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[3D printing in surgery: relevance of technology maturity assessment in bioprinting research studies]. [3D打印在外科手术中的应用:生物打印研究中技术成熟度评估的相关性]。
Pub Date : 2024-12-04 DOI: 10.1007/s00104-024-02197-5
Markus Laubach, Hanna Hartmann, Boris M Holzapfel, Susanne Mayer-Wagner, Katja Schenke-Layland, Dietmar W Hutmacher

Biological 3D printing (bioprinting) is an extension of what is defined as additive manufacturing in the American Society for Testing and Materials (ASTM) and International Organization for Standardization (ISO) standards and is based on the automated printing of living cells and biomaterials. Researchers and experts in the field of biomaterial science, tissue engineering and regenerative medicine (TE&RM) are constantly pointing to the potential of biological 3D printing and scientific articles regularly announce the imminent clinical application. We argue in this article that these announcements are often premature and counterproductive as they focus heavily on technological progress but regularly ignore the critical stages that need to be completed in order to successfully translate a technology into the healthcare market. The technology readiness level (TRL) scale is a potentially useful tool for measuring the relative maturity of a technology in terms of overcoming a series of critical milestones. We propose an adaptation of the TRL scale and use it to discuss the current state of research on biological 3D printing. Finally, we provide specific recommendations for optimizing future research projects to pave the way for clinical applications of biological 3D printing and thus achieve a direct positive impact on surgical patient care.

生物3D打印(生物打印)是美国材料测试协会(ASTM)和国际标准化组织(ISO)标准中增材制造定义的延伸,基于活细胞和生物材料的自动打印。生物材料科学、组织工程和再生医学(TE&RM)领域的研究人员和专家不断指出生物3D打印的潜力,科学文章定期宣布即将进行临床应用。我们在本文中认为,这些声明往往是不成熟的,而且适得其反,因为它们主要关注技术进步,但经常忽略将技术成功转化为医疗保健市场所需完成的关键阶段。技术就绪级别(TRL)是衡量技术相对成熟度的潜在有用工具,可以克服一系列关键里程碑。我们提出了一个适应TRL的尺度,并用它来讨论生物3D打印的研究现状。最后,我们提出了优化未来研究项目的具体建议,为生物3D打印的临床应用铺平道路,从而实现对外科患者护理的直接积极影响。
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引用次数: 0
[Conversion to outpatient treatment beyond the hybrid DRG-A view abroad]. [国外对混合 DRG-A 以外的门诊治疗的看法]。
Pub Date : 2024-12-01 Epub Date: 2024-09-05 DOI: 10.1007/s00104-024-02166-y
Franziska Peters, Jörg-Peter Ritz

Outpatient visceral surgery is still in its infancy in Germany. While hernia repair that can be performed on an outpatient basis is still being discussed in this country, larger visceral surgery procedures such as thyroidectomy, fundoplication, bariatric procedures and colorectal resection are increasingly being performed abroad on an outpatient basis or in a short inpatient setting (< 24 h). The USA is the pioneer of outpatient care. Due to the private sector character of the American health insurance system, structures were created that ensure seamless care for patients. Overall, a look abroad shows that outpatient surgical procedures are a promising development that can also be further promoted in Germany through appropriate measures and strategies.

在德国,门诊内脏手术仍处于起步阶段。虽然德国仍在讨论可在门诊进行的疝气修补术,但甲状腺切除术、胃底折叠术、减肥手术和结肠直肠切除术等大型内脏外科手术越来越多地在国外的门诊或短期住院环境中进行 (
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引用次数: 0
Secondary wound closure with a new transparent negative-pressure dressing. 采用新型透明负压敷料进行二次伤口闭合。
Pub Date : 2024-12-01 Epub Date: 2023-05-22 DOI: 10.1007/s00104-023-01864-3
Gunnar Loske

Secondary healing surgical wounds can be treated with negative-pressure therapy. Dressing changes can be painful due to the strong adherence of the polyurethane foam placed in the wound. After debridement and conditioning of the wound bed, secondary surgical wound closure with a surgical suture can be performed. Cutaneous negative-pressure therapy is used preventively after primary surgical suturing. Descriptions for secondary wound closure without a surgical suture are not known to date. The preparation and handling of an innovative transparent dressing for the cutaneous application of negative-pressure therapy is demonstrated here. The dressing assembly consists of a transparent drainage film and a transparent occlusion film. Negative pressure is applied via a tubing connector using a negative pressure pump. A new method of secondary wound closure using the transparent negative-pressure dressing is presented based on a case example. The treatment cycle with instructions for making the dressing is shown in a video.

