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1.
Min Li Ying Tao Sheng Shen Lujun Song Tao Suo Han Liu Yueqi Wang Dexiang Zhang Xiaoling Ni Houbao Liu 《Surgical endoscopy》2020,34(4):1551-1560
A history of abdominal biliary tract surgery has been identified as a relative contraindication for laparoscopic common bile duct exploration (LCBDE), and there are very few reports about laparoscopic procedures in patients with a history of abdominal biliary tract surgery. We retrospectively reviewed the clinical outcomes of 227 consecutive patients with previous abdominal biliary tract operations at our institution between December 2013 and June 2019. A total of 110 consecutive patients underwent LCBDE, and 117 consecutive patients underwent open common bile duct exploration (OCBDE). Patient demographics and perioperative variables were compared between the two groups. The LCBDE group performed significantly better than the OCBDE group with respect to estimated blood loss [30 (5–700) vs. 50 (10–1800) ml; p = 0.041], remnant common bile duct (CBD) stones (17 vs. 28%; p = 0.050), postoperative hospital stay [7 (3–78) vs. 8.5 (4.5–74) days; p = 0.041], and time to oral intake [2.5 (1–7) vs. 3 (2–24) days; p = 0.015]. There were no significant differences in the operation time [170 (60–480) vs. 180 (41–330) minutes; p = 0.067]. A total of 19 patients (17%) in the LCBDE group were converted to open surgery. According to Clavien’s classification of complications, the LCBDE group had significantly fewer postoperative complications than the OCBDE group (40 vs. 57; p = 0.045). There was no mortality in either group. Multiple previous operations (≥ 2 times), a history of open surgery, and previous biliary tract surgery (including bile duct or gallbladder + bile duct other than cholecystectomy alone) were risk factors for postoperative adhesion (p = 0.000, p = 0.000, and p = 0.000, respectively). LCBDE is ultimately the least invasive, safest, and the most effective treatment option for patients with previous abdominal biliary tract operations and is especially suitable for those with a history of cholecystectomy, few previous operations (< 2 times), or a history of laparoscopic surgery. 相似文献
2.
Carlos E. Pineda Andrew A. Shelton Tina Hernandez-Boussard John M. Morton Mark L. Welton 《Journal of gastrointestinal surgery》2008,12(11):2037-2044
Introduction Despite several meta-analyses and randomized controlled trials showing no benefit to patients, mechanical bowel preparation
(MBP) remains the standard of practice for patients undergoing elective colorectal surgery.
Methods We performed a systematic review of the literature of trials that prospectively compared MBP with no MBP for patients undergoing
elective colorectal resection. We searched MEDLINE, LILACS, and SCISEARCH, abstracts of pertinent scientific meetings and
reference lists for each article found. Experts in the field were queried as to knowledge of additional reports. Outcomes
abstracted were anastomotic leaks and wound infections. Meta-analysis was performed using Peto Odds ratio.
Results Of 4,601 patients (13 trials), 2,304 received MBP (Group 1) and 2,297 did not (Group 2). Anastomotic leaks occurred in 97(4.2%)
patients in Group 1 and in 81(3.5%) patients in Group 2 (Peto OR = 1.214, CI 95%:0.899–1.64, P = 0.206). Wound infections occurred in 227(9.9%) patients in Group 1 and in 201(8.8%) patients in Group 2 (Peto OR = 1.156,
CI 95%:0.946–1.413, P = 0.155).
Discussion This meta-analysis demonstrates that MBP provides no benefit to patients undergoing elective colorectal surgery, thus, supporting
elimination of routine MBP in elective colorectal surgery.
Conclusion In conclusion, MBP is of no benefit to patients undergoing elective colorectal resection and need not be recommended to meet
“standard of care.”
Paper presented at the 49th Meeting of the Society for Surgery of the Alimentary Tract, San Diego, CA, USA, May 21st.
Grant support and other assistance: none received. 相似文献
3.
