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Innovating neurosurgical training: a comprehensive evaluation of a 3D-printed intraventricular neuroendoscopy simulator and systematic review of the literature. 创新神经外科培训:3D 打印脑室内神经内镜模拟器的综合评估和文献系统回顾。
IF 1.6 4区 医学 Q2 SURGERY Pub Date : 2024-11-05 eCollection Date: 2024-01-01 DOI: 10.3389/fsurg.2024.1446067
Attill Saemann, Adriana De Rosa, Jokin Zubizarreta Oteiza, Neha Sharma, Florian M Thieringer, Jehuda Soleman, Raphael Guzman

Objective: The objective of this study was to develop and evaluate a low-cost 3D-printed simulator to improve the ability of neurosurgical residents to handle and coordinate endoscopes in performing technically demanding procedures such as neuroendoscopic removal of ventricular tumors or endoscopic third ventriculostomy (ETV).

Methods: The simulator was developed, printed in-house, and evaluated in a trial involving neurosurgery residents who performed ETV and intraventricular tumor resection tasks using it. Participants completed a questionnaire that assessed various aspects of the simulator's effectiveness, including anatomical visualization, procedural understanding, competency enhancement, and subjective impressions.

Results: A total of 12 participants were included in the evaluation. The majority (n = 7, 53.85%) were male, with a mean age of 29.8 ± 3.27 years and 4 ± 2 years of neurosurgical experience. All participants agreed or strongly agreed (4.5 ± 0.50) that the 3D printed simulator helped develop systematic intraventricular visualization and understanding of surgical steps (4.42 ± 0.64). The handling of the endoscope was rated as realistic (4.5 ± 0.50), while the haptic qualities of the tumor were rated lower (3.83 ± 0.80; 3.92 ± 0.64). Training increased competence (4.25 ± 0.45) and coordination skills (4.5 ± 0.50), with 75% (n = 9) feeling more confident with neuroendoscopic instruments and 91.7% (n = 11) in future procedures.

Conclusion: The developed 3D-printed simulator offers an accessible and practical training resource for neurosurgical residents, addressing the limitations of traditional training methods. The simulator appears to improve procedural skills and the competence of future neurosurgeons, potentially improving patient safety and outcomes in neurosurgical practice.

研究目的本研究的目的是开发和评估一种低成本的三维打印模拟器,以提高神经外科住院医师在执行技术要求较高的手术(如神经内镜下脑室肿瘤切除术或内镜下第三脑室造口术(ETV))时处理和协调内镜的能力:该模拟器由公司自行开发、印制,并在神经外科住院医师参与的试验中进行了评估,他们使用该模拟器完成了 ETV 和脑室内肿瘤切除术任务。参与者填写了一份问卷,对模拟器效果的各个方面进行评估,包括解剖可视化、程序理解、能力提高和主观印象:共有 12 名参与者参与了评估。大部分参与者(7 人,53.85%)为男性,平均年龄(29.8±3.27)岁,神经外科经验(4±2)年。所有参与者都同意或非常同意(4.5 ± 0.50)3D 打印模拟器有助于发展系统的脑室内可视化和对手术步骤的理解(4.42 ± 0.64)。内窥镜的操作被评为逼真(4.5 ± 0.50),而肿瘤的触觉质量评分较低(3.83 ± 0.80;3.92 ± 0.64)。培训提高了能力(4.25 ± 0.45)和协调技能(4.5 ± 0.50),75%(n = 9)的人对使用神经内镜器械更有信心,91.7%(n = 11)的人对今后的手术更有信心:结论:开发的三维打印模拟器为神经外科住院医师提供了方便实用的培训资源,解决了传统培训方法的局限性。该模拟器似乎能提高未来神经外科医生的手术技能和能力,从而改善神经外科实践中的患者安全和治疗效果。
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引用次数: 0
Postprandial hypoglycemia as a complication of bariatric and metabolic surgery: a comprehensive review of literature. 作为减肥和代谢手术并发症的餐后低血糖:文献综述。
IF 1.6 4区 医学 Q2 SURGERY Pub Date : 2024-11-01 eCollection Date: 2024-01-01 DOI: 10.3389/fsurg.2024.1449012
Mehdi Karimi, Omid Kohandel Gargari

