Surgery in practice and science最新文献_第6页

An Australian regional hospital's oesophagectomy experience: A 10-year case series from Tasmania 澳大利亚一家地区医院的食道切除术经验：来自塔斯马尼亚的10年病例系列

IF 0.6 Q4 SURGERY

Surgery in practice and science

Pub Date : 2025-03-17 DOI: 10.1016/j.sipas.2025.100279

Renishka Sellayah, Girish Pande

Introduction

Oesophagectomy is recommended as part of curative treatment for oesophageal cancer but is associated with substantial morbidity. Centralization has been recommended to improve outcomes, but this has not been widely applied in Australia. This study aimed to audit a regional hospital's experience over ten years and compare it to outcomes from national and international centres to support the view that oesophagectomy can be performed safely in select regional centres in Australia.

Methods

Patients undergoing oesophagectomy at a single regional hospital in North-East Tasmania, Australia between January 2014 and December 2023 were retrospectively identified. Preoperative patient and tumour characteristics, and outcomes (mortality, anastomotic leak, length of stay, respiratory complications, long-term complications and survival) were compared to other centres.

Results

65 patients were identified. 53 % were male, mean age was 65.2 years, 29.2 % had respiratory disease and 18.5 % were current smokers. The anastomotic leak rate was 7.7 %. 25 % developed pneumonia postoperatively. Average ICU length of stay was 4.6 days, median acute inpatient length of stay was 15 days. There was one in-hospital mortality and one 30-day mortality. 2 patients (3 %) required diaphragmatic hernia repair; 12 patients (18.5 %) required endoscopic dilatation of anastomotic strictures. The 5-year survival rate was 66 %. Our results compare favourably to published rates of anastomotic leak (10–15 %), inpatient stay (15 days), pneumonia (20–30 %), 30-day mortality (1–4 %) and anastomotic stricture (20 %).

Conclusions

Oesophagectomies can be safely performed in regional centres in Australia that routinely undertake a higher volume of cases per year, provided services required to manage complications are readily available.

食管癌切除术被推荐作为根治性治疗的一部分，但其发病率很高。集中化已被推荐用于改善结果，但这在澳大利亚尚未得到广泛应用。本研究旨在审核一家地区医院十年来的经验，并将其与国家和国际中心的结果进行比较，以支持食管切除术在澳大利亚选定的地区中心可以安全进行的观点。方法回顾性分析2014年1月至2023年12月在澳大利亚塔斯马尼亚东北部一家地区医院接受食管切除术的患者。术前患者和肿瘤特征以及结果（死亡率、吻合口漏、住院时间、呼吸并发症、长期并发症和生存率）与其他中心进行比较。结果共确诊65例。53%为男性，平均年龄65.2岁，29.2%患有呼吸系统疾病，18.5%为当前吸烟者。吻合口漏率为7.7%。25%的患者术后出现肺炎。ICU平均住院时间4.6天，急性住院时间中位数15天。有1例住院死亡率和1例30天死亡率。2例（3%）患者需要膈疝修补术；12例（18.5%）患者需要内镜扩张吻合口狭窄。5年生存率66%。我们的结果与已发表的吻合口漏（10 - 15%）、住院（15天）、肺炎（20 - 30%）、30天死亡率（1 - 4%）和吻合口狭窄（20%）的发生率相比较有利。结论：食管切除术在澳大利亚的区域中心可以安全进行，这些中心每年例行处理的病例量较高，只要并发症管理所需的服务容易获得。

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引用次数: 0

Surgical site infection reduction bundle in stoma closure: A retrospective cohort study 造口术中手术部位感染减少束：一项回顾性队列研究

IF 0.6 Q4 SURGERY

Surgery in practice and science

Pub Date : 2025-03-01 DOI: 10.1016/j.sipas.2025.100277

Kentaro Goto , Ryo Matsusue , Kanako Degawa , Akimori Miki , Hiroki Nakanishi , Hiroaki Hata , Masato Narita , Takashi Yamaguchi

Introduction

Advances in minimally invasive surgeries and pre-operative treatments allow the preservation of anal function through lower anastomosis in patients with rectal cancer, often necessitating temporary diverting stomas owing to the risk of anastomotic leakage. Stoma closure is associated with a high rate of surgical site infections (SSIs). Various measures, including purse-string skin sutures and negative-pressure wound therapy, have been implemented, and some guidelines recommend purse-string skin sutures as the standard method of stoma closure. However, at our institution, we used linear skin closure with an SSI reduction bundle. This study describes our stoma closure method and retrospectively analyses surgical outcomes.

