Annali italiani di chirurgia最新文献

Aim: Neostigmine is a competitive inhibitor of acetylcholinesterase commonly used in neuromuscular blockade (NMB). Sugammadex is a new drug for rapid and reliable reversal of NMB. This study evaluated the effects of sugammadex versus neostigmine on postoperative oxygenation and pulmonary in elderly patients undergoing lower abdominal surgery.

Methods: A retrospective analysis of 279 patients who underwent lower abdominal surgery in the Quzhou Affiliated Hospital of Wenzhou Medical University from July 2023 to February 2025 was performed. Patients were divided into two groups based on the NMB reversal agents used: the sugammadex group (129 patients) and neostigmine+atropine group (150 patients). The safety and effectiveness of sugammadex in patients undergoing lower abdominal surgery were evaluated in terms of postoperative saturation of peripheral oxygen/fraction of inspired oxygen (SpO₂/FiO₂) ratio, extubation time, post-anesthetic care unit (PACU) stay time, and length of postoperative hospital stay using independent sample t-test, Mann-Whitney U test and χ² test.

Results: There was no significant difference in baseline characteristics between the neostigmine+atropine group and the sugammadex group (p > 0.05). Compared with the neostigmine+atropine, sugammadex could reverse deep NMB more quickly. The incidence of residual NMB at 10 min (sugammadex: 6.98%, 9/129; neostigmine+atropine: 52.00%, 78/150) and 20 min (sugammadex: 0%, 0/129; neostigmine+atropine: 16.00%, 24/150) was significantly lower in the sugammadex group compared to the neostigmine+atropine group (p < 0.05) post-operatively. Sugammadex also significantly improved postoperative oxygenation of patients, reduced the time to achieve Train-of-Four ratio (TOFr) ≥0.9, shortened the extubation time (p < 0.05), decreased the duration of PACU stay (p < 0.05), and lowered the incidence of postoperative pulmonary complications (p < 0.05), but has no effect on the length of postoperative hospital stay (p > 0.05).

Conclusions: By effectively reversing NMB, sugammadex significantly relieves the symptoms of muscle relaxation, accelerates the recovery of respiratory function, shortens the time of TOFr ≥0.9, extubation time, PACU duration, and reduces pulmonary complications in elderly patients undergoing lower abdominal surgery.

Colorectal cancer (CRC) is the third most common tumour in men and the second most common in women. It ranks as the third leading cause of new cancer cases and cancer-related deaths in both sexes. Due to differences in embryonic origin, rectal cancer (RC) is considered a distinct entity from colon cancer in terms of staging and treatment. Mortality rates in more developed countries are decreasing, largely due to increased screening and advances in the staging and treatment of rectal cancer. Current screening methods include faecal occult blood testing (FOBT) and rectosigmoidoscopy. For staging, the most commonly used imaging modalities are abdominopelvic magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) for locoregional evaluation, and computed tomography (CT), MRI, or positron emission tomography (PET) for detecting distant metastases. Traditionally, the standard treatment for rectal cancer has been total mesorectal excision. However, more recently, it has been observed that patients with non-advanced stages of the disease may benefit from neoadjuvant radiochemotherapy, which can allow for less invasive surgery at a later stage. In recent years, radiomic studies have emerged to identify predictive features of tumour progression, with the goal of personalising treatment according to each patient's characteristics.

Aim: This study aims to evaluate the effectiveness of combining the risk assessment profile for thromboembolism (RAPT) score with thrombotic biomarkers in predicting postoperative deep vein thrombosis (DVT) in patients with traumatic fractures and to create a nomogram model for risk assessment.

