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[Pancreatic cystic neoplasms]. [胰腺囊性肿瘤]。
Pub Date : 2024-11-01 Epub Date: 2024-08-29 DOI: 10.1007/s00104-024-02143-5
Maximilian Brunner, Robert Grützmann

Pancreatic cystic lesions represent a challenging heterogeneous entity with a potential risk of malignant transformation. The diagnostics include in particular medical history taking with collection of relevant clinical information and high-resolution imaging, preferably using magnetic resonance imaging (MRI) with MR cholangiopancreatography (MRCP) and/or endoscopic ultrasonography. A differentiation between different cystic entities and identification of risk factors are crucial for making appropriate treatment decisions. Only a small proportion of pancreatic cystic neoplasms require surgery. Pancreatic cystic lesions with a relevant risk of malignancy, such as main duct intraductal papillary mucinous neoplasms (IPMN), mucinous cystic neoplasms (MCN), solid pseudopapillary neoplasms (SPN) and general cystic pancreatic lesions with risk factors regardless of the entity, should be resected, whereas an individualized approach is required for branch duct IPMN and serous cystic neoplasms (SCN) and dysontogenetic cysts require no treatment. Parenchyma-sparing and minimally invasive resection techniques should be preferred whenever possible for resecting pancreatic cystic tumors. Approximately 10% of patients develop recurrences over time.

胰腺囊性病变是一种具有挑战性的异质性病变,有恶变的潜在风险。诊断尤其包括病史采集、相关临床信息收集和高分辨率成像,最好使用磁共振成像(MRI)、磁共振胰胆管造影(MRCP)和/或内镜超声波检查。区分不同的囊肿实体和识别风险因素对于做出适当的治疗决定至关重要。只有一小部分胰腺囊性肿瘤需要手术治疗。具有相关恶性风险的胰腺囊性病变,如主导管内乳头状粘液瘤(IPMN)、粘液性囊性病变(MCN)、实性假乳头状瘤(SPN)和具有风险因素的一般胰腺囊性病变,无论其实体如何,都应切除、而对于分支管 IPMN、浆液性囊性瘤(SCN)和发育不良性囊肿则无需治疗。在切除胰腺囊性肿瘤时,应尽可能选择保全实质和微创切除技术。大约 10%的患者会随着时间的推移出现复发。
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引用次数: 0
[Perioperative results between cervical and retrosternal goiter : An international multicenter analysis]. [颈部甲状腺肿和胸骨后甲状腺肿的围手术期结果:国际多中心分析]。
Pub Date : 2024-11-01 Epub Date: 2024-09-20 DOI: 10.1007/s00104-024-02182-y
Ioannis Mintziras, Detlef K Bartsch
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引用次数: 0
[Modern approaches and technologies to prevent anastomotic leakage in the gastrointestinal tract]. [预防胃肠道吻合口漏的现代方法和技术]。
Pub Date : 2024-11-01 Epub Date: 2024-09-28 DOI: 10.1007/s00104-024-02179-7
Kamacay Cira, Dirk Wilhelm, Philipp-Alexander Neumann

The healing of gastrointestinal anastomoses is a complex biological process influenced by numerous factors. Various strategies to support healing and prevent anastomotic leakage (AL) exist, encompassing preoperative, intraoperative and postoperative measures. Preoperative interventions aim to optimize the patient and the tissue environment, particularly the gut microbiome. Intraoperative measures are technical in nature and include the choice of surgical access, the anastomotic technique and anastomotic reinforcement. Various procedures of the intraoperative diagnostics enable identification of such anastomoses requiring additional protective measures. Recently, indocyanine green (ICG) fluoroscopy has become established for evaluation of tissue perfusion, while newer techniques such as spectral microscopy offer promising possibilities. Postoperative diagnostic methods aim to identify potential AL as early as possible to enable initiation of therapeutic steps even before the onset of symptoms. These procedures range from various imaging techniques to innovative bioresorbable, pH-sensitive implants for early AL detection. Due to the multifactorial genesis of AL and the diverse technical possibilities, no single method will become established for prevention of AL. Instead, a combination of measures will ultimately lead to optimal anastomotic healing. The use of artificial intelligence and analyses based on the data promises a better interpretation of the vast amount of data and therefore to be able to provide general recommendations.

