BACKGROUND Varicosis is a common venous condition,which is typically treated surgically.However,selection of the optimal surgical approach can be challenging.Previous studies comparing endovenous laser treatment(EVLT)...BACKGROUND Varicosis is a common venous condition,which is typically treated surgically.However,selection of the optimal surgical approach can be challenging.Previous studies comparing endovenous laser treatment(EVLT)and conventional surgery were retrospective and observational in nature and the results may therefore have been influenced by selection bias and the presence of other confounding factors.In this study,we used propensity score matching to reduce selection bias when comparing EVLT and conventional surgery for the treatment of varicose great saphenous veins.METHODS We retrospectively reviewed the records of 1063 patients treated for primary varicosis of the great saphenous vein at the Second Affiliated Hospital of Xuzhou Medical University between January 2009 and December 2019.Among them,56 patients were excluded owing to additional small saphenous varicose vein involvement,81 owing to recurring varicose veins,83 owing to complicated varicose veins(CEAP clinical classification C5-C6),and 6 owing to perioperative phlebitis.Finally,772 patients were enrolled in this study.Standard demographic and clinicopathological data were collected from the medical records of the patients.For propensity score matching,522 patients(261 who underwent EVLT and 261 who underwent conventional surgery)were randomly matched 1:1 by age,sex,onset time,smoking status,presence of diabetes,family history,stress therapy,C class,and the affected leg.RESULTS Of the 772 patients included in the study,467 underwent EVLT and 305 underwent conventional surgery.There were significant differences in age,onset time,smoking and diabetes status,and family history between the two groups.Following propensity score matching,no significant differences in patients’characteristics remained between the two groups.ELVT was associated with a shorter operation time and hospital stay than conventional surgery,both before and after propensity score matching.There were no differences in complications between the two groups after propensity score matching.Patients who underwent EVLT had a higher recurrence rate during the two-year follow-up period than those who underwent conventional surgery(33.33%vs 21.46%,χ^(2)=11.506,P=0.001),and a greater percentage of patients who underwent EVLT experienced pain one week after the procedure(39.85%vs 19.54%,P=0.000).CONCLUSION EVLT may not always be the best option for the treatment of great saphenous vein varicosis.展开更多
BACKGROUND Gastric cancer surgery has advanced with minimally invasive techniques.This study compares outcomes between single-incision laparoscopic surgery plus one port(SILS+1)and conventional laparoscopic surgery(CL...BACKGROUND Gastric cancer surgery has advanced with minimally invasive techniques.This study compares outcomes between single-incision laparoscopic surgery plus one port(SILS+1)and conventional laparoscopic surgery(CLS)in treating gastric cancer.AIM To explore the curative effect of SILS+1 and CLS on gastric cancer and their influences on prognosis.METHODS A total of 93 patients with gastric cancer undergoing radical gastrectomy in the hospital were retrospectively analyzed between September 2019 and September 2022.According to different surgical methods,they were divided into SILS+1 group(n=56)and CLS group(n=37).The perioperative indexes,pain degree[visual analogue scale(VAS)]and stress response[C-reactive protein(CRP),white blood cell count(WBC)]in the two groups were compared.The postoperative complications,recurrence rate and mortality at 1 year after surgery were recorded.RESULTS Intraoperative blood loss was significantly lower in the SILS+1 group(76.53±8.12 mL)compared to the CLS group(108.67±12.34 mL,P<0.001),and the total incision length was also significantly shorter in the SILS+1 group(5.29±1.01 cm vs 9.45±2.34 cm,P<0.001).SILS+1 patients experienced faster recovery,with shorter times to first flatus(1.94±0.43 days vs 3.23±0.88 days,P<0.001)and ambulation(2.76±0.58 days vs 4.10±0.97 days,P<0.001).Postoperative pain,as measured by VAS scores,was significantly lower in the SILS+1 group on postoperative days 1,2,and 3(P<0.001).Additionally,stress markers(CRP and WBC)were significantly lower in the SILS+1 group on the first postoperative day(CRP:6.41±1.63 mg/L vs 7.82±1.88 mg/L,P<0.001;WBC:6.34±1.50×109/L vs 7.09±1.61×109/L,P=0.024).The complication rate in the SILS+1 group was also significantly lower than in the CLS group(8.93%vs 27.03%,P=0.020).However,there was no significant difference in recurrence rates between the two groups after one year(3.57%vs 8.11%,P>0.05).CONCLUSION SILS+1 and CLS have the comparable lymph node clearance effect in patients with gastric cancer.However,SILS+1 is more beneficial to reduce intraoperative blood loss,relieve pain,alleviate stress response,reduce the incidence of complications and promote rapid postoperative recovery.展开更多
