The development of endoscopic ear surgery techniques promises to change the way we approach ear surgery.In this review paper,we explore the current evidence,seek to determine the advantages of endoscopic ear surgery,a...The development of endoscopic ear surgery techniques promises to change the way we approach ear surgery.In this review paper,we explore the current evidence,seek to determine the advantages of endoscopic ear surgery,and see if these advantages are both measureable and meaningful.The wide field of view of the endoscope allows the surgeon to better visualize the various recesses of the middle ear cleft.Endoscopes make it possible to address the target pathology transcanal,while minimizing dissection or normal tissue done purely for exposure,leading to the evolution of minimally-invasive ear surgery and reducing morbidity.When used in chronic ear surgery,endoscopy appears to have the potential to significantly reduce cholesteatoma recidivism rates.Using endoscopes as an adjunct can increase the surgeon's confidence in total cholesteatoma removal.By doing so,endoscopes reduce the need to reopen the mastoid during second-look surgery,help preserve the canal wall,or even change post-cholesteatoma follow-up protocols by channeling more patients away from a planned second-look.展开更多
In the surgical treatment of hepatocellular carcinoma and colorectal liver metastasis, it is important to preserve sufficient liver volume after resection in order to avoid post-hepatectomy liver sufficiency and to in...In the surgical treatment of hepatocellular carcinoma and colorectal liver metastasis, it is important to preserve sufficient liver volume after resection in order to avoid post-hepatectomy liver sufficiency and to increase the feasibility of repeated hepatectomyin case of intrahepatic recurrence. Parenchymasparing approach, which minimizes the extent of resection while obtaining sufficient surgical margins, has been developed in open hepatectomy. Although this approach can possibly have positive impacts on morbidity and mortality, it is not popular in laparoscopic approach because parenchyma-sparing resection is technically demanding especially by laparoscopy due to its intricate curved transection planes. "Small incision, big resection" is the words to caution laparoscopic surgeons against an easygoing trend to seek for a superficial minimal-invasiveness rather than substantial patient-benefits. Minimal parenchyma excision is often more important than minimal incision. Recently, several reports have shown that technical evolution and accumulation of experience allow surgeons to overcome the hurdle in laparoscopic parenchymasparing resection of difficult-to-access liver lesions in posterosuperior segments, paracaval portion, and central liver. Laparoscopic surgeons should now seek for the possibility of laparoscopic parenchyma-sparing hepatectomy as open approach can, which we believe is beneficial for patients rather than just a small incision and lead laparoscopic hepatectomy toward a truly minimally-invasive approach.展开更多
Background Laparoscopic dismembered pyeloplasty is technically feasible for ureteropelvic junction （UP J） obstruction although it is still challenged by its technical difficulty and time-consuming. In this study, we...Background Laparoscopic dismembered pyeloplasty is technically feasible for ureteropelvic junction （UP J） obstruction although it is still challenged by its technical difficulty and time-consuming. In this study, we compared the initial results of retroperitoneal laparoscopic pyeloplasty versus a combined laparoscopic dissection and open reconstruction through a small incision in the treatment of UPJ obstruction.Methods Sixty-four patients with primary UPJ obstruction underwent pyeloplasty： 32 patients underwent laparoscopic procedure and 32 patients underwent open assisted laparoscopic surgery including two steps, ie, laparoscopic dissection of the UPJ transperitoneally and then pyeloplasty via an extended small incision. The demographic data and intraoDerative, postoperative and follow-up conditions of patients were compared between the two groups.Results Preoperative data were comparable