Materials and Methods

This retrospective study included patients aged ≥ 20 years who underwent loop stoma closure using linear skin sutures at our institution between January 2006 and March 2021. Our protocol emphasises the following: (1) pre-operative oral anti-microbials, (2) a surgical technique that distinctly separates clean and contaminated regions, and (3) wound closure to eliminate dead space. We evaluated the surgical outcomes, including the incidence of SSIs and other post-operative complications.

Results

Ninety-two patients (53 men, 39 women; mean age, 59.4 years) underwent loop stoma closure. SSIs occurred in two patients (2.2%). No risk factors for SSIs were identified.

Conclusion

In our department, the incidence of SSIs after linear skin closure of stomas was low. Adherence to proper infection prevention practices can effectively mitigate SSIs, even with linear skin closure.

微创手术和术前治疗的进步使得直肠癌患者通过下吻合术保留肛门功能，但由于有吻合口漏的风险，通常需要临时转移口。造口闭合与手术部位感染（ssi）的高发生率相关。各种措施，包括荷包线皮肤缝合和负压伤口治疗，已经实施，一些指南推荐荷包线皮肤缝合作为标准的缝合方法。然而，在我们的机构，我们使用线性皮肤闭合与SSI复位束。本研究描述了我们的造口闭合方法，并回顾性分析了手术结果。材料和方法本回顾性研究纳入了2006年1月至2021年3月期间在我院使用线性皮肤缝合线进行环口闭合的年龄≥20岁的患者。我们的方案强调以下几点：(1)术前口服抗微生物药物，(2)手术技术明确区分清洁和污染区域，(3)伤口闭合以消除死亡空间。我们评估了手术结果，包括ssi的发生率和其他术后并发症。结果92例患者(男53例，女39例；平均年龄59.4岁)行环口闭合术。2例患者发生ssi（2.2%）。未发现ssi的危险因素。结论本科创口线形皮肤闭合术后ssi发生率较低。坚持适当的感染预防措施可以有效地减轻ssi，即使是线性皮肤闭合。

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引用次数: 0

Simultaneous radical cystectomy and nephroureterectomy: A case series 同时根治性膀胱切除术和肾输尿管切除术：一个病例系列

IF 0.6 Q4 SURGERY

Surgery in practice and science

Pub Date : 2025-02-25 DOI: 10.1016/j.sipas.2025.100276

Gavin G. Calpin , Steven M. Anderson , Mark Broe , Ijaz Cheema , Niall F. Davis , Dilly Little

Introduction

Simultaneous radical cystectomy and nephroureterectomy (RCNU) is a complex procedure. Although performed infrequently, RCNU may be indicated in certain cases of multifocal high grade urothelial carcinoma (UC) or muscle-invasive bladder cancer (MIBC) with an obstructed and atrophic kidney. The aim of this study was to review the indications, operative approach and outcomes for patients undergoing RCNU in our institution.

Methods

A single-centre, retrospective review was performed. Cases were identified by reviewing theatre logbooks. Chart reviews were conducted and clinicopathological outcomes were recorded and analysed.

Results

Eight patients were identified between 2015–2024. All were male and had a mean age of 66.4 ± 4.7 years. All patients underwent RCNU with ileal conduit formation. The surgical approach for the nephroureterectomy was laparoscopic in four cases and open in the remaining four. The mean post-operative length of stay was 11.6 ± 1.75 days. All patients had high grade UC, seven patients had MIBC at presentation. Only two patients received neoadjuvant chemotherapy, one of whom achieved a complete pathological response. In total, 62.5% (n=5) had T3/4 disease while 50% (n=4) had node positive disease. Two patients had synchronous upper tract urothelial carcinoma (UTUC) on final histology. The remaining cases had chronically obstructed and atrophic kidneys. Incidental primary prostate cancer was found in 62.5% (n=5). The mean follow-up was 31.6 ± 7 months, during which time there were four recurrences with three patients dying from metastatic disease. The mean overall survival was 21.8 ± 11.8 months and the mean disease-free survival was 19.3 ± 12.3 months.

