Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland最新文献_第7页

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IF 2.3 4区医学 Q2 SURGERY

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2025-09-12 DOI: 10.1016/S1479-666X(25)00133-7

引用次数: 0

Massive ingestion of water-absorbent polymer beads in an adult requiring surgical management 成人大量摄入吸水聚合物珠需要手术治疗。

IF 2.3 4区医学 Q2 SURGERY

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2025-09-11 DOI: 10.1016/j.surge.2025.08.006

Solange Belinha , Elizabeth Hanna , Amira Orabi, Shayanthan Nanthakumaran, Campbell Macleod

Background

The incidence of intentional foreign body ingestion is rising in the UK, with water-absorbent polymer beads (WAPBs) increasingly implicated in children. While commonly used in horticulture and as toys, WAPBs can pose serious risks when ingested. This report details a unique case of massive WAPB ingestion in an adult, emphasizing the potential complications and management challenges.

Case report

A 60-year-old male presented with severe abdominal pain, nausea, and vomiting after ingesting an estimated 25,000 WAPBs. CT imaging showed a massive volume of WAPBs throughout the gastrointestinal (GI) tract, and free fluid around the duodenum likely due to reactive pancreatitis. An emergency laparotomy was performed due to the risk of impending perforation. At laparotomy, a gastrostomy and 2 enterotomies were made to remove as many WAPBs as possible. A loop ileostomy was formed due to ongoing retention of the beads and risk of obstruction. Post-operatively, the patient was placed on total parenteral nutrition and the remaining WAPBs passed through the ileostomy. Further imaging revealed ongoing pancreatitis and a peripancreatic collection, which was managed conservatively. The patient was discharged two months after surgery.

Discussion

This case represents the first documented instance of massive WAPB ingestion in an adult. It highlights the significant risks associated with ingesting large quantities of WAPBs, including GI obstruction and pancreatitis. Early surgical intervention was critical in preventing further complications, as endoscopic removal was impractical given the volume.

Conclusions

Massive ingestion of WAPBs poses significant health risks and may necessitate prompt surgical management. This case underscores the importance of timely intervention to prevent severe outcomes associated with large volumes of ingested WAPBs.

背景：在英国，蓄意异物摄入的发生率正在上升，吸水聚合物珠（WAPBs）越来越多地与儿童有关。虽然wapb通常用于园艺和玩具，但当摄入时可能会造成严重风险。本报告详细介绍了一例成人大量摄入WAPB的独特病例，强调了潜在的并发症和管理挑战。病例报告：一名60岁男性在摄入约25,000个wapb后出现严重腹痛、恶心和呕吐。CT图像显示大量wapb遍布胃肠道，十二指肠周围有游离液体，可能是由于反应性胰腺炎所致。由于即将发生穿孔的风险，我们进行了紧急剖腹手术。在剖腹手术中，进行了一次胃造口术和两次肠切开术，以尽可能多地切除wapb。由于念珠的持续保留和阻塞的风险，形成了回肠袢造口术。术后，患者接受全肠外营养，剩余的wapb通过回肠造口。进一步的影像学显示持续的胰腺炎和胰腺周围的收集，这是保守管理。病人术后两个月出院。讨论：本病例是第一例有文献记载的成人大量摄入WAPB的病例。它强调了与摄入大量wapb相关的重大风险，包括胃肠道梗阻和胰腺炎。早期手术干预是防止进一步并发症的关键，因为内窥镜切除是不切实际的体积。结论：大量摄入WAPBs会造成严重的健康风险，可能需要及时手术治疗。该病例强调了及时干预的重要性，以防止与大量摄入wapb相关的严重后果。

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引用次数: 0

Computed tomography scan-guided preoperative identification of the appendicular root as an indicator of the best skin incision site in open appendicectomy: a retrospective single-center study. 计算机断层扫描引导阑尾根术前识别作为阑尾开放性手术中最佳皮肤切口位置的指标：一项回顾性单中心研究。

IF 2.3 4区医学 Q2 SURGERY

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2025-09-08 DOI: 10.1016/j.surge.2025.08.007

Toshiyuki Suzuki, Daisuke Sugiki, Takahiko Akao, Hiroshi Matsumoto

Background: Appendicectomy is a well-established surgical procedure used for managing of acute appendicitis. In open appendicectomy, McBurney's point is the surgical landmark for locating the appendix, and it is common practice to make an incision there. However, in this study, we identified the root of the appendix via computed tomography, made an incision around that sites, and performed the appendicectomy through this incision. As such, this study aimed to assess the safety and outcomes of using the computed tomography scan-guided appendiceal root as a landmark of the incision site in open appendicectomy.

