Videosurgery and Other Miniinvasive Techniques最新文献_第4页

Minimally invasive autopsy – endoscopic approach to post-mortem diagnostics 微创尸检--内窥镜尸检诊断方法

IF 1.7 4区医学 Q2 SURGERY

Videosurgery and Other Miniinvasive Techniques

Pub Date : 2023-12-29 DOI: 10.5114/wiitm.2023.134122

Paweł Świderski, Szymon Rzepczyk, Beata Bożek, Czesław Żaba

The noticeable decline in the number of autopsies performed in recent years requires investigation into the causes of the phenomenon and attempts to prevent it. One potential cause of this trend is fear of disfiguring the body. Carrying out autopsies using a minimally invasive method may reduce the decrease in the number of autopsies performed. The first work on the development of the method and its continuation gave promising results. This allows us to start a discussion on attempts to introduce the method. The solution seems especially justified when the alternative is to completely abandon post-mortem examinations using the traditional method. Laparoscopy and thoracoscopy are tools that allow for accurate imaging and analysis of organ changes. Enriching them with additional tests using endoscopic techniques may have a positive impact on the accuracy of autopsy diagnoses. The development of a clear protocol for minimally invasive post-mortem diagnosis requires further research to determine the accuracy of the method.

近年来，尸体解剖的数量明显减少，这就要求对造成这一现象的原因进行调查，并设法加以预防。造成这种趋势的一个潜在原因是害怕毁容。使用微创方法进行尸体解剖可能会减少尸体解剖的数量。该方法的首次开发和延续工作取得了可喜的成果。因此，我们可以开始讨论引入该方法的尝试。在完全放弃使用传统方法进行尸检的情况下，该解决方案显得尤为合理。腹腔镜和胸腔镜是可以准确成像和分析器官变化的工具。利用内窥镜技术进行更多检查，可能会对尸检诊断的准确性产生积极影响。制定明确的微创尸检诊断方案需要进一步研究，以确定该方法的准确性。

引用次数: 0

IF 1.7 4区医学 Q2 SURGERY

Videosurgery and Other Miniinvasive Techniques

Pub Date : 2023-12-27 DOI: 10.5114/wiitm.2023.133916

Qiaoqin Yan, Haofeng Liang, Hengming Yin, Xianhua Ye

Introduction
In patients undergoing cancer surgery, it is ambiguous whether propofol-based total intravenous anesthesia (TIVA) elicits a significantly higher overall survival rate than volatile anesthetics (VA). Consequently, evaluating the impact of TIVA and VA on long-term oncological outcomes is crucial.

Aim
This study compared TIVA versus VA for cancer surgery patients and investigated the potential correlation between anesthetics and their long-term surgical outcomes.

Material and methods
A comprehensive search of Medline, EMBASE, Scopus, and Cochrane Library identified English-language peer-reviewed journal papers. The statistical measurements of hazard ratio (HR) and 95% CI were calculated. We assessed heterogeneity using Cochrane Q and I2 statistics and the appropriate p-value. The analysis used RevMan 5.3.

Results
The meta-analysis included 10 studies with 14036 cancer patients, 6264 of whom received TIVA and 7777 VA. In this study, we examined the long-term oncological outcomes of cancer surgery patients with TIVA and VA. Our data show that the TIVA group had a considerably higher overall survival rate (HR = 0.49, 95% CI: 0.30–0.80) and recurrence-free survival rate (HR = 0.56, 95% CI: 0.32–0.97). Each outcome was statistically significant (p < 0.05).

Conclusions
The present study concludes that TIVA is a more effective anesthetic agent than VA in obtaining better long-term oncological outcomes in cancer patients after surgery as it provides a higher overall survival rate, a higher recurrence-free survival rate and fewer post-operative pathological findings in patients who have undergone surgery for cancer as compared to VA.

