Objective This study aimed to systematically evaluate the application of the Cavitron Ultrasonic Surgical Aspirator(CUSA)system in epilepsy surgery and summarize associated surgical experiences.Methods In this retrosp...Objective This study aimed to systematically evaluate the application of the Cavitron Ultrasonic Surgical Aspirator(CUSA)system in epilepsy surgery and summarize associated surgical experiences.Methods In this retrospective analysis,70 patients with refractory epilepsy underwent CUSA-assisted resection,while 20 controls underwent conventional surgical resection.Patients were categorized according to surgical scenarios for CUSA application,including lesion-related epilepsy resections,mesial temporal lobe procedures,neocortical resections within eloquent areas,and cases requiring preservation of critical vascular structures.Detailed operative metrics were analyzed for each category.Comparative assessments between the CUSA and conventional groups included surgical efficiency,complication rates,and postoperative seizure outcomes on the basis of the modified Engel classification.Results CUSA was used for the following procedures:resection of epileptic lesions(n=26),mesial temporal structures(n=32),the epileptogenic neocortex(n=28),and the rolandic cortex(n=17).Additionally,it was utilized in 6 cases requiring vascular protection during insular resection and in 18 cases involving preservation of cortical dangerous veins.Although the overall surgical efficiency was comparable between the CUSA and conventional groups(68.0±18.2 vs.61.1±14.7 min,P=0.180),the CUSA group demonstrated superior efficiency in resecting low-grade tumors(58.6±14.9 vs.68.1±11.2 min,P=0.034).Furthermore,the CUSA group presented significantly fewer permanent complications(5.7%vs.10%,P<0.0001)and a higher rate of Engel Class I outcomes(82.9%vs.70.0%,P=0.278).Conclusions The CUSA system represents a suitable and promising surgical tool for resective epilepsy surgery,potentially serving as a valuable option for epilepsy surgeons.Further studies are warranted to validate these findings.展开更多
BACKGROUND: In spite of accurate selection of patients eligible for resection, and although advances in surgical techniques and perioperative management have greatly contributed to reducing the rate of perioperative d...BACKGROUND: In spite of accurate selection of patients eligible for resection, and although advances in surgical techniques and perioperative management have greatly contributed to reducing the rate of perioperative deaths, stress must be placed on reducing the postoperative complication rates reported to be still as high as 50%. This study was designed to analyze the causes and foreseeable risk factors linked to postoperative morbidity on the grounds of data derived from a single-center surgical population. METHODS: From September 1989 to March 2005, 287 consecutive patients, affected either with HCC or liver metastasis, had liver resection at our department. Among the HCC series we recorded 98 patients (73.2%) in Child- Pugh class A, 32 (23.8%) in class B and 4 in class C (3%). In 104 colorectal metastases, 71% were due to colon cancer, 25% rectal, 3% sigmoid, and 1% anorectal. In 49 non-colorectal metastases, 22.4% were derived from breast cancer, 63.2% gastrointestinal tumors (excluding colon) and 14.4% other cancers. We performed 80 wedge resections, 77 bisegmentectomies and/or left lobectomies, 74 segmentectomies, 22 major hepatectomies, 20 left hepatectomies, and 14 trisegmentectomies. RESULTS: The in-hospital mortality rate in this series was 4.5%, and the morbidity rate was 47.7%, because of pleural effusion (30%), hepatic abscess (25%), hepatic insufficiency (19%), ascites (10%), hemoperitoneum (10%), or biliary fistula (6%). The variables associated with the technical aspects of the surgical procedure thatwere responsible for the complications were: a Pringle maneuver length more than 20 minutes (P=0.001); the type of liver resection procedure, including major hepatectomy (P=0.02), left hepatectomy (P=0.04), trisegmentectomy (P=0.04), bisegmentectomy and/or left lobectomy (P=0,04); and a blood transfusion of more than 600 ml (P=0.04). CONCLUSION: The evaluation of causes and foreseeable risk factors linked to postoperative morbidity during the planning of surgical treatment should play the same role as other factors weighed in the selection of patients eligible for liver resection.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
BACKGROUND Repeated application of the Pringle maneuver is a key obstacle to safe minimally invasive repeat liver resection(MISRLR).However,limited technical guidance is available.AIM To study the utility of newly dev...BACKGROUND Repeated application of the Pringle maneuver is a key obstacle to safe minimally invasive repeat liver resection(MISRLR).However,limited technical guidance is available.AIM To study the utility of newly developed Pringle taping method guided by liver surface in MISRLR.METHODS We retrospectively reviewed 72 cases of MISRLR performed by a single surgeon at two centers from August 2015 to July 2024.Beginning in October 2019,a liver surface-guided encirclement of hepatoduodenal ligament(LSEH)was used for repeat Pringle taping.Perioperative outcomes including Pringle taping success,operative time,blood loss,conversion rate,morbidity,and mortality were assessed.RESULTS Laparoscopic and robotic approaches were used in 63 patients and 9 patients,respectively.The median operative time,blood loss,and hospital stay were 331.5 minutes,70 mL,and 8 days,respectively.Open conversion occurred in two cases(2.8%)due to severe adhesions and right renal vein injury.Clavien-Dindo grade≥III complications occurred in 5.6%of cases with no mortality.Anti-adhesion barriers were used in 54 patients(75.0%).LSEH was attempted in 57 cases,improving Pringle taping success from 33.0%to 91.4%(P<0.001).LSEH succeeded in all patients with prior open liver resection(n=11).Among 6 patients in whom LSEH failed,3 patients(50.0%)had undergone a third liver resection,and 1 patient had a history of distal gastrectomy with choledochoduodenostomy.CONCLUSION The newly developed LSEH technique for Pringle taping in MISRLR was feasible,enhancing safety and reproducibility even in patients with a history of open liver resection.展开更多
Background:According to the 2022 update of the BCLC strategy,laparoscopic liver resection(LLR)is considered feasible for BCLC stage 0-A hepatocellular carcinoma(HCC)patients with clinically significant portal hyperten...Background:According to the 2022 update of the BCLC strategy,laparoscopic liver resection(LLR)is considered feasible for BCLC stage 0-A hepatocellular carcinoma(HCC)patients with clinically significant portal hypertension(CSPH).However,there is still no research to explore the outcomes of laparoscopic versus open liver resection(OLR)in the specific patients with BCLC stage 0-A HCC and CSPH.Methods:Patients diagnosed with BCLC stage 0-A HCC and CSPH who underwent liver resection at West China Hospital of Sichuan University from February 2018 to December 2022 were analyzed.Demographic characteristics,pathological findings and postoperative outcomes were compared using propensity score matching(PSM).Long-term outcomes after surgery were analyzed using Kaplan-Meier analysis both before and after PSM.Results:A total of 409 patients,including 261 LLRs and 148 OLRs,were enrolled in this study.There were imbalances between the groups in baseline information.After 1:1 PSM,118 patients were included in each group with comparable baseline characteristics.Patients in the LLR group had significantly less intraoperative blood loss compared to those in the OLR group(median 223 vs.318 mL,P<0.001),and fewer postoperative complications(33.9%vs.57.6%,P<0.001),including lower rates of postoperative liver decompensation(16.9%vs.28.0%,P=0.043),postoperative ascites(18.6%vs.31.4%,P=0.024)and pulmonary infections(12.7%vs.29.7%,P=0.001).The long-term follow-up showed that overall survival(P=0.154)and recurrence-free survival(P=0.376)were comparable between the two groups.In subgroup analysis,patients with PLT≤75×10^(9)/L suffered more postoperative liver decompensation(PLD)and ascites than patiens with PLT>75×10^(9)/L.Conclusions:Compared with OLR,LLR had less intraoperative blood loss,fewer postoperative complications and comparable oncological outcomes for patients with BCLC stage 0/A HCC and CSPH.展开更多