Giuseppe S. Sica Edoardo Iaculli Domenico Benavoli Livia Biancone Emma Calabrese Sara Onali Achille L Gaspari 《Journal of gastrointestinal surgery》2008,12(6):1094-1102
Possible relations between surgical approaches, frequency, and severity of Crohn’s disease recurrence after ileo-colonic resection
is unknown. We aimed to assess perioperative outcomes and postsurgical complications of laparoscopic versus standard open
surgery and to detect differences between the two groups in endoscopical recurrence and patients’ satisfaction. Twenty-eight
consecutive patients undergoing elective ileo-colonic resection by either laparoscopic approach (n = 15) or conventional open surgery (n = 13) were prospectively enrolled. No mortality or major intraoperative complications were observed in both groups. Significant
differences between groups were the median operating time found shorter in the open group than in the laparoscopic group (p = 0.003), the higher dosage of pain killers needed in the open group (p = 0.05), the passage of flatus and\or stool after surgery found faster in group A (p = 0.004) and the shorter recovery period in the laparoscopic group (p = 0.007). Colonoscopy was performed in 27 patients. The frequency and pattern of recurrence did not differ between the two
groups (p = 0.63). Patients’ satisfaction was significantly in favor of laparoscopy. Present findings support the feasibility and advantages
in the short-term of laparoscopic ileo-colonic resection in patients with Crohn’s disease. No differences were observed in
terms of frequency, time of onset, and severity of recurrence in a 1-year follow-up. 相似文献
4.
Ryuichiro Sato Masaya Oikawa Tetsuya Kakita Takaho Okada Tomoya Abe Takashi Yazawa Haruyuki Tsuchiya Naoya Akazawa Masaki Sato Tetsuya Ohira Yoshihiro Harada Haruka Okano Kei Ito Noriaki Ohuchi Takashi Tsuchiya 《Surgery today》2020,50(3):232-239
Inflammation-based markers predict the long-term outcomes of various malignancies. We investigated the relationship between the modified Glasgow prognostic score (mGPS) and the long-term outcomes of obstructive colorectal cancer in patients who underwent self-expandable metallic colonic stent placement and subsequently received curative surgery. We retrospectively analyzed 63 consecutive patients with pathological stage II and III obstructive colorectal cancer from 2013 to 2018. The mGPS was calculated before stenting and surgery, and the difference of the scores was defined as the d-mGPS. All d-mGPS = 2 patients were > 70 years of age (p = 0.01). Postoperative complications were more common in the preoperative mGPS = 2 group (p = 0.02). The postoperative hospital stay was significantly longer in the mGPS = 2 group (p = 0.007). Multivariate analyses revealed that d-mGPS was an independent prognostic factor for overall survival (OS) (hazard ratio [HR] = 9.18, p = 0.004) and cancer-specific survival (HR = 9.98, p = 0.01). Preoperative mGPS = 2 was significantly associated with poor OS (HR = 5.53, p = 0.04). The results indicated that mGPS might serve as a valuable indicator of the immunonutritional status of preoperative patients, and a preoperative change of the status might affect the long-term outcomes of patients with obstructive colorectal cancer. 相似文献
5.
M. C. Mertens J. De Vries V. P. W. Scholtes P. Jansen J. A. Roukema 《Journal of gastrointestinal surgery》2009,13(2):304-311
Objective Many patients with symptomatic cholelithiasis report persisting symptoms after elective cholecystectomy. The current prospective
follow-up study aims at the identification and valuation of risk factors for negative symptomatic outcome at 6 weeks.
Methods Consecutive patients (n = 183), age 18–65 years, indicated for elective cholecystectomy due to symptomatic cholelithiasis, completed a self-report
questionnaire. At 6 weeks post-operatively, the same self-report questionnaires were completed (n = 129). Predictors of the persistence and emergence of biliary and dyspeptic symptoms at 6 weeks post-cholecystectomy were
investigated using univariate and multivariate logistic regression.
