Surgery open science最新文献_第7页

The outcomes of right and left complicated colonic diverticulitis 左、右合并结肠憩室炎的预后

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2025-06-15 DOI: 10.1016/j.sopen.2025.06.005

Anh Tuan Nguyen , Quang Tien Pham , Hoi Van Tran , Hoang Viet Truong , Loc Huynh Tran

Background

The incidence of complicated colonic diverticulitis is increasing in Asia, with notable differences in management between right-sided (RCD) and left-sided (LCD) cases. This study compared treatment outcomes and identified risk factors for complications.

Methods

A retrospective analysis was performed on 181 patients diagnosed with complicated colonic diverculitis from January 2022 to September 2024, including 99 RCD and 82 LCD cases.

Results

The mean age in the RCD group was 43.31 ± 14.6 years, compared to 63.9 ± 12.9 years in the LCD group. Recurrence rates were higher in LCD than RCD (19.5 % vs. 7.1 %). Surgical intervention was more frequent in LCD cases (63.4 % vs. 9.2 %), with longer hospital stay (9.3 vs 4.9 days). All RCD perforations were managed with primary anastomosis. Hartmann's procedure was the most common approach for LCD, with primary resection and anastomosis performed in 26.9 %. Postoperative complications occurred in 27.8 % of LCD patients, including wound infections, intra-abdominal abscesses, and pneumonia. Three patients in the LCD group died during hospitalization. Fever, elevated CRP levels, surgery type, and prolonged hospital stays were independent risk factors.

Conclusion

Patients with complicated RCD were younger than those with LCD. Conservative treatment for RCD had a high success rate, while complicated LCD often required surgery due to peritonitis. Fever, CRP level, type of surgery, and hospital stay were independent risk factors for complications.

亚洲地区复杂结肠憩室炎的发病率正在上升，右侧（RCD）和左侧（LCD）病例在治疗上存在显著差异。这项研究比较了治疗结果并确定了并发症的危险因素。方法回顾性分析2022年1月至2024年9月诊断为复杂性结肠憩室炎的181例患者，其中RCD 99例，LCD 82例。结果RCD组患者平均年龄43.31±14.6岁，LCD组患者平均年龄63.9±12.9岁。LCD的复发率高于RCD（19.5%比7.1%）。LCD患者手术干预更频繁（63.4% vs 9.2%），住院时间更长（9.3 vs 4.9天）。所有RCD穿孔均采用一期吻合。Hartmann手术是LCD最常见的手术方式，26.9%的患者进行了一次切除和吻合。术后并发症发生率为27.8%，包括伤口感染、腹内脓肿和肺炎。LCD组3例患者在住院期间死亡。发热、CRP水平升高、手术类型和住院时间延长是独立的危险因素。结论合并RCD患者年龄明显小于合并LCD患者。RCD的保守治疗成功率高，而复杂的LCD往往因腹膜炎需要手术治疗。发热、CRP水平、手术类型和住院时间是并发症的独立危险因素。

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引用次数: 0

Comparison of machine learning and Cox regression models for prognostic analysis in hepatocellular carcinoma patients with distant metastasis 机器学习与Cox回归模型在肝细胞癌远处转移患者预后分析中的比较

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2025-06-15 DOI: 10.1016/j.sopen.2025.06.007

Hailan Li , Junbo Wang , Xin Ming , Mingsha Zhou , Li Zhou

Background

With the development of conversion therapy, there has been a significant improvement in advanced stage hepatocellular carcinoma (HCC) patients' survival outcomes. Accurate prognostic assessment of patients with distant metastasis (DM) is therefore pivotal in improving quality of life, guiding treatment, and optimizing patient management.

Methods

This study extracted patients with distant metastatic HCC from the Surveillance, Epidemiology, and End Results database. Univariate and multivariate Cox regression were used to identify prognostic factors. Then, Cox regression, DeepSurv, Decision Tree, and Random Survival Forests models were used to predict overall survival. Model performance was evaluated by area under the curve (AUC), decision curve analysis, calibration curve, and Brier score. The visualization of Cox regression and machine learning algorithms utilized nomogram and Shapley additive explanations, respectively.

