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Robotic evolution from Si to Xi in rectal cancer assessing operative performance and oncological outcomes. 机器人在直肠癌中从Si到Xi的进化评估手术表现和肿瘤预后。
IF 1.6 4区 医学 Q2 SURGERY Pub Date : 2026-01-21 eCollection Date: 2025-01-01 DOI: 10.3389/fsurg.2025.1668213
Wenpeng Wang, Shan Gao, Jinghao Huang, Duo Yun, Jiefu Wang

Purpose: To compare perioperative and oncologic outcomes between robotic surgical platforms (Si vs. Xi) in rectal carcinoma.

Methods: A retrospective cohort study of 86 robotic rectal cancer resections (Si: n = 31; Xi: n = 55) were analyzed at Tianjin Medical University Cancer Hospital between November 2019 and June 2024.

Results: Among 86 patients with comparable baseline clinicopathological variables (all p > 0.05), the Xi system showed superior perioperative efficiency: shorter operation (226.7 vs. 282.1 min, p = 0.010), console (p = 0.016) and docking times (p = 0.013), less blood loss (83.8 vs. 155.8 mL, p = 0.005), and a shorter postoperative stay (7.8 vs. 9.7 days, p = 0.016). On multivariable analyses, Xi remained independently associated with a shorter operative time (p = 0.002), reduced blood loss (p = 0.027), and decreased length of stay (p = 0.038). Complication rates, lymph node yield, and short-term oncologic quality indicators (distal resection margin [DRM], circumferential resection margin [CRM], mesorectal integrity) were comparable between two systems (all p > 0.05). In low rectal cancers (≤ 5 cm from the anal verge) with balanced baselines, Xi achieved a higher sphincter preservation rate (90.5% vs. 55.6%, p = 0.049). Survival trends numerically favored Xi (3-year DFS 79.8% vs. 73.0%; OS 92.0% vs. 83.0%), but differences were not significant (DFS: p = 0.54; OS: p = 0.26). On Cox regression, TNM stage independently predicted both DFS (p = 0.041) and OS (p = 0.029). However, the robotic platform (Xi vs. Si) showed no survival advantage (DFS: HR = 1.33, 95% CI 0.53-3.37, p = 0.548; OS: HR = 1.43, 95% CI 0.76-2.67, p = 0.267).

Conclusions: Compared with Si, the Xi platform confers measurable perioperative advantages-shorter operative time, less blood loss, and reduced hospitalization-without compromising short-term oncologic quality or survival. In low rectal tumors, Xi may facilitate sphincter preservation under comparable baselines. Long-term outcomes appear driven primarily by disease stage rather than platform generation.

目的:比较直肠癌机器人手术平台(Si和Xi)的围手术期和肿瘤预后。方法:对2019年11月至2024年6月在天津医科大学肿瘤医院进行的86例机器人直肠癌切除术(Si: n = 31; Xi: n = 55)进行回顾性队列研究。结果:86例基线临床病理变量比较的患者(均p < 0.05)中,Xi系统表现出更优越的围手术期效率:更短的手术时间(226.7 vs. 282.1 min, p = 0.010),更少的失血量(83.8 vs. 155.8 mL, p = 0.005),更短的术后住院时间(7.8 vs. 9.7 d, p = 0.016)。在多变量分析中,Xi仍然与较短的手术时间(p = 0.002)、减少的出血量(p = 0.027)和缩短的住院时间(p = 0.038)独立相关。两种系统的并发症发生率、淋巴结产量和短期肿瘤质量指标(远端切除缘[DRM]、环周切除缘[CRM]、直肠系膜完整性)具有可比性(均p < 0.05)。在基线平衡的低位直肠癌(距肛门边缘≤5cm)中,Xi获得了更高的括约肌保留率(90.5%比55.6%,p = 0.049)。生存趋势在数字上有利于Xi(3年DFS 79.8% vs. 73.0%; OS 92.0% vs. 83.0%),但差异不显著(DFS: p = 0.54; OS: p = 0.26)。经Cox回归分析,TNM分期独立预测DFS (p = 0.041)和OS (p = 0.029)。然而,机器人平台(Xi vs. Si)没有表现出生存优势(DFS: HR = 1.33, 95% CI 0.53-3.37, p = 0.548; OS: HR = 1.43, 95% CI 0.76-2.67, p = 0.267)。结论:与Si相比,Xi平台具有可测量的围手术期优势-更短的手术时间,更少的出血量,更少的住院时间-而不会影响短期肿瘤质量或生存。在低位直肠肿瘤中,Xi可能有助于在可比基线下保存括约肌。长期结果似乎主要由疾病阶段而不是平台产生决定。
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引用次数: 0
One-stage vs. two-stage thoracoscopic surgery for synchronous bilateral pulmonary nodules: a systematic review and meta-analysis. 一期与两期胸腔镜手术治疗同步双侧肺结节:系统回顾和荟萃分析。
IF 1.6 4区 医学 Q2 SURGERY Pub Date : 2026-01-21 eCollection Date: 2025-01-01 DOI: 10.3389/fsurg.2025.1755084
Rachid Eduardo Noleto da Nobrega Oliveira, Guilherme Franceschini Machado, Isabella Cabianca Moriguchi Caetano Salvador, Paula Duarte D Ambrosio, Lucas Monteiro Delgado, Felipe S Passos, Tulio Caldonazo