Methods: This retrospective cohort study recruited 329 traumatic fracture patients from Shouxiang Community Health Service Center of Yinhu Street between September 2021 and September 2024. Patient data were randomly assigned to a training set (n = 230, 70%) and a test set (n = 99, 30%) for model development and validation. In the training set, patients were stratified based on DVT state into a DVT group (n = 110) and a non-DVT group (n = 120). The RAPT score and thrombotic biomarker levels were compared between the two groups. Multivariate logistic regression analysis was conducted to identify independent risk factors for postoperative DVT. Based on these factors, a nomogram model was developed, and its diagnostic performance was assessed through receiver operating characteristic (ROC) curve analysis, calibration curve analysis, and clinical decision curve analysis.

Results: The DVT group exhibited significantly higher levels of RAPT score (7.00 [5.00, 9.00] vs. 4.00 [2.00, 7.00]), D-dimer (D-D) (874.12 ± 77.16 vs. 841.37 ± 86.94), fibrinogen (FIB; 4.00 [3.90, 4.30] vs. 4.00 [3.70, 4.20]), and thrombin-antithrombin complex (TAT; 16.60 [14.43, 18.38] vs. 15.40 [14.10, 16.90]) relative to non-DVT group (p < 0.05). Multivariate logistic regression analysis identified the RAPT score, D-D, FIB, and TAT as independent risk factors for postoperative DVT, with odds ratios (ORs) of 1.209, 1.006, 3.625, and 1.246, respectively (p < 0.05). Using these factors, a nomogram model was constructed. In both the training and test sets, the fitting degree of this nomogram model was good. ROC curve analysis revealed that the area under the curve (AUC) of 0.7714 (0.7107-0.832) and 0.7066 (0.603-0.8103) for predicting the occurrence of lower extremity DVT in the training set and the test set, respectively. The calibration curve demonstrated excellent agreement between the predicted probabilities and the observed outcomes. Decision curve analysis (DCA) demonstrated that the nomogram yielded a higher net benefit than the "treat all" or "treat none" strategies across a threshold probability range of 0.055-0.755 in the training set and 0.095-0.805 in the testing set.

Conclusions: The integration of the RAPT score with thrombotic biomarkers (D-D, FIB, and TAT) offers a feasible and effective approach for predicting postoperative DVT in patients with traumatic fractures, guiding targeted prophylactic strategies and enhancing perioperative management and patient outcomes.

Aim: This study aimed to explore the effect of comprehensive warming measures on reducing limb pain in patients undergoing laparoscopic cholecystectomy during recovery from anaesthesia.

Methods: The medical records of 131 patients who underwent laparoscopic cholecystectomy in our hospital from June 2021 to June 2023 were retrospectively analyzed. According to the perioperative interventions administered, the samples were divided into a warming group (n = 62, in which comprehensive warming measures were applied, including preoperative forced-air warming, intraoperative use of warmed fluids and gases, and postoperative continuous warming) and a routine group (n = 69, in which routine management measures without active warming were applied, limited to maintenance of ambient room temperature, the use of standard draping and unheated fluids/gases). The Steward recovery score was used to evaluate the quality of anaesthesia recovery, and postoperative limb pain was assessed using the Visual Analogue Scale (VAS). Surgical indicators were also compared between the two groups.

Results: Baseline data, as well as operation time and blood loss, were not significantly different between the two groups (all p > 0.05). Infusion volume and length of hospital stay were significantly different between the two groups (p < 0.001). In terms of the quality of anaesthesia recovery, level of consciousness, level of airway patency, and limb movement in the warming group were significantly higher than those in the routine group (p < 0.05). The postoperative VAS score in the warming group was significantly lower than that in the routine group (p < 0.001). Incidence of complications was not significantly different between the two groups (p = 0.308).

Conclusions: Comprehensive warming measures improved limb pain and recovery quality in patients undergoing laparoscopic cholecystectomy, highlighting their clinical value.

Aim: This study aimed to investigate the incidence and risk factors of perioperative complications in two types of neurosurgical procedures performed in the sitting position: deep brain stimulation (DBS) electrode placement and suboccipital craniotomy/craniectomy, with a focus on comparing their outcomes.