二次愈合的外科伤口可以用负压治疗。由于放置在伤口上的聚氨酯泡沫的强力粘附,换药可能会很痛苦。在清创和伤口床调理后,可以进行外科缝合的二次手术伤口闭合。皮肤负压治疗在初次手术缝合后预防性使用。没有手术缝线的继发性伤口闭合的描述尚不清楚。制备和处理一种创新的透明敷料的皮肤应用负压治疗是演示在这里。敷料组件包括透明引流膜和透明闭塞膜。负压通过使用负压泵的油管连接器施加。通过一个实例,提出了一种利用透明负压敷料进行二次创面闭合的新方法。视频中展示了治疗周期和制作敷料的说明。
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引用次数: 0
Evaluation of the outcomes of fistulotomy with primary sphincter reconstruction in the management of high trans-sphincteric fistula and supra-sphincteric fistula-in-ano : A single-center prospective cohort study. 在治疗高位经括约肌瘘和括约肌上瘘中的瘘管切开术和原发性括约肌重建术的疗效评估:一项单中心前瞻性队列研究。
Pub Date : 2024-12-01 Epub Date: 2024-08-16 DOI: 10.1007/s00104-024-02134-6
Basma Hussein Abdelaziz Hassan, Philobater Bahgat Adly Awad, Mostafa Mohamed Abdelaziz, Mohammed Hossam, Mohamed Ali Mohamed Nada

Background: Supra-sphincteric and high trans-sphincteric fistula are very challenging procedures for both the patient and the surgeon. We aimed to evaluate the outcomes of anal sphincter repair in the management of supra-sphincteric and high trans-sphincteric fistula-in-ano in terms of postoperative wound infection, bleeding, incontinence to flatus or stool, and recurrence within 1 year.

Patients and methods: This single-center prospective cohort trial conducted from June 2020 to December 2023 at the Ain Shams University Hospitals included 20 patients who presented with supra-sphincteric or high trans-sphincteric fistula. There were nine (45%) male and 11 (55%) female patients, with a mean age of 41.5 years postoperatively.

Results: The mean duration of the procedure was 90.3 min (SD ± 11.9). During the first 2 weeks, ten (50%) patients scored their postoperative pain as mild, eight (40%) as moderate, and two (10%) as severe. Wound infection occurred in two (10%) patients and postoperative bleeding in three (15%) patients in the form of spotting after defecation. There were no cases of incontinence to stool. However, there were three (15%) cases of incontinence to gases. There were two cases (10%) of recurrence at the 1‑year follow-up. Postoperative patient satisfaction was assessed on a 5‑point Likert scale after 2 weeks: One patient (5%) was very dissatisfied, three (15%) patients were dissatisfied, and two (10%) patients were unsure, while five (25%) patients were satisfied and nine (45%) were very satisfied.

Conclusion: Immediate sphincter repair in supra-sphincteric and high trans-sphincteric fistula through a lay-open procedure was determined to be safe, easier than classic operations, and associated with a low incidence of recurrence at the 1‑year follow-up and a high quality of life.

背景:括约肌上瘘和高位经括约肌瘘对患者和外科医生来说都是非常具有挑战性的手术。我们的目的是评估肛门括约肌修复术在治疗括约肌上瘘和高位经括约肌肛瘘中的效果,包括术后伤口感染、出血、平卧或大便失禁以及一年内的复发情况:这项单中心前瞻性队列试验于 2020 年 6 月至 2023 年 12 月在艾因夏姆斯大学医院进行,共纳入 20 名括约肌上瘘或高位跨括约肌瘘患者。其中男性患者 9 人(45%),女性患者 11 人(55%),术后平均年龄 41.5 岁:手术平均持续时间为 90.3 分钟(标准差 ± 11.9)。在最初两周内,10 名患者(50%)将术后疼痛评为轻度,8 名患者(40%)评为中度,2 名患者(10%)评为重度。两名患者(10%)出现伤口感染,三名患者(15%)术后出血,表现为排便后点滴出血。没有大便失禁的病例。但有三例(15%)患者出现气体失禁。在一年的随访中,有两例(10%)复发。术后 2 周后,患者满意度以 5 分 Likert 量表进行评估:1名患者(5%)非常不满意,3名患者(15%)不满意,2名患者(10%)不确定,5名患者(25%)满意,9名患者(45%)非常满意:括约肌上瘘和高位经括约肌瘘的括约肌即刻修复术采用平卧开腹手术安全、比传统手术简单,随访一年后复发率低,患者生活质量高。
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引用次数: 0
Comparison between stapled hemorrhoidopexy and harmonic scalpel hemorrhoidectomy in the management of third- and fourth-degree piles: a randomized clinical trial. 在治疗三度和四度痔疮时,比较订书钉痔疮切除术和谐波刀痔疮切除术:随机临床试验。
Pub Date : 2024-12-01 Epub Date: 2023-12-29 DOI: 10.1007/s00104-023-02010-9
Mohamed Ali Mohamed Nada, Philobater Bahgat Adly Awad, Andrew Morcos Azmy Kirollos, Mostafa Mohamed Abdelaziz, Karim Mohamed Saad Mohamed, Kerolos Bahgat Adly Awad, Basma Hussein Abdelaziz Hassan