导言在接受癌症手术的患者中，以丙泊酚为基础的全静脉麻醉（TIVA）是否比挥发性麻醉药（VA）能显著提高总生存率尚不明确。因此，评估 TIVA 和 VA 对长期肿瘤预后的影响至关重要。本研究比较了癌症手术患者使用 TIVA 和 VA 的情况，并调查了麻醉药与其长期手术预后之间的潜在相关性。计算了危险比（HR）和 95% CI 的统计测量值。我们使用 Cochrane Q 和 I2 统计量以及适当的 p 值评估了异质性。分析使用 RevMan 5.3。结果荟萃分析纳入了 10 项研究，共研究了 14036 名癌症患者，其中 6264 人接受了 TIVA 治疗，7777 人接受了 VA 治疗。在这项研究中，我们考察了接受 TIVA 和 VA 的癌症手术患者的长期肿瘤治疗效果。我们的数据显示，TIVA 组的总生存率（HR = 0.49，95% CI：0.30-0.80）和无复发生存率（HR = 0.56，95% CI：0.32-0.97）明显更高。本研究得出结论，与 VA 相比，TIVA 是一种更有效的麻醉剂，能为癌症患者术后获得更好的长期肿瘤治疗效果，因为与 VA 相比，TIVA 能为癌症患者提供更高的总生存率、无复发生存率以及更少的术后病理结果。

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引用次数: 0

Minimally invasive treatment of postoperative fistulas, leakages, and perforations of the upper gastrointestinal tract: a single-center observational study 上消化道术后瘘管、渗漏和穿孔的微创治疗：单中心观察研究

IF 1.7 4区医学 Q2 SURGERY

Videosurgery and Other Miniinvasive Techniques

Pub Date : 2023-12-18 DOI: 10.5114/wiitm.2023.133838

Jaroslaw Cwaliński, Jacek Paszkowski, Filip Lorek, Pawel Samborski, Marcin Kucharski, Hanna Michalak, Tomasz Banasiewicz

Introduction
Most anastomotic leaks in the upper gastrointestinal (GI) tract can be treated with minimally invasive techniques dominated by endoluminal vacuum therapy (EVT) or stent implantation. Chronic leaks often require additional solutions, such as tissue adhesives or cellular growth stimulants.

Aim
To present a treatment strategy for postoperative leakage of upper GI anastomoses with noninvasive procedures.

Material and methods
A group of 19 patients treated in the period 2015–2023 with postoperative upper GI tract leakage was enrolled for endoscopic treatment. The indication for the therapy was anastomotic dehiscence not exceeding half of the circumference and the absence of severe septic complications. All patients were managed using endoscopic vacuum therapy (EVT) or a self-expanding stent while persistent fistulas were additionally treated with alternative methods.

Results
The EVT was successfully implemented in 13 cases, but 7 patients required alternative methods to achieve definitive healing. Self-expanding stent placement was performed in 6 patients; however, in 3 cases a periprosthetic leakage occurred. In this group, two patients had the stent removed and the third one died due to septic complications. Post-treatment stenosis was identified in 5 patients after EVT that required balloon dilation with acceptable resolution in all cases.

Conclusions
Early detected anastomotic dehiscence limited to half of the circumference most effectively responded to the noninvasive treatment. Nutritional support as well as complementary endoscopic solutions such as tissue adhesives, growth stimulants and hemostatic clips increase the percentage of complete healing.

导言上消化道（GI）吻合口漏大多可通过以腔内真空治疗（EVT）或支架植入为主的微创技术进行治疗。材料和方法2015-2023年间，19名上消化道吻合口术后渗漏患者接受了内镜治疗。治疗指征为吻合口开裂不超过周长的一半，且无严重化脓性并发症。所有患者均采用内镜真空疗法（EVT）或自膨胀支架进行治疗，而顽固性瘘管则采用其他方法进行治疗。有 6 例患者进行了自膨胀支架置入术，但有 3 例发生了假体周围渗漏。在这组患者中，有两名患者被移除支架，第三名患者因化脓性并发症死亡。结论早期发现的吻合口开裂仅限于周径的一半，对无创治疗的反应最为有效。营养支持以及组织粘合剂、生长刺激剂和止血夹等辅助性内窥镜解决方案可提高完全愈合的比例。

