SL group,the SL group had lower blood loss,smaller tumor size,higher R0 resection rate,and shorter hospital stay,but a higher incidence of postoperative complications.The OS of the SL group was better than that of the non-SL group(Median OS:31 months vs.20 months).The 1-,3-,and 5-year overall survival rates of the SL group were 77.9%,45.1%,and 32.9%,respectively,while the non-SL group had rates of 63.9%,31.3%,and 18.4%.SL was confirmed as an independent predictor of survival by multivariate Cox analysis.Conclusion:ICC patients receiving SL had better perioperative outcomes and significantly prolonged overall survival after resection surgery.The subgroup analysis results support the use of routine SL.展开更多
Background It is a surgical dilemma when patients present with both severe heart disease and neoplasms. The best surgical treatment remains controversial. This study aimed to analyze the early and long-term results of...Background It is a surgical dilemma when patients present with both severe heart disease and neoplasms. The best surgical treatment remains controversial. This study aimed to analyze the early and long-term results of simultaneous surgical treatment of severe heart disease and neoplasms. Methods We reviewed the clinical records of 15 patients who underwent simultaneous neoplastic resection and cardiac surgery between September 2006 and January 2011. There were 5 male and 10 female patients. The mean age was （59.2±12.5） years and the mean left ventricular ejection fraction was （57.4±11.0）%. All patients were followed up completely for a period of 12 to 51 months （mean, （33.1±11.2） months）. Results Fifteen patients underwent simultaneous cardiac surgery and neoplastic resection. Cardiac procedures consisted of off pump coronary artery bypass grafting （n=7）, aortic valve replacement （n=3）, mitral valve replacement （n=3）, mitral valve replacement with coronary artery bypass grafting （n=1） and left atrial myxoma resection （n=1）. Neoplastic resection consisted of lung cancer resection （n=5）, colonic cancer resection （n=3）, gallbladder resection （n=1）, colonic cancer resection with gallbladder resection （n=1）, hysterectomy （n=2）, hysterectomy with bilateral salpingo-oophorectomy （n=2） and left ovariectomy （n=1）. Pathological examination confirmed malignant disease in 10 patients and benign disease in 5 patients. There were no perioperative myocardial infarctions, stroke, pericardial tamponade, renal failure or hospital deaths. The most frequent complications were atrial fibrillation （33.3%）, pneumonia （26.7%）, low cardiac output syndrome （6.7%） and delayed healing of surgical wounds （6.7%）. There was 1 late death 42 months after surgery for recurrent malignant disease. At 1 and 3 years, survival rates were 100% （Kaplan-Meier method）. Conclusions Simultaneous cardiac surgery and neoplastic resection was not associated with increased early or late morbidity or mortality. Cardiopulmonary bypass does not appear to adversely affect survival in patients with malignant disease. The long-term survival was determined by tumor stage.展开更多
Background Temporal lobe epilepsy is one of the most common types of partial epilepsy.Although surgical treatment has led to signifcant improvements in seizure-free rates,nearly one-third of patients still have poor s...Background Temporal lobe epilepsy is one of the most common types of partial epilepsy.Although surgical treatment has led to signifcant improvements in seizure-free rates,nearly one-third of patients still have poor seizure control after surgery.Moreover,the long-term outcome is less favorable compared to short-term outcome,with 48-58%of patients experiencing seizures fve years after surgery.The aim of this study was to investigate the surgical outcomes and the predictive value of prognostic factors associated with poor surgical outcomes in temporal lobe epilepsy patients receiving surgery.Methods We retrospectively reviewed 94 patients undergoing temporal resective surgery in the Epilepsy Center of Guangdong Provincial Hospital of Traditional Chinese Medicine between July 2016 and July 2020.Patient information including age,gender,personal and family history,as well as preoperative and postoperative clinical data(clinical type and duration of disease)was collected.Results The diferences of postoperative clinical efcacy in both seizure free group and non-seizure free group patients were observed.A log-rank test was used for univariate analysis,and a Cox proportional hazard model was used for multivariate analysis.Ninety-four patients were followed up for at least 1 years.At 12 months of followup,71(75.5%)patients achieved Engel class I,5(5.3%)patients were classifed as Engel class II,5(5.3%)patients were classifed as Engel class Ⅲ,and 13(13.8%)patients were classifed as Engel class IV.Univariate analysis and multivariate Cox regression analysis indicated that the postoperative EEG abnormalities were signifcantly correlated with seizure recurrence and were signifcant independent predictive factors,with a hazard ratio of 12.940.Conclusions The relapse rate in our study was similar to commonly reported overall rates in temporal lobe epilepsy patients receiving surgery.Anterior temporal lobectomy is a reliable treatment option for temporal lobe epilepsy patients.Postoperative electroencephalograph abnormalities are independent risk factors for poor surgical prognosis.展开更多
基金National Natural Science Foundation of China,No.81860519.