Background: This study compared the results of stapled hemorrhoidopexy (SH) and harmonic scalpel hemorrhoidectomy (HSH) in the management of grade III and grade IV piles regarding the time of the procedure, postoperative pain, patient satisfaction, wound infection, bleeding, incontinence, and recurrence within 1 year.

Patients and methods: This was a single-blind, prospective, randomized, controlled, single-center trial conducted from January to December 2022 that included 50 (68.75%) male and 20 (31.25%) female patients with third- and fourth-degree piles.

Results: The patients were divided into two groups of 35 patients each. Group I underwent SH and group II underwent HSH. The mean age of group I was 42.94 years and of group II, 42.20 years. The mean time of the procedure was 24.42 min ± 2.367 for SH and 31.48 min ± 2.21 for HSH. Postoperative pain in group I was lower than in group II during the first 2 weeks, but there was persistent mild pain in most patients in group I at the 2‑week follow-up. In group II there was significant improvement in pain after 2 weeks, with higher patient satisfaction. Wound infection was detected in 3 (5%) patients in group I and no patients in group II (p = 0.077). Postoperative bleeding occurred in 4 (11.4%) patients in group I in the form of spotting after defecation only during the first postoperative month; no bleeding was detected in group II (p = 0.039). There were 3 (15%) cases of flatus incontinence but after taking a detailed history these were found to be cases of urgency to defecate rather than incontinence. There were 7 (20%) cases of recurrence at the 1‑year follow-up in group I and 1 (2.9%) case in group II (p = 0.024).

Conclusion: Compared with SH, HSH was safer, easier, and associated with a lower incidence of recurrence after 1 year and with higher patient satisfaction.

背景:本研究比较了订书钉痔疮切除术(SH)和谐波刀痔疮切除术(HSH)在治疗III级和IV级痔疮时,在手术时间、术后疼痛、患者满意度、伤口感染、出血、大小便失禁和1年内复发方面的效果:这是一项于2022年1月至12月进行的单盲、前瞻性、随机对照、单中心试验,纳入了50名(68.75%)男性和20名(31.25%)女性三度和四度痔疮患者:患者分为两组,每组35人。第一组接受肛门指诊,第二组接受肛门指诊。第一组的平均年龄为 42.94 岁,第二组为 42.20 岁。SH手术的平均时间为(24.42 min ± 2.367)分钟,HSH手术的平均时间为(31.48 min ± 2.21)分钟。术后头两周,第一组患者的疼痛感低于第二组,但在两周的随访中,第一组的大多数患者仍有轻微疼痛感。第二组患者在两周后疼痛明显改善,患者满意度更高。第一组有 3 名患者(5%)发现伤口感染,第二组没有发现(P = 0.077)。I 组有 4 例(11.4%)患者术后出血,仅在术后第一个月出现排便后点滴出血;II 组未发现出血(P = 0.039)。有 3 例(15%)患者出现肠胀气失禁,但在详细询问病史后,发现这些患者是排便急迫而非失禁。在一年的随访中,I 组有 7 例(20%)复发,II 组有 1 例(2.9%)复发(P = 0.024):结论:与 SH 相比,HSH 更安全、更简便,1 年后复发率更低,患者满意度更高。
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引用次数: 0
[Hybrid diagnosis-related groups-The challenge]. [混合诊断相关小组--挑战]。
Pub Date : 2024-12-01 Epub Date: 2024-11-06 DOI: 10.1007/s00104-024-02196-6
Tobias Kisch, Ralf Müller-Rath, Sven Gregor, Ralph Lorenz, Axel Neumann, Stephan Dittrich, Michael Müller, Ralf Lippert, Jan Henniger, Burkhard Lembeck, Eva-Maria Baur, Jörg Karst, Frank Vescia, Ralf Schmitz