Postprandial hypoglycemia (PPH) is a challenging and significant complication that can occur following bariatric and metabolic surgery. Symptoms of PPH are typical of hypoglycemia, such as sweating, weakness, disorientation, palpitation, etc. The complex nature of PPH is essential to achieve accurate diagnosis and effective management. This review aims to give extensive coverage of the intricate nature of PPH common with bariatric and metabolic surgery, outlining its pathogenesis, risk factors, clinical presentation, diagnostic strategies, and treatment options. The study explores various clinical forms and pathogenic mechanisms behind PPH while discussing diagnostic tools like continuous glucose monitoring or mixed meal tolerance tests. Furthermore, it considers possible interventions, including dietary changes, pharmaceutical therapies, and surgeries, to relieve symptoms and improve patient's quality of life. It aims to comprehensively understand how healthcare professionals can effectively manage this disorder for patients undergoing bariatric and metabolic surgery.

餐后低血糖症(PPH)是减肥和代谢手术后可能出现的一种具有挑战性的严重并发症。PPH 的症状是典型的低血糖,如出汗、虚弱、迷失方向、心悸等。PPH 具有复杂性,因此准确诊断和有效治疗至关重要。本综述旨在广泛介绍减肥和代谢手术常见 PPH 的复杂性,概述其发病机制、风险因素、临床表现、诊断策略和治疗方案。研究探讨了 PPH 背后的各种临床形式和致病机制,同时讨论了连续葡萄糖监测或混合餐耐受试验等诊断工具。此外,研究还考虑了可能的干预措施,包括改变饮食习惯、药物疗法和手术,以缓解症状并改善患者的生活质量。该书旨在全面了解医护人员如何为接受减肥和代谢手术的患者有效控制这种疾病。
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引用次数: 0
Fumarate hydratase-deficient renal cell carcinoma complicated with liver metastasis: case report. 富马酸氢化酶缺陷型肾细胞癌并发肝转移:病例报告。
IF 1.6 4区 医学 Q2 SURGERY Pub Date : 2024-11-01 eCollection Date: 2024-01-01 DOI: 10.3389/fsurg.2024.1430344
Hanmin Chen, Qingming Zeng, Folin Liu, Xiaofeng Zou

Background: Fumarate hydratase-deficient renal cell carcinoma (FH-RCC) is a rare subtype of kidney tumor. Most of them are solitary lesions, making preoperative diagnosis difficult, aggressive, and with poor prognosis. They may metastasize even at an early stage, however, there is currently no optimal diagnostic and therapeutic approach for metastatic FH-RCC.

Methods: We report the case of a 34-year-old male patient with renal tumor and liver metastasis, who underwent open tumor resection of the right kidney combined with resection of liver metastases. Postoperative pathology was confirmed, followed by targeted therapy.

Results: Postoperative pathological results confirmed FH-RCC, targeted therapy was performed after surgery. No tumor recurrence was observed during the follow-up of almost 16 months.

Conclusion: FH-RCC patients with liver metastasis can achieve a good prognosis through early resection of primary tumor and metastatic lesions combined with targeted therapy.

背景:富马酸氢化酶缺陷型肾细胞癌(FH-RCC)是肾脏肿瘤的一种罕见亚型。它们大多为单发病灶,术前诊断困难,侵袭性强,预后差。它们甚至在早期就可能发生转移,但目前还没有针对转移性 FH-RCC 的最佳诊断和治疗方法:我们报告了一例 34 岁男性肾肿瘤和肝转移患者的病例,该患者接受了开放性右肾肿瘤切除术和肝转移灶切除术。术后病理结果证实,随后进行了靶向治疗:术后病理结果证实为 FH-RCC,术后进行了靶向治疗。随访近16个月,未发现肿瘤复发:结论:FH-RCC 肝转移患者可通过早期切除原发肿瘤和转移病灶并结合靶向治疗获得良好的预后。
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引用次数: 0
Factors affecting the occurrence of maxillary sinus fungus ball. 影响上颌窦真菌球发生的因素。
IF 1.6 4区 医学 Q2 SURGERY Pub Date : 2024-11-01 eCollection Date: 2024-01-01 DOI: 10.3389/fsurg.2024.1491155
Hye-Bin Jang, Dong Hoon Lee, Sang Chul Lim

Objective: We identified patients who initially did not have a maxillary sinus fungus ball on computed tomography (CT) but developed it on a subsequent CT scan. We assessed potential risk factors for developing a maxillary sinus fungus ball between the two scans.

