Journal of Surgical Research最新文献

Case-Crossover Design for Assessing Associations With Short-Term, Intermediate-Term, and Long-Term Exposures 评估短期、中期和长期暴露相关性的病例交叉设计

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-17 DOI: 10.1016/j.jss.2025.11.072

Yaguang Wei PhD , Joel D. Schwartz PhD , Min Zhang PhD , Robert O. Wright MD, MPH

Introduction

The case-crossover design is a widely applicable design for observational studies. Its major advantages include robustness against unmeasured time-invariant and slowly varying confounders, as well as high statistical efficiency, both attributable to its self-controlled nature.

Methods

In this tutorial, we illustrate applications of the case-crossover design not only for assessing associations with short-term exposures, for which it was originally developed, but also for intermediate- and long-term exposures, using examples from our published studies. We further discuss key methodological considerations for its practical implementation.

Results

We presented two subtypes of the case-crossover design, time-stratified and symmetric bidirectional, illustrated through examples of published studies evaluating the associations between air pollution exposures and the risk of hypertension hospitalization. As the exposure time frame extends from short to long term, the ability of the case-crossover design to inherently adjust for slowly varying confounders through self-matching diminishes. Consequently, additional confounders should be included in the regression model. Several considerations are important when using the case-crossover design: first, analyses are restricted to discordant individuals whose exposures differ between the case and control periods; second, there should be no underlying time trend in exposure within the time scheme of case and control periods.

Conclusions

Despite these limitations, the case-crossover design remains an attractive method for observational studies as it inherently adjusts for unmeasured time invariant and slowly varying confounders, such as genetics. While the examples focus on air pollution, the broad applicability of the case-crossover design makes it a valuable approach in various fields, including clinical research.

病例交叉设计是一种广泛适用于观察性研究的设计。它的主要优点包括对不可测量的时不变和缓慢变化的混杂因素的鲁棒性，以及高统计效率，这两者都归因于它的自我控制性质。方法在本教程中，我们举例说明病例交叉设计的应用，不仅用于评估与短期暴露的关联，它最初是为短期暴露而开发的，而且还用于中期和长期暴露，使用我们发表的研究中的例子。我们进一步讨论其实际实施的关键方法考虑因素。结果通过已发表的评估空气污染暴露与高血压住院风险之间关系的研究实例，我们提出了病例交叉设计的两种亚型，即时间分层和对称双向。随着暴露时间从短期延长到长期，病例交叉设计通过自匹配对缓慢变化的混杂因素进行固有调整的能力减弱。因此，在回归模型中应该包括额外的混杂因素。在使用病例交叉设计时，有几个重要的考虑因素：首先，分析仅限于在病例和对照期间暴露不同的不一致个体；第二，在病例期和对照期的时间方案内，暴露量不存在潜在的时间趋势。尽管存在这些局限性，病例交叉设计仍然是一种有吸引力的观察性研究方法，因为它固有地调整了未测量的时不变和缓慢变化的混杂因素，如遗传学。虽然这些例子集中在空气污染上，但病例交叉设计的广泛适用性使其在包括临床研究在内的各个领域都有价值。

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引用次数: 0

Expanding the Methodology Toolkit for Surgical Research in a Data-Rich Era 在数据丰富的时代扩展外科研究的方法论工具包

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-17 DOI: 10.1016/j.jss.2025.12.037

Kanhua Yin MD, MPH , Lakshika Tennakoon MD, MPhil, DrPH , Amro M. Abdelrahman MBBS, MS

Introduction

The volume and variety of available data sources in surgical research continue to expand. While these advances enable increasingly sophisticated analyses, they also introduce substantial methodological complexity, which often exceeds the training in biostatistics and data science for surgeon investigators. Inefficiencies in collaboration between surgeons and methodological experts further compound these challenges.

Methods

This special edition was developed to address these gaps by providing clear, introductory, and clinically grounded explanations of emerging research methodologies, each illustrated with surgery-relevant examples.

