简介：AbstractThe contemporary embrace of endoscopic technology in the approach to the anterior skull base has altered the perioperative landscape for patients requiring pituitary surgery. Utility of a multi-disciplinary unit in management decisions facilitates the delivery of optimal care. Evolution of technology and surgical expertise in pituitary surgery mandates ongoing review of all components of the care central to these patients. The many areas of potential variability in the pre, intra and post-operative timeline of pituitary surgery are readily identifiable. Core undertakings and contemporary controversies in the peri-operative management of patients undergoing endoscopic transsphenoidal pituitary surgery are assessed against the available literature with a view to providing guidance for the best evidence-based practice.

简介：Objective:Todescribeseveralapproachesofearsurgeriesforexperimentalstudiesinrats.Methods:Anesthetizedratswerepreparedfordemonstrationofvariousearsurgeryapproachesdesignedtooptimizeexperimentaloutcomesinstudieswithspecificgoalsandexposurerequirements.Thesurgicalapproachesincludedtheposteriortympanum,superiortympanum,inferiortympanumandoccipitalapproaches.Results:Themiddleearcavityandinnerearweresuccessfullyexposedfromdifferentanglesviathementionedsurgicalapproaches.Forexample,electrodeplacementforrecordingofcochlearbioelectricresponseswaseasilyachievedthroughtheposteriortympanumorinferiortympanumapproach.Alternatively,drugdeliveryorgenetransfectionviaroundwindowmembranewasmosteasilyaccomplishedusingtheposteriortympanumapproach.Cochlearperfusionofprotectiveorototoxicdrugswasbestperformedusingtheinferiortympanumapproach.Ossicularchaininterruptiontoinduceaprolongedconductivehearinglosswasreadilyachievedusingasuperiortympanumapproach.Lastly,surgicaldestructionoftheendolymphaticsactoinduceexperimentalendolymphatichydropswasreadilyperformedviaanoccipitalsurgicalapproach.Conclusion:Thesestandardizedsurgicalapproachescanbeappliedinscientificstudiesoftheearwithdifferentpurposescoveringelectrophysiology,conductivehearingloss,intra-cochleardrugperfusionandexperimentalstudiesrelevanttoMeniere’sdisease.

简介：ObjectiveToreportexperienceswithuseofotoendoscopyincerebellopontineangle(CPA)surgeries.MethodsTwentyfivecasesofCPAsurgeriesperformedbetweenNovember2002andDecember2008inwhichmicroscopeenabledotoendoscopywasusedwerereviewed.The25casesincluded19casesofacousticneuroma,3casesofCPAfacialnervetumors,1caseoftrigeminalneurinoma,acaseofglossopharyngealneuralgiaand1caseofhemifacialspasm.Endoscopywasusedinallcasestogetherwithmonitoringofbrainstemauditoryresponsesandfacialelectromyography.Postoperativehearingandfacialnervefunctionwereevaluatedandcomparedtopre-operativelevels.ResultsEndoscopyprovidedimprovedvisualizationoflocalanatomy,revealedhiddenlesionsandreducedunnecessaryanatomicaldistortions.Totalresectionwasachievedin18ofthe19acousticneuromacases,Facialnerveanatomicalintegritywaspreservedinall19cases.OneweekpostoperativeHouse-BrackmanngradingwasIin3cases,Ⅱin10casesandⅢin6cases.Facialnervefunctioncontinuedtoimproveinsomecasesat3months.Totaltumorresectionwasachievedinall3patientswithfacialneurinoma.Thefacialnervewassacrificedin2ofthe3caseswithprimaryfaciohypoglossalnerveanastomosis.FacialnervefunctionwasGradeⅡandGradeIIIoneyearaftersurgery,respectively.Inthecasewithanatomicallypreservedfacialnerve,postoperativefacialnervefunctionwasinitiallyGradeⅢandimprovedtoⅡat3months.ThetumorwascompletelyresectedinthetrigeminalneurinomapatientwithaGradeⅢpostoperativefacialnervefunctionwhichimprovedGradeIIthreemonthslater.Seventeenofthe19patientswithacousticneuromaretainedhearingpostoperatively,ofthese12maintainedpreoperativelevelsofhearing.Preoperativehearingcapacitywaspreservedin2ofthe3patientswithfacialnervetumors,butlostinpatientswithothertumortypes.Glossopharyngealneurotomy(n=1)andmicrovasculardecompression(n=1)resultedinsatisfactorysymptomrelie

