Annali italiani di chirurgia最新文献

Aim: Tracheal diverticulum, an air-filled sac typically located on the right posterolateral aspect of the trachea, has an unclear etiology. This study evaluates the clinical management and outcomes of incidentally detected tracheal diverticula in patients with papillary thyroid carcinoma, emphasizing the need for preoperative diagnosis and selective treatment.

Case presentation: Within our multi-center thyroid surgery cohort, seven cases of tracheal diverticula were incidentally discovered during thyroidectomy, with preoperative diagnosis achieved in only a subset of patients. Some tracheal diverticula were surgically excised, allowing for histopathological examination, whereas others were left in situ. All patients recovered without postoperative complications.

Results: Histopathological examination of the resected tracheal diverticula confirmed benign pathology. All patients, including those with untreated tracheal diverticula, remained asymptomatic during follow-up, with no tracheal abnormalities or complications observed. High-resolution computed tomography and three-dimensional reconstruction technology proved effective for the preoperative diagnosis of tracheal diverticulum.

Conclusions: Routine surgical treatment is unnecessary for asymptomatic patients, with resection of tracheal diverticulum reserved for symptomatic cases. Diagnostic approaches such as high-resolution computed tomography and three-dimensional reconstruction serve as essential preoperative assessments before thyroidectomy, enabling accurate diagnosis of tracheal diverticulum.

Aim: This study aimed to evaluate the effect of nutritional support intervention, implemented within the framework of comprehensive nursing, on gastrointestinal function and primary symptom indices in patients with gastroparesis syndrome following radical gastrectomy for gastric cancer.

Methods: Based on existing case records, the clinical data of 225 patients who underwent radical gastrectomy (distal gastrectomy + Billroth II anastomosis) for gastric cancer at our hospital between October 2022 and October 2024 were retrospectively analyzed. After propensity score matching (PSM) at a 1:1 ratio, 160 patients were included in the final analysis and among them, 80 cases in the observation group and 80 cases in the control group. The control group received conventional nursing care, while the observation group received nutritional support intervention within a comprehensive nursing model. Levels of gastrointestinal hormones, severity of gastroparesis symptoms, gastrointestinal function, and nursing satisfaction were compared between the two groups before and after the intervention.

Results: Two weeks post-intervention, the levels of motilin (MTL) and gastrin (GAS) in the observation group were significantly lower than in the control group, whereas the pepsinogen I (PG I) level was significantly higher (p < 0.05). Following two weeks of treatment, the observation group demonstrated significantly lower Gastroparesis Cardinal Symptom Index (GCSI) scores than the control group (p < 0.05). Additionally, the observation group had shorter gastric drainage duration, earlier first flatus, quicker resumption of normal eating, and faster symptom resolution compared to the control group (p < 0.05). Nursing satisfaction was significantly higher in the observation group (p < 0.05).

Conclusions: Nutritional support intervention delivered through comprehensive nursing for patients with gastroparesis syndrome after radical gastrectomy for gastric cancer enhances gastric function, modulates gastrointestinal hormone levels, alleviates gastroparesis symptoms, and improves nursing satisfaction.

Aim: Preoperative anemia remains a common condition in elderly patients undergoing orthopedic surgery, and the choice of transfusion strategy may affect perioperative outcomes. Therefore, this study aims to investigate the effect of a restrictive transfusion strategy on perioperative outcomes in this population.

Methods: A retrospective analysis was conducted on 782 preoperatively anemic patients (aged ≥60 years) who underwent hip replacement, knee replacement, or spine surgery at Xuanwu Hospital Capital Medical University, China, between January 2018 and June 2024. Patients were categorized into the restrictive (n = 380) and liberal (n = 402) transfusion strategy groups. Perioperative indicators included estimated blood loss, transfusion volume, length of hospital stay, as well as additional relevant variables. Primary outcomes were 30-day all-cause mortality, transfusion-related adverse reactions, and postoperative infection rates. Secondary outcomes included postoperative hemoglobin levels, readmission rates, reoperation rates, thrombosis, and cardiovascular events.

