Table of Content

20 April 2024, Volume 24 Issue 02

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Original Articles and Clinical Research

The association between the fluid collections of left upper abdomen and splenic complications in acute pancreatitis by radiological study

XU Hao-tong, HE Ming-jing, XU Wan-yu, YANG Yue, TIAN Fu-zhou

2024, 24(02):  87-92.  DOI: 10.3969/j.issn.1009-976X.2024.02.001

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Objective The correlations between fluid collections at different areas of left upper abdomen and the risk factors of developing to splenic complications in acute pancreatitis （AP） were analyzed on the basis of radiology. Methods CT or MRI images of 236 patients with the AP admitted to the general hospital of western theater command from January 2018 to December 2022 were collected. The correlations of pancreatic fistula in the tail （PFIT）, pseudocysts in lesser sac （PILS） and fluid collections in left anterior renal fascia with different kinds of splenic complications were evaluated with the chi-squared test using odds ratio （OR） on radiological images. BISAP scores between patients with three aforementioned fluid collections of left upper abdomen and their controls were compared by two independent sample t-tests, respectively. Results The PFIT correlated postively with the pseudocyst of splenic hilum （OR=2.714, P<0.001）, splenic infarction （OR=9.970, P<0.001）, subcapsular fluid collections （OR= 10.903, P<0.001）, splenic rupture （OR=20.576, P<0.001） and the sinistral portal hypertation （SPH） （OR=6.524, P<0.001）, respectively. In contrast, the PILS correlatednegatively withthe pseudocyst of splenic hilum （OR=0.471, P=0.01）, splenic infarction （OR=0.316, P=0.010）, subcapsular fluid collections （OR=0.512, P=0.032）, splenic rupture （OR=0.092, P<0.001） and the SPH （OR=0.492, P=0.009）, respectively. The BISAP score in patients with the PILS and its controls was 0.511±0.723 vs 1.828±1.050 （P<0.001）. Conclusion The presence of a PFIT and PILS were important risk factor for a protective factor against splenic complications, respectively. Moreover, the presence of the PILS may decrease the risk of AP patients to develop to the severe acute pancreatitis （SAP）.

The value of broad-spectrum antimicrobials in reducing complications after pancreaticoduodenectomy

LIU Guo-hua, WU Jia-yuan, ZHONG Guo-hui, DI Jing-wei, TAN Xiao-yu

2024, 24(02):  93-99.  DOI: 10.3969/j.issn.1009-976X.2024.02.002

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Objective This study aimed to evaluate the application value of prophylactic broad-spectrum antimicrobials use in reducing complications after pancreaticoduodenectomy. Methods A retrospective analysis was conducted on 83 patients who underwent pancreaticoduodenectomy at Guangdong Medical University Affiliated Hospital from October 2018 to October 2023. The patients were divided into an observative group （receiving prophylactic treatment with broad-spectrum antimicrobial agents, n=40） and a control group （not receiving prophylactic treatment with narrow-spectrum antimicrobial agents, n=43）. Characteristics in patients such as gender, age, body mass index, pancreatic texture, pancreatic duct diameter, preoperative jaundice, preoperative percutaneous transhepatic cholangiodrainage （PTCD）, and preoperative biliary stent implantation were collected and analyzed for both groups. The positive bile culture rate, infection indicators （PCT, white blood cell count, CRP, postoperative fever）, as well as the incidence of postoperative abdominal infection, abdominal bleeding, delayed gastric emptying （DGE）, CRPOPF, and incision infection were compared between the two groups. Differences in hospitalization duration and costs were also analyzed. Results Prior to surgery, there were no statistically significant differences in demographic characteristics and infection indicators between the two groups. On the first postoperative day, infection indicators （PCT, white blood cell count, CRP） for both groups were elevated compared to preoperative levels. However, the observative group showed lower levels compared to the control group, and these differences were statistically significant. In terms of postoperative fever, there were 3 cases in the experimental group and 12 cases in the control group, with a statistically significant difference. Furthermore, there were no statistically significant differences in demographic characteristics between the fever group and the normal body temperature group （P>0.05）. However, the positive bile culture rate in the fever group was higher than that in the normal body temperature group, and this difference was statistically significant （P<0.05）. Additionally, the observative group had a higher rate of positive bile culture than the control group. Regarding postoperative complications, there were statistically significant differences between the two groups in terms of incision infection, abdominal infection, delayed gastric emptying （DGE）, and abdominal bleeding, while there were no significant differences in the incidence of other postoperative complications. The observative group had a shorter hospital stay and lower hospitalization costs. Conclusion Prophylactic use of broad-spectrum antimicrobials has a certain effect in reducing complications after pancreaticoduodenectomy, including incision infection, abdominal infection, delayed gastric emptying （DGE）, and abdominal bleeding. It can also improve patient prognosis by shortening hospitalization duration and reducing hospitalization costs.