胃肠道吻合口的愈合是一个复杂的生物学过程,受多种因素的影响。支持愈合和预防吻合口漏(AL)的策略多种多样,包括术前、术中和术后措施。术前干预旨在优化患者和组织环境,尤其是肠道微生物群。术中措施属于技术性措施,包括手术入路的选择、吻合技术和吻合口加固。术中诊断的各种程序可以识别需要额外保护措施的吻合口。最近,吲哚菁绿(ICG)透视技术已被用于评估组织灌注,而光谱显微镜等新技术也提供了很好的可能性。术后诊断方法的目的是尽早发现潜在的 AL,以便在症状出现之前就采取治疗措施。这些方法包括各种成像技术,以及用于早期 AL 检测的创新型生物可吸收、pH 值敏感植入物。由于 AL 的成因是多方面的,技术可能性也多种多样,因此没有任何一种方法可以预防 AL。取而代之的是,各种措施的综合应用将最终实现最佳的吻合口愈合。人工智能的使用和基于数据的分析有望更好地解读大量数据,从而提供一般性建议。
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引用次数: 0
[Predictability of anastomotic leaks in visceral surgery]. [内脏手术吻合口漏的可预测性]。
Pub Date : 2024-11-01 Epub Date: 2024-09-24 DOI: 10.1007/s00104-024-02175-x
Jin-On Jung, Georg Dieplinger, Christiane Bruns

Anastomotic leakage in visceral surgery is associated with a large number of known and also unknown or even unmeasurable parameters. Furthermore, the associations between the individual factors are intertwined and complex. According to current data a preoperative prediction is not reliably possible and should be distinguished from intraoperative or postoperative prediction models. Most studies on this topic do not exceed an area under the curve (AUC) of 0.70. A thorough understanding of statistics and prediction models is necessary to correctly interpret the published works. Due to the relatively low incidence rate of anastomotic leakage from a statistical point of view, large datasets are required for adequate prediction. Multimodal data and complex algorithms can potentially handle big data more accurately and improve predictability; however, these models have so far not been applied in the clinical routine.

内脏手术中的吻合口渗漏与大量已知、未知甚至无法测量的参数有关。此外,各个因素之间的关联错综复杂。根据目前的数据,术前预测并不可靠,应区别于术中或术后预测模型。大多数相关研究的曲线下面积(AUC)不超过 0.70。要正确理解已发表的研究成果,必须对统计学和预测模型有透彻的了解。从统计学角度来看,吻合口漏的发生率相对较低,因此需要大量数据集才能进行充分预测。多模态数据和复杂算法有可能更准确地处理大数据并提高预测能力;然而,这些模型至今尚未应用于临床常规。
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引用次数: 0
[Anastomotic leakage in visceral surgery]. [内脏手术中的吻合口漏]。
Pub Date : 2024-11-01 Epub Date: 2024-10-18 DOI: 10.1007/s00104-024-02187-7
Georg Dieplinger, Christiane Bruns
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引用次数: 0
[Anastomotic leakage following surgical resection in the upper gastrointestinal tract]. [上消化道手术切除后的吻合口渗漏]。
Pub Date : 2024-11-01 Epub Date: 2024-09-24 DOI: 10.1007/s00104-024-02174-y
Felix Berlth, Dörte Wichmann, Stefano Fusco, André Mihaljevic