in the patients of the two groups. The operative time was shorter （60.9 minutes vs 157.7 minutes, P 〈0.0001） and the complication rate was lower （9.4% vs 31.3%, P 〈0,05） in the open assisted group than in the laparoscopic group. The estimated blood loss （42.3 ml vs 47.8 ml）, time to have normal diet （37.6 hours vs 33.8 hours）, and hospital stay （6.7 days vs 6.2 days） were equivalent, The operative success rate was 97% for the open assisted group and 91% for the laparoscopic group. Conclusions The procedure of combined small incision with laparoscopy for UPJ obstruction is technically easy, and the results are promising. It can be used as an alternative to conventional procedures.展开更多
BACKGROUND Intravenous leiomyomatosis(IVL) is a rare and complicated disease, which requires surgery by a multidisciplinary team. However, the optimal surgical approach has not been determined.CASE SUMMARY Here we rep...BACKGROUND Intravenous leiomyomatosis(IVL) is a rare and complicated disease, which requires surgery by a multidisciplinary team. However, the optimal surgical approach has not been determined.CASE SUMMARY Here we report three cases of IVL treated with different surgical approaches. All patients presented with circulation symptoms. Two patients had lower extremity edema and the other had cardiopalmus. The diagnosis of IVL was confirmed based on the imagining examinations and pathological findings. All patients underwent surgical treatment and were discharged without any complications.CONCLUSION Preoperative examination is crucial for surgical planning and surgical approach is dependent on the patient's condition and tumor involvement.展开更多
Injectable materials show their special merits in regeneration of damaged/degenerated bones in minimally-invasive approach.Injectable calcium phosphate bone cement(CPC)has attracted broad attention for its bioactivity...Injectable materials show their special merits in regeneration of damaged/degenerated bones in minimally-invasive approach.Injectable calcium phosphate bone cement(CPC)has attracted broad attention for its bioactivity,as compared to non-degradable polymethyl methacrylate cement.However,its brittleness,poor anti-washout property and uncontrollable biodegradability are the main challenges to limit its further clinical application mainly because of its stone-like dense structure and fragile inorganic-salt weakness.Herein,we developed a kind of injectable CPC bone cement with porous structure and improved robustness by incorporating poly(lactide-co-glycolic acid)(PLGA)nanofiber into CPC,with carboxymethyl cellulose(CMC)to offer good injectability as well as anti-wash-out capacity.Furthermore,the introduction of PLGA and CMC also enabled a formation of initial porous structure in the cements,where PLGA nanofiber endowed the cement with a dynamically controllable biodegradability which provided room for cell movement and bone ingrowth.Inter-estingly,the reinforced biodegradable cement afforded a sustainable provision of Ca^(2+)bioactive components,together with its porous structure,to improve synergistically new bone formation and osteo-integration in vivo by using a rat model of femur condyle defect.Further study on regenerative mechanisms indicated that the good minimally-invasive bone regeneration may come from the synergistic enhanced osteogenic effect of calcium ion enrichment and the improved revascularization capacity contributed from the porosity as well as the lactic acid released from PLGA nanofiber.These results indicate the injectable bone cement with high strength,anti-washout property and controllable biodegradability is a promising candidate for bone regeneration in a minimally-invasive approach.展开更多
