Utilidad de la fluorescencia cercana al infrarrojo para la identificación del bronquio segmentario en segmentectomías mínimamente invasivas

Minimally invasive anatomical sublobar resections have gained relevance in recent years mainly due to advances in imaging techniques, screening programs and the increase in second neoplasms. Accurate identification of the segmental or subsegmental bronchus is vital to guarantee optimal results in segmentectomies and subsegmentectomies. Given the complexity and the possibility of anatomical variations, several authors have published different methods to identify the target bronchus. However, these methods have certain limitations. This article describes a new rapid and effective technique, with a low risk of complications and without additional cost, for the identification of segmental bronchi in minimally invasive segmentectomies.     

龈下楔状缺损予以微创牙冠延长术结合纳米树脂修复治疗的美学效果

目的 探讨龈下楔状缺损予以微创牙冠延长术结合纳米树脂修复治疗的美学效果。方法 选取我 院2021年12月-2022年12月收诊的50例龈下楔状缺损患者,按治疗方式的不同分为对照组与观察组,每组 25例,对照组配合常规牙冠延长术治疗,观察组采取微创牙冠延长术结合纳米树脂修复治疗,比较两组临 床指标、美学效果及满意度。结果 观察组治疗后附着丧失、探诊深度低于治疗前,且观察组低于对照组 （P＜0.05）;两组出血指数、牙齿松动度比较,差异无统计学意义（P＞0.05）;观察组治疗后美观度、舒 适度、牙齿颜色贴合度各项评分高于对照组（P＜0.05）;观察组满意度为100.00%,高于对照组的84.00% （P＜0.05）。结论 为龈下楔状缺损患者实施微创牙冠延长术结合纳米树脂修复治疗,能在提升患者美学 效果的同时,改善患者的临床相关指标,获得较高的满意度。     

胃癌微创外科治疗的难点及发展趋势

历经100多年的发展,外科手术仍是胃癌治疗的基石,并已初步实现了从“经典”的开放手术向“微创”的腹腔镜手术过渡。胃癌微创外科治疗经过30多年的探索,尤其是近十年中国腹腔镜胃肠外科研究组（CLASS研究组）先后启动了系列高水平腹腔镜胃癌外科临床研究,引领了该领域的范式革新。在此基础上,胃癌微创外科治疗的趋势逐渐聚焦在微创程度的升级、技术难度的降级、病人生活质量的优化和肿瘤疗效提高等方面。     

乳腺化生性癌临床特点及超声表现

目的 观察乳腺化生性癌(MBC)的临床特点及超声表现。方法 回顾性分析经手术病理证实的37例单发MBC与74例乳腺非特殊型浸润性癌(IC-NST)患者(74个病灶)的临床资料及病灶超声表现。结果 37个MBC病灶中,32个呈低回声、5个呈囊实性回声;9个呈规则椭圆形,28个形态不规则;14个边缘光整,13个内见点状强回声微钙化,2个后方回声衰减;35个肿瘤均呈平行生长;CDFI示29个为AdlerⅡ或Ⅲ级血流。MBC与IC-NST患者之间,Ki-67表达、雌激素受体(ER)阳性、孕激素受体(PR)阳性、就诊原因、自觉肿物生长迅速与否、有无腋窝淋巴结转移,以及肿瘤最大径、回声、形态、边缘、方位及后方回声衰减差异均有统计学意义(P均<0.05);患者年龄、人表皮生长因子受体2(HER-2)阳性及肿瘤微钙化及Adler血流分级差异均无统计学意义(P均>0.05)。结论 MBC临床及超声表现均有一定特异性,有助于诊断。     

Effect of minimally invasive surgery and laparotomy on wound infection and postoperative and intraoperative complications in the management of cervical cancer: A meta-analysis

We performed a meta-analysis to evaluate the effect of minimally invasive surgery and laparotomy on wound infection and postoperative and intraoperative complications in the management of cervical cancer. A systematic literature search up to July 2022 was performed and 10 231 subjects with cervical cancer at the baseline of the studies; 4307 of them were using the minimally invasive surgery, and 5924 were using laparotomy. Odds ratio (OR) with 95% confidence intervals (CIs) were calculated to assess the effect of minimally invasive surgery and laparotomy on wound infection and postoperative and intraoperative complications in the management of cervical cancer using the dichotomous methods with a random or fixed-effect model. The minimally invasive surgery had significantly lower wound infection (OR, 0.20; 95% CI, 0.13–0.30, P < .001), and postoperative complications (OR, 0.48; 95% CI, 0.37–0.64, P < .001) in subjects with cervical cancer compared laparotomy. However, minimally invasive surgery compared with laparotomy in subjects with cervical cancer had no significant difference in intraoperative complications (OR, 1.04; 95% CI, 0.80–1.36, P = 0.76). The minimally invasive surgery had significantly lower wound infection, and postoperative complications however, had no significant difference in intraoperative complications in subjects with cervical cancer compared with laparotomy. The analysis of outcomes should be with caution because of the low sample size of 22 out of 41 studies in the meta-analysis and a low number of studies in certain comparisons.     

Frequency of blood lactate elevation following esophagectomy and its association to postoperative complications

Background

Esophagectomy is a major surgical intervention and a cornerstone in the treatment of esophageal cancer. There is clinical experience that blood lactate concentration often is elevated in the period following esophagectomy, but the incidence and clinical consequences are sparsely studied.

