Objective To discuss the treatment of a patient with postoperative recurrence of hepatic epithelioid hemangioendothelioma by multidisciplinary team (MDT) model. MethodsThe MDT discussion and disease diagnosis and treatment process of one patient with recurrent hepatic epithelioid angioendothelioma admitted to Zhongnan Hospital of Wuhan University in April 2021 were summarized. Results The patient was admitted to the hospital for “more than one year after operation of hepatic epithelioid hemangioendothelioma”. Two years ago, the patient’s upper abdominal CT examination showed that there was a kind of round and slightly low-density nodule shadow in the left lateral lobe of the liver, which was about 30 mm×22 mm in size, and the boundary around the nodule was clear. There was a punctate high-density shadow in the S7 segment of the liver, which was not given special treatment and was reviewed regularly. One year later, the enhanced CT examination of the liver showed that the mass in the left lateral lobe of the liver was larger than before, and multiple nodules were seen in the right lobe of the liver. After admission, MRI examination showed multiple abnormal signal foci in the liver, so atypical hemangioma-like lesions (epithelioid hemangioendothelioma may be considered) were considered. Laparoscopic left lateral lobe resection + right liver lesion resection + radiofrequency ablation of liver lesion were performed in our department, and the patient recovered well after surgery. Four months after operation, MRI reexamined and found that intrahepatic metastasis might recur, so he was re-hospitalized, and after MDT discussion, it was decided to perform laparoscopic radiofrequency ablation of liver lesions (fluorescent laparoscopy) and laparoscopic partial liver resection (fluorescent laparoscopy) again. The patient recovered well after operation, and there was no recurrence after follow-up. Conclusion For patients with postoperative recurrence of hepatic epithelioid hemangioendothelioma, a comprehensive reoperation plan is made through MDT discussion, which may bring the best prognosis to patients.
ObjectiveTo investigate the long-term efficacy of intersphincter approach combined with virtual solid and hanging line in the treatment of posterior high complex anal fistulas and risk factors for recurrence. Methods A total of 167 patients with posterior high complex anal fistula treated in our hospital from April 2020 to June 2023 were retrospectively included. According to different treatment methods, the patients were divided into observation group (n=88) and control group (n=79). The observation group was treated with the combination of virtual solid and hanging line via intersphincter approach, while the control group was treated with cutting and wire hanging drainage. The general clinical data, the height of the internal fistula opening and the anorectal pressure before and after 1, 2 and 3 months were compared between the two groups. The patients were divided into recurrence group (n=50) and non-recurrence group (n=117) according to the recurrence situation during the follow-up period. Univariate and multivariate logistic regression were used to analyze the risk factors of postoperative anal fistula recurrence, and Kaplan-Meier method was ued to draw relapse-free curve. ResultsCompared with the control group, the observation group had longer operative time, shorter wound healing time and shorter hospital stay (P<0.05). At 1, 2 and 3 months after operation, the anal resting pressure and maximum anal retraction pressure in the observation group were significantly increased, while the height of the inner mouth was significantly decreased, with statistical significance (P<0.05). There were statistically significant differences in age, body mass index, gender, regular dressing change to hospital after discharge, history of anal fistula surgery, clarity of internal opening and treatment methods between the recurrence group and the non-recurrence group (P<0.05). The results of multivariate logistic regression analysis showed that the independent risk factors for postoperative recurrence of patients with posterior high complicated anal fistula were that they didn’t regularly go to the hospital for dressing change after discharge, had a history of anal fistula operation, had unclear internal orifice and underwent thread-drawing drainage (P<0.05). The cumulative relapse-free rate of patients in the observation group and the control group was 84.58% and 67.73% respectively, and the difference was statistically significant (P<0.05). ConclusionsThe treatment of posterior high complex anal fistulas by intersphincter approach combined with virtual solid and hanging line has a good effect in protecting anal function and promoting wound healing. After discharge, the factors affecting postoperative recurrence in patients with posterior high complex anal fistula are not regularly changed dressing, history of anal fistula surgery, unclear internal mouth, cutting and wire hanging drainage, which should be paid attention to.