AIM: To update and investigate the clinical outcomes and complications between femtosecond laser-assisted cataract surgery(FLACS) and conventional phacoemulsification cataract surgery(CPCS). METHODS: A Meta-analysis w...AIM: To update and investigate the clinical outcomes and complications between femtosecond laser-assisted cataract surgery(FLACS) and conventional phacoemulsification cataract surgery(CPCS). METHODS: A Meta-analysis was performed using databases, including Pubmed, Embase, and the Cochrane library. At least one of the clinical outcomes and/or complications data in each included randomized controlled trials(RCT) was reported. The quality of the RCT was assessed with the Cochrane risk assessments tool.RESULTS: Overall, 25 RCTs including 3781 eyes were included. No statistically significant difference detected between FLACS and CPCS in terms of corrected distant visual acuity(CDVA), uncorrected distant visual acuity(UDVA), and central corneal thickness(CCT) at the longterm follow up, although FLACS showed better CDVA at 1 wk postoperatively, and less increase in CCT at 1 d and 1 wk. FLACS had better postoperative endothelial cell count(ECC) at 1 and 4-6 wk, while there was no significantly difference between FLACS and CPCS at 1 d, 3 and 6 mo [weighted mean difference(WMD): 51.54, 95% confidence interval(CI):-5.46 to 108.54, P=0.08;WMD: 48.52, 95%CI:-17.54 to 114.58, P=0.15;WMD: 12.17, 95%CI:-48.61 to 72.94, P=0.69, respectively]. Postoperative endothelial cell loss(ECL) of the FLACS was significantly lower than that of the CPCS at 1, 4-6 wk, and 3 mo(P=0.02, 0.008, 0.03, respectively). However, there was no significant difference between two groups at 6 mo(WMD:-30.36, 95%CI:-78.84 to 18.12, P=0.22). No significant difference was discovered with respect to the macular edema [odds ratio(OR): 0.93, 95%CI: 0.42 to 2.05, P=0.85], capsular complication excluding posterior capsular tears(OR: 0.79, 95%CI: 0.42 to 1.50, P=0.47) and intraocular pressure change(OR: 0.82, 95%CI: 0.39 to 1.72, P=0.60). However, posterior capsular tears were more common in CPCS group(OR: 0.12, 95%CI: 0.01 to 0.98, P=0.05). The effective phacoemulsification times were significantly lower in the FLACS group compared to the CPCS group(WMD:-0.78, 95%CI:-1.23 to-0.34, P=0.0006).CONCLUSION: No statistically significant difference is discovered between FLACS and CPCS in clinical outcomes at the long-term follow up. However, higher rate of posterior capsular tears is detected in patients receiving CPCS.展开更多
BACKGROUND The advantages and disadvantages of various surgical procedures for radical dissection of left hemicolonic malignancies are controversial.We aimed to determine which procedures are best for patients with di...BACKGROUND The advantages and disadvantages of various surgical procedures for radical dissection of left hemicolonic malignancies are controversial.We aimed to determine which procedures are best for patients with different characteristics.The focus of this study was to investigate the safety and clinical efficacy of three different surgical procedures,namely,robotic-assisted surgery(RAS),handassisted laparoscopic surgery(HALS)and conventional laparoscopic surgery(CLS),for the dissection of malignant tumors of the left hemicolon and the effect of these procedures on long-term prognosis.AIM To determine which procedures are best for patients with malignant tumors of the left hemicolon and the safety and clinical efficacy of three different surgical procedures.METHODS A retrospective analysis of the clinical data of 224 patients with left hemicolonic malignancies admitted to the Department of General Surgery of the First Affiliated Hospital of Nanchang University from June 2015 to June 2024 was conducted.Patient data were analyzed to determine tumor stage,duration of surgery,number of lymph nodes cleared,incidence and severity of postoperative complications,amount of intraoperative bleeding,overall survival(OS),and progressionfree survival.RESULTS The short-term postoperative outcomes after RAS,HALS and CLS were compared.The leukocyte and absolute neutrophil counts on postoperative day 4 were highest after RAS,followed by CLS and then HALS,and the differences were statistically significant(P<0.05).The length of postoperative hospital stay was highest after CLS,followed by RAS and then HALS,and the differences were statistically significant(P<0.05).The postoperative recovery time of gastrointestinal function was shortest after HALS,followed by RAS and CLS,which had equal values,and the differences were statistically significant(P<0.05).Hospitalization costs were highest among patients who underwent RAS,followed by CLS and then HALS,and the differences were statistically significant(P<0.05).The OS among patients who underwent HALS,CLS,and RAS did not significantly differ(P=0.384).CONCLUSION There were no significant differences between procedures in the number of lymph nodes cleared or OS,and all procedures successfully achieved radical dissection of the malignant tumors.HALS had lower hospitalization costs and shorter postoperative recovery time of gastrointestinal function,and CLS performed between HALS and RAS.Different surgical procedures have varying impacts on the length of postoperative hospital stay and the degree of postoperative inflammation,so selection should be individualized to each patient.展开更多