Results: In hip replacement and spine surgery patients, the estimated blood loss was significantly lower in the restrictive transfusion group than in the liberal transfusion group (p < 0.001), while higher in knee replacement patients (p < 0.001). The restrictive transfusion strategy reduced transfusion requirements and shortened hospital stay across all surgical types (p < 0.001). No significant difference in 30-day all-cause mortality was observed between the groups (p > 0.05). However, the restrictive transfusion group had significantly lower rates of transfusion-related adverse reactions (1.3% vs. 5.0%, p < 0.001) and infections (2.6% vs. 6.5%, p = 0.017). Additionally, transfusion strategy was identified as an independent risk factor for transfusion-related adverse reactions [odds ratio (OR) = 3.96, 95% CI: 1.468-10.682, p = 0.007)].

Conclusions: A restrictive transfusion strategy reduces transfusion volume, minimizes the incidence of transfusion-related adverse reactions and infections. This study supports individualized perioperative anemia management to optimize outcomes in elderly patients.

Aim: Vocal cord cyst is a common benign proliferative lesion of the vocal cords, usually resulting from excessive use of the voice, environmental pollution, and inflammatory infections. This study aims to explore the differences in the effectiveness of carbon dioxide (CO₂) laser or surgical treatment for vocal cord cyst patients.

Methods: This retrospective study analyzed 81 patients with vocal cord cysts who underwent surgical treatment at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine between July 2021 and July 2024. Among them, 40 patients were treated with CO₂ laser surgery (the laser group), and 41 underwent traditional surgical treatment (the surgery group). The study compared the pre- and post-treatment voice acoustic parameters, aerodynamic parameters, levels of inflammatory factors, stress response indicators, and surgical complications between the two groups.

Results: Before surgery, there were no significant differences between the laser group and the surgery group regarding jitter, shimmer, harmonic-to-noise ratio (HNR), maximum phonation time (MPT), mean airflow rate, and subglottic pressure (p > 0.05). However, at 4 weeks post-surgery, the laser group showed lower values for jitter, shimmer, and mean airflow compared to the surgery group (p < 0.05), while the laser group demonstrated a longer MPT compared to the surgery group (p < 0.05). Before surgery, there were no significant differences between the laser and surgery groups regarding the levels of interleukin-6 (IL-6), interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α) (p > 0.05). However, at 4 weeks post-surgery, the IL-1β and TNF-α levels in the laser group were lower than those in the surgery group (p < 0.05). Before surgery, there were no significant differences between the laser and surgery groups in Voice Handicap Index (VHI-10) scores and the Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) scores (p > 0.05). Moreover, the VHI-10 and GRBAS scores were lower in the laser group compared to the surgery group at 4 weeks post-surgery (p < 0.05). Additionally, the complication rates in the laser group were 12.50%, compared to 24.39% in the surgery group, indicating no significant differences (p > 0.05).

Conclusions: Both CO₂ laser and conventional surgery for treating vocal cord cysts show favorable outcomes. However, CO₂ laser surgery offers faster recovery of vocal function and is more effective at reducing the inflammatory response.

Aim: This study aims to assess the impact of risk early warning management on postoperative rehabilitation outcomes in patients with unilateral intertrochanteric femur fracture (UIFF), and to investigate the effect on the incidence of postoperative delirium.

Methods: This study included 284 patients with unilateral femoral intertrochanteric fracture admitted between January 2023 and December 2023. The patients received internal fixation with proximal femoral nail (PFN). Patients were divided into two groups: the experimental group (n = 142), which received risk early warning management, and the control group (n = 142), which received routine perioperative management. The coagulation function and self-care ability were evaluated in both groups before (before surgery) and after intervention (10 days after surgery). Furthermore, postoperative complication rate, hip rehabilitation quality, and satisfaction levels were comparatively analyzed between the two study groups.

