Surgery in practice and science最新文献

Associations between obesity and lymph node metastasis and early recurrence in pancreatic head cancer: A single-center retrospective cohort study 肥胖与胰头癌淋巴结转移和早期复发的关系：一项单中心回顾性队列研究

IF 0.8 Q4 SURGERY

Surgery in practice and science

Pub Date : 2026-01-28 DOI: 10.1016/j.sipas.2026.100329

Kazuhiro Tada, Yo-ichi Yamashita, Naotaka Inomata, Sota Nakamura, Shun Nakamura, Shohei Yoshiya, Yosuke Kuroda, Kentaro Iwaki, Shoji Hiroshige, Kengo Fukuzawa

Background

Obesity may contribute to pancreatic cancer development via metabolic modulation. The number of obese patients with pancreatic cancer is expected to increase worldwide. Herein, we investigated the effects of obesity on patients with pancreatic head cancer who underwent pancreaticoduodenectomy (PD).

Methods

We reviewed 141 consecutive PDs and compared clinicopathological factors and survival outcomes in obese (O: 29 patients) or non-obese (N: 112 patients) groups. Obesity was defined as a body mass index > 25 kg/m².

Results

Intraoperative bleeding was higher in the O group than in the N group (450 vs. 280 mL, p < 0.001); however, there were no intergroup differences in operation time, frequencies of Clavien-Dindo grade Ⅲ or higher morbidities, pancreatic fistula grade B or higher, or postoperative hospital stay duration. There were no significant intergroup differences in the radical resection rate, but the O group had more advanced tumor-related factors than the N group, with higher lymphatic invasion (79 vs. 46%, p = 0.002) and lymph node metastasis rates (90 vs. 68%, p = 0.019). There was no intergroup difference in the rate of postoperative adjuvant therapy; however, the recurrence rate tended to be higher (83% vs. 69%, p = 0.136), whereas early recurrence within 6 months was significantly higher (38% vs. 19%, p = 0.02), in the O group than the N group. In addition, the median recurrence-free survival was significantly shorter in the O group than in the N group (7.6 vs. 17.3 months, p = 0.037).

Conclusions

Obesity was associated with early recurrence in patients undergoing PD for pancreatic head cancer.

背景：肥胖可能通过代谢调节促进胰腺癌的发展。肥胖胰腺癌患者的数量预计将在世界范围内增加。在此，我们研究了肥胖对胰头癌患者行胰十二指肠切除术（PD）的影响。方法回顾了141例连续的pd，比较了肥胖组（29例）和非肥胖组（112例）的临床病理因素和生存结果。肥胖被定义为体重指数为25kg /m2。结果O组术中出血量高于N组（450 vs 280 mL, p < 0.001）；然而，在手术时间、Clavien-Dindo级Ⅲ及以上发病率、B级及以上胰瘘发生率、术后住院时间等方面，组间无差异。组间肿瘤根治率差异无统计学意义，但O组肿瘤相关因素较N组更先进，淋巴浸润率（79比46%，p = 0.002）和淋巴结转移率（90比68%，p = 0.019）更高。术后辅助治疗率组间无差异；然而，O组的复发率更高（83%比69%，p = 0.136）， 6个月内早期复发率明显高于N组（38%比19%，p = 0.02）。此外，O组的中位无复发生存期明显短于N组（7.6个月对17.3个月，p = 0.037）。结论肥胖与胰头癌行PD治疗的早期复发有关。

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引用次数: 0

Pressure trends and diagnosis of acute compartment syndrome 压力趋势与急性筋膜室综合征的诊断

IF 0.8 Q4 SURGERY

Surgery in practice and science

Pub Date : 2026-01-18 DOI: 10.1016/j.sipas.2026.100327

Yasser Bouklouch , Justin Matta , William T Obremskey , Ross Leighton , Mitchell Bernstein , Edward J Harvey

Objectives

Acute compartment syndrome (ACS) is a serious condition resulting from increased intracompartmental pressure (ICP) within a closed muscle compartment. There is a lack of understanding of continuous pressure trends despite being an accepted method for tracking disease. It was hypothesized that trends in pressure would determine risk of ACS.