Introduction: The optimal surgical strategy for synchronous bilateral pulmonary nodules remains unclear. One-stage bilateral resections may offer logistical and clinical advantages, but safety concerns persist regarding bilateral complications.

Methods: We conducted a systematic review and meta-analysis of studies comparing one-stage vs. two-stage pulmonary resections in adult patients with synchronous bilateral nodules. Ten observational studies were included, encompassing 1,015 patients. Continuous outcomes were assessed using mean differences (MDs) and binary outcomes with odds ratios (ORs), applying DerSimonian and Laird random-effects models. Subgroup and meta-regression analyses were performed. Statistical analyses were conducted using R software (v4.4.1).

Results: One-stage resection was associated with significantly reduced operative time (MD -24.36 min; 95% CI -40.59 to -8.13), shorter hospital stay (MD -2.79 days; 95% CI -4.25 to -1.33), and lower direct surgical costs (MD -5,543.73 USD; 95% CI -6,601.05 to -4,486.40). No significant differences were observed in intraoperative blood loss, persistent air leak, or arrhythmia. Subgroup analysis revealed that the type of pulmonary lesion influenced hospital stay, while meta-regression showed no effect of lobectomy rate.

Conclusions: One-stage bilateral resection demonstrates greater efficiency without increased morbidity, supporting its use in experienced centers. These findings suggest that a single-anesthetic approach may facilitate earlier recovery and timely systemic therapy in selected patients.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251048804, identifier: CRD420251048804.

同步双侧肺结节的最佳手术策略尚不清楚。一期双侧切除术可能提供后勤和临床优势,但双侧并发症的安全性问题仍然存在。方法:我们进行了一项系统综述和荟萃分析,比较了成人同步双侧结节患者一期和两期肺切除术的研究。纳入了10项观察性研究,包括1015名患者。采用DerSimonian和Laird随机效应模型,采用均值差异(md)和比值比(ORs)评估连续结局。进行亚组和元回归分析。采用R软件(v4.4.1)进行统计分析。结果:一期切除与显著缩短手术时间(MD -24.36 min; 95% CI -40.59 ~ -8.13)、缩短住院时间(MD -2.79天;95% CI -4.25 ~ -1.33)、降低直接手术费用(MD -5,543.73美元;95% CI -6,601.05 ~ -4,486.40)相关。术中出血量、持续漏气或心律失常方面无显著差异。亚组分析显示肺病变类型影响住院时间,而meta回归显示肺叶切除术率没有影响。结论:一期双侧切除在不增加发病率的情况下显示出更高的效率,支持在经验丰富的中心使用。这些研究结果表明,单一麻醉方法可能有助于选定患者的早期恢复和及时的全身治疗。系统评价注册:https://www.crd.york.ac.uk/PROSPERO/view/CRD420251048804,标识符:CRD420251048804。
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引用次数: 0
A perspective on arthroscopic treatment for anterior ankle impingement syndrome: clinical research insights. 踝关节前撞击综合征的关节镜治疗:临床研究见解。
IF 1.6 4区 医学 Q2 SURGERY Pub Date : 2026-01-21 eCollection Date: 2025-01-01 DOI: 10.3389/fsurg.2025.1613472
Long-Ze Zong, Yong Feng, Dong-Yu Bai

