BACKGROUND Hernia is a common condition requiring abdominal surgery.The current standard treatment for hernia is tension-free repair using meshes.Globally,more than 200 new types of meshes are licensed each year.Howev...BACKGROUND Hernia is a common condition requiring abdominal surgery.The current standard treatment for hernia is tension-free repair using meshes.Globally,more than 200 new types of meshes are licensed each year.However,their clinical applications are associated with a series of complications,such as recurrence(10%-24%)and infection(0.5%-9.0%).In contrast,3D-printed meshes have significantly reduced the postoperative complications in patients.They have also shortened operating time and minimized the loss of mesh materials.In this study,we used the myopectineal orifice(MPO)data obtained from preoperative computer tomography(CT)-based 3D reconstruction for the production of 3D-printed biologic meshes.AIM To investigate the application of multislice spiral CT-based 3D reconstruction technique in 3D-printed biologic mesh for hernia repair surgery.METHODS We retrospectively analyzed 60 patients who underwent laparoscopic tension-free repair for inguinal hernia in the Department of General Surgery of the First Hospital of Shanxi Medical University from September 2019 to December 2019.This study included 30 males and 30 females,with a mean age of 40±5.6 years.Data on the MPO were obtained from preoperative CT-based 3D reconstruction as well as from real-world intraoperative measurements for all patients.Anatomic points were set for the purpose of measurement based on the definition of MPO:A:The pubic tubercle;B:Intersection of the horizontal line extending from the summit of the inferior edge of the internal oblique and transversus abdominis and the outer edge of the rectus abdominis,C:Intersection of the horizontal line extending from the summit of the inferior edge of the internal oblique and transversus abdominis and the inguinal ligament,D:Intersection of the iliopsoas muscle and the inguinal ligament,and E:Intersection of the iliopsoas muscle and the superior pubic ramus.The distance between the points was measured.All preoperative and intraoperative data were analyzed using the t test.Differences with P<0.05 were considered significant in comparative analysis.RESULTS The distance between points AB,AC,BC,DE,and AE based on preoperative and intraoperative data was 7.576±0.212 cm vs 7.573±0.266 cm,7.627±0.212 cm vs 7.627±0.212 cm,7.677±0.229 cm vs 7.567±0.786 cm,7.589±0.204 cm vs 7.512±0.21 cm,and 7.617±0.231 cm vs 7.582±0.189 cm,respectively.All differences were not statistically significant(P>0.05).CONCLUSION The use of multislice spiral CT-based 3D reconstruction technique before hernia repair surgery allows accurate measurement of data and relationships of different anatomic sites in the MPO region.This technique can provide precise data for the production of 3D-printed biologic meshes.展开更多
BACKGROUND The degree of obstruction plays an important role in decision-making for obstructive colorectal cancer(OCRC).The existing assessment still relies on the colorectal obstruction scoring system(CROSS)which is ...BACKGROUND The degree of obstruction plays an important role in decision-making for obstructive colorectal cancer(OCRC).The existing assessment still relies on the colorectal obstruction scoring system(CROSS)which is based on a comprehensive analysis of patients’complaints and eating conditions.The data collection relies on subjective descriptions and lacks objective parameters.Therefore,a scoring system for the evaluation of computed tomography-based obstructive degree(CTOD)is urgently required for OCRC.AIM To explore the relationship between CTOD and CROSS and to determine whether CTOD could affect the short-term and long-term prognosis.METHODS Of 173 patients were enrolled.CTOD was obtained using k-means,the ratio of proximal to distal obstruction,and the proportion of nonparenchymal areas at the site of obstruction.CTOD was integrated with the CROSS to analyze the effect of emergency intervention on complications.Short-term and long-term outcomes were compared between the groups.RESULTS CTOD severe obstruction(CTOD grade 3)was an independent risk factor[odds ratio(OR)=3.390,95%confidence interval(CI):1.340-8.570,P=0.010]via multivariate analysis of short-term outcomes,while CROSS grade was not.In the CTOD-CROSS grade system,for the non-severe obstructive(CTOD 1-2 to CROSS 1-4)group,the complication rate of emergency interventions was significantly higher than that of non-emergency interventions(71.4%vs 41.8%,P=0.040).The postoperative pneumonia rate was higher in the emergency intervention group than in the non-severe obstructive group(35.7%vs 8.9%,P=0.020).However,CTOD grade was not an independent risk factor of overall survival and progression-free survival.CONCLUSION CTOD was useful in preoperative decision-making to avoid unnecessary emergency interventions and complications.展开更多
基金Supported by the Shanxi Provincial Key Research and Development Program,No.201903D321175.
