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20 August 2022, Volume 22 Issue 04

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Application and progress of indocyanine green fluorescence imaging navigation technology in hepatobiliary surgery

CAI Shang-lin, WANG Bo, LI Jian

2022, 22(04):  315-321.  DOI: 10.3969/j.issn.1009-976X.2022.04.001

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Indocyanine green fluorescence imaging has been widely utilized in hepatobiliary surgery, including primary liver cancer, colorectal liver metastasis, liver transplantation, hepatolithiasis as well as other benign and malignant diseases of the liver. It has been proven that it can enhance the effect of surgical resection and improve the prognosis for patients undergoing surgery. By reviewing relevant research progress, the author summarizes the application of ICG imaging navigation technology in hepatobiliary surgery. Finally, the author makes further discussion and speculates on the development of the technology.

Original Articles and Clinical Research

Sequential resection of initial unresectable hepatocellular carcinoma following conversion therapy：a report of 13 cases

HUANG Shao-jian, HE Qing-hua, HAN Ze-min, LI Zhi-xi, WANG Kai, LI Chuan-jiang

2022, 22(04):  321-327.  DOI: 10.3969/j.issn.1009-976X.2022.04.002

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Objective To evaluate the clinical efficacy and clinical features of sequential surgical resection of unresectable hepatocellular carcinoma after conversion therapy. Methods Clinical data of 13 patients with initial unresectable liver cancer admitted to Nanfang Hospital of Southern Medical University from January 2020 to December 2021 were retrospectively analyzed. Results Of the 13 patients, 12 were male and 1 was female, aged 50.0±12.7 years （range:23-72 years）; The child-Pugh grades were all A; CNLC Stage:5 patients with Stage Ⅰb, 2 patients with Stage Ⅱa, 2 patients with Stage Ⅱb, 3 patients with Stage Ⅲa, and 1 patient with Stage Ⅲb; ECOG PS score ≤1; There were 6 cases with cirrhosis and 7 cases without cirrhosis; There were 2 cases with portal vein tumor thrombosisand 11 cases without. The maximum tumor diameter before treatment was 9.8±2.7 cm, and the median AFP was 848.1 ng/mL （IQR:20.0-4638.1 ng/mL）. There were 12 cases with hepatitis B and 1 case without hepatitis B. Conversion treatment programme:TACE combined with Immune checkpoint inhibitors in 2 cases, TACE combined with Anti-angiogenic targeting drugs and Immune checkpoint inhibitors and in 6 cases, HAIC combined with Anti-angiogenic targeting drugs and Immune checkpoint inhibitors in 3 cases, and TACE combined with HAIC and Anti-angiogenic targeting drugs and Immune checkpoint inhibitors in 2 cases.The median conversion time was 3.4 months （IQR:2.7~5.5 months）, the maximum tumor diameter before conversion therapy was 7.1±2.2 cm, and the median AFP level before conversion therapy was 17.2 ng/mL （IQR:4.0~121.6 ng/mL）, preoperative imaging assessment （mRECIST） of CR in 2 cases, PR in 5 cases, PD in 1 case, SD in 5 cases, and there were 7 cases of conversion in oncology and 6 cases of conversion in surgery, preoperative PS score ≤1 point. After therapy, surgical resection was performed:10 cases underwent partial hepatectomy, 3 cases underwent semi-hepatic resection, 6 cases underwent laparoscopic surgery, and 7 cases underwent laparotomy. The median operative time was 295.0 min （IQR:230.5~418.0 min）, the median intraoperative blood loss was 300 mL （IQR:100~375 mL）, the median postoperative hospital stay was 10 days （IQR:7 ~ 13 days）, and the median postoperative drainage tube removal time was 7 days （IQR:5.5~13 days）. Postoperative pathological results:pCR 6 cases, pPR 7 cases, MVI grade M0 10 cases, M1 3 cases, all <5 intravascular cancer thrombi, including 2 cases of 1 intravascular cancer thrombi, no resection margin positive case. Postoperative heart failure occurred in 1 case, pulmonary embolism occurred in 1 case and bile leakage occurred in 1 case. The median postoperative follow-up time was 11.9 months （IQR:6.3~15.1 months）, and 3 patients had a recurrence, and no patient died during follow-up. Conclusion Sequential resection of primary unresectable hepatocellular carcinoma following conversion therapy is effective and safe.