BACKGROUND Low anterior resection syndrome(LARS)is a prevalent and debilitating complication following sphincter-preserving surgery for rectal cancer.Evidence-based interventions for the concurrent psychological burde...BACKGROUND Low anterior resection syndrome(LARS)is a prevalent and debilitating complication following sphincter-preserving surgery for rectal cancer.Evidence-based interventions for the concurrent psychological burden are limited.Electroacupuncture has been proposed as a potential adjunctive therapy,but its psychological benefits remain inadequately studied.AIM To investigate the therapeutic effect of electroacupuncture on emotional recovery and gastrointestinal function in patients with moderate to severe LARS,and to explore its potential advantages in psychologically vulnerable subgroups.METHODS We conducted a retrospective,controlled study involving 100 patients with moderate to severe LARS(LARS score≥21)treated at two tertiary hospitals in China between January 2022 and December 2024.Patients received either standard postoperative care alone(n=50)or in combination with a standardized 4-week electroacupuncture protocol(n=50).Psychological and functional outcomes were assessed using validated instruments including Hospital Anxiety and Depression Scale(HADS),Body Image Scale(BIS),General Self-Efficacy Scale,Perceived Social Support Scale(PSSS),LARS score,and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 at four time points.The primary endpoint was emotional remission,defined as a≥3-point reduction in HADS-Anxiety subscale(HADS-A).Analyses included repeated-measures comparisons,Kaplan-Meier survival curves,Cox regression models,and subgroup-interaction testing.RESULTS At baseline,demographic,surgical,and psychosocial characteristics were comparable among groups.By week 4,patients receiving electroacupuncture demonstrated significantly greater reductions in anxiety(HADS-A:4.8±2.6 vs 7.3±3.0;P<0.001),depression,and body-image disturbance(BIS:8.7±3.6 vs 11.9±4.2;P<0.001),alongside enhanced coping capacity(Brief Coping Orientation to Problems Experienced),perceived social support(PSSS),and bowel function(LARS score).Emotional remission-defined as a≥3-point HADS-A reduction-was achieved more rapidly in the electroacupuncture group,as confirmed by Kaplan-Meier analysis(log-rank P<0.001;odds ratio=4.7).Multivariate Cox regression identified higher baseline LARS and BIS scores as independent predictors of delayed emotional recovery.Subgroup analyses revealed significantly amplified treatment benefits in patients with high baseline anxiety(HADS-A≥8),elevated body-image disturbance(BIS≥12),or low perceived social support(PSSS<60),with consistent interaction effects(P for interaction<0.05 across subgroups).CONCLUSION Electroacupuncture may accelerate emotional recovery and improve functional and psychosocial outcomes in patients with LARS.Its integration into postoperative care may offer particular benefits for psychologically vulnerable subgroups.展开更多
Based on the Bismuth-Corlette classification of hilar cholangiocarcinoma,the patients with types I,II,and III can undergo radical resection in the absence of extensive intrahepatic metastasis and vascular invasion[1]....Based on the Bismuth-Corlette classification of hilar cholangiocarcinoma,the patients with types I,II,and III can undergo radical resection in the absence of extensive intrahepatic metastasis and vascular invasion[1].Depending on the scope of tumor invasion in bile duct,a combined resection of parts of the liver,hepatic ducts,common bile ducts,regional lymph nodes,and even parts of the duodenum and pancreas is necessary,along with biliary and gastrointestinal reconstructions[2].The surgical plan is complex,involving a large resection area and significant trauma.In recent years,laparoscopic or robot assisted radical resection of hilar cholangiocarcinoma has been applied clinically[3,4].With the advanced laparoscopic equipment,many patients undergo hepatopancreatoduodenectomy successfully[5].The limitations of traditional laparoscopic techniques restrict their wide application in clinical practice.However,the Da Vinci robot has been widely applied due to its clear field of vision and flexible manipulation.However,its utilization in hepato-pancreatoduodenectomy for hilar cholangiocarcinoma is still relatively rare.Here,we report a case with hilar cholangiocarcinoma at clinical stage IIIb who underwent robot-assisted hepato-pancreatoduodenectomy.展开更多
Over the past ten years,numerous papers have been published on the use of indocyanine green(ICG)fluorescence in liver surgery for hepatocellular carcinoma(HCC).There are many different applications.The first involves ...Over the past ten years,numerous papers have been published on the use of indocyanine green(ICG)fluorescence in liver surgery for hepatocellular carcinoma(HCC).There are many different applications.The first involves targeting superficial tumors in patients with macronodular cirrhosis and an irregular liver surface.In a minimally invasive setting,the lack of tactile feedback on the hepatic surface makes detecting subcapsular HCC with ultrasound alone challenging.ICG fusion images can mimic the tactile feedback of the hand and act as an ultrasound booster.ICG fluorescence can be used to evaluate tumor residues after minimally invasive thermal ablation.ICG fluorescence imaging can also be used to identify the grade of HCC early on and evaluate the microinvasive component.展开更多
Echinococcus is a zoonotic parasite and 1 of 17 neglected tropical diseases with a worldwide distribution.The World Health Organization(WHO)targeted for control or elimination by 2050[1,2].Two main species of Echinoco...Echinococcus is a zoonotic parasite and 1 of 17 neglected tropical diseases with a worldwide distribution.The World Health Organization(WHO)targeted for control or elimination by 2050[1,2].Two main species of Echinococcus infect humans:Echinococcus granulosus,causing cystic echinococcosis(CE),and Echinococcus multilocularis(EM),causing alveolar echinococcosis(AE)[3].AE is much rarer but far more severe than CE and ranks as one of the most dangerous helminthic zoonoses in the world[4,5].Humans are rare aberrant intermediate hosts and typically become infected through the ingestion of EM eggs shed in the feces of definitive hosts[6].After an incubation period of many years,humans may develop AE[7].While slow-growing,AE is a devastating clinical condition characterized by silent progression and infiltrative proliferation of the parasite,mimicking a malignancy[7].Without appropriate treatment,AE has a death rate of more than 90%within 10 years of diagnosis[5].For this reason,AE must be considered in the differential diagnosis of patients presenting with a hepatic mass or malignancy.展开更多
Background:Clear cell sarcoma of the kidney(CCSK)is a rare and highly aggressive pediatric renal malignancy with a marked propensity for metastatic spread.Cases of CCSK associated with inferior vena cava(IVC)tumor thr...Background:Clear cell sarcoma of the kidney(CCSK)is a rare and highly aggressive pediatric renal malignancy with a marked propensity for metastatic spread.Cases of CCSK associated with inferior vena cava(IVC)tumor thrombus(IVCTT)are exceptionally uncommon in the literature.We report a case of CCSK with IVCTT in a 15-month-old male infant.Case Description:We reported a case admitted in May 2020 for a 3-day history of fever and hematuria.Abdominal CT revealed an unevenly enhanced mass and low-density shadows within the IVC.The diagnosis of CCSK was confirmed via needle biopsy.The patient received 4 cycles of adjuvant chemotherapy.The initial surgery lasted 10 h with 600 mL blood loss,and primary closure was achieved.Postoperative management included 6 cycles of radiotherapy and 5 cycles of chemotherapy.In March 2022,CT detected IVCTT recurrence,requiring surgical intervention involving thrombus removal and partial IVC resection.This procedure lasted 8 h with 300 mL blood loss,followed by 5 additional chemotherapy cycles.The patient showed no sign of IVC obstruction,including varicose veins or lower limb edema,and maintained renal function throughout follow-up.However,Intracranial metastases were detected 15 months postoperatively.After the family opted against additional treatment,the patient succumbed to the disease.Conclusions:The management of CCSK associated with IVCTT should include consideration of IVC thrombectomy.In case of recurrent IVCTT with preserved collateral circulation,combined thrombus excision and partial IVC resection may be warranted.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
