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Muscular tissue desaturation and pneumonia in patients receiving lung cancer surgery:a cohort study

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Chinese Medical Journal 2023年第1期136卷 65-72页

作者： Wei Zhao Caijuan Zhang Dongliang Mu Fan Cui Huiqun Jia Department of Anesthesiology The Fourth Hospital of Hebei Medical UniversityShijiazhuangHebei 050000China Department of Anesthesiology Peking University First HospitalBeijing 100034China Department of Anesthesiology Tangshan Gongren HospitalTangshanHebei 063000China

Background:post-operative pneumonia(POP)is a common complication of lung cancer surgery,and muscular tissue oxygenation is a root cause of post-operative complications.However,the association between muscular tissue desaturation and POP in patients receiving lung cancer surgery has not been specifically studied.This study aimed to investigate the potential use of intra-operative muscular tissue desaturation as a predictor of POP in patients undergoing lung cancer surgery.Methods:This cohort study enrolled patients(≥55 years)who had undergone lobectomy with one-lung ventilation.Muscular tissue oxygen saturation(SmtO_(2))was monitored in the forearm(over the brachioradialis muscle)and upper thigh(over the quadriceps)using a tissue oximeter.The minimum SmtO_(2)was the lowest intra-operative measurement at any time point.Muscular tissue desaturation was defined as a minimum baseline SmtO_(2)of15 s.The area under or above the threshold was the product of the magnitude and time of desaturation.The primary outcome was the association between intra-operative muscular tissue desaturation and POP within seven post-operative days using multivariable logistic regression.The secondary outcome was the correlation between SmtO_(2)in the forearm and that in the thigh.Results:We enrolled 174 patients.The overall incidence of muscular desaturation(defined as SmtO_(2)<80%in the forearm at baseline)was approximately 47.1%(82/174).The patients with muscular desaturation had a higher incidence of pneumonia than those without desaturation(28.0%[23/82]vs.12.0%[11/92];P=0.008).The multivariable analysis revealed that muscular desaturation was associated with an increased risk of pneumonia(odds ratio:2.995,95%confidence interval:1.080-8.310,P=0.035)after adjusting for age,American Society of Anesthesiologists status,Assess Respiratory Risk in Surgical Patients in Catalonia score,smoking,use of peripheral nerve block,propofol,and study center.Conclusion:Muscular tissue desaturation,defined as a baseline SmtO_(2)<80%in the forearm,m

关键词： Association Lung neoplasms Muscular tissue oxygenation One-lung ventilation post-operative complications Pneumonia Propofol Oxygen saturation

Laparoscopic appendectomy,stump closure and endoloops:A meta-analysis

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World Journal of Gastrointestinal Surgery 2022年第9期14卷 1060-1071页

作者： Noemi Zorzetti Augusto Lauro Maria Irene Bellini Samuele Vaccari Barbara Dalla Via Maurizio Cervellera Roberto Cirocchi Salvatore Sorrenti Vito D’Andrea Valeria Tonini Department of General Surgery Ospedale Civile A CostaPorretta Terme 40046Italy Department of Surgical Sciences Sapienza UniversityRome 00161Italy Department of General Surgery Ospedale di BentivoglioBologna 40010Italy Department of Emergency Surgery St Orsola University HospitalBologna 40138Italy Department of General Surgery Ospedale Santissima AnnunziataTaranto 74121Italy Department of General Surgery Ospedale di TerniUniversitàdi PerugiaTerni 05100Italy

BACKGROUND Acute appendicitis(AA)is one of the main indications for urgent surgery.Laparoscopic appendectomy(LA)has shown advantages in terms of clinical results and cost-effectiveness,even if there is still controversy about different devices to utilize,especially with regards to the endoloop(EL)vs endostapler(ES)when it comes to stump closure.AIM To compare safety and cost-effectiveness of EL vs ES.METHODS From a prospectively maintained database,data of 996 consecutive patients treated by LA with a 3 years-follow up in the department of Emergency General Surgery-St Orsola University Hospital,Bologna(Italy)were retrieved.A metaanalysis was performed in terms of surgical complications,in comparison to the international literature published from 1995 to 2021.RESULTS The meta-analysis showed no evidence regarding wound infections,abdominal abscesses,and total post-operative complications,in terms of superiority of a surgical technique for the stump closure in LA.CONCLUSION Even when AA is complicated,the routine use of EL is safe in most patients.

