Videosurgery and Other Miniinvasive Techniques最新文献

Introduction: Fluid resuscitation is the primary sepsis management strategy aimed at reducing mortality and achieving better treatment outcomes in critically hypotensive patients. Still, there are significant ambiguities regarding the most suitable fluid type that would ensure optimization of patient outcomes.

Aim: The aim of this systematic review and meta-analysis was to assess the clinical effectiveness of different resuscitation fluids for sepsis management in critically hypotensive patients.

Materials and methods: A systematic search of 4 electronic databases (PubMed, EMBASE, Scopus, and Cochrane Library) was conducted to identify relevant papers published in peer-reviewed journals since database inception until June 30, 2024. Odds ratios (ORs) with 95% CIs were calculated to evaluate the impact of individual resuscitation fluids on improvements in hemodynamic parameters and all-cause mortality. Heterogeneity was assessed using the Cochran Q, I² statistic, and the appropriate P value.

Results: Our meta-analysis included 18 randomized controlled trials comparing the efficacy of different resuscitation fluids for sepsis management in 14 469 critically hypotensive patients. We found that Ringer's lactate solution was more effective than saline in reducing mortality (OR, 0.53; 95% CI, 0.41-0.7; χ²= 3.47; degree of freedom [df] = 6; Z = 4.6; I² = 0%; P <⁠0.001) and improving hemodynamic parameters (OR, 2.64; 95% CI, 2.45-2.86; χ² = 48.36; df = 6; Z = 24.84; I² = 18%; P <⁠0.001). However, saline was superior to albumin and hydroxyethyl starch in reaching these end points.

Conclusion: We showed that in critically hypotensive septic patients, Ringer's lactate solution reduces all-cause mortality and improves hemodynamic parameters more effectively than saline, hydroxyethyl starch, and albumin solutions.

Introduction: Surgery is the principal treatment option for early colorectal cancer (CRC). Anesthesia plays a crucial role in any surgery as it allows for a painless procedure. Dexmedetomidine is a local anesthetic that reduces pain and discomfort during surgery.

Aim: The aim of this study was to investigate the efficacy of application of dexmedetomidine combined with total intravenous anesthesia in laparoscopic CRC surgery, with particular focus on its effects on patient hemodynamics and inflammatory factors.

Materials and methods: For the purposes of this study, 80 patients undergoing elective laparoscopic rectal cancer surgery were selected and subsequently divided into 2 groups: the experimental group (0.5 µg/kg dexmedetomidine infused at a constant speed for 20 minutes, followed by 0.4 µg/kg/h dexmedetomidine) and the control group (0.5 µg/kg sufentanil infused at a constant speed for 20 minutes, followed by 0.4 µg/kg/h sufentanil). Each group comprised 40 patients. Hemodynamic parameters were recorded 1 minute before pumping dexmedetomidine or sufentanil (S0), 1 minute after pneumoperitoneum position (S1), 1 hour after pneumoperitoneum (S2), and 1 minute after elimination of air from the patient's peritoneal cavity and position change (S3).

Result: Systolic blood pressure (SBP) and diastolic blood pressure (DBP) at S1 and S2 in the experimental group were lower than in the control group (P <0.05). Heart rate (HR) and mean arterial pressure (MAP) at S1, S2, and S3 in the experimental group were lower, as compared with the control group (P <0.05). The levels of serum inflammatory factors (tumor necrosis factor α [TNF‑α], interleukin [IL]‑8, and IL‑6) and stress response indicators (plasma epinephrine, norepinephrine, and plasma cortisol) at S1, S2, and S3 in the experimental group were lower than in the control group (P <0.05). The expressions of TNF‑α, IL‑8, and IL‑6 in the experimental group negatively correlated with SBP and DBP (P <0.05), and with MAP and HR (P <0.001).

Conclusion: Dexmedetomidine can effectively maintain hemodynamic stability and inhibit inflammatory and stress responses in patients undergoing laparoscopic CRC surgery, with its effect being superior to those of sufentanil.

Introduction: Endoscopic subcutaneous onlay approach (SCOLA) mesh repair in combination with anterior plication of diastasis has recently become a commonly performed procedure.

Aim: The aim of this study was to analyze the results of 1‑year follow‑up in patients after umbilical hernia with rectal abdominal muscle diastasis repair using endoscopic SCOLA.

Materials and methods: Our prospective cohort study included patients who underwent elective surgery for small‑ (<2 cm) and medium‑ (2-4 cm) size primary umbilical hernia with diastasis recti. The follow‑up period was 12 months. Hernia recurrence and postoperative seroma diagnosis were based on the patient's physical examination and ultrasound assessment. The Carolinas Comfort Scale questionnaire was used to evaluate the quality of life after the surgery.

Result: One hundred patients underwent surgery for umbilical hernia with rectal abdominal muscle diastasis repair. Their mean (SD) age was 39.6 (11.8) years. Most of the patients (n = 77) were women. We found no hernia or diastasis recurrence during 1‑year follow‑up. Seroma was found in 15 patients during the first month of follow‑up. The rate of seroma was 11% after 3 months and 2% after 6 months of follow‑up. Almost all the patients reported mild or moderate symptoms during daily activities after the surgery.

