open surgery

开放手术
  • 文章类型: Case Reports
    下腔静脉滤器通常使用血管内手术取回。然而,在出现与过滤器相关的并发症或血管内修复变得具有挑战性的情况下,可以考虑开放手术。
    一名65岁的女性因进行性静脉血栓栓塞(VTE)接受了下腔静脉滤器置入手术。两个月后,在外部医院进行了一次失败的血管内取回尝试,她经历了腹痛,并被转移到我们的设施进行进一步治疗。检查显示,她遇到了并发症,下腔静脉过滤器在植入后同时穿透了腔静脉和十二指肠。但幸运的是,患者的血液检查结果在正常范围内。最终,我们的机构通过开放手术成功移除过滤器,患者出院,没有任何并发症。
    这种情况下,随着我们的文献综述,说明了通过开放手术去除十二指肠穿透过滤器的可行性和安全性,为患者带来有利的结果和有希望的预后。
    UNASSIGNED: Inferior vena cava filters are typically retrieved using endovascular procedures. However, in cases where complications related to the filter arise or when endovascular retrieval becomes challenging, open surgery could be considered.
    UNASSIGNED: A 65-year-old woman underwent inferior vena cava filter placement surgery for progressive venous thrombosis embolism (VTE). Following an unsuccessful endovascular retrieval attempt at an external hospital two months later, she experienced abdominal pain and was transferred to our facility for further treatment. Examination revealed that she was encountered a complication where the inferior vena cava filter penetrated both the vena cava and the duodenum post-implantation. But fortunately, the patient\'s blood test results were within normal range. Ultimately, our institution successfully removed the filter through open surgery and the patient was discharged without any complications.
    UNASSIGNED: This case, along with our literature review, illustrates the viability and safety of duodenal-penetrated filter removal via open surgery, resulting in favorable outcomes and a promising prognosis for the patient.
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  • 文章类型: Comparative Study
    背景:腹腔镜手术已得到结肠癌临床指南的认可,但不适用于直肠癌,原因是未经批准的肿瘤学与开放手术相当。
    目的:我们开始了这项迄今为止最大的荟萃分析,以全面评估腹腔镜与开腹手术相比在直肠癌治疗中的安全性和有效性。
    方法:在PubMed中搜索了1990年1月至2020年3月之间比较腹腔镜直肠切除术和开腹手术的随机和非随机对照试验,Cochrane图书馆和Embase数据库(PROSPERO注册号CRD42020211718)。术中的数据,病态,比较两组患者术后和生存结果.
    结果:20个RCT和93个NRCT,包括216,615名患者符合纳入标准,其中48,888例患者接受腹腔镜手术,167,727例患者接受开腹手术.与开放手术相比,腹腔镜手术组恢复较快,30天内并发症少,死亡率降低。腹腔镜手术组环周切缘(RR=0.79,95%CI:0.72~0.85,p<0.0001)和远切缘(RR=0.75,95%CI:0.66~0.85p<0.0001)阳性率显著降低,但全直肠系膜切除的完整性无显著差异。3年和5年局部复发,腹腔镜手术组的无病生存率和总生存率均有所提高,而两种方法之间的远端复发没有显着差异。
    结论:在肿瘤学结果和长期生存率方面,腹腔镜检查在直肠癌治疗中不劣于开腹手术。此外,腹腔镜手术提供了短期优势,包括更快的恢复和更少的并发症。
    BACKGROUND: Laparoscopic surgery has been endorsed by clinical guidelines for colon cancer, but not for rectal cancer on account of unapproved oncologic equivalence with open surgery.
    OBJECTIVE: We started this largest-to-date meta-analysis to comprehensively evaluate the safety and efficacy of laparoscopy in the treatment of rectal cancer compared with open surgery.