Tumor infiltrating lymphocytes predict the efficacy of neoadjuvant chemotherapy for breast cancer

WU Hui-qian, NI Heng-li, ZHOU Ai-jun, YUAN Hang, LI Jian-ming

2024, 24(02):  100-105.  DOI: 10.3969/j.issn.1009-976X.2024.02.003

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Objective To evaluate the infiltration level of tumor infiltrating lymphocytes （TILs） and explore the correlation between TILs and the efficacy of neoadjuvant chemotherapy for breast cancer. Methods A total of 87 cases were included with invasive breast cancer were diagnosed by preoperative biopsy. TILs infiltration evaluated by H＆E staining under microscope. The correlation between the expression levels of TILs and clinicopathological features as well as the efficacy of neoadjuvant chemotherapy was analyzed. Results The expressions of TILs in the preoperative core needle biopsy were closely related to the molecular subtypes of breast cancer, and the expression was highest in the HER2 over-expression and triple negative breast cancer subtypes. TILs level was significantly correlated with the expression of ER, PR and pathological complete response（pCR）. TILs level was higher in ER-and PR- patients （P<0.05）. The pCR rate in patients with high TILs infiltration was significantly higher than that in low TILs infiltration （P<0.05）. The pCR rates were also higher in ER- and PR- patients （P<0.05）. Multivariate analysis showed that TILs was an independent predictor for efficacy of neoadjuvant chemotherapy （P=0.041）. Conclusion Our study found that TILs was an independent predictor of the efficacy of neoadjuvant chemotherapy. A high TILs lever indicates better therapeutic effect.

The impact of endoscopic vein harvesting on surgical incision and quality of life in the patients undergoing minimally invasive coronary artery bypass grafting

WU Guang, MA Xiao-long, LIU Jia-ji, LANG Li

2024, 24(02):  106-109.  DOI: 10.3969/j.issn.1009-976X.2024.02.004

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Objective To investigate the impact of endoscopic vein harvesting on lower limb incision and early postoperative quality of life in the patients undergoing MICABG. Methods A total of 82 patients in our hospital and the single medical group of Beijing Anzhen Hospital who underwent MICABG from January to September 2022 were collected, including 36 patients receiving EVH,46 patients receiving OVH. The preoperative baseline date and the rate of postoperative leg wound complications were compared between the two groups．The SF-36 was applied to compare the changes in early postoperative quality of life in the two groups. Results The rate of postoperative leg wound complications such as poor incision healing decreased conspicuously in EVH group; in two dimensions of bodily pain and general health change, improvement rate in EVH group excelled to OVH group（P<0.05）. Conclusion In the patients undergoing MICABG, EVH can reduce the rate of postoperative leg wound complications significantly and improve the quality of life in the early postoperative period.