Introduction: Anterior ankle impingement syndrome (AAIS) is a degenerative condition that causes anterior ankle pain and limited dorsiflexion, especially in athletes. It results from either osseous (osteophytes) or soft tissue (synovial hypertrophy, fibrosis) pathology.

Methods: Although conservative treatments offer temporary relief, arthroscopic surgery has become the preferred approach due to its minimally invasive technique and surgical precision.

Results: Current evidence shows 80%-90% success rates, with significant improvements in visual analog scale scores (mean reduction of 4.1 points) and American orthopedic foot & ankle society scores (mean increase of 28 points), along with low complication rates (2%-7%). However, outcomes are closely linked to the severity of pre-existing osteoarthritis, with 93% success in non-arthritic joints compared to 53% in cases with moderate osteoarthritis. Key research limitations include heterogeneous study designs, small sample sizes, and a lack of long-term data (only 18.6% of studies report ≥5-year follow-up).

Discussion: Future research should focus on standardizing outcome measures, assessing the cost-effectiveness of advanced techniques, and establishing evidence-based protocols for patient selection and rehabilitation. These efforts will help optimize surgical decision-making and enhance long-term outcomes for patients with AAIS.

简介:前踝关节撞击综合征(AAIS)是一种退行性疾病,引起前踝关节疼痛和有限的背屈,尤其是在运动员中。它是由骨性(骨赘)或软组织(滑膜肥大、纤维化)病理引起的。方法:虽然保守治疗可以暂时缓解,但关节镜手术因其微创技术和手术精度而成为首选方法。结果:目前的证据显示80%-90%的成功率,视觉模拟量表评分(平均降低4.1分)和美国骨科足踝社会评分(平均增加28分)显著提高,并发症发生率低(2%-7%)。然而,结果与先前存在的骨关节炎的严重程度密切相关,非关节炎关节的成功率为93%,而中度骨关节炎的成功率为53%。研究的主要局限性包括异质性研究设计、小样本量和缺乏长期数据(只有18.6%的研究报告≥5年随访)。讨论:未来的研究应侧重于标准化结果测量,评估先进技术的成本效益,并建立基于证据的患者选择和康复方案。这些努力将有助于优化手术决策,提高AAIS患者的长期预后。
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引用次数: 0
Case Report: SPECT-CT-guided minimally invasive transverse process resection for Bertolotti syndrome. 病例报告:spect - ct引导下微创横突切除术治疗Bertolotti综合征。
IF 1.6 4区 医学 Q2 SURGERY Pub Date : 2026-01-20 eCollection Date: 2025-01-01 DOI: 10.3389/fsurg.2025.1733483
Samantha E Spellicy, Ellen O'Callaghan, Michael Patetta, Dennis A Turner, Muhammad M Abd-El-Barr

Lumbosacral transitional vertebrae (LSTV) are a common congenital anomaly that often manifests as chronic low back or radicular pain, a condition clinically referred to as Bertolotti syndrome. One specific cause of Bertolotti syndrome is pseudoarticulation of the L5 transverse process with the sacrum or ilium due to LSTV. Although conventional magnetic resonance imaging (MRI) and computed tomography can identify structural changes, they provide limited functional information regarding sites of active arthropathy. Single-photon emission computed tomography (SPECT-CT) enables the localization of metabolically active pseudoarthrotic joints, thereby improving patient selection and surgical planning. We present the case of a 52-year-old woman with Bertolotti syndrome who presented with severe chronic axial back pain and left-sided pain radiating along portions of the L5 and S1 dermatomes. MRI revealed no significant compression of the neural elements but did demonstrate an incidental Tarlov cyst at S1, measuring 5.7 mm × 5.7 mm. SPECT-CT demonstrated localized, abnormal uptake between an anomalous left L5 transverse process and the sacrum. The patient underwent minimally invasive, image-guided removal of the left L5 transverse process, isolating L5 vertebral motion from the iliac crest. She was discharged on postoperative day 1 with significant improvement in her pain and radiculopathy. At 6-week, 3-, and 6-month follow-up, she reported near-complete resolution of presurgical radicular pain, functional restoration, and a return to normal activities. This case highlights the utility of SPECT-CT in evaluating Bertolotti syndrome. Functional imaging enabled precise structural localization of the pain generator, while targeted minimally invasive resection provided durable symptom relief.