Results At 6 weeks post-operatively, the report of post-operative biliary symptoms was independently predicted by pre-operative dyspeptic
symptoms (OR = 6.60) and bad taste (OR = 3.55). Pre-operative flatulence was an independent predictor of the report of biliary
and dyspeptic symptoms ((OR = 3.33) and (OR = 3.27), respectively) and persisting biliary symptoms (OR = 4.21). Predictors
of symptomatic outcome were only identified in women, not in men.
Conclusion Patients with pre-operative dyspeptic symptoms, notably bad taste and flatulence, have an increased risk of negative post-cholecystectomy
outcomes at 6 weeks. A symptom-specific approach should lead to optimalization of the indication of cholecystectomy and information
of patients. Known risk factors for long-term outcomes might be valuable in female patients only. 相似文献
6.
Background Gastric bypass surgery for morbid obesity has dramatically increased in volume over the past decade. Caucasian patients have
been noted previously to lose more weight after bariatric surgery than African-Americans patients. Data regarding predictors
of maintaining weight loss after surgery are minimal. We sought to determine predictors of long-term weight loss after bariatric
surgery.
Methods Retrospective analysis using a multivariate logistic regression model of all patients undergoing Roux-en-Y gastric bypass
surgery at the Medical University of South Carolina from May 1993 to December 2004 for whom 2 years of follow-up data was
available. Our dependent variable was the percentage of weight lost from baseline, dichotomized at ±35%. Our primary independent
variable was race, defined as Caucasian, African-American, or other. Relevant covariates were added to the model to control
for their potential effects on outcome.
Results One hundred eleven patients (17 male/94 female; 85% Caucasian, mean age 44 years (range 18–68 years). In our model, Caucasian
subjects (adjusted odds ratio [OR] = 7.60, 95% confidence intervals [95%CI] = 1.83–31.5) and late post surgical complications
(adjusted OR = 2.67, 95%CI = 1.05–6.80) significantly predicted weight loss at 2 years, after controlling for relevant confounders.
Other covariates did not significantly impact the model.
Conclusion Race and late post surgical complications significantly impacted the percentage of weight loss at 2 years for patients undergoing
Roux-en-Y gastric bypass surgery at our institution. Future research should be directed at determining potential genetic and/or
social reasons for these differences. 相似文献
7.
Matthew C. Hernandez Eric J. Finnesgard Omair A. Shariq Ariel Knight Daniel Stephens Johnathon M. Aho Brian D. Kim Henry J. Schiller Martin D. Zielinski 《World journal of surgery》2019,43(12):3027-3034
Adhesive small bowel obstruction (ASBO) severity has been associated with important clinical outcomes. However, the impact of ASBO severity on hospitalization cost is unknown. The American Association for the Surgery of Trauma (AAST) developed an Emergency General Surgery (EGS) disease severity grading system for ASBO. We stratified patients’ ASBO severity and captured hospitalization costs hypothesizing that increased disease severity would correlate with greater costs. This was a single-center study of hospitalized adult patients with SBO during 2015–2017. Clinical data and estimated total cost (direct + indirect) were abstracted. AAST EGS grades (I–IV) stratified disease severity. Costs were normalized to the median grade I cost. Univariate and multivariate analyses evaluated the relationship between normalized cost and AAST EGS grade, length of hospital and ICU stay, operative time, and Charlson comorbidity index. There were 214 patients; 119 (56%) were female. AAST EGS grades included: I (62%, n = 132), II (23%, n = 49), III (7%, n = 16), and IV (8%, n = 17). Relative to grade I, median normalized cost increased by 1.4-fold for grade II, 1.6-fold for grade III, and 4.3-fold for grade IV disease. No considerable differences in patient comorbidity between grades were observed. Pair-wise comparisons demonstrated that grade I disease cost less than higher grades (corrected p < 0.001). Non-operative management was associated with lower normalized cost compared to operative management (1.1 vs. 4.5, p < 0.0001). In patients who failed non-operative management, normalized cost was increased 7.2-fold. Collectively, the AAST EGS grade correlated well with cost (Spearman’s p = 0.7, p < 0.0001). After adjustment for covariates, AAST EGS grade maintained a persistent relationship with cost. Increasing ASBO severity is independently associated with greater costs. Efforts to identify and mitigate costs associated with this burdensome disease are warranted. III, economic/decision. 相似文献
8.