Methods: This retrospective single-center study included 117 consecutive patients undergoing surgery for acute appendicitis between April 2021 and December 2023. Patients with parabdominal rectus muscle incision and interval appendectomy were excluded. The root of the appendix was identified on computed tomography scan, and open appendicectomy was performed via an oblique incision made at the center of the site. The characteristics and perioperative factors of patients who underwent open appendicectomy and laparoscopic appendicectomy were compared.

Results: None of the patients required a change or widening of the incision site to identify the appendix, and there were no complications associated with using this site. The median wound size for open appendicectomy was 4 cm. Patients who underwent open appendicectomy performed comparable to those who underwent laparoscopic appendicectomy.

Conclusion: Using the computed tomography scan-guided appendiceal root as a landmark for the site of skin incision in appendicectomy is safe, acceptable, and useful.

背景：阑尾切除术是一种成熟的用于治疗急性阑尾炎的手术方法。在开放式阑尾切除术中，McBurney点是阑尾定位的手术标志，通常在那里切开。然而，在本研究中，我们通过计算机断层扫描确定了阑尾的根部，在该部位周围做了一个切口，并通过该切口进行了阑尾切除术。因此，本研究旨在评估使用计算机断层扫描引导阑尾根作为开放阑尾切除术切口部位的标志的安全性和结果。方法：该回顾性单中心研究纳入了2021年4月至2023年12月期间连续接受急性阑尾炎手术的117例患者。排除腹旁直肌切口及间隔阑尾切除术患者。在计算机断层扫描中确定阑尾的根，并通过在该部位的中心做一个斜切口进行阑尾切除术。比较开放式阑尾切除术与腹腔镜阑尾切除术患者的特点及围手术期因素。结果：没有患者需要改变或扩大切口部位来识别阑尾，使用该部位也没有并发症。开腹阑尾切除术创面中位大小为4cm。接受开放式阑尾切除术的患者与接受腹腔镜阑尾切除术的患者表现相当。结论：利用计算机断层扫描引导阑尾根作为阑尾切除术中皮肤切口位置的标志是安全、可接受和有用的。

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引用次数: 0

Transmetatarsal amputation versus multiple toes amputations for non-ischemic diabetic foot infection management 经跖骨截肢与多趾截肢对非缺血性糖尿病足感染的治疗。

IF 2.3 4区医学 Q2 SURGERY

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2025-09-05 DOI: 10.1016/j.surge.2025.08.005

Moustafa Mabrouk , Ahmed Fouda , Mohammed ElKassaby

Background

The management of diabetic foot infections (DFIs) is a complex multidisciplinary process and often necessitates surgical interventions. Unfortunately, amputations such as single or multiple toes amputations (MTA) or full transmetatarsal amputation (TMA) are often the unavoidable solution. This study aimed to compare the clinical outcomes of TMA versus MTA in managing non-ischemic diabetic foot infections.

Methods

This was a retrospective study on non-ischemic diabetic foot infection patients comparing the results of TMA and MTA in terms of healing, ulcer recurrence and overall complications, including further formal amputations.

Results

The healing rate was substantially higher in TMA group (89.3 % vs. 74.5 %, p=0.004). TMA group exhibited a significantly lower incidence of further proximal amputation (8.7 % vs. 21.3 %, p=0.002) and ulcer recurrence (11.3 % vs. 25.3 %, p=0.002). Tissue necrosis occurred less frequently in TMA group (4.5 % vs. 12.8 %, p<0.05). No significant differences were found between the groups regarding infection, hematoma, or residual edema.

Conclusions

Transmetatarsal amputation for diabetic foot infection demonstrated superior healing rates, lower ulcer recurrence, and reduced need for proximal amputation compared to multiple toe amputations for managing non-ischemic diabetic foot infections.

