Objective To introduce summarily and discuss current controversial problems in terms of necessity and methods of preoperative biliary drainage for patients with malignant biliary obstruction diseases. Method The relevant domestic and international literatures in recent years were reviewed and summarized, and the basis, pros and cons, selectable ways, and current controversy of preoperative biliary drainage were analyzed. Results With development of the research, the view of preoperative biliary drainage also has been changed continuously. At the present time, the main arguments focus on the necessity, timing, biliary decompression way of preoperative biliary drainage and corresponding surgical opportunity after biliary drainage. Incorrect patient selection and undue pursuit of preoperative biliary drainage would be completely opposite to the treatment of malignant biliary obstruction. Conclusions It is generally recommended that preoperative biliary drainage in patients with malignant biliary obstruction diseases is not needed and surgery is performed directly. For patients who have indications of preoperative biliary drainage, it could make patients spend perioperative period smoothly if a reasonable way of biliary decompression is chosen. However, it is necessary to take some large sample retrospective analyses or prospective studies for exploring existing problems of preoperative biliary drainage in future.
Objective To analyze the prognosis and indications of transjugular intrahepatic portosystemic shunt (TIPS) in patients with Budd-Chiari syndrome (BCS). MethodsPatients with primary BCS who received TIPS in the Department of Gastroenterology, West China Hospital of Sichuan University between February 2009 and February 2020 were retrospectively reviewed. The medical history, preoperative imaging, surgical records, and postoperative outpatient follow-up medical records were recorded. The laboratory indexes before and after operation were compared, and the cumulative free from hepatic encephalopathy rate, stent patency rate, and cumulative survive rate were calculated. Cox proportional hazards model was used to analyze the independent risk factors of hepatic encephalopathy, shunt dysfunction and death. Results A total of 48 patients were included. The main indications for TIPS included variceal bleeding (16 cases), refractory ascites (24 cases), and diffuse obstruction of hepatic vein with acute liver function impairment (8 cases). The cumulative 1 year, 2 years and 3 years of free from hepatic encephalopathy rates were 92.3%, 89.2% and 85.3%, respectively. The stent patency rates were 89.7%, 72.2% and 54.8% at postoperative 1 year, 3 years and 5 years, respectively. The cumulative survival rates were 86.0%, 79.5% and 71.4% at postoperative 1 year, 3 years and 5 years, respectively. Conclusion TIPS can achieve good efficacy in patients with BCS, and most patients receive TIPS for portal hypertension complications rather than acute liver function impairment.
Objective To investigate the appropriate indication about removing abdominal drainage after pancreaticoduodenectomy. Method The clinical data of 156 patients who underwent pancreaticoduodenectomy in our hospital from January 2014 to June 2016 were analyzed retrospectively. The patients were divided into two groups, with 76 patients in the enhanced recovery after surgery (ERAS) group and 80 patients in the control group according to the type of indications about removing abdominal drainage. The time of removing abdominal drainage, hospital stay, incidence of postoperative complications, and readmission rate during 30 days after surgery were compared between the2 groups. Results Compared with the control group, the time of removing abdominal drainage 〔(6.2±2.5) dvs. (10.8±2.2) d,P<0.001〕and hospital stay〔(11.8±3.4) dvs. (15.7±3.6) d,P<0.001〕 of the ERAS group were both shorter, incidence of abdominal infection was lower〔1.3% (1/76)vs. 10.0% (8/80), P=0.020〕 , but there was no significant difference in the incidence of postoperative pancreatic fistula 〔18.4% (14/76) vs. 21.3% (17/80)〕 , delayed gastric emptying〔1.4% (1/76) vs. 7.5% (6/80)〕 , and the readmission rate during 30 days after surgery〔5.3% (4/76) vs. 3.8% (3/80)〕 , P>0.05. Conclusions Indications about removing abdominal drainage after pancreaticoduodenectomy by authors are safe.