Results

The study included 3051 HCC patients with DM. Factors such as tumor size, lung metastasis, N stage, ace, chemotherapy, radiotherapy, AFP, fibrosis, treatment interval, and number of metastases were independently associated with patient prognosis. Among all models, Cox regression and Random Survival Forest models showed stable performance, achieving AUCs of 0.746/0.760, 0.745/0.749, and 0.729/0.718 at 3, 6, and 12 months, respectively. Meanwhile, Cox regression showed the lowest Brier score (0.180 and 0.125) at 6 and 12 months.

Conclusions

Cox regression and Random Survival Forest models demonstrated robust prognostic performance for HCC, with Cox regression exhibiting superior temporal stability. The Cox-based nomogram provides an intuitive tool for rapid 3-, 6-, and 12-month survival stratification in metastatic HCC patients.

随着转化疗法的发展，晚期肝细胞癌（HCC）患者的生存预后有了显著改善。因此，对远处转移（DM）患者进行准确的预后评估对于改善生活质量、指导治疗和优化患者管理至关重要。方法本研究从监测、流行病学和最终结果数据库中提取远处转移性HCC患者。采用单因素和多因素Cox回归分析确定预后因素。然后，使用Cox回归、DeepSurv、决策树和随机生存森林模型预测总生存率。通过曲线下面积（AUC）、决策曲线分析、校准曲线和Brier评分来评价模型的性能。Cox回归和机器学习算法的可视化分别使用了nomogram和Shapley additive解释。结果本研究共纳入3051例合并糖尿病的HCC患者，肿瘤大小、肺转移、N分期、ace、化疗、放疗、AFP、纤维化、治疗间隔、转移数等因素与患者预后独立相关。在所有模型中，Cox回归和随机生存森林模型表现稳定，在3个月、6个月和12个月的auc分别为0.746/0.760、0.745/0.749和0.729/0.718。Cox回归分析显示，第6个月和第12个月Brier评分最低，分别为0.180和0.125。结论：Cox回归模型和随机生存森林模型对HCC的预后具有良好的效果，Cox回归模型具有较好的时间稳定性。cox为转移性HCC患者提供了快速3、6、12个月生存分层的直观工具。

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引用次数: 0

Association of hospital for-profit status with clinical and financial outcomes following emergency general surgery 医院盈利状况与急诊普通外科手术后临床和财务结果的关系

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2025-06-12 DOI: 10.1016/j.sopen.2025.06.003

Izhar Mbarani MD , Sara Sakowitz MD, MBA , Amulya Vadlakonda MD , Troy Coaston MSCR , Esteban Aguayo MD , Syed Shaheer Ali , Konmal Ali , Saad Mallick MD , Peyman Benharash MD MS

Background

The impact of for-profit (FP) hospital ownership on healthcare outcomes has garnered increasing attention in recent years with limited work linking FP status with lower quality of care and higher costs. However, outcomes emergency general surgery (EGS) at FP hospitals remains unknown.

Methods

All non-elective adult (≥18 years) hospitalizations entailing EGS (appendectomy, cholecystectomy, laparotomy, large bowel resection, perforated ulcer repair, or small bowel resection), within 2 days of admission, were tabulated from the 2016 to 2021 National Inpatient Sample. Multivariable models were constructed to evaluate the independent associations between hospital FP status with key clinical and financial outcomes.

Results

Of an estimated 2,124,394 patients, 337,950 (16 %) were classified as FP. Compared to others, the FP cohort was younger, of lower comorbidity burden, and more frequently in the lowest income quartile. After risk adjustment, care at FP hospitals was associated with a greater likelihood of in-hospital mortality or any major complication (Adjusted Odds Ratio [AOR] 1.15, 95 % Confidence Interval [CI] 1.12–1.18), including infectious (AOR 1.22, 95 % CI 1.18–1.26), respiratory (AOR 1.26, 95 % CI 1.21–1.31), and renal sequelae (AOR 1.12, 95 % CI 1.08–1.16). While associated with reduced per-patient hospitalization costs (β -$2910, 95 % CI -3180,-2640), treatment at FP institutions was associated with increased odds of non-home discharge (AOR 1.09, 95 % CI 1.05–1.13).