Level of evidence

level 3 retrospective study

背景：糖尿病足感染（dfi）的治疗是一个复杂的多学科过程，经常需要手术干预。不幸的是，截肢，如单趾或多趾截肢（MTA）或全跖骨截肢（TMA）往往是不可避免的解决方案。本研究旨在比较TMA与MTA治疗非缺血性糖尿病足部感染的临床结果。方法：对非缺血性糖尿病足感染患者进行回顾性研究，比较TMA和MTA在愈合、溃疡复发和包括进一步正式截肢在内的总体并发症方面的结果。结果：TMA组愈合率明显高于TMA组（89.3% vs. 74.5%, p=0.004）。TMA组进一步近端截肢发生率（8.7%比21.3%,p=0.002）和溃疡复发率（11.3%比25.3%,p=0.002）显著降低。TMA组的组织坏死发生率较低（4.5% vs. 12.8%）。结论：与多趾截肢相比，经跖骨截肢治疗糖尿病足感染的治愈率更高，溃疡复发率更低，并且治疗非缺血性糖尿病足感染的近端截肢需求减少。证据等级：3级回顾性研究。

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引用次数: 0

Applied anatomy of accessory tendons of extensor hallucis longus muscle and hallux valgus deformity: a cadaveric and radiologic study 拇长伸肌副肌腱与拇外翻畸形的应用解剖：尸体及影像学研究。

IF 2.3 4区医学 Q2 SURGERY

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2025-08-26 DOI: 10.1016/j.surge.2025.08.004

Mustafa Aydin , Mehmet Aydin , Ayhan Comert , Emrah Koksal , Necati Salman , Emre Donmez , Omer Levent Karadamar , Begum Aslantas Kaplan , Murat Igde , Trifon Totlis , Necdet Kocabıyık

Introduction

The accessory tendon of the extensor hallucis longus (ATEHL) represents a common anatomical variant. However, the role of ATEHL in the etiology of hallux valgus (HV) has not yet been fully elucidated. This study aimed to determine the incidence and morphology of the ATEHL in cadavers and examine its possible correlation with the HV deformity presence and the relevant angular measurements of the feet.

Materials and methods

The study included 63 embalmed cadaveric feet. Following documentation of the demographic parameters of the cadavers, the dorsal aspect of the first ray was carefully dissected. The existence and morphological features of the ATEHL were recorded and analyzed. Subsequently, plain radiographs were taken to assess the hallux valgus angles (HVA) and intermetatarsal angles (IMA) without weight-bearing simulation. In this evaluation, HVA exceeding 15° and IMA exceeding 9° were characterized as hallux valgus (HV) deformity. Statistical analysis was used to examine any correlations between ATEHL existence and HV deformity presence, HVA degrees and IMA degrees.

Results

An ATEHL was found in 37 out of 63 cadaveric feet (58.73 %). A HV deformity was identified in 32 out of 63 cadaveric feet (50.79 %). The prevalence of the ATEHL was significantly higher in specimens with a HV deformity (26/32, 81.25 %) compared to specimens without a HV deformity (6/32, 18.75 %) (p < 0.001). A positive correlation was found between ATEHL existence and both HVA and IMA degrees (p < 0.001).

Conclusions

An ATEHL may be found in more than half of individuals. The current cadaveric and radiologic study revealed that ATEHL existence is significantly more common in feet with HV deformity and associated with increased HVA and IMA degrees. Further biomechanical studies are necessary to clarify the ATEHL role on the pathogenesis of HV deformity.

简介：拇长伸肌副肌腱（ATEHL）是一种常见的解剖变异。然而，ATEHL在拇外翻（HV）病因学中的作用尚未完全阐明。本研究旨在确定尸体中ATEHL的发生率和形态，并检查其与HV畸形存在和足部相关角度测量的可能相关性。材料与方法：研究对象为63只经防腐处理的尸体足。在记录了尸体的人口统计学参数后，我们仔细地解剖了第一条射线的背侧。记录并分析了ATEHL的存在及形态特征。随后，在没有负重模拟的情况下，采用平片评估拇外翻角（HVA）和跖间角（IMA）。在本评价中，HVA超过15°和IMA超过9°被认为是拇外翻（HV）畸形。采用统计学分析来检验ATEHL存在与HV畸形存在、HVA程度和IMA程度之间的相关性。结果：63只尸体足中有37只（58.73%）存在ATEHL。63只尸体足中有32只（50.79%）存在HV畸形。有HV畸形的患者患ATEHL的比例（26/32,81.25%）明显高于无HV畸形的患者（6/32,18.75%）(p结论：超过一半的患者存在ATEHL。目前的尸体和放射学研究表明，ATEHL的存在在HV畸形足中更为常见，并与HVA和IMA度增加有关。需要进一步的生物力学研究来阐明ATEHL在HV畸形发病机制中的作用。