Methods

This is a retrospective review of collected data from two prospective cohort trials. Anonymized ICP pressures from 147 trauma patients with extremity fractures were gathered. Patient data from multicenter level one trauma academic hospitals was analyzed. Data was taken from trauma patients that received a continuous real-time pressure device. Statistical and observational analysis were carried out to examine trends in patients with and without resultant acute compartment syndrome.

Results

Patients that developed ACS did not always have significantly higher absolute ICPs that exceed the theoretical critical 30 mmHg threshold for fasciotomy. Patients with ACS showed a consistent upward trend over time (average increase of 0.674 mmHg per hour). In contrast, non-ACS patients, even those that exceeded the previous postulated 30mmHg threshold, exhibit a natural and gradual decline in ICP over time (average decline of 0.285 mmHg per hour).

Conclusions

This research highlights the limitations of single-point pressure measurements and underscores the benefits of continuous ICP monitoring for timely ACS diagnosis. Continuous pressure data enables better clinical decision-making, reducing the risk of both unnecessary and delayed fasciotomies. This study emphasizes the need for integrating continuous pressure monitoring into standard practice to improve the management and outcomes of patients at risk for ACS.

目的急性筋膜室综合征（ACS）是由于闭合性肌室腔内压力（ICP）升高而引起的一种严重疾病。尽管连续压力趋势是一种公认的追踪疾病的方法，但缺乏对其的了解。假设血压的变化趋势会决定ACS的风险。方法对两项前瞻性队列试验收集的数据进行回顾性分析。收集147例四肢骨折创伤患者的匿名颅内压。对来自多中心一级创伤专科医院的患者资料进行分析。数据取自接受连续实时压力装置的创伤患者。统计和观察分析进行了检查趋势的患者有和没有由此产生的急性筋膜间室综合征。结果发生ACS的患者的绝对icp并不总是明显高于筋膜切开术的理论临界阈值30 mmHg。ACS患者呈持续上升趋势（平均每小时增加0.674 mmHg）。相比之下，非acs患者，即使超过了先前假设的30mmHg阈值，随着时间的推移，ICP也会自然逐渐下降（平均每小时下降0.285 mmHg）。结论：本研究强调了单点压力测量的局限性，并强调了持续ICP监测对ACS及时诊断的好处。持续的压力数据有助于更好的临床决策，减少不必要和延迟的筋膜切开术的风险。本研究强调需要将持续压力监测纳入标准实践，以改善ACS风险患者的管理和预后。

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引用次数: 0

Radioguided occult lesion localisation for wide local excision, excision biopsies and in combination with radioisotope sentinel lymph node localisation (SNOLL) – 10 year experience of a single centre 放射引导下广泛局部切除、切除活检和联合放射性同位素前哨淋巴结定位（SNOLL）的隐匿性病变定位-单一中心10年经验

IF 0.8 Q4 SURGERY

Surgery in practice and science

Pub Date : 2025-12-22 DOI: 10.1016/j.sipas.2025.100326

Bahar Mirshekar-Syahkal, Haifa Alotaibi, Sendhil Rajan, Mathew Gray, David Newman, Maged Hussien

Background

Various techniques are used to localise non-palpable breast cancer and identify sentinel lymph nodes (SLN). Seed-based localisations can be expensive, may dislodge and require special intraoperative equipment. We report our experience of using radioguided occult lesion localisation (ROLL) alone and with SLN (SNOLL)

Methods

This is a retrospective review of all patients undergoing breast excision procedures using ROLL between January 2008 and 2018. On the morning of surgery or the day before, patients had 10 MBq Technetium 99 m colloid injected into the centre of the breast lesion under ultrasound guidance with a further 10 MBq injected into the periareolar skin if SLN was planned. Surgery was performed with the aid of a gamma probe to detect the radioisotope signal in the breast and axilla and specimen X-rays of the breast excision specimen were performed with cavity shaves considered if appropriate.

