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Invited commentary: Training and generation of solid evidence are the shoulders of giants in robotic surgery. 特邀评论:培训和生成可靠证据是机器人手术巨人的肩膀。
IF 2.4 3区 医学 Q1 SURGERY Pub Date : 2024-03-01 Epub Date: 2024-02-27 DOI: 10.1177/14574969241234739
José M Balibrea, Jordi Tarascó, Pau Moreno
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引用次数: 0
Preoperative stoma site marking reduces postoperative stoma-related complications in emergency surgery: A single center retrospective cohort study. 术前造口部位标记可减少急诊手术中与造口相关的术后并发症:单中心回顾性队列研究。
IF 2.4 3区 医学 Q1 SURGERY Pub Date : 2024-03-01 Epub Date: 2023-07-18 DOI: 10.1177/14574969231186282
Hiroaki Nozawa, Sanae Sasaki, Chieko Hayashi, Akiko Kawasaki, Kazuhito Sasaki, Koji Murono, Shigenobu Emoto, Soichiro Ishihara

Background and objective: Stoma site marking is an important factor in reducing stoma-related complications, thereby influencing the long-term quality of life in the elective setting. The impact of preoperative stoma site marking in emergency stoma creation is largely unknown. We aimed to determine whether preoperative stoma site marking in emergency stoma creation reduces stoma-related complications.

Methods: Patients who underwent emergency stoma creation at our hospital between 2009 and 2022 were examined by reviewing our prospective database and retrospective chart review. Subjects were classified into the "marking (+)" or "marking (-)" group according to stoma site marking (194 and 151 patients, respectively). The changes in the frequency of stoma marking over time and the effects of stoma marking on stoma-related complications were analyzed.

Results: The overall frequency of grade 2 or higher stoma-related complications was lower in the marking (+) group than in the marking (-) group (24% versus 36%, p = 0.010). Stoma site marking was associated with fewer soma site bleeding (2% versus 10%, p < 0.001), and the frequency of peristomal dermatitis was also lower (10%) in the marking (+) group (versus 18%, p = 0.042). Moreover, the lack of stoma site marking was an independent risk factor for overall stoma-related complications (adjusted odds ratio: 1.69, p = 0.034).

Conclusions: Preoperative stoma site marking was associated with stoma-related complications in emergency surgery. The clinical significance of our attempt is worth validating with prospective studies.

背景和目的:造口部位标记是减少造口相关并发症的重要因素,从而影响择期手术的长期生活质量。在急诊造口术中,术前造口部位标记的影响尚不清楚。我们的目的是确定在急诊造口术中术前造口部位标记是否能减少造口相关并发症:方法:通过查阅前瞻性数据库和回顾性病历,对 2009 年至 2022 年期间在我院接受急诊造口术的患者进行研究。根据造口部位标记情况将受试者分为 "标记(+)"组和 "标记(-)"组(分别为 194 例和 151 例患者)。分析了随着时间推移造口标记频率的变化以及造口标记对造口相关并发症的影响:结果:造口标识(+)组出现 2 级或以上造口相关并发症的总体频率低于标识(-)组(24% 对 36%,P = 0.010)。造口部位标记与较少的造口部位出血有关(2% 对 10%,P = 0.042)。此外,缺乏造口部位标记是造口相关并发症的独立风险因素(调整后的几率比:1.69,P = 0.034):结论:术前造口部位标记与急诊手术中造口相关并发症有关。结论:术前造口部位标记与急诊手术中的造口相关并发症有关,我们的尝试的临床意义值得通过前瞻性研究加以验证。
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引用次数: 0
Impact of parastomal hernia on colostomy costs at 1 year: Secondary analysis of a randomized clinical trial (STOMAMESH). 吻合口旁疝对结肠造口术 1 年费用的影响:随机临床试验(STOMAMESH)的二次分析。
IF 2.4 3区 医学 Q1 SURGERY Pub Date : 2024-03-01 Epub Date: 2023-08-10 DOI: 10.1177/14574969231188021
Christoffer Odensten, Ulf Gunnarsson, Jeaneth Johansson, Pia Näsvall

Background and aims: Parastomal hernia (PSH) is a common complication after the creation of a colostomy, with a prevalence of approximately 50%. Despite the high frequency, little is known how PSH affects the cost of colostomy care.The hypothesis in this study was that PSH increases the cost of colostomy care compared with not having a PSH.