Results: Higher fibrinogen (FBG) and lower D-dimer (D-D) were found in the experimental group compared to the control group (p < 0.05). Furthermore, the experimental group showed a significantly lower incidence of delirium, as well as improved hip rehabilitation quality and self-care ability compared to the control group (p < 0.05). Additionally, the overall satisfaction levels were substantially higher in the experimental group of patients than those observed in the control group (p < 0.05).

Conclusions: Risk early warning management can enhance the coagulation function and reduce the risk of postoperative delirium in patients with UIFF. These findings will provide a more reliable safety package for the future surgical treatment of UIFF.

Aim: This study evaluates the demographic and clinicopathological characteristics of patients diagnosed with cutaneous melanoma in the Romanian population.

Methods: This retrospective population-based cohort study analyzed the histopathological parameters of primary cutaneous melanomas in 130 patients treated at the plastic surgery department of our hospital in Bucharest over a six-year period.

Results: The incidence of cutaneous melanoma in the cohort increased by approximately 15.6% annually, with a male predominance and a mean diagnosis age of 59.9 years. The majority (73.1%) of cases were within the 51-80 age group. Superficial spreading melanoma accounted for 52.3% of cases, followed by nodular melanoma at 35.4%. The mean Breslow index was 4.745 mm, and 35.4% of cases were diagnosed at stage T4. Spearman's rank correlation analysis demonstrated that the Breslow index was positively correlated with patient age (rho = 0.327, p < 0.001), indicating that older age is associated with higher Breslow index values. Males presented with higher tumor thickness and were diagnosed later than females, on average by a decade.

Conclusions: Cutaneous melanoma remains a high-risk malignancy with significant morbidity and mortality. Patients in Romania were diagnosed with thicker tumors compared to Western populations, potentially due to limited awareness and insufficient prevention strategies. These findings underscore the urgent need to improve early detection programs and public education on melanoma in Romania.

Aim: Proximal femoral nail antirotation (PFNA) fixation remains an effective surgical method in effectively managing intertrochanteric fractures in elderly patients with osteoporosis. While postoperative anti-osteoporotic therapy is essential, only a part of the elderly patients adhere to anti-osteoporosis treatment. Therefore, this study aims to investigate the therapeutic efficacy of combining alfacalcidol (an anti-osteoporotic drug) with PFNA fixation, as well as their effects on serum bone metabolic markers and inflammatory indicators in elderly patients with osteoporotic intertrochanteric fractures.

Methods: This retrospective study recruited 140 elderly patients with osteoporosis intertrochanteric fractures who were treated at Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, China, between January 2021 and January 2024. Patients were divided into two groups based on their treatment approach: a surgical group (n = 63, who received PFNA with routine postoperative care) and a combined group (n = 77, who received PFNA combined with alfacalcidol). Postoperatively, these patients were followed up for a six-month period. Fracture healing was comprehensively evaluated through functional assessment and X-ray imaging examination. Harris hip scores and bone mineral density (BMD) were assessed before surgery, and then again one month and six months after surgery. Furthermore, serum bone metabolic markers and inflammatory cytokines were evaluated preoperatively and then six months after surgery.

Results: The fracture healing time was significantly shorter in the combined group than in the surgical group (p < 0.001). Compared to the surgical group, the Harris scores in the combined group were significantly higher at one and six months postoperatively (p < 0.001, p = 0.003). Additionally, BMD in the combined group was significantly increased at six months postoperatively (p = 0.002). Serum levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), β-Crosslaps (β-CTX), and parathyroid hormone (PTH) were significantly lower in the combined group compared to the surgical group after surgery (p < 0.001), whereas 25-hydroxyvitamin D (25-OHD) and procollagen type I C-terminal propeptide (PICP) levels were significantly higher (p < 0.001). In the surgical group, there were 4 cases of screw migration, 2 cases of delayed healing, and 1 case of venous embedding in the lower limbs. There was 1 case of infection, 2 cases of screw migration, 1 case of delayed healing, and 2 cases of venous embedding in lower limbs in the combined group. The incidence of postoperative complications was comparable between the combined group (6/77, 7.79%) and the surgical group (7/63, 11.11%) (p = 0.501).

