Table of Content

20 February 2025, Volume 25 Issue 1

Previous Issue   

Original Articles and Clinical Research

ILEOSTOMY for abdominal compartment syndrome

YE Yi-biao, XU Yun-xiu-xiu, CHEN Jie, SONG Jing-lin, PENG Lin-hui, ZHOU Rui, YAO Ting-ting, ZHONG Guo-ping, LING Xiao-juan, LUO Xing-xi, ZHANG He-yun, XU Yun-yao, YE Hua, CHEN Ya-jin, WANG Jie, CHEN Tao

2025, 25(1):  1-5.  DOI: 10.3969/j.issn.1009-976X.2025.01.001

Asbtract ( 21 )   PDF (936KB) ( 5 )  

References | Related Articles | Metrics

Objective To investigate new treatment method “ILEOSTOMY” for abdominal compartment syndrome （ACS）. Methods Retrospectively reviewed clinical data of patients with ACS from May, 2017 through to March, 2022 admitted in Department General Surgery, and Department of Obstacles and Gynecology, Sun Yat-sen memorial hospital, Sun Yat-sen University. Patients included 6 cases of SAP（severe acute pancreatitis, SAP）, 2 cases of pancreas trauma, and 7 cases of abdominal or pelvic surgical complications. All patients received routine treatment plus with “ILEOSTOMY” aimed for quickly decreasing the Intra-abdominal Hypertension （IAH）. Clinical data of Intra-abdominal pressure （IAP）, urine output, heart rate, breath rate and survival were collected and analyzed. Results IAH in most patients （13/15, 86.67%） were adjusted to normal level soon postoperatively. Twelve cases survived while other 3 cases who suffered MOF （Multiple Organ Failure, MOF） or MODS（multiple organ dysfunction syndrome, MODS） dead postoperatively. Conclusion “ILEOSTOMY” along with routinely suggested operation modality for selected ACS patient might be a good choice. More clinical data should be needed in the future.

Application of nanoscale carbon lymph node tracer technique in complicated laparoscopic cholecystectomy

BAI Jie, WU Jin-Xiang, ZHAO Jia-Feng, CHEN Hai-Min, WANG Gui-Fu, WU Qing-Song

2025, 25(1):  6-11.  DOI: 10.3969/j.issn.1009-976X.2025.01.002

Asbtract ( 22 )   PDF (1345KB) ( 8 )  

References | Related Articles | Metrics

Objective To investigate the feasibility and application value of carbonnanoscale lymph node tracing technique in complex and difficult cholecystectomy. Methods This study was a single-center, single-blind, randomized controlled clinical trial. Patients diagnosed with cholecystolithiasis with cholecystitis admitted to the Department of Hepatobiliary Pancreatic Minimally Invasive Surgery of Yuebei People's Hospital from January 2022 to December 2022 were recruited. Sixty subjects were collected according to the inclusion and exclusion criteria, and were divided into the study group and the control group with 30 cases in each group by random number table method. The study group received laparoscopic cholecystectomy （LC） combined with carbon nanoscale lymph node tracer, and the control group received conventional LC. Gender, age and other general basic data of the two groups were compared, and the incidence of postoperative complications, exposure time of the gallbladder triangle, and intraoperative blood loss were used as outcome indicators. Results Among the two groups, the study group was not inferior to the control group in terms of postoperative exhaust time, intraoperative bleeding, exposure time of gallbladder triangleand total hospitalization cost, but had no significant difference with the control group. The total complication rate of the study group （6.66%） was as that of the control group （13.33%）, with no significant difference. Conclusion Nano-carbon tracer technology can assist in locating the anatomical relationship of gallbladder triangle in complex and difficult cholecystectomy, with strong feasibility and safety. Compared with LC alone, it has advantages in reducing bleeding and reducing complication rate, and is worth promoting and applying in clinical practice.