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引用次数: 0

Revisional bariatric procedures in the group of patients over 60 years of age: a multicenter cohort study (PROSS Study) 60 岁以上患者群体中的再减肥手术：一项多中心队列研究（PROSS 研究）

IF 1.7 4区医学 Q2 SURGERY

Videosurgery and Other Miniinvasive Techniques

Pub Date : 2023-12-15 DOI: 10.5114/wiitm.2023.133843

Piotr Zarzycki, Justyna Rymarowicz, Piotr Małczak, Magdalena Pisarska-Adamczyk, Mateusz Wierdak, Natalia Dowgiałło-Gornowicz, Paweł Lech, Michał Pędziwiatr, Piotr Major

Introduction
The constantly increasing prevalence of obesity in the population and the lengthening of life expectancy affect the appearance of the problem of pathological obesity also in the elderly. At the same time, an increase in the number of bariatric procedures (also revisional) performed in elderly patients is observed.

Aim
To assess the indications for revisional bariatric procedures along with the safety and postoperative results in the group of patients over 60 years of age.

Material and methods
The study was conducted in 2019–2020 among patients undergoing revisional bariatric procedures in Polish bariatric centers. The data were obtained through a multicenter, observational retrospective study.

Results
Our data consist of 55 (8.1%) patients older than 60 years of age who underwent revisional bariatric procedures. Revisional procedures in the group of patients over 60 years of age had fewer postoperative complications (16.4% vs. 23.1%, p < 0.05). Remission of type II diabetes or arterial hypertension was achieved to a lesser extent in patients operated on over the age of 60 (13% and 15%, respectively) compared to patients operated on under the age of 60 (47% and 34%, respectively; p < 0.05).

Conclusions
Revisional bariatric procedures in the group of patients over 60 years of age do not cause an increased risk of postoperative complications or prolonged hospital stay. The possibility of achieving remission or improvement in the treatment of comorbidities in patients operated on over 60 years of age is relatively lower compared to a younger group.

导言随着肥胖症在人群中的发病率不断上升以及预期寿命的延长，老年人也出现了病理性肥胖的问题。材料和方法该研究于 2019-2020 年在波兰减肥中心接受减肥手术（包括翻修手术）的患者中进行。结果我们的数据包括 55 名（8.1%）接受过减肥翻修手术的 60 岁以上患者。在 60 岁以上的患者组中，翻修手术的术后并发症较少（16.4% 对 23.1%，P <0.05）。结论：在 60 岁以上人群中进行减肥手术不会增加术后并发症或延长住院时间的风险。与年轻群体相比，60 岁以上接受手术的患者在合并症治疗方面获得缓解或改善的可能性相对较低。

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引用次数: 0

A modified laparoscopic lateral suspension with mesh for apical and anterior pelvic organ prolapse: a retrospective cohort study 改良腹腔镜侧悬吊术与网片治疗盆腔顶端和前部器官脱垂：一项回顾性队列研究

IF 1.7 4区医学 Q2 SURGERY

Videosurgery and Other Miniinvasive Techniques

Pub Date : 2023-12-13 DOI: 10.5114/wiitm.2023.133777

Sheng Xu, Jingya Nie, Wenjie Zeng, Yucheng Lai, Xiaoyan Chen, Yan Yu

Introduction
Pelvic organ prolapse (POP), a common and benign condition, is characterized by the descent of one or more aspects of the vagina and uterus. A wide variety of mesh-based surgical techniques have been proved to be effective in the treatment of pelvic organ prolapse (POP).

Aim
To evaluate the efficacy of a modified laparoscopic lateral suspension with mesh (mLLSM) in patients with apical and anterior pelvic organ prolapse.

Material and methods
All patients diagnosed with apical and anterior pelvic organ prolapse underwent a modified laparoscopic lateral suspension with mesh (mLLSM). Perioperative parameters including surgical time, blood loss and complications were recorded. At the minimal 12-month follow-up, primary outcome measures included both anatomical and functional points. The anatomical cure rate was evaluated using the Pelvic Organ Prolapse Questionnaire (POP-Q) assessment. Patient satisfaction was evaluated using questionnaires.