A retrospective study on the treatment of sacrococcygeal pilonidal sinus with conformal flap technique

WANG Qian-qian, WANG Jian-heng, HAN Xian-long, DONG Yong-zhen, LIU Min, ZHANG Zhi-gang, LIU Chun-xiang, LIU Peng-lin

2024, 24(02):  110-115.  DOI: 10.3969/j.issn.1009-976X.2024.02.005

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Objective To compare the clinical efficacy of conformal flap technique （Limberg operation combined with Karydakis operation） and Limberg operation in the treatment of sacrococcygeal pilonidal sinus. Methods A retrospective study was conducted on 40 patients who met the inclusion criteria and received treatment for large pilonidal sinus in the anorectal Department of Affiliated Hospital of Qingdao University from January 2021 to January 2023, and were divided into two groups according to the operation type： conformal flap group and Limberg flap group. Postoperative rehabilitation indexes of patients in the two groups were observed and compared： the time of negative pressure drainage tube removal, the time of complete suture removal after surgery, the pain score of the patient on the 1st and 3rd day after surgery （using VAS score）, postoperative complications （incision bleeding, incision infection, incision dehiss） and recurrence. Results The surgery was successful in both groups. The pain score of the conformal flap group was lower than that of the Limberg flap group on the first day after surgery, with statistical significance （P<0.05）, indicating that the conformal flap technique could reduce postoperative pain more than Limberg surgery. Drainage tube removal time and suture removal time were shorter in the conformal flap group than Limberg flap group, and the difference was statistically significant （P<0.05）. The results showed that postoperative recovery was faster in the conformal flap group than in the Limberg group. In terms of complications, there were two cases of incision complications in the conformal flap group （subcutaneous effusion in one patient, partial incision dehiscence in one patient）, and three cases of incision complications in the Limberg treatment group （subcutaneous effusion in two patients, partial incision dehiscence in one patient）. Conclusion Through retrospective study, Compared with the Limberg flap, the conformal flap is suitable for treating pilonidal sinuses with wide sinus tracts and long walking distance by retaining more normal tissue and lower injury, faster wound healing and lower pain score than Limberg flaps.

Clinical application of retrograde intrarenal surgery for the treatment of kidney stones measuring 2~3 cm in diameter

ZHOU Xiao-bo, LI Mao-zhang

2024, 24(02):  116-120.  DOI: 10.3969/j.issn.1009-976X.2024.02.006

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Objective To investigate the clinical application of retrograde intrarenal surgery （RIRS） in the treatment of kidney stones measuring 2-3 cm in diameter. Methods A total of 80 patients with kidney stones with a diameter of 2-3 cm treated in our hospital from January 2022 to March 2023 were selected and divided into observation group （retrograde intrarenal surgery RIRS group, n=40） and control group （percutaneous nephrolithotripsis PCNL group, n=40） according to different surgical methods. The general condition, stone characteristics, intraoperative indexes and postoperative recovery of the two groups were compared. Results There was no significant difference between the two groups in general condition data and stone characteristics （P>0.05）. The decrease of hemoglobin in RIRS group was lower than that in PCNL group, the difference was statistically significant （P<0.05）, but there was no statistically significant difference in other perioperative data （P>0.05）. The length of hospital stay and total complications in RIRS group were lower than those in PCNL group, and the differences were statistically significant （P<0.05）. One month after surgery, 34 patients （85.00%） in the RIRS group and 36 patients （90.00%） in the PCNL group were cleared of stone, and there was no significant difference in stone clearance between the two groups （P>0.05）. Conclusion The use of ureteral flexible lithotripsy in patients with larger renal stones of 2-3 cm in diameter is comparable to percutaneous nephrolithotripsy in terms of operative time, stone clearance, and causing postoperative elevation of PCT. Patients with ureteral soft lithotripsy have less bleeding, faster recovery, shorter postoperative hospital stay and lower complication rate.

