Asian Journal of Surgery最新文献

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IF 3.8 3区医学 Q1 SURGERY

Asian Journal of Surgery

Pub Date : 2025-10-21 DOI: 10.1016/S1015-9584(25)02867-2

引用次数: 0

The application of remimazolam tosilate combined with low-dose propofol anesthesia in hysteroscopy 雷马唑仑联合小剂量异丙酚麻醉在宫腔镜检查中的应用

IF 3.8 3区医学 Q1 SURGERY

Asian Journal of Surgery

Pub Date : 2025-10-18 DOI: 10.1016/j.asjsur.2025.08.298

Yafen Leng, Qifeng Lou

引用次数: 0

Acute paraplegia from undiagnosed spinal dural arteriovenous fistula following epidural anesthesia: Case report and surgical outcome 硬膜外麻醉后未确诊硬脊膜动静脉瘘引起的急性截瘫：病例报告和手术结果

IF 3.8 3区医学 Q1 SURGERY

Asian Journal of Surgery

Pub Date : 2025-10-17 DOI: 10.1016/j.asjsur.2025.09.054

Mingkun Zhang , Li Gao , Tao Xin , Xiaoyong Fan

引用次数: 0

Efficacy and safety of intra-articular dexmedetomidine in knee arthroscopy surgeries: A systematic review and meta-analysis of randomized controlled trials 右美托咪定在膝关节镜手术中的疗效和安全性：随机对照试验的系统回顾和荟萃分析

IF 3.8 3区医学 Q1 SURGERY

Asian Journal of Surgery

Pub Date : 2025-10-13 DOI: 10.1016/j.asjsur.2025.08.263

Wei-Hsiang Yang , Tsung-Yu Hung , Ying-Chun Lin , Yung-Chang Lu , Chung-Ting Liu , Tsung-Yu Lin , Wei-Cheng Chen

The main purposes of this study were to compare the efficacy and safety of adding intra-articular dexmedetomidine as an adjunct to local anesthetics for knee arthroscopy. A systematic literature review was conducted to search for randomized controlled trials (RCTs) published from database inception to November 11, 2023, comparing intra-articular dexmedetomidine combined with local anesthetics to intra-articular anesthetics alone. The primary outcome was the time to the first rescue analgesic administration. Secondary outcomes included rescue analgesic dosage, postoperative pain scores at rest and during movement within 24 h, patient satisfaction, and adverse effects. In total, 24 eligible RCTs comprising 1289 participants were included. Compared to local anesthetics alone, intra-articular dexmedetomidine combined with local anesthetics resulted in a significantly prolonged time to the first rescue analgesic (MD: 249.44 min, 95 % CI: [178.73, 320.16]). The rescue analgesic dosage and postoperative pain score at rest and during movement within 24 h were also significantly decreased in the intra-articular dexmedetomidine group. Patient satisfaction was significantly higher in the intra-articular dexmedetomidine group than in the control group. Adverse effects, including hypotension and bradycardia, are rare. However, the long-term effects of intra-articular dexmedetomidine were not investigated in the included RCTs.

Adding intra-articular dexmedetomidine as an adjunct to local anesthetics prolongs the time to the first rescue analgesic and decreases the postoperative pain score compared to local anesthetics alone without increasing short-term side effects in knee arthroscopy.

本研究的主要目的是比较膝关节镜手术中加入局部麻醉剂的关节内右美托咪定的疗效和安全性。通过系统的文献综述，检索从数据库建立到2023年11月11日发表的随机对照试验（rct），比较关节内右美托咪定联合局部麻醉剂与单独关节内麻醉剂。主要观察指标为第一次给药时间。次要结局包括救援镇痛剂量、术后24小时内静息和运动时疼痛评分、患者满意度和不良反应。共纳入24项符合条件的随机对照试验，包括1289名受试者。与单用局麻药相比，关节内右美托咪定联合局麻药可显著延长至首次抢救镇痛的时间（MD: 249.44 min, 95% CI:[178.73, 320.16]）。右美托咪定关节内组的镇痛剂量和术后24 h内静息和运动时疼痛评分均显著降低。右美托咪定关节内组患者满意度明显高于对照组。副作用，包括低血压和心动过缓，是罕见的。然而，在纳入的随机对照试验中没有研究关节内右美托咪定的长期影响。与单用局麻药相比，关节内加用右美托咪定辅助局麻药可延长到第一次抢救镇痛的时间，降低术后疼痛评分，且不增加膝关节镜手术的短期副作用。