Conclusions

Care at for-profit hospitals appears to be associated with greater risk of morbidity and nonhome discharge. Future work is needed to consider the factors contributing to greater morbidity, and developing interventions aimed at improving quality of care.

近年来，营利性（FP）医院所有权对医疗保健结果的影响引起了越来越多的关注，将FP状态与较低的护理质量和较高的成本联系起来的工作有限。然而，在计划生育医院进行急诊普通外科手术（EGS）的结果尚不清楚。方法将2016年至2021年全国住院患者样本中所有入院2天内接受EGS（阑尾切除术、胆囊切除术、剖腹手术、大肠切除术、穿孔溃疡修复术或小肠切除术）的非选择性成人（≥18岁）纳入统计。我们构建了多变量模型来评估医院计划生育状况与关键临床和财务结果之间的独立关联。结果在估计的2,124,394例患者中，337,950例（16%）被归类为FP。与其他队列相比，计划生育队列更年轻，合并症负担更低，并且在最低收入四分位数中更常见。风险调整后，在计划生育医院的护理与院内死亡或任何主要并发症的可能性较大相关（调整优势比[AOR] 1.15, 95%可信区间[CI] 1.12 - 1.18），包括感染性（AOR 1.22, 95% CI 1.18-1.26）、呼吸道（AOR 1.26, 95% CI 1.21-1.31）和肾脏后遗症（AOR 1.12, 95% CI 1.08-1.16）。虽然与每位患者住院费用降低相关（β -$2910, 95% CI -3180,-2640），但在计划生育机构接受治疗与非家庭出院的几率增加相关（AOR 1.09, 95% CI 1.05-1.13）。结论营利性医院的恐慌似乎与更高的发病率和非家庭出院风险相关。未来的工作需要考虑导致更高发病率的因素，并制定旨在提高护理质量的干预措施。

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引用次数: 0

The impact of online teaching curricula on undergraduate basic surgical skills acquisition 网络教学课程对本科外科基本技能习得的影响

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2025-06-06 DOI: 10.1016/j.sopen.2025.06.002

Devansh Tandon , Ayush Gupta , Rhianna Patel , Anushka Shukla , Saran Singh Gill , Rhea Elise Patel , Keshav Krishnan , Bishoy Yassa , Shivansh Tandon , Amar Rai , Matt Boal , Nader Francis

Introduction

Despite the growing use of online teaching in medical education, undergraduate surgical skills training remains predominantly face-to-face, with limited structured curricula and resources. Consequently, many students lack confidence performing basic procedures independently. While online programmes offer a potential alternative, comparative evidence is limited. This service evaluation assessed the effectiveness of online surgical skills teaching on student skill acquisition and confidence.

Methods

Medical students who participated in five UK national surgical skills programmes between 2022 and 2024 were selected, having received either online or face-to-face instruction. Skill acquisition was measured using the Objective Structured Assessment of Technical Skills (OSATS) tool and confidence was measured pre- and post-training via a Likert scale. Non-parametric data were analysed using the Mann-Whitney U test, with significance set at p < 0.05.

Results

Of 133 participants, 82 received online and 51 face-to-face training. Fifty-six percent were in their first or second year of study. No significant differences were found in continuous (p = 0.0652) or mattress suturing (p = 0.143), while interrupted suturing scores were significantly higher in the online group (p = 0.0143). Both modalities significantly improved confidence (p < 0.0001), with no significant difference between groups (p > 0.05).

Conclusion

This study demonstrates that online surgical skills teaching is as effective as face-to-face methods, with both positively impacting skill acquisition and confidence. A hybrid approach, integrating online and face-to-face teaching, could optimise learning by combining the scalability of online instruction with essential practical experience, enhancing medical students' confidence and technical proficiency in surgical skills.