Valentin Schnitzbauer Michael Gerken Stefan Benz Vinzenz Vlkel Teresa Draeger Alois Frst Monika Klinkhammer-Schalke 《Surgical endoscopy》2020,34(3):1132-1141
Rectal cancer is frequent in Germany and worldwide. Several studies have assessed laparoscopic surgery as a treatment option and most have shown favorable results. However, long-term oncologic safety remains a controversial issue. The current dataset derives from 30 clinical cancer registries in Germany and includes 16,378 patients diagnosed with rectal cancer between 2007 and 2016. Outcomes were 90-day mortality, overall survival (OS), local recurrence-free survival (RFS) and relative survival of patients treated with either open or laparoscopic surgery. Multivariable logistic regression was used to evaluate factors that affected the probability of a patient undergoing laparoscopic surgery as well as to evaluate short-term mortality. OS and RFS were analyzed by Kaplan–Meier plots and multivariable Cox regression conducted separately for UICC stages I–III, tumor location, and sex as well as by propensity score matching followed by univariable and multivariable survival analysis. Of 16,378 patients, 4540 (27.7%) underwent laparoscopic surgery, a trend which increased during the observation period. Patients undergoing laparoscopy attained better results for 90-day mortality (odds ratio, OR 0.658, 95% confidence interval, CI 0.526–0.822). The 5-year OS rate in the laparoscopic group was 82.6%, vs. 76.6% in the open surgery group, with a hazard ratio (HR) of 0.819 in multivariable Cox regression (95% CI 0.747–0.899, p < 0.001). The laparoscopic group showed a better 5-year RFS, with 81.8 vs. 74.3% and HR 0.770 (95% CI 0.705–0.842, p < 0.001). The 5-year relative survival rates were also in favor of laparoscopy, with 93.1 vs. 88.4% (p = 0.012). Laparoscopic surgery for rectal cancer can be performed safely and, according to this study, is associated with an oncological outcome superior to that of the open procedure. Therefore, in the absence of individual contraindications, it should be considered as a standard approach. 相似文献
9.
Yifan Wang Abdulaziz Alnumay Tiffany Paradis Andrew Beckett Paola Fata Kosar Khwaja Tarek Razek Jeremy Grushka Dan L. Deckelbaum 《World journal of surgery》2019,43(12):3044-3050
Management of the post-traumatic open abdomen (OA) using negative pressure wound therapy (NPWT) alone is associated with low rates of primary fascial closure. The abdominal reapproximation anchor (ABRA) system exerts dynamic medial fascial traction and may work synergistically with NPWT to facilitate primary fascial closure. Patients with an OA following trauma laparotomy between 2009 and 2018 were identified from a prospectively maintained institutional database. Patients treated with ABRA in conjunction with NPWT (ABRA) versus NPWT alone (NPWT) were compared in terms of primary fascial closure rate, number of surgeries to closure, tracheostomy duration, length of stay and incidence of entero-atmospheric fistula. Multivariable linear regression was performed to identify predictors of tracheostomy duration. We identified 48 patients [ABRA, 12 and NPWT, 36]. The ABRA group was significantly younger (25 vs. 37 years, p = 0.027) and included a lower proportion of males (58% vs. 89%, p = 0.032). Groups were similar with respect to the incidence of hollow viscus injury, injury severity score and abdominal abbreviated injury score. Compared to the NPWT group, the ABRA group had a significantly higher rate of primary fascial closure (100% vs. 28%, p < 0.001), fewer surgeries to abdominal closure (2 vs. 2.5, p = 0.023) and shorter duration of tracheostomy (15.5 vs. 36 days, p = 0.008). There were no differences in length of stay or incidence of entero-atmospheric fistula. On multivariable linear regression, ABRA placement was an independent predictor of shorter tracheostomy duration, after adjusting for covariates (β = − 0.294, p = 0.036). For the post-traumatic OA, ABRA coupled with NPWT achieves a higher rate of primary fascial closure compared to NPWT alone, while requiring fewer surgeries and a shorter duration of tracheostomy. 相似文献
10.