AIM:To investigate the role of laparoscopy in the surgical management of hepatocellular adenoma(HA). METHODS:We reviewed a prospectively collected database of consecutive patients undergoing laparoscopic liver resecti...AIM:To investigate the role of laparoscopy in the surgical management of hepatocellular adenoma(HA). METHODS:We reviewed a prospectively collected database of consecutive patients undergoing laparoscopic liver resection for HA. RESULTS:Thirteen patients underwent fifteen pure laparoscopic liver resections for HA(male/female:3/10; median age 42 years,range 22-72 years).Two patients with liver adenomatosis required two different laparoscopic operations for ruptured adenomas.Indications for surgery were:symptoms in 12 cases,need to rule out malignancy in 2 cases and preoperative diagnosis of large HA in one case.Symptoms were related to bleeding in 10 cases,sepsis due to liver abscess following embolization of HA in one case and mass effect in one case(shoulder tip pain).Five cases with ruptured bleeding adenoma required emergency admis-sion and treatment with selective arterial embolization. Laparoscopic liver resection was then semi-electively performed.Eight patients(62%)required major hepatectomy[right hepatectomy(n=5),left hepatectomy (n=3)].No conversion to open surgery occurred.The median operative time for pure laparoscopic procedures was 270 min(range 135-360 min).The median size of the excised lesions was 85 mm(range 25-180 mm). One patient with adenomatosis developed postoperative bleeding requiring embolization.Mortality was nil. The median hospital stay was 4 d(range 1-18 d)with a median high dependency unit stay of 1 d(range 0-7 d). CONCLUSION:The laparoscopic approach represents a safe option for the management of HA in a semi-elective setting and when major hepatectomy is required.展开更多
Tympanic paragangliomas are uncommon vascular tumors of neural crest origin.Classically these lesions have been surgically managed via a transcanal or transmastoid approach using binocular microscopy.We describe a cas...Tympanic paragangliomas are uncommon vascular tumors of neural crest origin.Classically these lesions have been surgically managed via a transcanal or transmastoid approach using binocular microscopy.We describe a case in which a tympanic paraganglioma was removed via a transcanal approach,using the endoscope exclusively.Endoscopic ear surgery enhances visualization,helping to ensure complete tumor removal,while reducing unnecessary dissection and its associated morbidity.For small middle ear neoplasms,a purely endoscopic approach is feasible,with excellent results.Resident education in ear surgery has also been enhanced by the use of endoscopes.The wide field of view provided by the endoscope helps trainees understand the intricate three-dimensional anatomy of the middle ear cleft.展开更多
Background:Economic impact of robotic liver surgery(RLS)is still a debated issue due to the heterogeneity of liver resections considered and the lack of a rigorous methodology.Therefore,the aim of this study is to per...Background:Economic impact of robotic liver surgery(RLS)is still a debated issue due to the heterogeneity of liver resections considered and the lack of a rigorous methodology.Therefore,the aim of this study is to perform a time-driven activity-based costing(TD-ABC)comparing the costs of RLS,laparoscopic liver surgery(LLS)and open liver surgery(OLS)in the context of complex liver resections and to compare short term perioperative outcomes.Methods:The institutional databases of two Italian high volume hepatobiliary centres were retrospectively reviewed from February 2021 to April 2022.Patients submitted to major hepatectomies or postero-superior liver resections were selected and divided into three groups according to the approach scheduled(RLS,LLS and OLS)and compared.Major contributors of perioperative expenses were calculated using the TD-ABC model and accurately quantifying each unit resource consumed per patient and the time spent performing each activity.A primary intention-to-treat analysis(ITT-A)including conversions in the RLS and LLS groups was performed.Results:Forty-seven RLS,101 LLS and 124 OLS were collected.LLS and RLS showed reduced blood loss,morbidity,mortality and hospital stay compared with open.A trend towards reduced conversion rate in RLS compared to LLS was registered.Total costs associated with RLS were estimated at€10,637 vs.€9,543 for LLS and vs.€13,960 for OLS.The higher intraoperative costs associated with RLS(+153.3%vs.OLS and+148.2%vs.LLS,P<0.001),primarily related to surgical equipment expenses,were slightly offset by the postoperative savings(−56.0%vs.OLS and−29.4%vs.LLS,P<0.001)resulting from significantly reduced hospital stays.Conclusions:RLS offers economic advantages over OLS,as initial higher costs are offset by better perioperative outcomes.The evolving robotic marketplace is expected to drive down RLS costs,promoting widespread adoption in minimally invasive procedures.Despite its higher costs than LLS,RLS’s ability to enhance minimally invasive feasibility make展开更多