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引用次数: 0

Moral injury and second victim syndrome in healthcare providers: A continuum 道德伤害和第二受害者综合症在医疗保健提供者：一个连续体。

IF 2.3 4区医学 Q2 SURGERY

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2025-08-12 DOI: 10.1016/j.surge.2025.08.001

Aisling O'Donnell , Michael Devine

引用次数: 0

Environmental impact of single-use items and their contamination levels in elective orthopaedic surgery 选择性骨科手术中一次性用品对环境的影响及其污染水平。

IF 2.3 4区医学 Q2 SURGERY

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2025-08-12 DOI: 10.1016/j.surge.2025.07.007

Jessica Rotaru , Peggy Miller , Luke McGarry , John M. O'Byrne

Background

Single-use items have dominated operating theatres since the 1980s, initially perceived to carry a lower risk of surgical site infection and occupational blood exposure while maintaining hospital expenditure. The topic of reusable surgical gowns and drapes has naturally emerged due to discussions regarding climate change. Considering reusable alternatives is the next step in reducing the carbon footprint of operating theatres.

Methods

Clinical waste attributable to single-use items was collected from 93 cases in an elective orthopaedic hospital over four weeks, comprising knee arthroplasty and arthroscopy, hip arthroplasty, foot and ankle and upper limb. Tourniquet use, operation time and blood loss were other parameters collected in each operation. Disposable gowns were visually examined and graded by contamination level. Clinical waste was weighed using a handheld electronic scale.

Results

The mean waste from knee, hip and minor (upper limb, foot and ankle) operating theatres was 3533g, 3966g and 2349g respectively. The average number of gowns used per case was four, as was the number of drapes. Minor operating theatres had the lowest levels of contamination, with 84.34 % of gowns not contaminated at all. Tourniquet use was associated with less waste, carbon emissions, and gown contamination.

Conclusion

A large proportion of operating theatre waste is attributable to disposable items such as gowns and drapes. In the elective orthopaedic setting, these are not heavily contaminated, especially in procedures where tourniquets are utilised. Given the environmental impact of clinical waste, we advocate for the use of reusable alternatives in these procedures.

背景：自20世纪80年代以来，一次性用品在手术室占主导地位，最初被认为在维持医院支出的同时具有较低的手术部位感染和职业性血液暴露风险。由于有关气候变化的讨论，可重复使用的手术服和窗帘的话题自然出现了。考虑可重复使用的替代品是减少手术室碳足迹的下一步。方法：收集某骨科择期医院4周内93例一次性用品废弃物，包括膝关节置换术及关节镜、髋关节置换术、足踝关节及上肢。止血带的使用、手术时间和出血量是每次手术的其他参数。对一次性长袍进行目视检查，并按污染程度分级。使用手持式电子秤称医疗废物的重量。结果：膝关节、髋关节和下肢（上肢、足部和踝关节）手术室的平均废物量分别为3533g、3966g和2349g。每个病例使用的长袍的平均数量是四件，窗帘的数量也是如此。小手术室的污染程度最低，84.34%的手术服完全没有污染。止血带的使用与更少的废物、碳排放和长袍污染有关。结论：手术室废弃物的很大一部分是一次性用品，如手术衣和窗帘。在选择性矫形设置中，这些没有严重污染，特别是在使用止血带的程序中。鉴于医疗废物对环境的影响，我们提倡在这些程序中使用可重复使用的替代品。

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引用次数: 0

Feasibility of pancreaticoduodenectomy for octogenarian based on safety and postoperative nutritional recovery 基于安全性和术后营养恢复的八旬老人胰十二指肠切除术的可行性。

IF 2.3 4区医学 Q2 SURGERY

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2025-08-05 DOI: 10.1016/j.surge.2025.07.005

Naoki Iwanaga, Hiroyuki Sugo, Takeshi Yamamoto, Takuji Noro, Michio Machida, Ikuo Watanobe

Background

Pancreaticoduodenectomy (PD) for very elderly patients was still controversial. We evaluated the feasibility of PD for octogenarian (patients older than 80 years) from safety and postoperative nutritional changes including body composition.