Sebastian Decker Michael Mayer Axel Hempfing Lukas Ernstbrunner Wolfgang Hitzl Christian Krettek Heiko Koller 《European spine journal》2020,29(4):813-820
Proximal junctional kyphosis (PJK) in adult spinal deformity (ASD) surgery patients is a severe complication with potential need for revision surgery. While thoracic kyphosis (TK) is known to influence PJK, the role of TK flexibility is still unknown. We analyzed the influence of TK flexibility to predict postoperative sagittal alignment. Patients with ASD, ≥ 2-year follow-up, and upper-most instrumented vertebra (UIV) including and below T10 were included in this retrospective study. TK flexibility, defined as > 10° difference of the TK in standing and supine imaging, was analyzed. Patient characteristics like age, sex, weight, total hip arthroplasty, and sagittal alignment parameters were studied. Sixty-five patients aged 66 ± 8 years were included in the study. Lowest instrumented vertebra was S1 or the ilium in 85% of them; the number of levels being fused averaged 7. Flexible TK was present in 31% (n = 20). These patients had a larger preoperative TK (p < 0.01), but no PJK was found (p = 0.04). In contrast, patients who underwent revision surgery had a decreased TK flexibility (p = 0.04) and increased PJK angle at follow-up (p = 0.01). In the non-flexible patients, the PJK was found in 14% of patients. Based on our retrospective data, TK flexibility influences the outcome of ASD surgery. In patients demonstrating no TK flexibility, a more cephalad UIV-level should be considered because spontaneous curve correction in the sagittal plane might be low in these patients. This new parameter should be included in future prediction models. These slides can be retrieved under Electronic Supplementary Material. 相似文献
11.
Prakash K Varma D Rajan M Kamlesh NP Zacharias P Ganesh Narayanan R Philip M 《The Indian journal of surgery》2010,72(4):318-322
Laparoscopic approach for treatment of colorectal malignancy is gaining acceptance gradually; however the benefits of laparoscopic
surgery in colonic and rectal tumours is still open to debate. This study aims at a retrospective analysis of operative and
short term outcome of patients with rectosigmoid tumours. A retrospective analysis of operative, postoperative and short-term
outcome of 62 patients who underwent laparoscopic colorectal resection for cancer of rectosigmoid region were compared with
a same number of parameters-matched patients who underwent open colorectal resection. Blood transfusion requirement was significantly
more in the open group compared to the laparoscopy group (38.7% versus 6.4%, p = 0.001). ICU stay was less in the laparoscopy
group (p = <0.05) and they were started on oral liquid diet earlier (p = 0.013). The number of the lymph nodes retrieved,
positive distal margin and radial involvement were similar in both groups. The hospital stay was significantly shorter in
laparoscopy group (8.4 versus 13.8 days, p < 0.05). Radical operation for rectosigmoid tumors is technically feasible with
laparoscopic surgery. Laparoscopic approach is associated with less blood loss, transfusion and significantly less ICU stay.
Laparoscopic group recovers early and needs less hospital stay 相似文献
12.