    METHODS: Both randomized and nonrandomized controlled trials comparing laparoscopic proctectomy and open surgery between January 1990 and March 2020 were searched in PubMed, Cochrane Library and Embase Databases (PROSPERO registration number CRD42020211718). The data of intraoperative, pathological, postoperative and survival outcomes were compared between two groups.
    RESULTS: Twenty RCTs and 93 NRCTs including 216,615 patients fulfilled the inclusion criteria, with 48,888 patients received laparoscopic surgery and 167,727 patients underwent open surgery. Compared with open surgery, laparoscopic surgery group showed faster recovery, less complications and decreased mortality within 30 days. The positive rate of circumferential margin (RR = 0.79, 95% CI: 0.72 to 0.85, p < 0.0001) and distal margin (RR = 0.75, 95% CI: 0.66 to 0.85 p < 0.0001) was significantly reduced in the laparoscopic surgery group, but the completeness of total mesorectal excision showed no significant difference. The 3-year and 5-year local recurrence, disease-free survival and overall survival were all improved in the laparoscopic surgery group, while the distal recurrence did not differ significantly between the two approaches.
    CONCLUSIONS: Laparoscopy is non-inferior to open surgery for rectal cancer with respect to oncological outcomes and long-term survival. Moreover, laparoscopic surgery provides short-term advantages, including faster recovery and less complications.
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  • 文章类型: Systematic Review
    已经发表了一些比较开放(ORC)和机器人辅助根治性膀胱切除术(RARC)的随机对照试验(RCT)。然而,关于这个问题的不确定性仍然存在,由于仍然缺乏关于RARC的证据和建议。在这篇系统综述和荟萃分析中,我们总结了这方面的证据.根据PRISMA标准进行了文献检索,使用PubMed/Medline,WebofScience和Embase,到2024年3月。仅选择随机对照试验(RCTs)。主要终点是调查手术后3个月和6个月的健康相关生活质量(QoL)。次要终点包括病理和围手术期结果,术后并发症和肿瘤预后。此外,我们根据现有证据进行了成本评估。包括八个RCT,涵盖1024名患者(515RARC和509ORC)。两组在3个月和6个月后的QoL相似。在30天(分别为p=0.11和p>0.9)和90天(分别为p=0.28和p=0.57)的总体和主要并发症没有显着差异,以及肿瘤学,病理和围手术期结果,除手术时间外,在RARC中更长(MD92.34分钟,95%CI83.83-100.84,p<0.001)和输血率,RARC较低(OR0.43,95%CI0.30-0.61,p<0.001)。ORC和RARC都是膀胱癌的可行选择,具有可比的并发症发生率和肿瘤结局。RARC提供输血率优势,然而,它有更长的手术时间和更高的成本。两组的QoL结果相似,三个月和六个月后。
    Several randomized control trials (RCTs) have been published comparing open (ORC) with robot-assisted radical cystectomy (RARC). However, uncertainty persists regarding this issue, as evidences and recommendations on RARC are still lacking. In this systematic review and metaanalysis, we summarized evidence in this context. A literature search was conducted according to PRISMA criteria, using PubMed/Medline, Web Of Science and Embase, up to March 2024. Only randomized controlled trials (RCTs) were selected. The primary endpoint was to investigate health-related quality of life (QoL) both at 3 and 6 months after surgery. Secondary endpoints include pathological and perioperative outcomes, postoperative complications and oncological outcomes. Furthermore, we conducted a cost evaluation based on the available evidence. Eight RCTs were included, encompassing 1024 patients (515 RARC versus 509 ORC). QoL appeared similar among the two groups both after 3 and 6 months. No significant differences in overall and major complications at 30 days (p = 0.11 and p > 0.9, respectively) and 90 days (p = 0.28 and p = 0.57, respectively) were observed, as well as in oncological, pathological and perioperative outcomes, excepting from operative time, which was longer in RARC (MD 92.34 min, 95% CI 83.83-100.84, p < 0.001) and transfusion rate, which was lower in RARC (OR 0.43, 95% CI 0.30-0.61, p < 0.001). Both ORC and RARC are viable options for bladder cancer, having comparable complication rates and oncological outcomes. RARC provides transfusion rate advantages, however, it has longer operative time and higher costs. QoL outcomes appear similar between the two groups, both after 3 and 6 months.
