Frontiers in Surgery最新文献

Objective: To compare the effectiveness of different measurement methods on bone miner density (BMD), including cervical HU of CT, MRI-based cervical vertebral bone quality (C-VBQ), and T value of DEXA, for predicting cage subsidence after single-level ACDF.

Methods: This is a retrospective study, and patients who underwent single-level ACDF from June 2019 to June 2022 were recruited. We collected preoperative total segmental vertebral height (pre-TSVH), cage subsidence height, cervical angle (CA), T1-slope, straight or reverse cervical curvature, mean HU value of C3-7 (C-HU), mean HU of segment (seg-HU), C-VBQ, segmental C-VBQ (seg-VBQ), and total lumbar T value (T value). The variables between the two groups were compared by Student's t test or chi-square test. Logistic regression was used to determine the independent risk factors for subsidence. The ROC curve was used to analyze the predictive efficiency of C-HU, seg-HU, C-VBQ, seg-VBQ and T value for cage subsidence. Finally, the correlations of C-HU, seg-HU, C-VBQ, seg-VBQ, T value and subsidence height were analyzed.

Results: A total of 320 patients were included in this study, and 97 patients (30.31%) had cage subsidence at the last follow-up. The subsidence height was 4.25 ± 0.937 mm in the subsidence group and 1.40 ± 0.726 mm in the nonsubsidence group. There were statistically significant differences between the two groups in bone mineral density-related indexes, including C-HU, seg-HU, C-VBQ, seg-VBQ, and T value (p < 0.05). Logistic regression analysis showed that C-HU was an independent risk factor for vertebral subsidence after single-level ACDF. ROC curve analysis showed that C-HU had the largest AUC of 0.897 (0.862, 0.933) in predicting vertebral subsidence. Correlation analysis showed that C-HU had a high correlation with the T value (r = 0.662, p < 0.001), while C-VBQ had a low correlation with the T value (r = -0.173, p = 0.002), and C-VBQ had a low correlation with subsidence height (r = 0.135, p = 0.016).

Conclusion: Our study showed that compared with the C-VBQ and T value, C-HU is more effective for predicting cage subsidence after ACDF. Using the segmental index of C-VBQ or HU could not improve predictive effectiveness. C-VBQ may be insufficient in predicting cage subsidence and estimating BMD.

Introduction: The incidence of foreign bodies within the human body is uncommon, with thermometers representing an exceptionally rare subset of such cases. The management of these cases is particularly challenging due to the fragility of mercury thermometers and the toxic nature of their contents.

Case description: A 16-year-old male adolescent presented with a three-month history of persistent, dull pain localized to the right inguinal region. Diagnostic imaging, including an abdominal upright x-ray and CT scans, revealed the presence of an intra-abdominal foreign body, specifically a thermometer. The diagnosis was subsequently confirmed intraoperatively through laparoscopic exploration. The foreign body was successfully extracted via laparoscopic intervention. The patient's postoperative course was uneventful, leading to discharge on the second day following the procedure. A one-month follow-up examination revealed no complications.

Conclusion: A comprehensive literature review was conducted, focusing on cases involving thermometers as foreign bodies. The diagnostic and treatment experiences from the present case were integrated into this analysis. Based on these findings, a summary of diagnostic and treatment strategies for thermometer-related foreign body incidents has been formulated. It is recommended that an abdominal upright x-ray examination be employed as the primary diagnostic modality. The integrity and location of the thermometer, along with the presence of associated complications, should be considered as crucial factors in determining the most appropriate treatment approach. Furthermore, it is imperative to address the psychological and mental health aspects of these cases, particularly in adolescent patients.

Objective: Lung cancer is the leading cause of cancer-related mortality. Lymph node involvement remains a crucial prognostic factor in non-small cell lung cancer (NSCLC), and the TNM system is the current standard for staging. However, it mainly considers the anatomical location of lymph nodes, neglecting the significance of node count. Metrics like metastatic lymph node count and lymph node ratio (LNR) have been proposed as more accurate predictors.

Methods: We used data from the SEER 17 Registry Database (2010-2019), including 52,790 NSCLC patients who underwent lobectomy or pneumonectomy, with at least one lymph node examined. Primary outcomes were overall survival (OS) and cancer-specific survival (CSS). Cox regression models assessed the prognostic value of negative lymph node (NLN) count, number of positive lymph node (NPLN), and LNR, with cut-points determined using X-tile software. Model performance was evaluated by the Akaike information criterion (AIC).