Patients and methods: This study included 35 patients with 38 lesions who initially had no maxillary sinus fungus balls on CT but were later diagnosed with the condition and underwent surgery.

Results: We analyzed 38 lesions in 35 patients, each of whom had normal CT scan results initially but later developed a maxillary sinus fungus ball. No specific risk factors for developing a maxillary sinus fungus ball were identified. However, when compared to the maxillary sinusitis group, facial trauma and dental implant surgery appeared to be associated with maxillary sinus fungus ball formation (p < 0.05).

Conclusion: We investigated factors influencing the development of maxillary sinus fungus balls that were absent in previous CT scans and found no significant risk factors. Nonetheless, relative to the maxillary sinusitis (control) group, the maxillary sinus fungus ball group tended to have more previous facial trauma and dental implant surgery.

目的:我们发现了一些患者,他们最初在计算机断层扫描(CT)中没有发现上颌窦真菌球,但在随后的CT扫描中出现了真菌球。我们评估了在两次扫描之间出现上颌窦真菌球的潜在风险因素:这项研究包括 35 名患者的 38 个病灶,他们最初在 CT 上没有发现上颌窦真菌球,但后来被诊断出患有这种疾病并接受了手术:我们对 35 名患者的 38 个病灶进行了分析,每名患者最初的 CT 扫描结果都正常,但后来都出现了上颌窦真菌球。没有发现导致上颌窦真菌球的特殊风险因素。不过,与上颌窦炎组相比,面部创伤和牙科植入手术似乎与上颌窦真菌球的形成有关(P 结论:上颌窦真菌球的形成与面部创伤和牙科植入手术有关:我们研究了影响上颌窦真菌球形成的因素,发现这些因素在之前的 CT 扫描中并不存在。不过,与上颌窦炎(对照)组相比,上颌窦真菌球组往往有更多的面部创伤和牙科植入手术经历。
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引用次数: 0
Analyzing postoperative complications in colorectal cancer surgery: a systematic review enhanced by artificial intelligence. 分析结直肠癌手术的术后并发症:人工智能增强型系统综述。
IF 1.6 4区 医学 Q2 SURGERY Pub Date : 2024-10-31 eCollection Date: 2024-01-01 DOI: 10.3389/fsurg.2024.1452223
Dan Andras, Angela Madalina Lazar, Dragoş Crețoiu, Florian Berghea, Dragos Eugen Georgescu, Valentin Grigorean, Simona Raluca Iacoban, Bogdan Mastalier

Introduction: Colorectal cancer stands as a predominant cause of cancer-related mortality worldwide. Despite progressive strides in surgical methodologies, the specter of postoperative complications is very large, significantly impacting both morbidity and mortality rates. This review aims to meticulously examine existing scholarly works to gauge the prevalence, severity, and therapeutic approaches to postoperative complications arising from colorectal cancer surgeries.

Methods: Employing a systematic approach, this study reviewed 135 peer-reviewed publications from the period of 2000-2023. The corpus was organized into categories reflective of the postoperative complications discussed: anastomotic leakage, port-site metastases, small bowel adhesions and obstructions, thrombosis, ileus, postoperative infections, urinary dysfunctions, and cardiovascular dysfunctions. Advanced artificial intelligence tools were leveraged for in-depth literature searches and semantic analyses to pinpoint research lacunae.

Results: The analysis revealed that anastomotic leakage and postoperative infections garnered the majority of academic focus, representing 35% and 25% of the studies, respectively. Conversely, port-site metastases and cardiovascular dysfunctions were less frequently examined, accounting for merely 5% and 3% of the literature. The reviewed studies indicate a disparity in the reported prevalence rates of each complication, oscillating between 3% and 20%. Furthermore, the review identified a dearth of evidence-based management protocols, underscored by a pronounced heterogeneity in treatment guidelines.