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引用次数: 0

Tumor sidedness and the usefulness of laparoscopic surgery in obese colorectal cancer patients in Japan 日本肥胖结直肠癌患者的肿瘤侧边性和腹腔镜手术的有效性

IF 3.8 3区医学 Q1 SURGERY

Asian Journal of Surgery

Pub Date : 2025-10-11 DOI: 10.1016/j.asjsur.2025.08.301

Hiroshi Miyakita , Seiichiro Yamamoto , Junichiro Hiro , Kiyonori Kanemitsu , Tomonori Akagi , Kentaro Nakajima , Yutaka Kojima , Takatoshi Nakamura , Masafumi Inomata , Shuji Saito , Takeshi Naitoh , Masahiko Watanabe

Background/objective

Numerous reports suggest that there is no difference in treatment outcomes between obese and non-obese patients undergoing laparoscopic surgery for colorectal cancer. However, contrasting findings also suggest that treatment results may be inferior in obese patients. We aimed to retrospectively analyze outcomes of laparoscopic and open surgeries for right- and left-sided colectomies in 1572 obese patients with colorectal cancer.

Methods

Patients were classified by surgical type (laparoscopic vs. open) and colectomy location (right vs. left). We assessed body mass index, tumor diameter, blood loss, operative time, lymph nodes removed, metastases, recurrence rate, and overall survival.

Results

No relationship was found between body mass index and the surgical method. Tumor diameter was significantly larger in open surgeries for both sides (p < 0.001). The combined resection rate was also significantly higher in open surgeries (p < 0.001). Laparoscopic surgeries resulted in significantly lower blood loss but significantly longer operative times on both sides (p < 0.001). No difference in operative times was noted between left and right laparoscopic surgeries, whereas left-sided open colectomies took significantly longer (p = 0.9086, p < 0.001). Lymph node-positive metastasis rate, recurrence rate, and overall survival showed no differences.

Conclusion

Combined resection (T4b) and tumor size are more critical than body mass index in selecting the surgical approach. Open surgeries had longer operative times for left-sided colectomies, whereas laparoscopic surgeries showed no time difference between sides, suggesting potential advantages for left-sided procedures or greater difficulty with right-sided colectomies. Despite longer operative times, laparoscopic surgery's lower blood loss indicates its oncological safety.

背景/目的大量报道表明，肥胖和非肥胖患者接受腹腔镜结直肠癌手术的治疗结果没有差异。然而，对比研究结果也表明，肥胖患者的治疗效果可能较差。我们的目的是回顾性分析1572例肥胖结直肠癌患者的腹腔镜和开放手术治疗右侧和左侧结肠切除术的结果。方法根据手术类型（腹腔镜vs开放式）和结肠切除位置（右侧vs左侧）对患者进行分类。我们评估了身体质量指数、肿瘤直径、出血量、手术时间、淋巴结切除、转移、复发率和总生存率。结果体重指数与手术方式无关。两侧开放手术的肿瘤直径明显较大（p < 0.001）。开放手术的联合切除率也显著高于开放手术（p < 0.001）。腹腔镜手术显著降低了双侧出血量，但显著延长了手术时间（p < 0.001）。左侧和右侧腹腔镜手术的手术时间没有差异，而左侧开放式结肠手术的手术时间明显更长（p = 0.9086, p < 0.001）。淋巴结阳性转移率、复发率及总生存率无差异。结论在选择手术入路时，联合切除（T4b）和肿瘤大小比体重指数更重要。开放手术对左侧结肠切除术的手术时间更长，而腹腔镜手术在两侧之间没有时间差异，提示左侧结肠手术的潜在优势或右侧结肠切除术的更大困难。尽管手术时间较长，但腹腔镜手术的低出血量表明其肿瘤安全性。