Objective To investigate the knowledge level of Chinese cardiac surgeons regarding the management of infective endocarditis (IE), in order to identify the gap between clinical practices and the latest guidelines, and provide evidence-based support for improving the clinical management of IE. Methods A nationwide survey was conducted through an online questionnaire from December 5, 2024, to December 31, 2024. Descriptive analysis of the survey data was performed. Results A total of 67 valid responses were received from 18 provincial-level administrative divisions across China. While 56.7% (38/67) of respondents demonstrated familiarity with the modified Duke criteria, only 43.3% (29/67) comprehended the 2023 Duke- International Society of Cardiovascular Infectious Diseases criteria. Conversely, 43.3% (29/67) exhibited limited understanding of the former, and 56.7% (38/67) showed deficient knowledge of the latter diagnostic standards. Only 46.3% (31/67) reported proficiency in current IE management guidelines/consensus. Regarding surgical timing, 26.9% (18/67) advocated intervention within 7-14 days of antimicrobial therapy, 22.4% (15/67) during 14-28 days, and 10.5% (7/67) beyond 28 days. Notably, a significant proportion of respondents opted for delayed surgical intervention beyond guideline recommendations when managing patients with heart failure, uncontrolled infection, or neurological complications. Conclusion A knowledge gap and practice discrepancies exist among Chinese surgeons regarding the management of IE. There is an urgent need to promote updated concepts regarding surgical indications and timing for IE in order to optimize treatment strategies and improve patient prognosis.
This paper describes the advantages and disadvantages of radiofrequency ablation from the current situation of hepatocellular carcinoma treatment, radiofrequency ablation treatment, the efficacy of radiofrequency ablation in hepatocellular carcinoma, the shortcomings of radiofrequency ablation treatment, and the experience of the author’s treatment team. For the treatment of liver cancer, we should not blindly pursue minimally invasive and ignore the principle of radical resection, nor blindly pursue radical resection and ignore the risk of surgery. We should choose reasonable treatment methods, let the patient get the best treatment.
ObjectiveTo compare the ascending aortic diameter and postoperative outcomes of patients with simple ascending aortic dissection or simple ascending aortic dilatation and to study the reliability of the surgical indication in present guideline for Chinese patients with ascending aortic dilatation.MethodsThe clinical data of patients with aortic aneurysm and aortic dissection who underwent surgery at Beijing Anzhen Hospital, Capital Medical University from 2010 to 2017 were retrospectively reviewed. After exclusion of patients with Marfan syndrome, heart valve and other diseases, 139 patients were divided into two groups: a simple ascending aorta dilatation group (56 patients) and a simple ascending aortic dissection group (83 patients). The ascending aortic diameter and postoperative outcomes of two groups were compared. ResultsThe inner ascending aortic diameter (57.30±9.41 mm vs. 50.72±9.53 mm, P <0.001) and the inner ascending aortic diameter index (31.12±5.38 vs. 27.22±6.40, P<0.001) in the simple ascending aorta dilatation group were significantly greater than those in the simple ascending aortic dissection group. For male patients, the results were similar (60.28±10.80 mm vs. 47.40±6.53 mm; 30.00±6.33 vs. 23.60±3.72, both P<0.001). But for the female patients, there was no significant difference between the two groups (54.90±7.47 mm vs. 53.81±10.84 mm; 32.03±4.37 vs. 30.58±6.56, both P>0.05). The mortality, the incidence of tracheotomy and postoperative reopen rate in the simple ascending aortic dissection group were higher.ConclusionIn this study, the inner diameter of the ascending aorta in the group of ascending aorta is mostly < 5.5 cm. In our opinion, the present surgical indication for Chinese patients with ascending aortic dilatation is not enough. In the future clinical studies, we also need to find more reasonable surgical indications.