Conclusions: The literature is replete with analyses on anastomotic leakage and postoperative infections; however, there exists a glaring scarcity of exhaustive research on other postoperative complications. This review emphasizes the pressing need for uniform treatment guidelines and spotlights areas in dire need of further research, aiming at the comprehensive enhancement of patient outcomes following colorectal cancer surgery.

导言:结直肠癌是全球癌症相关死亡的主要原因。尽管手术方法在不断进步,但术后并发症的阴影仍然很大,对发病率和死亡率都有很大影响。本综述旨在仔细研究现有的学术著作,以衡量结直肠癌手术术后并发症的发生率、严重程度和治疗方法:本研究采用系统方法,对 2000-2023 年间 135 篇同行评审出版物进行了审查。这些文献按术后并发症的类别进行了分类:吻合口漏、端口部位转移、小肠粘连和梗阻、血栓形成、回肠梗阻、术后感染、排尿功能障碍和心血管功能障碍。利用先进的人工智能工具进行了深入的文献检索和语义分析,以找出研究空白点:分析结果显示,吻合口漏和术后感染是学术界关注的焦点,分别占研究的 35% 和 25%。相反,对端口转移和心血管功能障碍的研究较少,仅占文献的 5%和 3%。综述研究表明,每种并发症的报告发病率都不尽相同,介于 3% 和 20% 之间。此外,综述还发现缺乏循证管理方案,治疗指南的明显异质性也凸显了这一点:结论:关于吻合口漏和术后感染的分析文献比比皆是,但关于其他术后并发症的详尽研究却明显不足。这篇综述强调了制定统一治疗指南的迫切性,并指出了急需进一步研究的领域,旨在全面提高结直肠癌术后患者的治疗效果。
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引用次数: 0
Outcome and survival analysis of pulmonary metastasectomy for primary sarcoma with pulmonary metastases. 原发性肉瘤伴肺部转移的肺转移切除术的结果和存活率分析。
IF 1.6 4区 医学 Q2 SURGERY Pub Date : 2024-10-30 eCollection Date: 2024-01-01 DOI: 10.3389/fsurg.2024.1470784
Chih-Hsiang Chang, Xu-Heng Chiang, Mong-Wei Lin, Shuenn-Wen Kuo, Pei-Ming Huang, Hsao-Hsun Hsu, Jin-Shing Chen

Background: Sarcomas are rare malignancies, accounting for approximately 1% of all cancers. Pulmonary metastases are the most preferential site for distant metastasis in malignant soft tissue sarcomas. Despite the lack of evidence from large randomized trials to support treatment guidelines, surgical resection of resectable metastatic tumors remains the current standard of care. This study aimed to explore the survival status of patients with soft tissue sarcoma after resection of pulmonary metastases.

Methods: This study is a retrospective analysis of patients who mestastasectomy by means of lobar or sublobar resections at National Taiwan University Hospital and its branches. The statistical and investigation period was from February 2007 to December 2020.

Results: Among 110 samples during the investigation period, the overall 5-year survival rate was 62.9%, which was higher than the 15%-50.9% reported previously. A disease-free interval of more than 12 months and the occurrence of local recurrence of sarcoma at the time of resection of pulmonary metastases are associated with overall survival. Most of the samples were treated with minimally invasive surgery (VATS), and therefore, most patients had a shorter hospital stay and better postoperative recovery.

Conclusion: For pulmonary metastatic sarcoma, pulmonary metastasectomy is a relatively safe treatment method with short hospital stay and short ICU stay. The results of this study suggest that VATS is preferred over thoracotomy, but further observations are needed to confirm these findings.