腰骶过渡椎(LSTV)是一种常见的先天性异常,通常表现为慢性腰痛或神经根性疼痛,临床上称为Bertolotti综合征。Bertolotti综合征的一个特殊原因是LSTV引起的L5横突与骶骨或髂骨的假关节。尽管传统的磁共振成像(MRI)和计算机断层扫描可以识别结构变化,但它们提供的有关活动性关节病部位的功能信息有限。单光子发射计算机断层扫描(SPECT-CT)能够定位代谢活跃的假关节,从而改善患者选择和手术计划。我们报告一名患有Bertolotti综合征的52岁女性,她表现为严重的慢性腰轴性疼痛和左侧沿L5和S1部分皮节放射的疼痛。MRI显示神经元件无明显压迫,但在S1处发现偶发的Tarlov囊肿,尺寸为5.7 mm × 5.7 mm。SPECT-CT显示在异常左L5横突和骶骨之间有局部异常摄取。患者在图像引导下微创切除左L5横突,分离L5椎体运动与髂骨。患者术后第1天出院,疼痛和神经根病明显改善。在6周、3和6个月的随访中,患者报告手术前神经根疼痛几乎完全消退,功能恢复,并恢复正常活动。本病例强调SPECT-CT在评估Bertolotti综合征中的应用。功能成像能够精确定位疼痛源的结构,而靶向微创切除提供持久的症状缓解。
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引用次数: 0
Case Report: Application of the LVIS stent as a bridging device for salvage treatment of malapposed lattice flow diverter in a giant posterior circulation aneurysm: technical note and clinical efficacy. 病例报告:LVIS支架作为桥接装置抢救治疗巨大后循环动脉瘤错位点阵分流术:技术要点及临床疗效。
IF 1.6 4区 医学 Q2 SURGERY Pub Date : 2026-01-20 eCollection Date: 2025-01-01 DOI: 10.3389/fsurg.2025.1732753
Musheng Rao, Guan Lin, Shuzhou Cai

Objective: To evaluate the feasibility, technical nuances, and clinical outcomes of using the LVIS stent as a bridging device for the salvage treatment of a malapposed Lattice flow diverter (FD) in a giant posterior circulation aneurysm.

Methods: We present a detailed case report of a patient with a giant aneurysm in the V4 segment of the vertebral artery. Following implantation of a Lattice blood flow diverter and coils, immediate post-procedural angiography revealed incomplete opening and malapposition at the proximal segment of the stent, accompanied by delayed distal flow. After unsuccessful attempts to improve wall apposition via microcatheter massage, a salvage strategy was employed by deploying an LVIS stent within the malapposed FD segment. This approach aimed to enhance overall wall apposition and metal coverage to achieve ultimate aneurysm occlusion.

Results: The salvage procedure was performed successfully. The LVIS stent was accurately deployed within the malapposed segment of the FD. Angiographic assessment after the procedure demonstrated complete wall apposition of the composite stent construct and total occlusion of the aneurysm sac. The patient experienced no new neurological deficits during the perioperative period. Short-term follow-up indicated an excellent clinical outcome, with a modified Rankin Scale score of 0.

Conclusion: Utilizing the LVIS stent as a bridging salvage strategy is a safe and effective technical option for managing malapposed FDs in complex giant posterior circulation aneurysms. This technique effectively enhances stent wall apposition and structural integrity, potentially promoting intra-aneurysmal thrombosis and eventual occlusion. It provides a valuable clinical approach for managing this challenging complication.