简介：AbstractBackground:The neoadjuvant chemotherapy is increasingly used in advanced gastric cancer, but the effects on safety and survival are still controversial. The objective of this meta-analysis was to compare the overall survival and short-term surgical outcomes between neoadjuvant chemotherapy followed by surgery (NACS) and surgery alone (SA) for locally advanced gastric cancer.Methods:Databases (PubMed, Embase, Web of Science, Cochrane Library, and Google Scholar) were explored for relative studies from January 2000 to January 2021. The quality of randomized controlled trials and cohort studies was evaluated using the modified Jadad scoring system and the Newcastle-Ottawa scale, respectively. The Review Manager software (version 5.3) was used to perform this meta-analysis. The overall survival was evaluated as the primary outcome, while perioperative indicators and post-operative complications were evaluated as the secondary outcomes.Results:Twenty studies, including 1420 NACS cases and 1942 SA cases, were enrolled. The results showed that there were no significant differences in overall survival (P = 0.240), harvested lymph nodes (P = 0.200), total complications (P = 0.080), and 30-day post-operative mortality (P = 0.490) between the NACS and SA groups. However, the NACS group was associated with a longer operation time (P < 0.0001), a higher R0 resection rate (P = 0.003), less reoperation (P = 0.030), and less anastomotic leakage (P = 0.007) compared with SA group.Conclusions:Compared with SA, NACS was considered safe and feasible for improved R0 resection rate as well as decreased reoperation and anastomotic leakage. While unbenefited overall survival indicated a less important effect of NACS on long-term oncological outcomes.

简介：ChinaJournalofOralandMaxillofacialSurgery(CJOMS)(ISSN1672-3244),foundedinNovember82002,isanofficialjournalofChineseSocietyofOralandMaxillofacialSurgery,beingdesignedtopresentthelatestbasicscientificandclinicalfindingsofOralandMaxillofacialSurgeryinChina.ItispublishedquarterlycurrentlybyEditorialBoardofChinaJournalofOralandMaxillofacialSurgery.

简介：ChinaJournalofOralandMaxillofacialSurgery(CJOMS)(ISSN1672-3244),foundedinNovember82002,isanofficialjournalofChineseSociety

简介：ChinaJournalofOralandMaxillofacialSurgery(CJOMS)(ISSN1672-3244),foundedinNovember82002,isanofficialjournalofChineseSocietyofOralandMaxillofacialSurgery,beingdesignedtopresentthelatestbasicscientificandclinicalfindingsofOralandMaxillofacialSurgeryinChina.ItispublishedquarterlycurrentlybyEditorialBoardofChinaJournalofOralandMaxillofacialSurgery.

简介：AbstractBackground and objective:Functional endoscopic sinus surgery (FESS) increases the nasal volume, and thereby it can alter the nasal resonance. The objectives were to measure the percentage of nasal resonance following FESS and compare it with healthy individuals with normal nasal findings.Methods:The nasometric analysis of voice was done using n/p/m consonant sounds in 72 individuals with healthy post FESS cavities (group 1) and 72 healthy individuals with normal nasal findings without any nasal pathology (group 2). The scores of nasal resonances were expressed in percentages and were compared between the two groups. Both in group 1 and group 2, 32 (44.4%) were females, and 40(55.6%) were males. In group 1, 51 participants had bilateral FESS cavities, and 21 had unilateral FESS cavities. Kannada was the mother tongue in 30 (41.7%) participants in group 1 and 36 (50.0%) in group 2. Malayalam was the mother tongue in 42(58.3%) participants in group 1 and 36 (50.0%) in group 2.Results:In both cases and control groups, more than 80% of the participants were showing less than 20% of nasal resonance. In group 1, the mean values of/n/p/m sounds were 11.23%, 10.23% and 11.42% respectively, and in group 2 the mean values were 8.27%, 8.58% and 8.58% respectively. But the P value was not statistically significant. Individuals with unilateral FESS cavities had more nasal resonance values compared to bilateral FESS cavities. Similarly, Kannada speaking people had more values compared to Malayam speaking individua.Conclusion:Changes in nasal resonance after FESS is minimal, and it is unnoticed. But it may affect the speech quality in professional voice users, depending on their language. Though the nasometer is considered as the most validated instrument to record nasal resonance, we feel that further standardization is needed to evaluate the nasalance.