Methods

We included 141 consecutive patients who underwent PD: 24 patients aged ≥80 years were assigned to the octogenarian group, and the remaining 117 were assigned to the non-octogenarian group. Surgical outcomes and the change in postoperative nutritional status (body weight and serum albumin level during 12 months post-surgery) were compared. Among latest 24 patients, the change of body composition was also evaluated using bioelectrical impedance analysis.

Results

Preoperatively, the octogenarian group had a significantly lower Katz index score for Activities of Daily Living (P = 0.038), higher incidence of comorbidities (P < 0.05), lower serum albumin levels (P = 0.033), and lower body weight (P = 0.017) than the non-octogenarian patients; however, the incidence of morbidity and mortality was the same in both groups. Overall survival rates were lower in the octogenarian group, even without significant difference. Multivariate analysis showed that the diagnosis of pancreatic cancer (P = 0.022), the serum albumin level (P = 0.018), and the UICC stage (P = 0.009) were useful to be an independent and significant predictor of overall survival. In assessment of postoperative nutritional status including body composition, the octogenarian group was not inferior compared to the non-octogenarian group.

Conclusions

In this study, PD for octogenarian was safe and feasible including nutritional aspects. Although careful patient selection and optimal perioperative care are necessary to consider whether PD is indicated for elderly patients, the advanced age alone should not be an exclusion criterion in considering of PD.

背景：胰十二指肠切除术（PD）对高龄患者的治疗仍有争议。我们从安全性和术后营养变化（包括身体成分）两方面评估了八十多岁（80岁以上）患者PD的可行性。方法：我们纳入141例连续接受PD治疗的患者，其中24例年龄≥80岁的患者被分配到80岁组，其余117例被分配到非80岁组。比较手术结果和术后营养状况（术后12个月体重和血清白蛋白水平）的变化。在最近的24例患者中，还使用生物电阻抗分析评估了身体成分的变化。结果：老年组术前日常生活活动Katz指数评分显著低于老年组（P = 0.038），合并症发生率显著高于老年组(P)。结论：本研究中，老年PD治疗在营养方面是安全可行的。虽然仔细的患者选择和最佳的围手术期护理是考虑老年患者是否适用PD的必要条件，但不应仅将高龄作为考虑PD的排除标准。

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引用次数: 0

Use of omental flap in left-sided hepatectomy for prevention of delayed gastric emptying: a systematic review and meta-analysis 在左侧肝切除术中使用网膜瓣预防胃排空延迟：系统回顾和荟萃分析。

IF 2.3 4区医学 Q2 SURGERY

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2025-07-31 DOI: 10.1016/j.surge.2025.07.006

Stefan Simeonovski , Karim Ataya , Tsonka Lukanova , Yusuf Ahmed , Dima Salloum , Ivelin Takorov

Background

Delayed gastric emptying (DGE) is a widespread complication after left-sided hepatectomy (LSH). The usage of omental flap (OF) in patients after LSH is thought to reduce the incidence of DGE. Therefore, a meta-analysis was performed in order these findings to be explored.

Methods

Pubmed, Embase and Cochrane Central were searched for studies comparing usage of omental flap to no-OF in patients after LSH. The primary outcome was DGE. Statistical analysis was performed using Review Manager 5.4 (Cochrane Collaboration). Heterogeneity was assessed using I² statistics. Odds ratios (OR) were computed for binary endpoints using a random-effects model.

Results

358 patients were included from 7 studies, of which 2 were randomized controlled trials (RCTs). Male sex was predominant (68 %). OF was used for prevention of DGE in 155 cases. In 3 of the studies the greater omentum was divided for the preparation of the flap. DGE (OR 0.10; 95 % CI 0.04–0.23; p < 0.00001; I² = 0 %) and overall morbidity (OR 0.31; 95 % CI 0.13–0.74; p = 0.008; I² = 0 %) were significantly reduced in the OF group, compared to the no-OF group.