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  • 文章类型: Journal Article
    对腹腔镜胆囊癌(GBC)根治术的安全性的担忧仍然存在。这项系统评价和荟萃分析试图比较腹腔镜手术(LS)与开腹手术(OS)治疗GBC的安全性和有效性。
    PubMed,EMBASE,和WebofScience从成立到2022年7月18日进行了搜索。文献检索,质量评估,和数据提取独立完成,一式两份。在随机效应模型下得出以加权平均差(WMD)或比值比(OR)表示的效应大小估计值,置信区间为95%(CI)。
    对包括2,868名参与者在内的27项独立研究进行了荟萃分析。术中失血量有显著性意义(WMD:-117.194,95%CI:-170.188至64.201,P<0.001),收集的淋巴结(WMD:-1.023,95%CI:-1.776至-0.269,P=0.008),术后住院时间(WMD:-3.555,95%CI:-4.509至-2.601,P<0.001),术后发病率(OR:0.596,95%CI:0.407~0.871,P=0.008),2年总生存率(OR:1.524,95%CI:1.143至2.031,P=0.004),T2生存率在1年(OR:1.799,95%CI:1.777至2.749,P<0.01)和2年(OR:2.026,95%CI:1.392至2.949,P<0.001),以及1年(OR:2.669,95%CI:1.564至4.555,P<0.001)和2年(OR:2.300,95%CI:1.308至4.046,P=0.004)的T3生存率。亚组分析显示,种族,附带GBC,样本量,和随访期是异质性的可能来源。除术后发病率外,所有结局的发表偏倚概率较低。
    我们的研究结果表明,从统计学上讲,LS具有更好的2年生存率,术中出血少,住院时间缩短,并发症发生率低于OS。然而,由于附带GBC的影响,LS的优越性甚至安全性仍然是一个悬而未决的问题,下落不明的异质性,出版偏见,淋巴结清扫术,和端口部位转移。
    UNASSIGNED: Concerns over the security of laparoscopic radical operation for gallbladder cancer (GBC) persist. This systematic review and meta-analysis attempted to compare the safety and efficacy of laparoscopic surgery (LS) versus open surgery (OS) in the treatment of GBC.
    UNASSIGNED: The PubMed, EMBASE, and Web of Science were searched from inception to July 18, 2022. Literature search, quality assessment, and data extraction were completed independently and in duplicate. Effect-size estimates expressed as weighted mean difference (WMD) or odds ratio (OR) with 95% confidence interval (CI) were derived under the random-effects model.
    UNASSIGNED: A total of 27 independent studies including 2,868 participants were meta-analyzed. Significance was noted for intraoperative blood loss (WMD: -117.194, 95% CI: -170.188 to 64.201, P<0.001), harvested lymph nodes (WMD: -1.023, 95% CI: -1.776 to -0.269, P=0.008), postoperative hospital stay (WMD: -3.555, 95% CI: -4.509 to -2.601, P<0.001), postoperative morbidity (OR: 0.596, 95% CI: 0.407 to 0.871, P=0.008), overall survival rate at 2-year (OR: 1.524, 95% CI: 1.143 to 2.031, P=0.004), T2 survival at 1-year (OR: 1.799, 95% CI: 1.777 to 2.749, P<0.01) and 2-year (OR: 2.026, 95% CI: 1.392 to 2.949, P<0.001), as well as T3 survival at 1-year (OR: 2.669, 95% CI: 1.564 to 4.555, P<0.001) and 2-year (OR: 2.300, 95% CI: 1.308 to 4.046, P=0.004). Subgroup analyses revealed that ethnicity, incidental GBC, sample size, and follow-up period were possible sources of heterogeneity. There was a low probability of publication bias for all outcomes except postoperative morbidity.