Methods: Two groups with (N = 61) and without (n = 147) PSH were compared regarding costs of stoma appliances and visits. The population from a large randomized trial comparing construction of colostomy with or without prophylactic mesh (STOMAMESH) was used and cross-matched with health economic data from the National Pharmaceutical Register, 1 year after initial surgery.

Results: Patients with and without a PSH were similar in basic demographic data. No difference in cost of stoma appliances (with PSH 2668.3 EUR versus no PSH 2724.5 EUR, p = 0.938) or number of visits to a stoma therapist (p = 0.987) was seen, regardless of the presence or not of a PSH.

Conclusions: PSH appears not to affect costs due to colostomy appliances or the need to visit a stoma therapist, in the first year. The lesson to be learnt is that PSHs are not a driver for costs. Other factors may be determinants of the cost of a colostomy, including manufacturers' price and persuasion, means of procurement, and presence of guidelines.

背景和目的:腹股沟旁疝(PSH)是结肠造口术后常见的并发症,发病率约为 50%。尽管发病率很高,但人们对副乳疝如何影响结肠造口护理的成本知之甚少。本研究的假设是,与没有副乳疝的患者相比,副乳疝会增加结肠造口护理的成本:就造口用具和就诊费用对有 PSH 的两组(61 人)和没有 PSH 的两组(147 人)进行比较。我们使用了一项大型随机试验(STOMAMESH)的研究对象,该试验比较了使用或不使用预防性网片构建结肠造口的情况,并与国家药品登记处提供的首次手术 1 年后的卫生经济数据进行了交叉比对:结果:使用和未使用预防性肠造口网的患者在基本人口统计学数据上相似。无论有无造口护垫,造口用具费用(有造口护垫2668.3欧元对无造口护垫2724.5欧元,p = 0.938)或造口治疗师就诊次数(p = 0.987)均无差异:结论:PSH 似乎不会影响第一年因使用结肠造口设备或造口治疗师而产生的费用。值得吸取的教训是,造口护 理站并不是费用的驱动因素。其他因素也可能是决定结肠造口术费用的因素,包括制造商的价格和说服力、采购方式以及是否有相关指南。
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引用次数: 0
Robot-assisted pelvic and renal surgery compared with laparoscopic or open surgery: Literature review of cost-effectiveness and clinical outcomes. 机器人辅助盆腔和肾脏手术与腹腔镜或开放手术的比较:关于成本效益和临床结果的文献综述。
IF 2.4 3区 医学 Q1 SURGERY Pub Date : 2024-03-01 Epub Date: 2023-08-09 DOI: 10.1177/14574969231186283
Thomas Davidson, Rune Sjödahl, Åke Aldman, Claes Lennmarken, Ann-Sofi Kammerlind, Elvar Theodorsson

Background and aim: The purpose of this study was to evaluate clinical experiences and cost-effectiveness by comparing robot-assisted surgery with laparoscopic- or open surgery for pelvic and renal operations.

Methods: A narrative review was carried out.

Results: When using robotic-assisted surgery, oncological and functional results are similar to after laparoscopic or open surgery. One exception may be a shorter survival in cancer of the cervix uteri. In addition, postoperative complications after robotic-assisted surgery are similar, bleeding and transfusion needs are less, and the hospital stay is shorter but the preparation of the operating theater before and after surgery and the operation times are longer. Finally, robot-assisted surgery has, in several studies, been reported to be not cost-effective primarily due to high investment costs. However, more recent studies provide improved cost-effectiveness estimates due to more effective preparation of the operating theater before surgery, improved surgeon experience, and decreased investment costs.

Conclusions: Complications and functional and oncological outcomes after robot-assisted surgery are similar to open surgery and laparoscopic surgery. The cost-effectiveness of robot-assisted surgery is likely to equal or surpass the alternatives.