Methods

We extracted data from all patients undergoing esophagectomy at Karolinska University Hospital 2016–2018, n = 153. Most were performed with minimally invasive technique, n = 130. Blood lactate values directly after surgery, highest value during the first night, and morning level on postoperative day one were recorded. Primary outcome was hospital length of stay and secondary outcome was a composite of postoperative infection, additional surgery, or intensive care during the hospital stay. Development of anastomotic leak was analyzed separately.

Results

Postoperative hyperlactatemia was common as 93% of patients had peak lactate concentration >1.6 mmol/L and 27% >3.5 mmol/L in the first night following operation. Median hospital length of stay was 14 days. Blood lactate showed a weak correlation to hospital stay and intensive care the morning following surgery, but not at arrival to postoperative ward. There were no statistical differences between those with and without anastomotic leak at any of the time points. Elevated lactate in the first 12–16 h postoperatively was related to surgical factors (open technique, surgery time, and perioperative bleeding) but not to patient related factors (ASA-class, Charlson comorbidity index, sex, age) or cumulative fluid balance.

Conclusion

In conclusion, elevated blood lactate in the immediate time following esophagectomy showed a weak association to intensive care and length of stay but not anastomotic leak.     

Minimally Invasive 360° Fusion Using a Combination of INFIX and Minimally Invasive Spinopelvic Fixation by Intraoperative Computed Tomography Navigation for Unstable Pelvic Ring Fracture: A Technical Note

Objective

Fluoroscopy is often used in the surgery of unstable pelvic ring fractures, and improved safety in implant placement is an issue. An anterior subcutaneous pelvic fixator (INFIX) combined with a percutaneous screw has been reported to be a minimally invasive and effective surgical technique for unstable pelvic ring injuries. However, although percutaneous screw fixation is minimally invasive, its indications for fracture fixation and fractures with large fragment displacements in the vertical plane remain controversial. Therefore, this technical note aims to describe a new technique for unstable pelvic ring fractures.

Methods

We describe a 360° fusion of the pelvic ring to treat unstable pelvic ring fractures, including vertical shear pelvic ring fractures, using an intraoperative CT navigation system. Seven patients were treated with 360° fusion for type C pelvic ring fractures. In surgery, after reducing the fracture with external fixation, intraoperative CT navigation is used to perform a 360° fusion with INFIX and minimally invasive surgical spinopelvic fixation (MIS-SPF). We will introduce a typical case and explain the procedure.

Results

A 360° fixation was performed, and no perioperative complications were noted. The mean blood loss was 253.2 ± 141.0 mL, and the mean operative time was 224.3 ± 67.4 min. In a typical case, bone union was obtained 1 year after surgery, and we removed all implants.

Conclusions

MIS-SPF has a strong fixation force and helps reduce fractures' horizontal and vertical planes. In addition, 360° fusion with intraoperative CT navigation may help treat unstable pelvic ring fractures.     

斜外侧椎间融合术与微创经椎间孔入路腰椎椎间融合术治疗单节段轻中度腰椎滑脱的临床疗效

目的 比较斜外侧椎间融合术（OLIF）与微创经椎间孔入路腰椎椎间融合术（MIS-TLIF）治疗单节段轻中度腰椎滑脱的临床疗效和影像学结果。方法 2015年2月—2018年2月,收治单节段轻中度腰椎滑脱患者48例,其中22例采用OLIF治疗（OLIF组）,26例采用MIS-TLIF治疗（MIS-TLIF组）。记录2组手术时间、术中出血量、住院时间及并发症发生情况;术前及术后1周、1个月、6个月及末次随访时采用疼痛视觉模拟量表（VAS）评分和Oswestry功能障碍指数（ODI）评估腰腿痛程度及腰椎功能。术前及末次随访时在影像学资料上测量腰椎前凸角（LL）、手术节段Cobb角、椎间高度（DH）、椎管横截面积（CSA）及椎间孔面积（FA）。结果 所有手术顺利完成,所有患者随访24～45个月,平均32.8个月。OLIF组手术时间、术中出血量及住院时间明显少于MIS-TLIF组,差异均有统计学意义（P <0.05）。2组术后各随访时间点VAS评分和ODI较术前明显改善,差异均有统计学意义（P <0.05）;术后1周OLIF组VAS评分和ODI优于MIS-TLIF组,差异均有统计学意义...     

微创环切技术在老年牙列缺损患者中的应用效果

目的 分析微创环切技术在老年牙列缺损患者治疗中的作用。方法 选取2021年1月-12月我院收 治的98例老年牙列缺损患者作为研究对象,应用随机数字表法分为对照组和观察组,各49例。对照组采 用传统翻瓣种植术进行治疗,观察组采用微创环切术进行治疗,比较两组不良事件发生率、炎症应激反 应、疼痛介质含量、种植牙稳定性、骨吸收水平以及美观度。结果 观察组不良事件发生率低于对照组 （ P ＜0.05）;观察组术后3 d炎症应激各项指标均低于对照组（ P ＜0.05）;观察组术后3 d各项疼痛介质含 量均低于对照组（ P ＜0.05）;观察组种植牙稳定性高于对照组,骨吸收量低于对照组（ P ＜0.05）;观察 组术后3、6、12个月美观度评分均高于对照组（ P ＜0.05）。结论 微创环切技术应用于老年牙列缺损治疗 中效果确切,可以促进骨吸收、提高牙体稳定性和美观度,有利于减轻炎症应激反应以及疼痛情况。