Bioinformatics of key genes in hepatocellular carcinoma after incomplete radiofrequency ablation using the GEO database

ZHANG Zhou, HUANG Bi, ZHAO Hui-ying

2025, 25(1):  12-18.  DOI: 10.3969/j.issn.1009-976X.2025.01.003

Asbtract ( 24 )   PDF (3280KB) ( 3 )  

References | Related Articles | Metrics

Objective The aim of this study was to identify differentially expressed genes associated with IRFA-treated HCC and to provide potential therapeutic targets by comparing the gene expression profiles of hepatocellular carcinoma （HCC） patients after incomplete radiofrequency ablation （IRFA） with those of HCC. Methods The GSE212604 dataset was downloaded from the GEO database and divided into IRFA and control groups according to whether they received IRFA treatment or not, and analysed and screened for differentially expressed genes. Potential key biological functions and pathways were identified using functional pathway enrichment analysis （GO, KEGG）. We also downloaded the GSE186280 dataset and constructed the co-expressed gene modules of HCC by weighted gene co-expression network analysis （WGCNA） to screen the core genes in the key modules. Results A total of 263 differentially expressed genes were identified, including 179 up-regulated genes and 84 down-regulated genes, and GO and KEGG analyses showed that these genes were mainly enriched in metabolic remodelling, cytoskeletal regulation, immune regulation and neural-related mechanisms. In addition, WGCNA analysis identified gene modules closely related to HCC after IRFA, and further screened 15 core genes, including LOC112268313, RNA5-8SN3 and so on. Conclusion In this study, key genes associated with IRFA-treated HCC were identified by bioinformatics analysis, suggesting that immune signalling and pathways such as p53 and PPAR may play an important role in its occurrence and progression. These key genes and pathways are expected to be new targets for the treatment and diagnosis of HCC.

Effect of percutaneous transhepatic gallbladder drainage combined with laparoscopic cholecystectomy in patients ≥65 years old with moderate acute cholecystitis

ZHUANG Hong-cai, LUO Dan-dan, HE Chao

2025, 25(1):  19-23.  DOI: 10.3969/j.issn.1009-976X.2025.01.004

Asbtract ( 14 )   PDF (2364KB) ( 7 )  

References | Related Articles | Metrics

Objective To investigate the effect of percutaneous transhepatic gallbladder drainage （PTGBD） combined with laparoscopic cholecystectomy （LC） versus direct LC in patients ≥65 years old with moderate acute cholecystitis. Methods The clinical data of 97 patients ≥65 years old with moderate acute cholecystitis admitted to our hospital from November 2020 to November 2023 were analyzed retrospectively. They were divided into PTGBD+LC group （41 cases） and LC group （56 cases） according to the different surgical procedures. The preoperative general condition, intraoperative bleeding, operation time, intra-operative transit open rate, time of first exhaustion, postoperative pain level, postoperative abdominal drain time, postoperative hospitalization time, total hospitalization cost, total hospitalization time and surgical complications were compared between the two groups. Results The proportion of ASA grade >Ⅱ in PTGBD+LC group was higher than that in LC group （P<0.05）. Intraoperative bleeding in PTGBD+LC group was less than that in LC group. The operation time, time of the first exhaustionand time of the postoperative hospital stay were shorter than that in LC group.The postoperative VAS score of 24 h was lower than that in LC group, but the total hospitalization cost and total hospital stay were greater than those in LC group （P<0.05）. There was no statistically significant difference in the intra-operative transit open rate between two groups, with 0 cases in PTGBD+LC group and 4 casesin LC group. There was a statistically significant difference in the comparison of the rate of complications between the two groups （P<0.05）, with 5 cases（12.2%） of complications in PTGBD+LC group and 17 cases （30.4%） in LC group. Conclusion PTGBD combined with LC can significantly reduce the difficulty and risk of surgery, improve the safety of LC, and accelerate postoperative recovery, making it a worthwhile option to consider for patients ≥65 years old with moderate acute cholecystitis.