背景和目的:本研究的目的是通过比较机器人辅助手术与腹腔镜或开放手术在盆腔和肾脏手术中的临床经验和成本效益:结果结果:使用机器人辅助手术时,肿瘤和功能效果与腹腔镜或开腹手术相似。一个例外是子宫颈癌患者的生存期较短。此外,机器人辅助手术后的术后并发症相似,出血和输血需求较少,住院时间较短,但手术前后手术室的准备工作和手术时间较长。最后,一些研究报告称,机器人辅助手术的成本效益不高,主要原因是投资成本较高。不过,最近的研究提供了更高的成本效益估算,原因是手术前手术室的准备工作更有效、外科医生经验更丰富、投资成本更低:结论:机器人辅助手术后的并发症、功能和肿瘤预后与开放手术和腹腔镜手术相似。机器人辅助手术的成本效益很可能等于或超过其他手术。
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引用次数: 0
The current application and evidence for robotic approach in abdominal surgery: A narrative literature review. 腹部手术中机器人方法的当前应用和证据:文献综述。
IF 2.4 3区 医学 Q1 SURGERY Pub Date : 2024-03-01 Epub Date: 2024-03-18 DOI: 10.1177/14574969241232737
Niclas Dohrn, Stefan Kobbelgaard Burgdorf, Pieter de Heer, Mads Falk Klein, Kristian Kiim Jensen

The current application of robotic surgery is evolving at a high pace in the current years. The technical advantages enable several abdominal surgical procedures to be performed minimally invasive instead of open surgery. Furthermore, procedures previously performed successfully using standard laparoscopy are now performed with a robotic approach, with conflicting results. The present narrative review reports the current literature on the robotic surgical procedures typically performed in a typical Scandinavian surgical department: colorectal, hernia, hepato-biliary, and esophagogastric surgery.

近年来,机器人手术的应用正在飞速发展。由于其技术优势,一些腹部外科手术可以用微创方式代替开腹手术。此外,以前使用标准腹腔镜成功完成的手术,现在也使用机器人方法进行,但结果不尽相同。本综述报告了在典型的斯堪的纳维亚外科部门通常采用的机器人外科手术的最新文献:结直肠、疝气、肝胆和食道胃手术。
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引用次数: 0
Short-term results after robot-assisted surgery for primary rectal cancers requiring beyond total mesorectal excision in multiple compartments. 机器人辅助原发性直肠癌手术后的短期结果,需要在多个隔间进行全直肠系膜切除术。
IF 2.4 3区 医学 Q1 SURGERY Pub Date : 2024-03-01 Epub Date: 2023-10-03 DOI: 10.1177/14574969231200654
Ebbe B Thorgersen, Arne M Solbakken, Tuva K Strøm, Mariusz Goscinski, Milan Spasojevic, Stein G Larsen, Kjersti Flatmark

Aim: Rectal cancers requiring beyond total mesorectal excision (bTME) are traditionally operated using an open approach, but the use of minimally invasive robot-assisted procedures is increasing. Introduction of minimal invasive surgery for complex cancer cases could be associated with compromised surgical margins or increased complication rates. Therefore, reporting results both clinical and oncological in large series is important. Since bTME procedure reports are heterogeneous, comparing results is often difficult. In this study, a magnetic resonance imaging (MRI) classification system was used to describe the bTME surgery according to pelvic compartments.

Methods: Consecutive patients with primary rectal cancer operated with laparoscopic robot-assisted bTME were prospectively included for 2 years. All patients had tumors that threatened the mesorectal fascia, invaded adjacent organs, and/or involved metastatic pelvic lateral lymph nodes. Short-term clinical outcomes and oncological specimen quality were registered. Surgery was classified according to pelvic compartments resected.

Results: Clear resection margins (R0 resection) were achieved in 95 out of 105 patients (90.5%). About 26% had Accordion Severity Grading System of Surgical Complications grade 3-4 complications and 15% required re-operations. About 7% were converted to open surgery. The number of compartments resected ranged from one to the maximum seven, with 83% having two or three compartments resected. All 10 R1 resections occurred in the lateral and posterior compartments.