BACKGROUND Laparoscopic liver resection(LLR)can be challenging due to the difficulty of establishing a retrohepatic tunnel under laparoscopy.Dissecting the third hepatic hilum before parenchymal transection often lead...BACKGROUND Laparoscopic liver resection(LLR)can be challenging due to the difficulty of establishing a retrohepatic tunnel under laparoscopy.Dissecting the third hepatic hilum before parenchymal transection often leads to significant liver mobilization,tumor compression,and bleeding from the short hepatic veins(SHVs).This study introduces a novel technique utilizing the ventral avascular area of the inferior vena cava(IVC),allowing SHVs to be addressed after parenchymal transection,thereby reducing surgical complexity and improving outcomes in in situ LLR.AIM To introduce and evaluate a novel LLR technique using the ventral avascular area of the IVC and compare its short-term outcomes with conventional methods.METHODS The clinical cohort data of patients with pathologically confirmed hepatocellular carcinoma or intrahepatic cholangiocarcinoma who underwent conventional LLR and novel LLR between July 2021 and July 2023 at the First Affiliated Hospital of Chongqing Medical University were retrospectively analyzed.In novel LLR,we initially separated the caudate lobe from the IVC using dissecting forceps along the ventral avascular area of the IVC.Then,we transected the parenchyma of the left and right caudate lobes from the caudal side to the cephalic side using the avascular area as a marker.Subsequently,we addressed the SHVs and finally dissected the root of the right hepatic vein or left hepatic vein.The short-term postoperative outcomes and oncological results of the two approaches were evaluated and compared.RESULTS A total of 256 patients were included,with 150(58.59%)undergoing conventional LLR and 106(41.41%)undergoing novel LLR.The novel technique resulted in significantly larger tumor resections(6.47±2.96 cm vs 4.01±2.33 cm,P<0.001),shorter operative times(199.57±60.37 minutes vs 262.33±83.90 minutes,P<0.001),less intraoperative blood loss(206.92±37.09 mL vs 363.34±131.27 mL,P<0.001),and greater resection volume(345.11±31.40 mL vs 264.38±31.98 mL,P<0.001)compared to conventional LLR.CONCLUSION This novel technique enhances liver resection outcomes by reducing intraoperative complications such as bleeding and tumor compression.It facilitates a safer,in situ removal of complex liver tumors,even in challenging anatomical locations.Compared to conventional methods,this technique offers significant advantages,including reduced operative time,blood loss,and improved overall surgical efficiency.展开更多
BACKGROUND There are few clinicopathologic characteristics and clinical results for oesophageal gastrointestinal stromal tumours(GISTs).Thus,the objective of this study was to identify the clinicopathologic characteri...BACKGROUND There are few clinicopathologic characteristics and clinical results for oesophageal gastrointestinal stromal tumours(GISTs).Thus,the objective of this study was to identify the clinicopathologic characteristics and clinical results of oesophageal GISTs.AIM To investigate endoscopic treatment effective of oesophageal GISTs.METHODS It was retrospective research that collected 32 patients with oesophageal GISTs treated by endoscopic resection(ER)between January 2012 and January 2023 in two Hospital.Clinicopathologic,endoscopic records,and follow-up data were collected and analysed.RESULTS Thirty-one patients underwent en bloc resection and 24(75.0%)lesions underwent R0 resection.The size of GISTs was 2.12±1.88 cm.The overall complication rate was 25.0%,including hydrothorax and post-endoscopic submucosal dissection electrocoagulation syndrome.The mean mitotic index was 3.34±5.04(median,1.50;range,1.00-4.00).Eighteen(56.3%),6(18.8%),2(6.3%),and 6(18.8%)patients were identified as very low,low,intermediate,and high risk,respectively.Three patients developed recurrence after a median follow-up of 64.69±33.13 months.The 5-year overall survival rate was 100%,and the disease-free survival rate was 90.6%.CONCLUSION ER is safe and effective for patients with low-risk oesophageal GISTs.Early detection of oesophageal GISTs is essential to achieve a favourable prognosis.展开更多
Extracorporeal liver surgery(ELS), also known as liver autotransplantation, is a hybrid(cross-fertilized) surgery incorporating the technical knowledge from extreme liver and transplant liver surgeries, and recently b...Extracorporeal liver surgery(ELS), also known as liver autotransplantation, is a hybrid(cross-fertilized) surgery incorporating the technical knowledge from extreme liver and transplant liver surgeries, and recently became more embraced and popularized among leading centers. ELS could be summarized into three major categories, namely, ex-situ liver resection and autotransplantation(ELRA), ante-situm liver resection and autotransplantation(ALRA) and auxiliary partial liver autotransplantation(APLA). The successful development of ELS during the past 37 years is definitely inseparable from continuous effort s done by Chinese surgeons and researchers. Especially, the precision liver surgery paradigm has allowed to transform ELS into a modularized, more simplified, and standardized surgery, to upgrade surgical skills, to improve peri-operative outcome and long-term survival, to increase the capability of surgeons to select more complex diseases and to expand the level of medical service to the population. This review highlights the Chinese contributions to the field of ELS, focusing thereby on features of different surgical types, technical innovations, disease selection and surgical indication, patient prognosis and future perspectives.展开更多
BACKGROUND Gastric cancer(GC)is a prevalent tumor in the digestive system,with around one million new cases reported annually,ranking it as the third most common malignancy.Reducing pain is a key research focus.This s...BACKGROUND Gastric cancer(GC)is a prevalent tumor in the digestive system,with around one million new cases reported annually,ranking it as the third most common malignancy.Reducing pain is a key research focus.This study evaluates the effect of nalbuphine on the analgesic effect and the expression of pain factors in patients after radical resection.AIM To provide a reference for postoperative analgesia methods.METHODS One hundred eight patients with GC,admitted between January 2022 and June 2024,underwent radical gastrectomy.They received a controlled analgesia pump and a transverse abdominis muscle plane block,divided into two groups of 54 patients in each group.The control group received sufentanil,while the observation group received nalbuphine as an analgesic.Postoperative analgesic effects,pain factor expression,and adverse effects were compared.RESULTS The resting pain and activity pain scores in the observation group at 6,12,24 and 48 hours were significantly lower than those in the control group.Additionally,the number of presses and consumption of the observation group at 48 hours were lower than those of the control group;and the response rate of the observation group was higher than that of the control group(P<0.05).The prostaglandin E2,substance P,and serotonin levels 24 hours after the observation group were lower than those in the control group,and the incidence of adverse reactions was 5.56%lower than 22.22%in the control group(P<0.05).CONCLUSION The findings suggest that nalbuphine enhances postoperative multimodal analgesia in patients with radical GC,effectively improving postoperative analgesic effect,relieving postoperative resting and active pain,and reducing postoperative pain factor expression,demonstrating its potential for clinical application.展开更多
