Journal of Investigative Surgery最新文献

Purpose: We aimed to present the results of patients with central retinal artery obstruction (CRAO) who underwent 23-G pars plana vitrectomy (PPV) or hyperbaric oxygen therapy (HBOT) following emergency medical therapy.

Method: The files of 15 patients with acute CRAO were retrospectively reviewed. Comprehensive ophthalmological examinations of the patients were performed. Seven patients received HBOT, and eight patients received PPV following emergency medical treatment. The patient's demographic characteristics, initial and final visual acuity, intraocular pressure were examined.

Results: The mean age was 65.2 ± 9.9 years in the hyperbaric oxygen therapy group and 58.7 ± 12.8 years in the PPV group. There was no statistically significant difference between the group receiving HBOT and the group undergoing PPV regarding age, initial visual acuity, final visual acuity, visual gain difference between visual acuity improvements, intraocular pressure, and time lag for treatment initiation (p > 0.05).

Conclusion: Although some improvement in visual acuity was observed in both treatment groups - particularly in patients who underwent PPV - this change did not reach statistical significance. Therefore, despite timely intervention, the overall visual outcomes in CRAO remain poor.

Background: This study aims to investigate the incidence of hyperamylasemia after LCBDE with primary closure and to identify the associated risk factors.

Methods: A retrospective analysis of 436 patients categorized by serum amylase levels was performed. Univariate and multivariate logistic regression analyses were performed to identify risk factors, and clinical interventions were compared between patients with and without postoperative hyperamylasemia.

Results: Hyperamylasemia occurred in 53 patients (12.2%), with 10 cases exceeding three times the upper limit of normal and 4 cases (0.9%) diagnosed with pancreatitis. Independent risk factors included longer surgical duration (OR = 1.008, p = 0.035), postoperative abdominal drainage (OR = 2.216, p = 0.045), and differences in neutrophil counts (OR = 1.242, p = 0.038). Although hyperamylasemia showed no significant association with short-term overall complications (p = 1.000) or individual complications (p > 0.05), it was linked to longer postoperative (p = 0.022) and total hospital stays (p = 0.032), higher hospitalization costs (p = 0.036), and greater postoperative use of antibiotics (p = 0.013), antispasmodics, and analgesics (p = 0.037).

Conclusion: Hyperamylasemia after LCBDE is linked to specific risk factors, but its clinical significance remains limited. Accurate recognition is crucial to avoid unnecessary interventions.

Objective: To investigate the effectiveness of sciatic nerve block by evaluating changes in regional blood flow and the Perfusion Index (PI) in the lower extremities, and to develop a predictive model for assessing the success of the block using multifactor logistic regression.

Methods: This prospective study included 157 patients undergoing sciatic nerve blocks. Patients were randomly assigned to training and validation cohorts. All blocks were performed under ultrasound guidance using a subgluteal approach. Variables were screened using the Boruta algorithm and univariate analysis, and a predictive model was constructed using multifactor logistic regression. Model validation was performed using ROC curves, calibration curves, and the Hosmer-Lemeshow test.

Results: The perfusion index and changes in regional blood flow parameters were identified as significant predictors of sciatic nerve block success. The logistic regression model exhibited high sensitivity and specificity, with area under the curve (AUC) values of 0.909, 0.957, and 0.890 for the training, internal validation, and external validation cohorts, respectively.

Conclusion: The Perfusion Index and regional blood flow changes in the lower extremities are reliable predictors of the success of sciatic nerve blocks. The predictive model developed in this study is accurate and clinically applicable, providing an objective tool for the early assessment of block efficacy.

Introduction: Chen's U-suture technique has undergone revisions since it was first devised and has shown low postoperative pancreatic fistula (POPF) rates after pancreaticoduodenectomy (PD). This study aims to evaluate the efficacy of the modified Chen's U-suture technique among patients with soft pancreas and small pancreatic duct (diameter ≤3mm), either with or without stent placement.

Methods: Of 1852 patients screened, 198 patients with high-risk anatomy who received the modified Chen's U-suture technique for PD from 6 hospitals between 2018 and 2024 were included. Patients were classified into the stent (n = 159) and the non-stent group (n = 39) according to whether a pancreatic duct stent was placed. The primary endpoint was to evaluate the rate of POPF.

Results: Among the patients, four (2.5%) experienced grade B POPF, without grade C POPF occurred. A higher biochemical leak rate was observed in the non-stent group (n = 16, 41.0%) than in the stent group (n = 14, 8.8%) (p < 0.001). No statistically significant difference was found between the two groups in overall complication rates (30.8% vs. 37.7%, p = 0.407).