Conclusions: The short-term clinical outcomes and oncological specimen quality after robot-assisted bTME surgery were comparable to previously published open bTME surgery. The description of surgical procedures using the Royal Marsden MRI compartment classification was feasible.

目的:需要全直肠系膜切除术(bTME)的直肠癌传统上采用开放式手术方法,但微创机器人辅助手术的使用正在增加。对复杂的癌症病例采用微创手术可能与手术边缘受损或并发症发生率增加有关。因此,大量报告临床和肿瘤学结果是很重要的。由于bTME程序报告是异构的,比较结果通常很困难。在这项研究中,使用磁共振成像(MRI)分类系统来描述根据骨盆分区的bTME手术。方法:对连续2例原发性癌症患者行腹腔镜机器人辅助bTME手术 年。所有患者的肿瘤都威胁到直肠系膜筋膜,侵犯邻近器官,和/或涉及转移性盆腔外侧淋巴结。登记短期临床结果和肿瘤标本质量。手术根据切除的骨盆分区进行分类。结果:105例患者中有95例(90.5%)获得了清晰的切除边缘(R0切除)。约26%的患者有手术并发症严重程度分级系统3-4级并发症,15%的患者需要再次手术。约7%转为开放手术。切除的隔室数量从一个到最多七个不等,83%的隔室切除了两个或三个。所有10例R1切除均发生在侧隔室和后隔室。结论:机器人辅助bTME手术后的短期临床结果和肿瘤学标本质量与先前发表的开放式bTME术相当。使用Royal Marsden MRI隔室分类描述外科手术是可行的。
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引用次数: 0
Current status and outlook of robotic surgery in the Nordic countries. 北欧国家机器人手术的现状与展望。
IF 2.4 3区 医学 Q1 SURGERY Pub Date : 2024-03-01 Epub Date: 2023-11-16 DOI: 10.1177/14574969231211078
John C F Glent, Ebbe B Thorgersen
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引用次数: 0
Five-year follow-up of appendiceal neoplasm risk in periappendicular abscess in the Peri-Appendicitis Acuta Randomized Clinical Trial. 急性阑尾炎随机临床试验中阑尾周围脓肿患阑尾肿瘤风险的5年随访。
IF 2.4 3区 医学 Q1 SURGERY Pub Date : 2023-12-01 Epub Date: 2023-09-01 DOI: 10.1177/14574969231192128
Roosa Salminen, Tero Rautio, Pia Nordström, Tuomo Rantanen, Jari Mällinen, Juha Grönroos, Paulina Salminen
from January 2013 to April 2016. This long-term follow-up at a minimum of 5 years was added to the study protocol subsequently targeted to assess the follow-up group patients initially declining to undergo appendectomy after study termination. First, this long-term MRI follow-up was added to ensure patient safety based on the high appendiceal tumor rate at 1-year follow-up. 1 Patients gave a separate written informed consent for this imaging. Second, this observational follow-up assessed the long-term outcomes of the trial patients initially diagnosed with an appendiceal tumor by reviewing their medical records. The detailed methods and primary results have been previously published 1. The difference between groups in age was tested using Mann–Whitney U-test. The study was approved by the Ethical Committee of Turku University Hospital district and conducted in accordance with the Declaration of Helsinki following the relevant portions of the Consolidated Standards of Reporting Trials (CONSORT) reporting guideline.
{"title":"Five-year follow-up of appendiceal neoplasm risk in periappendicular abscess in the Peri-Appendicitis Acuta Randomized Clinical Trial.","authors":"Roosa Salminen, Tero Rautio, Pia Nordström, Tuomo Rantanen, Jari Mällinen, Juha Grönroos, Paulina Salminen","doi":"10.1177/14574969231192128","DOIUrl":"10.1177/14574969231192128","url":null,"abstract":"from January 2013 to April 2016. This long-term follow-up at a minimum of 5 years was added to the study protocol subsequently targeted to assess the follow-up group patients initially declining to undergo appendectomy after study termination. First, this long-term MRI follow-up was added to ensure patient safety based on the high appendiceal tumor rate at 1-year follow-up. 1 Patients gave a separate written informed consent for this imaging. Second, this observational follow-up assessed the long-term outcomes of the trial patients initially diagnosed with an appendiceal tumor by reviewing their medical records. The detailed methods and primary results have been previously published 1. The difference between groups in age was tested using Mann–Whitney U-test. The study was approved by the Ethical Committee of Turku University Hospital district and conducted in accordance with the Declaration of Helsinki following the relevant portions of the Consolidated Standards of Reporting Trials (CONSORT) reporting guideline.","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"265-268"},"PeriodicalIF":2.4,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10484304","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
Ultrasound-guided closure of the femoral artery during venoarterial decannulation using a large-bore closure device. 超声引导下使用大口径封闭装置在静脉动脉脱脉术中封闭股动脉。
IF 2.4 3区 医学 Q1 SURGERY Pub Date : 2023-12-01 Epub Date: 2023-07-10 DOI: 10.1177/14574969231181232
Tasnia Rahman, Johanna Herajärvi, Henri Ahonen, Mikko Jormalainen, Simo Syrjälä, Tommi Järvinen, Tatu Juvonen, Sebastian Dahlbacka