Ke Chen Yucheng Zhou Weiwei Jin Qicong Zhu Chao Lu Nan Niu Yuanyu Wang Yiping Mou Zheling Chen 《Surgical endoscopy》2020,34(5):1948-1958
The study aimed to compare the oncologic outcomes and long-term survival of laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD) for patients diagnosed with pancreatic ductal adenocarcinoma (PDAC). Substantial evidence demonstrated that LPD is technically safe and feasible with perioperative outcomes equivalent to that of OPD. However, for patients with malignancy, especially PDAC, the oncologic outcomes and long-term survival of patients who underwent LPD remains to be elucidated. Studies on LPD for the treatment of PDAC published before December 25, 2018 were searched online. The oncologic outcomes (e.g., numbers of lymph nodes retrieved, negative margin (R0) resection), and long-term survival (postoperative survival from 1 to 5 year) of LPD were compared to that of ODP. After screening 1507 studies, six comparative cohort studies, which reported the oncologic outcomes and long-term survival of patients with PDAC were included. No significant difference was found between LPD and OPD regarding lymph nodes harvested (OR 1.96, 95% CI − 1.17 to 5.09, p = 0.22), R0 rate (OR 1.44, 95% CI 1.00 to 2.06, p = 0.05), number of positive lymph nodes (OR − 0.44, 95% CI − 1.06 to 0.17, p = 0.16), rate of adjuvant treatment (OR 1.04, 95% CI 0.68 to 1.59, p = 0.86) and time to adjuvant treatment (OR − 6.21, 95% CI − 16.00 to 3.59, p = 0.21). LPD showed similar 1-year (OR 1.20, 95% CI 0.87 to 1.65, p = 0.28), and 2-year survival (OR 1.25, 95% CI 0.94 to 1.66, p = 0.13) to that of OPD. The 3-year (OR 1.50, 95% CI 1.12 to 2.02, p = 0.007), 4-year (OR 1.73, 95% CI 1.02 to 2.93, p = 0.04), and 5-year survival (OR 2.11, 95% CI 1.35 to 3.31, p = 0.001) were significantly longer in LPD group. For the treatment of PDAC, the oncologic outcomes of LPD were equivalent to that of OPD; LPD seemed promising regarding the postoperative long-term survival. 相似文献
13.
14.
Routine Liver Biopsy to Screen for Nonalcoholic Fatty Liver Disease (NAFLD) during Cholecystectomy for Gallstone Disease: Is it Justified? 总被引:1,自引:0,他引:1
Antonio Ramos-De la Medina José M. Remes-Troche Federico B. Roesch-Dietlen Alfonso G. Pérez-Morales Silvia Martinez Silvia Cid-Juarez 《Journal of gastrointestinal surgery》2008,12(12):2097-2102
Background Nonalcoholic fatty liver disease (NAFLD) and gallstone disease (GD) share common risk factors. There are no firm recommendations
regarding screening of NAFLD in patients at risk. Our aim was to assess the prevalence of and factors associated with NAFLD
in a cohort of patients operated for symptomatic GD and evaluate the usefulness of routine liver biopsy.
Methods Ninety-five consecutive patients underwent a liver biopsy at the end of a standard laparoscopic cholecystectomy for symptomatic
GD. Clinical, biochemical, demographic, and anthropometric variables were obtained prospectively.
Results Fifty-two patients (55%) had biopsies compatible with NAFLD. These patients were classified according to the system proposed
by Brunt et al. as follows: grade I, n = 27 (52%); grade II, n = 15 (29%); grade III, n = 10 (19%). Two grade III patients had zone III focal perisinusoidal fibrosis and three had overt cirrhosis. Only 13% of
subjects had a suspected diagnosis of NAFLD preoperatively. In multivariate logistic regression, only obesity was significantly
associated with NAFLD. There were no complications or mortality.
Discussion Fifty-five percent of patients with GD have associated NAFLD. Awareness of this association may result in an earlier diagnosis.
The high prevalence of NAFLD in patients with GD may justify routine liver biopsy during cholecystectomy to establish the
diagnosis, stage, and possible direct therapy.
This work was presented at the Plenary Session of the 2008 Society of Surgery of the Alimentary Tract meeting in San Diego,
CA, USA. 相似文献
15.
Bek K Ozkaya O Fişgin T Aliyazicioğlu Y Paksu MS Ozgen T Albayrak D Baysal K 《Pediatric nephrology (Berlin, Germany)》2007,22(6):881-886
Hemostatic alterations due to abnormalities in the coagulation and fibrinolytic system may occur in dialysis patients. Protein
Z (PZ) is a vitamin K-dependent coagulation protein promoting assembly of thrombin with phospholipid vesicles. The aim of
this study was to investigate PZ and natural anticoagulants in children on hemodialysis (HD) and peritoneal dialysis (PD).