Rectal neuroendocrine tumor(rNET)is an indolent malignancy often detected during colonoscopy screening.The incidence of rNET has increased approximately 10-fold over the past 30 years.Most rNETs detected during screen...Rectal neuroendocrine tumor(rNET)is an indolent malignancy often detected during colonoscopy screening.The incidence of rNET has increased approximately 10-fold over the past 30 years.Most rNETs detected during screening endoscopy are small,measuring<10 mm.Current guidelines recommend endoscopic resection for small,well-differentiated rNET using modified endoscopic submucosal resection(mEMR)or endoscopic submucosal dissection.However,the optimal endoscopic treatment method remains uncertain.This paper summarizes the evidence on mEMR with submucosal stretching,mEMR without submucosal stretching,endoscopic submucosal dissection and endoscopic full-thickness resection.Given that rNETs often exhibit submucosal invasion,achieving adequate resection depth is crucial to ensure histological complete resection.mEMR with submucosal stretching appears favorable due to its high rate of histological complete resection,safety and convenience.Risk factors associated with lymph node and distant metastases are also discussed.A treatment algorithm is proposed to facilitate clinical decision-making.展开更多
BACKGROUND The discrepancy between endoscopic biopsy pathology and the overall pathology of gastric low-grade intraepithelial neoplasia(LGIN)presents challenges in developing diagnostic and treatment protocols.AIM To ...BACKGROUND The discrepancy between endoscopic biopsy pathology and the overall pathology of gastric low-grade intraepithelial neoplasia(LGIN)presents challenges in developing diagnostic and treatment protocols.AIM To develop a risk prediction model for the pathological upgrading of gastric LGIN to aid clinical diagnosis and treatment.METHODS We retrospectively analyzed data from patients newly diagnosed with gastric LGIN who underwent complete endoscopic resection within 6 months at the First Medical Center of Chinese People’s Liberation Army General Hospital between January 2008 and December 2023.A risk prediction model for the pathological progression of gastric LGIN was constructed and evaluated for accuracy and clinical applicability.RESULTS A total of 171 patients were included in this study:93 patients with high-grade intraepithelial neoplasia or early gastric cancer and 78 with LGIN.The logistic stepwise regression model demonstrated a sensitivity and specificity of 0.868 and 0.800,respectively,while the least absolute shrinkage and selection operator(LASSO)regression model showed sensitivity and specificity values of 0.842 and 0.840,respectively.The area under the curve(AUC)for the logistic model was 0.896,slightly lower than the AUC of 0.904 for the LASSO model.Internal validation with 30%of the data yielded AUC scores of 0.908 for the logistic model and 0.905 for the LASSO model.The LASSO model provided greater utility in clinical decision-making.CONCLUSION A risk prediction model for the pathological upgrading of gastric LGIN based on white-light and magnifying endoscopic features can accurately and effectively guide clinical diagnosis and treatment.展开更多
BACKGROUND Underwater endoscopic mucosal resection(UEMR)has been shown to be a good treatment option for the management of nonpedunculated polyps≥10 mm since its introduction.However,there is a paucity of randomized ...BACKGROUND Underwater endoscopic mucosal resection(UEMR)has been shown to be a good treatment option for the management of nonpedunculated polyps≥10 mm since its introduction.However,there is a paucity of randomized controlled trials(RCTs)in Asia.AIM To compare the efficacy and safety of UEMR with those of conventional EMR(CEMR)in treating nonpedunculated colorectal lesions.METHODS We carried out this RCT at a tertiary hospital from October 2022 to July 2024.Patients with nonpedunculated colorectal neoplasms ranging from 10 mm to 30 mm in size were randomly assigned to either the UEMR or CEMR group.The primary outcome was the curative resection(R0)rate.The secondary outcomes included en bloc resection,procedure time,adverse events,and the number of clips used for defect closure.RESULTS A total of 260 patients with 260 lesions(130 in each UEMR and CEMR group)were recruited.The median age was 58(27-85)years,the male/female ratio was 1.74,and the median lesion size was 20(10-30 mm)mm.Compared with CEMR,UEMR was associated with a significantly greater curative resection(R0)rate(98.4%vs 90.3%;P=0.007),greater en bloc resection rate(100%vs 94.6%;P=0.014),shorter procedure time(65 vs 185 seconds;P<0.001),lower rate of bleeding complications(1.5%vs 10%;P=0.003),and fewer clips used(2 vs 3;P<0.001).No perforations were observed in either group.CONCLUSION Compared with CEMR,UEMR has a higher R0 rate,greater en bloc resection rate,shorter procedure time,fewer bleeding complications,and clips used in the management of nonpedunculated colorectal neoplasms.展开更多
Liver transplantation represents a complex surgical procedure and serves as a curative treatment for patients presenting an acute or chronic end-stage liver disease, or carefully selected liver malignancy. A significa...Liver transplantation represents a complex surgical procedure and serves as a curative treatment for patients presenting an acute or chronic end-stage liver disease, or carefully selected liver malignancy. A significant gap still exists between the number of available donor organs and potential recipients. The use of an otherwise-wasted resected liver lobe from patients with benign liver tumors is a new, albeit small, option to alleviate the allograft shortage. This review provides evidence that resected liver lobes may be used successfully in liver transplantation.展开更多
BACKGROUND Identifying factors that influence non-curative resection(NCR)is critical to optimize treatment strategies and improve patient outcomes in patients with early gastric cancer(EGC).AIM To investigate the fact...BACKGROUND Identifying factors that influence non-curative resection(NCR)is critical to optimize treatment strategies and improve patient outcomes in patients with early gastric cancer(EGC).AIM To investigate the factors influencing the NCR of EGC and to evaluate the predictive value of these factors.METHODS The clinical data of 173 patients with EGC admitted between July 2020 and July 2023 were retrospectively collected.According to radical resection criteria,the patients were further divided into curative resection group(n=143)and NCR group(n=30).Clinical information was collected,including surgical method,tumor diameter,tumor site,ulcer formation,depth of invasion,pathological type,and lymph node metastasis.Logistic regression analysis was used to explore the factors affecting non-curable resection.RESULTS Multivariate logistic regression analysis showed that ulcer formation[odds ratio(OR)=3.53;95%confidence interval(CI):1.55-8.01,P=0.003],pathological type(OR=3.73;95%CI:1.60-8.74,P=0.002),tumor diameter(OR=3.15;95%CI:1.40-7.05,P=0.005),tumor location(OR=3.50;95%CI:1.16-10.58,P=0.027),lymph node metastasis(OR=4.40;95%CI:1.83-10.57,P=0.001),and depth of penetration(OR=3.75;95%CI:1.60-8.74,P=0.002)were all risk factors for NCR in EGC patients.Predictive analysis showed varying area under the curve values for factors such as tumor diameter(0.636),tumor location(0.608),ulcer formation(0.652),infiltration depth(0.658),pathological type(0.656),and lymph node metastasis(0.674).CONCLUSION The results suggest that factors such as tumor diameter,tumor location,ulcer formation,depth of invasion,pathological type,and lymph node metastasis increase the risk of NCR in EGC patients.展开更多
基金supported by the Featured Clinical Technique of Guangzhou(2023P-TS09).