Surgical resection is the consistent component of curative treatment strategies for primary malignant diseases of the stomach and the esophagus. The placement of anastomoses for the necessary reconstruction still accounts for substantial morbidity and in the case of a failure to rescue also for mortality, especially for esophagojejunostomy and esophagogastrostomy. The diagnostics of anastomotic leakage routinely involve computed tomography and endoscopy and timely performance appears to be essential. Endoscopy can simultaneously initiate the essential treatment step. A major reason for the improvement of postoperative outcomes after resection in the upper gastrointestinal tract in the last decades is the successful and mostly endoscopically performed management of anastomotic leakage, whereby different endoscopic treatment options are now available. Endoscopic vacuum therapy has become established as the standard, normally with an endoscopic vacuum sponge technique but is also now supplemented by a combination system of vacuum sponge and stent. Furthermore, a foil-coated multiple lumen nasogastric tube represents another available option, which can possibly especially be used as a prophylactic measure. The longest established endoscopic therapy option for anastomotic leaks, the endoluminal metal stent, has been replaced as the standard by the vacuum treatment but is still used in suitable situations. Additionally, there are endoscopic suture devices that are currently only used very occasionally. Surgical revision is always available as treatment escalation but is only recommended for very early occurrences and possibly technically related anastomotic leakage and in the case of failure of endoscopic treatment. This article describes and summarizes the diagnostics and treatment of anastomotic leakages after surgical procedures of the upper gastrointestinal tract.

手术切除是胃和食道原发性恶性疾病治愈性治疗策略的一贯组成部分。为进行必要的重建而放置吻合口仍会导致大量的发病率,在抢救失败的情况下还会导致死亡,尤其是食管空肠吻合术和食管胃造瘘术。吻合口漏的常规诊断包括计算机断层扫描和内窥镜检查,及时进行诊断似乎至关重要。内镜检查可同时启动必要的治疗步骤。过去几十年来,上消化道切除术后疗效得到改善的一个主要原因是吻合口漏的成功治疗,而且大多是在内镜下进行的,现在有了不同的内镜治疗方案。内镜真空疗法已成为标准疗法,通常采用内镜真空海绵技术,但现在也有真空海绵和支架组合系统作为补充。此外,箔涂层多腔鼻胃管也是另一种可用的选择,尤其可用作预防措施。内腔金属支架是治疗吻合口漏时间最长的内镜疗法,已被真空疗法取代,但在适当的情况下仍可使用。此外,还有内镜缝合装置,但目前只是偶尔使用。手术翻修始终可以作为治疗的升级手段,但只推荐用于非常早期的吻合口漏和可能与技术有关的吻合口漏,以及内窥镜治疗失败的情况。本文介绍并总结了上消化道手术后吻合口漏的诊断和治疗方法。
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引用次数: 0
[Optimal surveillance interval for patients with branch duct intraductal papillary mucinous neoplasms of the pancreas (IPMN)]. [胰腺分支导管内乳头状黏液瘤(IPMN)患者的最佳监测间隔时间]。
Pub Date : 2024-11-01 Epub Date: 2024-09-23 DOI: 10.1007/s00104-024-02185-9
J Fritsch, M Ardelt, U Settmacher
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引用次数: 0
[Anastomotic leakage in hepato-pancreato-biliary surgery]. [肝胰胆手术中的吻合口漏]。
Pub Date : 2024-11-01 Epub Date: 2024-09-28 DOI: 10.1007/s00104-024-02176-w
Emrullah Birgin, Jan Heil, Benjamin Walter, Martin Wagner, Benjamin Müssle, Marko Kornmann, Thomas Seufferlein, Nuh N Rahbari

Severe complications following hepato-pancreato-biliary surgery are frequently due to leakage of anastomoses. Local intraoperative and systematic measures can reduce the incidence of leaks and leak-related sequelae. The early identification of leak-related sequelae, such as hemorrhage is pivotal to reduce the mortality risk. Therefore, perioperative risk stratification incorporating surgical and patient risk factors is crucial. The management of anastomotic leaks is complex and an interdisciplinary treatment is therefore recommended. The treatment depends on the institutional expertise, localization, characteristic features of the anastomosis and the onset of insufficiency. This article describes the different concepts of the diagnostics, prevention, consequences and management of anastomotic leakage in hepato-pancreato-biliary surgery in more detail.