关键词： Acute appendicitis Laparoscopic appendectomy Endoloops Stapler post-operative complications

Which octogenarian patients are at higher risk after cholecystectomy for symptomatic gallstone disease? A single center cohort study

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World Journal of Clinical Cases 2022年第24期10卷 8556-8567页

作者： Fabrizio D'Acapito Leonardo Solaini Daniela Di Pietrantonio Francesca Tauceri Maria Teresa Mirarchi ElenaAntelmi Francesca Flamini Alessio Amato Massimo Framarini Giorgio Ercolani Department of General and Oncologic Surgery Morgagni-Pierantoni HospitalAUSL RomagnaForlì47121Italy Department of Medical and Surgical Sciences University of BolognaBologna 40126Italy

BACKGROUND Incidence of gallstones in those aged≥80 years is as high as 38%-53%.The decision-making process to select those oldest old patients who could benefit from cholecystectomy is challenging.AIM To assess the risk of morbidity of the“oldest-old”patients treated with cholecystectomy in order to provide useful data that could help surgeons in the decision-making process leading to surgery in this population.METHODS A retrospective study was conducted between 2010 and 2019.Perioperative variables were collected and compared between patients who had postoperative complications.A model was created and tested to predict severe postoperative morbidity.RESULTS The 269 patients were included in the study(193 complicated).The 9.7%of complications were grade 3 or 4 according to the Clavien-Dindo classification.Bilirubin levels were lower in patients who did not have any postoperative complications.American Society of Anesthesiologists scale 4 patients,performing a choledocholithotomy and bilirubin levels were associated with Clavien-Dindo>2 complications(Ppostoperative course.Alternative endoscopic or percutaneous treatments should be considered in this subgroup of octogenarians.

关键词： Cholecystitis Gallstones Choledocholithotomy Elderly post-operative complications

Pattern of Presentation of Iatrogenic Biliary Injury Following Laparoscopic Cholecystectomy

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Open Journal of Clinical Diagnostics 2022年第4期12卷 55-62页

作者： Fahmid-Uz-Zaman Mohammad Aminul Islam Md. Saba Al Galib Md. Mashkurul Alam Md. Shamsuddoha Khan Muhammad Tanvir Alam Akhanda Sania Hossain Laila Siddika Mohammad Emrul Hasan Khan Abul Bashar Md. Jamal Department of Surgery Dhaka Medical College Hospital Dhaka Bangladesh Department of Surgery Shaheed M. Monsur Ali Medical College Hospital Shirajgonj Bangladesh Department of Pediatric Surgery Dhaka Medical College Hospital Dhaka Bangladesh Department of Surgery Shaheed Suhrawardy Medical College Hospital Dhaka Bangladesh National Institute of Cancer Research and Hospital Dhaka Bangladesh Department of Laboratory Medicine Sheikh Russel National Gastroliver Institute and Hospital Dhaka Bangladesh Mugda Medical College and Hospital Dhaka Bangladesh