Protein Z, protein C (PC), protein S (PS), antithrombin III (AT III), and fibrinogen levels were studied in 24 PD, 13 HD patients
and 23 controls. Plasma PZ levels in patients on HD were significantly higher than those on PD and control group (p = 0.04,
p = 0.03). We observed elevated PC, PS and AT III activities in children on PD when compared to controls (p = 0.011, p = 0.003,
p < 0.001). In HD patients, only PS activity was increased compared to controls (p = 0.016). PC and PS activities did not
differ between PD and HD patients whereas AT III activity was higher in PD patients compared to HD patients (p < 0.001). Normal/high
levels of PC, PS and AT III suggest that children on PD or HD treatment do not seem to have an increased risk of thrombogenesis
due to reduction of these proteins. Increased PZ levels, however, might contribute to the hemostatic alterations in children
on HD treatment along with other well known abnormalities. 相似文献
16.
Wen-Jie Jiang Pei-Jing Yan Chun-Lin Zhao Mou-Bo Si Wen Tian Yan-Jun Zhang Hong-Wei Tian Shuang-Wu Feng Cai-Wen Han Jia Yang Ke-Hu Yang Tian-Kang Guo 《Surgical endoscopy》2020,34(5):1891-1903
Despite the fact that thyroid surgery has evolved towards minimal incisions and endoscopic approaches, the role of total endoscopic thyroidectomy (TET) in thyroid cancer has been highly disputed. We performed a systematic review and meta-analyses of peer reviewed studies in order to evaluate the safety and effectiveness of TET compared with conventional open thyroidectomy (COT) in papillary thyroid cancer (PTC). Medical literature databases such as PubMed, Embase, the Cochrane Library, and Web of science were systematically searched for articles that compared TET and COT in PTC treatment from database inception until March 2019. The quality of the studies included in the review was evaluated using the Downs and Black scale using Review Manager software Stata V.13.0 for the meta-analysis. The systematic review and meta-analysis were based on 5664 cases selected from twenty publications. Criteria used to determine surgical completeness included postoperative thyroglobulin (TG) levels, recurrence of the tumor after long-term follow-up. Adverse event and complication rate scores included transient recurrent laryngeal nerve (RLN) palsy, permanent RLN palsy, transient hypocalcaemia, permanent hypocalcaemia, operative time, number of removed lymph nodes, length of hospital stay and patient cosmetic satisfaction. TET was found to be generally equivalent to COT in terms of surgical completeness and adverse event rate, although TET resulted in lower levels of transient hypocalcemia (OR 1.66; p < 0.05), a smaller number of the retrieved lymph nodes (WMD 0.46; p < 0.05), and better cosmetic satisfaction (WMD 1.73; p < 0.05). COT was associated with a shorter operation time (WMD − 50.28; p < 0.05) and lower rates of transient RLN palsy (OR 0.41; p < 0.05). The results show that in terms of safety and efficacy, TET was similar to COT for the treatment of thyroid cancer. Indeed, the tumor recurrence rates and the level of surgical completeness in TET are similar to those obtained for COT. TET was associated with significantly lower levels of transient hypocalcemia and better cosmetic satisfaction, and thus is the better option for patients with cosmetic concerns. Overall, randomized clinical trials and studies with larger patient cohorts and long-term follow-up data are required to further demonstrate the value of the TET. 相似文献
17.
We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. 相似文献
18.