文摘Objective This study aimed to systematically evaluate the application of the Cavitron Ultrasonic Surgical Aspirator(CUSA)system in epilepsy surgery and summarize associated surgical experiences.Methods In this retrospective analysis,70 patients with refractory epilepsy underwent CUSA-assisted resection,while 20 controls underwent conventional surgical resection.Patients were categorized according to surgical scenarios for CUSA application,including lesion-related epilepsy resections,mesial temporal lobe procedures,neocortical resections within eloquent areas,and cases requiring preservation of critical vascular structures.Detailed operative metrics were analyzed for each category.Comparative assessments between the CUSA and conventional groups included surgical efficiency,complication rates,and postoperative seizure outcomes on the basis of the modified Engel classification.Results CUSA was used for the following procedures:resection of epileptic lesions(n=26),mesial temporal structures(n=32),the epileptogenic neocortex(n=28),and the rolandic cortex(n=17).Additionally,it was utilized in 6 cases requiring vascular protection during insular resection and in 18 cases involving preservation of cortical dangerous veins.Although the overall surgical efficiency was comparable between the CUSA and conventional groups(68.0±18.2 vs.61.1±14.7 min,P=0.180),the CUSA group demonstrated superior efficiency in resecting low-grade tumors(58.6±14.9 vs.68.1±11.2 min,P=0.034).Furthermore,the CUSA group presented significantly fewer permanent complications(5.7%vs.10%,P<0.0001)and a higher rate of Engel Class I outcomes(82.9%vs.70.0%,P=0.278).Conclusions The CUSA system represents a suitable and promising surgical tool for resective epilepsy surgery,potentially serving as a valuable option for epilepsy surgeons.Further studies are warranted to validate these findings.
文摘BACKGROUND: In spite of accurate selection of patients eligible for resection, and although advances in surgical techniques and perioperative management have greatly contributed to reducing the rate of perioperative deaths, stress must be placed on reducing the postoperative complication rates reported to be still as high as 50%. This study was designed to analyze the causes and foreseeable risk factors linked to postoperative morbidity on the grounds of data derived from a single-center surgical population. METHODS: From September 1989 to March 2005, 287 consecutive patients, affected either with HCC or liver metastasis, had liver resection at our department. Among the HCC series we recorded 98 patients (73.2%) in Child- Pugh class A, 32 (23.8%) in class B and 4 in class C (3%). In 104 colorectal metastases, 71% were due to colon cancer, 25% rectal, 3% sigmoid, and 1% anorectal. In 49 non-colorectal metastases, 22.4% were derived from breast cancer, 63.2% gastrointestinal tumors (excluding colon) and 14.4% other cancers. We performed 80 wedge resections, 77 bisegmentectomies and/or left lobectomies, 74 segmentectomies, 22 major hepatectomies, 20 left hepatectomies, and 14 trisegmentectomies. RESULTS: The in-hospital mortality rate in this series was 4.5%, and the morbidity rate was 47.7%, because of pleural effusion (30%), hepatic abscess (25%), hepatic insufficiency (19%), ascites (10%), hemoperitoneum (10%), or biliary fistula (6%). The variables associated with the technical aspects of the surgical procedure thatwere responsible for the complications were: a Pringle maneuver length more than 20 minutes (P=0.001); the type of liver resection procedure, including major hepatectomy (P=0.02), left hepatectomy (P=0.04), trisegmentectomy (P=0.04), bisegmentectomy and/or left lobectomy (P=0,04); and a blood transfusion of more than 600 ml (P=0.04). CONCLUSION: The evaluation of causes and foreseeable risk factors linked to postoperative morbidity during the planning of surgical treatment should play the same role as other factors weighed in the selection of patients eligible for liver resection.
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.
文摘BACKGROUND Repeated application of the Pringle maneuver is a key obstacle to safe minimally invasive repeat liver resection(MISRLR).However,limited technical guidance is available.AIM To study the utility of newly developed Pringle taping method guided by liver surface in MISRLR.METHODS We retrospectively reviewed 72 cases of MISRLR performed by a single surgeon at two centers from August 2015 to July 2024.Beginning in October 2019,a liver surface-guided encirclement of hepatoduodenal ligament(LSEH)was used for repeat Pringle taping.Perioperative outcomes including Pringle taping success,operative time,blood loss,conversion rate,morbidity,and mortality were assessed.RESULTS Laparoscopic and robotic approaches were used in 63 patients and 9 patients,respectively.The median operative time,blood loss,and hospital stay were 331.5 minutes,70 mL,and 8 days,respectively.Open conversion occurred in two cases(2.8%)due to severe adhesions and right renal vein injury.Clavien-Dindo grade≥III complications occurred in 5.6%of cases with no mortality.Anti-adhesion barriers were used in 54 patients(75.0%).LSEH was attempted in 57 cases,improving Pringle taping success from 33.0%to 91.4%(P<0.001).LSEH succeeded in all patients with prior open liver resection(n=11).Among 6 patients in whom LSEH failed,3 patients(50.0%)had undergone a third liver resection,and 1 patient had a history of distal gastrectomy with choledochoduodenostomy.CONCLUSION The newly developed LSEH technique for Pringle taping in MISRLR was feasible,enhancing safety and reproducibility even in patients with a history of open liver resection.
基金supported by grants from the Sichuan Science and Technology Program(2023YFQ0094)the 1.3.5 project for disciplines of excellence,West China Hospital,Sichuan University(25HXJS028).