ObjectiveTo review the research progress of indication and treatment of graft in shoulder superior capsular reconstruction (SCR) for rotator cuff tear (RCT).MethodsThe literature related to shoulder SCR in recent years was extensively reviewed, and the anatomy, biomechanics, surgical indications, and treatment of graft in SCR were summarized.ResultsSuperior capsule plays a role as a functional complex with rotator cuff, ligament, and whole capsule. SCR can effectively restore the superior stability of the shoulder. The indications of SCR include the irreparable massive RCT, massive RCT combined with pseudoparalysis shoulder, medium/large RCT with severe degenerative rotator cuff tissue, and dual-layer RCT. In order to achieve a better healing of tendon-bone in graft and decrease the rate of long-term graft retearing, it is essential to select an appropriate thickness graft, fix the graft in right intensity, and get a better capsular continuity.ConclusionThe technique of SCR advanced to SCR for reinforcement and it is indicated from substantial massive RCT to severe degeneration of rotator cuff tissue. Graft treatment is the key step for a successful SCR.
Objective To discuss the surgical indication of mammotome （MMT） operation and its auxiliary diagnosis value on breast cysts. Methods Seventy-eight patients with breast cysts from May 2010 to November 2011 in this hospital were enrolled. Excision and biopsy were performed according to the following guidelines：Single cyst with inhomogeneous interna echoes and diameter at least 1 cm；Multiple cysts associated with irregular megalgia， localized thickening of breast or ineffective drug treatment after three months；High risk of breast cancer；Hypoechoic nodules and laticifers exaggerated cysts；Ultrasonography showed disorderly echo and abundant blood supply in glandular tissues around the lesions. The result of preoperative ultrasound was compared with that of postoperative pathology diagnosis. Results In these 78 breast cysts patients with preoperative ultrasound diagnosis， 40 cases were breast multiple cysts， 38 cases were multiple cysts plus untouchable hypoecho nodules；42 cases were high risk lesions， and the other 36 cases were low risk lesions. Postoperative pathology diagnosis revealed 27 cases of cystic hyperplasia， 2 cases of atypical hyperplasia， and 1 case of breast cancer in the ultrasonic high risk lesions， and 19 cases of cystic hyperplasia in the ultrasonic low risk lesions. Ultrasound diagnostic accuracy rate was 60.26%（47/78）， sensitivity was 61.22%（30/49）， and specificity was 58.62%（17/29）. The number of resection lesions was 13.00±8.16， the time of operation was （74.25±22.68） min. The average hospital stay was 1 d after surgery. The local hematoma occurred in 2 cases and no other complications occurred during one month of follow-up. Conclusions The guidelines of MMT protocoled according to clinical manifestation of breast cyst patients and imaging of high-frequency ultrasound in author’s department are simple and utility. Minimal excision and biopsy via MMT can confirm the histological type and help for early diagnosis of breast cancer and precancerous lesion. It is important and necessary to standardize the surgical indications of MMT in the clinical work.
ObjectiveTo summarize the procedures of the shoulder arthroplasty and the evolution of the shoulder prosthesis, and to discuss the indications and contraindications of the several common shoulder arthroplastis. MethodsThe related literature on shoulder arthroplasty was extensively reviewed, summarized, and analyzed. ResultsAt present, shoulder arthroplasties can be classified into shoulder hemiarthroplasty, total shoulder arthroplasty, resurfacing shoulder arthroplasty, stemless shoulder arthroplasty, and reserve shoulder arthroplasty, etc. Each type of the prosthesis has several special indications and contraindications. Mostly, the shoulder arthroplasties achieved the satisfied results, such as pain-relief and restoration of the elevation and adduction of shoulder. The survival rate of the most shoulder prostheses may reach 10 years or more. ConclusionMost shoulder arthroplasties are effective and satisfied to treat the shoulder traumas and diseases in pain-free and functional restoration of shoulders.
Mitral regurgitation (MR) is the most common type of valvular heart disease. Mitral valve repair/replacement can improve the prognosis of patients with severe MR, but a large proportion of patients cannot tolerate surgical procedures due to comorbidities and surgical risks. Transcatheter mitral valve replacement (TMVR) is a kind of treatment for mitral valve disease in which an artificial valve is delivered to the mitral valve annulus through a catheter and released into place, with the advantages of no thorax opening, less trauma and high safety. Early clinical studies of TMVR have shown good results, but still face many challenges. Strict indications are effective measures to reduce surgical risks and postoperative complications. This article explores the relevant indications of TMVR by analyzing several studies at home and abroad.