Establishment and validation of a clinical prediction model for the risk of lateral lymph node metastasis in follicular thyroid cancer

CAI Li-si, XU Ming, ZHENG Yan-ling, LIE Yang-yang, LI Jie, XIE Xiao-yan

2025, 25(1):  24-30.  DOI: 10.3969/j.issn.1009-976X.2025.01.005

Asbtract ( 17 )   PDF (1663KB) ( 5 )  

References | Related Articles | Metrics

Objective This study aimed to create a clinical predictive model to assess the probability of lateral lymph node metastasis in patients diagnosed with PTC. Methods A retrospective analysis was conducted on 336 patients with pathologically confirmed PTC with cervical lymph node metastasis at our hospital from January 2022 to January 2024, including 189 cases of central cervical lymph node metastasis and 147 cases of central + lateral lymph node metastasis. Clinical, imaging, and histopathological data were gathered. The cohort was randomly divided into a training group （n=235） and a validation group （n=101）. Independent risk factors were identified through univariate and multivariate logistic regression analyses to develop a nomogram model, with its performance assessed using the receiver operating characteristic （ROC） curve, consistency index （consistency-index, C-index）, and calibration curve. Results The multivariate logistic regression analysis identified significant predictors of LNM, which included the number of lesions （single or multiple）, composition, the presence of fine calcification, invasion of the thyroid envelope, and low or very low echogenicity. A nomogram was constructed based on these five indicators, and the C-index for the training and validation groups was 0.836（95%CI：0.783-0.890）, 0.839（95%CI：0.761-0.917）, respectively. Calibration curves demonstrated good agreement of the model. Conclusion The clinical prediction model developed in this study serves as a valuable instrument for forecasting lateral lymph node metastasis in patients with PTC. This model aids in the effective monitoring of lateral lymph node metastasis in this patient population.

A clinical research on endoscopic breast reconstruction with modified retractor

ZHAN Yong-tao, HUANG Wan-yi, AO Xiang, XIA Hao-ming, JIANG Ming, LI Hong-sheng

2025, 25(1):  31-35.  DOI: 10.3969/j.issn.1009-976X.2025.01.006

Asbtract ( 21 )   PDF (6790KB) ( 6 )  

References | Related Articles | Metrics

Objective To investigate the clinical application,effect,complication and satisfaction of patients between endoscopic breast reconstruction with suspension and traditional open breast reconstruction. Methods A total of 116 patients undergoing breast reconstruction in the Cancer Hospital of Guangzhou Medical University from 2019 to 2024 were divided into two groups： suspensory endoscopic breast reconstruction （n=60） and open breast construction （n=56）. The general data and surgical incision length, operation duration, surgical blood loss, surgical complications （infection, skin margin necrosis, prosthesis expose, nipple and areola necrosis）, and breast satisfaction （BREAST-Q score） were compared between the two groups. Results There was no significant difference in the operative time（178.5±18.2 min vs. 171.0±40.3 min）, blood loss（47.3±13.3 ml vs. 44.2±17.7 ml and infection （1.67% vs. 5.3%）, between the two methods. The length of incision was significantly shorter in suspension versus open breast construction （6.5±0.9 cm vs. 12.8±3.7 cm,P<0.05）. The patient satisfaction is higher （82.1±2.5 vs. 78.4±2.4, P<0.05）. Conclusion Endoscopic breast reconstructionwith modified retractor is safe. The surgical incision length is shorter, the incidence of postoperative complications is lower, and the patient satisfaction is higher.