背景:肉瘤是一种罕见的恶性肿瘤,约占所有癌症的 1%。肺转移是恶性软组织肉瘤远处转移的首选部位。尽管缺乏大型随机试验的证据来支持治疗指南,但手术切除可切除的转移性肿瘤仍是目前的治疗标准。本研究旨在探讨切除肺转移灶后软组织肉瘤患者的生存状况:本研究是一项回顾性分析,对象为在台湾大学医院及其分院接受肺叶或肺叶下切除术的转移瘤患者。统计和调查时间为 2007 年 2 月至 2020 年 12 月:在调查期间的 110 个样本中,总体 5 年生存率为 62.9%,高于之前报告的 15%-50.9% 的水平。无病间隔期超过12个月以及切除肺转移灶时肉瘤局部复发与总生存率有关。大多数样本采用微创手术(VATS)治疗,因此,大多数患者的住院时间较短,术后恢复较好:结论:对于肺转移性肉瘤,肺转移瘤切除术是一种相对安全的治疗方法,住院时间短,入住重症监护室时间短。结论:对于肺转移肉瘤,肺转移切除术是一种相对安全的治疗方法,住院时间短,重症监护室停留时间短。本研究结果表明,VATS 比开胸术更受欢迎,但还需要进一步观察来证实这些结果。
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引用次数: 0
Machine learning perioperative applications in visceral surgery: a narrative review. 内脏外科围手术期的机器学习应用:综述。
IF 1.6 4区 医学 Q2 SURGERY Pub Date : 2024-10-30 eCollection Date: 2024-01-01 DOI: 10.3389/fsurg.2024.1493779
Intekhab Hossain, Amin Madani, Simon Laplante

Artificial intelligence in surgery has seen an expansive rise in research and clinical implementation in recent years, with many of the models being driven by machine learning. In the preoperative setting, machine learning models have been utilized to guide indications for surgery, appropriate timing of operations, calculation of risks and prognostication, along with improving estimations of time and resources required for surgeries. Intraoperative applications that have been demonstrated are visual annotations of the surgical field, automated classification of surgical phases and prediction of intraoperative patient decompensation. Postoperative applications have been studied the most, with most efforts put towards prediction of postoperative complications, recurrence patterns of malignancy, enhanced surgical education and assessment of surgical skill. Challenges to implementation of these models in clinical practice include the need for more quantity and quality of standardized data to improve model performance, sufficient resources and infrastructure to train and use machine learning, along with addressing ethical and patient acceptance considerations.

近年来,人工智能在外科手术领域的研究和临床应用大幅增加,其中许多模型都是由机器学习驱动的。在术前环境中,机器学习模型已被用于指导手术适应症、手术的适当时机、风险计算和预后,以及改进手术所需时间和资源的估算。已证实的术中应用包括手术区域的可视化注释、手术阶段的自动分类以及术中病人失代偿的预测。对术后应用的研究最多,主要集中在预测术后并发症、恶性肿瘤复发模式、加强手术教育和评估手术技能等方面。在临床实践中实施这些模型所面临的挑战包括:需要更多数量和质量的标准化数据来提高模型性能,需要足够的资源和基础设施来训练和使用机器学习,同时还要解决道德和患者接受度方面的问题。
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引用次数: 0
Effects of different hinge positions on tibial rotation in uniplanar medial opening wedge high tibial osteotomy with three-dimensional tibial models. 使用三维胫骨模型进行单平面内侧开口楔形高胫骨截骨术时,不同铰链位置对胫骨旋转的影响。
IF 1.6 4区 医学 Q2 SURGERY Pub Date : 2024-10-30 eCollection Date: 2024-01-01 DOI: 10.3389/fsurg.2024.1441777
Lizhong Jing, Yulian Ren, Shaoshan Wang, Jiushan Yang, Jian Wang

Background: To investigate the effects of different hinge positions in the sagittal and axial planes on distal tibial rotation (DTR) during medial opening wedge high tibial osteotomy (MOWHTO) with three-dimensional tibial models.

Methods: Preoperative CT data from 30 knee joints in 30 patients who underwent surgery for varus malalignment of knee were included. 1 standard hinge position (0°), 6 axial planes (±5°, ±10°, ±15°), and 6 sagittal planes (±5°, ±10°, ±15°) hinge positions were defined and virtual uniplanar osteotomy was performed. The correction angle of each model was generated using Fujisawa's point. Participants' baseline characteristics, radiologic parameters and DTR were measured. One-Way Repeated Measures ANOVA and single factor linear regression analysis were used to analyze the association between tibial rotation and hinge position in the sagittal and axial planes.

