Extensive hepatectomy can achieve a higher chance of radical resection of lesions in the hepatobiliary system, but the risk of fatal complications of severe liver failure after surgery also increases accordingly. Therefore, enhancing the liver’s regenerative capacity has always been a hot topic in clinical research. Portal vein blood supply is of great significance for maintaining the normal function of the liver and promoting the repair and proliferation of damaged liver tissue. After selectively altering the blood flow distribution in the portal vein, atrophy or proliferation will occur in different liver lobes. The discovery of the important physiological phenomenon of liver regeneration induced by deportalized blood flow of portal vein has made it possible to promote the volume growth and functional enhancement of the residual liver lobes before hepatectomy, and various technical schemes have been applied and developed in clinical practice. The interim research results show that the portal vein embolization technique is mature, has less trauma, but the induction speed is relatively slow. Portal vein combined with hepatic vein embolization has better induction efficacy and does not increase embolism-related complications, and has a wider range of applications. The induction ability of associating liver partition and portal vein ligation for staged hepatectomy is significant, but the surgical trauma is large, and there are higher requirements for perioperative management. There is a clear correlation between high surgical volume centers and technical improvements and a significant reduction in complications. Resection and partial liver transplantation with delayed total hepatectomy not only break through the bottlenecks of safety and ethical requirements for living donor liver transplantation in adults, but also innovate and enrich the second-stage extensive hepatectomy schemes. However, their technical standards and application scope still need more high-quality research evidence to support them.
Lung cancer is a complex disease with its own challenges, and is considered to be one of the most common causes of cancer death worldwide. The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has exacerbated these challenges. The aim of this review is to explore the impact of the COVID-19 pandemic on the screening, diagnosis and treatment of lung cancer. We hope to provide some experience and help for the whole process management of lung cancer patients.
A complex mechanism of reduced number of bile duct innervating ganglion cells, smooth muscle distribution, foregut duplications, and abnormal pancreaticobiliary duct junction, which occurs during embryonic development and after birth in a genetic context, can lead to pathological congenital biliary dilatation. As a precancerous lesion of the biliary system, irrational treatment of congenital biliary dilatation will further increase the risk of malignancy in patients. By understanding the causes, pathological features, and limitations of early detection techniques of malignant tumor secondary to congenital biliary dilatation is helpful to clarify the key points in the management of congenital biliary dilatation, reduce the incidence of postoperative adverse treatment events and avoid the medical risk of secondary malignancy.
Surgery is the only effective treatment for congenital choledochal cysts, as it allows for the resection of the cysts, the complete relief of cholangitis, and the prevention of canceration of cysts. The key elements of surgery for central choledochal cysts involve the cysts resection, bile-intestinal anastomosis, and biliopancreatic diversion. The difficulty in operating on central choledochal cysts lies in the rational decision making and effective management of cysts in the hilar and pancreatic regions. Depending on the type of central choledochal cysts with different anatomical patterns, a reasonable and feasible individualized surgical management strategy can be established to effectively avoid adverse therapeutic consequences such as postoperative biliary leakage, cholangio-intestinal anastomotic stricture, residual choledochal cysts and its carcinogenesis.
ObjectiveTo systematically review the efficacy of hamstring tendon autograft versus hamstring tendon allograft in anterior cruciate ligament reconstruction by arthroscopy. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 2, 2015), CNKI, VIP, WanFang Data were electronically searched to collect randomized controlled trials (RCTs) about hamstring tendon autograft versus hamstring tendon allograft in anterior cruciate ligament reconstruction by arthroscopy from inception to February 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 6 RCTs involving 535 knees were included. The results of meta-analysis showed that:(1) Postoperative physical outcomes:There were no significant differences between the hamstring tendon autograft group and the hamstring tendon allograft group in positive rate of Lachman test (RR=1.25, 95%CI 0.92 to 1.71, P=0.15) and positive rate of Pivot shift test (RR=1.04, 95%CI 0.93 to 1.17, P=0.47) at 1 year postoperatively. (2) Postoperative functional recovery outcomes:There were no significant differences between both groups in KT-1000/2000 measurement (MD=-0.79, 95%CI -1.78 to 1.20, P=0.12), abnormal rate of IKDC scores (RR=1.03, 95%CI 0.90 to 1.1, P=0.42) and Lysholm scores (MD=0.23, 95%CI -1.86 to 2.33, P=0.83) at 1 year postoperatively. ConclusionHamstring tendon autograft and hamstring tendon allograft have similar efficacy in anterior cruciate ligament reconstruction by arthroscopy. Due to limited quality and quantity of the included studies, more large-scale and high quality studies are needed to verify the above conclusion.
ObjectiveTo explore the effect of metabolic syndrome (MS) on postoperative pulmonary infection in patients with colorectal cancer (CRC) and to construct a risk prediction model for postoperative pulmonary infection in CRC patients. MethodsRetrospective collection of clinical data from 291 CRC patients who underwent surgical treatment at Department of General Surgery, Suzhou Ninth People’s Hospital in the period of January 2020 to August 2024. To explore the risk factors of postoperative pulmonary infection in patients with CRC and to establish a nomogram model. ResultsAmong the 291 CRC patients enrolled, there were 58 MS patients (19.93%) and 233 non-MS patients (80.07%). Compared with patients without MS, CRC patients with MS had longer surgery time (P<0.001) and higher incidence of postoperative pulmonary infection (P<0.001). The results of multiple logistic regression analysis showed that smoking history [OR=2.184, 95%CI (1.097, 4.345), P=0.026], body mass index (BMI)≥25 kg/m2 [OR=2.662, 95%CI (1.241, 5.703), P=0.012], MS [OR=2.770, 95%CI (1.415, 5.425), P=0.003], increased surgical time [OR=4.039, 95%CI (1.774, 9.197), P<0.001] and increased intraoperative bleeding [OR=2.398, 95%CI (1.246, 4.618), P=0.009] were all risk factors for postoperative pulmonary infection in CRC patients. Based on these risk factors, a nomogram model was constructed. The area under the curve (AUC) was 0.845 [95%CI (0.769, 0.906)], and the sensitivity and specificity were 84.2% and 87.5% respectively. The internal verification of Bootstrap test showed that the simulated curve and the actual curve had good consistency. The clinical decision curve analysis showed that when the threshold probability was in the range of 8%–84%, the net benefit of the model for patient diagnosis was higher. ConclusionsMS increases the risk of postoperative pulmonary infection in CRC patients. At the same time, smoking history, BMI≥25 kg/m2, long operation time, and more intraoperative blood loss are also risk factors for postoperative pulmonary infection in patients with CRC. Building a model based on this can effectively evaluate the risk of postoperative pulmonary infection in CRC patients.