    UNASSIGNED: Our findings indicated that LS statistically had better 2-year survival rates, less intraoperative bleeding, shorter hospitalization times, and lower rates of complications than OS. However, the superiority and even the safety of LS still remain an open question due to the impact of incidental GBC, unaccounted heterogeneity, publication bias, lymph node dissection, and port-site metastasis.
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  • 文章类型: Journal Article
    包虫病是由棘球蚴虫引起的,是一种人畜共患病,在某些地理区域流行,在畜牧业中患病率很高。由于全球化,病理也可以在这些优选的地理区域之外遇到。它主要影响肝脏和肺,包虫囊肿的胰腺定位很少见,对鉴别诊断和手术策略构成了挑战。本研究旨在提供有关这种本地化的文献的最新范围,分析人口统计数据,治疗管理,和术后结果。据观察,女性更频繁地受到胰腺包虫定位的影响(p<0.001),最常见的症状表现为腹痛。首选定位在胰尾水平(32.5%),其次是头部定位(25%)。首选的手术方式是开放手术,在特定的位置观察到对开放手术的偏好,比如头,地峡,和胰体(p<0.001)。激进手术比保守手术更常用(52.5%vs.47.5%),矛盾的是,虽然侵入性较小,灭活和引流等手术与更常见的并发症相关(p=0.03).这种类型的本地化,由于局部解剖地形的因素,在胆胰脏手术中需要充足的准备,考虑到有时术前诊断没有针对性,术中记录可能需要广泛的干预措施。我们的研究包括使用PubMed和GoogleScholar数据库对过去十年的文献进行全面回顾,特别关注涉及胰腺内发现的原发性包虫囊肿的病例。2014年至2024年期间发表了33篇相关文章。此外,我们提出了一个独特的案例研究,说明这种罕见的发生。
    Hydatid disease is caused by the Echinococcus tapeworm and is a zoonosis that endemically affects certain geographic areas with a high prevalence in animal husbandry. Due to globalization, the pathology can also be encountered beyond these preferred geographic areas. It predominantly affects the liver and lungs, with pancreatic localizations of hydatid cysts being rare and posing a challenge for differential diagnosis and surgical tactics. The present study aimed to provide a recent scoping of the literature on this type of localization, analyzing demographic data, therapeutic management, and postoperative outcomes. It was observed that females are more frequently affected in pancreatic hydatid localizations (p < 0.001), with the most common symptomatology represented by abdominal pain. The preferred localization was at the level of the pancreatic tail (32.5%), followed by cephalic localizations (25%). The preferred surgical approach was open surgery, with an observed preference for open surgery in specific localizations, such as the head, isthmus, and body of the pancreas (p < 0.001). Radical procedures are more commonly used than conservative ones (52.5% vs. 47.5%), and paradoxically, although less invasive, procedures such as inactivation and drainage are associated with more frequent complications (p = 0.03). This type of localization, due to the elements of local anatomical topography, requires adequate preparation in biliopancreatic surgery, considering that sometimes preoperative diagnosis is not oriented, and intraoperative records may require extensive interventions. Our research encompassed a thorough review of literature spanning the last decade using PubMed and Google Scholar databases, focusing specifically on cases involving primary hydatid cysts found within the pancreas. Thirty-three relevant articles were published between 2014 and 2024. In addition, we presented a unique case study that illustrates this uncommon occurrence.