文摘BACKGROUND Robotic resection using the natural orifice specimen extraction surgery I-type F method(R-NOSES I-F)is a novel minimally invasive surgical strategy for the treatment of lower rectal cancer.However,the current literature on this method is limited to case reports,and further investigation into its safety and feasibility is warranted.AIM To evaluate the safety and feasibility of R-NOSES I-F for the treatment of low rectal cancer.METHODS From September 2018 to February 2022,206 patients diagnosed with low rectal cancer at First Affiliated Hospital of Nanchang University were included in this retrospective analysis.Of these patients,22 underwent R-NOSES I-F surgery(RNOSES I-F group)and 76 underwent conventional robotic-assisted low rectal cancer resection(RLRC group).Clinicopathological data of all patients were collected and analyzed.Postoperative outcomes and prognoses were compared between the two groups.Statistical analysis was performed using SPSS software.RESULTS Patients in the R-NOSES I-F group had a significantly lower visual analog score for pain on postoperative day 1(1.7±0.7 vs 2.2±0.6,P=0.003)and shorter postoperative anal venting time(2.7±0.6 vs 3.5±0.7,P<0.001)than those in the RLRC group.There were no significant differences between the two groups in terms of sex,age,body mass index,tumor size,TNM stage,operative time,intrao-perative bleeding,postoperative complications,or inflammatory response(P>0.05).Postoperative anal and urinary functions,as assessed by Wexner,low anterior resection syndrome,and International Prostate Symptom Scale scores,were similar in both groups(P>0.05).Long-term follow-up revealed no significant differences in the rates of local recurrence and distant metastasis between the two groups(P>0.05).CONCLUSION R-NOSES I-F is a safe and effective minimally invasive procedure for the treatment of lower rectal cancer.It improves pain relief,promotes gastrointestinal function recovery,and helps avoid incision-related complications.
文摘BACKGROUND The number of population-based studies on unclassified inflammatory bowel disease(IBD-U)is very limited.AIM To evaluate the long-term incidence,disease course and surgery rates of IBD-U in a prospective population-based cohort.METHODSThe present study is a continuation of the well-established Veszprem IBD cohort with patient inclusion between1977 and 2018. Both in-hospital and outpatient records were collected. The source of age- and gender-specificdemographic data was derived from the Hungarian Central Statistical Office. Medical therapy, surgery and changein disease phenotype were analyzed.RESULTSData of 119 incident IBD-U patients were analyzed [male/female: 55/64;median age at diagnosis: 34 years(interquartile range: 24-47.5)]. Adjusted mean incidence rate was 0.76 (95%CI: 0.63-0.9)/105 person-years in the totalstudy period. Disease extent at diagnosis was extensive (pancolitis) in 56.3%. Twenty-two of 119 (18.5%) patientswere reclassified to Crohn’s disease during follow up, the probability of developing terminal ileum involvementwas 6.8%, while perianal disease developed in 5% (n = 6). The probability of receiving biological therapy in patientsdiagnosed after the year 2000 (n = 62), was 15.5% (SD: 4.8) at 5 years. The overall resective surgery rate was 16.8%.Segment resection was performed in 5.0% of the patients, and 11.8% underwent subtotal or total colectomy. Thecumulative probability of resective surgery was 7.6% (SD: 2.4) at 1 year, 9.3% (SD: 2.7) at 5 years, 13.5% (SD: 3.3) at10 years, and 18.5% (SD: 3.9) at 20 years.CONCLUSIONThese data extend our knowledge on the overall burden of IBD-U. Colonic involvement was extensive in a highproportion of IBD-U. Disease reclassification to Crohn’s disease was relatively high. High rates of biologicaltherapy and surgery rates support a relatively severe disease course of IBD-U.