Results: We found a clear linear correlation between changes in hinge position in the sagittal plane and DTR. The changes in DTR were the smallest when the hinge position was at 5°, where internal or external rotation of the DTR may occur. When the front aspect of hinge axis rotated distally, DTR tended towards internal. Meanwhile, when the front aspect of hinge axis rotated proximally, DTR tended towards external. There were no correlations with every hinge axis position in the axial plane.

Conclusions: It is sagittal but not axial hinge axis affects DTR in uniplanar MOWHTO with three-dimensional tibial models. In the sagittal plane, every change in hinge position was significantly linearly correlated with DTR. However, no linear correlations were observed between every hinge position change in the axial plane.

背景:利用三维胫骨模型研究矢状面和轴向不同铰链位置对胫骨内侧开放楔形高位截骨术(MOWHTO)中胫骨远端旋转(DTR)的影响:方法:纳入因膝关节内翻错位而接受手术的 30 名患者的 30 个膝关节的术前 CT 数据。定义 1 个标准铰链位置(0°)、6 个轴向平面(±5°、±10°、±15°)和 6 个矢状平面(±5°、±10°、±15°)铰链位置,并进行虚拟单平面截骨。每个模型的矫正角度都是使用藤泽点生成的。测量参与者的基线特征、放射学参数和 DTR。采用单向重复测量方差分析和单因素线性回归分析来分析胫骨旋转与铰链位置在矢状平面和轴向平面上的关联:我们发现矢状面铰链位置的变化与DTR之间存在明显的线性相关。当铰链位置为5°时,DTR的变化最小,此时DTR可能发生内旋或外旋。当铰链轴前端向远端旋转时,DTR倾向于内旋。同时,当铰链轴前端向近端旋转时,DTR 倾向于外旋。在轴向平面上,铰链轴的每个位置都没有相关性:结论:在使用三维胫骨模型进行单平面 MOWHTO 时,影响 DTR 的是矢状面铰链轴,而非轴向铰链轴。在矢状面上,铰链位置的每一个变化都与 DTR 呈显著线性相关。然而,在轴向平面上,铰链位置的每次变化都没有线性关系。
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引用次数: 0
Cost-consequence analysis of the enhanced recovery after surgery protocol in major lung resection with minimally invasive technique (VATS). 微创技术(VATS)肺大部切除术中术后恢复强化方案的成本后果分析。
IF 1.6 4区 医学 Q2 SURGERY Pub Date : 2024-10-30 eCollection Date: 2024-01-01 DOI: 10.3389/fsurg.2024.1471070
Alessandra Buja, Giuseppe De Luca, Stefano Dal Moro, Marco Mammana, Anna Zanovello, Stefano Miola, Deris Gianni Boemo, Ilaria Storti, Pietro Bovo, Fabio Zorzetto, Marco Schiavon, Federico Rea

Background: ERAS is an evidence-based multimodal perioperative protocol focused on stress reduction and promoting a return to function. The aim of this work is to perform a cost-consequence analysis for the implementation of ERAS in major lung resection by means of minimally invasive surgery (VATS) from the public health service perspective, evaluating resource consumption and clinical outcomes with respect to a control group of past patients, which did not adopt an ERAS protocol.

Methods: Outcome differences (re-intervention rates, major and minor intraoperative and postoperative complications, readmissions, and mortality) as well as the costs of preoperative, operative, and postoperative care were estimated. The sample consisted of 64 consecutive patients enrolled in the ERAS programme between April 2021 and August 2022, compared to a control group (historical cohort) comprising 31 patients treated from April 2020 to December 2020, prior to the implementation of the ERAS programme. The study sample comprises patients who fulfil the established ERAS protocol inclusion criteria, including general criteria (acceptance of the protocol, proximity of residence, absence of contraindications to physiotherapy and early mobilisation), surgical criteria (anatomical lung resection up to lobectomy, absence of extensive resection, good possibility of conducting the operation in VATS) and anaesthesiologic criteria (ASA ≤2). Costs were quantified using the national health system perspective.