目的:评估LVIS支架作为桥接装置抢救治疗巨大后循环动脉瘤中错位点阵血流分流器(FD)的可行性、技术差异和临床结果。方法:我们报告了一例椎动脉V4段巨大动脉瘤的病例。在植入点阵血流分流器和线圈后,立即术后血管造影显示支架近段开放不完全和错位,并伴有远端血流延迟。在尝试通过微导管按摩改善管壁贴壁不成功后,我们采用了一种挽救策略,即在贴壁错误的FD段内放置LVIS支架。该方法旨在增强整体壁面和金属覆盖以达到最终的动脉瘤闭塞。结果:打捞手术成功。LVIS支架准确地部署在FD的错位段内。手术后的血管造影评估显示复合支架结构完全贴壁,动脉瘤囊完全闭塞。患者围手术期无新的神经功能缺损。短期随访显示临床预后良好,改良Rankin量表评分为0分。结论:LVIS支架作为桥接挽救策略是治疗复杂后循环巨动脉瘤畸形fd的一种安全有效的技术选择。这项技术有效地增强了支架壁的贴合和结构的完整性,潜在地促进了动脉瘤内血栓形成和最终的闭塞。它为处理这一具有挑战性的并发症提供了一种有价值的临床方法。
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引用次数: 0
Construction of prediction models for prolonged length of postoperative hospital stay in patients undergoing primary total hip arthroplasty via direct anterior approach. 直接前路初次全髋关节置换术患者术后住院时间延长预测模型的建立
IF 1.6 4区 医学 Q2 SURGERY Pub Date : 2026-01-20 eCollection Date: 2025-01-01 DOI: 10.3389/fsurg.2025.1720930
Linjie Hu, Guosong Xu, Weiyi Chen, Yiqun Chen, Qichao Ou, Zhibin Wu, Guoxian Chen

Purpose: To investigate the risk factors associated with prolonged postoperative length of stay (PLOS) in patients undergoing primary total hip arthroplasty (THA) via direct anterior approach (DAA) and develop a perioperative dynamic prediction nomogram for optimizing the perioperative management of THA.

Methods: This single-center, retrospective cohort study analyzed the perioperative clinical data of patients who underwent primary THA through DAA by a single surgical team at our institution between September 2022 to September 2024. Patients were divided into two groups based on postoperative hospital stay duration: the normal group (PLOS < 6 days) and the prolonged group (PLOS > 6 days). LASSO regression was used to screen variables, multivariate logistic regression was applied to establish the model and then a nomogram was developed. The area under the curve (AUC) of receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) were adopted to evaluate the performance and clinical applicability of the model.

Results: This study included a total of 413 patients. Multivariate logistic regression analysis revealed that higher body mass index (BMI), longer operation time, American Society of Anesthesiologists classification (ASA) > II, postoperative extra opioid use, postoperative nausea and vomiting (PONV), postoperative blood transfusion, lower preoperative albumin (ALB) levels, and no prior contralateral THA history were independent risk factors for prolonged postoperative hospital stay in patients undergoing primary DAA-THA (P < 0.05). The AUC of the established predictive model was 0.766, indicating good predictive performance. The calibration curve demonstrated good consistency between actual delayed discharge rates and predicted probabilities. DCA showed that the model provided maximum net benefit when the threshold probability ranged from 2% to 85%.

Conclusions: BMI, operation time, ASA classification, postoperative extra opioid use, PONV, postoperative transfusion, preoperative ALB, and previous contralateral THA history can be used as predictive factors. The LASSO regression-based model for predicting prolonged hospital stay after primary DAA-THA demonstrates accurate predictive performance and strong clinical utility. It can assist clinicians in stratifying patient risk effectively, thereby supporting enhanced recovery protocols.

