Journal of Investigative Surgery最新文献

Background: Idiopathic retroperitoneal fibrosis (IRPF) is a rare fibroinflammatory condition that is challenging to distinguish from retroperitoneal malignancies based solely on imaging. We evaluated laparoscopic ultrasound-guided biopsy for diagnosing IRPF.

Methods: We retrospectively analyzed 12 patients with suspected retroperitoneal fibrosis who underwent laparoscopic ultrasound-guided biopsy. The surgical technique involved systematic laparoscopic exploration, intraoperative ultrasound to delineate the mass and its relation to great vessels, and targeted biopsy.

Results: Preoperative imaging suggested retroperitoneal masses in all 12 patients but failed to provide a definitive diagnosis in any case. Laparoscopic biopsy was successfully performed in all patients without conversion to laparotomy. Pathological examination confirmed IRPF in 11 patients and retroperitoneal adenocarcinoma in one. The procedure was safe, with minimal blood loss (20.4 ± 14.8 mL) and a short operative time (68.3 ± 19.0 min). All IRPF patients were treated with a combination of prednisone, tamoxifen, and mycophenolate mofetil, leading to significant lesion regression on follow-up imaging (median 37.9 months).

Conclusions: Laparoscopic ultrasound-guided biopsy is a safe and highly effective diagnostic procedure for IRPF. It provides definitive pathological diagnosis to guide appropriate therapy and should be considered when percutaneous biopsy is not feasible.

Background: This retrospective study compared the perioperative outcomes of vaginal natural orifice transluminal endoscopic surgery (V-NOTES) and total laparoscopic hysterectomy (TLH).

Materials and methods: This analysis included 62 patients: 32 underwent V-NOTES and 30 underwent TLH. Patients with a body mass index (BMI) >30, a history of endometriosis, multiple cesarean sections, or a uterine size >12 week were excluded. Perioperative data-including visual analog scale (VAS) scores, analgesia use, mobilization time, hospitalization duration, and hemoglobin deficit-were compared using independent sample t tests and Mann-Whitney U tests.

Results: There were no significant differences in BMI, number of pregnancies, or operative time (p > 0.05). VAS scores at 6 and 24 h were significantly lower in the V-NOTES group (p < 0.001). Patients in the V-NOTES group required less analgesia, had shorter mobilization and hospitalization periods, and returned to daily activities sooner (p < 0.001). However, the hemoglobin deficit was higher in the V-NOTES group (1.85 g/dl vs. 0.7 g/dl, p < 0.001). The neutrophil-to-lymphocyte ratio (NLR) was lower in the V-NOTES group (p = 0.013), whereas the platelet-to-lymphocyte ratio (PLR) and mean platelet volume (MPV) did not differ significantly between the two groups.

Conclusion: V-NOTES offers advantages such as reduced postoperative pain and faster recovery compared to TLH. The higher hemoglobin deficit observed with V-NOTES may be related to the surgeon's experience. Further randomized studies are warranted to validate these findings and define appropriate patient selection criteria.

Aim: Acute mesenteric ischemia (AMeI) is a mortal intestinal emergency with vascular origin. Mortality and morbidity can be prevented by early diagnosis and prompt intervention. In this study, an AMeI rat model was established to investigate the efficacy of immunophenotyping to reveal a biomarker of AMeI.

Material and methods: Twenty-one adult female Sprague-Dawley rats were divided into three groups. In the Sham group (Group 1), after laparotomy, the superior mesenteric artery (SMA) was found, and no further intervention was performed. In the ischemia-reperfusion group (Group 2), SMA was occluded only for 45 min whereas in Group 3(ischemia group), SMA was permanently occluded. Peripheral blood mononuclear cells were quantified for T cell subsets using flow cytometry.

Results: Regarding hematological biomarkers, only mean platelet volume (MPV) values in Group 3 were significantly higher compared to Group 2 (p = 0.0134). Platelet lymphocyte ratio values and D dimer levels were higher in Group 3 compared to the sham Group (p = 0.0219, p = 0.0012; respectively). No statistically significant difference was detected between groups considering the subtypes of lymphocytes surface antigens. However, in the correlation matrix analysis, significant correlations were observed between Chiu histopathological stage of ileum mucosa and CD45+ and CD4 + CD8 + [Spearman r = 0.571 (95% CI: 0.172-0.809) p = 0.0068 and Spearman r = 0.4908 (95% CI: 0.061-0.767) p = 0.0239]. Likewise, a positive linear correlation was found between MPV, D-dimer and Chiu score [Spearman r = 0.5155 (95% CI: 0.094 - 0.780; p = 0.0168) and r = 0.7828 (95% CI: 0.520 - 0.910; p < 0.0001), respectively].

Conclusion: Blood levels of CD45+ and CD4 + CD8+ were proved to be higher in study groups. Remarkable positive linear correlation with histopathological changes may also play a predictive role to investigate the role of these markers in larger samples.