Results

1073 ROLL-guided excisions were performed in 1050 patients: 1043 of these were wide local excisions (WLE), which included 11 level two oncoplastic procedures, with the remaining being excision biopsies. 957 of the WLEs were SNOLL procedures. ROLL was successful in 1065 (99.3 %) procedures. Of the eight ROLL failures, three were due to incorrect lesion localisation and two were due to diffuse ROLL signal. SLN biopsy was successful in 955 (99.8 %) of cases.

Conclusions

SNOLL/ROLL is a reliable, cheap and easy localisation technique where the marker cannot be dislodged during the procedure. Both localisations are performed on the day of surgery using the same equipment for signal detection in the breast and axilla.

背景：各种技术用于定位不可触及的乳腺癌和识别前哨淋巴结（SLN）。基于种子的定位可能很昂贵，可能会脱臼，并且需要特殊的术中设备。我们报告了我们单独使用放射引导隐匿病灶定位（ROLL）和SLN （SNOLL）方法的经验。这是一项回顾性研究，涉及2008年1月至2018年期间使用ROLL进行乳房切除术的所有患者。在手术当天早晨或前一天，患者在超声引导下在乳腺病变中心注射10 MBq锝99 m胶体，如果计划进行SLN，则在乳晕周围皮肤注射10 MBq。手术在伽玛探针的帮助下进行，以检测乳房和腋窝中的放射性同位素信号，乳房切除标本的x射线标本在适当的情况下被认为是腔剃。结果1050例患者共进行了1073例roll引导切除，其中1043例为广域局部切除（WLE），其中11例为二级肿瘤成形性手术，其余为切除活检。957例wle为SNOLL程序。ROLL在1065例（99.3%）手术中成功。在8例ROLL失败中，3例是由于病灶定位不正确，2例是由于弥漫性ROLL信号。955例（99.8%）SLN活检成功。结论snoll /ROLL是一种可靠、廉价、简便的定位技术，标记物在手术过程中不会移位。这两种定位都是在手术当天进行的，使用相同的设备来检测乳房和腋窝的信号。

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引用次数: 0

Comment on “Improving consenting practice in trauma and orthopaedics: A single centre original mixed methods study” 对“改进创伤骨科的同意实践：单中心原创混合方法研究”的评论

IF 0.8 Q4 SURGERY

Surgery in practice and science

Pub Date : 2025-12-20 DOI: 10.1016/j.sipas.2025.100325

Ankit Batra , Prashant Kokiwar , Priyanka Aher , Indu Singh

引用次数: 0

From prediction to action—Making emergency laparotomy risk scores clinically usable 从预测到行动——使急诊剖腹手术风险评分具有临床应用价值

IF 0.8 Q4 SURGERY

Surgery in practice and science

Pub Date : 2025-12-19 DOI: 10.1016/j.sipas.2025.100324

Shashikanth Vijayaraghavalu

引用次数: 0

Predictors of post-operative complications following thyroid surgeries at a tertiary hospital in Tanzania 坦桑尼亚一家三级医院甲状腺手术后并发症的预测因素

IF 0.8 Q4 SURGERY

Surgery in practice and science

Pub Date : 2025-12-08 DOI: 10.1016/j.sipas.2025.100323

Albert Lazaro , Mungeni Misidai , Daniel Kitua , Abdulrahaman Amin , Charles Komba , Ally Mwanga , Larry Akoko , Nashivai Kivuyo

Background

Thyroid disorders pose a substantial burden in low- and middle-income countries (LMICs), where late presentation and limited access to specialized care often result in advanced disease at surgery. Despite thyroidectomy being the definitive treatment for many thyroid conditions, data on surgical outcomes and complication rates from sub-Saharan Africa remain scarce. This study aimed to describe the clinical characteristics, surgical approaches, and in-hospital postoperative outcomes of patients undergoing thyroidectomy at a tertiary hospital in Tanzania, and to identify factors associated with postoperative complications.