Conclusion: SCOLA is a safe and effective technique for patients with small umbilical hernia with diastasis. It provides an acceptable cosmetic result for carefully selected patients, low postoperative pain, and good quality of life.

Introduction: Cesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy. Lack of timely CSP treatment can lead to severe postpartum bleeding, affect fertility, and threaten patients' life and health.

Aim: This work explored the use of laparoscopic temporary uterine artery blocking (TUAB) and uterine artery embolization (UAE) in treating CSP.

Materials and methods: For the purpose of the study, 60 patients with CSP were selected and equally divided into the UAE group and the TUAB group. Both groups underwent cesarean scar lesion repair (CSLR) after the procedure. The differences in surgical outcomes, β‑human chorionic gonadotropin (β‑HCG) levels, ovarian reserve, endocrine function indicators, as well as the incidence of complications were compared between the groups.

Result: The TUAB group presented a shorter length of hospital stay, shorter vaginal bleeding time, shorter menstrual recovery time, and shorter mass disappearance time than the UAE group (all P <0.05). The patients in the TUAB group had lower β‑HCG, estradiol, and progesterone levels, and higher levels of luteinizing hormone and follicle‑stimulating hormone (all P <0.05). Furthermore, the TUAB patients had a larger mean ovary diameter, an increased antral follicle count, and an elevated level of anti‑Müllerian hormone, as compared with the individuals treated with UAE (all P <0.05). The total incidence of complications in the UAE and TUAB groups was 23.33% (7/30) and 6.67% (2/30), respectively (P <0.05).

Conclusions: Laparoscopic TUAB for CSLR proved to be a more effective and safer CSP treatment method than UAE.

Introduction: Cervical disc herniation (CDH) is a common condition, usually caused by excessive strain or trauma to the spine. Initially, it is treated conservatively; however, complex and resistant cases may require a surgical intervention.

Aim: We aimed to compare the clinical effect of endoscopy-assisted anterior cervical discectomy and fusion (ACDF) with internal fixation and conventional surgery in the treatment of CDH.

Materials and methods: Patients with CDH who underwent ACDF with fixation at the Zhoushan Dinghai Guanghua Hospital were enrolled. Of them, 10 individuals were treated with conventional ACDF (conventional surgery group), and the other 10 with endoscopy-assisted ACDF (endoscopy-assisted surgery group). The general characteristics, postoperative Japanese Orthopedic Association (JOA), visual analogue scale (VAS), 12-Item Short Form Survey Physical Component Summary (SF-12 PCS), and SF-12 Mental Component Summary (SF-12 MCS) scores, physiological stress response, rate of the improved JOA score (RIS), hemoglobin level, and bone graft fusion were compared between the groups.

Result: Outcomes of the patients treated with endoscopy-assisted surgery were clearly superior to those observed in the conventional surgery group. The postoperative JOA, VAS, SF-12 PCS, and SF-12 MCS scores and RIS in the endoscopy-assisted surgery group were higher than in the conventional surgery group (P <⁠0.05). Following operation, there were significant differences between the 2 groups with respect to RIS at 1 week and 6 months postsurgery and hemoglobin levels on postoperative day 2. Changes in heart rate and diastolic blood pressure in the endoscopy-assisted surgery group were less pronounced than in the conventional surgery group (P <⁠0.05), and the fusion rate was significantly higher in the former group (90% vs 80%, respectively).

Conclusion: Endoscopy-assisted ACDF with internal fixation has a greater clinical therapeutic effect than the conventional approach in the treatment of CDH. It is associated with a higher bone graft fusion rate and reduced intraoperative blood loss.

Introduction: Lung resection continues to be the most effective treatment for early‑stage lung cancer. Prediction of postoperative lung function is particularly important when evaluating patient eligibility for surgery, as it helps assess the likelihood of experiencing difficulty breathing after the operation.

Aim: We aimed to identify the most common methods used to predict postoperative lung function in clinical practice and to compare their accuracy.

Materials and methods: A systematic review and meta‑analysis were performed to synthesize research focused on the prediction of postoperative lung function. A total of 10 studies were included in the analysis. The Cochrane risk of bias tool was utilized to evaluate the risk of bias in the studies. Additionally, a meta‑analysis of the mean difference between the predicted and measured values of forced expiratory volume in 1 second (FEV₁) was conducted. The I² value was computed as a metric of coherence among studies, while funnel plots and the Begg test were used to evaluate the likelihood of publication bias.

Results: The analyzed studies had a low risk of bias. The meta‑analysis showed that computed tomography (CT) volume and density measurement had the highest level of accuracy for predicting postoperative FEV₁ , with a mean difference between the predicted and actual value of 83 ml (95% CI, 41-116).

Conclusions: The results indicate that using CT volume and density is the optimal method for predicting postoperative FEV₁ . Additional research is necessary to establish the connection between the type of surgical procedure, adopted thresholds, and outcomes reported by patients.