Cirugia Espanola最新文献

英文中文

Tipo de abordaje y complicaciones postoperatorias tras pancreatectomia izquierda (estudio prospectivo SPANDISPAN) 左胰腺切除术后的治疗方法和术后并发症类型（SPANDISPAN前瞻性研究）

IF 1.3 4区医学 Q3 SURGERY

Cirugia Espanola

Pub Date : 2025-09-01 DOI: 10.1016/j.ciresp.2025.800197

Belén Hernández-Roca , José M. Ramia , Juli Busquets , Luis Secanella , Nuria Peláez , Maialen Alkorta , Itziar de Ariño Hervas , M. Mar Achalandabaso , Enrique Toledo , Fernando Rotellar , Pablo Marti-Cruchaga , Miguel Ángel Gómez-Bravo , Gonzalo Suárez , Marina Garcés , Luis Sabater , Gabriel García Plaza , Francisco Javier Alcalá , Enrique Asensio , David Pacheco , Esteban Cugat , Cándido Alcazar

Introduction

Left pancreatectomy (LP) is a surgical technique with low mortality but high morbidity (30%), particularly pancreatic fistula (PF). Its minimally invasive (MI) approach has become popular, but its implementation in Spain remains unknown. We present a national multicenter study on LP to determine morbidity-mortality, PF incidence, and the percentage of MI approach.

Methods

A descriptive, observational, prospective, and multicenter study on LP. Study period: 02/01/2022–02/28/2023. Inclusion criteria: Elective LP. Exclusion criteria: LP following pancreaticoduodenectomy, with celiac trunk resection, or performed as an emergency. Major complications (MC): Clavien-Dindo ≥ IIIA.

Results

A total of 41 centers participated, including 313 patients. Women accounted for 53.4%. Mean age: 63.4 years. The most common indications for LP were neuroendocrine tumors (32.6%), pancreatic adenocarcinoma (28%), and IPMN (15.7%). The surgical approach was laparoscopic (53%), open (30.7%), and robotic (16.3%). The most frequently performed techniques were distal splenopancreatectomy (72.2%) and radical antegrade modular pancreatosplenectomy (RAMPS) (14.4%). Complications occurred in 57.5% of patients, with 21.1% classified as MC. The most frequent was PF (38.3%), with 52.5% of PFs classified as B-C (20.1% of the total). The 90-day mortality rate was 1.6%. The use of a protective sleeve and the absence of drains were associated with the absence of PF in multivariate analysis.

Conclusion

In our series, the MI approach was significantly higher than expected (70%). The MC rate was 21.1%, and mortality was 1.6%, confirming that LP is a procedure with low mortality but high morbidity.

左胰切除术（LP）是一种低死亡率但高发病率（30%）的手术技术，尤其是胰瘘（PF）。其微创（MI）方法已成为流行，但其在西班牙的实施仍然未知。我们提出了一项关于LP的全国性多中心研究，以确定发病率-死亡率、PF发病率和心肌梗死方法的百分比。方法对LP进行描述性、观察性、前瞻性、多中心研究。学习时间：2022年2月1日- 2023年2月28日。纳入标准：选择性LP。排除标准：LP后胰十二指肠切除术，腹腔干切除术，或作为紧急情况。主要并发症（MC）： Clavien-Dindo≥IIIA。结果共纳入41个中心，313例患者。女性占53.4%。平均年龄：63.4岁。LP最常见的适应症是神经内分泌肿瘤（32.6%）、胰腺腺癌（28%）和IPMN（15.7%）。手术入路为腹腔镜（53%）、开放（30.7%）和机器人（16.3%）。最常用的技术是远端脾切除术（72.2%）和根治性顺行模块化胰脾切除术（RAMPS）（14.4%）。57.5%的患者出现并发症，其中21.1%为MC，最常见的是PF(38.3%)，其中52.5%的PF为B-C（20.1%）。90天死亡率为1.6%。在多变量分析中，使用保护套和没有引流管与没有PF相关。结论：在我们的研究中，心肌梗死入路明显高于预期（70%）。MC率为21.1%，死亡率为1.6%，证实LP是一种死亡率低但发病率高的手术。

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引用次数: 0

Severe bacterial soft tissue infection in the chest due to S. pyogenes: A case series 由化脓性链球菌引起的胸部严重细菌性软组织感染：一个病例系列

IF 1.3 4区医学 Q3 SURGERY

Cirugia Espanola

Pub Date : 2025-09-01 DOI: 10.1016/j.ciresp.2025.800187

Leonidas Alejandro Landero Ascencio, Raúl Guerrero Lopez, Marc Perez Xaus, Sara Fernandez Planas, Hellena Vallverdú Cartié

引用次数: 0

Hemorragia digestiva secundaria a múltiples GIST duodeno-yeyunales en un paciente con neurofibromatosis tipo 1 1型神经纤维瘤病患者的多发性十二指肠-乳腺GIST继发性消化道出血

IF 1.3 4区医学 Q3 SURGERY

Cirugia Espanola

Pub Date : 2025-09-01 DOI: 10.1016/j.ciresp.2025.800191

Franciso Castillejos Ibañez , María Carmen Fernández-Moreno , Carolina Martinez Ciarpaglini , Ricardo Gadea Mateo , María Eugenia Barrios Carvajal