目的:探讨经直接前路(DAA)行原发性全髋关节置换术(THA)患者术后住院时间(PLOS)延长的相关危险因素,并建立围手术期动态预测图,以优化THA围手术期管理。方法:本研究为单中心、回顾性队列研究,分析我院于2022年9月至2024年9月通过DAA行原发性THA手术的患者围手术期临床资料。根据术后住院时间将患者分为两组:正常组(PLOS 6天)。采用LASSO回归对变量进行筛选,采用多元logistic回归建立模型,然后形成拟合图。采用受试者工作特征(ROC)曲线、校正曲线、决策曲线分析(DCA)的曲线下面积(AUC)评价模型的性能和临床适用性。结果:本研究共纳入413例患者。多因素logistic回归分析显示,较高的体重指数(BMI)、较长的手术时间、美国麻醉学会分级(ASA) > II、术后额外使用阿片类药物、术后恶心呕吐(PONV)、术后输血、术前白蛋白(ALB)水平较低、无对侧THA病史是原发性DAA-THA患者术后住院时间延长的独立危险因素(P)。BMI、手术时间、ASA分级、术后额外阿片类药物使用、PONV、术后输血、术前ALB、既往对侧THA病史均可作为预测因素。基于LASSO回归的预测原发性DAA-THA术后住院时间延长的模型显示出准确的预测性能和强大的临床实用性。它可以帮助临床医生有效地对患者风险进行分层,从而支持增强的恢复方案。
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引用次数: 0
Glycosaminoglycans and hyaluronic acid in chronic prostatitis/primary prostate pain syndrome: an evidence-grounded perspective. 糖胺聚糖和透明质酸在慢性前列腺炎/原发性前列腺疼痛综合征中的作用:基于证据的观点。
IF 1.6 4区 医学 Q2 SURGERY Pub Date : 2026-01-20 eCollection Date: 2025-01-01 DOI: 10.3389/fsurg.2025.1753129
Valerio Iacovelli, Carlo Brocca, Marco Carilli, Matteo Vittori, Michele Antonucci, Pierluigi Bove
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引用次数: 0
Development and validation of a nomogram for predicting bone metastasis in breast cancer: a retrospective study. 预测乳腺癌骨转移的nomogram发展与验证:一项回顾性研究。
IF 1.6 4区 医学 Q2 SURGERY Pub Date : 2026-01-20 eCollection Date: 2025-01-01 DOI: 10.3389/fsurg.2025.1722983
Yingnan Li, Teng Ma, Xinyi Sun, Changgen Liu, Haibo Wang

Background: Bone metastasis is the most common site of distant metastasis in breast cancer. Patients with bone metastasis have their quality of life and survival rate threatened. This study aims to develop a practical nomogram for predicting the risk of bone metastasis in breast cancer by integrating clinical data, assisting doctors in making more scientific clinical decisions.

Methods: We conducted a retrospective analysis of the data of newly diagnosed breast cancer patients from the database of the Affiliated Hospital of Qingdao University from January 2015 to December 2017. The cohort is divided into training set and validation set in a ratio of 7.5:2.5. Determine independent risk factors through Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis and logistic regression, and develop a nomogram prediction model. The model's performance and clinical utility were evaluated by Receiver Operating Characteristic (ROC) curve analysis, Area Under the Curve (AUC), calibration curves, and Decision Curve Analysis (DCA).

Results: During the 5-year follow-up period, bone metastases developed in 48 of 421 patients (11.40%). Ultimately, six independent risk factors were identified: neoadjuvant chemotherapy, family history of cancer, distant metastasis in other locations, axillary lymph node metastasis, marital status, and primary tumor site. The nomogram demonstrated excellent predictive performance, with AUC values of 0.89 and 0.86 in the training and validation cohorts, respectively.

Conclusions: This pioneering nomogram, incorporating baseline, tumor characteristics, and therapeutic parameters, provides visual guidance for breast surgeons to assess bone metastasis risk in breast cancer patients. It enables clinicians to prioritize high-risk patients through early identification, thereby optimizing surveillance protocols and therapeutic strategies to safeguard patients' quality of life.