Materials and Methods

This was a hospital-based retrospective cohort study involving patients who underwent thyroid surgery between January 2018 and December 2023. Data were retrieved from case notes and surgical records in the hospital’s medical records department. Sociodemographic and clinical characteristics were analyzed as predictor variables, while postoperative in-hospital complications were the primary outcomes. Multivariable logistic regression was performed to identify independent predictors of complications.

Results

A total of 405 patients underwent thyroidectomy during the study period, with a female predominance (89.6%) and a mean age of 48 ± 13 years. The majority presented with anterior neck swelling (98.5%), and 24% had retrosternal extension. Benign pathology accounted for 77% of cases. The overall complication rate was 15.3%, with hypocalcemia (4%) and superior laryngeal nerve injury (3%) being the most common. The mortality rate was 0.5%. Independent predictors of in-hospital complications included total thyroidectomy (aOR: 3.12; 95% CI: 1.08–9.02) and symptom duration exceeding 10 years (aOR: 4.12; 95% CI: 1.60–10.58).

Conclusion

Postoperative morbidity following thyroidectomy in this setting was primarily driven by delayed presentation and the extent of surgery. Targeted interventions to promote early diagnosis and optimize perioperative care are essential to improve patient outcomes.

在低收入和中等收入国家（LMICs），甲状腺疾病是一个沉重的负担，在这些国家，姗姗来迟和获得专业护理的机会有限往往导致手术时疾病进展。尽管甲状腺切除术是许多甲状腺疾病的最终治疗方法，但撒哈拉以南非洲地区关于手术结果和并发症发生率的数据仍然很少。本研究旨在描述坦桑尼亚一家三级医院甲状腺切除术患者的临床特征、手术方式和住院术后结果，并确定与术后并发症相关的因素。材料和方法这是一项基于医院的回顾性队列研究，涉及2018年1月至2023年12月期间接受甲状腺手术的患者。数据从医院病历部门的病例记录和手术记录中检索。社会人口学和临床特征作为预测变量进行分析，而术后院内并发症是主要结局。采用多变量逻辑回归来确定并发症的独立预测因素。结果研究期间共行甲状腺切除术405例，女性占89.6%，平均年龄48±13岁。大多数患者表现为颈前肿胀（98.5%），24%为胸骨后伸展。良性病理占77%。总并发症发生率为15.3%，其中以低钙血症（4%）和喉上神经损伤（3%）最为常见。死亡率为0.5%。院内并发症的独立预测因子包括全甲状腺切除术（aOR: 3.12; 95% CI: 1.08-9.02）和症状持续时间超过10年（aOR: 4.12; 95% CI: 1.60-10.58）。结论本组甲状腺切除术后的术后发病率主要由延迟出现和手术范围引起。有针对性的干预措施促进早期诊断和优化围手术期护理对改善患者预后至关重要。

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引用次数: 0

Red blood cell mass as a predictor of transfusion risk of packed red blood cells in cardiac surgery patients requiring cardiopulmonary bypass 红细胞质量作为需要体外循环的心脏手术患者充血红细胞输血风险的预测因子

IF 0.8 Q4 SURGERY

Surgery in practice and science

Pub Date : 2025-12-01 DOI: 10.1016/j.sipas.2025.100321

Jennette Hansen, Niaman Nazir, George Zorn III

Introduction

Red blood cell (RBC) transfusion in cardiac surgery is associated with adverse outcomes and increased costs. Traditional predictors such as hemoglobin and BMI offer limited physiologic insight. This study evaluates RBC mass, a calculated measure of total red cell volume, as a preoperative predictor of transfusion in adult cardiac surgery patients undergoing cardiopulmonary bypass (CPB).

Materials and Methods

This retrospective observational study included 463 adult patients undergoing elective cardiac surgery with CPB at a single academic center in 2024. Exclusion criteria included procedures with inherently high transfusion risk (e.g., redo sternotomy, LVAD implantation, circulatory arrest, and “bring-backs”). RBC mass was calculated using estimated blood volume (sex-adjusted mL/kg) and hematocrit. Patients were categorized into three RBC mass groups: 1–2 L, 2–3 L, and >3 L. Multivariable logistic regression was used to assess the association between RBC mass and transfusion, adjusting for sex, age, BMI, and bypass time.