引用次数: 0

Reconstrucciones 3 D en cáncer de recto. Nuevas herramientas para un mejor diagnóstico y planificación operatoria 直肠癌的3D重建。改进诊断和手术计划的新工具

IF 1.3 4区医学 Q3 SURGERY

Cirugia Espanola

Pub Date : 2025-09-01 DOI: 10.1016/j.ciresp.2025.800198

Álvaro García-Granero , Sebastián Jerí-McFarlane , Aina Ochogavía , Margarita Gamundí-Cuesta , Eduardo Garcia-Granero , Francisco Xavier González-Argenté

引用次数: 0

Cirugía por cáncer de recto más allá del mesorrecto: indicaciones, preparación límites y resultados 直肠癌手术：适应症、界限和结果

IF 1.3 4区医学 Q3 SURGERY

Cirugia Espanola

Pub Date : 2025-09-01 DOI: 10.1016/j.ciresp.2025.800202

Blas Flor-Lorente, Mario Javier de Miguel Valencia

Pelvic exenteration (PE) is a potentially curative surgical option for patients with locally advanced rectal cancer (LARC) or locally recurrent rectal cancer (LRRC) involving multivisceral structures. Originally conceived as a palliative procedure, advancements in surgical techniques and multidisciplinary management have broadened its indications, enabling R0 resections in over 60% of cases. Appropriate patient selection, based on advanced imaging and comprehensive functional assessment, is essential to optimize oncologic outcomes. Currently, the surgical indication is primarily determined by the reasonable possibility of achieving an R0 resection with acceptable morbidity in a suitable candidate, which may translate into high survival rates.

Surgical planning should follow a compartmental approach and require close collaboration among colorectal, urologic, gynecologic, vascular, orthopedic, plastic, and reconstructive surgeons. Urinary, gynecologic, vascular, osseous, and soft tissue reconstructions are tailored to the tumor's extent and the patient's individual needs. In selected cases, PE may be performed with palliative intent. Intraoperative radiotherapy (IORT) and minimally invasive approaches have emerged as valuable adjuncts.

Long-term oncologic and functional outcomes are closely linked to the achievement of negative margins. While postoperative morbidity remains significant, mortality rates have declined in high-volume centers. Postoperative quality of life has become a key outcome, with increasing emphasis on patient-reported outcome measures (PROMs) to guide clinical decision-making. PE continues to challenge traditional limits of resectability, offering renewed hope to carefully selected patients.

对于局部晚期直肠癌（LARC）或局部复发性直肠癌（LRRC）累及多脏器结构的患者，盆腔切除（PE）是一种潜在的治愈手术选择。最初被认为是一种姑息性手术，手术技术和多学科管理的进步扩大了其适应症，使60%以上的病例能够进行R0切除。适当的患者选择，基于先进的影像学和全面的功能评估，是优化肿瘤预后的必要条件。目前，手术指征主要取决于在合适的候选者中实现R0切除的合理可能性和可接受的发病率，这可能转化为高生存率。手术计划应遵循分区方法，并要求结直肠、泌尿外科、妇科、血管外科、骨科、整形外科和重建外科医生密切合作。泌尿、妇科、血管、骨骼和软组织重建是根据肿瘤的程度和患者的个人需要量身定制的。在选定的病例中，PE可能出于缓和的目的而进行。术中放疗（IORT）和微创入路已成为有价值的辅助手段。长期的肿瘤和功能结果与实现负边缘密切相关。虽然术后发病率仍然很高，但大容量中心的死亡率已经下降。术后生活质量已成为一个关键的预后指标，越来越重视患者报告的预后指标（PROMs）来指导临床决策。PE继续挑战可切除性的传统限制，为精心挑选的患者带来新的希望。

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引用次数: 0

Intestinal obstruction secondary to uterine broad ligament hernia 子宫宽韧带疝继发肠梗阻

IF 1.3 4区医学 Q3 SURGERY

Cirugia Espanola

Pub Date : 2025-09-01 DOI: 10.1016/j.ciresp.2025.800154

Lucas Rodríguez-Carreño Díaz, Luis Cadaval Moreno, Ismael Mora-Guzmán

引用次数: 0

Coexistence of Morgagni and Bochdalek hernias in an asymptomatic adult 一例无症状成人同时存在Morgagni和Bochdalek疝

IF 1.3 4区医学 Q3 SURGERY

Cirugia Espanola

Pub Date : 2025-09-01 DOI: 10.1016/j.ciresp.2025.800188

Yener Aydin, Ali Bilal Ulas, Atilla Eroglu

引用次数: 0

Neuropatía pudenda por cistoadenoma apocrino: revisión de la literatura 囊性腺瘤性脓疱性神经病变：文献综述

IF 1.3 4区医学 Q3 SURGERY

Cirugia Espanola

Pub Date : 2025-09-01 DOI: 10.1016/j.ciresp.2025.800193

Belén Hernández Roca , María Jesús Segura Jiménez , Vidina Rodrigo Amador , Enrique Fernández Rodríguez , José Manuel Ramia Angel