Purpose:To compare the complications of femtosecond laser-assisted cataract surgery(FLACS)with those of conventional phacoemulsification surgery(CPS)for age-related cataracts.Methods:PubMed,Cochrane Library,and EMBASE...Purpose:To compare the complications of femtosecond laser-assisted cataract surgery(FLACS)with those of conventional phacoemulsification surgery(CPS)for age-related cataracts.Methods:PubMed,Cochrane Library,and EMBASE were systematically searched for studies comparing FLACS and CPS.Outcomes were operative complications,including the intraoperative capsule tear,postoperative corneal edema,macular edema,uncontrolled IOP,etc.The effect measures were weighted with odds ratios with 95%CIs.Results:Nineteen RCTs and 18 cohort studies,including 24,806 eyes(11,375 of the FLACS group and 13,431 of the CPS group),were identified.There were no significant differences between the two groups in anterior capsule tear,corneal edema,macular edema,uncontrolled IOP,vitreous loss,posterior vitreous detachment,etc.Posterior capsule tear rate showed a significantly lower in RCT subgroups(P=0.04)and without differences in total(P=0.63).Significant differences were observed in the incidence of descemet membrane tear/trauma(P=0.02)and IFIS/iris trauma(P=0.04.Additionally,The FLACS specific complications showed a significantly higher rate of miosis(P=0.0001),corneal epithelial defect(P=0.001),corneal haze(P=0.002),and subconjunctival hemorrhage(P=0.01).Conclusions:FLACS maintains the same safety compared with CPS in terms of all intraoperative and postoperative complications.Although FLACS did show a statistically significant difference for several FLACS specific complications,it would not influence the visual outcome and heal itself.展开更多
基金the Excellent Talents Fund Project of Xuzhou Medical University,No.XYFY2021019.
文摘BACKGROUND Varicosis is a common venous condition,which is typically treated surgically.However,selection of the optimal surgical approach can be challenging.Previous studies comparing endovenous laser treatment(EVLT)and conventional surgery were retrospective and observational in nature and the results may therefore have been influenced by selection bias and the presence of other confounding factors.In this study,we used propensity score matching to reduce selection bias when comparing EVLT and conventional surgery for the treatment of varicose great saphenous veins.METHODS We retrospectively reviewed the records of 1063 patients treated for primary varicosis of the great saphenous vein at the Second Affiliated Hospital of Xuzhou Medical University between January 2009 and December 2019.Among them,56 patients were excluded owing to additional small saphenous varicose vein involvement,81 owing to recurring varicose veins,83 owing to complicated varicose veins(CEAP clinical classification C5-C6),and 6 owing to perioperative phlebitis.Finally,772 patients were enrolled in this study.Standard demographic and clinicopathological data were collected from the medical records of the patients.For propensity score matching,522 patients(261 who underwent EVLT and 261 who underwent conventional surgery)were randomly matched 1:1 by age,sex,onset time,smoking status,presence of diabetes,family history,stress therapy,C class,and the affected leg.RESULTS Of the 772 patients included in the study,467 underwent EVLT and 305 underwent conventional surgery.There were significant differences in age,onset time,smoking and diabetes status,and family history between the two groups.Following propensity score matching,no significant differences in patients’characteristics remained between the two groups.ELVT was associated with a shorter operation time and hospital stay than conventional surgery,both before and after propensity score matching.There were no differences in complications between the two groups after propensity score matching.Patients who underwent EVLT had a higher recurrence rate during the two-year follow-up period than those who underwent conventional surgery(33.33%vs 21.46%,χ^(2)=11.506,P=0.001),and a greater percentage of patients who underwent EVLT experienced pain one week after the procedure(39.85%vs 19.54%,P=0.000).CONCLUSION EVLT may not always be the best option for the treatment of great saphenous vein varicosis.