目的系统评价(QS)入路全膝关节置换(TKA)与传统入路临床疗效的差异,为临床提供参考。方法检索Cochrane图书馆、PubMed、EMbase、CNKI、万方数据库、维普资讯数据库等中英文数据库,检索截止日期为2013年2月。由两名评价员独立筛查文献、...目的系统评价(QS)入路全膝关节置换(TKA)与传统入路临床疗效的差异,为临床提供参考。方法检索Cochrane图书馆、PubMed、EMbase、CNKI、万方数据库、维普资讯数据库等中英文数据库,检索截止日期为2013年2月。由两名评价员独立筛查文献、提取资料和方法学质量评估,采用Rev Man 5.2.0软件进行Meta分析,并绘制漏斗图评定有无发表偏倚。结果一共纳入11篇临床随机对照试验文献(8篇英文文献,3篇中文文献),共分析813膝,其中QS入路407膝,传统入路406膝。Meta分析结果显示:与传统TKA相比,QS入路术后负重下地行走时间、直腿抬高时间、VAS评分、屈膝度数、引流量及切口长度等方面更有优势,在KSS功能评分、屈膝90°时间、术中出血量、总出血量、假体位置(下肢力线、α角、β角、γ角及δ角)及并发症发生率等方面均无统计学差异,而在手术时间、止血带时间等方面并无优势。结论对于经验丰富且已走出学习曲线的关节外科医生,选择QS入路会使患者术中创伤小,术后疼痛轻,下地锻炼时间早,功能恢复快,引流量少,而假体位置及并发症发生率较传统TKA无统计学差异。上述结果尚需更多高质量随机对照试验来进一步验证。展开更多
Objective:We conducted an analysis of the American College of Surgeons National Surgical Quality Improvement Program database for minimally-invasive partial nephrectomy cases reported with the goal to identify pre-and...Objective:We conducted an analysis of the American College of Surgeons National Surgical Quality Improvement Program database for minimally-invasive partial nephrectomy cases reported with the goal to identify pre-and peri-operative variables associated with length of stay(LOS)greater than 3 days and readmission within 30 days.Methods:Records from 2008 to 2018 for“laparoscopy,surgical;partial nephrectomy”for prolonged LOS and readmission cohorts were compiled.Univariate analysis with Chi-square,t-tests,and multivariable logistic regression analysis with odds ratios(ORs),p-values,and 95%confidence intervals assessed statistical associations.Results:Totally,20306 records for LOS greater than 3 days and 15854 for readmission within 30 days were available.Univariate and multivariable analysis exhibited similar results.For LOS greater than 3 days,undergoing non-elective surgery(OR=5.247),transfusion of greater than four units within 72 h prior to surgery(OR=5.072),pre-operative renal failure or dialysis(OR=2.941),and poor pre-operative functional status(OR=2.540)exhibited the strongest statistically significant associations.For hospital readmission within 30 days,loss in body weight greater than 10%in 6 months prior to surgery(OR=2.227)and bleeding disorders(OR=2.081)exhibited strongest statistically significant associations.Conclusion:Multiple pre-and peri-operative risk factors are independently associated with prolonged LOS and hospital readmission within 30 days of surgery using the American College of Surgeons National Surgical Quality Improvement Program data.Recognizing the risks factors that can potentially be improved prior to minimally-invasive partial nephrectomy is crucial to informing patient selection,optimization strategies,and patient education.展开更多
文摘The development of endoscopic ear surgery techniques promises to change the way we approach ear surgery.In this review paper,we explore the current evidence,seek to determine the advantages of endoscopic ear surgery,and see if these advantages are both measureable and meaningful.The wide field of view of the endoscope allows the surgeon to better visualize the various recesses of the middle ear cleft.Endoscopes make it possible to address the target pathology transcanal,while minimizing dissection or normal tissue done purely for exposure,leading to the evolution of minimally-invasive ear surgery and reducing morbidity.When used in chronic ear surgery,endoscopy appears to have the potential to significantly reduce cholesteatoma recidivism rates.Using endoscopes as an adjunct can increase the surgeon's confidence in total cholesteatoma removal.By doing so,endoscopes reduce the need to reopen the mastoid during second-look surgery,help preserve the canal wall,or even change post-cholesteatoma follow-up protocols by channeling more patients away from a planned second-look.