文摘Many patients with Crohn’s disease (CD) require surgery. Indications for surgery include failure of medical treatment, bowel obstruction, fistula or abscess formation. The most common surgical procedure is resection. In jejunoileal CD, strictureplasty is an accepted surgical technique that relieves the obstructive symptoms, while preserving intestinal length and avoiding the development of short bowel syndrome. However, the role of strictureplasty in duodenal and colonic diseases remains controversial. In extensive colitis, after total colectomy with ileorectal anastomosis (IRA), the recurrence rates and functional outcomes are reasonable. For patients with extensive colitis and rectal involvement, total colectomy and end-ileostomy is safe and effective; however, a few patients can have subsequent IRA, and half of the patients will require proctectomy later. Proctocolectomy is associated with a high incidence of delayed perineal wound healing, but it carries a low recurrence rate. Patients undergoing proctocolectomy with ileal pouch-anal anastomosis had poor functional outcomes and high failure rates. Laparoscopic surgery has been introduced as a minimal invasive procedure. Patients who undergo laparoscopic surgery have a more rapid recovery of bowel function and a shorter hospital stay. The morbidity also is lower, and the rate of disease recurrence is similar compared with open procedures.
文摘Background: In patients undergoing pneumonectomy, intraoperative pulmonary and cardiac complications are the major cause of morbidity and mortality. Protective lung ventilation strategies may decrease the overall lung injury. Right, ventricular dysfunction may occur during the surgery and after the pneumonectomy, in the early postoperative period, with reduced RV ejection fraction and increased RV end-diastolic volume index, caused by increased RV afterload. Case report: We describe the case of a 28-year-old non-smoker female who underwent to a right pneumonectomy. The patient presented intraoperative hemodynamic instability and signs of RV dysfunction, requiring vasoactive amines and nitric oxide. Discussion: This article is intended to provide an overview of the anesthetic management for pneumonectomy including the hemodynamic management and considerations of the causes and management of right ventricular dysfunction.
基金supported by the National Science Foundation of China(No.81772521)Multicenter Clinical Research Project of Shanghai Jiaotong University School of Medicine(No.DLY201807)Clinical Training Program of Shanghai Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine(No.17CSK06).
文摘Aim:To evaluate the perioperative outcomes and postoperative survival of applying staging laparoscopy(SL)in intrahepatic cholangiocarcinoma(ICC)patients undergoing surgical resection.Methods:A retrospective analysis was performed on all selected ICC patients who underwent curative-intent resection with/without applying staging laparoscopy from January 2010 to August December 2021.Perioperative outcomes and postoperative survival were analyzed.Propensity score matching(PSM)and inverse probability of treatment weighting(IPTW)were performed to reduce the bias due to confounding variables in the SL group and the non-SL group.Multivariate Cox analysis was used to ascertain the independent predictor of survival for ICC patients.Results:A total of 279 patients(24.1%)were included in the SL group,while 881 patients(75.9%)were included in the non-SL group.Compared with the non-SL group,the SL group had lower blood loss,smaller tumor size,higher R0 resection rate,and shorter hospital stay,but a higher incidence of postoperative complications.The OS of the SL group was better than that of the non-SL group(Median OS:31 months vs.20 months).The 1-,3-,and 5-year overall survival rates of the SL group were 77.9%,45.1%,and 32.9%,respectively,while the non-SL group had rates of 63.9%,31.3%,and 18.4%.SL was confirmed as an independent predictor of survival by multivariate Cox analysis.Conclusion:ICC patients receiving SL had better perioperative outcomes and significantly prolonged overall survival after resection surgery.The subgroup analysis results support the use of routine SL.