Comparison of survival outcomes between radiofrequency ablation and surgery for solitary hepatocellular carcinoma ≤ 5 cm （multicenter prognostic analysis）

ZHANG Qiao, MO A-li, GAO Heng-yi, ZHOU Wei, Xia Feng, ZHANG Wei-liao, CHEN Wei-qiang

2022, 22(04):  328-335.  DOI: 10.3969/j.issn.1009-976X.2022.04.003

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Objective To compare the effects of radiofrequency ablation （RFA） and surgical resection （SR） on the prognosis of solitary hepatocellular carcinoma with tumor diameter ≤5 cm. Method Theclinicopathological data of patients with solitary hepatocellular carcinoma with a diameter of ≤5 cm who were admitted to Zhongshan Hospital Affiliated to Sun Yat-sen University, Tongji Hospital Affiliated to Huazhong University of Science and Technology, and Xiaogan Central Hospital from January 2015 to December 2018 and who received the above two treatments were collected. A total of 606 cases were included in this study. According to tumor diameter, the patients were divided into three subgroups:Group A （diameter≤2 cm）, Group B （2 cm<diameter≤3 cm）, Group C （3 cm<diameter≤5 cm）, among which Group A:77 patients; Group B:239 patients; Group C:290 patients. The effects of RFA and SR on the prognosis in each subgroup and the total population were compared and analyzed, and the main reasons affecting the efficacy of RFA were further explored. Results In the overall population of patients, the survival prognosis of patients in the SR group was better than that in the RFA group, and the difference was statistically significant （P<0.05）. When the tumor diameter was less than or equal to 2 cm, the clinical efficacy of SR and RFA were comparable, and there was no significant difference in overall survival （OS） and recurrence-free survival （RFS） （P>0.05）. When 2 cm<diameter≤3 cm, SR had better OS and RFS than RFA; for patients with HCC whose tumor diameter was >3cm and ≤5 cm, SR had better long-term prognosis and RFS than RFA, the difference was statistically significant （P<0.05）. Conclusion For patients with tumor diameter ≤2 cm, RFA can achieve the same clinical efficacy as SR; for patients with of 2 cm<tumor diameter ≤5 cm, SR should be given priority.

Application effects of modified gunsight technique closure of the wound following protective ileostomy reversal

ZHANG Lei, HU Jing, CHAO Juan, XIAO Zhi-qiang, MIAO Tong-lin, SHAN Chang-ling

2022, 22(04):  336-339.  DOI: 10.3969/j.issn.1009-976X.2022.04.004

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Objective To explore the application effects of modified gunsight skin incision and suture technique in the treatment of ileostomy closure after abdominal wall incision. Methods Fifty-eight patients of ileostomy from February 2019 to February 2022 in our hospital were also retrospectively analyzed, the subjects were divided into observation group（n=26） and control group（n=32）. The patients in the observation group were treated with modified gunsight technique while the control group with traditional primary suture. The operative time, intraoperative blood loss, postoperative diet time, stitches removing time, postoperative hospital stay,wound infection rate and postoperative pain score were compared between the two groups. Results The postoperative diet time,stitches removing time,postoperative hospital stay,wound infection rate and pain score on the first postoperative day of the observation group were significantly lower than those of the control group（all P values< 0.05）. There were no significant difference in the operative time and intraoperative blood loss between the two groups（all P values >0.05）. Conclusion Compared with the traditional primary suture, the modified gunsight technique can effectively reduce postoperative diet time, stitches removing time, postoperative hospital stay, wound infection and pain on the first postoperative day.

Correlation analysis of gastric xanthoma and early gastric cancer after Helicobacter pylori eradication

YANG Ke-ge, ZHOU Si-jun, ZHOU Xiao-ge, CHEN Hong-cheng

2022, 22(04):  340-343.  DOI: 10.3969/j.issn.1009-976X.2022.04.005

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Objective A retrospective, single center observational research to study the correlation between gastric xanthoma and early gastric cancer after radical eradication of Helicobacter pylori, in order to determine the predictive value of gastric xanthoma in the diagnosis of early gastric cancer after radical eradication of Helicobacter pylori. Methods Patients who successfully eradicated Helicobacter pylori in our hospital from 2018 to 2021 and were followed up by gastroscopy were selected to collect relevant case data. The cases finally confirmed as early gastric cancer by gastroscopy and pathology were classified into the study group, and the rest into the control group. Statistical analysis was conducted to analyze the correlation between gastric xanthoma and early gastric cancer after radical eradication of Helicobacter pylori. Results The proportion of patients with gastric xanthoma in the study group was significantly higher than that in the control group （71.1% vs. 13.9%,P < 0.05）. Logistic regression analysis showed that atrophy, intestinal metaplasia and gastric xanthoma were independent predictors of early gastric cancer detection after Helicobacter pylori eradication. Atrophy matched control analysis also identified gastric xanthoma as an independent predictor. Conclusion Gastric xanthoma can be used as a predictor of early gastric cancer after Helicobacter pylori eradication.