Background: Despite advancements in surgical techniques, coronary artery bypass grafting (CABG) for patients with recent acute myocardial infarction (AMI) remains associated with relatively high mortality. Risk prediction in these patients is essential. The aim of this study was to develop a nomogram model to predict the early postoperative mortality in patients undergoing surgical revascularization for AMI based on preoperative clinical features.

Method: We retrospectively analyzed the clinical data of 332 consecutive patients who underwent CABG for AMI at our center from January 2018 to December 2024. Independent predictors for early postoperative death were identified by using univariate and multivariate logistic regression models. A nomogram prediction model was developed based on all independent predictors. Discriminative ability, calibration, and clinical utility of the model were evaluated. Internal validation was performed utilizing the bootstrapping method.

Results: The nomogram model incorporated seven independent predictors: preoperative cardiac arrest, previous history of myocardial infarction(MI), left ventricular ejection fraction (LVEF) <50%, MI-to-CABG interval ≤ 3d, age > 75 years, serum albumin < 35g/L and serum creatinine > 2.0 mg/dL. The model achieved good discrimination with an area under the receiver operating characteristic curve (AUC) of 0.905 (95% CI: 0.832-0.978), and showed well-fitted calibration curves with Hosmer-Lemeshow test results (χ² = 3.437, p = 0.944). Decision curve analysis indicated that the model can provide greater clinical net benefits compared to "operate-all" or "operate-none" strategies in a wide range of threshold probability.

Conclusions: The novel nomogram model combining seven preoperative clinical predictors can provide an accurate preoperative estimation of early postoperative death for AMI patients undergoing surgical revascularization, with satisfactory discrimination and calibration.

Purpose: To introduce a modified intrascleral suture technique (MIST) for repairing iridodialysis combined with phacoemulsification cataract surgery and evaluate its efficacy.

Methods: We retrospectively analyzed the clinical characteristics and surgical outcomes of patients undergoing iridodialysis repair and cataract surgery (2018-2023). Twelve eyes received MIST, and eleven received the modified sewing-machine technique (MSMT). Both techniques utilized the closed-chamber sewing-machine principle of suture loop formation. MIST utilized a 10-0 polypropylene suture with long straight and short curved needles, guided by a 26-gauge syringe tip for intrascleral suturing. MSMT involved creating a partial-thickness scleral tunnel, through which a prethreaded needle with 10-0 polypropylene suture was passed for fixation.

Results: Iridodialysis was successfully repaired in all patients. The median procedure time was significantly shorter in the MIST group (25 min, IQR: 24.0-27.5) than in the MSMT group (34 min, IQR: 29.0-35.0; p < 0.0001). Although postoperative day 1 best-corrected visual acuity (BCVA) did not differ significantly between groups (p = 0.08), the median BCVA was better in the MIST group (0.1 logMAR, IQR: 0.0-0.4) than the MSMT group (0.4 logMAR, IQR: 0.1-0.6). Complication rates were comparable between groups.

Conclusion: The MIST technique provides a minimally invasive alternative for iridodialysis repair by eliminating the need for conjunctival or scleral dissection. This approach significantly reduces operative time while maintaining surgical efficacy and safety, making it a valuable option for combined iridodialysis and cataract surgery.

Background: Malignant anorectal melanoma (AM) is a rare tumor characterized by its aggressive behavior. To date, there has been no comprehensive investigation into the association between the log odds of positive lymph nodes (LODDS) and the prognosis of patients with malignant AM who have undergone surgical intervention.

Methods: Data were extracted from the Surveillance, Epidemiology and End Results (SEER) database for patients diagnosed with primary malignant AM who have undergone surgical intervention between 2000 and 2021. The Kaplan-Meier (KM) method with the log-rank test was used to compare survival curves between different LODDS groups. Multivariate Cox models were employed to evaluate the independent association between LODDS and overall survival (OS). An analysis to explore the potential influence of unmeasured confounders on the relationship between LODDS and OS was conducted using the E value.

Results: The study included a total of 126 eligible patients. KM analysis revealed that patients with low LODDS exhibited significantly improved OS compared to those with high LODDS (p < 0.001). The multivariate Cox analysis demonstrated that LODDS was independently associated with OS. The calculated E value suggested that the potential impact of unmeasured confounders on the association between LODDS and OS was likely minimal.

Conclusion: The findings indicate that LODDS is independently associated with the prognosis of patients with AM undergoing surgical intervention. These results may enhance clinicians' understanding of the prognosis of this rare malignancy and provide a basis for guiding therapeutic decisions.

Objective: The correlation between atrial fibrillation (AF) and atherosclerosis remains inadequately elucidated. This study sought to examine the correlation between AF and atherosclerosis risk in patients with acute lower limb ischemia (ALLI).

Methods: This retrospective cohort study involved 175 patients with ALLI admitted to our hospital from May 2015 to May 2023, all of whom underwent CT angiography (CTA). We gathered data on patient demographics, risk factors, ischemic sites, and CTA results to explore the correlation between AF and atherosclerosis.

