影响LEEP治疗宫颈上皮内瘤变预后的因素分析

目的:探讨影响宫颈环状电切术(loop electrosurgical excision procedure,LEEP)治疗宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)的预后因素。方法:2011年8月至2013年12月选择在我院进行诊治的宫颈上皮内瘤变患者170例,都给予LEEP治疗,观察术后疗效及其不良反应发生情况。结果:所有患者都完成LEEP术,有效率为94.7%;发生不良反应14例,发生率为8.2%,都经过对症处理后好转。Logistic回归模型进行分析结果显示年龄、CIN分级、宫颈糜烂状况是影响宫颈上皮内瘤变预后的主要独立危险因素(P<0.05)。结论:LEEP治疗宫颈上皮内瘤变具有很好的预后疗效,不良反应较少,影响其预后的因素主要为年龄、疾病分级与宫颈糜烂状况。     

Risk factors for major complications after liver resection: A large liver resection study from Morocco and audit of a non-Eastern/non-Western experience

Background and Study AimsIn developing countries, endemic indications, blood shortages, and the scarcity of liver surgeons and intensive care providers can affect liver resection (LR) outcomes, but these have been rarely addressed in the literature. Therefore, in this study we determined risk factors for major complications after LR in a North African general surgery and teaching department.Patients and MethodsFrom January 2010 to December 2015, 213 consecutive LRs were performed on 203 patients. All patients underwent a postoperative follow-up of >90 days. Postoperative complications were assessed according to the Clavien–Dindo (CD) classification of surgical complications. A score of CD ≥III is considered as major postoperative complications. In this study, we analyzed the variables assumed to affect these complications.ResultsThe overall 90-day complication rate was 35.7% (n = 76), including a CD ≥III of 14% (n = 30) and a mortality rate of 6.1% (n = 14). According to the multivariate analysis, a preoperative performance status (PS) of ≥2 (P = 0.011; odds ratios [OR], 6.8; 95% confidence intervals [CI], 1.55–29.8), an estimated intraoperative blood loss of >500 ml (P = 0.002; OR, 3.71; 95% CI, 1.23–11.20), and bilioenteric anastomosis (P < 0.004; OR, 7.76; 95% CI, 1.5–3.89) were independent risk factors for major complications after LR.ConclusionWe recommend that, in the setting of a non-Eastern/non-Western general surgery and teaching department, patients with a PS of ≥2 should undergo a specific selection and preoperative optimization protocol; intermittent clamping indications should be extended; and special attention should paid to patients undergoing LR associated with biliary reconstruction, such as for perihilar cholangiocarcinoma.     

Tumor teratoide/rabdoide atípico con diferenciación tipo ganglioglioma: reporte de caso

BackgroundAtypical teratoide/rhabdoid tumor is a very rare and aggressive disease that primarily presents in pediatric patients. To the best of our knowledge, the initial presentation of this type of tumor with ganglioglioma-like differentiation is rare in the literature.Case reportWe present the case of a 9-month-old patient with left facial paralysis. An MRI revealed a lesion at the left cerebellopontine angle. Complete macroscopic surgical resection was performed. Histopathology and immunohistochemistry testing revealed an atypical teratoid/rhabdoid tumor with ganglioglioma-like differentiation.ConclusionsThis case report presents an atypical teratoid/rhabdoid tumor with initial gangligioma-like differentiation. This study adds to the data in the literature and promotes the study of this type of histogenesis. It lays a foundation for encouraging further studies to determine whether changes should be made to existing management protocols and, at the same time, determine whether there would be any variation with regard to disease prognosis.     

Is laparoscopic liver resection safe for intrahepatic cholangiocarcinoma? A meta-analysis