Meta-analysis on the clinical efficacy of proximal gastrectomy with double tract anastomosis and total gastrectomy with Roux-en-Y anastomosis for upper gastric cancer

LIU Hui, HUI Yuan-jian, DI Mao-jun, LIU Yan-wei, LI Jun, TAN Hua-yong

2022, 22(04):  344-353.  DOI: 10.3969/j.issn.1009-976X.2022.04.006

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Objective To compare the clinical efficacy of proximal gastrectomy with double tract anastomosis（PG-DT group） and total gastrectomy with Roux-en-Y anastomosis（TG-RY group） for upper gastric cancer using meta-analysis. Methods Pubmed, Embase, the Cochrane library, VIP and Wanfang database, CNKI were systematically searched for the research about proximal gastrectomy with double tract anastomosis（PG-DT group） and total gastrectomy with Roux-en-Y anastomosis（TG-RY group） for upper gastric cancer. The time limit for the retrieval of literature are set to from database building time to March 31, 2020. Information were extracted on the basis of the evaluation criteria of manual 5.1.0 Cochrane system by two evaluators independently,the quality of entrolled literatures was evaluated according to Jadad scale and Newcastle-Ottawa Scale, and RevMan 5.3 software are applied to perform a meta-analysis. Results A total of 16 studies with 1346 patients, all of the studies were case-control studies. There were 589 cases in PG-DT group,and 757 cases in TG-RY group. Meta-analysis showed that the incidence of perioperative complications was lower in PG-DT group than in TG-RY group（OR=0.56,95%CI:0.39~0.79, P<0.001）, However there was no significant statistical difference in the incidence of serious complications（OR=0.47,95%CI：0.2~1.08,P=0.08） and anastomotic leakage（OR=0.75,95%CI：0.4~1.39,P=0.35） between the two groups, Compared with TG-RY group,PG-DT group had a lower incidence of long-term complications such as dumping syndrome（OR=0.21,95%CI：0.09~0.48,P<0.001）and reflux esophagitis（OR=0.36,95%CI：0.21~0.65,P<0.001）.The hemoglobin（MD=5.3, 95%CI:3.18~7.42, P<0.001）, total protein（MD=1.74, 95%CI：0.62~2.85,P<0.001） and albumin levels（MD=2.59,95%CI：0.9~4.28,P=0.00） were significantly improved 1 year after surgery. There were no statistically significant difference in operative time and intraoperative blood loss between PG-DT group and TG-RY group（all P values >0.05）, However fewer lymph nodes were dissected in PG-DT group than in TG-RY group（MD=-7.35, 95%CI:-8.55~-6.15, P<0.001）. Conclusion Proximal gastrectomy with double tract anastomosis（PG-DT） is safe and effective for upper gastric cancer, it can effectively reduce perioperative complication,and it can also reduce long-term complications such as dumping syndrome and reflux esophagitis, and it can improve postoperative nutritional status to some extent.

Value of ultrasound-guided vacuum assisted resection in the diagnosis and treatment of breast intraductal papilloma

ZHOU Jie, ZUO Yan-ling, WANG Qian, JIANG Ming, WU Dan-dan, LI Hong-sheng

2022, 22(04):  354-357.  DOI: 10.3969/j.issn.1009-976X.2022.04.007

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Objective To evaluate the value of ultrasound-guided vacuum assisted resection （UGVAE） in the diagnosis and treatment of breast intraductal papilloma. Methods From February 2018 to February 2021, our department used UGVAE to diagnose 89 patients with intraductal papilloma of the breast. We retrospectively analyzed 33 patients who had regular postoperative breast imaging follow-up, 8 patients were diagnosed as bilateral intraductal papilloma of the breast. The follow-up period ranged from 14 to 50 months, with an average of 25.7 months. All intraductal papillomas of the breast were far away from the skin. The diameter of the lesion was 2.4~20 mm, with an average of 9 mm. The breast image report and data system （BIRADS） were diagnosed as category 2-4a. Vacuum-assisted excision was used for complete resection. All VAEs were performed with 8G vacuum assisted biopsy needle under the guidance of 12 mHz linear high frequency probe. Results In this study, the diameter of papilloma was less than 20 mm, and most of the patients with breast papilloma were asymptomatic （19/33, 57.6%）. When the diameterof breast papilloma on ultrasound was more than 10 mm, the pathological diagnosis after biopsy might be papilloma with atypical hyperplasia. The recurrence rate of papilloma after VAE is very low even without extensive resection. Conclusion Papilloma of breast with diameter less than 20 mm, including papilloma with atypical hyperplasia, which can be completely removed by VAE, with accurate diagnosis and low recurrence rate. We believe that the papilloma diagnosed by VAE does not need extensive resection, and imaging follow-up is sufficient.