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引用次数: 0

En bloc resection of adrenocortical carcinoma invading the inferior vena cava using total hepatic vascular exclusion and active venovenous bypass (with video) 全肝血管排除和主动静脉-静脉旁路术治疗侵犯下腔静脉的肾上腺皮质癌（附视频）

IF 3.8 3区医学 Q1 SURGERY

Asian Journal of Surgery

Pub Date : 2025-10-11 DOI: 10.1016/j.asjsur.2025.08.300

Kosei Takagi, Susumu Doita, Motohiko Yamada, Tomokazu Fuji, Kazuya Yasui, Shingo Nishimura, Takeyoshi Nishiyama, Yasuo Nagai, Noriyuki Kanehira, Toshiyoshi Fujiwara

Technique

Adrenocortical carcinoma (ACC) is a rare malignant tumor with poor prognosis. Although complete surgical resection remains the only potentially curative treatment, the surgical treatment of ACC with venous tumor invasion is challenging. Our surgical techniques for radical adrenalectomy and inferior vena cava (IVC) reconstruction using total hepatic vascular exclusion (THVE) and active venovenous bypass included five steps: Step 1, preparation for en bloc resection; Step 2, preparation for active venovenous bypass; Step 3, preparation for THVE; Step 4, en bloc resection; and Step 5, IVC reconstruction.

Results

The renal veins and infrahepatic IVC were isolated and taped. Subsequently, the right and left lobes of the liver were mobilized to completely expose the IVC. After cannulation of the femoral and axillary veins, an active venovenous bypass was initiated. THVE was performed in cases requiring cross-clamping of the suprahepatic IVC above the hepatic veins. Finally, radical adrenalectomy and IVC graft replacement with a 20-mm ringed e-polytetrafluoroethylene graft were performed under THVE and active venovenous bypass.

Conclusions

Radical adrenalectomy and IVC graft replacement using THVE and active venovenous bypass were successfully performed in a patient with right ACC invading the IVC. Surgical approaches for ACC with IVC invasion should be determined based on tumor thrombus level and tumor characteristics. Accurate preoperative evaluation and surgical strategy are essential for the radical resection of ACC with IVC invasion.

肾上腺皮质癌是一种少见的恶性肿瘤，预后较差。虽然完全手术切除仍然是唯一可能治愈的治疗方法，但手术治疗伴有静脉肿瘤侵袭的ACC是具有挑战性的。我们采用全肝血管排除术（THVE）和主动静脉-静脉旁路术进行肾上腺根治性切除和下腔静脉（IVC）重建的手术技术包括五个步骤：第一步，为整体切除做准备；步骤2，主动静脉-静脉旁路术准备；第三步，THVE准备；步骤4，整体切除；第五步，下腔静脉重建。结果对肾静脉和肝下静脉进行了分离和包扎。随后，动员肝左右叶以完全暴露下腔静脉。在股静脉和腋窝静脉插管后，主动静脉-静脉旁路术开始。在肝静脉上方的肝上静脉需要交叉夹持的情况下进行THVE。最后，在THVE和主动静脉-静脉旁路下行根治性肾上腺切除术和下腔静脉移植物置换20mm环形聚四氟乙烯移植物。结论1例右脑ACC侵犯下腔静脉的患者行根治性肾上腺切除术和下腔静脉移植物置换术，手术成功。ACC合并下腔静脉侵犯的手术入路应根据肿瘤血栓水平和肿瘤特点确定。准确的术前评估和手术策略是根治性切除ACC合并下腔静脉侵犯的关键。

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引用次数: 0

Metagenomic sequencing versus culture for faster and broader pathogen detection after liver transplantation: A 23-patient retrospective analysis 宏基因组测序与培养在肝移植后更快更广泛的病原体检测：一项23例患者的回顾性分析