Results

Of the 463 patients, 102 (22 %) received RBC transfusions. Transfused patients had significantly lower RBC mass (mean 1.95 L) versus non-transfused (2.58 L, p < 0.001). Patients in the 1–2 L group accounted for 54.9 % of transfusions despite representing only 25.5 % of the cohort. These patients had 18.7 times the odds of transfusion compared to those with >3 L RBC mass. Female sex, older age, lower BMI, and longer CPB time were also associated with increased transfusion risk.

Discussion

RBC mass proved a more physiologically integrated and predictive metric for transfusion risk than hemoglobin or BMI alone. It may be especially useful in identifying at-risk female patients and those with normal hemoglobin but limited oxygen-carrying reserve.

Conclusions

Preoperative RBC mass is a strong independent predictor of transfusion in cardiac surgery. Its incorporation into preoperative planning may improve patient optimization and reduce unnecessary transfusions.

心脏手术中输血红细胞（RBC）与不良后果和费用增加有关。血红蛋白和BMI等传统的预测指标提供的生理学信息有限。本研究评估了红细胞质量（红细胞总体积的计算指标）作为成人心脏手术患者体外循环（CPB）术前输血的预测指标。材料与方法本回顾性观察性研究纳入了2024年在同一学术中心接受选择性CPB心脏手术的463例成人患者。排除标准包括具有高输血风险的手术（例如，重做胸骨切开术、左心室辅助装置植入、循环停止和“恢复”）。红细胞质量计算使用估计血容量（性别调整mL/kg）和红细胞压积。将患者分为3个红细胞质量组：1-2 L、2-3 L和3 L。采用多变量logistic回归评估红细胞质量与输血之间的关系，调整性别、年龄、BMI和旁路时间。结果463例患者中，102例（22%）接受了红细胞输注。输血患者的红细胞质量（平均1.95 L）明显低于未输血患者（2.58 L, p < 0.001）。1-2 L组患者占54.9%的输血量，尽管仅占队列的25.5%。这些患者输血的几率是3l红细胞肿块患者的18.7倍。女性、年龄较大、较低的BMI和较长的CPB时间也与输血风险增加有关。与单独的血红蛋白或BMI相比，rbc质量被证明是一个更综合的生理指标和预测输血风险的指标。它在鉴别高危女性患者和血红蛋白正常但携氧储备有限的患者时可能特别有用。结论术前RBC肿块是心脏手术输血的独立预测指标。将其纳入术前计划可改善患者优化并减少不必要的输血。

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引用次数: 0

Prognostic value of tumor-infiltrating lymphocytes, tumor associated neutrophils and metabolic checkpoint molecules on survival of patients with metastatic pancreatic ductal adenocarcinoma 肿瘤浸润淋巴细胞、肿瘤相关中性粒细胞和代谢检查点分子对转移性胰腺导管腺癌患者生存的预后价值

IF 0.8 Q4 SURGERY

Surgery in practice and science

Pub Date : 2025-12-01 DOI: 10.1016/j.sipas.2025.100320

Tao Zhang , Rainer C. Miksch , Ughur Aghamaliyev , Maximilian Weniger , Michael Günther , Steffen Ormanns , Fatma Parsa , Jan G. D’Haese , Alexandr V. Bazhin , Matthias Ilmer , Bernhard W. Renz , Jens Werner

Objectives

This study aimed to investigate the tumor microenvironment (TME) of metastatic PDAC, focusing on tumor-infiltrating leukocytes (TILs) and metabolic checkpoint molecules (MCMs).

Background

The role of TME in primary and metastatic PDAC is not well understood. Furthermore, the role of energy metabolism in metastatic PDAC is unclear. Therefore, this study aimed to explore the TME in primary tumors and metastases of PDAC, and its prognostic role.

Materials and Methods

We included 26 cases of metastatic PDAC in this study. We performed immunohistochemistry for TILs and MCMs (HIF-1α, GLUT1, and PDHK1) in primary and corresponding metastatic tumor tissues. We quantified stromal TILs and MCMs using a tumor immune stroma (QTiS) algorithm and correlated the data with clinical outcome.