Results

The included articles cover high-impact topics, such as cost-effectiveness analysis, causal inference, spatial analysis, natural language processing, and modern survival analysis. Together, they aim to improve methodological literacy and promote more effective interdisciplinary collaboration in surgical research.

Conclusions

By making modern research methods more accessible, understandable, and clinically relevant, this issue seeks to support rigorous study design, sound interpretation, and evidence-based decision making within the surgical community.

外科研究中可用数据源的数量和种类不断扩大。虽然这些进步使分析变得越来越复杂，但它们也引入了大量的方法复杂性，这往往超出了外科医生调查员在生物统计学和数据科学方面的培训。外科医生和方法学专家之间的合作效率低下进一步加剧了这些挑战。方法：本特别版旨在通过对新兴研究方法提供清晰、介绍性和临床基础的解释来解决这些差距，每种方法都配有与手术相关的例子。结果纳入的文章涵盖了成本效益分析、因果推理、空间分析、自然语言处理和现代生存分析等高影响主题。他们的共同目标是提高方法素养，促进外科研究中更有效的跨学科合作。通过使现代研究方法更容易获得、理解和临床相关，本问题旨在支持外科社区严格的研究设计、合理的解释和基于证据的决策。

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引用次数: 0

Robotic-Assisted Simultaneous Bilateral Native Nephrectomy and Living Donor Kidney Transplantation 机器人辅助双侧自体肾切除术和活体供肾移植

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-17 DOI: 10.1016/j.jss.2025.12.015

Rodrigo Vianna MD, PhD , Mahmoud Morsi MD , Armando Salim Munoz-Abraham MD, MBEE , Giselle Guerra MD , Gaetano Ciancio MD, MBA

Introduction

Simultaneous bilateral nephrectomy and living donor kidney transplantation (LDKT) is often indicated for autosomal dominant polycystic kidney disease (ADPKD) with end-stage kidney disease (ESKD). Robotic-assisted surgery offers a minimally invasive alternative to open approaches and may reduce perioperative morbidity and length of stay.

Methods

Four adults with ADPKD/ESKD underwent fully robotic-assisted simultaneous bilateral nephrectomy/LDKT (RASBN/LDKT) at a single high-volume transplant center. All procedures used an intra-abdominal approach with a Pfannenstiel incision and GelPort for native kidney extraction and allograft introduction. Clinical, perioperative, and functional outcomes were recorded prospectively and analyzed retrospectively.

Results

Median total operative time was 462.5 min (range, 401-544 min). Median length of stay was 3.5 days (range, 3-5 d). There were no intraoperative or postoperative vascular, urological, or surgical complications, and no conversions or hand assistance were required. All recipients had immediate graft function without delayed graft function (no hemodialysis in the first postoperative week). Kidney allograft function remained stable through 12 mo after transplant.

Conclusions

Robotic-assisted simultaneous bilateral nephrectomy/LDKT is feasible and safe in carefully selected ADPKD/ESKD recipients, providing excellent early clinical outcomes and expanding the role of minimally invasive techniques for complex scenarios.

常染色体显性多囊肾病（ADPKD）合并终末期肾病（ESKD）常适用于双侧肾切除术和活体供体肾移植（LDKT）。机器人辅助手术为开放性手术提供了一种微创选择，并可减少围手术期的发病率和住院时间。方法4例成人ADPKD/ESKD患者在同一大容量移植中心接受全机器人辅助双侧肾切除术/LDKT （RASBN/LDKT）。所有手术均采用腹腔内入路Pfannenstiel切口和GelPort进行原生肾脏取出和同种异体移植。前瞻性记录临床、围手术期和功能结果并回顾性分析。结果总手术时间中位数为462.5 min（范围401 ~ 544 min）。中位住院时间为3.5天（范围3-5天）。术中或术后无血管、泌尿或外科并发症，不需要手术或手辅助。所有受者均有立即移植功能，无延迟移植功能（术后第一周无血液透析）。同种异体肾移植后12个月功能保持稳定。结论机器人辅助双侧肾切除术/LDKT在精心选择的ADPKD/ESKD受者中是可行和安全的，提供了良好的早期临床结果，扩大了微创技术在复杂情况下的作用。