文摘BACKGROUND Gastric cancer surgery has advanced with minimally invasive techniques.This study compares outcomes between single-incision laparoscopic surgery plus one port(SILS+1)and conventional laparoscopic surgery(CLS)in treating gastric cancer.AIM To explore the curative effect of SILS+1 and CLS on gastric cancer and their influences on prognosis.METHODS A total of 93 patients with gastric cancer undergoing radical gastrectomy in the hospital were retrospectively analyzed between September 2019 and September 2022.According to different surgical methods,they were divided into SILS+1 group(n=56)and CLS group(n=37).The perioperative indexes,pain degree[visual analogue scale(VAS)]and stress response[C-reactive protein(CRP),white blood cell count(WBC)]in the two groups were compared.The postoperative complications,recurrence rate and mortality at 1 year after surgery were recorded.RESULTS Intraoperative blood loss was significantly lower in the SILS+1 group(76.53±8.12 mL)compared to the CLS group(108.67±12.34 mL,P<0.001),and the total incision length was also significantly shorter in the SILS+1 group(5.29±1.01 cm vs 9.45±2.34 cm,P<0.001).SILS+1 patients experienced faster recovery,with shorter times to first flatus(1.94±0.43 days vs 3.23±0.88 days,P<0.001)and ambulation(2.76±0.58 days vs 4.10±0.97 days,P<0.001).Postoperative pain,as measured by VAS scores,was significantly lower in the SILS+1 group on postoperative days 1,2,and 3(P<0.001).Additionally,stress markers(CRP and WBC)were significantly lower in the SILS+1 group on the first postoperative day(CRP:6.41±1.63 mg/L vs 7.82±1.88 mg/L,P<0.001;WBC:6.34±1.50×109/L vs 7.09±1.61×109/L,P=0.024).The complication rate in the SILS+1 group was also significantly lower than in the CLS group(8.93%vs 27.03%,P=0.020).However,there was no significant difference in recurrence rates between the two groups after one year(3.57%vs 8.11%,P>0.05).CONCLUSION SILS+1 and CLS have the comparable lymph node clearance effect in patients with gastric cancer.However,SILS+1 is more beneficial to reduce intraoperative blood loss,relieve pain,alleviate stress response,reduce the incidence of complications and promote rapid postoperative recovery.
基金Supported by Youth Research Project of the Fujian Provincial Health Commission (No.2019-1-94)the Startup Fund for Scientific Research, Fujian Medical University (No.2018QH170)。
文摘AIM: To update and investigate the clinical outcomes and complications between femtosecond laser-assisted cataract surgery(FLACS) and conventional phacoemulsification cataract surgery(CPCS). METHODS: A Meta-analysis was performed using databases, including Pubmed, Embase, and the Cochrane library. At least one of the clinical outcomes and/or complications data in each included randomized controlled trials(RCT) was reported. The quality of the RCT was assessed with the Cochrane risk assessments tool.RESULTS: Overall, 25 RCTs including 3781 eyes were included. No statistically significant difference detected between FLACS and CPCS in terms of corrected distant visual acuity(CDVA), uncorrected distant visual acuity(UDVA), and central corneal thickness(CCT) at the longterm follow up, although FLACS showed better CDVA at 1 wk postoperatively, and less increase in CCT at 1 d and 1 wk. FLACS had better postoperative endothelial cell count(ECC) at 1 and 4-6 wk, while there was no significantly difference between FLACS and CPCS at 1 d, 3 and 6 mo [weighted mean difference(WMD): 51.54, 95% confidence interval(CI):-5.46 to 108.54, P=0.08;WMD: 48.52, 95%CI:-17.54 to 114.58, P=0.15;WMD: 12.17, 95%CI:-48.61 to 72.94, P=0.69, respectively]. Postoperative endothelial cell loss(ECL) of the FLACS was significantly lower than that of the CPCS at 1, 4-6 wk, and 3 mo(P=0.02, 0.008, 0.03, respectively). However, there was no significant difference between two groups at 6 mo(WMD:-30.36, 95%CI:-78.84 to 18.12, P=0.22). No significant difference was discovered with respect to the macular edema [odds ratio(OR): 0.93, 95%CI: 0.42 to 2.05, P=0.85], capsular complication excluding posterior capsular tears(OR: 0.79, 95%CI: 0.42 to 1.50, P=0.47) and intraocular pressure change(OR: 0.82, 95%CI: 0.39 to 1.72, P=0.60). However, posterior capsular tears were more common in CPCS group(OR: 0.12, 95%CI: 0.01 to 0.98, P=0.05). The effective phacoemulsification times were significantly lower in the FLACS group compared to the CPCS group(WMD:-0.78, 95%CI:-1.23 to-0.34, P=0.0006).CONCLUSION: No statistically significant difference is discovered between FLACS and CPCS in clinical outcomes at the long-term follow up. However, higher rate of posterior capsular tears is detected in patients receiving CPCS.