文摘Background It is a surgical dilemma when patients present with both severe heart disease and neoplasms. The best surgical treatment remains controversial. This study aimed to analyze the early and long-term results of simultaneous surgical treatment of severe heart disease and neoplasms. Methods We reviewed the clinical records of 15 patients who underwent simultaneous neoplastic resection and cardiac surgery between September 2006 and January 2011. There were 5 male and 10 female patients. The mean age was （59.2±12.5） years and the mean left ventricular ejection fraction was （57.4±11.0）%. All patients were followed up completely for a period of 12 to 51 months （mean, （33.1±11.2） months）. Results Fifteen patients underwent simultaneous cardiac surgery and neoplastic resection. Cardiac procedures consisted of off pump coronary artery bypass grafting （n=7）, aortic valve replacement （n=3）, mitral valve replacement （n=3）, mitral valve replacement with coronary artery bypass grafting （n=1） and left atrial myxoma resection （n=1）. Neoplastic resection consisted of lung cancer resection （n=5）, colonic cancer resection （n=3）, gallbladder resection （n=1）, colonic cancer resection with gallbladder resection （n=1）, hysterectomy （n=2）, hysterectomy with bilateral salpingo-oophorectomy （n=2） and left ovariectomy （n=1）. Pathological examination confirmed malignant disease in 10 patients and benign disease in 5 patients. There were no perioperative myocardial infarctions, stroke, pericardial tamponade, renal failure or hospital deaths. The most frequent complications were atrial fibrillation （33.3%）, pneumonia （26.7%）, low cardiac output syndrome （6.7%） and delayed healing of surgical wounds （6.7%）. There was 1 late death 42 months after surgery for recurrent malignant disease. At 1 and 3 years, survival rates were 100% （Kaplan-Meier method）. Conclusions Simultaneous cardiac surgery and neoplastic resection was not associated with increased early or late morbidity or mortality. Cardiopulmonary bypass does not appear to adversely affect survival in patients with malignant disease. The long-term survival was determined by tumor stage.
文摘Background Temporal lobe epilepsy is one of the most common types of partial epilepsy.Although surgical treatment has led to signifcant improvements in seizure-free rates,nearly one-third of patients still have poor seizure control after surgery.Moreover,the long-term outcome is less favorable compared to short-term outcome,with 48-58%of patients experiencing seizures fve years after surgery.The aim of this study was to investigate the surgical outcomes and the predictive value of prognostic factors associated with poor surgical outcomes in temporal lobe epilepsy patients receiving surgery.Methods We retrospectively reviewed 94 patients undergoing temporal resective surgery in the Epilepsy Center of Guangdong Provincial Hospital of Traditional Chinese Medicine between July 2016 and July 2020.Patient information including age,gender,personal and family history,as well as preoperative and postoperative clinical data(clinical type and duration of disease)was collected.Results The diferences of postoperative clinical efcacy in both seizure free group and non-seizure free group patients were observed.A log-rank test was used for univariate analysis,and a Cox proportional hazard model was used for multivariate analysis.Ninety-four patients were followed up for at least 1 years.At 12 months of followup,71(75.5%)patients achieved Engel class I,5(5.3%)patients were classifed as Engel class II,5(5.3%)patients were classifed as Engel class Ⅲ,and 13(13.8%)patients were classifed as Engel class IV.Univariate analysis and multivariate Cox regression analysis indicated that the postoperative EEG abnormalities were signifcantly correlated with seizure recurrence and were signifcant independent predictive factors,with a hazard ratio of 12.940.Conclusions The relapse rate in our study was similar to commonly reported overall rates in temporal lobe epilepsy patients receiving surgery.Anterior temporal lobectomy is a reliable treatment option for temporal lobe epilepsy patients.Postoperative electroencephalograph abnormalities are independent risk factors for poor surgical prognosis.