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引用次数: 0

Improving College Readiness Through a High School Surgery Exposure Program 通过高中手术曝光计划提高大学准备

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-17 DOI: 10.1016/j.jss.2025.12.025

Kevin T. Mutore MD , Katalina Acevedo BA, MS , Phillip Taboada BS , Munir Buhaya MD, Geli Kane BA, Anthony Froix MD, Thomas Shoultz MD

Introduction

Racial and ethnic minorities remain significantly underrepresented in the health care workforce. Despite ongoing efforts, gains in representation have been limited and the disparity widens across successive stages of medical training. Early interventions are essential to empower underrepresented minority students interested in health care with the tools to navigate the educational path toward health careers. This study evaluated whether a three-session college preparatory course could influence the attitudes and perceived preparedness for college among high school students enrolled in a medical and surgical exposure program.

Methods

Seventy-nine 10th grade students participated in a three-session workshop. Preintervention and postintervention surveys were administered using a modified version of the validated College-Going Self-Efficacy Scale and College Planning Behaviors Scale. Paired presurvey and postsurvey data were analyzed using student's t-tests and Fisher's exact tests, with statistical significance defined as P < 0.05.

Results

Forty-four students (56%) completed both surveys. Postintervention, more students had researched the college application process (P = 0.02), college costs (P < 0.01), and identified someone to answer their college-related questions (P < 0.01). Students also reported increased confidence in choosing a good college (P = 0.01) and belief in their academic ability to finish college (P = 0.02).

Conclusions

This is the first study to assess and improve college planning attitudes and behaviors in high school students participating in a surgery exposure program. This suggests that integrating college preparation into health care exposure programs may better support students' educational advancement. Future work should examine whether these improvements lead to increased college application and matriculation rates.

种族和少数民族在卫生保健工作人员中的代表性仍然严重不足。尽管不断作出努力，但在代表性方面取得的进展有限，而且在医疗培训的各个阶段差距越来越大。早期干预对于赋予对卫生保健感兴趣的代表性不足的少数民族学生权力，使其具备在通往卫生事业的教育道路上导航的工具至关重要。本研究评估了三期大学预备课程是否会影响参加医学和外科接触计划的高中生对大学的态度和感知准备。方法79名10年级学生参加了三次研讨会。干预前和干预后调查采用改良版的大学自我效能量表和大学计划行为量表进行。对调查前后数据进行配对分析，采用学生t检验和Fisher精确检验，统计学意义定义为P <； 0.05。结果44名学生（56%）完成了两项调查。干预后，更多的学生研究了大学申请程序（P = 0.02），大学费用（P < 0.01），并确定了有人回答他们的大学相关问题（P < 0.01）。此外，学生们对选择好大学的信心（P = 0.01）和对完成大学学业的能力的信心（P = 0.02）也有所增加。这是第一个评估和改善高中学生参加手术暴露计划的大学计划态度和行为的研究。这表明，将大学准备纳入医疗保健暴露计划可能更好地支持学生的教育进步。未来的工作应该研究这些改进是否会导致大学申请和入学率的提高。

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引用次数: 0

Performance of Postoperative Imaging for Leak Detection Following Repair of Upper Gastrointestinal Perforation 上消化道穿孔修补术后影像学检漏性能的研究

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-16 DOI: 10.1016/j.jss.2025.12.026

Mary Junak MD , Devashish Joshi MD , Victoria R. Rendell MD , Giuseppe V. Toia MD , Charles Patrick Shahan MD, MS

Introduction

Gastric and duodenal perforations are surgical emergencies with high morbidity and mortality. Postoperative leak is a serious complication, yet there are no guidelines for imaging modality or patient selection. This study compared fluoroscopic upper gastrointestinal series (fUGI) and computed tomography (CT) for postoperative leak detection following surgical repair.