Surgical selection and comparison of nipple-areola complex sensation after nipple-sparing mastectomy

LUO Kang-wei, CHEN Yong-ni, QIU Pu, LI Jia-lun

2022, 22(04):  358-362.  DOI: 10.3969/j.issn.1009-976X.2022.04.008

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Objective To summarize the effect and experience of preserving nipple-areola complex （NAC） in radical mastectomy for breast cancer. Methods Female patients who underwent surgical treatment for breast cancer in our hospital from March 2018 to March 2021 were selected. The inclusion criteria included that the primary tumor was located outside the areola and the tumor was more than 2 cm away from the areolar edge. A total of 99 patients were enrolled, including 45 patients who underwent nipple-sparing mastectomy （NSM） （NSM group） and 44 patients who underwent standard mastectomy （standard group）. The clinical effects including the sensory recovery of NAC after operation were observed after NSM. The postoperative pathological characteristics and complications between the patients with and without preservation of NAC were compared. Results Preoperative examination:there was no significant difference between the two groups in age, NAC diameter, nipple distance from tumor, preoperative tumor stage, type, tumor location and number of multiple lesions （P > 0.05）. Postoperative pathology in NSM group:35 cases （77.8%） were invasive carcinoma, 10 cases （22.2%） were ductal carcinoma in situ, the median tumor size was 2.4 cm （0.2~4.1 cm）, and axillary lymph node metastasis was found in 5 cases; In standard group, 37 cases （84.1%） were invasive carcinoma, 7 cases （15.9%） were carcinoma in situ, the median tumor size was 2.6 cm （0.2~4.7） cm, and 7 cases were axillary lymph node metastasis. There were 12 cases of fat liquefaction and seroma in each group, and 2 cases of slight wound infection in each group, which healed after conservative treatment. There were 8 cases of nipple or areolar necrosis in the NAC preservation group, of which 7 cases were small part necrosishealed after conservative treatment, and one case required NAC excision due to nipple necrosis. In addition, there were 3 cases and 5 cases of flap necrosis in NSM group and standard group respectively, all of which were healed by conservative treatment. Among the patients with NSM, 3（7.3%） had complete areola sensation recovery, 18（43.9%） had partial recovery, 20 had no sensation, and the nipple sensation recovery was the worst. Only one patient had postoperative nipple sensation sensitivity. The postoperative satisfaction of the two groups was similar. Conclusion Nipple-sparing mastectomy is feasible and has good cosmetic effect, but nipple sensitivity following NSM was markedly diminished.

Closure of a direct inguinal hernia defect with barbed suture for seroma prevention in laparoscopic direct inguinal hernia repair

MO Yu-xuan, TANG Ling-jia

2022, 22(04):  363-368.  DOI: 10.3969/j.issn.1009-976X.2022.04.009

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Objective To investigate the efficacy of the preventive effect of a simple technique by closing the direct hernia defect with barbed suture in laparoscopic direct inguinal hernia. Methods In total, 54 patients who presented to our hospital between January 1, 2020 and January 31, 2021 with primary direct inguinal hernia were randomized into the defect-closing group （by closing the transversalis） and the control groups. The primary outcomes were to compare the ultrasonic seroma number and volume at the inguinal region at 7 days, 1, 3 and 6 months postoperatively. Secondary outcomes included total operative time, acute pain, chronic pain, hospital stay, recurrence, and any other complications. Results All patients underwent surgery successfully. There were no significant differences in baseline demographic characteristics between the 2 groups including age, sex, hernia type, size of hernia defect, surgical approach, and follow-up time. Compared with control group, there were significantly fewer patients with seroma formation at 7 days, and 1 months after the operations in the defect closing group （P < 0.001, P = 0.05, respectively）. In addition, ultrasonic seroma volume was less in the defect-closing group on postoperative day 7 and 1 months （P < 0.001, P < 0.01, respectively）. The acute pain and hospital stay were comparable, and no chronic pain, early recurrence or other postoperative complications observed in both groups during the follow-up period. Conclusion The closure of pseudohernia sac with barbed suture in laparoscopic direct inguinal hernia repair is a secure and effective technique, which is easy to perform and could significantly reduce both incidence and volume of seroma formation without increasing the risk of recurrence, acute, and chronic pain.