背景:骨转移是乳腺癌最常见的远处转移部位。骨转移患者的生活质量和生存率受到威胁。本研究旨在通过整合临床数据,开发一种实用的预测乳腺癌骨转移风险的nomogram,帮助医生做出更科学的临床决策。方法:对青岛大学附属医院2015年1月至2017年12月数据库中新诊断乳腺癌患者的资料进行回顾性分析。队列按7.5:2.5的比例分为训练集和验证集。通过最小绝对收缩和选择算子(LASSO)回归分析和逻辑回归确定独立风险因素,并建立nomogram预测模型。通过受试者工作特征(ROC)曲线分析、曲线下面积(AUC)、校准曲线和决策曲线分析(DCA)评价模型的性能和临床应用价值。结果:在5年随访期间,421例患者中有48例发生骨转移(11.40%)。最终确定了6个独立的危险因素:新辅助化疗、癌症家族史、其他部位远处转移、腋窝淋巴结转移、婚姻状况和原发肿瘤部位。模态图表现出优异的预测性能,在训练和验证队列中的AUC值分别为0.89和0.86。结论:这一开创性的nomogram图结合了基线、肿瘤特征和治疗参数,为乳腺外科医生评估乳腺癌患者骨转移风险提供了视觉指导。它使临床医生能够通过早期识别来优先考虑高危患者,从而优化监测方案和治疗策略,以保障患者的生活质量。
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引用次数: 0
Controlled venospasm-assisted foam sclerotherapy combined with high ligation-a novel minimally invasive approach for primary great saphenous vein varicosities. 控制静脉痉挛辅助泡沫硬化疗法联合高位结扎-一种治疗原发性大隐静脉曲张的微创新方法。
IF 1.6 4区 医学 Q2 SURGERY Pub Date : 2026-01-20 eCollection Date: 2025-01-01 DOI: 10.3389/fsurg.2025.1730329
Chen Ya, Liu Zechao, Zhu Xuchang, Chen Boyu, Liu Zhengli, Kong Jie

Purpose: This study aimed to evaluate the efficacy and safety of Controlled Venospasm-Assisted Foam Sclerotherapy (CVAFS) combined with high ligation (HL) for treating primary great saphenous vein (GSV) varicosities.

Materials and methods: A retrospective cohort of 127 patients with primary GSV varicosities underwent CVAFS with high ligation between 1 Jan 2023 and 1 October 2023. Venospasm was induced by rotational mechanical stimulation of the catheter combined with external compression, resulting in a transient reduction of vessel diameter by 50%-70%, followed by DSA (Digital subtraction angiography)-guided foam injection (1:4 liquid-to-gas ratio). Technical success was defined as complete procedural execution under imaging guidance. Primary endpoints included 1-year GSV occlusion rate (assessed by duplex ultrasound) and reduction in Venous Clinical Severity Score (VCSS). Complications were recorded and managed conservatively.

Results: Technical success was achieved in 100% of limbs (145/145). Among 127 enrolled patients, 109 patients (125 limbs) completed the 12-month follow-up, yielding a follow-up rate of 85.8% (109/127). At 12 months, 93.6% of great saphenous veins (117/125 limbs) maintained complete occlusion. The Venous Clinical Severity Score (VCSS) significantly decreased from 6.18 ± 3.90 preoperatively to 0.86 ± 0.90 postoperatively (V = 7,875, p < 0.001). Thrombophlebitis observed in 9.6% of limbs (12/125), all cases resolved spontaneously within 2 weeks with conservative management (warm compression and NSAIDs). Saphenous Junction Pain occurred in 32.8% of limbs (41/125), with complete resolution within 2 weeks without intervention. No deep venous thrombosis (DVT), pulmonary embolism, skin necrosis, or neurological injuries were documented.

Conclusion: CVAFS leverages controlled venospasm to enhance foam-endothelium contact, significantly improving occlusion rates and symptom relief with acceptable safety. This approach offers a promising minimally invasive alternative for GSV varicosities.