Methods

This is a retrospective cohort study of patients who underwent repair of a gastric or duodenal perforation between 2011 and 2023. Surgical interventions, postoperative imaging (UGI vs CT), and clinical outcomes were assessed. Post repair leak was defined by radiographic evidence of contrast extravasation, change in drain character, and/or intraoperative findings. Performance of UGI and CT to identify post repair leak was assessed.

Results

A total of 168 patients were included; 142 underwent open repair and 26 laparoscopic. An omental patch was used in 87.5%, and drains were placed in 81.5%. Postoperative imaging was obtained in 85.7%, most often on postoperative day 5, with 95 fUGI and 49 CT studies. Postoperative leak occurred in 20.2% (34/168). All patients with leaks underwent imaging. For patients with confirmed leaks, fUGI demonstrated a sensitivity of 56.3% and negative predictive value (NPV) of 91.9%, while CT demonstrated a sensitivity of 44.4% and NPV of 75.6%. Discordant imaging results were frequent, and CT contrast protocols were not standardized.

Conclusions

Postoperative imaging after gastric or duodenal perforation repair is common but variable, often performed for surveillance. fUGI demonstrated modestly higher sensitivity and NPV compared with CT, suggesting greater reliability for ruling out early leaks. Both modalities showed limitations, underscoring the need for standardized imaging protocols.

胃和十二指肠穿孔是一种高发病率和死亡率的外科急症。术后渗漏是一种严重的并发症，但对于成像方式或患者选择尚无指导方针。本研究比较了透视上消化道系列（fUGI）和计算机断层扫描（CT）在手术修复后的术后泄漏检测中的应用。方法：这是一项回顾性队列研究，研究对象是2011年至2023年间接受胃或十二指肠穿孔修复术的患者。评估手术干预、术后影像（UGI vs CT）和临床结果。修复后渗漏的定义是通过造影剂外渗、引流特征改变和/或术中发现的影像学证据来确定的。评估UGI和CT识别修复后泄漏的性能。结果共纳入168例患者；142例行开腹修复，26例行腹腔镜修复。87.5%的患者使用网膜贴片，81.5%的患者放置引流管。术后影像学检查占85.7%，多见于术后第5天，fUGI检查95例，CT检查49例。术后发生渗漏的占20.2%（34/168）。所有有渗漏的患者都进行了影像学检查。对于确诊渗漏的患者，fUGI的敏感性为56.3%，阴性预测值（NPV）为91.9%，而CT的敏感性为44.4%，NPV为75.6%。不一致的成像结果是常见的，CT对比方案不标准化。结论胃或十二指肠穿孔修补术后的术后影像学是常见但不稳定的，常用于监测。与CT相比，fUGI显示出更高的灵敏度和NPV，表明排除早期泄漏的可靠性更高。这两种方式都显示出局限性，强调了标准化成像方案的必要性。