Background: Peripheral femoro-femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO) is viable for fast hemodynamic assistance during cardiogenic shock. Ultrasound-guided closure with a large-bore device (MANTA®) is a feasible option potentially replacing surgical arteriotomy closure in peripheral VA-ECMO decannulation.

Methods: This retrospective study included patients weaning from percutaneously inserted femoro-femoral VA-ECMO at the Helsinki University Hospital, Finland in 2012-2020. The primary endpoints were access-site complications, a composite of hematomas/seromas/surgical site infections (SSIs), and the safety endpoint of vascular complications (VCs).

Results: A total of 100 consecutive percutaneously implanted and weaned VA-ECMO patients were stratified into two groups by decannulation strategy: percutaneous ultrasound-guided MANTA device (n = 21, 21.0%) or surgical approach (n = 79, 79.0%). The mean age of the cohort was 51 ± 13 years and females represented 25.0%. The technical success rate of the percutaneous ultrasound-guided MANTA technique was 95.2%. In multivariate analysis, surgical closure was associated with a higher incidence of combined access site hematomas/seromas/SSIs compared to percutaneous ultrasound-guided deployment of MANTA device (44.3% versus 9.5%, odds ratio (OR): 7.162, 95% confidence interval (CI): 1.544-33.222; p = 0.012). Similarly, access-site complications necessitating interventions were more frequent in the surgical closure group compared to US-MANTA (ultrasound-guided MANTA) group (26.6% versus 0.0%, p = 0.005). VCs were infrequent in both groups without any significant intergroup difference (p > 0.99).

Conclusions: Percutaneous ultrasound-guided MANTA closure of the femoral artery after VA-ECMO decannulation was associated with high technical success rate and low incidence of VCs. Compared to surgical closure, access-site complications were significantly less frequent, along with access-site complications necessitating interventions.

背景:外周股-股静脉-体外膜氧合(VA-ECMO)可用于心源性休克时的快速血流动力学辅助。超声引导下的大口径装置(MANTA®)闭合是一种可行的选择,可能取代外周VA-ECMO脱管手术动脉切开术闭合。方法:本回顾性研究纳入2012-2020年在芬兰赫尔辛基大学医院经皮插入股股VA-ECMO的患者。主要终点是手术部位并发症,血肿/血肿/手术部位感染(ssi)的复合,以及血管并发症(VCs)的安全终点。结果:100例连续经皮植入和脱机VA-ECMO患者按脱管策略分为两组:经皮超声引导的MANTA装置(n = 21, 21.0%)和手术入路(n = 79, 79.0%)。队列的平均年龄为51±13岁,女性占25.0%。经皮超声引导下的MANTA技术成功率为95.2%。在多因素分析中,与经皮超声引导下部署MANTA装置相比,手术关闭与更高的联合通路部位血肿/血肿/ ssi发生率相关(44.3%对9.5%,优势比(OR): 7.162, 95%可信区间(CI): 1.544-33.222;p = 0.012)。同样,与超声引导下的US-MANTA(超声引导下的MANTA)组相比,手术闭合组需要干预的通路部位并发症更频繁(26.6%对0.0%,p = 0.005)。两组vc发生率均较低,组间差异无统计学意义(p > 0.99)。结论:经皮超声引导下行VA-ECMO脱管后股动脉MANTA封闭术技术成功率高,VCs发生率低。与手术闭合相比,通路部位并发症的发生频率明显较低,需要干预的通路部位并发症也较少。
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引用次数: 0
Risk of appendiceal malignancy in conservatively treated acute appendicitis. 保守治疗急性阑尾炎发生阑尾恶性肿瘤的风险。
IF 2.4 3区 医学 Q1 SURGERY Pub Date : 2023-12-01 Epub Date: 2023-09-13 DOI: 10.1177/14574969231190293
Shaima Ramadan, Pamela Buchwald, Åsa Olsson