IF 3.8 3区医学 Q1 SURGERY

Asian Journal of Surgery

Pub Date : 2025-10-11 DOI: 10.1016/j.asjsur.2025.08.355

Pengchao Fan , Wenyue Liu

引用次数: 0

Revolutionary therapeutic targets have transformed the treatment of diabetic foot ulcers 革命性的治疗靶点已经改变了糖尿病足溃疡的治疗

IF 3.8 3区医学 Q1 SURGERY

Asian Journal of Surgery

Pub Date : 2025-10-10 DOI: 10.1016/j.asjsur.2025.09.031

Dongya Lu , Zhenbin Liu , Menghu Li , Gang Wang

引用次数: 0

Outcomes of living-donor liver transplantation in older patients over 65 and 70 years compared to the younger recipients 65岁以上和70岁以上老年患者活体肝移植与年轻受者的结果比较

IF 3.8 3区医学 Q1 SURGERY

Asian Journal of Surgery

Pub Date : 2025-10-10 DOI: 10.1016/j.asjsur.2025.08.303

Deok-Gie Kim, Young Jin Yoo, Minyu Kang, Hwa-hee Koh, Eun-Ki Min, Jae Geun Lee, Myoung Soo Kim, Dong Jin Joo

Background

As liver transplantation is increasingly considered for older adults with high perioperative risks, this study investigated the outcomes of living donor liver transplantation (LDLT) in older compared to younger recipients.

Methods

A retrospective analysis was performed involving 908 LDLT recipients, categorized by age: ≤64 years (n = 862), 65–69 years (n = 80), and ≥70 years (n = 28). Graft survival and complications were compared between the age groups.

Results

Older recipients (≥65 years) exhibited a high incidence of preexisting conditions including hypertension and diabetes. Five-year graft survival was reduced in older recipients in unmatched analysis (81.8 % in ≤64 years vs. 75.0 % in 65–69 years vs. 69.7 % in ≥70 years, P = 0.045). However, this difference was not significant in multivariable Cox regression (hazard ratio [HR] 1.44, P = 0.156 for 65–69 years and HR 1.69, P = 0.156 for ≥70 years). In matched analyses, graft survival in the 65–69 age group (78.9 % vs. 74.5 %, P = 0.324) and the ≥70 age group (80.3 % vs. 76.0 %, P = 0.551) was not inferior to that of the ≤64 age group. Rejection and surgical complications within 1 year were similar between the groups. However, the incidence of pneumonia was significantly higher in the older group than that in the younger group (11.3 % vs. 20.8 % vs. 19.3 %, P = 0.019).

Conclusion

LDLT in older patients demonstrated survival comparable to that in younger patients when pre-transplant characteristics were adjusted. Patient selection based on comorbidities and infection prevention strategies is critical for optimizing postoperative outcomes in this demographic group.

随着肝移植被越来越多地考虑用于围手术期高风险的老年人，本研究调查了老年人活体供肝移植（LDLT）与年轻受者的结果。方法回顾性分析908例LDLT受者，按年龄分为≤64岁（n = 862）、65 ~ 69岁（n = 80）和≥70岁（n = 28）。比较两组间移植存活率及并发症。结果接受焊料者（≥65岁）既往病史包括高血压和糖尿病的发生率较高。在非匹配分析中，老年受者的5年移植物存活率降低（≤64岁为81.8%，65-69岁为75.0%，≥70岁为69.7%,P = 0.045）。然而，在多变量Cox回归中，这一差异不显著（65-69岁的风险比[HR] 1.44, P = 0.156；≥70岁的风险比[HR] 1.69, P = 0.156）。在匹配分析中，65-69岁年龄组（78.9% vs. 74.5%, P = 0.324）和≥70岁年龄组（80.3% vs. 76.0%, P = 0.551）的移植物存活率不低于≤64岁年龄组。两组1年内的排斥反应和手术并发症相似。然而，老年组肺炎的发病率明显高于年轻组（11.3% vs. 20.8% vs. 19.3%, P = 0.019）。结论调整移植前特征后，老年ldlt患者的生存率与年轻患者相当。基于合并症和感染预防策略的患者选择对于优化该人群的术后结果至关重要。