{"title":"Performance of Postoperative Imaging for Leak Detection Following Repair of Upper Gastrointestinal Perforation","authors":"Mary Junak MD , Devashish Joshi MD , Victoria R. Rendell MD , Giuseppe V. Toia MD , Charles Patrick Shahan MD, MS","doi":"10.1016/j.jss.2025.12.026","DOIUrl":"10.1016/j.jss.2025.12.026","url":null,"abstract":"<div><h3>Introduction</h3><div>Gastric and duodenal perforations are surgical emergencies with high morbidity and mortality. Postoperative leak is a serious complication, yet there are no guidelines for imaging modality or patient selection. This study compared fluoroscopic upper gastrointestinal series (fUGI) and computed tomography (CT) for postoperative leak detection following surgical repair.</div></div><div><h3>Methods</h3><div>This is a retrospective cohort study of patients who underwent repair of a gastric or duodenal perforation between 2011 and 2023. Surgical interventions, postoperative imaging (UGI vs CT), and clinical outcomes were assessed. Post repair leak was defined by radiographic evidence of contrast extravasation, change in drain character, and/or intraoperative findings. Performance of UGI and CT to identify post repair leak was assessed.</div></div><div><h3>Results</h3><div>A total of 168 patients were included; 142 underwent open repair and 26 laparoscopic. An omental patch was used in 87.5%, and drains were placed in 81.5%. Postoperative imaging was obtained in 85.7%, most often on postoperative day 5, with 95 fUGI and 49 CT studies. Postoperative leak occurred in 20.2% (34/168). All patients with leaks underwent imaging. For patients with confirmed leaks, fUGI demonstrated a sensitivity of 56.3% and negative predictive value (NPV) of 91.9%, while CT demonstrated a sensitivity of 44.4% and NPV of 75.6%. Discordant imaging results were frequent, and CT contrast protocols were not standardized.</div></div><div><h3>Conclusions</h3><div>Postoperative imaging after gastric or duodenal perforation repair is common but variable, often performed for surveillance. fUGI demonstrated modestly higher sensitivity and NPV compared with CT, suggesting greater reliability for ruling out early leaks. Both modalities showed limitations, underscoring the need for standardized imaging protocols.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 188-192"},"PeriodicalIF":1.7,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Associations of Hernia Sac Size, Serum Indicators, and Postoperative Complications After Laparoscopic Inguinal Hernia Repair 腹腔镜腹股沟疝修补术后疝囊大小、血清指标与并发症的关系

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-14 DOI: 10.1016/j.jss.2025.12.019

Fan Liu MD, Tao Kuang MD, Chao Chen MD, Guangyu Liu MD

Introduction

Inguinal hernia is a common surgical condition with a low rate of self-healing. This study aimed to analyze the associations of hernia sac size, serum indicators, and postoperative complications following laparoscopic inguinal hernia surgery.

Methods

Eighty-one patients with inguinal hernia who underwent laparoscopic surgery from January 2021 to July 2024 were enrolled and followed up at 2 weeks, 1 month, 3 months, and 6 months after surgery. Based on the presence or absence of postoperative complications, the patients were divided into a complication group (n = 30) and a noncomplication group (n = 51). The complication group was subdivided according to the type of complication into a seroma group/a nonseroma group, an incision infection group/a nonincision infection group, and a chronic pain group/a nonchronic pain group.

Results

The postoperative follow-up showed that 30 of the 81 patients had complications, with an incidence rate of 37.04%. Multivariate ridge regression analysis identified hernia sac size, body mass index, and age as significant positive predictors of postoperative complications, whereas serum Na⁺ level was inversely associated (P < 0.05). The combined ridge regression model had an area under the curve of 0.93 (95% confidence interval: 0.86-0.98), with a sensitivity of 91% and specificity of 88%, indicating good discriminatory ability. Subgroup analyses further demonstrated consistent predictive capacity for seroma, incision infection, and chronic pain.

Conclusions

Hernia sac size, body mass index, age, and serum Na⁺ are independently associated with postoperative complications following laparoscopic inguinal hernia repair. A combined predictive model incorporating these factors allows early risk stratification, which may guide targeted perioperative management.

腹股沟疝是一种常见的外科疾病，自愈率低。本研究旨在分析腹腔镜腹股沟疝手术后疝囊大小、血清指标与术后并发症的关系。方法选取2021年1月至2024年7月行腹腔镜手术的腹股沟疝患者81例，分别于术后2周、1个月、3个月、6个月进行随访。根据有无术后并发症将患者分为并发症组（n = 30）和无并发症组（n = 51）。并发症组按并发症类型细分为血清肿组/非血清肿组、切口感染组/非切口感染组、慢性疼痛组/非慢性疼痛组。结果81例患者术后随访，并发症30例，发生率为37.04%。多因素脊回归分析发现，疝囊大小、体重指数和年龄是术后并发症的显著阳性预测因素，而血清Na+水平呈负相关（P < 0.05）。联合脊回归模型的曲线下面积为0.93(95%可信区间为0.86 ~ 0.98)，灵敏度为91%，特异度为88%，具有较好的判别能力。亚组分析进一步证明了对血肿、切口感染和慢性疼痛的一致预测能力。结论疝囊大小、体重指数、年龄、血清Na+与腹腔镜腹股沟疝修补术后并发症独立相关。结合这些因素的联合预测模型允许早期风险分层，可以指导有针对性的围手术期管理。