尽管在医学教育中越来越多地使用在线教学，但本科外科技能培训仍然主要是面对面的，结构化的课程和资源有限。因此，许多学生缺乏独立执行基本程序的信心。尽管在线课程提供了一种潜在的替代方案，但比较证据有限。本服务评估评估了在线外科技能教学对学生技能习得和信心的效果。方法选择2022年至2024年期间参加5个英国国家外科技能项目的医学生，接受在线或面对面教学。使用客观结构化技术技能评估（OSATS）工具测量技能习得，通过李克特量表测量培训前和培训后的信心。非参数数据分析采用Mann-Whitney U检验，显著性设置为p <；0.05.结果133名参与者中，82人接受了在线培训，51人接受了面对面培训。56%的学生是一年级或二年级学生。连续缝合组（p = 0.0652）和床垫缝合组（p = 0.143）的评分差异无统计学意义，而间断缝合组（p = 0.0143）的评分明显高于在线组（p = 0.0143）。两种方式都显著提高了信心(p <；0.0001)，组间无显著差异(p >；0.05)。结论本研究表明，在线外科技能教学与面对面教学一样有效，对技能习得和信心都有积极的影响。将在线和面对面教学相结合的混合方法，可以通过将在线教学的可扩展性与必要的实践经验相结合，优化学习，增强医学生对外科技能的信心和技术熟练程度。

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引用次数: 0

Editorial Board Page 编委会页面

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2025-06-01 DOI: 10.1016/S2589-8450(25)00052-1

引用次数: 0

Role of cholecystectomy in hyperkinetic biliary dyskinesia: A systematic review and meta-analysis 胆囊切除术在高运动性胆道运动障碍中的作用：一项系统综述和荟萃分析

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2025-06-01 DOI: 10.1016/j.sopen.2025.06.001

Duyen Quach MD , Kayla Nguyen MD , Gabriella Tavera BS , Rachel Wright MD , Zuhair Ali MD , Mike Liang MD

Background

Biliary dyskinesia is disorder characterized by reduced gallbladder ejection fraction, which have shown a good response to cholecystectomy. In contrast, hyperkinetic biliary dyskinesia (HBD), as defined by ejection fraction ≥80 %, is an emerging phenomenon, and the role of cholecystectomy is not yet clearly defined. This review investigates the effectiveness of cholecystectomy in alleviating symptoms of HBD.

Material and methods

A comprehensive literature search was conducted to retrieve studies based on predefined inclusion criteria. Data were extracted by two-independent reviewers. A random-effects model was used for meta-analysis. Risk ratios (RR) were calculated to estimate the impact of cholecystectomy on symptom improvement. Heterogeneity was calculated using the I² statistic and Q-test, with subgroup analyses performed based on study design.

Results

Fourteen studies involving 416 patients with HBD were included. Overall, the pooled RR for symptom relief post-cholecystectomy was 3.72 (95 % CI: 2.57–5.38). A subgroup analysis of retrospective reviews showed an RR of 3.9 (95 % CI: 2.57–5.92). Moderate heterogeneity (I² = 30.01 %) was observed.

Conclusion

Based on existing evidence, cholecystectomy appeared to be a promising and effective treatment for HBD in select patients.

胆道运动障碍是一种以胆囊射血分数降低为特征的疾病，在胆囊切除术后表现出良好的反应。相比之下，以射血分数≥80%为定义的胆道运动障碍（hyperkinetic biliary dydyesia， HBD）是一种新兴现象，胆囊切除术的作用尚未明确定义。本文综述了胆囊切除术在缓解HBD症状方面的有效性。材料和方法根据预先确定的纳入标准进行全面的文献检索。数据由两位独立审稿人提取。meta分析采用随机效应模型。计算风险比（RR）来评估胆囊切除术对症状改善的影响。采用I2统计量和q检验计算异质性，并根据研究设计进行亚组分析。结果纳入14项研究，涉及416例HBD患者。总体而言，胆囊切除术后症状缓解的总RR为3.72 （95% CI: 2.57-5.38）。回顾性分析的亚组分析显示RR为3.9 （95% CI: 2.57-5.92）。观察到中度异质性（I2 = 30.01%）。结论根据现有证据，胆囊切除术似乎是一种有希望且有效的治疗HBD的方法。