Results
Mean surgical time was 91.56 ±15.33 min; mean estimated blood loss was 55.42 ±36.73 ml; no intraoperative complications were noted in the perioperative period. After a minimal 12-month follow-up period, rates of anatomical success and subjective satisfaction were 96.33% and 94.50%, respectively. Symptom severity and quality of life also improved significantly.

Conclusions
We found mLLSM to be a safe and effective treatment for patients suffering apical and anterior pelvic organ prolapse. We found mLLSM to result in excellent outcomes and fewer mesh complications, underscoring its potential as an alternative treatment option for the management of apical and anterior pelvic organ prolapse.

简介：盆腔器官脱垂（POP）是一种常见的良性疾病，其特征是阴道和子宫的一个或多个部位下垂。材料和方法所有确诊为盆腔器官顶端和前部脱垂的患者均接受了改良腹腔镜下网片侧悬吊术（mLLSM）。记录围手术期参数，包括手术时间、失血量和并发症。在最短12个月的随访中，主要结果指标包括解剖和功能两方面。解剖学治愈率通过盆腔器官脱垂问卷（POP-Q）评估进行评价。结果平均手术时间为（91.56 ± 15.33）分钟；估计平均失血量为（55.42 ± 36.73）毫升；围手术期未发现术中并发症。经过最短 12 个月的随访，解剖成功率和主观满意度分别为 96.33% 和 94.50%。结论我们发现 mLLSM 是一种安全有效的治疗方法，适用于患有顶端和前方盆腔器官脱垂的患者。我们发现 mLLSM 的疗效极佳，网片并发症较少，突出了其作为治疗顶端和前方盆腔器官脱垂的替代疗法的潜力。

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引用次数: 0

Influence of staple line reinforcement on the occurrence of bleeding complications following laparoscopic sleeve gastrectomy: a retrospective analysis 腹腔镜袖带胃切除术后缝合线加固对出血并发症发生的影响：回顾性分析

IF 1.7 4区医学 Q2 SURGERY

Videosurgery and Other Miniinvasive Techniques

Pub Date : 2023-12-11 DOI: 10.5114/wiitm.2023.133679

Michal Janik, Krzysztof Jędras, Dawid Golik, Przemysław Sroczyński

Introduction
Laparoscopic sleeve gastrectomy (LSG) has gained prominence as a therapeutic option for obesity and metabolic diseases. The choice of staple line reinforcement technique in LSG remains a subject of debate, particularly concerning postoperative bleeding complications.

Aim
The aim of this retrospective analysis is to assess the influence of different staple line reinforcement techniques on the occurrence of bleeding complications LSG.

Material and methods
We conducted a retrospective analysis of patients undergoing LSG between September 2021 and April 2023 at our institution. Patients were stratified into two groups based on the staple line reinforcement method: continuous suturing (n = 53) and clipping (n = 28). Surgical outcomes, including operative time, length of hospital stay, and bleeding complications, were assessed. Complications were classified using the Clavien-Dindo classification.

Results
Continuous suturing was associated with a significantly longer operative time (88.15 min vs. 74.64 min, p < 0.05) but a similar length of hospital stay. Notably, no bleeding complications occurred in the continuous suturing group, while the clipping group experienced postoperative bleeding in 7.14% of cases (p < 0.05). Continuous suturing exhibited a slightly higher incidence of minor complications classified as Class I in the Clavien-Dindo classification (7.55% vs. 0%).

Conclusions
This retrospective analysis suggests that continuous suturing may provide enhanced hemostasis along the staple line, reducing the risk of postoperative bleeding compared to clipping. Despite the longer operative time and a slightly higher rate of minor complications, the clinical significance of these findings should be considered within the context of individual patient risk profiles.