BackgroundThe use of laparoscopic liver resection for curative surgery of intrahepatic cholangiocarcinoma (ICC) is not well established. Herein, we perform a meta-analysis to compare the differences between laparoscopic liver resection (LLR) and open liver resection (OLR) for ICC.MethodsMultiple electronic databases were searched and 8 relevant studies containing 552 patients treated by LLR and 2320 treated by OLR were identified. The fixed effects and a random-effects model were used to perform a meta-analysis.ResultsCompared with OLR, LLR for ICC was associated with less blood transfusion (7.14% versus 17.11%; OR: 0.32; 95% CI 0.15 to 0.71; P < 0.05), higher R0 resection (85.63% versus 74.69%; OR: 1.48; 95% CI 1.13 to 1.95; P < 0.05), shorter length of stay (LOS) (SMD: −0.40; 95% CI -0.80 to 0.00; P = 0.05), less overall morbidities (20% versus 32.69%; OR: 0.50; 95% CI 0.33 to 0.78; P < 0.05), and less death due to tumor recurrence (22.39% versus 35.48%; OR: 0.50; 95% CI 0.29 to 0.86; P <0.05); but LLR was associated with smaller ICC, fewer major hepatectomies, less lymph node (LN) dissection rate, and inferior 5-year overall survival (OS) (P < 0.05). Duration of operation, blood loss, average LN retrieved, LN metastasis, major morbidities, mortality, tumor recurrence, 3-year OS and disease free survival (DFS), and 5-year DFS were comparable (P >0.05).ConclusionLLR for ICC is in the initial phase of exploration. More evidence is necessary to validate LLR for ICC.     

Comparison of anatomic and non-anatomic resections for very early-stage hepatocellular carcinoma: The importance of surgical resection margin width in non-anatomic resection

BackgroundThe superiority of anatomic resection (AR) over non-anatomic resection (NAR) for very early-stage hepatocellular carcinoma (HCC) has remained a topic of debate. Thus, this study aimed to compare the prognosis after AR and NAR for single HCC less than 2 cm in diameter.MethodsConsecutive patients with single HCC of diameter less than 2 cm who underwent curative hepatectomy between 1997 and 2017 were included in this retrospective study.ResultsIn total, 159 patients were included in this study. Of these, 52 patients underwent AR (AR group) and 107 patients underwent NAR (NAR group). No significant differences were noted in recurrence-free survival (RFS) and overall survival (OS) between the AR and NAR groups (P = 0.236 and P = 0.363, respectively). Multivariate analysis revealed that low preoperative platelet count and presence of satellite nodules were independent prognostic factors of RFS and OS. Wide surgical resection margin did not affect RFS (P = 0.692) in the AR group; however, in the NAR group, RFS was found to be higher with surgical resection margin widths ≥1 cm than with surgical resection margin widths <1 cm (P = 0.038).ConclusionsPrognosis was comparable between the NAR and AR groups for very early-stage HCC with well-preserved liver function. For better oncologic outcomes, surgeons should endeavor in keeping the surgical resection margin widths during NAR ≥1 cm.     

经尿道前列腺切除术后尿路感染的危险因素及病原菌分布

 目的 探讨经尿道前列腺电切术（TURP）后尿路感染的危险因素及病原菌构成特征。方法 回顾性收集某院泌尿外科良性前列腺增生行TURP患者的临床资料，采用单因素和多因素logistic回归分析TURP术后尿路感染的危险因素，并分析患者尿标本中病原菌构成情况。结果 155例接受TURP患者中，24例患者（15.5%）发生术后尿路感染。单因素分析结果显示，尿路感染组与非感染组患者年龄、前列腺大小、术前留置导尿管，曾行泌尿道医疗操作、糖尿病史、电切镜鞘尺寸、手术时间和灌洗液温度各项比较，差异均有统计学意义（均P<0.05）；多因素logistic回归分析结果显示，患者的年龄>65岁（OR=4.18，95% CI：1.19~14.75，P=0.026）、前列腺>55 g（OR=3.92，95% CI：1.11~13.83，P=0.034）、术前留置导尿管（OR=0.28，95% CI：0.11~0.70，P=0.006）、曾行泌尿道医疗操作（OR=4.70，95% CI：1.85~11.94，P=0.001）、有糖尿病史（OR=2.54，95% CI：1.00~6.48，P=0.050）、电切镜鞘尺寸26F（OR=9.05，95% CI：1.18~69.48，P=0.034）、手术时间>60 min（OR=10.48，95% CI：1.37~80.25，P=0.024）和灌洗液温度<37℃（OR=4.06，95% CI：1.57~10.50，P=0.004）是TURP术后尿路感染的独立危险因素。感染患者尿标本共检出病原菌23株，主要为革兰阴性菌（78.26%），其中大肠埃希菌占比达52.17%（12株）。结论 TURP术后尿路感染与手术时间、电切镜鞘尺寸、曾有泌尿道医疗操作、前列腺大小等相关，感染病原菌仍以大肠埃希菌为主，有效避免高危因素及合理预防性使用抗菌药物，可有助于预防TURP术后尿路感染的发生。