{"title":"Role of cholecystectomy in hyperkinetic biliary dyskinesia: A systematic review and meta-analysis","authors":"Duyen Quach MD , Kayla Nguyen MD , Gabriella Tavera BS , Rachel Wright MD , Zuhair Ali MD , Mike Liang MD","doi":"10.1016/j.sopen.2025.06.001","DOIUrl":"10.1016/j.sopen.2025.06.001","url":null,"abstract":"<div><h3>Background</h3><div>Biliary dyskinesia is disorder characterized by reduced gallbladder ejection fraction, which have shown a good response to cholecystectomy. In contrast, hyperkinetic biliary dyskinesia (HBD), as defined by ejection fraction ≥80 %, is an emerging phenomenon, and the role of cholecystectomy is not yet clearly defined. This review investigates the effectiveness of cholecystectomy in alleviating symptoms of HBD.</div></div><div><h3>Material and methods</h3><div>A comprehensive literature search was conducted to retrieve studies based on predefined inclusion criteria. Data were extracted by two-independent reviewers. A random-effects model was used for meta-analysis. Risk ratios (RR) were calculated to estimate the impact of cholecystectomy on symptom improvement. Heterogeneity was calculated using the I<sup>2</sup> statistic and Q-test, with subgroup analyses performed based on study design.</div></div><div><h3>Results</h3><div>Fourteen studies involving 416 patients with HBD were included. Overall, the pooled RR for symptom relief post-cholecystectomy was 3.72 (95 % CI: 2.57–5.38). A subgroup analysis of retrospective reviews showed an RR of 3.9 (95 % CI: 2.57–5.92). Moderate heterogeneity (I<sup>2</sup> = 30.01 %) was observed.</div></div><div><h3>Conclusion</h3><div>Based on existing evidence, cholecystectomy appeared to be a promising and effective treatment for HBD in select patients.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 128-134"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144212228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Association of body mass index and outcomes in surgical and transcatheter aortic valve replacement 体质量指数与手术和经导管主动脉瓣置换术预后的关系

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2025-06-01 DOI: 10.1016/j.sopen.2025.05.008

Bennet S. Cho MD , Troy N. Coaston BS , Amulya Vadlakonda BS , Sara Sakowitz MPH, MS , Syed Shaheer Ali , Esteban Aguayo MD , Peyman Benharash MD

Background

The association between body mass index (BMI) and outcomes in surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) is not well understood. This study assessed the nuanced relationship between BMI and clinical outcomes in a nationally representative cohort undergoing aortic valve replacement.

Methods

Adult (≥18 years) admissions for elective SAVR or TAVR from the 2016–2021 National Inpatient Sample were analyzed. BMI was categorized as underweight (<20), ideal weight (20–30), obesity class I (30–34.9), class II (35–39.9), and class III (≥40). The primary outcome was in-hospital mortality. Secondary outcomes included major adverse events (MAE), a composite of mortality and complications (e.g., stroke, thromboembolic, cardiac, respiratory, infection, renal).

Results

Among 103,000 patients, 61.2 % underwent TAVR. TAVR patients were older (76 vs. 64 years; p < 0.001) and more frequently underweight (3.1 % vs. 1.5 %; p < 0.001) compared to SAVR patients. In TAVR, BMI < 20 was associated with higher mortality (AOR 2.99, 95 % CI 1.16–7.74) and MAE (AOR 1.74, 95 % CI 1.30–2.34) compared to ideal BMI. Obesity did not increase the overall incidence of MAE in patients undergoing TAVR. In SAVR, mortality was not associated with BMI, but underweight (AOR 2.05, 95 % CI 1.33–3.15) and class III obesity (AOR 1.34, 95 % CI 1.09–1.65) were linked to higher MAE risk.