Analysis of relevant factors affecting the rapid recovery of patients with chronic subdural hematoma

WU Hui-wen, LI Jia-rong, BAO Hui-lian, QIU Yi-hong

2024, 24(02):  121-126.  DOI: 10.3969/j.issn.1009-976X.2024.02.007

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Objective To analyze the influencing factors of rapid recovery of patients with chronic subdural hematoma, and to avoid the influence of these factors on postoperative rehabilitation, so as to shorten the length of hospital stay and improve the quality of long-term survival after surgery. Methods A total number of 222 patients diagnosed with chronic subdural hematoma admitted from January 2016 to August 2023 were selected. The fundamental data, imaging data, and inpatient treatment were analyzed. Univariate analysis and logistic regression analysis were used to explore the independent risk factors contributing to the speeded recovery of patients. Results Univariate analysis showed that there were statistical differences in preoperative imaging CT or MR examination for subfalx cerebri hernia, anesthesia method, postoperative urinary catheter indwelling time, subdural drainage tube indwelling time, and ambulation on the first postoperative day （P<0.05）. Logistic regression analysis results showed that preoperative subfalx cerebri hernia and subdural drainage tube indwelling time were independent factors affecting the patient's hospitalization time （P<0.05）. The regression coefficient comparing the two groups of patients with preoperative subfalx cerebri hernia was -1.014. Conclusion The duration of subdural drainage tube indwelling is the main factor affecting the length of hospital stay.

Case Report

Recurrence of primary thyroid paraganglioma with trachea invasion： a case report and literature reviews

ZHU Pei-feng, WANG Yong

2024, 24(02):  127-130.  DOI: 10.3969/j.issn.1009-976X.2024.02.008

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We report and analyze a case of TP recurrence, reviewing the initial surgery, follow-up, clinical presentation during recurrence, and treatment process. Additionally, we conduct a literature review to discuss diagnostic and therapeutic strategies for TP. The diagnosis of TP relies on immunohistochemical examination, and careful selection of surgical treatment plans is required based on the tumor's malignant potential. Lobectomy, including tumor resection, is a reasonable treatment option. Prompt intervention is recommended for recurrence or metastasis. This case report is intended to provide a reference for the clinical management of TP.

Review

Analysis of risk factors for rupture in unruptured intracranial aneurysms

LUO Bin, WU Xiao-liang, HUANG Ying

2024, 24(02):  131-135.  DOI: 10.3969/j.issn.1009-976X.2024.02.009

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The mortality rate of subarachnoid hemorrhage （SAH） caused by aneurysm rupture can be as high as 32% to 67%, with approximately 30% of patients suffering from moderate to severe disability. With advancements in imaging diagnostic techniques, an increasing number of unruptured intracranial aneurysms （UIAs） are being detected, providing clinicians with more opportunities for preventive interventions before rupture. There are many risk factors for predicting UIA rupture, such as morphological factors like the location and size of the aneurysm, as well as hypertension, hyperlipidemia, and other factors. However, none of these can objectively evaluate the risk of rupture individually or provide more insights for treatment decision-making. Moreover, the relationships between various factors are intricate, making it very difficult to establish reliable and precise predictive models. This article provides a brief overview of the more common risk factors for UIA rupture.

Advancements in research and analysis of current trends in laparoscopic inguinal hernia repair

DENG Xue-yong, XU Ji-wei

2024, 24(02):  136-140.  DOI: 10.3969/j.issn.1009-976X.2024.02.010

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Laparoscopic inguinal hernia repair（LIHR） has progressively emerged as the primary approach for treating inguinal hernias. In recent years, notable progress has been made： day surgery for LIHR, Single-incision laparoscopic surgery （SILS） and robotic-assisted LIHR, prevention of seroma and treatment options for the occult inguinal hernia. This review aims to explore the developmental trajectory, current trends, challenges, and future development directions of LIHR by examining recent original articles and reviews. It is intended to provide reference for clinicians and scholars interested in this field.