导言腹腔镜袖带胃切除术（LSG）作为肥胖症和代谢性疾病的一种治疗方法，其地位日益突出。本回顾性分析旨在评估不同的缝合线加固技术对 LSG 出血并发症发生的影响。材料和方法我们对 2021 年 9 月至 2023 年 4 月期间在本院接受 LSG 的患者进行了回顾性分析。根据钉线加固方法将患者分为两组：连续缝合（53 例）和剪断（28 例）。对手术结果进行了评估，包括手术时间、住院时间和出血并发症。结果连续缝合的手术时间明显更长（88.15 分钟对 74.64 分钟，P < 0.05），但住院时间相似。值得注意的是，连续缝合组未出现出血并发症，而剪切组有 7.14% 的病例出现术后出血（p <0.05）。结论这项回顾性分析表明，与剪切术相比，连续缝合术可增强缝合线的止血效果，降低术后出血风险。尽管手术时间较长，轻微并发症的发生率略高，但这些发现的临床意义应结合患者的个体风险情况来考虑。

{"title":"Influence of staple line reinforcement on the occurrence of bleeding complications following laparoscopic sleeve gastrectomy: a retrospective analysis","authors":"Michal Janik, Krzysztof Jędras, Dawid Golik, Przemysław Sroczyński","doi":"10.5114/wiitm.2023.133679","DOIUrl":"https://doi.org/10.5114/wiitm.2023.133679","url":null,"abstract":"Introduction Laparoscopic sleeve gastrectomy (LSG) has gained prominence as a therapeutic option for obesity and metabolic diseases. The choice of staple line reinforcement technique in LSG remains a subject of debate, particularly concerning postoperative bleeding complications. Aim The aim of this retrospective analysis is to assess the influence of different staple line reinforcement techniques on the occurrence of bleeding complications LSG. Material and methods We conducted a retrospective analysis of patients undergoing LSG between September 2021 and April 2023 at our institution. Patients were stratified into two groups based on the staple line reinforcement method: continuous suturing (n = 53) and clipping (n = 28). Surgical outcomes, including operative time, length of hospital stay, and bleeding complications, were assessed. Complications were classified using the Clavien-Dindo classification. Results Continuous suturing was associated with a significantly longer operative time (88.15 min vs. 74.64 min, p < 0.05) but a similar length of hospital stay. Notably, no bleeding complications occurred in the continuous suturing group, while the clipping group experienced postoperative bleeding in 7.14% of cases (p < 0.05). Continuous suturing exhibited a slightly higher incidence of minor complications classified as Class I in the Clavien-Dindo classification (7.55% vs. 0%). Conclusions This retrospective analysis suggests that continuous suturing may provide enhanced hemostasis along the staple line, reducing the risk of postoperative bleeding compared to clipping. Despite the longer operative time and a slightly higher rate of minor complications, the clinical significance of these findings should be considered within the context of individual patient risk profiles. ","PeriodicalId":49361,"journal":{"name":"Videosurgery and Other Miniinvasive Techniques","volume":"45 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139055783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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

A meta-analysis of randomized controlled trials comparing enteral immunonutrition (EIN) and standard enteral nutrition regarding biochemical, immunological, and clinical outcomes in gastrectomy patients with gastric cancer and investigating evidence networks for EIN formulae 对随机对照试验进行荟萃分析，比较肠道免疫营养（EIN）和标准肠道营养对胃癌胃切除术患者的生化、免疫和临床疗效，并调查肠道免疫营养配方的证据网络

IF 1.7 4区医学 Q2 SURGERY

Videosurgery and Other Miniinvasive Techniques

Pub Date : 2023-12-04 DOI: 10.5114/wiitm.2023.133439

Lidan Huang, Qi Zhao, Weihang Li

Introduction
For patients with gastric cancer who have undergone gastrectomy, recent research has shown that enteral immunonutrition (EIN) is more successful than enteral nutrition (EN) at boosting host immunity and, in turn, improving prognosis. The claimed outcomes, however, are inconsistent.

Aim
This meta-analysis examines how EIN affects biochemical, immunological, and clinical outcomes for gastrectomy (GC) patients following gastrectomy and EIN formulae evidence networks.

Material and methods
A comprehensive search of the Medline, EMBASE, Scopus, and Cochrane Library databases identified English-language peer-reviewed journal papers. The odds ratio (OR) and standard mean difference (SMD) were calculated, along with their 95% confidence intervals. The heterogeneity was assessed using Cochrane Q and I2 statistics and the appropriate p-value. The analysis used RevMan 5.3.