Results: The Cox proportional hazards model analysis revealed that NLN, NPLN, and LNR are independent prognostic factors for OS and LCSS (P < 0.0001). Higher NLN counts were associated with better survival (HR = 0.79, 95% CI = 0.76-0.83, P < 0.0001), while higher NPLN (HR = 2.19, 95% CI = 1.79-2.67, P < 0.0001) and LNR (HR = 1.64, 95% CI = 1.79-2.67, P < 0.0001) values indicated worse outcomes. Kaplan-Meier curves for all three groups (NLN, NPLN, LNR) demonstrated clear stratification (P < 0.0001). The NLN-based model (60,066.5502) exhibited the strongest predictive performance, followed by the NPLN (60,508.8957) and LNR models (60,349.4583), although the differences in AIC were minimal.

Conclusions: NLN count, NPLN, and LNR were all identified as independent prognostic indicators in patients with NSCLC. Among these, the predictive model based on NLN demonstrated a marginally superior prognostic value compared to NPLN, with NPLN outperforming the LNR model. Notably, higher NLN counts, along with lower NPLN and LNR values, were consistently associated with improved survival outcomes. The relationship between these prognostic markers and NSCLC survival warrants further validation through prospective studies.

Background: Chronic limb-threatening ischemia (CLTI) is the most severe form of peripheral artery disease (PAD). Patients with diabetes mellitus (DM) have a faster progression of PAD and a fourfold increased risk of CLTI compared to patients without DM. Epidural spinal cord stimulation (SCS) has been used as a method to improve microcirculation, relieve ischemic pain and reduce the number of amputations in patients with PAD. This is a retrospective small cohort analysis of patients with diabetes and the long-term treatment effect of spinal cord stimulation.

Methods: As the main outcome of the study, we evaluated the survival and amputation of 13 diabetic patients with chronic lower-limb ischemia who were not eligible for surgical or interventional therapy. Secondary outcomes included ankle-brachial index (ABI), ischemic pain intensity, quality of life, use of analgesic medications and skin wound outcomes analyzed during long-term follow-up.

Results: Between January 2010 and January 2017, 13 patients underwent SCS implantation in our vascular center. At 1-year follow-up, the limb salvage rate was 92.3% (12 of 13 patients), and limb ulcers healed in 75% of patients (6/8). No patient died during the one-year follow-up. A total of 4 of patients (31%) experienced major amputation during long-term follow-up, all of them were Fontaine stage IV. Pain intensity and quality of life improved significantly at 6-month follow-up (p < 0.05). ABI measurements were unaffected by SCS treatment. There were no complications related to the procedure or device.

Conclusions: SCS is a promising treatment option for diabetic patients unsuitable for endovascular or surgical revascularization. The method improves limb survival in diabetic patients with critical limb ischemia, provides significant pain control, and improves patients' quality of life. However, more studies are needed to clarify the indications for SCS and clarify its effects on the vascular system.

Introduction: The relationship between the Enhanced Recovery After Surgery (ERAS) guidelines and inflammatory markers in laparoscopic surgery has garnered increasing attention. These recommendations are designed to minimize surgical stress and potentially improve recovery outcomes by modifying perioperative care.

Objective: This scoping review aims to evaluate the impact of ERAS recommendations on inflammatory markers in patients undergoing laparoscopic surgeries, identifying current research gaps and consolidating findings from existing studies.

Methods: Guided by the Cochrane Handbook for Systematic Reviews and adhering to the PRISMA-ScR guidelines, this review analyzed studies from databases like PubMed, Scopus, and Cochrane Library. We included both randomized controlled trials and observational studies that assessed inflammatory markers such as C-reactive protein (CRP), white blood cells (WBC), and Interleukin-6 (IL-6) in laparoscopic surgery patients managed with ERAS recommendations.

Results: Out of 64 initial studies, 7 met the inclusion criteria, involving a total of 2,047 patients. Most of the studies focused on laparoscopic colorectal surgeries. Commonly assessed markers were CRP and WBC. The findings consistently showed that ERAS guideline could mitigate the inflammatory response, evidenced by reduced levels of CRP and IL-6, which correlated with fewer postoperative complications and expedited recovery.