ObjectiveTo explore the location and characteristics of postoperative recurrence of papillary thyroid carcinoma. MethodsThe clinical data of 96 patients who underwent reoperation for papillary thyroid cancer at the Affiliated Cancer Hospital of Zhengzhou University from January 2017 to March 2024 were retrospectively analyzed. ResultsOut of 96 patients, 3 had thyroid recurrence, 89 had lymph node recurrence, and 4 had thyroid and lymph node recurrence. There were 69 cases of single recurrence and 27 cases of multiple recurrence. Ten cases underwent lobectomy and lateral area cleaning, 8 cases underwent central area cleaning, 33 cases underwent lateral area cleaning, and 45 cases underwent central area+lateral area cleaning. Postoperative pathological examination revealed that there was lymph node metastasis in 93 cases (16 cases in the central region, 44 cases in the lateral region, and 33 cases in both the central and lateral regions), with 3 cases remaining non metastatic; 58 cases had extracapsular invasion of lymph nodes. Compared with patients with multiple relapses, patients with single recurrence had younger age (t=–3.385, P=0.001), lower incidence of gross extracapsular invasion of lymph nodes during surgery (χ2=6.970, P=0.008), higher number of metastatic lymph nodes (t=4.034, P=0.001), and higher rate of lymph node metastasis in zones Ⅱ, Ⅲ, and Ⅳ (χ2=8.142, P=0.004; χ2=6.357, P=0.012; χ2=12.547, P<0.001). ConclusionsPostoperative recurrence of papillary thyroid cancer is mainly due to lymph node recurrence. The advanced age and the visible lymph node extracapsular invasion may increased risk of postoperative recurrence of papillary thyroid cancer. Lymph node metastasis in the central region is a possible cause of multiple relapses and surgeries.
ObjectiveTo predict the risk factors affecting postoperative recurrence of granulomatous lobular mastitis (GLM) in the mass stage by machine learning algorithm, and to provide a reference for the early identification and prevention of postoperative recurrence of GLM in the mass stage. MethodsThe electronic medical records and follow-up data of patients with GLM in the Department of Breast Disease Unit, the First Affiliated Hospital of Henan University of Traditional Chinese Medicine from October 2020 to January 2023 were selected. A total of 340 patients with GLM in the mass stage who met the inclusion and exclusion criteria were selected as the research subjects. According to whether the patients relapsed after surgery, they were divided into recurrence group and non-recurrence group. The collected cases were randomly divided into training set and test set according to the ratio of 7:3. In the training set, the recurrence prediction model was constructed by using traditional logistic regression and three machine learning algorithms: artificial neural network, random forest and XGBoost (extrem gradient boosting). In the test set, the performance of the model was evaluated by sensitivity, specificity, accuracy,positive predictive value, negative predictive value, F1 value and area under the curve (AUC) value. The Shapley Additive exPlanation (SHAP) method was used to explore the important variables that affect the optimal model in identifying postoperative recurrence in the GLM mass phase. The optimal risk cutoff value of the prediction model was determined by the Youden index. Based on this, the postoperative patients in the GLM mass phase of the external test set were divided into high-risk and low-risk groups. ResultsA total of 392 patients who met the GLM mass stage were included, and 52 cases were excluded according to the exclusion criteria, and 340 cases were finally included, including 60 cases in the recurrence group and 280 cases in the non-recurrence group. Based on the results of univariate analysis, correlation analysis and clinically meaningful influencing factors, 12 non-zero coefficient characteristic variables were screened for the construction of the prediction model, and these 12 characteristic variables included other disease history, number of miscarriages, breastfeeding duration of the affected breast, history of milk stasis, lesion location, nipple indentation, fluctuation sensation, low-density lipoprotein, testosterone, previous antibiotic therapy, previous oral hormone medication, and perioperative traditional Chinese medicine treatment duration. The logistic regression prediction model, artificial neural network, random forest and XGBoost prediction models were constructed, and the results showed that the accuracy, positive predictive value and negative predictive value of the four prediction models were all >75%, among which the XGBoost model had the best performance, with accuracy, specificity, sensitivity, AUC, positive predictive value, negative predictive value and F1 values of 0.93, 0.99, 0.65, 0.87, 0.92, 0.93 and 0.76, respectively. SHAP method found that the duration of traditional Chinese medicine treatment during perioperative period, the duration of breast-feeding on the affected side, low density lipoprotein, testosterone and previous hormone drugs were the top five factors affecting XGBoost model to identify postoperative recurrence of GLM in mass stage. ConclusionsCompared with the traditional Logistic regression prediction model, the models based on machine learning for identifying postoperative recurrence in the GLM mass phase showed better performance, among which the XGBoost model performed best. Targeted preventive measures can be given based on the above risk factors to improve the postoperative prognosis of the GLM mass phase.