Discussion

Utilization of omental flap in patients with left-sided hepatectomy significantly reduces the incidence of DGE and overall morbidity, compared to the no-omental flap procedure.

背景：胃排空延迟（DGE）是左侧肝切除术（LSH）后常见的并发症。在LSH患者中使用网膜瓣（of）被认为可以减少DGE的发生率。因此，为了探索这些发现，进行了荟萃分析。方法：检索Pubmed， Embase和Cochrane Central，以比较LSH患者使用网膜瓣和不使用网膜瓣的研究。主要结局为DGE。采用Review Manager 5.4 （Cochrane Collaboration）进行统计分析。采用I2统计量评估异质性。使用随机效应模型计算二元终点的优势比（OR）。结果：7项研究共纳入358例患者，其中2项为随机对照试验（rct）。男性占多数（68%）。155例应用OF预防DGE。在3项研究中，大网膜被分开以准备皮瓣。Dge(或0.10；95% ci 0.04-0.23；p 2 = 0 %)和总发病率(OR 0.31；95% ci 0.13-0.74；p = 0.008；I2 = 0%)，与无OF组相比，OF组显著降低。讨论：与不使用大网膜皮瓣相比，在左侧肝切除术患者中使用大网膜皮瓣可显著降低DGE的发生率和总体发病率。

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引用次数: 0

Size of small pneumothorax on chest radiograph as a predictor for failure of conservative management in thoracic stab wounds - A critical analysis of 284 cases at a major trauma centre in South Africa. 胸片上小气胸的大小作为胸刺伤保守治疗失败的预测因素——对南非一家主要创伤中心284例病例的关键分析。

IF 2.3 4区医学 Q2 SURGERY

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2025-07-14 DOI: 10.1016/j.surge.2025.06.005

Victor Kong, Cynthia Cheung, Daniel Lee, Jonathan Ko, William Yeung, Hong Lee, Reuben He, Howard Wain, Damian Clarke

Introduction: Selective conservative management of asymptomatic patients with small pneumothorax (PTX) in the setting of thoracic stab wounds (SWs) appears safe, but the correlation between the size of PTX and rate of failure of conservative management remains largely unknown.

Materials and methods: A prospective study was conducted over a 14-year period on patients with isolated thoracic SWs who were asymptomatic with small PTX on CXR (<2 cm) and underwent clinical observation at a major trauma centre in South Africa.

Results: 284 patients were included (91 % male, mean age: 24 yrs). Eight (3 %) eventually required TT, and all other patients were managed successfully with clinical observation alone. There was no morbidity or mortality as a direct result of our selective conservative management approach. The need for TT was based on the size of initial PTX; Group A: <0.5 cm (0 %), Group B: ≥0.5 to < 1 cm (0 %), Group C: ≥1 cm to < 1.5 cm (3 %) and Group D: ≥1.5 cm to < 2 cm (13 %). For every 0.5 cm increase in PTX size, there was a five-fold (95 % CI, 1.73 to 16.67, p = 0.004) increased risk for the need for TT.

Conclusion: Selective conservative management of patients with asymptomatic small PTX of < 2 cm on CXR following thoracic SWs appears safe although the greater the size of the initial PTX, there was a higher risk of failure of conservative management. This should alert clinicians to remain vigilant and have a low threshold for intervention.

摘要：对胸椎刺伤（SWs）的无症状小气胸（PTX）患者进行选择性保守治疗似乎是安全的，但PTX的大小与保守治疗失败率之间的相关性在很大程度上仍然未知。材料和方法：一项为期14年的前瞻性研究，研究对象为无症状且胸腔镜下PTX较小的孤立性胸腔镜患者(结果：纳入284例患者（91%为男性，平均年龄24岁）。8例（3%）最终需要TT治疗，其余患者均通过单独临床观察获得成功。我们的选择性保守治疗方法没有直接导致发病率或死亡率。TT的需求取决于初始PTX的大小；结论：胸椎SWs术后x光检查无症状小PTX < 2cm的患者，选择性保守治疗是安全的，但初始PTX越大，保守治疗失败的风险越高。这应该提醒临床医生保持警惕，降低干预的门槛。

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引用次数: 0