{"title":"Outcomes of living-donor liver transplantation in older patients over 65 and 70 years compared to the younger recipients","authors":"Deok-Gie Kim, Young Jin Yoo, Minyu Kang, Hwa-hee Koh, Eun-Ki Min, Jae Geun Lee, Myoung Soo Kim, Dong Jin Joo","doi":"10.1016/j.asjsur.2025.08.303","DOIUrl":"10.1016/j.asjsur.2025.08.303","url":null,"abstract":"<div><h3>Background</h3><div>As liver transplantation is increasingly considered for older adults with high perioperative risks, this study investigated the outcomes of living donor liver transplantation (LDLT) in older compared to younger recipients.</div></div><div><h3>Methods</h3><div>A retrospective analysis was performed involving 908 LDLT recipients, categorized by age: ≤64 years (n = 862), 65–69 years (n = 80), and ≥70 years (n = 28). Graft survival and complications were compared between the age groups.</div></div><div><h3>Results</h3><div>Older recipients (≥65 years) exhibited a high incidence of preexisting conditions including hypertension and diabetes. Five-year graft survival was reduced in older recipients in unmatched analysis (81.8 % in ≤64 years vs. 75.0 % in 65–69 years vs. 69.7 % in ≥70 years, P = 0.045). However, this difference was not significant in multivariable Cox regression (hazard ratio [HR] 1.44, P = 0.156 for 65–69 years and HR 1.69, P = 0.156 for ≥70 years). In matched analyses, graft survival in the 65–69 age group (78.9 % vs. 74.5 %, P = 0.324) and the ≥70 age group (80.3 % vs. 76.0 %, P = 0.551) was not inferior to that of the ≤64 age group. Rejection and surgical complications within 1 year were similar between the groups. However, the incidence of pneumonia was significantly higher in the older group than that in the younger group (11.3 % vs. 20.8 % vs. 19.3 %, P = 0.019).</div></div><div><h3>Conclusion</h3><div>LDLT in older patients demonstrated survival comparable to that in younger patients when pre-transplant characteristics were adjusted. Patient selection based on comorbidities and infection prevention strategies is critical for optimizing postoperative outcomes in this demographic group.</div></div>","PeriodicalId":55454,"journal":{"name":"Asian Journal of Surgery","volume":"49 1","pages":"Pages 76-82"},"PeriodicalIF":3.8,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145753948","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

A comparative study for the efficacy of ISM versus SSM for marginal status of MMG-guided excisional biopsy ISM与SSM在mmg引导下切除活检边缘状态的疗效比较研究

IF 3.8 3区医学 Q1 SURGERY

Asian Journal of Surgery

Pub Date : 2025-10-10 DOI: 10.1016/j.asjsur.2025.08.311

Kuan-Jie Huang , Yi-Fang Tsai , Po-Ying Lee , Yen-Shu Lin , Chin-Jung Feng , Yen-Chen Chen , Jen-Hwey Chiu , Yi-Chen Lai , Jane Wang , Chi-Cheng Huang , Ling-Ming Tseng

Background

Specimen mammography (SM) is routinely used to assess surgical margins in non-palpable mammography (MMG)-detected breast lesions. Standard specimen MMG (SSM) requires physical transportation, which is time-consuming, while intraoperative specimen MMG (ISM) offers an alternative. This study compares outcomes of ISM and SSM regarding margin status and reoperation rates.

Methods

We retrospectively analyzed 1119 patients who underwent MMG-guided wide excision from October 2017 to August 2021. Specimens were assessed via SSM (n = 579) or ISM (n = 537). Outcomes included operative time, margin status, and re-excision rates. Comparisons were adjusted for clinical and pathological variables.