Conclusions

Extremes of BMI results in poorer outcomes in SAVR and TAVR. Underweight patients had increased risks across both approaches, while severe obesity elevated MAE risk in SAVR. These findings underscore the need for tailored perioperative strategies and risk counseling.

背景：身体质量指数（BMI）与外科主动脉瓣置换术（SAVR）和经导管主动脉瓣置换术（TAVR）预后之间的关系尚不清楚。本研究评估了在全国代表性的主动脉瓣置换术队列中BMI与临床结果之间的微妙关系。方法分析2016-2021年全国住院患者样本中因选择性SAVR或TAVR入院的成人（≥18岁）。BMI分为体重过轻（20）、理想体重（20 - 30）、肥胖I级（30-34.9）、II级（35-39.9）和III级（≥40）。主要终点是住院死亡率。次要结局包括主要不良事件（MAE）、死亡率和并发症（如中风、血栓栓塞、心脏、呼吸、感染、肾脏）的组合。结果在103,000例患者中，61.2%的患者接受了TAVR。TAVR患者年龄较大(76岁vs. 64岁；p & lt;0.001)和更频繁的体重不足(3.1% vs. 1.5%；p & lt;0.001)，与SAVR患者相比。在TAVR中，BMI <；与理想BMI相比，20与更高的死亡率（AOR 2.99, 95% CI 1.16-7.74）和MAE （AOR 1.74, 95% CI 1.30-2.34）相关。肥胖并没有增加TAVR患者MAE的总发生率。在SAVR中，死亡率与BMI无关，但体重不足（AOR 2.05, 95% CI 1.33-3.15）和III级肥胖（AOR 1.34, 95% CI 1.09-1.65）与较高的MAE风险相关。结论BMI值越高，SAVR和TAVR的预后越差。体重过轻的患者在两种方法中都增加了风险，而严重肥胖的患者在SAVR中增加了MAE的风险。这些发现强调了量身定制围手术期策略和风险咨询的必要性。

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引用次数: 0

Surgical trainee education in benign anorectal disease: a scoping review 良性肛肠疾病的外科培训生教育：范围综述

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2025-06-01 DOI: 10.1016/j.sopen.2025.05.001

Eleanor G.R. Watson BSc (Hons), MD , Tony Y. Zhang BBMed , Hwa Ian Ong MBChB, FRACS , David M. Proud MBBS (Hons), FRACS , Helen M. Mohan PhD, FRCSI

Background

Benign anorectal diseases such as haemorrhoids, perianal abscesses and fistulas are prevalent and disabling conditions that can be difficult to diagnose and treat.

This review aims to evaluate current education for training doctors around these diseases to inform the revision and development of surgical curricula.

Materials and methods

A literature search was conducted in MEDLINE, Embase and Google Scholar and data from included articles were charted in a semi-structured table. Quantitative outcomes were presented using simple descriptive statistics. Qualitative data were analysed using a reflexive thematic analysis framework.

Results

Ten studies were included. Most education was centred around haemorrhoids and delivered in the format of lectures and simulations. Harnessing the benefits of both on-demand and in-person content was key to optimising education delivery. In simulation studies, low-fidelity models were generally sufficient to meet educational objectives. There was universal agreement that the purpose of education was to supplement or prepare for clinical exposure, rather than to replace or ‘bridge gaps’ in experience. Education was found to be most useful and relevant when delivered to junior surgical or non-surgical cohorts.

Conclusions

This review elucidates gaps in current literature on benign anorectal disease education and provides recommendations for the development and implementation of future education for surgical trainees. There is a need for education that addresses a broader range of anorectal conditions and has a greater focus on the retention and clinical translation of acquired knowledge and skills. Interventions should be designed to enhance clinical exposure and maintain relevance throughout training progression.