Discussion: This technique is reliable for patients with soft pancreas and small pancreatic duct, including those who have ducts too small to undergo stent placement.

Objective: Hepatitis B virus (HBV) remains an important risk factor for hepatocellular carcinoma (HCC), and inflammation plays an essential role in tumor development. This study aimed to investigate the impact of inflammatory markers in the postoperative outcomes of patients with HBV-related HCC, providing valuable prognostic indicators after hepatectomy.

Methods: We retrospectively analyzed 222 patients with HBV-related HCC after surgical resection. The ROC curve was used to calculate biomarker cutoff values. The Kaplan-Meier method was used to estimate overall survival (OS) and recurrence-free survival (RFS), and univariate and multivariate analyses were used to identify the prognostic factors.

Results: The Kaplan-Meier analysis revealed that patients with high albumin-bilirubin (ALBI) score, aspartate aminotransferase to platelet ratio index (APRI), and monocyte to lymphocyte ratio (MLR) had worse OS, while those with high ALBI score and MLR had shorter RFS. Multivariate Cox regression analysis identified alpha-fetoprotein >400 ng/mL (hazard ratio [HR]: 2.447, 95% confidence interval [CI]: 1.273-4.706, p = 0.007), alanine aminotransferase (HR: 0.377, 95% CI: 0.171-0.834, p = 0.016), platelet to lymphocyte ratio (HR: 0.385, 95% CI: 0.196-0.755, p = 0.006), systemic inflammatory response index (HR: 1.844, 95% CI: 1.049-3.239, p = 0.033), ALBI score (HR: 1.808, 95% CI: 1.020-3.203, p = 0.043), APRI score (HR: 3.193, 95% CI: 1.662-6.137, p < 0.001), tumor diameter (HR: 1.083, 95% CI: 1.012-1.160, p = 0.022), and portal vein tumor thrombosis (PVTT) (HR: 6.083, 95% CI: 2.774-13.338, p < 0.0001) as independent predictors for OS. MLR (HR: 2.285, 95% CI: 1.290-4.048, p = 0.005) and PVTT (HR: 2.672, 95% CI: 1.280-5.579, p = 0.009) were confirmed as significant prognostic markers of RFS in patients with HBV-related HCC.

Conclusions: ALBI score, APRI, and MLR are effective prognostic predictors in patients with HBV-related HCC after curative resection. Close monitoring and adjuvant therapies should be considered for high-risk patients.

Objective: Extant imaging methods used for the proper identification of the parathyroid glands to prevent post-operative hypothyroidism associated with the resection of differentiated thyroid cancer (DTC) are limited by factors such as low specificity, high cost, and technical complexity. This study, therefore, sought to investigate the efficacy of the immunocolloidal gold strip method combined with nanocarbon negative imaging tracing technology for parathyroid gland imaging during radical resection of DTC in elderly patients.

Methods: A total of 100 elderly patients with DTC were enrolled and randomly divided into two groups: the control group and the observation group. The control group underwent conventional radical thyroidectomy with bilateral cervical lymph node dissection, while the observation group received the immunocolloidal gold strip method combined with nanocarbon negative imaging tracing technology for parathyroid gland imaging during the surgery. The baseline characteristics, intraoperative findings, postoperative parathyroid hormone (PTH), and serum calcium levels, as well as postoperative complications, were compared between the two groups.

Results: There were no significant differences in age, gender, body mass index, comorbidities, or smoking history between the two groups. The observation group had a significantly higher number of parathyroid glands identified during surgery compared with the control group. The postoperative PTH and serum calcium levels at postoperative days 1 and 3 and at 6 months were significantly higher in the observation group than those in the control group. The incidence of postoperative hypoparathyroidism was significantly lower in the observation group.

Conclusion: The immunocolloidal gold strip method combined with nanocarbon negative imaging tracing technology is effective in identifying and preserving parathyroid glands during radical resection of DTC in elderly patients.

Background: To evaluate the efficacy of low screw density constructs versus high screw density constructs in adolescent idiopathic scoliosis (AIS) surgery.

Methods: Data were collected from AIS patients who underwent pedicle screw fixation surgery at two medical centers. Patients were stratified into low and high screw density groups, calculated as pedicle screws per fused vertebral level. The dataset comprised demographics, radiological parameters, surgical outcomes and postoperative complications.