简介：Single-portlaparoscopicsurgery(SPLS)isproposedtobeasteptowardsminimizingtheinvasivenessofsurgery,andhassincegainedpopularityinseveralsurgicalsub-specialtiesincludinghepatopancreatobiliarysurgery.SPLShassincebeenappliedtocholecystectomy,liverresectionaswellaspancreatectomyforamultitudeofpathologies.BenefitsofSPLSoverconventionalmulti-incisionlaparoscopicsurgeryincludeimprovedcosmesisandpotentiallypost-operativepainatspecifictimeperiodsandextra-umbilicalsites.However,itisalsoassociatedwithlongeroperatingtime,increasedrateofcomplications,andincreasedrateofport-sitehernia.Thereisnosignificantdifferencebetweenlengthofhospitalstay.SPLShasasignificantlearningcurvethataffectsoperatingtime,rateofconversionandrateofcomplications.Inthisarticle,wereviewtheliteratureonSPLSinhepatobiliarysurgery-cholecystectomy,hepatectomyandpancreatectomy,andoffertipsonovercomingpotentialtechnicalobstaclesandminimizingthecomplicationswhenperformingSPLS-surgeonposition,positionofportandinstruments,instrumentcrossingposition,standardhandgripvsreversehandgrip,snookercueguideposition,preventionofincisionalhernia.SPLSisapromisingdirectioninlaparoscopicsurgery,andwerecommendstep-wiseprogressionofapplicationsofSPLStovarioushepatopancreatobiliarysurgeriestoensuresafeadoptionofthesurgicaltechnique.

简介：Background:Themeasurementofthepistonlengthduringstapedotomyisimportantanditmayhavesignificanteffectsonthesurgicaloutcome.Objective:Todeterminethepistonlengthinagroupofotosclerosispatientswhounderwentprimarystapedotomy.Materialandmethods:BetweenSep2013andSep2014,85patientswithdiagnosedotosclerosisunderwentprimarystapedotomy.Teflonprosthesisof0.6mmofdiameterwasusedinallpatients.Thedistancebetweenmedialsurfaceofthelongprocessofincusandcenterpointofthestapedialfootplatemeasured.Thepistonlengthcalculatedbyadding0.25mmforthethicknessoffootplateand0.50mmforplacementoftheprosthesisintothevestibule.Results:Thedistancebetweenstapedialfootplateandincusrangedfrom3.50to4.50mm.Themeandistancewas3.95±0.16mm.Inmajorityofcases(74.1%)pistonlengthwas4.75mmfollowedby4.50mmin15.3%and5.00mmin5.9%.Pistonlengthwas4.25mmin3.5%and5.25mminonly1.2%ofpatients.Therewasnosignificantpost-operativecomplicationandairbonegapclosureobtainedinallpatients.Conclusion:Themostcommondistancebetweenfootplateandincusis4.00mm.Nocaseneededapistonlongerthan5.25mmorshorterthan4.25mm.

简介：由美国腹腔镜内镜外科医师协会（SLS）举办的“瓶美多学科峰会Ⅵ-腹腔镜与微创外科”将于2014年2月12～15日在美国夏威夷檀香山举行。会议涉及环太平洋亚太国家普通外科、妇科与泌尿外科腹腔镜和做创外科技术在多学科中诊断与治疗的最新进展。内容涉及最新的和标准的腹腔镜内镜没备，新技术、新概念以及如何提高对患者监护的标准，以及微创外科医师的培训和继续教育等。