The value of ultrasound-guided fine needle aspiration combined with coarse needle biopsy in the diagnosis of supraclavicular lymph node disease

YI Xiu-wen, OU Bing, LIN Qiu-ling, PAN Jing-sheng

2022, 22(04):  369-372.  DOI: 10.3969/j.issn.1009-976X.2022.04.010

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Objective To explore the clinical application value of ultrasound-guided fine needle aspiration combined with coarse needle biopsy in the diagnosis of supraclavicular lymph node lesions. Methods A total of 147 supraclavicular lymph node puncture specimens that underwent both ultrasound-guided fine needle aspiration combined with coarse needle biopsy in our department from January 2016 to May 2022 were retrospectively selected for analysis of their clinicopathological data. Results The results showed that the sampling satisfactory rate of supraclavicular lymph node was approximately 99% in 147 cases, and the overall diagnosis rate was approximately 82.3%. Two of the patients could not be diagnosed due to inadequate sampling and 24 could not be specifically staged due to immunohistochemistry. 113 cases were clearly identified as supraclavicular lymph node metastases from lung cancer and could be further differentiated between small cell carcinoma and non-small cell carcinoma. Non-small cell carcinoma can be subdivided into adenocarcinoma and squamous carcinoma. Some rare types of lung cancer such as neuroendocrine tumours, typical carcinoid tumours and lymphoepithelioma-like carcinomas were also diagnosed in the supraclavicular lymph nodes. We also identified eight specimens of extra-pulmonary origin from the gastrointestinal tract, gynaecological, urological, breast and haematological systems. Conclusion This study shows that fine needle aspiration combined with coarse needle biopsy has a high clinical value in the pathological diagnosis and staging of supraclavicular lymph node disease, and it avoids unnecessary surgical excisional biopsies to a certain extent.

The mechanism of the colonic epithelial metaplasia induced by colon valvoplasty in SD rats with short bowel syndrome

DENG Gao-yan, ZENG Ji-xiao

2022, 22(04):  373-377.  DOI: 10.3969/j.issn.1009-976X.2022.04.011

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Objective The author firstly invented colon valvoplasty to make colonic epithelium have similar absorptive function like small intestine. The study aims to find out the mechanism of the epithelial metaplasia from colon to intestine inducted by colon valvoplasty. Methods Fourty SD rats were randomly divided into two groups （each with 20 SD rats）, and the rats in control group had been removed eighty percent of intestines, while the rats in experimental group had been performed colon valvoplasty in the same time. 30 weeks later, the rats were killed, and the ilium, the colon before and after the valve were tested. Protein Wnt7b and β-catenin were tested by immunofluorescence histochemistry. Results The rats in experimental group were heavier than that in control group. HE examination found that the epithelium before the valve had some features like intestine, including thicker epithelium, longer villi and less goblet cells. Protein Wnt7b and β-catenin of colon epithelium before valve were more than that after the vale. Conclusion Colon valvoplasty increased the absorptive function of colon, and the mechanism was the regeneration of stem cells by the pathway of Wnt/β-catenin, and the procedure had large valve of clinical practice.

Analysis of influencing factors of Gleason grade upgrading after radical prostatectomy（Based on 2014 ISUP grouping）

SONG Hong-wen, WANG Ji-xin, Asimujiang Abula, Wang Yu-jie, WANG Wen-guang

2022, 22(04):  378-383.  DOI: 10.3969/j.issn.1009-976X.2022.04.012

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Objective To explore the influencing factors of Gleason upgrade after radical prostatectomy on the basis of ISUP grouping in 2014 edition. Methods Clinical data of 189 patients who underwent radical prostatectomy in the First Affiliated Hospital of Xinjiang Medical University from 2016 to 2021 were retrospectively collected. According to whether Gleason after radical prostatectomy was higher than that during prostate puncture, 60 cases were divided into Gleason Grade Upgrading group （GGU group） and 129 cases were Gleason Grade non-Upgrading group （non-GGU group）. Univariate analysis and multivariate Logistic regression were performed to compare the data differences between the two groups. Results In univariate analysis, the length of punctured tumor tissue, Gleason major area score and Gleason minor area score were related to GGU （P<0.05）. After Logistic regression, the history of hypertension （OR=2.651）, Gleason major area score （OR=4.186）, tumor tissue length （OR=10.989） and positive rate of biopsy （OR=3.684） were related to GGU （P<0.05）. Conclusion History of hypertension, Gleason major area score of biopsy specimens, tumor tissue length in specimens, and positive biopsy rate may be associated with the risk of GGU.