Conclusion

The results from this study demonstrate that combined laparoscopic and open RCNU is an effective treatment for both panurothelial cancer and MIBC with severe upper tract dysfunction.

同时根治性膀胱切除术和肾输尿管切除术（RCNU）是一个复杂的手术。尽管RCNU手术并不常见，但在某些多灶性高级别尿路上皮癌（UC）或肌肉浸润性膀胱癌（MIBC）伴梗阻和肾萎缩的病例中，RCNU可能是指征。本研究的目的是回顾我院RCNU患者的适应证、手术入路和预后。方法采用单中心回顾性分析。病例是通过查阅剧院日志确定的。进行图表回顾，记录和分析临床病理结果。结果2015-2024年共发现8例患者。所有患者均为男性，平均年龄66.4±4.7岁。所有患者均行RCNU伴回肠导管形成。肾输尿管切除术4例为腹腔镜手术，其余4例为开放手术。术后平均住院时间11.6±1.75天。所有患者均为高级别UC， 7例患者在就诊时为MIBC。只有2例患者接受了新辅助化疗，其中1例获得了完全的病理反应。62.5% （n=5）为T3/4病变，50% （n=4）为淋巴结阳性病变。2例患者最终组织学检查为同步上尿路上皮癌（UTUC）。其余病例为慢性肾阻塞和肾萎缩。偶发原发性前列腺癌发生率为62.5% （n=5）。平均随访31.6±7个月，4例复发，3例死于转移性疾病。平均总生存期为21.8±11.8个月，平均无病生存期为19.3±12.3个月。结论腹腔镜联合开放RCNU是治疗重度上尿路功能障碍的全尿路上皮癌和MIBC的有效方法。

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引用次数: 0

Disparities in the expansion of telemedicine in pediatric specialty care through the COVID-19 pandemic and beyond 在2019冠状病毒病大流行期间及之后，在儿科专科护理中扩大远程医疗的差距

IF 0.6 Q4 SURGERY

Surgery in practice and science

Pub Date : 2025-02-14 DOI: 10.1016/j.sipas.2025.100275

Monalisa Attif Hassan, Jeffrey Fine, Kathleen Doyle, Emily Byrd, Minna M. Wieck

Introduction

The COVID-19 pandemic resulted in the rapid expansion of telemedicine, including in specialties traditionally dependent on physical exams, such as pediatric surgery. Trends in its utilization as in-person visits resumed are not well understood, nor is its effect on mitigating disparities related to social determinants of health (SDOH). We hypothesize that telemedicine utilization increased after the pandemic and has remained higher compared to pre-pandemic levels. Additionally, we hypothesize that increased telemedicine use has contributed to lower no-show rates and more equitable access to care.

Methods

A retrospective cohort analysis was conducted of all outpatient visits at a single outpatient pediatric surgery clinic at a quaternary academic center from 01/02/2018 to 10/26/2022. Clinical variables extracted included demographic data, no-show rate (patient did not attend scheduled appointment), and visit type (in person vs telemedicine). Geocoded census data was used to determine SDOH variables such as internet and computer access. A mixed effect logistic regression model was performed to identify which variables were associated with differences in telemedicine usage.

Results

6339 encounters for 2735 patients were analyzed. Odds of presenting to a scheduled telemedicine visit compared to an in-person visit was 0.76 (CI 0.63-0.91, p-value < 0.01). The odds of selecting a telemedicine visit decreased by 34 % for Spanish speakers and 63 % for ‘other’ language speakers compared to English speakers (p-value < 0.01). The odds of choosing a telemedicine visit also decreased by 4 % for every one-unit increase in the probability of having access to the internet (p < 0.01). There was no significant difference in the odds of choosing a telemedicine visit for insurance status, age, distance, or probability of having access to a computer.