背景：良性肛肠疾病如痔疮、肛周脓肿和瘘管是常见的致残性疾病，很难诊断和治疗。本综述旨在评价目前医生围绕这些疾病的培训教育，为外科课程的修订和发展提供信息。材料与方法在MEDLINE、Embase和谷歌Scholar中进行文献检索，并将纳入文章的数据用半结构化表格绘制。定量结果采用简单的描述性统计。使用反身性专题分析框架对定性数据进行分析。结果纳入10项研究。大多数教育以痔疮为中心，以讲座和模拟的形式进行。利用点播和现场内容的优势是优化教育交付的关键。在模拟研究中，低保真度模型通常足以满足教育目标。人们普遍认为，教育的目的是补充或准备临床接触，而不是取代或“弥合经验差距”。教育被发现是最有用的和相关的，当提供给初级外科或非手术队列。结论本文综述了目前关于肛肠良性疾病教育的文献空白，并对今后外科培训生教育的制定和实施提出了建议。有必要开展针对更广泛的肛肠疾病的教育，并更加注重已获得的知识和技能的保留和临床转化。干预措施的设计应加强临床暴露，并在整个培训过程中保持相关性。

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引用次数: 0

Prevalence of recurrent nerve injury among esophageal cancer patients undergoing esophagectomy: A systematic review and meta-analysis 食管癌切除术患者复发性神经损伤的发生率：系统回顾和荟萃分析

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2025-05-30 DOI: 10.1016/j.sopen.2025.05.009

Prakasini Satapathy , Abhay M. Gaidhane , Nasir Vadia , Soumya V. Menon , Kattela Chennakesavulu , Rajashree Panigrahi , Ganesh Bushi , Mahendra Singh , Sanjit Sah , Awakash Turkar , S. Govinda Rao , Khang Wen Goh , Muhammed Shabil

Background

Esophageal cancer remains a major cause of cancer-related mortality worldwide, and esophagectomy is a primary curative treatment for localized disease. However, recurrent laryngeal nerve (RLN) injury is a common and impactful complication that can impair vocal cord function, increase aspiration risk, and hinder postoperative recovery. To quantify its prevalence and explore contributing factors, we conducted a systematic review and meta-analysis including 24 studies and 6015 patients. The overall pooled prevalence of RLN injury was 18.36 % (95 % CI, 11.50 %–28.00 %), with substantial heterogeneity (I² = 95.8 %). Subgroup analysis revealed a lower pooled prevalence in robot-assisted minimally invasive esophagectomy (RAMIE) at 13.39 % (95 % CI, 9.28 %–18.95 %) compared to 21.89 % (95 % CI, 12.92 %–34.62 %) in minimally invasive esophagectomy (MIE). Among surgical techniques, the McKeown approach had the highest RLN injury prevalence (26.32 %; 95 % CI, 15.59 %–40.85 %), whereas the Ivor Lewis approach demonstrated a notably lower rate (5.77 %; 95 % CI, 1.00 %–100.00 %). RLN injury was more frequent in studies from low-volume or early-learning curve centers, while high-volume single-center RAMIE cohorts showed both lower prevalence and reduced heterogeneity. Sensitivity analyses supported the robustness of these findings, and publication bias assessment indicated only minor asymmetry (LFK index −1.81). These results highlight the clinical importance of RLN injury and support the role of robotic-assisted techniques, surgical experience, and intraoperative neuromonitoring in mitigating risk. Standardized definitions and procedural training are essential to improving outcomes and reducing the burden of this complication.

食管癌仍然是世界范围内癌症相关死亡的主要原因，食管癌切除术是局部疾病的主要治疗方法。然而，喉返神经（RLN）损伤是一种常见且有影响的并发症，可损害声带功能，增加误吸风险，阻碍术后恢复。为了量化其患病率并探讨影响因素，我们对24项研究和6015例患者进行了系统回顾和荟萃分析。RLN损伤的总总患病率为18.36 %(95 % CI, 11.50 % -28.00 %)，具有很大的异质性（I2 = 95.8 %）。亚组分析显示，机器人辅助微创食管切除术（RAMIE）的总患病率为13.39 %(95 % CI, 9.28 % -18.95 %)，而微创食管切除术（MIE）的总患病率为21.89 %（95 % CI, 12.92 % -34.62 %）。在手术技术中，McKeown入路的RLN损伤发生率最高(26.32 %；95% % CI, 15.59 % -40.85 %)，而Ivor Lewis方法的发生率明显较低(5.77 %；95 % ci, 1.00 % -100.00 %)。RLN损伤在小容量或早期学习曲线中心的研究中更为常见，而大容量的单中心RAMIE队列显示出更低的患病率和更低的异质性。敏感性分析支持这些发现的稳健性，发表偏倚评估显示只有轻微的不对称性（LFK指数- 1.81）。这些结果强调了RLN损伤的临床重要性，并支持机器人辅助技术、手术经验和术中神经监测在降低风险方面的作用。标准化的定义和程序性培训对于改善结果和减轻这种并发症的负担至关重要。