Conclusions: Alfacalcidol combined with PFNA provides superior therapeutic outcomes for elderly patients with osteoporotic intertrochanteric fract

Aim: Postoperative pulmonary complications (PPCs) commonly ensue after thoracic surgery and can impair patients' recovery. This study aimed to evaluate the effectiveness of preoperative respiratory training (PRT) in various perioperative outcomes in patients undergoing thoracic surgery, including pulmonary function, exercise capacity, incidence of postoperative complications, and length of hospital stay.

Methods: Randomized controlled trials (RCTs) comparing PRT with routine care, that were published in the period of 1 January 2000 to 30 June 2025, were identified through PubMed, Embase, Web of Science, and Cochrane Library. Pooled analyses were performed using RevMan 5.4.1 to calculate odds ratio (OR) or mean difference (MD) with 95% CI.

Results: Nine studies were included in the meta-analysis. The results revealed that PRT significantly reduces PPCs (OR = 0.31, 95% CI: 0.21 to 0.46) and improved the change in six-minute walking distance (6MWD) (MD = 20.50, 95% CI: 11.72 to 29.28). No significant effects were observed on absolute 6MWD, forced expiratory volume in one second (FEV₁), peak expiratory flow, or length of hospital stay. Sensitivity analysis confirmed result stability, and no substantial publication bias was found.

Conclusions: PRT reduces PPCs and improves postoperative functional recovery in patients undergoing thoracic surgery. Its impact on spirometry-based pulmonary function and length of hospital stay remains uncertain. Further large-scale trials are needed to investigate the effect of integrating perioperative care into routine healthcare, especially for high-risk patients.

Aim: The demand for total knee arthroplasty (TKA) is projected to double over the next decade; consequently, the incidence of periprosthetic fractures associated with TKA is also rising. One of the most frequently used constructs is a single lateral locking plate, chosen for its ease of application and familiarity. However, single lateral plating has been associated with a high incidence of nonunion, complications, and revision. Augmenting the lateral plate construct with a medial plate decreases the likelihood of failure, offering stronger fixation for low periprosthetic fractures. The aim of this study was to review the existing literature on dual plating for distal femoral fractures in patients undergoing TKA.

Methods: A systematic review of scientific articles listed in medical databases (PubMed, Scopus) from September 2014 to December 2024 was carried out, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data collected included author name, study design, patient demographic characteristics, clinical results, radiological outcomes, postoperative complications or adverse events, length of follow-up, cause and rate of failure, and time to full weight-bearing.

Results: Of the 895 articles identified, 690 did not meet the eligibility criteria and were excluded. Thirty-eight articles underwent full-text review, and six studies were included in the final analysis. Five were retrospective studies and one was a case series. The total number of patients was 137 (16 male, 121 female), with study sizes ranging from 15 to 38 patients. The double plate technique was most frequently applied in Su type 3 fractures. Dual plating resulted in positive clinical outcomes and a satisfactory union rate in comminuted distal femoral fractures: bone callus formation was observed in 135 of 137 patients (98.5%). Immediate postoperative weight-bearing was permitted in three of the six studies, while in two others it was delayed until 10-12 or 23 weeks. Osteosynthesis failure occurred in only two cases (2%). Secondary intervention was required in nine cases (6.5%), and complications were reported in 24 patients (17.6%), primarily due to infection or intolerance of plate screws.

Conclusions: Dual plating is a reliable approach for managing periprosthetic fractures associated with TKA, even in low fractures and when medial or metaphyseal comminution is present, offering high rates of anatomic reduction and low rates of reoperation and complications.