文摘BACKGROUND Hernia is a common condition requiring abdominal surgery.The current standard treatment for hernia is tension-free repair using meshes.Globally,more than 200 new types of meshes are licensed each year.However,their clinical applications are associated with a series of complications,such as recurrence(10%-24%)and infection(0.5%-9.0%).In contrast,3D-printed meshes have significantly reduced the postoperative complications in patients.They have also shortened operating time and minimized the loss of mesh materials.In this study,we used the myopectineal orifice(MPO)data obtained from preoperative computer tomography(CT)-based 3D reconstruction for the production of 3D-printed biologic meshes.AIM To investigate the application of multislice spiral CT-based 3D reconstruction technique in 3D-printed biologic mesh for hernia repair surgery.METHODS We retrospectively analyzed 60 patients who underwent laparoscopic tension-free repair for inguinal hernia in the Department of General Surgery of the First Hospital of Shanxi Medical University from September 2019 to December 2019.This study included 30 males and 30 females,with a mean age of 40±5.6 years.Data on the MPO were obtained from preoperative CT-based 3D reconstruction as well as from real-world intraoperative measurements for all patients.Anatomic points were set for the purpose of measurement based on the definition of MPO:A:The pubic tubercle;B:Intersection of the horizontal line extending from the summit of the inferior edge of the internal oblique and transversus abdominis and the outer edge of the rectus abdominis,C:Intersection of the horizontal line extending from the summit of the inferior edge of the internal oblique and transversus abdominis and the inguinal ligament,D:Intersection of the iliopsoas muscle and the inguinal ligament,and E:Intersection of the iliopsoas muscle and the superior pubic ramus.The distance between the points was measured.All preoperative and intraoperative data were analyzed using the t test.Differences with P<0.05 were considered significant in comparative analysis.RESULTS The distance between points AB,AC,BC,DE,and AE based on preoperative and intraoperative data was 7.576±0.212 cm vs 7.573±0.266 cm,7.627±0.212 cm vs 7.627±0.212 cm,7.677±0.229 cm vs 7.567±0.786 cm,7.589±0.204 cm vs 7.512±0.21 cm,and 7.617±0.231 cm vs 7.582±0.189 cm,respectively.All differences were not statistically significant(P>0.05).CONCLUSION The use of multislice spiral CT-based 3D reconstruction technique before hernia repair surgery allows accurate measurement of data and relationships of different anatomic sites in the MPO region.This technique can provide precise data for the production of 3D-printed biologic meshes.
基金the Youth Foundation of Fujian Provincial Health Commission,No.2021QNA014the Construction Project of Fujian Province Minimally Invasive Medical Center,No.[2021]76.
文摘BACKGROUND The degree of obstruction plays an important role in decision-making for obstructive colorectal cancer(OCRC).The existing assessment still relies on the colorectal obstruction scoring system(CROSS)which is based on a comprehensive analysis of patients’complaints and eating conditions.The data collection relies on subjective descriptions and lacks objective parameters.Therefore,a scoring system for the evaluation of computed tomography-based obstructive degree(CTOD)is urgently required for OCRC.AIM To explore the relationship between CTOD and CROSS and to determine whether CTOD could affect the short-term and long-term prognosis.METHODS Of 173 patients were enrolled.CTOD was obtained using k-means,the ratio of proximal to distal obstruction,and the proportion of nonparenchymal areas at the site of obstruction.CTOD was integrated with the CROSS to analyze the effect of emergency intervention on complications.Short-term and long-term outcomes were compared between the groups.RESULTS CTOD severe obstruction(CTOD grade 3)was an independent risk factor[odds ratio(OR)=3.390,95%confidence interval(CI):1.340-8.570,P=0.010]via multivariate analysis of short-term outcomes,while CROSS grade was not.In the CTOD-CROSS grade system,for the non-severe obstructive(CTOD 1-2 to CROSS 1-4)group,the complication rate of emergency interventions was significantly higher than that of non-emergency interventions(71.4%vs 41.8%,P=0.040).The postoperative pneumonia rate was higher in the emergency intervention group than in the non-severe obstructive group(35.7%vs 8.9%,P=0.020).However,CTOD grade was not an independent risk factor of overall survival and progression-free survival.CONCLUSION CTOD was useful in preoperative decision-making to avoid unnecessary emergency interventions and complications.