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引用次数: 0

Spatial Analysis in Surgical Research 外科研究中的空间分析

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-14 DOI: 10.1016/j.jss.2025.11.071

Hongke Wu MD, MS, MPH , Ye Liu MD, MPH, DrPH

Introduction

Spatial analysis helps to understand geographic influences on surgical outcomes, healthcare access, and resource allocation.

Materials and methods

This commentary reviews spatial methods, including Kernel Density Estimation, indicators of spatial autocorrelation, spatial autoregression models, and Bayesian spatial modeling.

Results

Kernel Density Estimation and Local Moran's Index effectively identify geographic clusters of surgical complications. Spatial autoregression models quantify direct and indirect (spillover) effects, and Bayesian approaches provide stable estimates, especially for small-area studies. Despite these advantages, careful consideration of methodological challenges and limitations is crucial for accurate interpretation and application of spatial analytical findings in surgical research.

Conclusions

Spatial analysis provides powerful tools for examining geographic disparities in surgical care, but thoughtful application and interpretation are essential to ensure valid and actionable insights.

空间分析有助于理解地理因素对手术结果、医疗保健获取和资源分配的影响。材料和方法本文综述了空间方法，包括核密度估计、空间自相关指标、空间自回归模型和贝叶斯空间建模。结果核密度估计和局部Moran指数能有效识别手术并发症的地理聚类。空间自回归模型量化了直接和间接（溢出）效应，贝叶斯方法提供了稳定的估计，特别是对于小区域研究。尽管有这些优势，仔细考虑方法学的挑战和局限性对于外科研究中空间分析结果的准确解释和应用至关重要。结论空间分析为研究外科护理的地理差异提供了有力的工具，但需要深思熟虑的应用和解释，以确保有效和可操作的见解。

引用次数: 0

Surgical Resection for Pulmonary Metastasis From Cholangiocarcinoma: A Retrospective Case Series 胆管癌肺转移的手术切除：回顾性病例系列

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-13 DOI: 10.1016/j.jss.2025.12.006

Yuhi Yoshizaki MD, PhD , Nobuyuki Takemura MD, PhD , Takashi Kokudo MD, PhD , Fuyuki Inagaki MD, PhD , Fuminori Mihara MD , Tatsuo Maeyashiki MD, PhD , Satoshi Nagasaka MD, PhD , Norihiro Kokudo MD, PhD

Introduction

Cholangiocarcinoma (CCA) is associated with a high incidence of recurrence and patients occasionally develop pulmonary metastases. Systemic chemotherapy is the first-line treatment for unresectable or recurrent CCA. However, we have occasionally encountered cases of favorable prognosis following pulmonary resection for CCA metastases.

Materials and methods

Data from patients undergoing surgery for CCA between 2012 and 2021 were obtained from a prospectively maintained database. We retrospectively reviewed patients with pulmonary metastases from CCA, including those who underwent pulmonary resection and those who did not. Additionally, we described a representative case of repeated pulmonary resection with long-term survival.

Results

Among 122 patients who underwent surgery for CCA with curative intent, 64 patients (52.5%) experienced recurrence, including 14 patients (11.5%) who developed pulmonary metastases. Of these, five underwent pulmonary resection, including 1 who received two resections. None of the patients experienced postoperative complications. With a median follow-up of 2.6 y, three patients remained alive without recurrence. A representative case achieved long-term survival after repeated pulmonary resections. The 5-y overall survival rates were significantly better in patients who underwent pulmonary resection than in those who did not (75.0% versus 0%, P = 0.011).

Conclusions

Pulmonary resection may represent a feasible treatment option for carefully selected patients with pulmonary metastases from CCA.