Clinical and pathological characteristics of 52 cases of pulmonary invasive adenocarcinoma and analysis of risk factors for hilar and mediastinal lymph node metastasis

WANG Dao-du, ZHAO Qi-jiong, ZHOU Zhi-biao, CHEN Xin

2025, 25(1):  36-40.  DOI: 10.3969/j.issn.1009-976X.2025.01.007

Asbtract ( 19 )   PDF (936KB) ( 5 )  

References | Related Articles | Metrics

Objective This study aims to retrospectively analyze the clinicopathological characteristics and risk factors for hilar and mediastinal lymph node metastasis in non-small cell lung adenocarcinoma. Methods We conducted a retrospective analysis of 52 patients with invasive adenocarcinoma who underwent initial surgery and had postoperative pathology reports from October 2018 to October 2023 at the Oncological Surgery Department of Shanwei Second People's Hospital. We investigated the risk factors for hilar mediastinal lymph node metastasis, and used chi-square tests and logistic regression models to find the threshold points of risk factors through the ROC curve. Results Regarding clinicopathological characteristics, the male-to-female ratio was 0.92∶1, with 6 patients （11.5%） developing lymph node metastasis. Univariate analysis revealed that a primary tumor diameter ≥2 cm and CEA ≥5 ng/mL increased the risk of hilar and mediastinal lymph node metastasis （P<0.05）. Multivariate logistic analysis demonstrated that a tumor maximum diameter of ≥2 cm was a statistically significant risk factor for lymph node metastasis （P<0.05）. Conclusion In patients with invasine adenocarcinoma of the lung, a tumor mass larger than 2 cm and aserum CEA level of 5 ng/mL are risk factors for lymph node metastasis

Study on the risk factors associated with refracture after PVP for osteoporotic vertebral compression fractures

LIU Si-ding, WANG Yun

2025, 25(1):  41-46.  DOI: 10.3969/j.issn.1009-976X.2025.01.008

Asbtract ( 19 )   PDF (957KB) ( 4 )  

References | Related Articles | Metrics

Objective This study aimed to explore the relevant risk factors for recurrent fractures after percutaneous vertebroplasty （PVP） in patients with osteoporotic vertebral compression fractures. Methods A retrospective analysis was conducted on the clinical data of patients with OVCF who underwent PVP at Shuangfeng County People's Hospital between April 2021 and June 2023. Relevant information from 409 patients was collected and categorized into a re-fracture group and a non-re-fracture group. Univariate analysis was performed on factors such as patient age, gender, time to surgery after fracture, number of initially fractured vertebrae, surgical puncture method, bone cement injection volume, presence of bone cement leakage, total protein level, globulin level, prognostic nutritional index （PNI）, albumin/fibrinogen ratio （AFR）, CT value, body weight, and whether regular anti-osteoporosis treatment was administered. Influential factors were then included in a multivariate logistic regression analysis to identify associated risk factors. Results Univariate analysis revealed significant associations between factors such as time to surgery after fracture, globulin level, albumin level, absolute lymphocyte count, fibrinogen level, PNI, AFR, CT value, surgical puncture method, and regular anti-osteoporosis treatment with the occurrence of re-fracture （P<0.05）. Multivariate logistic regression analysis showed significant relationships between unilateral puncture as the surgical puncture method （OR=2.181, 95% CI： 1.249-3.809）, PNI （OR=0.876, 95%CI： 0.821-0.934）, CT value （HU） （OR=0.961, 95%CI： 0.948-0.974）, globulin level （OR=1.078, 95% CI： 1.013-1.147）, and lack of regular anti-osteoporosis treatment （OR=1.816, 95% CI： 1.029-3.206） with the occurrence of re-fracture （P<0.05）. Conclusion Based on our findings, surgical puncture method, PNI, CT value, globulin level, and whether regular anti-osteoporosis treatment is administered are independent risk factors for re-fracture after PVP for OVCF. Assessing these factors may help predict the risk of re-fracture among patients and provide a reference for clinical intervention and treatment strategy formulation.