Outcomes and analysis on treatment of ureteral and kidney stones in patients with overweight and obesity

XU Kai, LIN Yuan, ZHU Guo-shu

2022, 22(04):  384-388.  DOI: 10.3969/j.issn.1009-976X.2022.04.013

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Objective To investigate whether obesity affects the efficacy of kidney stone treatment and increases the incidence of complications. Methods The clinical data of patients with kidney or ureteral stones who were treated with extracorporeal shock wave lithotripsy （ESWL）, percutaneous nephrolithotomy （PCNL）, or flexible ureteroscopic （FURS） from March 2018 to April 2022 were retrospectively analyzed, and the patients were divided into overweight/obesity group and normal weightgroup according to Body Mass Index （BMI）, with 98 in the overweight/obesity group（BMI≥24.0 kg/m²） and 212 in the normal weigh group, respectively. The clinical outcomes and complications were compared between two groups when patients underwent ESWL, PCNL, or FURS lithotripsy. Results The BMI of patients in the overweight/obese group was 27.6±1.9 kg/m², of which 29 patients had BMI ≥28 kg/m², and the highest was 30.8 kg/m². The performance of ESWL in overweight/obese patients showed a lower success rate of lithotripsy （68.5%）, and compared with normal weight patients （72.7%）, the difference between the two groups was statistically significant （P=0.0046）; due to the high Skin-to-Stone Distance （SSD） in overweight/obese patients were higher than that of normal weight patients （P<0.001）, the X-ray exposure time during lithotripsy was also significantly longer than that of normal weight patients （P=0.005）. The stone-free rate of PCNL was comparable between the two groups, and the difference was not statistically significant （P=0.118）. However, in overweight/obese patients, the operation time of PCNL was significantly longer in overweight/obese patients than in normal-weight patients （P=0.038）, and the former showed a decrease of Hb slightly, but the difference was not statistically significant （P=0.069）. In the two groups of patients treated with FURS, the overweight/obese group was comparable to the normal weight group in terms of residual stone, postoperative hospital stay, and complications. Conclusion The obese patients with kidney or ureteral stones can choose various treatment methods to remove stones like normal-weight patients. The clinical effects of the two groups are similar, but the success rate of ESWL is slightly lower. The choice of ESWL in obese patients should be based on a more information. In addition, the overweight/obese group may be at increased risk of associated treatment costs and complications.

Therapeutic effects of reconstruction of ankle joint via posterior approach on malunion ankle fracture involving posterior malleolar and fibular fracture

LI Wen-gui, CHEN Chen, ZENG Gang, LIU Wen-zhou, CHEN Yan-bo, YANG Tao, SONG Wei-dong

2022, 22(04):  389-394.  DOI: 10.3969/j.issn.1009-976X.2022.04.014

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Objective To summarize the clinical outcomes of reconstruction of malunited ankle fracture involving posterior malleolar and fibular fracture via combined posterior approach. Methods From December 2015 to December 2021, 18 malunited ankle fractures involving posterior malleolar and fibular fracture were treated via posterior approach in our departments.All deformities were open and reduced and dislocated ankle were reconstructed; Radiographic assessments were performed using plain radiographs and computed tomographic （CT） scans pre- and post-operation to evaluate the relocation of the fracture, congruence of the ankle joint and the union rate of the bone. The complications were recorded. Clinical outcomes were assessed using the AOFAS ankle-hindfoot score, visual analog scale （VAS）, active range of motion of ankle. Results Eleven patients were followed up with an average period of 32 months （14~48 months）. Postoperatively, congruence of joint and alignment of lower extremity were achieved in all patients as judged by X ray and CT scans. The median AOFAS score improved from 40 to 84（P<0.001）. Median pain VAS score improved from 5.3 to 1.5 （P<0.001）. The ROM of ankle improved from 15 to 35 degree. Conclusion In treatment of malunited ankle fracture involving posterior malleolar and fibular fracture, reduction of the fracture through the combined posterior approach, will reconstruct the congruity of ankle mortise and save the ankle function greatly.