文摘In the surgical treatment of hepatocellular carcinoma and colorectal liver metastasis, it is important to preserve sufficient liver volume after resection in order to avoid post-hepatectomy liver sufficiency and to increase the feasibility of repeated hepatectomyin case of intrahepatic recurrence. Parenchymasparing approach, which minimizes the extent of resection while obtaining sufficient surgical margins, has been developed in open hepatectomy. Although this approach can possibly have positive impacts on morbidity and mortality, it is not popular in laparoscopic approach because parenchyma-sparing resection is technically demanding especially by laparoscopy due to its intricate curved transection planes. "Small incision, big resection" is the words to caution laparoscopic surgeons against an easygoing trend to seek for a superficial minimal-invasiveness rather than substantial patient-benefits. Minimal parenchyma excision is often more important than minimal incision. Recently, several reports have shown that technical evolution and accumulation of experience allow surgeons to overcome the hurdle in laparoscopic parenchymasparing resection of difficult-to-access liver lesions in posterosuperior segments, paracaval portion, and central liver. Laparoscopic surgeons should now seek for the possibility of laparoscopic parenchyma-sparing hepatectomy as open approach can, which we believe is beneficial for patients rather than just a small incision and lead laparoscopic hepatectomy toward a truly minimally-invasive approach.
文摘Background Laparoscopic dismembered pyeloplasty is technically feasible for ureteropelvic junction （UP J） obstruction although it is still challenged by its technical difficulty and time-consuming. In this study, we compared the initial results of retroperitoneal laparoscopic pyeloplasty versus a combined laparoscopic dissection and open reconstruction through a small incision in the treatment of UPJ obstruction.Methods Sixty-four patients with primary UPJ obstruction underwent pyeloplasty： 32 patients underwent laparoscopic procedure and 32 patients underwent open assisted laparoscopic surgery including two steps, ie, laparoscopic dissection of the UPJ transperitoneally and then pyeloplasty via an extended small incision. The demographic data and intraoDerative, postoperative and follow-up conditions of patients were compared between the two groups.Results Preoperative data were comparable in the patients of the two groups. The operative time was shorter （60.9 minutes vs 157.7 minutes, P 〈0.0001） and the complication rate was lower （9.4% vs 31.3%, P 〈0,05） in the open assisted group than in the laparoscopic group. The estimated blood loss （42.3 ml vs 47.8 ml）, time to have normal diet （37.6 hours vs 33.8 hours）, and hospital stay （6.7 days vs 6.2 days） were equivalent, The operative success rate was 97% for the open assisted group and 91% for the laparoscopic group. Conclusions The procedure of combined small incision with laparoscopy for UPJ obstruction is technically easy, and the results are promising. It can be used as an alternative to conventional procedures.
文摘BACKGROUND Intravenous leiomyomatosis(IVL) is a rare and complicated disease, which requires surgery by a multidisciplinary team. However, the optimal surgical approach has not been determined.CASE SUMMARY Here we report three cases of IVL treated with different surgical approaches. All patients presented with circulation symptoms. Two patients had lower extremity edema and the other had cardiopalmus. The diagnosis of IVL was confirmed based on the imagining examinations and pathological findings. All patients underwent surgical treatment and were discharged without any complications.CONCLUSION Preoperative examination is crucial for surgical planning and surgical approach is dependent on the patient's condition and tumor involvement.
基金National Key R&D Program of China(2018YFE0201500)National Natural Science Foundation of China(81772317,82272457 and 51973060)+4 种基金National Natural Science Foundation of China for Innovative Research Groups(51621002)“Technology Innovation Action Plan”of Shanghai Science and Technology Commission(21S11902700)Natural Science Foundation of Shanghai(21ZR1412300)Shanghai Talent Development Fund(2020067)Shanghai“Rising Stars of Medical Talent”Youth Development Program(Youth Medical Talents–Specialist Program,[2020]087).