Application of disc region localization and classification method in percutaneous endoscopic lumbar discectomy and its predictive role on postoperative prognosis

LI Tao, YE Ji-chao, LI Shuang-xing, XIE Tian-yu, OU Mao-ta, WANG Zhen-bo, LI Min, FAN Ji, TANG Yong

2025, 25(1):  47-53.  DOI: 10.3969/j.issn.1009-976X.2025.01.009

Asbtract ( 18 )   PDF (2470KB) ( 6 )  

References | Related Articles | Metrics

Objective This study aims to improve the accuracy of preoperative evaluation for percutaneous endoscopic lumbar discectomy （PELD） through a modified regional localization and classification method for intervertebral discs, providing a new basis for individualized prediction of postoperative functional recovery and recurrence risk for patients. Methods This is a retrospective cohort study including 113 patients with LDH who underwent PELD treatment at Shenshan Medical Center, Sun Yat-sen Memorial Hospital,Sun Yat-sen University, between January 1, 2022, and September 30, 2023. The regional localization and classification method was applied based on imaging data to record the position and most protruding point of the intervertebral disc in the sagittal, transverse, and coronal planes. Through preoperative imaging data and clinical evaluations （VAS score, JOA score, ODI score, etc.）, the impact of regional localization and classification on postoperative recovery and prognosis was systematically analyzed. Results L5/S1 and L4/5 were the most commonly affected segments among LDH patients. Furthermore, the most protruding point of the intervertebral disc could effectively predict patients' functional recovery at 1 year postoperatively, as indicated by VAS score （P=0.039）, JOA score （P=0.031）, and ODI score （P=0.045）. Additionally, PELD surgery reduced intraoperative blood loss, shortened hospital stay, and contributed to rapid recovery for patients. Conclusion This study suggests that the modified regional localization and classification method can provide a new predictive approach for different patients with intervertebral disc herniation undergoing PELD surgery, thereby assessing prognostic differences and potential recurrence probabilities among various patients.

Study on the internal fixation with suture anchors and locking plate in the treatment of the greater tuberosity fracture

LIU Jun-bo, CHEN Tai-qiu, ZHENG Chao-shun, QIU Xue-li

2025, 25(1):  54-59.  DOI: 10.3969/j.issn.1009-976X.2025.01.010

Asbtract ( 14 )   PDF (2067KB) ( 4 )  

References | Related Articles | Metrics

Objective This study aimed to explore the therapeutic effect of internal fixation with high strength suture, anchors and locking plate on greater tuberosity fracture, and provided a safer and more effective treatment. Methods A total of 40 patients diagnosed with greater tuberosity fracture in the Department of Orthopedics of Jieyang People's Hospital, Guangdong Province,were included from September 2016 to June 2024. They were divided into the locking plate fixation group and combined group with high strength suture, anchors and locking plate randomly. Statistical analysis will be conducted to compare the baseline data, preoperative, postoperative, and 3-month follow-up clinical indicators between the two groups. Results All patients in this study were followed up, and there was no statistically significant difference in preoperative data between the two groups P>0.05. Compared with the locking plate fixation group, the combined group had a smaller displacement distance, a greater range of motion on shoulder （P<0.05）. The Constant-Murley score in the combined group was higher during the 3-month follow-up, and there were fewer post-operative complications （P<0.05）. Conclusion Compared with the locking plate fixation, the combined group has more satisfactory clinical efficacy, with faster postoperative recovery, less impact on shoulder motions, and fewer post-operative complications.

USP10 promotes the maglignant proliferation of glioblastoma by enhancing the stability of DNMT1

YANG Chao-ye, XIAO Song-hua

2025, 25(1):  60-69.  DOI: 10.3969/j.issn.1009-976X.2025.01.011

Asbtract ( 18 )   PDF (12269KB) ( 2 )  