文摘Background:According to the 2022 update of the BCLC strategy,laparoscopic liver resection(LLR)is considered feasible for BCLC stage 0-A hepatocellular carcinoma(HCC)patients with clinically significant portal hypertension(CSPH).However,there is still no research to explore the outcomes of laparoscopic versus open liver resection(OLR)in the specific patients with BCLC stage 0-A HCC and CSPH.Methods:Patients diagnosed with BCLC stage 0-A HCC and CSPH who underwent liver resection at West China Hospital of Sichuan University from February 2018 to December 2022 were analyzed.Demographic characteristics,pathological findings and postoperative outcomes were compared using propensity score matching(PSM).Long-term outcomes after surgery were analyzed using Kaplan-Meier analysis both before and after PSM.Results:A total of 409 patients,including 261 LLRs and 148 OLRs,were enrolled in this study.There were imbalances between the groups in baseline information.After 1:1 PSM,118 patients were included in each group with comparable baseline characteristics.Patients in the LLR group had significantly less intraoperative blood loss compared to those in the OLR group(median 223 vs.318 mL,P<0.001),and fewer postoperative complications(33.9%vs.57.6%,P<0.001),including lower rates of postoperative liver decompensation(16.9%vs.28.0%,P=0.043),postoperative ascites(18.6%vs.31.4%,P=0.024)and pulmonary infections(12.7%vs.29.7%,P=0.001).The long-term follow-up showed that overall survival(P=0.154)and recurrence-free survival(P=0.376)were comparable between the two groups.In subgroup analysis,patients with PLT≤75×10^(9)/L suffered more postoperative liver decompensation(PLD)and ascites than patiens with PLT>75×10^(9)/L.Conclusions:Compared with OLR,LLR had less intraoperative blood loss,fewer postoperative complications and comparable oncological outcomes for patients with BCLC stage 0/A HCC and CSPH.
文摘BACKGROUND Low anterior resection syndrome(LARS)is a prevalent and debilitating complication following sphincter-preserving surgery for rectal cancer.Evidence-based interventions for the concurrent psychological burden are limited.Electroacupuncture has been proposed as a potential adjunctive therapy,but its psychological benefits remain inadequately studied.AIM To investigate the therapeutic effect of electroacupuncture on emotional recovery and gastrointestinal function in patients with moderate to severe LARS,and to explore its potential advantages in psychologically vulnerable subgroups.METHODS We conducted a retrospective,controlled study involving 100 patients with moderate to severe LARS(LARS score≥21)treated at two tertiary hospitals in China between January 2022 and December 2024.Patients received either standard postoperative care alone(n=50)or in combination with a standardized 4-week electroacupuncture protocol(n=50).Psychological and functional outcomes were assessed using validated instruments including Hospital Anxiety and Depression Scale(HADS),Body Image Scale(BIS),General Self-Efficacy Scale,Perceived Social Support Scale(PSSS),LARS score,and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 at four time points.The primary endpoint was emotional remission,defined as a≥3-point reduction in HADS-Anxiety subscale(HADS-A).Analyses included repeated-measures comparisons,Kaplan-Meier survival curves,Cox regression models,and subgroup-interaction testing.RESULTS At baseline,demographic,surgical,and psychosocial characteristics were comparable among groups.By week 4,patients receiving electroacupuncture demonstrated significantly greater reductions in anxiety(HADS-A:4.8±2.6 vs 7.3±3.0;P<0.001),depression,and body-image disturbance(BIS:8.7±3.6 vs 11.9±4.2;P<0.001),alongside enhanced coping capacity(Brief Coping Orientation to Problems Experienced),perceived social support(PSSS),and bowel function(LARS score).Emotional remission-defined as a≥3-point HADS-A reduction-was achieved more rapidly in the electroacupuncture group,as confirmed by Kaplan-Meier analysis(log-rank P<0.001;odds ratio=4.7).Multivariate Cox regression identified higher baseline LARS and BIS scores as independent predictors of delayed emotional recovery.Subgroup analyses revealed significantly amplified treatment benefits in patients with high baseline anxiety(HADS-A≥8),elevated body-image disturbance(BIS≥12),or low perceived social support(PSSS<60),with consistent interaction effects(P for interaction<0.05 across subgroups).CONCLUSION Electroacupuncture may accelerate emotional recovery and improve functional and psychosocial outcomes in patients with LARS.Its integration into postoperative care may offer particular benefits for psychologically vulnerable subgroups.
文摘Based on the Bismuth-Corlette classification of hilar cholangiocarcinoma,the patients with types I,II,and III can undergo radical resection in the absence of extensive intrahepatic metastasis and vascular invasion[1].Depending on the scope of tumor invasion in bile duct,a combined resection of parts of the liver,hepatic ducts,common bile ducts,regional lymph nodes,and even parts of the duodenum and pancreas is necessary,along with biliary and gastrointestinal reconstructions[2].The surgical plan is complex,involving a large resection area and significant trauma.In recent years,laparoscopic or robot assisted radical resection of hilar cholangiocarcinoma has been applied clinically[3,4].With the advanced laparoscopic equipment,many patients undergo hepatopancreatoduodenectomy successfully[5].The limitations of traditional laparoscopic techniques restrict their wide application in clinical practice.However,the Da Vinci robot has been widely applied due to its clear field of vision and flexible manipulation.However,its utilization in hepato-pancreatoduodenectomy for hilar cholangiocarcinoma is still relatively rare.Here,we report a case with hilar cholangiocarcinoma at clinical stage IIIb who underwent robot-assisted hepato-pancreatoduodenectomy.
文摘Over the past ten years,numerous papers have been published on the use of indocyanine green(ICG)fluorescence in liver surgery for hepatocellular carcinoma(HCC).There are many different applications.The first involves targeting superficial tumors in patients with macronodular cirrhosis and an irregular liver surface.In a minimally invasive setting,the lack of tactile feedback on the hepatic surface makes detecting subcapsular HCC with ultrasound alone challenging.ICG fusion images can mimic the tactile feedback of the hand and act as an ultrasound booster.ICG fluorescence can be used to evaluate tumor residues after minimally invasive thermal ablation.ICG fluorescence imaging can also be used to identify the grade of HCC early on and evaluate the microinvasive component.
文摘Echinococcus is a zoonotic parasite and 1 of 17 neglected tropical diseases with a worldwide distribution.The World Health Organization(WHO)targeted for control or elimination by 2050[1,2].Two main species of Echinococcus infect humans:Echinococcus granulosus,causing cystic echinococcosis(CE),and Echinococcus multilocularis(EM),causing alveolar echinococcosis(AE)[3].AE is much rarer but far more severe than CE and ranks as one of the most dangerous helminthic zoonoses in the world[4,5].Humans are rare aberrant intermediate hosts and typically become infected through the ingestion of EM eggs shed in the feces of definitive hosts[6].After an incubation period of many years,humans may develop AE[7].While slow-growing,AE is a devastating clinical condition characterized by silent progression and infiltrative proliferation of the parasite,mimicking a malignancy[7].Without appropriate treatment,AE has a death rate of more than 90%within 10 years of diagnosis[5].For this reason,AE must be considered in the differential diagnosis of patients presenting with a hepatic mass or malignancy.
基金Research Project of Hunan Health Commission in 2023(D202304058618)Innovation Project of Hunan Science and Technology Department(2018SK504)National Nature Science Foundation of China(No.82203414).