Results

We found that CD3⁺, CD8⁺, and CD20⁺ TILs were increased in primary tumors compared to metastatic ones. Kaplan-Meier plots revealed that high infiltration of CD20⁺ and its combinations in primary tumors correlated with better OS in metastatic PDAC patients. We also found that high infiltration of CD8⁺ TILs in metastatic tumors correlated with better OS, as did the low density of GLUT1 in both PDAC primary and metastatic tumors. A multivariate Cox regression analysis revealed that CD8⁺ TILs in metastatic tumors and GLUT1 in PDAC primary and metastatic tumors were independent predictors of survival.

Conclusion

Distribution of TILs in the TMEs of primary and metastases of metastatic PDAC is different. Our results suggest that TILs (CD8⁺) and MCMs (GLUT1) in tumor stromal areas can predict OS of patients with metastatic PDAC.

目的探讨转移性PDAC的肿瘤微环境（TME），重点研究肿瘤浸润白细胞（til）和代谢检查点分子（MCMs）。背景：TME在原发性和转移性PDAC中的作用尚不清楚。此外，能量代谢在转移性PDAC中的作用尚不清楚。因此，本研究旨在探讨TME在PDAC原发肿瘤和转移瘤中的作用及其对预后的影响。材料与方法本研究纳入26例转移性PDAC。我们对原发和相应转移性肿瘤组织中的TILs和MCMs （HIF-1α、GLUT1和PDHK1）进行了免疫组化。我们使用肿瘤免疫基质（QTiS）算法量化基质TILs和mcm，并将数据与临床结果相关联。结果我们发现，与转移性肿瘤相比，原发肿瘤中CD3+、CD8+和CD20+ TILs升高。Kaplan-Meier图显示，原发性肿瘤中CD20+的高浸润及其组合与转移性PDAC患者更好的OS相关。我们还发现，转移性肿瘤中CD8+ TILs的高浸润与更好的OS相关，PDAC原发肿瘤和转移性肿瘤中GLUT1的低密度也是如此。多因素Cox回归分析显示，转移性肿瘤中的CD8+ TILs和PDAC原发和转移性肿瘤中的GLUT1是生存的独立预测因子。结论转移性PDAC原发灶和转移灶TMEs中TILs的分布存在差异。我们的研究结果表明，肿瘤间质区TILs （CD8+）和MCMs （GLUT1）可以预测转移性PDAC患者的OS。

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引用次数: 0

The role of artificial intelligence in advancing urologic care: From diagnostics to therapeutics 人工智能在推进泌尿科护理中的作用：从诊断到治疗

IF 0.8 Q4 SURGERY

Surgery in practice and science

Pub Date : 2025-11-29 DOI: 10.1016/j.sipas.2025.100322

Sina Samenezhad , Dorna Rafighi

Artificial intelligence (AI) is gradually altering urology by improving diagnostic precision, prognostic evaluation, and therapy decisions in a broad spectrum of urologic diseases. Utilizing machine learning, deep learning, and radiomics, applications of AI have exhibited promise in enhancing cancer identification, stratification, and therapy response prediction, especially in prostate, bladder, and kidney cancers. Beyond cancer therapy, AI enables individually tailored care for benign diseases like benign prostatic hyperplasia, urolithiasis, Functional Urology even in pediatrics by enhancing diagnostic ability and outcome prediction. Heterogeneity of data, model explainability, ethical issues, and lack of prospective validation constrain incorporation into everyday practice. This review summarizes current applications and discusses methodological and ethical limitation, and defines future directions toward enhancing multidisciplinary interaction, standardization across datasets, and prudent implementation. Eventually, AI provides large-scale opportunity to transform urologic care by facilitating individually tailored, expedient, and equitable patient care.