References | Related Articles | Metrics

Objective In order to investigate the role of the deubiquitinating enzyme USP10 in the malignant progression of glioblastoma and elucidate its underlying mechanisms. Methods The GEPIA2 database was used to analyze the mRNA expression of USP10 in glioblastoma samples and its relationship with the prognosis of patients compared with normal tissue samples. The CRISPR-Cas9 plasmid was designed to knock out the expression of USP10 in glioma cells.Cellular proliferation was assessed through clonal formation assays, EdU incorporation experiments, and flow cytometry analysis. Coimmunoprecipitation （Co-IP） assay combined with mass spectrometry was used to identify USP10 interacting proteins. Two siRNAs were designed to knock down the expression of endogenous USP10 in glioma cells, and RNA-Seq analysis was used to compare the different RNA between before and after knockdown, and signaling pathway enrichment analysis was performed. Western blot （WB） analysis was conducted to evaluate protein expression levels in cells. Results Compared with adjacent tissues （n=207）, USP10 was significantly higher expressed in glioma cells （n=163, P<0.05）, and its high expression was significantly associated with poor prognosis. Knockout of USP10 led to a significant reduction in the proportion of glioma cells in the S phase （P<0.05）, decreased clonal formation （P<0.05）, and an even more pronounced decrease in colony formation under the same doses of ionizing radiation and TMZ （P<0.05）. RNAseq results indicated that USP10 affected multiple metabolic pathways related to cell proliferation. USP10 interacted with DNMT1 and was positively correlated with the expression level in glioma samples. WB analysis revealed a significant decrease in DNMT1 protein levels and a shortened half-life following USP10 knockdown; The growth kinetics of USP10 and DNMT1 proteins, as determined by the HU release assay, were found to be synchronized with those of Cyclin E1. Flow cytometry analysis showed that USP10 knockout increased the proportion of cells in the G1 phase （P<0.05）, decreased the proportion in the S phase （P<0.05）, and increased the proportion in the G2 phase （P<0.05）. Additionally, the number of colony formation decreased when USP10 and DNMT1 were knocked down in glioma cells, and the proportion of colony formation decreased higher with the increase of IR and TMZ doses. Conclusion The deubiquitinating enzyme USP10 is overexpressed in glioblastoma and is linked to an unfavorable prognosis. USP10 promotes the transition of glioblastoma from G1 to S phase by enhancing the stability of DNMT1, thereby promoting the proliferative capacity of glioblastoma cells.

Review

Progress in the treatment of high and complex anal fistulas by transanal opening of intersphincteric space

GUO Shuo-hao, SONG Shun-xin

2025, 25(1):  70-78.  DOI: 10.3969/j.issn.1009-976X.2025.01.012

Asbtract ( 22 )   PDF (963KB) ( 5 )  

References | Related Articles | Metrics

Surgical treatment of anal fistulas faces the dual challenge of achieving wound healing while preserving anal function. High or complex anal fistulas represent a closed-space, non-functional cavity within the perianal musculature, predominantly occurring in the posterior deep space of the anal sphincter complex. Effective management requires complete opening of this space and ensuring adequate drainage to control infection and promote healing. Traditional fistulotomy with seton placement is primarily suitable for simple fistulas, but its application in complex cases often results in high incontinence rates. In the era of sphincter-preserving techniques, surgeons must select appropriate surgical approaches that prioritize the anatomical integrity of the anal sphincter system. Current literature and guidelines propose multiple therapeutic options, including mucosal advancement flap （MAF）, laser therapy, video-assisted anal fistula treatment （VAAFT）, ligation of intersphincteric fistula tract （LIFT）, over-the-scope clip closure （OTSC）, and radiofrequency ablation （RAF）, however, up to the present moment, no single method has demonstrated substantial and promising potential. The transanal opening of intersphincteric space （TROPIS） technique, introduced in recent years, offers a unique approach. Instead of closing the internal fistula opening, TROPIS enlarges it by incising the fistula tract along the intersphincteric plane. This method fully preserves the external anal sphincter （EAS） and facilitates secondary healing through sustained drainage. Transanal opening of intersphincteric space （TROPIS） is a novel technique developed in recent years for high or complex anal fistulas. Instead of closing the internal fistula opening, it enlarges the opening by incising the fistula tract along the intersphincteric plane, completely preserving the external anal sphincter （EAS） and allowing secondary healing through drainage. First reported in 2017, TROPIS has demonstrated good efficacy and safety in treating complex high anal fistulas and is gaining wider adoption. This article reviews the clinical outcomes and future prospects of TROPIS.