Treatment of unstable scapula fracture with miniature locking titanium plate

HE Gang, WONG Chi-piu, ZHENG Xiang, ZHANG Wei-qiong, CHEN Qian, CHEN Yan-tao

2022, 22(04):  395-397.  DOI: 10.3969/j.issn.1009-976X.2022.04.015

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Objective To investigate the effect of miniature locking titanium plate in the treatment of unstable scapula fracture. Methods From January 2018 to December 2020, 21 patients with unstable scapular fractures were treated with miniature locking titanium plates. Judet approach, auxiliary approach to the lateral border approaches were adopted at the scapula respectively. After fracture reduction, miniature locking titanium plates were used for fixation. Results X-ray examination results showed satisfactory postoperative reduction. According to Hardegger's evaluation criterion,18 cases showed excellent results,2 good and 1 fair with an excellent-to-good rate of 95.2%. Conclusion For the unstable scapula fracture, the corresponding approach was selected according to the fracture site and the miniature locking titanium plate was used for internal fixation, supplemented by early functional exercise, and the effect was satisfactory.

The application of noise-optimized virtual monoenergetic imaging technique in the CT examinations of patients with metallic dental implants

LU Guo-xiong, JIANG Yu-song, YAN Zhuo-heng, ZHANG Fang, SHI Guang-zi, HU Hui-jun

2022, 22(04):  398-403.  DOI: 10.3969/j.issn.1009-976X.2022.04.016

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Objective To compare the effect of noise-optimized virtual monoenergetic imaging （VMI+） and conventional virtual monoenergetic imaging （VMI） on CT images in oral cancer patients with oral metal implants. Methods Data were retrospectively collected in 54 patients with metal implants who underwent maxillofacial scanning by using the third-generation dual-source CT in our hospital from August 2019 to April 2020. CT images with VMI+ and VMI from 40 to 190 keV （10 keV as interval） were reconstructed separately using the venous phase. CT images were analyzed byfourradiologists. The quantitative assessments regarding of CT values, noise （SD）, artifact index （AI）, and subjective assessments in hyperdense artifacts, hypodense artifacts, soft palate, floor of mouth, tongue, buccal soft tissue, subcutaneous fat, tumor, internal carotid artery （ICA）, and internal jugular vein （IJV） were compared between the VMI+ and VMI image. Results The lowest AI values were found in 120 keV VMI+ for the floor of the mouth, tongue and IJV; in 130 keV VMI+ for low-density artifacts and tumors; in 150 keV VMI+ for ICA; in 160 keV VMI+ for the buccal region; and in 190 keV VMI+ for high-density artifacts and soft palate. AI values in the VMI+ series were lower than that in all VMI series except for high-density artifacts, buccal and tumor （all P<0.05）. Image scores were highest at 190 keV VMI+ for high-density artifacts, at 180 keV VMI+ for the soft palate, at 160 keV VMI+ for the buccal region, and at 130 keV VMI+ for low-density artifacts, floor of the mouth, tongue, tumor, ICA, and IJV （all P<0.05）. The overall image quality was best at 130 keV VMI+ （all P<0.05）. Conclusion The high keV VMI+ technique of dual-source CT can effectively reduce metallic artifacts and improve image quality, and 130 keV VMI+ was the optimal energy level which could combine the best artifact removal effect and good tissue contrast.

The prevention and treatment of deep venous thrombosis after oral and maxillofacial tumor resection and flap reconstruction

ZHANG Li-ping, LIU Qiu-ling, WANG You-yuan

2022, 22(04):  404-407.  DOI: 10.3969/j.issn.1009-976X.2022.04.017

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Objective To investigate the causes and nursing measures of deep venous thrombosis （DVT） after oral and maxillofacial tumor resection and flap reconstruction. Methods From January 2017 to November 2019, 1600 patients underwent oral and maxillofacial tumor resection and flap reconstruction in our center were retrospectively analyzed. Seventeen patients with deep venous thrombosis were detected in lower extremity by Doppler ultrasound examination. The treatment data of 17 patients, such as age, operation time, postoperative in bed time, kind of flaps, were analyzed. The blood coagulation test and Doppler ultrasound examination were analyzed before and after operation. Results Seventeen patients with deep venous thrombosis with average age of 63 years old. The average operation time was 8.09 hours. There were 14 cases of free flaps from lower limbs, accounting for 82.4% of all DVT patients and these patients were in bed for 5~7 days after the operation. After treatment, there was no flap lost, and no bleeding and hematoma in the operation area. The level of D-dimer was decreased. The deep vein thrombosis of lower extremity was dissolved or attached to the wall, and the blood flow was unobstructed. Conclusion Patients underwent oral and maxillofacial tumors resection and flap reconstruction have high risk of DVT in lower extremities and effective prevention and treatment strategies should be taken.