Results

ISM showed a significantly lower positive margin rate than SSM (8.73 % vs. 21.2 %, p = 0.009). Among malignancies, invasive ductal carcinoma (IDC) had a higher re-excision rate than ductal carcinoma in situ (DCIS) (73.21 % vs. 21.3 %, p < 0.001). Positive margin rates were higher in IDC (28.57 % vs. 10 %, p = 0.004). ISM significantly reduced positive margins in IDC (8.3 % vs. 40.6 %, p = 0.007). Comedo-type DCIS had a higher re-excision rate than non-comedo DCIS (32.7 % vs. 15.3 %, p = 0.009).

Conclusion

ISM improves margin clearance and efficiency compared to SSM, particularly in IDC cases, while comedo-DCIS remains associated with higher re-excision rates.

背景：标本乳房x线照相术（SM）通常用于评估非可触及乳房x线照相术（MMG）检测到的乳房病变的手术边缘。标准标本MMG （SSM）需要物理运输，耗时，而术中标本MMG （ISM）提供了另一种选择。本研究比较了ISM和SSM在边缘状态和再手术率方面的结果。方法回顾性分析2017年10月至2021年8月接受mmg引导的1119例患者。通过SSM （n = 579）或ISM （n = 537）对标本进行评估。结果包括手术时间、切缘状态和再切除率。比较根据临床和病理变量进行调整。结果ism组阳性边缘率明显低于SSM组（8.73%比21.2%,p = 0.009）。恶性肿瘤中，浸润性导管癌（IDC）的再切除率高于导管原位癌（DCIS）（73.21% vs. 21.3%, p < 0.001）。IDC的正利润率更高（28.57%比10%，p = 0.004）。ISM显著降低了IDC的正利润率（8.3%对40.6%,p = 0.007）。粉刺型DCIS的再切除率高于非粉刺型DCIS（32.7%比15.3%,p = 0.009）。结论：与SSM相比，ism可提高切缘清除率和手术效率，特别是在IDC病例中，而喜剧- dcis仍然与更高的再切除率相关。

{"title":"A comparative study for the efficacy of ISM versus SSM for marginal status of MMG-guided excisional biopsy","authors":"Kuan-Jie Huang , Yi-Fang Tsai , Po-Ying Lee , Yen-Shu Lin , Chin-Jung Feng , Yen-Chen Chen , Jen-Hwey Chiu , Yi-Chen Lai , Jane Wang , Chi-Cheng Huang , Ling-Ming Tseng","doi":"10.1016/j.asjsur.2025.08.311","DOIUrl":"10.1016/j.asjsur.2025.08.311","url":null,"abstract":"<div><h3>Background</h3><div>Specimen mammography (SM) is routinely used to assess surgical margins in non-palpable mammography (MMG)-detected breast lesions. Standard specimen MMG (SSM) requires physical transportation, which is time-consuming, while intraoperative specimen MMG (ISM) offers an alternative. This study compares outcomes of ISM and SSM regarding margin status and reoperation rates.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 1119 patients who underwent MMG-guided wide excision from October 2017 to August 2021. Specimens were assessed via SSM (n = 579) or ISM (n = 537). Outcomes included operative time, margin status, and re-excision rates. Comparisons were adjusted for clinical and pathological variables.</div></div><div><h3>Results</h3><div>ISM showed a significantly lower positive margin rate than SSM (8.73 % vs. 21.2 %, p = 0.009). Among malignancies, invasive ductal carcinoma (IDC) had a higher re-excision rate than ductal carcinoma in situ (DCIS) (73.21 % vs. 21.3 %, p < 0.001). Positive margin rates were higher in IDC (28.57 % vs. 10 %, p = 0.004). ISM significantly reduced positive margins in IDC (8.3 % vs. 40.6 %, p = 0.007). Comedo-type DCIS had a higher re-excision rate than non-comedo DCIS (32.7 % vs. 15.3 %, p = 0.009).</div></div><div><h3>Conclusion</h3><div>ISM improves margin clearance and efficiency compared to SSM, particularly in IDC cases, while comedo-DCIS remains associated with higher re-excision rates.</div></div>","PeriodicalId":55454,"journal":{"name":"Asian Journal of Surgery","volume":"49 1","pages":"Pages 83-89"},"PeriodicalIF":3.8,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145753949","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}

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