Conclusion: ERAS recommendations appear to beneficially modulate inflammatory responses in laparoscopic surgery, which suggests a potential for enhanced recovery outcomes. However, the evidence is currently limited by the small number of studies and inherent methodological biases. Further robust RCTs are required to strengthen the evidence base and refine these protocols for broader clinical application.

Systematic review registration: https://osf.io/tj8mw/.

Background: A traumatic diaphragm defect is a rare injury. A missed diaphragm injury may cause serious morbidity and mortality. Detection rate during the first assessment of trauma patients is notoriously low. However, important improvements in imaging modalities were developed. The aim of this study was to analyze traumatic diaphragm injuries in relation to diagnostic tools, therapeutic interventions and outcome over the past two decades.

Methods: A retrospective analysis was performed of all trauma patients with traumatic diaphragm injuries between 2000 and 2018 at a level I trauma center. Data collected were baseline characteristics, diagnostics that were performed, treatment given and follow-up.

Results: A total of 47 patients with traumatic diaphragm injuries were evaluated. The majority of injuries was seen following blunt trauma (72%). Mortality was 21%, mainly due to concomitant injuries. One patient died due to the consequences of an unrecognized diaphragm injury. In 29 cases (62%) the injury was diagnosed pre-operatively through imaging, with the remaining being diagnosed during laparotomy. In 11 patients (35%) the diaphragmatic injury was not seen on a pre-operative CT-scan. Postoperative complications occurred in 19 patients, mostly of pulmonary origin (i.e., pneumonia). No recurrences were reported.

Conclusion: This study confirms diaphragm injuries are infrequent injuries, with high mortality. Even more, despite major improvement in diagnostic modalities over the past 2 decades, the algorithm for detection of diaphragmatic injuries has not changed nor has its outcome. Although the incidence is low, since consequences are severe, it is important to have a high index of suspicion in abdominal trauma, even in a non-conclusive CT-scan.

Background: Anterior column realignment (ACR), using a lateral lumbar or thoracic interbody fusion (LLIF) approach to release the anterior longitudinal ligament (ALL), is a powerful technique to increase segmental lordosis. We here report our experience with the use of expandible LLIF cages for ACR.

Methods: Retrospective, single-center observational cohort study including consecutive patients treated by LLIF using an expandible interbody implant. Patients with ACR were compared to patients without ACR. Our outcomes include adverse events (AEs), radiological (segmental sagittal cobb angle, spinopelvic parameters) and clinical outcomes until 12 months postoperative.

Results: We identified 503 patients, in which we performed LLIF at 732 levels. In 63 patients (12.5%) and 70 levels (9.6%) an expandable cage was used. Of those, in 30 patients (47.6%) and 30 levels, the ALL was released (42.8%). Age (mean 61.4 years), sex (57.1% female), comorbidities and further demographic features were similar, but patients in the ACR group had a higher anesthesiologic risk, were more frequently operated for degenerative deformity and had a more severely dysbalanced spine (all p < 0.05). ACR was most frequently done at L3/4 (36.7%) and L4/5 (23.3%), entailing multilevel fusions in 50% (3-7 levels) and long constructs in 26.7% (>7 levels). Intraoperative AEs occurred in 3.3% (ACR) and 3.0% (no ACR; p = 0.945). In ACR cases, mean segmental lordosis changed from -2.8° (preoperative) to 16.4° (discharge; p < 0.001), 15.0° (3 months; p < 0.001) and 16.9° (12 months; p < 0.001), whereas this change was less in non-ACR cases [4.3° vs. 10.5° (discharge; p < 0.05), 10.9 (3 months; p < 0.05) and 10.4 (12 months; p > 0.05)]. Total lumbar lordosis increased from 27.8° to 45.2° (discharge; p < 0.001), 45.8° (3 months; p < 0.001) and 41.9° (12 months; p < 0.001) in ACR cases and from 37.4° to 46.7° (discharge; p < 0.01), 44.6° (3 months; n.s.) and 44.9° (12 months; n.s.) in non-ACR cases. Rates of AEs and clinical outcomes at 3 and 12 months were similar (all p > 0.05) and no pseudarthrosis at the LLIF level was noted.

Conclusions: ACR using an expandible LLIF interbody implant was safe, promoted solid fusion and restored significantly more segmental lordosis compared to LLIF without ALL release, which was maintained during follow-up.