Background: Cholecystectomy is one of the most now common abdominal surgeries performed every day. The incidence of bile duct injury (BDI) following open cholecystectomy is only 0.1% - 0.2%. After the introduction of laparoscopic cholecystectomy, the incidence has gone up to 0.4% - 0.7%. The present study is a prospective analysis of all patients with bile duct injury who were admitted to Dhaka Medical College Hospital during or at a variable period following cholecystectomy. Methods: To determine the pattern of presentation of iatrogenic biliary injury following cholecystectomy in the department of surgery of Dhaka Medical College Hospital, a total of 30 patients were purposively selected from May 2018 to November 2018. Patient particulars, records of physical and clinical evaluation, and operative details were collected by individual researchers. Data analysis was done by SPSS for windows version 21. Results: BDI was found very common among the age group 21 - 30 yrs (36%) and female dominant (60%). Majority of the patients presented with abdominal pain (96%), intra-abdominal collection (88%), biliary peritonitis (68%), cholangitis (60%), and obstructive jaundice (40%), and biliary fistula (40%). Laparoscopic cholecystectomy (84%) was the principal cause of biliary injury in our study. 48% of patients experienced clinical features within 7 days post-cholecystectomy. Per-operative diagnosis was done in only 12% of cases. 44% of patients in this study were recognized as Bismuth grade-3, followed by 36%, grade-2 patients. Management outcomes included wound infection (41.66%), minor bile leak (25%), peritonitis (8.33%), and renal impairment (8.33%). Conclusion: The effect of BDI is an extremely distressful clinical condition for the patients and their family members, hence proper care and management protocol should be followed.

关键词： Bile Duct Injury Laparoscopic Cholecystectomy post-operative complications Bangladesh

术前全胃肠外营养可改善行主要腹部手术的克罗恩病患者的手术疗效

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Gastroenterology Report 2019年第2期7卷 107-114,I0002页

作者： Fares Ayoub Amir Y.Kamel Ahmed Ouni Naueen Chaudhry Yan Ader Sanda Tan Atif Iqbal Ellen M.Zimmermann Sarah C.Glover Department of Medicine University of FloridaGainesvilleFLUSA Department of Pharmacy University of FloridaGainesvilleFLUSA Division of Gastroenterology Hepatology&NutritionDepartment of MedicineUniversity of FloridaGainesvilleFLUSA Department of Surgery University of FloridaGainesvilleFLUSA

背景:尽管克罗恩病(CD)的药物治疗取得了重大进展,但仍有相当一部分患者在诊断后5年内需要接受外科手术治疗。营养不良是胃肠手术疗效欠佳的独立危险因素。术前全胃肠外营养(TPN)在CD患者中的应用价值,各项研究数据并不一致,而且缺少生... 详细信息

背景:尽管克罗恩病(CD)的药物治疗取得了重大进展,但仍有相当一部分患者在诊断后5年内需要接受外科手术治疗。营养不良是胃肠手术疗效欠佳的独立危险因素。术前全胃肠外营养(TPN)在CD患者中的应用价值,各项研究数据并不一致,而且缺少生物治疗时代的相关研究数据。本研究旨在明确TPN在CD手术患者中的应用价值。方法:这是一项在一家三级转诊中心完成的回顾性队例研究。纳入接受主要腹部手术的CD患者,按术前有无接受TPN治疗分为TPN组与非TPN组。比较两组患者术后30天感染性与非感染性并发症发生率。结果:纳入2007年3月至2017年3月间行主要腹部手术的144例CD患者,其中55例接受术前TPN治疗,非TPN组89例。21例(14.6%)患者术后出现感染性并发症,其中TPN组与非TPN组发生率分别为18.2%和12.3%(P=0.34);23例(15.9%)术后发生非感染性并发症,其中TPN组与非TPN组发生率分别为14.5%和16.9%(P=0.71)。采用多因素分析校正两组间基线疾病严重度和营养不良程度的差异后,术前TPN治疗≥60天的患者,其术后发生非感染性并发症的风险显著降低(OR=0.07,95%CI:0.01-0.80,P=0.03)。近6个月内体重下降>10%则是术后并发症的危险因素。结论:对于营养不良的CD患者,TPN是安全的,而且可以使其获得与营养正常CD患者相当的手术疗效。术前行≥60天TPN治疗可减少术后非感染性并发症的发生,而且并不会增加感染性并发症的发生概率。