Discussion

Telemedicine continues to be utilized at higher rates compared to pre-pandemic levels, but does not reduce no-show rates, which may reflect limits in its clinical utility. It is used less frequently by non-English speakers, which may contribute to ongoing disparities in access to specialty pediatric care.

2019冠状病毒病大流行导致远程医疗的迅速扩张，包括传统上依赖体检的专业，如儿科外科。随着面对面访问的恢复，其利用趋势尚不清楚，其对减轻与健康的社会决定因素有关的差距的影响也不清楚。我们假设远程医疗的使用率在大流行后有所增加，并且与大流行前的水平相比仍然更高。此外，我们假设远程医疗使用的增加有助于降低缺勤率和更公平地获得护理。方法回顾性队列分析某第四学术中心2018年2月1日至2022年10月26日单一儿科门诊门诊的所有门诊人次。提取的临床变量包括人口统计数据、缺勤率（患者未参加预定的预约）和就诊类型（面对面与远程医疗）。地理编码普查数据用于确定SDOH变量，如互联网和计算机访问。采用混合效应逻辑回归模型来确定哪些变量与远程医疗使用差异相关。结果共分析2735例患者的6339例就诊情况。与现场就诊相比，预约远程医疗就诊的几率为0.76 (CI 0.63-0.91， p值<；0.01)。与说英语的人相比，说西班牙语的人选择远程医疗的几率降低了34%，说“其他”语言的人选择远程医疗的几率降低了63% (p值<；0.01)。选择远程医疗访问的几率也降低了4%，每增加一个单位有机会访问互联网(p <；0.01)。在选择远程医疗访问的几率上，保险状况、年龄、距离或使用计算机的可能性没有显著差异。讨论远程医疗的使用率继续高于大流行前的水平，但未出诊率并未减少，这可能反映出远程医疗在临床应用中的局限性。非英语使用者较少使用它，这可能会导致在获得儿科专科护理方面的持续差异。

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引用次数: 0

Computed tomography in initially unstable thoracoabdominal trauma can safely enhance triage 在最初不稳定的胸腹创伤中，计算机断层扫描可以安全地加强分诊

IF 0.6 Q4 SURGERY

Surgery in practice and science

Pub Date : 2025-02-09 DOI: 10.1016/j.sipas.2025.100274

Anna White , Lindsey Loss , John Carney , Christopher Barrett , Kazuhide Matsushima , Kenji Inaba , Aaron Strumwasser , Reynold Henry

Introduction

Computed tomography (CT) imaging of hemodynamically abnormal trauma patients undergoing aggressive resuscitation is controversial. Our study investigated outcomes for hemodynamically abnormal thoracoabdominal trauma undergoing CT prior to definitive therapy.

Methods

Hemodynamically abnormal (HR≥120 bpm, SBP<90 mmHg) patients arriving to our Level I trauma center between 2015 and 2022 were reviewed. Patients with thoracoabdominal trauma achieving hemodynamic improvement (SBP≥90 mmHg) were included. Pediatric patients, pregnant patients, and traumatic arrests were excluded. After matching for baseline characteristics, CT findings, and operative details, clinical outcomes were tabulated. Primary outcomes included hospital length of stay (HLOS), intensive care unit length of stay (ICU LOS), ventilator days and mortality. Secondary outcomes included intraoperative data, transfusions, additional procedures, and complications

Results

A total of 235 patients met inclusion criteria. Thirty-six (15 %) were triaged directly to the OR while 199 (85 %) went to CT. The CT and OR groups were matched for injury burden (mean ISS OR group=21±2.6 vs. CT group=18.4 ± 0.8, p = 0.24). Overall, no difference in HLOS (p = 0.3), ICU LOS (p = 0.9), time on ventilator (p = 0.4) or mortality (p = 0.5) was observed. Patients undergoing CT needed less PRBCs (9.0 ± 2.6 vs. 3.4 ± 0.7 units) and FFP (5.1 ± 1.9 vs. 1.6 ± 0.4 units). The OR group patients had a higher probability of needing to undergo additional procedures (36 % vs. 12 %).