文摘Background:Clear cell sarcoma of the kidney(CCSK)is a rare and highly aggressive pediatric renal malignancy with a marked propensity for metastatic spread.Cases of CCSK associated with inferior vena cava(IVC)tumor thrombus(IVCTT)are exceptionally uncommon in the literature.We report a case of CCSK with IVCTT in a 15-month-old male infant.Case Description:We reported a case admitted in May 2020 for a 3-day history of fever and hematuria.Abdominal CT revealed an unevenly enhanced mass and low-density shadows within the IVC.The diagnosis of CCSK was confirmed via needle biopsy.The patient received 4 cycles of adjuvant chemotherapy.The initial surgery lasted 10 h with 600 mL blood loss,and primary closure was achieved.Postoperative management included 6 cycles of radiotherapy and 5 cycles of chemotherapy.In March 2022,CT detected IVCTT recurrence,requiring surgical intervention involving thrombus removal and partial IVC resection.This procedure lasted 8 h with 300 mL blood loss,followed by 5 additional chemotherapy cycles.The patient showed no sign of IVC obstruction,including varicose veins or lower limb edema,and maintained renal function throughout follow-up.However,Intracranial metastases were detected 15 months postoperatively.After the family opted against additional treatment,the patient succumbed to the disease.Conclusions:The management of CCSK associated with IVCTT should include consideration of IVC thrombectomy.In case of recurrent IVCTT with preserved collateral circulation,combined thrombus excision and partial IVC resection may be warranted.
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.
基金Supported by the General Project of the Natural Science Foundation of Chongqing,No.cstc2021jcyj-msxmX0604.
文摘BACKGROUND Laparoscopic liver resection(LLR)can be challenging due to the difficulty of establishing a retrohepatic tunnel under laparoscopy.Dissecting the third hepatic hilum before parenchymal transection often leads to significant liver mobilization,tumor compression,and bleeding from the short hepatic veins(SHVs).This study introduces a novel technique utilizing the ventral avascular area of the inferior vena cava(IVC),allowing SHVs to be addressed after parenchymal transection,thereby reducing surgical complexity and improving outcomes in in situ LLR.AIM To introduce and evaluate a novel LLR technique using the ventral avascular area of the IVC and compare its short-term outcomes with conventional methods.METHODS The clinical cohort data of patients with pathologically confirmed hepatocellular carcinoma or intrahepatic cholangiocarcinoma who underwent conventional LLR and novel LLR between July 2021 and July 2023 at the First Affiliated Hospital of Chongqing Medical University were retrospectively analyzed.In novel LLR,we initially separated the caudate lobe from the IVC using dissecting forceps along the ventral avascular area of the IVC.Then,we transected the parenchyma of the left and right caudate lobes from the caudal side to the cephalic side using the avascular area as a marker.Subsequently,we addressed the SHVs and finally dissected the root of the right hepatic vein or left hepatic vein.The short-term postoperative outcomes and oncological results of the two approaches were evaluated and compared.RESULTS A total of 256 patients were included,with 150(58.59%)undergoing conventional LLR and 106(41.41%)undergoing novel LLR.The novel technique resulted in significantly larger tumor resections(6.47±2.96 cm vs 4.01±2.33 cm,P<0.001),shorter operative times(199.57±60.37 minutes vs 262.33±83.90 minutes,P<0.001),less intraoperative blood loss(206.92±37.09 mL vs 363.34±131.27 mL,P<0.001),and greater resection volume(345.11±31.40 mL vs 264.38±31.98 mL,P<0.001)compared to conventional LLR.CONCLUSION This novel technique enhances liver resection outcomes by reducing intraoperative complications such as bleeding and tumor compression.It facilitates a safer,in situ removal of complex liver tumors,even in challenging anatomical locations.Compared to conventional methods,this technique offers significant advantages,including reduced operative time,blood loss,and improved overall surgical efficiency.
基金Supported by National Natural Science Foundation of China,No.82002515,No.82273025 and No.82203460China Postdoctoral Science Foundation,No.2022TQ0070 and No.2022M710759Shanghai Municipal Commission of Science and Technology,No.22JC1403003,No.22XD1402200,No.19140901902 and No.22S31903800.
文摘BACKGROUND There are few clinicopathologic characteristics and clinical results for oesophageal gastrointestinal stromal tumours(GISTs).Thus,the objective of this study was to identify the clinicopathologic characteristics and clinical results of oesophageal GISTs.AIM To investigate endoscopic treatment effective of oesophageal GISTs.METHODS It was retrospective research that collected 32 patients with oesophageal GISTs treated by endoscopic resection(ER)between January 2012 and January 2023 in two Hospital.Clinicopathologic,endoscopic records,and follow-up data were collected and analysed.RESULTS Thirty-one patients underwent en bloc resection and 24(75.0%)lesions underwent R0 resection.The size of GISTs was 2.12±1.88 cm.The overall complication rate was 25.0%,including hydrothorax and post-endoscopic submucosal dissection electrocoagulation syndrome.The mean mitotic index was 3.34±5.04(median,1.50;range,1.00-4.00).Eighteen(56.3%),6(18.8%),2(6.3%),and 6(18.8%)patients were identified as very low,low,intermediate,and high risk,respectively.Three patients developed recurrence after a median follow-up of 64.69±33.13 months.The 5-year overall survival rate was 100%,and the disease-free survival rate was 90.6%.CONCLUSION ER is safe and effective for patients with low-risk oesophageal GISTs.Early detection of oesophageal GISTs is essential to achieve a favourable prognosis.
基金supported by grants from the Beijing Hospitals Authority Youth Program (12022B4010)BTCH Young Talent En-lightenment Program (2024QMRC24)CAMS Innovation Fund for Medical Sciences (2019-I2M-5–056)。
文摘Extracorporeal liver surgery(ELS), also known as liver autotransplantation, is a hybrid(cross-fertilized) surgery incorporating the technical knowledge from extreme liver and transplant liver surgeries, and recently became more embraced and popularized among leading centers. ELS could be summarized into three major categories, namely, ex-situ liver resection and autotransplantation(ELRA), ante-situm liver resection and autotransplantation(ALRA) and auxiliary partial liver autotransplantation(APLA). The successful development of ELS during the past 37 years is definitely inseparable from continuous effort s done by Chinese surgeons and researchers. Especially, the precision liver surgery paradigm has allowed to transform ELS into a modularized, more simplified, and standardized surgery, to upgrade surgical skills, to improve peri-operative outcome and long-term survival, to increase the capability of surgeons to select more complex diseases and to expand the level of medical service to the population. This review highlights the Chinese contributions to the field of ELS, focusing thereby on features of different surgical types, technical innovations, disease selection and surgical indication, patient prognosis and future perspectives.
文摘BACKGROUND Gastric cancer(GC)is a prevalent tumor in the digestive system,with around one million new cases reported annually,ranking it as the third most common malignancy.Reducing pain is a key research focus.This study evaluates the effect of nalbuphine on the analgesic effect and the expression of pain factors in patients after radical resection.AIM To provide a reference for postoperative analgesia methods.METHODS One hundred eight patients with GC,admitted between January 2022 and June 2024,underwent radical gastrectomy.They received a controlled analgesia pump and a transverse abdominis muscle plane block,divided into two groups of 54 patients in each group.The control group received sufentanil,while the observation group received nalbuphine as an analgesic.Postoperative analgesic effects,pain factor expression,and adverse effects were compared.RESULTS The resting pain and activity pain scores in the observation group at 6,12,24 and 48 hours were significantly lower than those in the control group.Additionally,the number of presses and consumption of the observation group at 48 hours were lower than those of the control group;and the response rate of the observation group was higher than that of the control group(P<0.05).The prostaglandin E2,substance P,and serotonin levels 24 hours after the observation group were lower than those in the control group,and the incidence of adverse reactions was 5.56%lower than 22.22%in the control group(P<0.05).CONCLUSION The findings suggest that nalbuphine enhances postoperative multimodal analgesia in patients with radical GC,effectively improving postoperative analgesic effect,relieving postoperative resting and active pain,and reducing postoperative pain factor expression,demonstrating its potential for clinical application.