Background: HSip Osteoporotic fractures are common complications with high mortality in patients undergoing maintenance hemodialysis (MHD). It remains unclear whether surgical or conservative should be adopted for hip fractures in MHD patients.

Methods: A retrospective analysis was conducted in Tianjin Hospital of Tianjin University from August 2019 to August 2023. A total of 43 MHD patients with hip fracture were included, with 30 cases in the surgical group and 13 cases in the conservative group. The differences in cumulative survival rates, time to first ambulation, Harris score, Barthel index, and incidence of complications were compared.

Results: The surgical group had remarkable lower mortality rates as compared with the conservative group at 1, 2, 3, 6, 12, 24 months (13.33 VS. 38.46%, 26.67 VS. 53.85%, 26.67 VS. 53.85%, 26.67 VS. 61.54%, 26.67 VS. 61.54%, and 26.67 VS. 69.23%). In the surgical treatment group, the first ambulation time was reduced to 28 (26) days, which was superior to the conservative group (134.17 ± 43.18 days, P < 0.001). The Harris score at 1 month (61.50 ± 4.10) and the Barthel index at 3 months (95, 11.25) were also significantly higher (P < 0.001). Furthermore, the surgical group had a significantly lower overall incidence of complications (60.00 vs. 92.31%, P = 0.034). The risk of death and complications of surgical treatment was only 23.0 and 32.4% of conservative treatment in MHD patients with hip fracture.

Conclusion: Surgical treatment is effective and safe and should be the first choice for hip fracture in MHD patients.

Purpose: The reconstruction of dura matter is a challenging problem for neurosurgeons. A number of materials for dural reconstruction have recently been developed, but some of them have poor biocompatibility, poor mechanical properties, and adverse effects. Bovine parietal peritoneum is a promising natural material for regenerative medicine and reconstructive surgery. In this study, we conducted an in vivo evaluation of the safety and efficacy of using decellularized bovine peritoneum membranes (BPMs) as natural dural substitutes in a rabbit model.

Methods: The dural defects in mature New Zealand rabbits were studied. A BPM was sutured on the dural defect area of each animal. Autologous periosteum and collagen membranes (Lyoplant®) were used to facilitate a comparison with the BPMs. ELISA, histomorphological analysis, and hematological analysis were carried out to examine the safety and efficacy of using BPMs as dural substitutes.

Results: Our results showed that the BPMs demonstrated a deterioration rate that is suitable for gathering newly formed meningothelial tissue. The thickness and density of BPM fibers prevents resorption in the first few days after use as a plastic material, and the regeneration of the dura mater does not occur at an accelerated pace, meaning that the gradual formation of fibrous tissue prevents adhesion to the brain surface. It was observed that the BPM can integrate with the adjacent tissue to repair dural defects. Moreover, the transplantation of BPMs did not cause significant adverse effects or immunological responses, indicating the safety and good biocompatibility of the BPM.

Conclusion: Thus, our in vivo study in a rabbit model showed that decellularized BPMs may represent a biocompatible natural material that can be used in cases requiring dura matter repair without significant adverse effects.

Objectives: To present our initial experience of robotic ureteroplasty with lower-lip mucosal graft (LLMG) for treating ureteral stenosis longer than 2 cm and evaluate its feasibility and efficacy.

Materials and methods: A total of thirteen patients with ureteral stenosis who underwent robotic ureteroplasty with LLMG were retrospectively analyzed. After identification and dissection of the ureteral stenosis segment, the segment was incised longitudinally. Then, the LLMG was harvested according to the characteristics of stenosis and sutured with the ureter in onlay fashion. All procedures were completed successfully.

Result: The median stenosis length was 3.5 cm (ranged: 3.0-4.5 cm). The mean length and width of the LLMG were 3.81 ± 0.60 cm and 1.27 ± 0.26 cm, respectively. The mean operative time and anastomosis time were 212.31 ± 23.06 min and 36.54 ± 6.58 min, respectively. The double-J stent was removed at 8 weeks postoperatively in all patients. Three patients (23.1%) suffered postoperative complications during the follow-up period (range, 6-18 months), including fever, urinary tract infection and stenosis recurrence. The success rate was 92.3% (12/13).

Conclusion: Robotic ureteroplasty with LLMG is a safe and feasible technique for treating ureteral stenosis.