Conclusion

Hemodynamically abnormal thoracoabdominal trauma patients who are resuscitated to a SBP≥90 mmHg can safely undergo CT prior to definitive therapy.

接受积极复苏的血流动力学异常创伤患者的计算机断层扫描（CT）成像存在争议。我们的研究调查了在最终治疗前进行CT检查的胸腹创伤血流动力学异常的结果。方法回顾性分析2015 - 2022年我院一级创伤中心收治的血流动力学异常（HR≥120bpm, SBP< 90mmhg）患者。胸腹外伤患者血流动力学改善（收缩压≥90 mmHg）。排除了儿科患者、孕妇患者和创伤性骤停。在匹配基线特征、CT表现和手术细节后，将临床结果制成表格。主要结局包括住院时间（HLOS）、重症监护病房时间（ICU LOS）、呼吸机天数和死亡率。次要结局包括术中数据、输注、附加程序和并发症。结果共有235例患者符合纳入标准。36例（15%）直接转手术室，199例（85%）转CT。CT组与OR组损伤负荷匹配（平均ISS OR组=21±2.6 vs CT组=18.4±0.8,p= 0.24）。总体而言，HLOS （p = 0.3）、ICU LOS （p = 0.9）、呼吸机使用时间（p = 0.4）和死亡率（p = 0.5）均无差异。接受CT的患者需要较少的红细胞（9.0±2.6比3.4±0.7单位）和FFP（5.1±1.9比1.6±0.4单位）。OR组患者需要接受额外手术的可能性更高（36%对12%）。结论胸腹外伤患者复苏至收缩压≥90 mmHg时，可安全接受CT检查。

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引用次数: 0

Costs of surgical futility in emergency laparotomy 急诊剖腹手术无效的成本

IF 0.6 Q4 SURGERY

Surgery in practice and science

Pub Date : 2025-02-03 DOI: 10.1016/j.sipas.2025.100273

C.L. Downey, D.G. Jayne

Background

Surgical futility has been defined as death within 72 h of emergency laparotomy. It is associated with patient distress, moral injury and opportunity costs. This study aimed to determine the rates of surgical futility after emergency laparotomy at a single high-volume centre, and to attribute costs to cases of surgical futility.

Methods

A retrospective cohort study was conducted between 1st August 2021 and 1st August 2023 at a single high-volume acute hospital trust in the United Kingdom. A national patient-level costings system was used to determine the costs of hospital care from the day of surgery to the time of death.

Results

In a cohort of 741 patients, there was a 3.6 % surgical futility rate. Most of these patients died within 24 h of surgery. The median total cost of admission for each patient was £14,118 (range £6,618 to £29,583). The median cost per day of admission was £6,004 (range £1,324 to £15,255).

Conclusion

This is the first study to report the costs of surgical futility in the emergency laparotomy setting. Futile surgery appears to cost more and require more resource than non-futile laparotomies. Further research should focus on how to better predict surgical futility, reduce inappropriate interventions and improve patient care.

背景：手术无效被定义为急诊剖腹手术后72小时内死亡。它与病人痛苦、道德伤害和机会成本有关。本研究旨在确定在单个大容量中心急诊剖腹手术后手术无效的发生率，并将手术无效的成本归因于病例。方法回顾性队列研究于2021年8月1日至2023年8月1日在英国一家大容量急性医院进行。一个国家病人层面的成本系统被用来确定从手术当天到死亡时间的医院护理费用。结果本组741例患者的手术失败率为3.6%。这些患者大多在手术后24小时内死亡。每位患者的住院总费用中位数为14,118英镑（范围为6,618英镑至29,583英镑）。每天的平均费用为6004英镑（1324英镑至15255英镑）。结论：本研究首次报道了急诊剖腹手术无效的成本。无效手术似乎比非无效的剖腹手术花费更多，需要更多的资源。进一步的研究应集中在如何更好地预测手术无效，减少不适当的干预和改善患者护理。

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引用次数: 0

Respiratory dysfunction in whiplash associated disorders (WAD) with cervical plexus syndrome – A case report 颈部扭伤相关疾病（WAD）伴颈丛综合征的呼吸功能障碍1例报告