人工智能（AI）通过提高广泛泌尿系统疾病的诊断精度、预后评估和治疗决策，正在逐渐改变泌尿外科。利用机器学习、深度学习和放射组学，人工智能的应用在增强癌症识别、分层和治疗反应预测方面表现出了希望，特别是在前列腺癌、膀胱癌和肾癌方面。除了癌症治疗，人工智能还可以通过提高诊断能力和结果预测，为良性疾病（如良性前列腺增生、尿石症、功能泌尿科甚至儿科）提供个性化护理。数据的异质性、模型的可解释性、伦理问题和缺乏前瞻性验证限制了将其纳入日常实践。这篇综述总结了目前的应用，讨论了方法和伦理限制，并定义了未来的方向，以加强多学科的互动，跨数据集的标准化和谨慎的实施。最终，人工智能通过促进个体化、权宜之计和公平的患者护理，为改变泌尿科护理提供了大规模的机会。

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引用次数: 0

Outcomes of primary intestinal anastomosis versus stoma in necrotizing enterocolitis: A systematic review and meta-analysis 坏死性小肠结肠炎原发肠吻合术与造口术的预后：系统回顾和荟萃分析

IF 0.8 Q4 SURGERY

Surgery in practice and science

Pub Date : 2025-11-10 DOI: 10.1016/j.sipas.2025.100319

Amani N. Alansari , Salma Mani , Marwa Messaoud , Tariq Altokhais

Background

Approximately one-quarter of necrotizing enterocolitis (NEC) cases require surgical resection due to bowel perforation, necrosis, or failure to respond to conservative management. In such cases, the optimal method for restoring intestinal continuity remains debatable. Stoma is traditionally favored over primary anastomosis for its perceived safety, particularly in unstable infants, but it is associated with complications such as fluid and electrolyte imbalances, impaired growth, and the need for a second surgery. This study aims to systematically review and analyze the evidence comparing stoma versus primary anastomosis in neonates undergoing surgery for NEC.

Methods

We searched PubMed, Web of Science (WOS), the Cochrane Library, and Scopus for studies comparing the outcomes of stoma versus primary anastomosis in neonates with NEC. The primary outcomes included overall postoperative complications, intestinal perforation, stricture, mortality, wound infection, time to full enteral nutrition, time to end parenteral nutrition, and length of hospital stay. The meta-analysis was conducted using Review Manager (RevMan) version 5.4.

Results

Eighteen studies were included in the meta-analysis. Primary anastomosis was associated with lower mortality risk: (risk ratios (RR) = 0.61; 95 % confidence interval (CI): 0.42:0.88). No significant differences were observed between groups in overall complications, wound infection, duration of hospital stay, duration of parenteral nutrition, the need for a second operation (excluding stoma closure), strictures, and perforations.

Conclusion

Primary anastomosis for neonates with NEC is associated with lower mortality and comparable complication rates compared to stoma formation in selected cases.

背景：大约四分之一的坏死性小肠结肠炎（NEC）病例由于肠穿孔、坏死或对保守治疗无效需要手术切除。在这种情况下，恢复肠道连续性的最佳方法仍然存在争议。传统上，由于其安全性，特别是在不稳定的婴儿中，Stoma比primary吻合术更受青睐，但它与诸如液体和电解质失衡，生长受损以及需要第二次手术等并发症相关。本研究旨在系统回顾和分析新生儿NEC手术中吻合口与一期吻合的比较证据。方法：我们检索PubMed、Web of Science （WOS）、Cochrane Library和Scopus，以比较新生儿NEC的造口吻合术和一期吻合术的结果。主要结局包括总体术后并发症、肠穿孔、狭窄、死亡率、伤口感染、完全肠内营养时间、结束肠外营养时间和住院时间。meta分析使用Review Manager (RevMan) 5.4版本进行。结果meta分析共纳入18项研究。初级吻合与较低的死亡风险相关：(风险比(RR) = 0.61；95%置信区间（CI）： 0.42:0.88。在总体并发症、伤口感染、住院时间、肠外营养时间、第二次手术（不包括造口）、狭窄和穿孔方面，两组间无显著差异。结论与部分病例的造口术相比，原发性吻合术治疗新生儿NEC的死亡率和并发症发生率较低。

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引用次数: 0