胆管癌（CCA）具有高复发率，患者偶尔会发生肺转移。全身化疗是不可切除或复发性CCA的一线治疗方法。然而，我们偶尔会遇到肺切除CCA转移灶后预后良好的病例。材料和方法从前瞻性维护的数据库中获得2012年至2021年接受CCA手术的患者的数据。我们回顾性分析了CCA肺转移患者，包括接受肺切除术和未接受肺切除术的患者。此外，我们描述了一个具有代表性的长期生存的反复肺切除病例。结果122例手术治疗CCA患者中，64例（52.5%）复发，其中14例（11.5%）发生肺转移。其中，5人接受了肺切除术，其中1人接受了两次切除术。所有患者均未出现术后并发症。中位随访时间为2.6年，3例患者存活且无复发。一例典型病例在多次肺切除术后获得长期生存。接受肺切除术的患者的5年总生存率明显优于未接受肺切除术的患者（75.0%对0%，P = 0.011）。结论肺切除术可能是一种可行的治疗方案，为精心挑选的肺转移患者的CCA。

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引用次数: 0

Xq28 Variants as Novel Male-Specific Susceptibility Factors for Hirschsprung Disease Xq28变异是先天性巨结肠疾病男性特异性易感因素

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-13 DOI: 10.1016/j.jss.2025.12.017

Xiaoli Xie MS , Xiaoyu Zuo PhD , Qiuming He MD , Wei Zhong MS , Liucheng Yang MD

Introduction

Hirschsprung's disease (HSCR) is a complex congenital digestive tract disease affected by multiple genes. Despite the identification of >20 risk loci, no susceptibility variants map to sex chromosomes—a striking gap given the 4- to 6-fold male predominance in short-segment HSCR. This study investigates the contribution of X-chromosomal variation to HSCR pathogenesis.

Methods

We conducted a large case-control study involving a South Chinese population. Four single nucleotide polymorphisms (SNPs) in a disease hotspot region spanning on Xq28 were genotyped through MassARRAY genotyping platform. Association analysis of the selected SNPs with HSCR were performed using PLINK1.9. RNA quantitative analysis, immunohistochemistry staining, and Western blot analysis were performed to observe the expression of the newly identified gene IRAK1 of colon tissues of HSCR patients.

Results

This study included 1470 HSCR patients and 1473 ethnically matched controls. Four SNPs (rs2071128, rs17422, rs1059702, and rs2734647) were identified as associated with HSCR in a male-specific manner, with odds ratios ranging from 1.20 to 1.52. These variants conferred an even higher risk for long-segment HSCR in males, with odds ratios between 1.75 and 2.53. We demonstrated higher expression of the newly identified gene IRAK1 in aganglionic colon samples compared with ganglionic colon tissues, especially in the males (P = 0.00046).

Conclusions

We identified a novel male-specific region Xq28 as associated with HSCR. The differential expression of the newly identified gene IRAK1 in HSCR patients suggests an important role for the HSCR-associated common variants in shaping the male-specific disease.

巨结肠病（hirschsprung 's disease， HSCR）是一种多基因影响的复杂先天性消化道疾病。尽管确定了20个风险位点，但没有易感性变异映射到性染色体上——考虑到短段HSCR中男性的4- 6倍优势，这是一个惊人的差距。本研究探讨了x染色体变异在HSCR发病中的作用。方法我们进行了一项涉及华南人群的大型病例对照研究。通过MassARRAY基因分型平台对跨越Xq28的疾病热点区域的4个单核苷酸多态性（snp）进行基因分型。使用PLINK1.9对选择的snp与HSCR进行关联分析。采用RNA定量分析、免疫组化染色、Western blot等方法观察新发现的IRAK1基因在HSCR患者结肠组织中的表达情况。结果本研究纳入1470例HSCR患者和1473例种族匹配的对照组。4个snp （rs2071128、rs17422、rs1059702和rs2734647）与男性特异性HSCR相关，比值比为1.20 ~ 1.52。这些变异使男性长段HSCR的风险更高，比值比在1.75到2.53之间。我们发现，新发现的IRAK1基因在神经节结结肠样本中的表达高于神经节结结肠组织，尤其是在男性中（P = 0.00046）。结论：我们发现了一个新的男性特异性区域Xq28与HSCR相关。新发现的基因IRAK1在HSCR患者中的差异表达表明，HSCR相关的常见变异在形成男性特异性疾病中起重要作用。