文摘Injectable materials show their special merits in regeneration of damaged/degenerated bones in minimally-invasive approach.Injectable calcium phosphate bone cement(CPC)has attracted broad attention for its bioactivity,as compared to non-degradable polymethyl methacrylate cement.However,its brittleness,poor anti-washout property and uncontrollable biodegradability are the main challenges to limit its further clinical application mainly because of its stone-like dense structure and fragile inorganic-salt weakness.Herein,we developed a kind of injectable CPC bone cement with porous structure and improved robustness by incorporating poly(lactide-co-glycolic acid)(PLGA)nanofiber into CPC,with carboxymethyl cellulose(CMC)to offer good injectability as well as anti-wash-out capacity.Furthermore,the introduction of PLGA and CMC also enabled a formation of initial porous structure in the cements,where PLGA nanofiber endowed the cement with a dynamically controllable biodegradability which provided room for cell movement and bone ingrowth.Inter-estingly,the reinforced biodegradable cement afforded a sustainable provision of Ca^(2+)bioactive components,together with its porous structure,to improve synergistically new bone formation and osteo-integration in vivo by using a rat model of femur condyle defect.Further study on regenerative mechanisms indicated that the good minimally-invasive bone regeneration may come from the synergistic enhanced osteogenic effect of calcium ion enrichment and the improved revascularization capacity contributed from the porosity as well as the lactic acid released from PLGA nanofiber.These results indicate the injectable bone cement with high strength,anti-washout property and controllable biodegradability is a promising candidate for bone regeneration in a minimally-invasive approach.
文摘AIM:To investigate the role of laparoscopy in the surgical management of hepatocellular adenoma(HA). METHODS:We reviewed a prospectively collected database of consecutive patients undergoing laparoscopic liver resection for HA. RESULTS:Thirteen patients underwent fifteen pure laparoscopic liver resections for HA(male/female:3/10; median age 42 years,range 22-72 years).Two patients with liver adenomatosis required two different laparoscopic operations for ruptured adenomas.Indications for surgery were:symptoms in 12 cases,need to rule out malignancy in 2 cases and preoperative diagnosis of large HA in one case.Symptoms were related to bleeding in 10 cases,sepsis due to liver abscess following embolization of HA in one case and mass effect in one case(shoulder tip pain).Five cases with ruptured bleeding adenoma required emergency admis-sion and treatment with selective arterial embolization. Laparoscopic liver resection was then semi-electively performed.Eight patients(62%)required major hepatectomy[right hepatectomy(n=5),left hepatectomy (n=3)].No conversion to open surgery occurred.The median operative time for pure laparoscopic procedures was 270 min(range 135-360 min).The median size of the excised lesions was 85 mm(range 25-180 mm). One patient with adenomatosis developed postoperative bleeding requiring embolization.Mortality was nil. The median hospital stay was 4 d(range 1-18 d)with a median high dependency unit stay of 1 d(range 0-7 d). CONCLUSION:The laparoscopic approach represents a safe option for the management of HA in a semi-elective setting and when major hepatectomy is required.
文摘Tympanic paragangliomas are uncommon vascular tumors of neural crest origin.Classically these lesions have been surgically managed via a transcanal or transmastoid approach using binocular microscopy.We describe a case in which a tympanic paraganglioma was removed via a transcanal approach,using the endoscope exclusively.Endoscopic ear surgery enhances visualization,helping to ensure complete tumor removal,while reducing unnecessary dissection and its associated morbidity.For small middle ear neoplasms,a purely endoscopic approach is feasible,with excellent results.Resident education in ear surgery has also been enhanced by the use of endoscopes.The wide field of view provided by the endoscope helps trainees understand the intricate three-dimensional anatomy of the middle ear cleft.