引用次数: 0

Mastectomía preservadora de piel y pezón asistida por endoscopia y reconstrucción inmediata con implante prepectoral. Estudio prospectivo para la evaluación de la viabilidad y seguridad de la técnica, calidad de vida y secuelas cosméticas. Código Promotor: VideoBreast-24 保护皮肤和乳头的乳房切除术，内窥镜辅助和立即重建与预胸植入。前瞻性研究，评估技术的可行性和安全性，生活质量和化妆品的后遗症。推广代码：VideoBreast-24

IF 1.3 4区医学 Q3 SURGERY

Cirugia Espanola

Pub Date : 2025-09-01 DOI: 10.1016/j.ciresp.2025.800159

Benigno Acea-Nebril, Alejandra García-Novoa, Sergio Sierra Fernández

Skin-sparing or nipple-skin-sparing mastectomy (NSSM) with immediate reconstruction with a prepectoral implant is the procedure of choice for women with breast cancer or high risk for breast cancer who require a mastectomy. This procedure can be performed with endoscopic or robotic assistance, however, the complexity of the technique, the increase in surgical time and costs, as well as the lack of prospective studies with long-term follow-up have limited its implementation. The present study aims to evaluate the non-inferiority of NSSM with endoscopic support compared to open NSSM in terms of feasibility and safety of the technique, oncological safety and cosmetic sequelae.

保留皮肤或乳头保留皮肤乳房切除术（NSSM）与乳房前植入物立即重建是乳腺癌或乳腺癌高风险妇女需要乳房切除术的手术选择。该手术可以在内窥镜或机器人辅助下进行，然而，技术的复杂性，手术时间和成本的增加，以及缺乏长期随访的前瞻性研究限制了其实施。本研究旨在从技术的可行性和安全性、肿瘤安全性和美容后遗症等方面评价内镜支持下的非劣效性NSSM与开放式NSSM的比较。

引用次数: 0

Yeyunoplastia de avance esofágico en el tratamiento de las estenosis esofágicas cervicales 用食道进行性阳离子成形术治疗宫颈食道狭窄症

IF 1.3 4区医学 Q3 SURGERY

Cirugia Espanola

Pub Date : 2025-09-01 DOI: 10.1016/j.ciresp.2025.800195

Leandre Farran Teixidó , Mónica Miró Martín , Anna López Ojeda , Cristóbal Cañete Cabanillas , Fernando Estremiana García , Oriol Bermejo Segu , Humberto Aranda Danso , Joan Gornals Soler

Introduction

Cervical esophageal stenosis is a complex surgical problem when endoscopic treatment fails. The distance between the stenosis and the dental arch (DA) determines the need for a longer flap, with an increased risk of ischemia.

Our group proposed the use of an esophageal advancement jejunoplasty (JAE) in patients with esophageal stenosis less than 17 centimeters from the DA to «lengthen» the residual esophagus and, in a second stage, complete the reconstruction of digestive transit with a gastroplasty or coloplasty.

Method

Descriptive and retrospective analysis of a prospective database of patients who had esophageal stenosis less than 17 centimeters from the DA, who were indicated a JAE between November 2020 and May 2024.

Results

A total of 16 patients with a mean age of 52 years were included. In 13 cases the stenosi was secundary to càustics and 3 to radiotherapy; the mean distance between AD and stenosis was 14 cm. Five cases were reoperated and 2 esophageal-jejunal fístulas were diagnosed. There was no mortality. The second stage of reconstruction was completed in 10 patients (5 gastroplasties and 5 coloplasties). Two jejuno-ileal stenosis and one esophageal-jejunal stenosis were diagnosed. Functionally, 5 patients are exclusively nourished orally, 2 through a mixed diet and 3 exclusively enterally.

Conclusion

We believe that JAE can be a technically feasible option, with acceptable morbidity, in patients with upper esophageal stenosis to minimize the risk of ischemia that involves a longer flap.

宫颈食管狭窄是一个复杂的手术问题，内镜治疗失败。狭窄和牙弓（DA）之间的距离决定了需要更长的皮瓣，增加了缺血的风险。我们的研究小组建议对食管狭窄距离DA小于17厘米的患者使用食管前移空肠成形术（JAE）来“延长”残余食管，并在第二阶段通过胃成形术或结肠成形术完成消化系统的重建。方法对2020年11月至2024年5月期间食管狭窄小于17厘米的前瞻性数据库进行描述性和回顾性分析。结果共纳入16例患者，平均年龄52岁。13例继发于càustics， 3例继发于放疗；AD与狭窄的平均距离为14 cm。再次手术5例，确诊食管空肠fístulas 2例。没有死亡。10例患者完成第二期重建（5例胃成形术，5例结肠成形术）。2例为空肠-回肠狭窄，1例为食管-空肠狭窄。功能上，5例患者完全口服营养，2例通过混合饮食，3例完全肠内营养。结论：我们相信，对于食管上段狭窄的患者，JAE是一种技术上可行的选择，其发病率可接受，可以最大限度地减少涉及较长皮瓣的缺血风险。

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