Results
This meta-analysis included 10 RCTs involving 1409 GC patients, 714 of whom were assigned to EIN and 695 to EN. After EIN treatment, serum proalbumin, serum transferrin, lymphocyte count, and CD4+/CD8+ ratio had statistically significant standardised mean differences (SMDs) of 2.39, 2.39, 1.34, and 0.72, respectively. EIN reduces postoperative infectious complications with an OR of 0.63 (95% CI: 0.41–0.77) for infections, an OR of 0.63 for complications, and an SMD of –1.05 for systemic inflammations. A network diagram with high-quality data and a well-defined network design with consistent and accurate connection shows that EIN can improve serum protein levels, immunological parameters, and post-operative problems.

Conclusions
The use of EIN has been shown to enhance cellular immunity, regulate inflammatory response, and decrease postoperative complications in GC patients who underwent major GI surgery.

导言对于接受胃切除术的胃癌患者，最近的研究表明，肠内免疫营养（EIN）比肠内营养（EN）更能提高宿主免疫力，进而改善预后。材料和方法对 Medline、EMBASE、Scopus 和 Cochrane 图书馆数据库进行了全面检索，找到了经同行评审的英文期刊论文。计算了几率比（OR）和标准平均差（SMD）及其 95% 的置信区间。使用 Cochrane Q 和 I2 统计量及相应的 p 值评估异质性。分析使用RevMan 5.3。结果该荟萃分析包括10项RCT，涉及1409名GC患者，其中714人被分配到EIN治疗，695人被分配到EN治疗。EIN治疗后，血清原白蛋白、血清转铁蛋白、淋巴细胞计数和CD4+/CD8+比值的标准化均值差异（SMD）分别为2.39、2.39、1.34和0.72，具有统计学意义。EIN可减少术后感染并发症，感染的OR值为0.63（95% CI：0.41-0.77），并发症的OR值为0.63，全身炎症的SMD值为-1.05。通过高质量数据的网络图和定义明确、连接一致且准确的网络设计，可以看出EIN可以改善血清蛋白水平、免疫学参数和术后问题。结论在接受大型消化道手术的GC患者中，使用EIN已被证明可以增强细胞免疫、调节炎症反应和减少术后并发症。

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引用次数: 0

Comparison of two methods for CT-guided pulmonary nodule location before thoracoscopic surgery 胸腔镜手术前 CT 引导肺结节定位的两种方法比较

IF 1.7 4区医学 Q2 SURGERY

Videosurgery and Other Miniinvasive Techniques

Pub Date : 2023-11-20 DOI: 10.5114/wiitm.2023.133073

Dehao Liu, Rongzhou Zhang, Xiuyi Yu, Liangzhong Liao, Sien Shi, Lichun Chen

Introduction
Preoperative computed tomography (CT)-guided localization can shorten the time of video-assisted thoracoscopic surgery (VATS) and accurately aid in pulmonary nodule removal.

Aim
To discuss the application value and safety of 2 kinds of breast localization needles and anchor localization needles in clinical practice for pulmonary nodules under CT guidance before VATS.

Material and methods
We retrospectively studied 215 patients with 247 pulmonary nodules, who underwent CT-guided pulmonary nodule location before VATS. The 2 kinds of localization needles were randomly used, and we collected and analysed the clinical data.

Results
We used breast and anchor localization needles in 27.9% and 72.1% of cases, respectively. Differences were observed in puncture localization time, detachment rate, and visual analogue scale (VAS). The detachment rate (0%) and positioning time (median: 12 min) were less in the anchor than in the breast localization needle group (8.7% and median: 13 min, respectively). The median VAS was approximately 2 and 5 in the anchor and breast localization needle groups, respectively. Surgical pathology revealed that 155 (62.8%) pulmonary nodules were malignant while 92 (37.2%) were benign. The primary distinction in surgical procedures is the higher proportion of segmental resections in the middle and inner band group (19.3%) compared to the periphery band group (4.2%).