The introduction of hybrid diagnosis-related groups (DRG) presents new challenges for healthcare providers and health insurances. The same applied in 2023 to the institute designated by the Federal Ministry of Health (BMG) to extract medical procedures and calculate remuneration levels for the first hybrid DRGs. A responsible calculation methodology and a realistic data basis are required as the result of the calculation can lead to controversy, even to a splitting among specialist groups and constructs. There is also the threat of mismanagement with subsequent supply problems. In this context, a loss of quality can occur due to the use of simple surgical procedures that are less complex and not expensive with respect to material costs and are economical but not state of the art and thus directly worsen the medical care of patients in the statutory health insurance (GKV). Furthermore, it is already becoming apparent that procedures that are uneconomical due to the miscalculation are partially no longer being comprehensively rendered by healthcare providers due to adjustment of the service portfolio. An appropriate compensation of procedures is only possible based on a remuneration that adequately covers the costs. In this respect, this article is not intended to be understood as a "solution to the problem of the internal distribution of the remuneration in hybrid DRGs" but more to offer suggestions for solutions for the required further development of the hybrid DRG compensation level calculation to prevent a threat to the treatment of GKV patients due to mismanagement. As required in § 115f of the Sozialgesetzbuch V (SGB V), the recalculation of an economic remuneration must be carried out urgently and promptly using an empirical calculation basis and methodology and this must be regularly adapted.

混合诊断相关分组(DRGs)的引入为医疗服务提供者和医疗保险机构带来了新的挑战。联邦卫生部(BMG)于 2023 年指定了一家机构,负责提取医疗程序并计算首批混合诊断相关分组的报酬水平。由于计算结果可能会引起争议,甚至导致专家小组和结构的分裂,因此需要一个负责任的计算方法和现实的数据基础。此外,还可能出现管理不善和随后的供应问题。在这种情况下,使用简单的外科手术可能会导致质量下降,因为这些手术并不复杂,在材料成本方面也不昂贵,虽然经济实惠,但并不先进,因此直接恶化了法定医疗保险(GKV)患者的医疗服务。此外,由于服务组合的调整,医疗服务提供者部分不再全面提供因计算错误而不经济的程序,这一点已经变得很明显。只有在报酬能够充分补偿成本的基础上,才有可能对手术进行适当补偿。在这方面,本文无意被理解为 "混合 DRGs 薪酬内部分配问题的解决方案",而更多的是为混合 DRGs 薪酬水平计算的进一步发展提供解决方案建议,以防止因管理不善而对 GKV 患者的治疗造成威胁。正如《社会法典第五编》(SGB V)第 115f 条所要求的,经济报酬的重新计算必须紧急、迅 速地使用经验计算基础和方法,并且必须定期进行调整。
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引用次数: 0
[Change to outpatient treatment in surgery]. [外科手术改为门诊治疗]。
Pub Date : 2024-12-01 Epub Date: 2024-11-25 DOI: 10.1007/s00104-024-02163-1
Christoph Reißfelder
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引用次数: 0
[Extended mesenterial resection vs. mesentery-sparing resection in ileocolic resection for Crohn's disease]. [克罗恩病回肠结肠切除术中的肠系膜扩大切除术与肠系膜保留切除术]。
Pub Date : 2024-12-01 Epub Date: 2024-10-04 DOI: 10.1007/s00104-024-02188-6
C T Germer, J Reibetanz
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引用次数: 0
[Feasibility and structural prerequisites for conversion to outpatient treatment in proctology]. [肛肠科转为门诊治疗的可行性和结构性先决条件]。
Pub Date : 2024-12-01 Epub Date: 2024-09-13 DOI: 10.1007/s00104-024-02168-w
Stefan Fritz, Christoph Reissfelder, Dieter Bussen

Background: Despite the introduction of the diagnosis-related groups (DRG) system, costs in the German healthcare system have risen continuously for years. In order to reduce costs the federal government is aiming to shift inpatient services to the outpatient sector. Outpatient services affect many areas of medicine, including proctological operations as these are common and can often be carried out on an outpatient basis.