基金Supported by Nanchang High-Level Scientific and Technological Innovation Talents‘Double Hundred Plan’Project,China,No.2022-312.
文摘Rectal neuroendocrine tumor(rNET)is an indolent malignancy often detected during colonoscopy screening.The incidence of rNET has increased approximately 10-fold over the past 30 years.Most rNETs detected during screening endoscopy are small,measuring<10 mm.Current guidelines recommend endoscopic resection for small,well-differentiated rNET using modified endoscopic submucosal resection(mEMR)or endoscopic submucosal dissection.However,the optimal endoscopic treatment method remains uncertain.This paper summarizes the evidence on mEMR with submucosal stretching,mEMR without submucosal stretching,endoscopic submucosal dissection and endoscopic full-thickness resection.Given that rNETs often exhibit submucosal invasion,achieving adequate resection depth is crucial to ensure histological complete resection.mEMR with submucosal stretching appears favorable due to its high rate of histological complete resection,safety and convenience.Risk factors associated with lymph node and distant metastases are also discussed.A treatment algorithm is proposed to facilitate clinical decision-making.
基金Supported by the National Key Research and Development Program of China,No.2022YFC2503600。
文摘BACKGROUND The discrepancy between endoscopic biopsy pathology and the overall pathology of gastric low-grade intraepithelial neoplasia(LGIN)presents challenges in developing diagnostic and treatment protocols.AIM To develop a risk prediction model for the pathological upgrading of gastric LGIN to aid clinical diagnosis and treatment.METHODS We retrospectively analyzed data from patients newly diagnosed with gastric LGIN who underwent complete endoscopic resection within 6 months at the First Medical Center of Chinese People’s Liberation Army General Hospital between January 2008 and December 2023.A risk prediction model for the pathological progression of gastric LGIN was constructed and evaluated for accuracy and clinical applicability.RESULTS A total of 171 patients were included in this study:93 patients with high-grade intraepithelial neoplasia or early gastric cancer and 78 with LGIN.The logistic stepwise regression model demonstrated a sensitivity and specificity of 0.868 and 0.800,respectively,while the least absolute shrinkage and selection operator(LASSO)regression model showed sensitivity and specificity values of 0.842 and 0.840,respectively.The area under the curve(AUC)for the logistic model was 0.896,slightly lower than the AUC of 0.904 for the LASSO model.Internal validation with 30%of the data yielded AUC scores of 0.908 for the logistic model and 0.905 for the LASSO model.The LASSO model provided greater utility in clinical decision-making.CONCLUSION A risk prediction model for the pathological upgrading of gastric LGIN based on white-light and magnifying endoscopic features can accurately and effectively guide clinical diagnosis and treatment.
文摘BACKGROUND Underwater endoscopic mucosal resection(UEMR)has been shown to be a good treatment option for the management of nonpedunculated polyps≥10 mm since its introduction.However,there is a paucity of randomized controlled trials(RCTs)in Asia.AIM To compare the efficacy and safety of UEMR with those of conventional EMR(CEMR)in treating nonpedunculated colorectal lesions.METHODS We carried out this RCT at a tertiary hospital from October 2022 to July 2024.Patients with nonpedunculated colorectal neoplasms ranging from 10 mm to 30 mm in size were randomly assigned to either the UEMR or CEMR group.The primary outcome was the curative resection(R0)rate.The secondary outcomes included en bloc resection,procedure time,adverse events,and the number of clips used for defect closure.RESULTS A total of 260 patients with 260 lesions(130 in each UEMR and CEMR group)were recruited.The median age was 58(27-85)years,the male/female ratio was 1.74,and the median lesion size was 20(10-30 mm)mm.Compared with CEMR,UEMR was associated with a significantly greater curative resection(R0)rate(98.4%vs 90.3%;P=0.007),greater en bloc resection rate(100%vs 94.6%;P=0.014),shorter procedure time(65 vs 185 seconds;P<0.001),lower rate of bleeding complications(1.5%vs 10%;P=0.003),and fewer clips used(2 vs 3;P<0.001).No perforations were observed in either group.CONCLUSION Compared with CEMR,UEMR has a higher R0 rate,greater en bloc resection rate,shorter procedure time,fewer bleeding complications,and clips used in the management of nonpedunculated colorectal neoplasms.
基金supported by grants from the National Natural Science Foundation of China (82150 0 04)the National Municipal Key Clinical Specialtythe Clinical Research Project for Major Diseases in Municipal Hospitals (SHDC2020CR1022B)。
文摘Liver transplantation represents a complex surgical procedure and serves as a curative treatment for patients presenting an acute or chronic end-stage liver disease, or carefully selected liver malignancy. A significant gap still exists between the number of available donor organs and potential recipients. The use of an otherwise-wasted resected liver lobe from patients with benign liver tumors is a new, albeit small, option to alleviate the allograft shortage. This review provides evidence that resected liver lobes may be used successfully in liver transplantation.
文摘BACKGROUND Identifying factors that influence non-curative resection(NCR)is critical to optimize treatment strategies and improve patient outcomes in patients with early gastric cancer(EGC).AIM To investigate the factors influencing the NCR of EGC and to evaluate the predictive value of these factors.METHODS The clinical data of 173 patients with EGC admitted between July 2020 and July 2023 were retrospectively collected.According to radical resection criteria,the patients were further divided into curative resection group(n=143)and NCR group(n=30).Clinical information was collected,including surgical method,tumor diameter,tumor site,ulcer formation,depth of invasion,pathological type,and lymph node metastasis.Logistic regression analysis was used to explore the factors affecting non-curable resection.RESULTS Multivariate logistic regression analysis showed that ulcer formation[odds ratio(OR)=3.53;95%confidence interval(CI):1.55-8.01,P=0.003],pathological type(OR=3.73;95%CI:1.60-8.74,P=0.002),tumor diameter(OR=3.15;95%CI:1.40-7.05,P=0.005),tumor location(OR=3.50;95%CI:1.16-10.58,P=0.027),lymph node metastasis(OR=4.40;95%CI:1.83-10.57,P=0.001),and depth of penetration(OR=3.75;95%CI:1.60-8.74,P=0.002)were all risk factors for NCR in EGC patients.Predictive analysis showed varying area under the curve values for factors such as tumor diameter(0.636),tumor location(0.608),ulcer formation(0.652),infiltration depth(0.658),pathological type(0.656),and lymph node metastasis(0.674).CONCLUSION The results suggest that factors such as tumor diameter,tumor location,ulcer formation,depth of invasion,pathological type,and lymph node metastasis increase the risk of NCR in EGC patients.