Results: AF was present in 46 out of 175 patients (26.3%). In the AF group, 25 patients (54.3%) were rated as IIb according to the Rutherford classification. According to the Trans-Atlantic Inter-Society Consensus II (TASC II) classification, 4 patients (9.3%) were classified as Grade D in the aorto-iliac lesions, while 19 patients (41.9%) were classified as Grade D in the femoral-popliteal lesions. The median calcification score was 1.3 ± 1.3 for the aorto-iliac lesions and 0.5 ± 0.8 for the femoral-popliteal lesions. Multiple logistic analyses showed a significant negative correlation between AF and atherosclerosis in the aorto-iliac and femoral-popliteal lesions.

Conclusions: This retrospective study indicates that AF is linked to a decreased risk of aorto-iliac and femoral-popliteal atherosclerosis in patients with ALLI, with significant variations in these associations upon adjustment for confounding factors. This finding contests established assumptions and requires validation through extensive, prospective cohort studies and fundamental research to clarify the underlying mechanisms.

Background: This study aimed to compare the operative outcomes of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) and total laparoscopic hysterectomy (TLH). We also aimed to determine the feasibility of performing vNOTES hysterectomy in primary hospitals.

Methods: This prospective cohort study enrolled 54 patients with indications for hysterectomy related to benign uterine disease without prolapse, between September 1, 2020, and November 30, 2024. The patients were categorized into two groups: vNOTES hysterectomy and TLH (n = 27 each). Surgical outcomes, including operative time, blood loss, recovery parameters, and complications, were assessed.

Results: Preoperative baseline characteristics were comparable between the two groups. The vNOTES group had a longer mean operative time (187.6 vs. 154.4 min, p < 0.05) and greater median blood loss (100 vs. 30 mL, p < 0.05) compared to the TLH group. However, there were no significant differences in conversion rates, uterine weights, complications, 24-h pain scores, hospital stay, costs, or readmission rates. The vNOTES group demonstrated shorter times to postoperative ambulation, earlier return of bowel function (anal exhaust), and reduced urinary catheter insertion duration (p < 0.05).

Conclusion: vNOTES hysterectomy is feasible in primary hospitals, with surgical outcomes comparable to those of TLH. Patients who underwent vNOTES experienced faster recovery, indicating that it serves as a potential minimally invasive alternative to TLH. However, the small sample size warrants further studies to validate these findings.

Background: Total hip arthroplasty (THA) in elderly patients is often associated with significant perioperative pain. This study aimed to evaluate the analgesic efficacy of fascia iliaca compartment block (FICB) and pericapsular nerve group block (PENGB) in elderly patients undergoing THA.

Methods: This retrospective study included two patient groups: the PENGB group (n = 62) and the FICB group (n = 64). The primary outcome was the analgesic efficacy, assessed using Visual Analog Scale (VAS) pain scores at multiple postoperative time points. Secondary outcomes included motor blockade, the time to first rescue analgesia, postoperative analgesia quality and systemic inflammatory responses.

Results: PENGB provided significantly superior analgesia at 6 and 12 h postoperatively, as evidenced by lower VAS pain scores compared to the FICB group. Motor blockade was also less pronounced in the PENGB group at 3 and 6 h post-surgery. The time to first rescue analgesia was significantly longer in the PENGB group, indicating more sustained pain control. Additionally, PENGB was associated with reduced use of patient-controlled analgesia pumps and lower total sufentanil consumption. At 24 h postoperatively, interleukin-6 levels were significantly lower in the PENGB group, suggesting an attenuated inflammatory response.

Conclusions: Compared to FICB, PENGB provided superior analgesia in elderly patients undergoing THA.

Background: Ischemia-reperfusion injury is a well-recognized challenge in reconstructive flap surgery, often leading to partial or total tissue necrosis. In this experimental study, we aimed to evaluate the protective effects of lutein-a non-provitamin A carotenoid known for its antioxidant and anti-inflammatory actions-against ischemia-reperfusion -induced damage in a rat epigastric flap model.

Methods: Sixteen Sprague-Dawley rats were randomized to receive either intraperitoneal lutein (0.5 mg/kg) or saline prior to inducing 10 h of ischemia. Flap viability was assessed macroscopically on postoperative day 10, and biochemical and histopathological analyses were conducted to explore underlying mechanisms.

Results: Compared to controls, lutein-treated animals demonstrated significantly larger flap survival areas (21.18 ± 0.88 cm² vs. 8.42 ± 1.15 cm², p < 0.05), lower malondialdehyde levels (p < 0.01) and myeloperoxidase levels (p < 0.05), and higher glutathione (p < 0.05) and nitric oxide concentrations (p < 0.01), suggesting reduced oxidative stress and improved vascular function. Histological examination revealed less necrosis, edema, and neutrophil infiltration in the Lutein group, alongside enhanced fibroblast activity, collagen deposition, and neovascularization. Additionally, increased epidermal thickness and a notable rise in lymphocyte infiltration indicated the potential modulation of the adaptive immune response during repair.

Conclusion: Taken together, our findings suggest that lutein exerts a multifaceted protective effect on ischemic flap tissue and may serve as a useful adjunct in reconstructive surgery, particularly in settings with high risk of ischemia-reperfusion injury. Given its safety and supplement status, these preclinical findings support further exploration in human studies.