Objective: The aim of the present work is to discuss which areas of proctology are suitable for outpatient treatment and which structural requirements are necessary.

Material and methods: The present article is intended to provide a narrative overview with reference to the literature on the topic of outpatient care in proctology. A literature search was carried out using the following keywords: outpatient care, selective sector-level remuneration, day care, proctological operations, AOP catalog and hybrid DRG.

Results: In proctology, outpatient surgical care is implementable in many cases; however, not every patient is suitable for this. In addition to previous illnesses, patient compliance and the possibility of postoperative care from relatives must also be taken into account. In addition, emergency treatment must be guaranteed. Contraindications include severe heart and circulatory diseases as well as severe coagulation or organ dysfunction. Extensive abscesses, complex fistulas or sphincter reconstructions should be surgically treated in an inpatient setting. The prerequisite for successful outpatient care is to make the sector boundaries between outpatient and inpatient patient care more permeable and to adequately remunerate the interventions.

Conclusion: In addition to the surgical indications, the prerequisites for successful proctological operations are the correct assessment of the operational capability and compliance. From an organizational and economic perspective, better networking between outpatient and inpatient treatment and equal remuneration across the sector boundaries are crucial.

背景:尽管引入了诊断相关分组(DRG)系统,但德国医疗系统的成本多年来一直在持续上升。为了降低成本,联邦政府正致力于将住院服务转向门诊服务。门诊服务影响到许多医疗领域,包括肛肠科手术,因为这些手术很常见,通常可以在门诊进行:本文旨在讨论肛肠科的哪些领域适合门诊治疗,以及哪些结构要求是必要的:本文旨在参考有关肛肠科门诊治疗这一主题的文献,提供一个叙述性概述。文献检索使用了以下关键词:门诊护理、选择性部门级薪酬、日间护理、肛肠科手术、AOP 目录和混合 DRG:在肛肠科,门诊手术护理在很多情况下都可以实施,但并不是每个病人都适合。除了既往疾病外,还必须考虑患者的依从性以及术后亲属护理的可能性。此外,还必须保证紧急治疗。禁忌症包括严重的心脏和循环系统疾病,以及严重的凝血功能障碍或器官功能障碍。大面积脓肿、复杂的瘘管或括约肌重建应在住院环境中进行手术治疗。成功开展门诊治疗的前提是使门诊和住院病人治疗之间的部门界限更加透明,并为干预措施提供足够的报酬:除手术适应症外,成功进行肛肠科手术的先决条件是正确评估操作能力和遵守规定。从组织和经济角度来看,门诊治疗和住院治疗之间更好的联网以及跨部门的平等薪酬至关重要。
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引用次数: 0
[Outpatient treatment for hernia surgery in Germany]. [德国疝气手术的门诊治疗]。
Pub Date : 2024-12-01 Epub Date: 2024-09-13 DOI: 10.1007/s00104-024-02164-0
Bernhard J Lammers, Alexis Ulrich

Outpatient surgery in the treatment of hernia is currently a major challenge for patients and treating physicians in Germany due to the new legal regulations (key term hybrid diagnosis-related groups, DRG). Despite large economic challenges and empty funds, the principle of medical treatment is still the patient-oriented scientifically founded medicine. Although outpatient treatment would be very desirable, clear medical knowledge should the basis for the justification of surgical strategies: outpatient short hospitalization (24h) or fully inpatient hospitalization (>24h). A completely outpatient treatment of hernias is not meaningful and the demarcation of outpatient, short inpatient and inpatient treatment should be demonstrated in a risk-adjusted manner. A classification is essential, particularly against the background of an intersectoral hybrid DRG.

在德国,由于新的法律规定(关键术语混合诊断相关组,DRG),治疗疝气的门诊手术目前对患者和主治医生来说都是一大挑战。尽管面临巨大的经济挑战和资金空虚,但医疗原则仍然是以患者为导向的科学医疗。虽然门诊治疗非常理想,但明确的医学知识应成为手术策略的依据:门诊短期住院(24 小时)或完全住院(>24 小时)。完全在门诊治疗疝气是没有意义的,应该以风险调整的方式来区分门诊治疗、短期住院治疗和住院治疗。特别是在跨部门混合 DRG 的背景下,分类至关重要。
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引用次数: 0
期刊
Chirurgie (Heidelberg, Germany)
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