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引用次数: 0

Adaptation and Recovery Challenges After Ostomy Surgery: Qualitative Study of Clinician Perspectives 造口手术后的适应和恢复挑战：临床医生观点的定性研究。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-12 DOI: 10.1016/j.jss.2025.12.009

Stefanie J. Soelling MD, MPH , Atziri Rubio-Chavez MD , Laura Baird BA , Mary E. Brindle MD , Zara Cooper MD, MSc , Ana-Maria Vranceanu PhD , Christine S. Ritchie MD, MSPH , Christy E. Cauley MD, MPH

Introduction

Patients undergoing colorectal surgery with fecal ostomy experience biopsychosocial challenges during recovery. We aimed (1) to describe clinician's perceived challenges with biopsychosocial recovery after ostomy surgery and (2) to examine current solutions to address patient psychosocial challenges while recovering.

Methods

We conducted qualitative focus groups evaluating clinician perspectives using a semistructured interview guide. Colorectal surgeons, gastrointestinal psychologists, colorectal surgery nurse practitioners, and ostomy nurses were included.

Results

Five interview sessions were performed including focus groups and individual interviews. Clinicians were 73% female, all White, and with varied experience (2-40 y in practice). All participants reported ostomy-related emotional distress occurs after surgery and impacts patient recovery and adaptation. Participants reported distress was mitigated when the ostomy relieved functional symptoms and in patients with time to cope with needing an ostomy due to chronic diseases. Patients with permanent ostomies were felt to adapt faster. Emotional distress increased dependence on caregivers, prolonged hospital stays, and delayed adaptation to daily life. Ostomy nurses reported they spent significant time addressing patient distress in clinical encounters. Participants reported a lack of training, time, and resources to help manage patients’ emotional distress.

Conclusions

Clinicians treating colorectal surgery patients with ostomy frequently note clinically significant emotional distress. This distress hinders patients’ ability to adapt to life with an ostomy. An ostomy specific distress management intervention is needed to improve biopsychosocial outcomes during surgical recovery and adaptation.

导读：结肠直肠手术伴粪便造口术患者在康复过程中会遇到生物心理社会挑战。我们的目的是(1)描述临床医生对造口手术后生物心理社会恢复的感知挑战；(2)研究当前解决方案，以解决患者在恢复过程中的心理社会挑战。方法：我们采用半结构化访谈指南进行定性焦点小组评估临床医生的观点。包括结直肠外科医生、胃肠心理学家、结直肠外科执业护士和造口护士。结果：共进行了5次访谈，包括焦点小组访谈和个人访谈。临床医生73%为女性，全部为白人，具有不同的经验（2-40岁）。所有参与者都报告了造口术相关的情绪困扰发生在手术后，并影响了患者的恢复和适应。参与者报告说，当造口术缓解了功能性症状，并且患者有时间应对由于慢性疾病而需要造口术时，痛苦减轻了。永久性造口术患者适应速度更快。情绪困扰增加了对照顾者的依赖，延长了住院时间，延迟了对日常生活的适应。造口护士报告说，他们在临床遭遇中花了大量时间来解决病人的痛苦。参与者报告缺乏培训、时间和资源来帮助管理患者的情绪困扰。结论：临床医生在治疗结直肠手术造口患者时经常注意到临床上明显的情绪困扰。这种痛苦阻碍了患者适应造口术生活的能力。在手术恢复和适应过程中，需要一个特定的造口窘迫管理干预来改善生物心理社会结果。

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