Results: The average length-of-stay was at least one day shorter in the ERAS group [<0.001. Average total costs including entire pathway healthcare costs were substantially reduced for ERAS-VATS patients (mean: € 5,955.71 vs. €6,529.41 Δ = -573.70 p = 0.018)]. Specifically, the median costs of the admission phase were significantly different between the two groups (median: €4,648.82 vs. €5,596.58, p = 0.008), with a reduction in hospital stay expenditure in the ERAS-VATS group (median: €1,599.62 vs. €2,399.43, p = 0.025). No significant differences were found regarding major clinical outcomes.

Conclusions: The implementation of an ERAS programme is a dominant strategy, representing an intervention capable of reducing overall costs in the context of elective anatomical lung resection with VATS without any significant differences in major complications and re-intervention rates.

背景:ERAS 是一种以证据为基础的多模式围手术期方案,重点是减轻压力和促进功能恢复。这项工作的目的是从公共卫生服务的角度,对在微创手术(VATS)肺大部切除术中实施ERAS进行成本-后果分析,评估与未采用ERAS方案的过往患者对照组相比的资源消耗和临床结果:方法:对结果差异(再介入率、术中和术后主要和次要并发症、再入院率和死亡率)以及术前、术中和术后护理成本进行了估算。样本包括在2021年4月至2022年8月期间连续参加ERAS计划的64名患者,对照组(历史队列)包括在ERAS计划实施前的2020年4月至2020年12月期间接受治疗的31名患者。研究样本包括符合既定ERAS方案纳入标准的患者,包括一般标准(接受方案、居住地就近、无理疗禁忌症和早期活动能力)、手术标准(解剖学肺切除至肺叶切除、无大范围切除、VATS手术可能性大)和麻醉标准(ASA≤2)。结果显示,平均住院时间为2.5天:结果:ERAS 组的平均住院时间至少缩短了一天[p = 0.018]。具体而言,两组入院阶段的费用中位数有显著差异(中位数:4648.82 欧元对 5596.58 欧元,p = 0.008),ERAS-VATS 组的住院费用有所减少(中位数:1599.62 欧元对 2399.43 欧元,p = 0.025)。在主要临床结果方面没有发现明显差异:结论:实施ERAS计划是一种主要策略,代表了一种能够降低VATS择期解剖性肺切除术总成本的干预措施,且在主要并发症和再介入率方面无明显差异。
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引用次数: 0
Case Report: Postoperative ascites: allergic reaction to the drainage tube in a 12-year-old patient. 病例报告:术后腹水:一名 12 岁患者对引流管的过敏反应。
IF 1.6 4区 医学 Q2 SURGERY Pub Date : 2024-10-30 eCollection Date: 2024-01-01 DOI: 10.3389/fsurg.2024.1409673
Ren-Sen Jiang, Jing Lao, Huan-Sheng Wang, Miao-Bing Wu, Bing Wang, Jian-Yao Wang

Allergic reaction to the silicone is rare in children and as a result very little experience has been reported on symptom and treatment. We presented a case involving a child who experienced prolonged ascites following a surgery of placing an abdominal drainage tube, characterized by the ongoing drainage of clear, light-yellow fluid at a rate of 250 mL/day through the drainage tube for 36 days. Examination of the ascitic fluid revealed an abnormal elevation in eosinophil proportion, which exhibited positive response to anti-allergic treatment. Subsequent to the removal of the drainage tube, the ascites gradually resolved. In conclusion, we presented here the first and youngest case of allergic ascites associated with drainage tube after surgery of ovarian mucinous cystadenoma, it is imperative not to overlook the possibility of drainage tube allergy in the diagnostic process.

儿童对硅胶的过敏反应非常罕见,因此有关症状和治疗方法的报道非常少。我们介绍了一个病例,该患儿在接受腹腔引流管置入手术后出现了长时间腹水,其特点是引流管不断排出浅黄色透明液体,每天 250 毫升,持续 36 天。腹水检查显示嗜酸性粒细胞比例异常升高,对抗过敏治疗呈阳性反应。拔除引流管后,腹水逐渐消退。总之,我们在此介绍了第一例也是最年轻的一例卵巢粘液性囊腺瘤术后引流管相关过敏性腹水病例,在诊断过程中切勿忽视引流管过敏的可能性。
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Frontiers in Surgery
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