Methods: This retrospective analysis included 259 patients who underwent sitting-position neurosurgery (DBS electrode placement, n = 104; suboccipital craniotomy/craniectomy, n = 155) between January 2019 and June 2024. Complications, including venous air embolism (VAE), tension pneumocephalus, and hemorrhage, were analyzed separately for each group. Multivariate logistic regression and subgroup analyses were performed to identify independent risk factors specific to each procedure.

Results: The overall complication rate was higher in suboccipital craniotomy/craniectomy (14.19%) than in DBS (5.77%). For DBS, diabetes (odds ratio (OR) = 6.000, p = 0.039) was identified as a key risk factor. For suboccipital craniotomy/craniectomy, independent risk factors included age ≥60 years (OR = 2.152, p = 0.006), diabetes (OR = 3.412, p = 0.020), heart disease (OR = 3.262, p = 0.048), American Society of Anesthesiologists (ASA) grade III (OR = 2.346, p = 0.007), and prolonged operative time (OR = 1.983, p = 0.015).

Conclusions: Neurosurgery in the sitting position demonstrates varying complication risks depending on surgical type and patient-specific factors. Strict perioperative monitoring and individualized positioning strategies are essential, particularly for elderly patients and those with comorbidities. These findings provide valuable insights for optimizing surgical safety and guiding future prospective studies.

Aim: This study aimed to evaluate the clinical efficacy of unilateral biportal endoscopy (UBE) technology in patients with complex spinal stenosis and to identify factors associated with postoperative complications to optimize individualized treatment strategies.

Methods: This single-center retrospective study included 146 patients with complex spinal stenosis, characterized by multi-segmental involvement and/or ligamentum flavum calcification, who underwent UBE between May 2020 and March 2023. Eligible patients had complete clinical and imaging data and a minimum follow-up of 6 months. Surgical variables (operative time, intraoperative blood loss, and length of hospital stay), perioperative information, and early mobilization protocols were collected. Primary outcomes included pain intensity (visual analog scale (VAS)), functional disability (Oswestry Disability Index (ODI)), and neurological recovery (Japanese Orthopaedic Association (JOA)). Secondary outcomes involved complication rates, recurrence, and patient satisfaction. Pre- and postoperative differences were assessed using paired t-tests, and multivariate logistic regression was performed to identify independent risk factors for postoperative complications.

Results: UBE significantly improved clinical symptoms, with VAS scores decreasing from 7.5 ± 0.9 preoperatively to 2.5 ± 0.8 postoperatively (p < 0.001), ODI scores decreasing from 55.8 ± 8.3% to 19.6 ± 6.4% (p < 0.001), and JOA scores increasing from 8.7 ± 1.9 to 19.8 ± 3.1 (p < 0.001). Imaging evaluations showed a significant increase in spinal canal area (p < 0.001). The overall complication rate was 19.9% (29 cases), with ligamentum flavum calcification identified as an independent risk factor (odds ratio (OR) = 3.414, 95% confidence interval (CI): 1.383-8.432, p = 0.008). The satisfaction score of 88.4% of patients is ≥4 points.

Conclusions: UBE technology effectively improves clinical symptoms and imaging outcomes for managing complex spinal stenosis, with low complication and recurrence rates. However, the presence of ligamentum flavum calcification is a critical risk factor for complications, highlighting the need for tailored preoperative planning to optimize surgical outcomes and reduce risks.

Aim: This study aimed to compare the advantages of π-shaped anastomosis with reverse puncture device (RPD) anastomosis following totally laparoscopic total gastrectomy (TLTG).

Methods: Clinical data from 133 patients with gastric cancer who underwent TLTG between 1 January 2020 and 1 January 2024, in the Department of Gastrointestinal Surgery at the First Affiliated Hospital of Bengbu Medical University were retrospectively analyzed. Patients were categorized into a π-shaped group (67 patients) and an RPD group (66 patients) according to the esophagojejunal anastomosis method. The median follow-up duration was 6 months (95% CI: 5.2-6.8 months). Baseline characteristics, postoperative conditions, and postoperative complications were compared and analyzed between the two groups.