Vilarrasa N San José P García I Gómez-Vaquero C Miras PM de Gordejuela AG Masdevall C Pujol J Soler J Gómez JM 《Obesity surgery》2011,21(4):465-472
Studies that evaluate the influence of gastric bypass (RYGP) on bone mass are limited to short-term follow-up. We analysed
changes in bone mineral density (BMD) three years after surgery and evaluated the main determinants of the development of
bone disease. Prospective study of 59 morbidly obese white women aged 46 ± 8 years. BMD scanning using DEXA and plasma determinations
of calcium, parathyroid hormone, 25-hydroxyvitamin D and insulin-like growth factor-I were made prior, at 12 months and 3
years after surgery. In the first postoperative year BMD decreased at femoral neck (FN) 10.2 % and in the lumbar spine (LS)
3.2 %, in the third year it additionally decreased 2.7 % and 3.1 %, respectively. BMD at both sites remained above the values
of women of the same age. In the follow-up, 1.7 % developed osteoporosis at FN and 6.8 % at LS. Patients with bone disease
were older, the percentage of women with menopause was greater in this group and had lower initial and final values of lean
mass. The percentage of BMD loss at FN remained positively associated with the percentage of lean mass loss [β 0.304, p = 0.045],
and menopause [β 0.337, p = 0.025]. Major osteoporotic fracture and hip fracture risk was low even in menopausal patients
(3.1 % and 0.40 %, respectively). After RYGP menopausal women and those with greater lean mass loss are at higher risk of
BMD loss but progression to osteoporosis is uncommon and the risk of fracture is low. 相似文献
19.
Background Roux-en-Y gastric bypass (RYGBP) has become a common surgical procedure to treat morbid obesity. Furthermore, it strongly
reduces the incidence of type 2 diabetes and mortality. However, there is scant information on how magnesium status is affected
by RYGBP surgery. Previous bariatric surgery methods, like jejunoileal bypass, are associated with hypomagnesemia.
Methods Twenty-one non-diabetic morbidly obese patients who underwent RYGBP were evaluated before and 1 year after surgery and compared
to a matched morbidly obese control group regarding serum magnesium. Groups were matched regarding weight, BMI, abdominal
sagittal diameter and fasting glucose, blood pressure, and serum magnesium concentrations before surgery in the RYGBP group.
Results The serum magnesium concentrations increased by 6% from 0.80 to 0.85 mmol/l (p = 0.019) in the RYGBP group while a decrease by 4% (p = 0.132) was observed in the control group. The increase in magnesium concentration at the 1-year follow-up in the RYGBP
group was accompanied by a decreased abdominal sagittal diameter (r
2 = 0.32, p = 0.009), a lowered BMI (r
2 = 0.28, p = 0.0214), a lowered glucose concentration (r
2 = 0.28, p = 0.027) but not by a lowered insulin concentration (p = 0.242), a lowered systolic (p = 0.789) or a lowered diastolic (p = 0.785) blood pressure.
Conclusion RYGBP surgery in morbidly obese subjects is characterized by reduced visceral adiposity, lowered plasma glucose, and increased
circulating magnesium concentrations. The inverse association between lowered central obesity, lowered plasma glucose and
increased magnesium concentrations, needs further detailed studies to identify underlying mechanisms. 相似文献
20.
Background In the present study, criteria were investigated to predict major benefit after laparoscopic adjustable gastric banding (LAGB).
Materials and Methods 85 morbidly obese patients were operated with LAGB between 1999 and 2005. Seventy-one of these patients were analyzed according
to several possible predictive characteristics for success as the primary endpoint. Success was defined as excess body weight
loss (EBWL) >50% and no band removal. Median follow-up was 27 months (range 8–90 months).
Results In total, median EBWL was 43% (−41 to 171.5%) with a decrease in BMI of 8.0 kg/m2 (−9 to 35 kg/m2). Success rate was 37% (n = 26). These patients were compared to all other patients (n = 45). Significant success predictors were baseline absolute BW, EBW, BMI (p < 0.01), BMI with a threshold value of 50 kg/m2 (p = 0.02), and female sex (p = 0.02) as well as postoperative vomiting (p = 0.02), eating behavior and physical activity after LAGB (p < 0.01). Baseline EBW and change in eating behavior after surgery were identified as independent predictors in multivariate
analysis.
Conclusion Patients with a lower excess body weight who improve especially their eating behavior after surgery have the highest chance
of success after LAGB. 相似文献