IF 0.6 Q4 SURGERY

Surgery in practice and science

Pub Date : 2025-01-12 DOI: 10.1016/j.sipas.2025.100271

NA Nystrom , SR Daulat , A Zakaria , M Petersen , VM Moodley , LP. Champagne

Whiplash Associated Disorders (WAD) represents a chronic post-traumatic pain syndrome from indirect flexion-extension trauma to the neck. The condition exhibits significant variability among affected individuals and can involve numerous secondary symptoms, including but not limited to myalgia, central sensitization, migraines, photophobia, jaw pain, dysphagia, joint stiffness, and tinnitus, while significant breathing problems are not commonly associated with or prominently considered in WAD.

Herein, we present the diagnosis and successful surgical treatment of severe respiratory dysfunction and staccato speech in a patient with WAD, who over a period of more than ten years underwent multiple spirometry evaluations for breathing difficulties that correlated with the severity of neck pain. In 2019, his condition deteriorated, with significantly increased pain and dyspnea leading to further evaluations that included laboratory studies and consultations with specialists in neurosurgery, neurology, pulmonology, neurophysiology, ENT, general internal medicine, cardiology, radiology, speech pathology, physical medicine, orthopedic surgery, and hand surgery at three separate academic centers in Norway.

Eventually, the patient was diagnosed with a condition that is regularly observed among patients referred to our office for evaluation and surgical treatment of chronic, whiplash related pain, and that we propose to label Cervical Plexus Syndrome.

One year following exploration and neurolysis of sensory nerves to the right and left superficial cervical plexus, the patient remains pain free, with unimpeded speech and breathing as demonstrated by postoperative spirometry and video recordings.

Although the underlying pathophysiology remains unclear, we report what we believe to be the first successful surgical treatment of serious respiratory dysfunction from pain generators in tissue that historically is considered anatomically and functionally separate from the mechanics of breathing. Further investigation will be needed to determine prevalence of respiratory dysfunction in chronic neck pain.

颈部扭伤相关疾病（WAD）是一种由颈部间接屈伸创伤引起的慢性创伤后疼痛综合征。这种情况在受影响的个体之间表现出显著的差异，可能包括许多继发症状，包括但不限于肌痛、中枢敏化、偏头痛、畏光、颌痛、吞咽困难、关节僵硬和耳鸣，而严重的呼吸问题通常与WAD不相关或不被突出考虑。在此，我们报告了一名WAD患者严重呼吸功能障碍和断音的诊断和成功的手术治疗，该患者在十多年的时间里接受了多次肺活量测定法评估与颈部疼痛严重程度相关的呼吸困难。2019年，他的病情恶化，疼痛和呼吸困难明显增加，导致进一步的评估，包括实验室研究和咨询神经外科、神经病学、肺脏学、神经生理学、耳鼻喉科、普通内科、心脏病学、放射学、语言病理学、物理医学、整形外科和手外科专家，在挪威的三个独立学术中心。最终，患者被诊断出患有一种经常在我们办公室进行评估和手术治疗的慢性颈部扭伤相关疼痛的患者中观察到的疾病，我们建议将其标记为颈丛综合征。在对左右颈浅丛的感觉神经进行探查和神经松解术一年后，患者无疼痛，术后肺活量测定和录像显示患者言语和呼吸通畅。尽管潜在的病理生理学尚不清楚，但我们报告了我们认为是第一个成功的手术治疗严重呼吸功能障碍的组织疼痛源，历史上被认为是解剖学和功能上与呼吸机制分离的组织。需要进一步的调查来确定慢性颈部疼痛中呼吸功能障碍的患病率。

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引用次数: 0

IF 0.8 Q4 SURGERY

Surgery in practice and science

Pub Date : 2025-01-01

引用次数: 0

IF 0.8 Q4 SURGERY

Surgery in practice and science

Pub Date : 2025-01-01

引用次数: 0

IF 0.8 Q4 SURGERY

Surgery in practice and science

Pub Date : 2025-01-01

引用次数: 0