Conclusions
Unlike breast localization needles, anchor localization needles can reduce pain and discomfort after positioning, and they are not easy to decouple. These 2 needles are safe for CT-guided localization, which can shorten the time of VATS and accurately aid in pulmonary nodule removal.

导言术前计算机断层扫描（CT）引导下的定位可缩短视频辅助胸腔镜手术（VATS）的时间，并准确帮助肺结节的切除。材料和方法我们回顾性研究了215例247个肺结节的患者，这些患者在VATS前接受了CT引导下的肺结节定位。结果我们分别在 27.9% 和 72.1% 的病例中使用了乳房定位针和锚定定位针。在穿刺定位时间、脱落率和视觉模拟量表（VAS）方面观察到了差异。锚定针组的脱落率（0%）和定位时间（中位数：12 分钟）低于乳房定位针组（分别为 8.7% 和中位数：13 分钟）。锚定组和乳房定位针组的 VAS 中位数分别约为 2 和 5。手术病理显示，155 个（62.8%）肺结节为恶性，92 个（37.2%）为良性。结论与乳腺定位针不同，锚定定位针可减少定位后的疼痛和不适，且不易脱钩。这两种针在 CT 引导下进行定位是安全的，可缩短 VATS 的时间并准确帮助肺结节的切除。

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引用次数: 0

Risk factors for extensive subcutaneous emphysema after pulmonary resection by video-assisted thoracoscopic surgery: a case-control study. 电视胸腔镜肺切除术后广泛性皮下气肿的危险因素：一项病例对照研究。

IF 1.7 4区医学 Q2 SURGERY

Videosurgery and Other Miniinvasive Techniques

Pub Date : 2023-09-01 Epub Date: 2023-05-30 DOI: 10.5114/wiitm.2023.127786

Tingting Liu, Jing Feng, Xiaoxin Liu

Introduction: Extensive subcutaneous emphysema may lead to a significantly prolonged hospital stay, cosmetic problems, and even death without timely treatment. However, the risk factors for it have been poorly studied.

Aim: To clarify the prevalence and risk factors of extensive subcutaneous emphysema after pulmonary resection by video-assisted thoracoscopic surgery.

Material and methods: This is a retrospective matched case-control study. A sample of 86 cases and 258 matched controls was recruited from among 4339 patients admitted to the thoracic surgery department from October 2018 to October 2020 in a tertiary teaching hospital in China. Cases were patients who were diagnosed with extensive subcutaneous emphysema after pulmonary resection through video-assisted thoracoscopic surgery. Controls were matched in a ratio of 3 : 1 to the cases based on age and sex.

Results: In this study, the incidence rate of extensive subcutaneous emphysema was 2.05%, and approximately 75.58% of the cases occurred within 1 to 4 days postoperatively. In univariate analysis, patients with extensive subcutaneous emphysema were also likely to have a significant lower body mass index, worse pulmonary function, greater intraoperative blood loss, longer time of operation, history of lung surgery, wider scope of surgery, and more extensive pleural adhesion. The results of multivariate logistic regression showed that segmentectomy (OR = 3.130, 95% CI: 1.055-9.283, p = 0.040), lobectomy (OR = 4.487, 95% CI: 1.704-11.812, p = 0.002), and extensive pleural adhesion (OR = 4.514, 95% CI: 1.763-11.556, p = 0.002) were independent risk factors.

Conclusions: Segmentectomy, lobectomy, and extensive pleural adhesions were identified as independent risk factors for extensive subcutaneous emphysema after video-assisted thoracoscopic surgery.