关键词： Crohn’s disease total parenteral nutrition pre-operative malnutrition post-operative complications

克罗恩病患者回结肠切除一期吻合手术的围手术期处理和术后近期并发症:对PRACTICROHN研究的数据分析

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Gastroenterology Report 2019年第3期7卷 168-175,I0001,I0002页

作者： Ana Gutierrez Montserrat Rivero Maria Dolores Martin-Arranz Valle Garcia Sanchez Manuel Castro Jesus Barrio Ruth de Francisco Manuel Barreiro-de Acosta Berta Julia Luis Cea-Calvo Cristina Romero Natalia Borruel Sainz Eugeni Domenech Gastroenterology Department General University Hospital of Alicante and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas(CIBERehd)CarlosⅢHealth InstituteMadridSpain Gastroenterology Department Marques de Valdecilla General University HospitalSantanderSpain Gastroenterology Department La Paz General University HospitalInstituto de Investigacion Biomedica La Paz(IdiPaz)MadridSpain Clinical Management of Gastrointestinal Tract Diseases Unit Reina Sofia University HospitalMaimonides Institute of Biomedical Research of Cordoba(IMIBIC)Cordoba UniversityCordobaSpain Gastroenterology Department Valme University HospitalSevillaSpain Gastroenterology Department University HospitalRio HortegaValladolidSpain Gastroenterology Department University Hospital Central de AsturiasOviedoSpain Gastroenterology Department Inflammatory Bowel Disease UnitUniversity Hospital Complex of Santiago de CompostelaSantiago de CompostelaSpain Medical Department Merck Sharp and DohmeMadridSpain Crohn-Colitis Care Unit(UACC) Digestive Tract ServiceHospital Universitari Vall d’HebronBarcelonaSpain Gastroenterology Department Germans Trias i Pujol University Hospital and CIBERehdBadalonaSpain

背景:本研究旨在分析克罗恩病患者回结肠切除术后近期并发症的发生率及危险因素。方法:对PRACTICROHN研究队列进行回顾性分析,纳入2007年1月至2010年12月间行回结肠切除一期吻合的成人克罗恩病患者。术后近期并发症定义为术后30天内出... 详细信息

背景:本研究旨在分析克罗恩病患者回结肠切除术后近期并发症的发生率及危险因素。方法:对PRACTICROHN研究队列进行回顾性分析,纳入2007年1月至2010年12月间行回结肠切除一期吻合的成人克罗恩病患者。术后近期并发症定义为术后30天内出现的并发症,包括死亡、肠梗阻、吻合口漏、消化道出血、腹腔脓肿、切口感染、导管相关感染及其他腹腔外感染。结果:364例患者纳入分析,手术时患者的中位年龄38岁,男性占50%。手术适应证:狭窄型占46.4%,穿透型占31.3%,狭窄+穿透型占14.0%,药物难治性占5.8%。100例(27.5%)出现术后近期并发症,其中切口感染、腹腔脓肿和吻合口漏最为常见。出现并发症的患者其中位住院时间较未出现并发症者显著延长(16 vs 9天,P<0.001)。术后并发症更多发生于穿透型病变(36/114,31.6%)和药物难治性(9/21,42.9%)患者,而狭窄型(45/169,26.6%)和狭窄+穿透型(6/51,11.8%)患者并发症发生率相对较低(P=0.040)。术中才作出诊断的患者,术后并发症发生率较术前已明确诊断者显著升高[48.4%(15/31)vs.25.7%(85/331),P=0.013)。手术期间接受药物治疗并不会影响并发症发生率。结论:约四分之一的克罗恩病患者行回结肠切除术后会出现近期并发症,其中穿透型病变和急诊手术患者术后并发症风险增高。

关键词： Ileocolonic resection Crohn’s disease post-operative complications risk factors