Correlation analysis of occupational risk and psychological resilience among front-line personnel in nuclear medicine department

HUANG Wei, LIU Xiu-wen, YU Xiu-xian, LIN Mei

2022, 22(04):  408-413.  DOI: 10.3969/j.issn.1009-976X.2022.04.018

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Objective To investigate the current situation of occupational risk and psychological resilience of front-line personnel in nuclear medicine department, and explore the influence of occupational risk on psychological resilience, so as to provide a scientific basis for improving their psychological resilience. Methods From July to November 2021, a convenience sampling method was used to investigate the demographic characteristics, occupational risk and psychological resilience of front-line personnel in nuclear medicine departments nationwide, and the results were analyzed by univariate analysis, correlation analysis and multiple linear regression analysis. Results Among the 284 respondents, the total occupational risk score was 179.99±108.03, among which work environment hazards dimension scored the highest. The univariate analysis showed that occupational risk was statistically associated with age, marital status, time on working in nuclear medicine, diseases history（P<0.05）. The total psychological resilience score was 88.84±14.16,among which the strength dimension scored the highest and the optimism dimension scored the lowest. Occupational hazard risk is negatively corelated with the psychological resilience of front-line personnel in the nuclear medicine department （P<0.05）. Multiple linear regression showed that levels of leadership had a positive effect on psychological resilience （β=2.115, P<0.05） while accidental factor hazards had a negative effect （β=-0.084, P<0.05）. Conclusion The psychological resilience is negatively related with the occupational risk of front-line personnel in nuclear medicine department, and managers should pay more attention to their occupational risk and control it with scientific methods, so as to improve the level of psychological resilience

Review

Research progress on influencing factors of patient satisfaction after anterior cruciate ligament reconstruction

WANG De-ning, WANG Xin, ZHANG Ke-fan, SHI Hui

2022, 22(04):  414-420.  DOI: 10.3969/j.issn.1009-976X.2022.04.019

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Anterior cruciate ligament reconstruction （ACLR） is an effective method for the treatment of anterior cruciate ligament injury. Doctors often use specific objective indicators to evaluate the clinical efficacy, which is inconsistent with the patient's subjective evaluation of the surgical prognosis. In the modern patient-centered medical model, patient satisfaction has become a more and more important index of efficacy evaluation. This paper summarizes and analyzes the influencing factors of patient satisfaction after ACLR in recent years. It is found that the factors affecting patient satisfaction mainly focus on patient factors, treatment selection, perioperative management, curative effect evaluation and so on. It is hoped that understanding these influencing factors can help doctors make better clinical decisions, so as to improve the curative effect of ACLR and benefit patients.

Management of irreparable rotator cuff tears

LIANG Shen-hao, WANG Zhe, WANG Da-lin

2022, 22(04):  421-427.  DOI: 10.3969/j.issn.1009-976X.2022.04.020

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Rotator cuff tears are the most common clinical muscle injuries, and the treatment of irreparable rotator cuff tears （IRCT） is still difficult. Current treatments for IRCT include:non-surgical treatment, shoulder debridement, partial and complete rotator cuff repair, biological patch technology, tendon transposition, in space balloon, and Reverse shoulder arthroplasty.Since there is no consensus on the indications for each therapeutic measure, this paper discusses the efficacy of each therapeutic measure and the related indications for IRCT by searching and reviewing the relevant literature to provide a theoretical reference for clinical treatment.

The role of protein glycosylation in the development of lung cancer

XU Sheng-shan, WANG Zhi-gang, LU Zhu-ming

2022, 22(04):  428-432.  DOI: 10.3969/j.issn.1009-976X.2022.04.021

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Globally, lung cancer is the second-highest cancer incidence and remains the leading cause of cancer mortality worldwide. Early detection can greatly improve patient survival rates. However, the lack of reliable blood biomarkers remains a major factor in early diagnosis. Recent studies have shown that aberrant glycosylation plays an important role in tumor growth, invasion, and metastasis,and is closely related to the prognosis of lung cancer. The expression and regulation of proteins associated with lung cancer have a characteristic glycosylation pattern, and the detection of glycoproteins in tracheal secretions and blood is expected to be a biomarker for the early diagnosis of lung cancer. This article reviews the role of aberrant protein glycosylation in the progression of lung cancer.