目的:本研究旨在评价控制性静脉痉挛辅助泡沫硬化疗法(CVAFS)联合高位结扎(HL)治疗原发性大隐静脉(GSV)静脉曲张的疗效和安全性。材料和方法:在2023年1月1日至2023年10月1日期间,对127例原发性GSV静脉曲张患者进行CVAFS高位结扎的回顾性队列研究。通过旋转机械刺激导管并结合外压引起静脉痉挛,使血管直径短暂缩小50%-70%,然后进行DSA(数字减影血管造影)引导下泡沫注射(1:4液气比)。技术成功定义为在成像指导下完成程序执行。主要终点包括1年GSV闭塞率(通过双工超声评估)和静脉临床严重程度评分(VCSS)的降低。记录并发症并保守处理。结果:100%肢体技术成功率(145/145)。127例入组患者中,109例(125条肢体)完成了12个月的随访,随访率为85.8%(109/127)。12个月时,93.6%的大隐静脉(117/125)保持完全闭塞。静脉临床严重程度评分(VCSS)由术前的6.18±3.90降至术后的0.86±0.90 (V = 7,875, p)。结论:CVAFS通过控制静脉痉挛,增强泡沫与内皮细胞的接触,明显改善闭塞率和症状缓解,安全性可接受。这种方法为GSV静脉曲张提供了一种很有前途的微创治疗方法。
{"title":"Controlled venospasm-assisted foam sclerotherapy combined with high ligation-a novel minimally invasive approach for primary great saphenous vein varicosities.","authors":"Chen Ya, Liu Zechao, Zhu Xuchang, Chen Boyu, Liu Zhengli, Kong Jie","doi":"10.3389/fsurg.2025.1730329","DOIUrl":"10.3389/fsurg.2025.1730329","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the efficacy and safety of Controlled Venospasm-Assisted Foam Sclerotherapy (CVAFS) combined with high ligation (HL) for treating primary great saphenous vein (GSV) varicosities.</p><p><strong>Materials and methods: </strong>A retrospective cohort of 127 patients with primary GSV varicosities underwent CVAFS with high ligation between 1 Jan 2023 and 1 October 2023. Venospasm was induced by rotational mechanical stimulation of the catheter combined with external compression, resulting in a transient reduction of vessel diameter by 50%-70%, followed by DSA (Digital subtraction angiography)-guided foam injection (1:4 liquid-to-gas ratio). Technical success was defined as complete procedural execution under imaging guidance. Primary endpoints included 1-year GSV occlusion rate (assessed by duplex ultrasound) and reduction in Venous Clinical Severity Score (VCSS). Complications were recorded and managed conservatively.</p><p><strong>Results: </strong>Technical success was achieved in 100% of limbs (145/145). Among 127 enrolled patients, 109 patients (125 limbs) completed the 12-month follow-up, yielding a follow-up rate of 85.8% (109/127). At 12 months, 93.6% of great saphenous veins (117/125 limbs) maintained complete occlusion. The Venous Clinical Severity Score (VCSS) significantly decreased from 6.18 ± 3.90 preoperatively to 0.86 ± 0.90 postoperatively (<i>V</i> = 7,875, <i>p</i> < 0.001). Thrombophlebitis observed in 9.6% of limbs (12/125), all cases resolved spontaneously within 2 weeks with conservative management (warm compression and NSAIDs). Saphenous Junction Pain occurred in 32.8% of limbs (41/125), with complete resolution within 2 weeks without intervention. No deep venous thrombosis (DVT), pulmonary embolism, skin necrosis, or neurological injuries were documented.</p><p><strong>Conclusion: </strong>CVAFS leverages controlled venospasm to enhance foam-endothelium contact, significantly improving occlusion rates and symptom relief with acceptable safety. This approach offers a promising minimally invasive alternative for GSV varicosities.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1730329"},"PeriodicalIF":1.6,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12864433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146118631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Editorial: Surgical approaches and outcomes in cervical and thoracic myelopathies. 社论:颈、胸椎脊髓病的手术入路和预后。
IF 1.6 4区 医学 Q2 SURGERY Pub Date : 2026-01-19 eCollection Date: 2025-01-01 DOI: 10.3389/fsurg.2025.1775565
Samar S Ayache, Georges Naïm Abi Lahoud, Moussa A Chalah
{"title":"Editorial: Surgical approaches and outcomes in cervical and thoracic myelopathies.","authors":"Samar S Ayache, Georges Naïm Abi Lahoud, Moussa A Chalah","doi":"10.3389/fsurg.2025.1775565","DOIUrl":"10.3389/fsurg.2025.1775565","url":null,"abstract":"","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1775565"},"PeriodicalIF":1.6,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12862826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146112457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Frontiers in Surgery
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