Results: Of 213 AIS patients analyzed, 114 and 99 comprised low- and high-density groups respectively. Compared with high-density constructs, low-density constructs demonstrated shorter operative time (median: 17.93 min, IQR: 14.66-20.50 vs. 22.15 min, IQR: 16.80-24.77; p = 6.30e-07), lower intraoperative blood loss (median: 762.29 ml, IQR: 600-900 vs. 954.19 ml, IQR: 800-1030; p = 7.70e-07), fewer postoperative pain (median: 4.719, IQR: 3-7 vs. 5.505, IQR: 3.5-7; p = 0.009), and shorter hospital stays (median: 11.15 days, IQR: 7-13.5 vs. 12.48 days, IQR: 8-15; p = 0.04). Both groups had equivalent Cobb angle correction (median: 67.31%, IQR: 60.50% -76.84% vs. 67.97%, IQR: 62.54%-73.52%; p = 0.90).

Conclusion: Optimizing screw density may minimize intraoperative blood loss and postoperative pain without affecting correction efficacy in AIS; however, longitudinal studies are needed to assess long-term functional and quality-of-life outcomes.

Objective: This study evaluated the neutrophil-to-hemoglobin ratio (NHR) and monocyte-to-hemoglobin ratio (MHR) as predictors of prolonged hospital stay in patients undergoing surgery for pelvic or acetabular fractures.

Methods: We retrospectively reviewed records of patients aged ≥ 18 years who underwent open reduction and internal fixation (ORIF). NHR and MHR were calculated from blood samples at admission and 24 hours postoperatively. Prolonged hospital length of stay (LOS) was defined as ≥ 25 days (75th percentile). Optimal cutoffs were determined by ROC curve analysis. Multivariable logistic regression identified associations between clinical variables and prolonged LOS.

Results: Among 172 patients (mean age 44.5), postoperative NHR > 0.46 and MHR > 0.02 were independently associated with prolonged LOS in patients with acetabular fractures (aOR = 5.90 and 5.42, respectively). No significant associations were found in pelvic fractures.

Conclusions: Elevated postoperative NHR and MHR are strongly associated with prolonged LOS in patients with acetabular fractures and may assist in perioperative risk stratification and clinical decision-making.

Background: This study aims to evaluate the safety of primary anastomosis (PA) without a protective stoma in emergency left colon surgery.

Methods: A systematic search was conducted in the PubMed, Web of Science, Embase, and Cochrane Library databases, covering articles from the inception of these databases until September 2024. The primary outcome was the incidence of anastomotic leakage.

Results: The PA group exhibited a higher incidence of anastomotic leakage compared to the stoma surgery group (odds ratios (OR) = 5.86, p = 0.05). However, in cases of perforated diverticulitis (OR = 3.80, p = 0.19) and malignant obstruction (OR = 5.40, p = 0.23), the PA group did not show an increased risk of anastomotic leakage. In terms of other outcomes, the reoperation rate in the PA group was higher compared to the stoma surgery group (OR = 1.89, p < 0.001). However, there were no statistically significant differences in the mortality rate (OR = 1.04, p = 0.80) or the incidence of postoperative complications (OR = 1.50, p = 0.27) between the two groups.

Conclusion: Primary anastomosis without a protective stoma is generally safe and can be considered a viable option in emergency left colon surgery.

Purpose: This study evaluated the clinical effectiveness of combined treatment of sevoflurane with propofol or remimazolam in decreasing hemodynamic changes and postoperative pain in pediatric patients undergoing laparoscopic inguinal hernia repair (LIHR).

Methods: This study prospectively recruited 287 children with hernia admitted to our hospital from September 2020 to October 2023. These children were allocated into the sevoflurane plus remimazolam and sevoflurane plus propofol groups using the random number table method. General clinical data at admission were collected. Clinical outcomes were compared between the two groups. The primary outcomes included anesthesia quality, intraoperative hemodynamic indicators at different time points (MAP, SpO₂, HR), and the postoperative FLACC score, while the secondary outcomes included the PAED score of the children and the incidence of postoperative adverse reactions.

Results: No remarkable difference occurred between these two groups regarding general clinical data. Compared to the sevoflurane plus propofol group, the sevoflurane plus remimazolam group resulted in significantly lower MAP and HR at T1, T2, T3, and T4 (p < .05), shorter postoperative awakening time (mean difference: 2.9 min, p < .01), lower FLACC pain scores at 0.5, 1, and 2 h postoperatively (p < .05), and lower PAED scores at 5, 15, and 30 min postoperatively (p < .05). Adverse effects were lower in the sevoflurane + remimazolam group (5% vs. 12%, p = .076).

Conclusion: Sevoflurane plus remimazolam in children receiving LIHR has minimal impact on hemodynamics, reduces pain levels within 4 h postoperatively, lowers PAED and agitation scores, and demonstrates high safety.