Results: There were no significant differences between the groups in intraoperative bleeding volume, total lymph node dissection number, first flatus time, hospitalization time, or the incidence of postoperative non-anastomotic complications (all p > 0.05). Compared with the RPD group, the π-shaped group demonstrated shorter anastomosis time, smaller main incision length, and a lower incidence of anastomotic complications (all p < 0.05). Conversely, the RPD group has a significantly longer esophageal resection margin compared to the π-shaped anastomosis group (p < 0.05).

Conclusions: Both RPD and π-shaped anastomosis are safe and effective for esophagojejunal reconstruction after TLTG. The π-shaped anastomosis is recommended as the preferred anastomosis for totally laparoscopic total gastrectomy, and the RPD anastomosis can be applied to gastroesophageal junction cancer with a higher tumor location.

Aim: Hepatocellular carcinoma (HCC) remains a significant global health concern, often diagnosed at advanced stages, limiting the efficacy of surgical interventions. Early and accurate diagnosis is critical for improving surgical outcomes and reducing mortality. Traditional biomarkers, such as alpha-fetoprotein (AFP), des-gamma-carboxyprothrombin (DCP), and the lectin-bound fraction of AFP (AFP-L3), show limited sensitivity and specificity. Advanced diagnostic models, including GALAD, TAGALAD, and GAP_TALAD, offer a promising multi-biomarker approach but lack extensive evaluation in surgical contexts.

Methods: This retrospective study included a cohort of 267 untreated hepatocellular carcinoma patients and 231 control patients (with hepatitis or cirrhosis). We applied the predefined formulas for the TAGALAD, GAP_TALAD, and other models to the cohort data. The diagnostic performance of each model and individual biomarker for detecting HCC was assessed using receiver operating characteristic (ROC) curve analysis to determine the area under the curve (AUC), sensitivity, and specificity at optimal cut-offs. Additionally, key clinical subgroups, including pathologically confirmed HCC, clinically diagnosed HCC, early-stage HCC (TNM I+II), patients with complete data (no imputation), and hepatitis B virus (HBV)-related disease, were also analyzed.

Results: TAGALAD and GAP_TALAD demonstrated superior performance compared to the GALAD model and traditional biomarkers across all patient subgroups. Notably, TAGALAD achieved the highest diagnostic accuracy, with an AUC of 0.880, sensitivity of 0.760, and specificity of 0.861, followed closely by GAP_TALAD (AUC = 0.874). Both models demonstrated excellent performance in early-stage HCC detection (TAGALAD AUC = 0.860, GAP_TALAD AUC = 0.867), highlighting their potential in identifying candidates for surgical resection or transplant at an early curative stage. In HBV-related HCC, TAGALAD (AUC = 0.874) and GAP_TALAD (AUC = 0.857) showed superior diagnostic accuracy compared to GALAD (AUC = 0.731) and single biomarkers (AUC = 0.598-0.799).

Conclusions: The TAGALAD and GAP_TALAD models offer a robust and reliable framework that supports early diagnosis of HCC. Their superior accuracy indicates a more reliable foundation for identifying candidates for curative surgical interventions, suggesting the potential to refine patient selection. Future research should focus on multi-center validation and the integration of novel biomarkers to further optimize these models for surgical decision-making and personalized treatment strategies.

This review explores the biomechanical evaluation of calcaneal fractures, utilizing techniques such as computed tomography (CT) imaging and finite element analysis to assess fracture stability, alignment, and load distribution. These evaluations are essential for enhancing treatment approaches and improving patient outcomes. The review underscores the significance of quantitative metrics in linking biomechanical parameters with clinical outcomes, thereby facilitating personalized treatment planning. Future research advancements are anticipated to focus on integrating high-throughput biomechanical approaches, multimodal datasets, and artificial intelligence to enhance the precision of fracture evaluations and develop tailored interventions that foster better recovery and overall quality of life for patients with calcaneal fractures.