引言：广泛的皮下气肿可能会导致住院时间明显延长，出现美容问题，甚至在没有及时治疗的情况下死亡。然而，对其风险因素的研究却很少。目的：明确电视胸腔镜肺切除术后广泛性皮下气肿的发生率和危险因素。材料和方法：这是一项回顾性配对病例对照研究。从2018年10月至2020年10月在中国一家三级教学医院入住胸外科的4339名患者中，招募了86例病例和258名匹配的对照者。例患者在电视胸腔镜肺切除术后被诊断为广泛性皮下气肿。对照组根据年龄和性别以3:1的比例与病例相匹配。结果：在本研究中，广泛性皮下气肿的发生率为2.05%，约75.58%的病例发生在术后1至4天内。在单变量分析中，广泛性皮下气肿患者的体重指数也可能显著降低，肺功能更差，术中失血量更大，手术时间更长，有肺部手术史，手术范围更广，胸膜粘连更广泛。多变量logistic回归结果显示，节段切除术（OR=3.30，95%CI:1.055-9.283，p=0.040）、肺叶切除术（OR=4.487，95%CI:1.704-11.812，p=0.002）和广泛性胸膜粘连（OR=4.514，95%CI:11.763-11.556，p=0.002）是独立的危险因素。结论：电视胸腔镜手术后，节段切除术、肺叶切除术和广泛性胸膜粘连被确定为广泛性皮下气肿的独立危险因素。

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引用次数: 0

Comparison between preoperative hook-wire and liquid material localization for pulmonary nodules: a meta-analysis. 肺结节术前钩丝和液体材料定位的比较：一项荟萃分析。

IF 1.7 4区医学 Q2 SURGERY

Videosurgery and Other Miniinvasive Techniques

Pub Date : 2023-09-01 Epub Date: 2023-08-04 DOI: 10.5114/wiitm.2023.130330

Si-Jia Wang, Xing-Xing Gao, Hui Hui, Na Li, Yun Zhou, Hai-Tao Yin

Introduction: Computed tomography (CT)-guided liquid material (LM) and hook-wire (HW) are usually localized for pulmonary nodules (PNs) before video-assisted thoracic surgery (VATS) resection, but the relative advantages of these 2 techniques remain uncertain.

Aim: This meta-analysis was conceived to juxtapose the efficacy and safety of HW localization (HWL) and LM localization (LML), both guided by CT, for the preoperative localization of PNs.

Material and methods: The PubMed, Web of Science, and Wanfang databases were searched to identify relevant studies published as of March 2023, after which pooled analyses of study outcomes were conducted.

Results: A total of 7 studies were included in this meta-analysis from 142 relevant studies. These 7 studies included 551 patients (583 PNs) with CT-guided HWL and 551 patients (612 PNs) with LML. The successful localization rate was significantly higher in the LM group (LMG) than in the HW group (HWG) (p = 0.002). The LMG also exhibited significantly lower pooled total complication and lung haemorrhage rates than the HWG (p = 0.007 and 0.00001, respectively). Pooled localization duration, pneumothorax rates, and VATS procedure duration were comparable in both groups (p = 0.45, 0.15, and 0.74, respectively). Furthermore, the pooled postoperative hospital stay was significantly shorter in the LMG than in the HWG (p = 0.009). Significant heterogeneity was detected in the endpoints of localization duration and pneumothorax rate (I² = 93% and 66%, respectively).

Conclusions: CT-guided LML is safer and more successful than HWL for patients with PNs before VATS resection.

引言：计算机断层扫描（CT）引导的液体材料（LM）和钩丝（HW）通常在电视胸腔镜手术（VATS）切除前定位肺结节（PNs），但这两种技术的相对优势仍不确定。目的：本荟萃分析旨在将CT引导下的HW定位（HWL）和LM定位（LML）在PNs术前定位中的有效性和安全性并置。材料和方法：检索PubMed、Web of Science和Wanfang数据库，以确定截至2023年3月发表的相关研究，然后对研究结果进行汇总分析。结果：本荟萃分析共纳入142项相关研究中的7项研究。这7项研究包括551名CT引导的HWL患者（583名PNs）和551名LML患者（612名PNs）。LM组（LMG）的定位成功率显著高于HW组（HWG）（p=0.002）。LMG的合并总并发症和肺出血率也显著低于HWG（分别为p=0.007和0.00001）。两组患者的合并定位持续时间、肺气肿发生率和VATS手术持续时间具有可比性（分别为0.45、0.15和0.74）。此外，LMG的合并术后住院时间明显短于HWG（p=0.009）。定位持续时间和肺气肿发生率的终点存在显著的异质性（I2分别为93%和66%）。结论：对于VATS切除前的PNs患者，CT引导的LML比HWL更安全、更成功。

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