基金Supported by Jiangxi Provincial Natural Science Foundation of China,No.20224BAB206063.
文摘BACKGROUND The advantages and disadvantages of various surgical procedures for radical dissection of left hemicolonic malignancies are controversial.We aimed to determine which procedures are best for patients with different characteristics.The focus of this study was to investigate the safety and clinical efficacy of three different surgical procedures,namely,robotic-assisted surgery(RAS),handassisted laparoscopic surgery(HALS)and conventional laparoscopic surgery(CLS),for the dissection of malignant tumors of the left hemicolon and the effect of these procedures on long-term prognosis.AIM To determine which procedures are best for patients with malignant tumors of the left hemicolon and the safety and clinical efficacy of three different surgical procedures.METHODS A retrospective analysis of the clinical data of 224 patients with left hemicolonic malignancies admitted to the Department of General Surgery of the First Affiliated Hospital of Nanchang University from June 2015 to June 2024 was conducted.Patient data were analyzed to determine tumor stage,duration of surgery,number of lymph nodes cleared,incidence and severity of postoperative complications,amount of intraoperative bleeding,overall survival(OS),and progressionfree survival.RESULTS The short-term postoperative outcomes after RAS,HALS and CLS were compared.The leukocyte and absolute neutrophil counts on postoperative day 4 were highest after RAS,followed by CLS and then HALS,and the differences were statistically significant(P<0.05).The length of postoperative hospital stay was highest after CLS,followed by RAS and then HALS,and the differences were statistically significant(P<0.05).The postoperative recovery time of gastrointestinal function was shortest after HALS,followed by RAS and CLS,which had equal values,and the differences were statistically significant(P<0.05).Hospitalization costs were highest among patients who underwent RAS,followed by CLS and then HALS,and the differences were statistically significant(P<0.05).The OS among patients who underwent HALS,CLS,and RAS did not significantly differ(P=0.384).CONCLUSION There were no significant differences between procedures in the number of lymph nodes cleared or OS,and all procedures successfully achieved radical dissection of the malignant tumors.HALS had lower hospitalization costs and shorter postoperative recovery time of gastrointestinal function,and CLS performed between HALS and RAS.Different surgical procedures have varying impacts on the length of postoperative hospital stay and the degree of postoperative inflammation,so selection should be individualized to each patient.
基金National Natural Science Foundation(No.81870641 and 82070939)Zhejiang Province Key Research and Development Program(No.2020C03035)Medical Health Science and technology Project of Zhejiang Provincial Health Commission(No.2022RC031).
文摘Purpose:To compare the complications of femtosecond laser-assisted cataract surgery(FLACS)with those of conventional phacoemulsification surgery(CPS)for age-related cataracts.Methods:PubMed,Cochrane Library,and EMBASE were systematically searched for studies comparing FLACS and CPS.Outcomes were operative complications,including the intraoperative capsule tear,postoperative corneal edema,macular edema,uncontrolled IOP,etc.The effect measures were weighted with odds ratios with 95%CIs.Results:Nineteen RCTs and 18 cohort studies,including 24,806 eyes(11,375 of the FLACS group and 13,431 of the CPS group),were identified.There were no significant differences between the two groups in anterior capsule tear,corneal edema,macular edema,uncontrolled IOP,vitreous loss,posterior vitreous detachment,etc.Posterior capsule tear rate showed a significantly lower in RCT subgroups(P=0.04)and without differences in total(P=0.63).Significant differences were observed in the incidence of descemet membrane tear/trauma(P=0.02)and IFIS/iris trauma(P=0.04.Additionally,The FLACS specific complications showed a significantly higher rate of miosis(P=0.0001),corneal epithelial defect(P=0.001),corneal haze(P=0.002),and subconjunctival hemorrhage(P=0.01).Conclusions:FLACS maintains the same safety compared with CPS in terms of all intraoperative and postoperative complications.Although FLACS did show a statistically significant difference for several FLACS specific complications,it would not influence the visual outcome and heal itself.