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简介：Objective:Toanalyzeretrospectivelytheclinicalsymptoms,signs,radiologicalfindingsandresultsoftreatmentofposttraumaticsyringomyelia.Methods:Thedataof7patientswithposttranmaticsyringomyeliaconfirmedbycomputerizedtomography(CT)andmagneticresonanceimaging(MRI)inourhospitalbetween1999and2004werereviewedretrospectively.Thepatientsunderwentdecompressivelaminectomyorsyringo-subarachnoid(S-S)shuntingwithmicrosurgery.Long-termfollow-upwasavailable(range:13-65months).Results:Themajorclinicalmanifestationsofposttraumaticsyringomyefiausuallyincludedtheonsetofincreasingsignsandthedevelopmentofnewsymptomsafteranapparentlystableperiod.Theclinicalsymptomsincludedpain,sensorydisturbance,weakness,andproblemsinautonomicnerves.Syrinxexistedmerelyatthecervicallevelin4casesandextendeddownwardtothethoraciclevelsintheother3cases.Onecaseunderwentdecompressivelaminectomy,6casesweretreatedbyS-Sshunting.Duringtheearlypostoperativeperiod,allthepatientsshowedanimprovementofsymptomsofsyrinxwithoutmajorcomplicationordeath.ThedecreasedsizeorcollapseofthesyrinxwasdemonstratedbypostoperativeMRI.Conclusions:Posttraumaticsyringomyeliaisadisablingsequelaofspinalcordinjury,developingmonthstoyearsafterspinalinjury.MRIisthestandarddiagnostictechniqueforsyringomyelia.Thepatientswithposttraumaticsyringomyeliacombinedwithprogressiveneurologicaldeteriorationshouldbetreatedwithoperations.S-Sshuntingprocedureiseffectiveinsomepatientswithposttraumaticsyringomyelia.Decompressiveproceduremaybeanalternativeprimarysurgicaltreatmentforpatientswithkyphosisandcordcompression.

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简介：AbstractBackground:Postoperative chylous ascites is an infrequent condition after colorectal surgery and is easily treatable. However, its effect on the long-term oncological prognosis is not well established. This study aimed to investigate the short-term and long-term impact of chylous ascites treated with neoadjuvant therapy followed by rectal cancer surgery and to evaluate the incidence of chylous ascites after different surgical approaches.Methods:A total of 898 locally advanced rectal cancer patients treated with neoadjuvant chemoradiotherapy followed by surgery between January 2010 and December 2018 were included. The clinicopathological data and outcomes of the patients with chylous ascites were compared with those of the patients without chylous ascites. The primary endpoint was recurrence-free survival (RFS). To balance baseline confounders between groups, propensity score matching (PSM) was performed for each patient with a logistic regression model.Results:Chylous ascites was detected in 3.8% (34/898) of the patients. The incidence of chylous ascites was highest after robotic surgery (6.9%, 6/86), followed by laparoscopic surgery (4.2%, 26/618) and open surgery (1.0%, 2/192, P = 0.021). The patients with chylous ascites had a significantly higher number of lymph nodes harvested (15.6 vs. 12.8, P = 0.009) and a 3-day longer postoperative hospital stay (P = 0.017). The 5-year RFS rate was 64.5% in the chylous ascites group, which was significantly lower than the rate in the no chylous ascites group (79.9%; P = 0.007). The results remained unchanged after PSM was performed. The chylous ascites group showed a nonsignificant trend towards a higher peritoneal metastasis risk (5.9% vs. 1.6%, P = 0.120). Univariate analysis and multivariate analysis confirmed chylous ascites (hazard ratio= 3.038, P < 0.001) as an independent negative prognostic factor for RFS.Conclusions:Considering the higher incidence of chylous ascites after laparoscopic and robotic surgery and its adverse prognosis, we recommend sufficient coagulation of the lymphatic tissue near the vessel origins, especially during minimally invasive surgery.

简介：AbstractBackground:Although breast-conserving surgery is one of the standard treatments for breast cancer, few studies have assessed its recent implementation in China. We aimed to clarify the current real-world status of breast-conserving surgery in China.Methods:This cross-sectional survey relied on data collected by the Chinese Society of Breast Surgery (CSBrS) to examine patients who underwent this surgery between January 2018 and December 2018. The survey was conducted using a uniform electronic questionnaire to collect information, including clinical and pathological data on these patients.Results:Overall, 4459 breast-conserving surgeries were performed in 34 member units of CSBrS, accounting for 14.6% of all breast cancer surgeries performed in these units during the study period. In patients who underwent breast-conserving surgery with information on tumor size available, more than half (61.2%) of the tumors were smaller than 2 cm in diameter, and only 87 (3.2%) tumors were larger than 4 cm in diameter. Among patients who underwent breast-conserving surgeries, 457 (10.2%) patients received neoadjuvant therapy before the surgery. Among patients with a reported margin width, 34 (2.0%) patients had a margin of ≤2 mm, and 1530 (88.2%) of them had a margin of >5 mm.Conclusions:This study demonstrated the rates of breast-conserving surgery in member units of the CSBrS, and introduced the characteristics and surgical margins of patients who underwent this surgery. This information helps describe the real-world status of breast-conserving surgery in China.Trial registration:chictr.org.cn, ChiCTR1900026841; http://www.chictr.org.cn/showproj.aspx?proj=42783