文摘Background:Economic impact of robotic liver surgery(RLS)is still a debated issue due to the heterogeneity of liver resections considered and the lack of a rigorous methodology.Therefore,the aim of this study is to perform a time-driven activity-based costing(TD-ABC)comparing the costs of RLS,laparoscopic liver surgery(LLS)and open liver surgery(OLS)in the context of complex liver resections and to compare short term perioperative outcomes.Methods:The institutional databases of two Italian high volume hepatobiliary centres were retrospectively reviewed from February 2021 to April 2022.Patients submitted to major hepatectomies or postero-superior liver resections were selected and divided into three groups according to the approach scheduled(RLS,LLS and OLS)and compared.Major contributors of perioperative expenses were calculated using the TD-ABC model and accurately quantifying each unit resource consumed per patient and the time spent performing each activity.A primary intention-to-treat analysis(ITT-A)including conversions in the RLS and LLS groups was performed.Results:Forty-seven RLS,101 LLS and 124 OLS were collected.LLS and RLS showed reduced blood loss,morbidity,mortality and hospital stay compared with open.A trend towards reduced conversion rate in RLS compared to LLS was registered.Total costs associated with RLS were estimated at€10,637 vs.€9,543 for LLS and vs.€13,960 for OLS.The higher intraoperative costs associated with RLS(+153.3%vs.OLS and+148.2%vs.LLS,P<0.001),primarily related to surgical equipment expenses,were slightly offset by the postoperative savings(−56.0%vs.OLS and−29.4%vs.LLS,P<0.001)resulting from significantly reduced hospital stays.Conclusions:RLS offers economic advantages over OLS,as initial higher costs are offset by better perioperative outcomes.The evolving robotic marketplace is expected to drive down RLS costs,promoting widespread adoption in minimally invasive procedures.Despite its higher costs than LLS,RLS’s ability to enhance minimally invasive feasibility make
文摘目的系统评价(QS)入路全膝关节置换(TKA)与传统入路临床疗效的差异,为临床提供参考。方法检索Cochrane图书馆、PubMed、EMbase、CNKI、万方数据库、维普资讯数据库等中英文数据库,检索截止日期为2013年2月。由两名评价员独立筛查文献、提取资料和方法学质量评估,采用Rev Man 5.2.0软件进行Meta分析,并绘制漏斗图评定有无发表偏倚。结果一共纳入11篇临床随机对照试验文献(8篇英文文献,3篇中文文献),共分析813膝,其中QS入路407膝,传统入路406膝。Meta分析结果显示:与传统TKA相比,QS入路术后负重下地行走时间、直腿抬高时间、VAS评分、屈膝度数、引流量及切口长度等方面更有优势,在KSS功能评分、屈膝90°时间、术中出血量、总出血量、假体位置(下肢力线、α角、β角、γ角及δ角)及并发症发生率等方面均无统计学差异,而在手术时间、止血带时间等方面并无优势。结论对于经验丰富且已走出学习曲线的关节外科医生,选择QS入路会使患者术中创伤小,术后疼痛轻,下地锻炼时间早,功能恢复快,引流量少,而假体位置及并发症发生率较传统TKA无统计学差异。上述结果尚需更多高质量随机对照试验来进一步验证。
文摘Objective:We conducted an analysis of the American College of Surgeons National Surgical Quality Improvement Program database for minimally-invasive partial nephrectomy cases reported with the goal to identify pre-and peri-operative variables associated with length of stay(LOS)greater than 3 days and readmission within 30 days.Methods:Records from 2008 to 2018 for“laparoscopy,surgical;partial nephrectomy”for prolonged LOS and readmission cohorts were compiled.Univariate analysis with Chi-square,t-tests,and multivariable logistic regression analysis with odds ratios(ORs),p-values,and 95%confidence intervals assessed statistical associations.Results:Totally,20306 records for LOS greater than 3 days and 15854 for readmission within 30 days were available.Univariate and multivariable analysis exhibited similar results.For LOS greater than 3 days,undergoing non-elective surgery(OR=5.247),transfusion of greater than four units within 72 h prior to surgery(OR=5.072),pre-operative renal failure or dialysis(OR=2.941),and poor pre-operative functional status(OR=2.540)exhibited the strongest statistically significant associations.For hospital readmission within 30 days,loss in body weight greater than 10%in 6 months prior to surgery(OR=2.227)and bleeding disorders(OR=2.081)exhibited strongest statistically significant associations.Conclusion:Multiple pre-and peri-operative risk factors are independently associated with prolonged LOS and hospital readmission within 30 days of surgery using the American College of Surgeons National Surgical Quality Improvement Program data.Recognizing the risks factors that can potentially be improved prior to minimally-invasive partial nephrectomy is crucial to informing patient selection,optimization strategies,and patient education.