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引用次数: 0

Systematic review and meta-analysis of Transanal Opening of Intersphincteric Space (TROPIS) versus conventional treatments for anal fistula 经肛门括约肌间隙（TROPIS）与传统治疗肛瘘的系统回顾和荟萃分析

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2025-05-30 DOI: 10.1016/j.sopen.2025.05.010

Yang-Tao Chen , Zhao-Chu Wang, Ya-Meng Xie, Xun Wang, Xu-Xiong Wu, Yang Li, Rong Shi, Jing Wang

Transanal Opening of Intersphincteric Space (TROPIS) has emerged as a promising surgical approach for anal fistula management over recent years. This meta-analysis comprehensively evaluates the comparative efficacy and safety of TROPIS versus conventional treatments through systematic analysis of 24 clinical studies involving 2813 patients. Through systematic searches across 7 major biomedical databases (including PubMed, EMBASE, and Chinese repositories) from inception to March 2024, we identified comparative studies assessing TROPIS against six established interventions: incision-thread-drawing, seton placement, LIFT, EAFR, fistulotomy, and incision-suture techniques. Pooled analysis demonstrated TROPIS achieved superior clinical outcomes, with a 3.15-fold higher total efficacy rate (95 % CI 1.22–8.13, p = 0.02) and 64 % lower complication risk compared to conventional methods (OR 0.28, 95 % CI 0.18–0.42, p < 0.00001). Sensitivity analyses confirmed result stability across study designs, while publication bias assessment via funnel plots and Egger's test revealed no significant distortion. Importantly, TROPIS maintained its advantage across various complication subtypes including incontinence (OR 0.31), infection (OR 0.27), and recurrence (OR 0.19). These findings establish TROPIS as a clinically superior alternative that significantly improves therapeutic outcomes while reducing procedure-related risks, suggesting its potential to become the new reference standard in anal fistula management. The consistent results across diverse patient populations and comparator procedures underscore the robustness of this evidence synthesis.

近年来，经肛门括约肌间隙开放术（TROPIS）已成为肛瘘治疗的一种很有前途的手术方法。本荟萃分析通过对涉及2813例患者的24项临床研究的系统分析，综合评价了TROPIS与常规治疗的比较疗效和安全性。通过对7个主要生物医学数据库（包括PubMed、EMBASE和中文数据库）从成立到2024年3月的系统检索，我们确定了比较研究，评估了TROPIS与六种已建立的干预措施：切口线绘制、seton放置、LIFT、EAFR、瘘切开术和切口缝合技术。合并分析显示，与传统方法相比，TROPIS获得了更好的临床结果，总有效率提高3.15倍（95% CI 1.22-8.13, p = 0.02），并发症风险降低64% (OR 0.28, 95% CI 0.18-0.42, p <；0.00001)。敏感性分析证实了研究设计结果的稳定性，而通过漏斗图和Egger检验进行的发表偏倚评估显示没有显著的失真。重要的是，TROPIS在包括尿失禁（OR 0.31）、感染（OR 0.27）和复发（OR 0.19）在内的各种并发症亚型中保持了优势。这些研究结果表明，TROPIS在临床上是一种优越的选择，可以显著改善治疗结果，同时降低手术相关风险，这表明它有可能成为肛瘘治疗的新参考标准。不同患者群体和比较程序的一致结果强调了这一证据综合的稳健性。

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