肝胆胰外科手术后的严重并发症常常是由于吻合口渗漏造成的。术中采取局部措施和系统性措施可以降低渗漏和渗漏相关后遗症的发生率。早期发现与渗漏相关的后遗症,如出血,对于降低死亡风险至关重要。因此,结合手术和患者风险因素进行围手术期风险分层至关重要。吻合口漏的处理非常复杂,因此建议采用跨学科治疗。治疗方法取决于相关机构的专业知识、定位、吻合口的特征以及吻合口功能不全的发病时间。本文将详细介绍肝胆胰外科吻合口漏的诊断、预防、后果和处理的不同概念。
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引用次数: 0
[The use of botulinum toxin in hernia surgery: results of a survey in certified hernia centers]. [疝气手术中肉毒素的使用:认证疝气中心的调查结果]。
Pub Date : 2024-11-01 Epub Date: 2024-06-25 DOI: 10.1007/s00104-024-02121-x
Sebastian Schaaf, Aliona Wöhler, Patricia Gerlach, Arnulf G Willms, Robert Schwab

Background: Botulinum toxin application into the abdominal wall prior to major hernia repair can reduce the complexity of surgery and has been increasingly used in recent years, even if it is an off-label use.

Objective: To what extent is botulinum toxin used in hernia surgery in German-speaking countries and what is the current evidence in the literature?

Material and methods: In a voluntary online survey of German Society for General and Visceral Surgery (DGAV)-certified competence centers and reference centers for hernia surgery, aspects of botulinum toxin application were surveyed and the results analyzed.

Results: A total of 57 centers took part in the survey, of which 27 (47%) use botulinum toxin. The main reasons for not using it were lack of experience and reimbursement. Of the centers 85% have treated less than 50 patients with botulinum toxin. The main indications were midline hernias (M2-4 according to the EHS classification) with a hernia gap > 10 cm (W3 according to EHS classification) and loss of domain situations. The application was predominantly ultrasound-guided by designated hernia surgeons with 100-200 Allergan or 500 Speywood units 4-6 weeks preoperatively and without complications related to the botulinum toxin application.

Conclusion: Botulinum toxin injections in hernia surgery appear to be safe and effective. Ultrasound-guided preoperative bilateral administration is supported by the available data. Specific course and information formats should be offered by the hernia surgery institutions.

背景:在疝气修补术前将肉毒杆菌毒素应用于腹壁可降低手术的复杂性,近年来,即使是标签外使用,也越来越多地使用肉毒杆菌毒素:目的:在德语国家,肉毒杆菌毒素在疝气手术中的应用程度如何,目前的文献证据如何?对德国普通与内脏外科学会(DGAV)认证的疝气手术能力中心和参考中心进行自愿在线调查,调查肉毒杆菌毒素应用的各个方面,并对结果进行分析:共有 57 家中心参与了调查,其中 27 家(47%)使用了肉毒杆菌毒素。不使用的主要原因是缺乏经验和报销问题。85%的中心使用肉毒杆菌毒素治疗过不到50名患者。主要适应症是疝气间隙大于 10 厘米(根据 EHS 分类为 W3)的中线疝气(根据 EHS 分类为 M2-4)和疝气域缺失情况。肉毒素注射主要由指定的疝外科医生在超声波引导下进行,术前4-6周注射100-200 Allergan或500 Speywood单位,没有出现与肉毒素注射相关的并发症:结论:在疝气手术中注射肉毒杆菌毒素似乎是安全有效的。现有数据支持在超声引导下进行术前双侧注射。疝气手术机构应提供具体的课程和信息形式。
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引用次数: 0
[POSE-2 for patients with obesity: a safe and effective treatment option]. [针对肥胖症患者的 POSE-2:一种安全有效的治疗方案]。
Pub Date : 2024-11-01 Epub Date: 2024-09-26 DOI: 10.1007/s00104-024-02186-8
Alida Finze, Christine Stier, Christoph Reißfelder
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引用次数: 0
期刊
Chirurgie (Heidelberg, Germany)
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