Background and aims: Appendectomy has historically been the standard treatment of acute appendicitis, but lately, conservative treatment of uncomplicated acute appendicitis with antibiotics has successfully been used in selected patients. Complicated acute appendicitis is often treated conservatively initially, but may benefit from interval appendectomy due to the higher risk of appendiceal malignancy and recurrence. Recommendations for follow-up after conservatively treated appendicitis vary. Furthermore, the risk of underlying malignancy and the necessity of routine interval appendectomy are unclear. This study aims to evaluate follow-up status, recurrence, and underlying appendiceal malignancy in conservatively treated uncomplicated and complicated acute appendicitis.

Methods: This study included patients with conservatively treated acute appendicitis at Skåne University Hospital, Sweden during 2012-2019. Information on patient demographics at index admission and data on follow-up, recurrence, number of appendectomies after initial conservative treatment, and underlying malignancy were retrieved from medical charts.

Results: The study cohort included 391 patients, 152 with uncomplicated and 239 with complicated acute appendicitis. Median time of study follow-up was 52 months. The recurrence risk was 23 (15.1%) after uncomplicated and 58 (24.3%) after complicated acute appendicitis (p = 0.030). During follow-up, 55 (23%) patients with complicated acute appendicitis underwent appendectomy. Appendiceal malignancies were found in 12 (5%) patients with previous complicated acute appendicitis versus no appendiceal malignancies after uncomplicated acute appendicitis (p = 0.002).

Conclusion: The risk of appendiceal malignancy and recurrent appendicitis was significantly higher in patients with complicated acute appendicitis compared with uncomplicated acute appendicitis.

背景与目的:阑尾切除术历来是急性阑尾炎的标准治疗方法,但近年来,一些非并发症急性阑尾炎患者成功地采用了抗生素保守治疗。复杂性急性阑尾炎最初通常采用保守治疗,但由于阑尾恶性肿瘤和复发的风险较高,间隔期阑尾切除术可能会受益。阑尾炎保守治疗后随访的建议各不相同。此外,潜在恶性肿瘤的风险和常规间隔阑尾切除术的必要性尚不清楚。本研究旨在评估保守治疗的非并发和并发急性阑尾炎的随访情况、复发率和潜在的阑尾恶性肿瘤。方法:本研究纳入2012-2019年在瑞典sk大学医院接受保守治疗的急性阑尾炎患者。从医学图表中检索患者入院时的人口统计信息和随访、复发、初始保守治疗后阑尾切除术次数和潜在恶性肿瘤的数据。结果:纳入391例患者,其中单纯急性阑尾炎152例,合并急性阑尾炎239例。研究随访时间中位数为52个月。单纯急性阑尾炎复发风险为23(15.1%),合并急性阑尾炎复发风险为58 (24.3%)(p = 0.030)。随访期间,55例(23%)合并急性阑尾炎患者行阑尾切除术。12例(5%)合并急性阑尾炎患者发现阑尾恶性肿瘤,而非合并急性阑尾炎患者未发现阑尾恶性肿瘤(p = 0.002)。结论:合并急性阑尾炎患者发生阑尾恶性肿瘤和阑尾炎复发的风险明显高于未合并急性阑尾炎患者。
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引用次数: 0
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Scandinavian Journal of Surgery
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