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  • 文章类型: Journal Article
    系统评价;荟萃分析。
    腰椎退行性疾病频发,对患者的残疾和生活质量产生巨大影响。已经使用开放和微创手术来实现充分的减压和融合。内窥镜腰椎椎间融合术(Endo-LIF)正在成为一种替代方法,试图降低发病率,同时达到与优越的临床结果相当。这项工作的目的是进行系统评价和荟萃分析,以研究Endo-LIF与开放或微创手术的比较。
    电子数据库(MEDLINE,Scopus,WebofScience,Cochrane)使用以下查询进行了系统审查:\'(经皮或内窥镜*)和(开放式或微创*)以及腰椎和融合\'。遵循PRISMA指南。
    纳入了27篇文章(25项队列研究,1个准实验研究,和1项随机对照试验;对于荟萃分析结果,仅考虑观察性研究)。Endo-LIF调节手术时间较长,明显减少失血,就寝时间,和住院时间。术后早期背痛有利于内镜技术。Endo-LIF和非Endo-LIF微创手术对大多数背部和腿部疼痛或残疾结果具有可比性。尽管Endo-LIF在后期随访时与更高的残疾相关(与Open-LIF相比)。在融合率方面没有发现差异,网箱沉降,或不良事件。由于研究数量少和融合定义不标准化,因此无法得出有关融合率的明确结论。
    Endo-LIF是常规腰椎椎间融合术的有效且安全的替代品。证据缺陷可能会得到解决,未来的随机对照试验可以进行技术比较和结果验证.
    UNASSIGNED: Systematic review; meta-analysis.
    UNASSIGNED: Lumbar degenerative disease is frequent and has a tremendous impact on patients\' disability and quality-of-life. Open and minimally invasive procedures have been used to achieve adequate decompression and fusion. Endoscopic lumbar interbody fusion (Endo-LIF) is emerging as an alternative, trying to reduce morbidity, while achieving comparable to superior clinical outcomes. The aim of this work is to perform a systematic review and meta-analysis to investigate how Endo-LIF compares to open or minimally invasive procedures.
    UNASSIGNED: Electronic databases (MEDLINE, Scopus, Web of Science, Cochrane) were systematically reviewed using the query: \'(percutaneous OR endoscop*) AND (open OR minimal* invasive) AND lumbar AND fusion\'. PRISMA guidelines were followed.
    UNASSIGNED: Twenty-seven articles were included (25 cohort study, 1 quasi-experimental study, and 1 randomized control trial; for meta-analytical results, only observational studies were considered). Endo-LIF conditioned longer operative time, with significantly lower blood loss, bedtime, and hospital length of stay. Early post-operative back pain favored endoscopic techniques. Endo-LIF and non-Endo-LIF minimally invasive surgery displayed comparable results for most back and leg pain or disability outcomes, despite Endo-LIF having been associated with higher disability at late follow-up (versus Open-LIF). No differences were found regarding fusion rates, cage subsidence, or adverse events. Definitive conclusions regarding fusion rate cannot be drawn due to low number of studies and unstandardized fusion definition.
    UNASSIGNED: Endo-LIF is an effective and safe alternative to conventional lumbar interbody fusion procedures. Evidence shortcomings may be addressed, and future randomized control trials may be performed to compare techniques and to validate results.
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  • 文章类型: Journal Article
    比较机器人辅助切除与开放手术治疗胆管癌的临床疗效和安全性。我们对PubMed进行了全面搜索,Cochrane图书馆,和Embase数据库,用于比较CCA的治疗方法,涵盖从数据库开始到2024年1月30日的时期。两名研究人员将独立筛选文献并提取数据,然后使用ReviewManager5.3软件进行荟萃分析。共纳入5篇文章,共513例患者。其中,机器人组中的231人,公开组282人。Meta分析显示,机器人组在术中出血量方面具有显著优势(MD=-101.44,95%CI-135.73~-67.15,P<0.05)。淋巴结收获(MD=1.03,95%CI0.30-1.76,P<0.05)和住院时间(MD=-1.92,95%CI-2.87至-0.97,P<0.05)。然而,两组输血率比较差异无统计学意义(OR=0.62,95%CI0.31~1.23,P>0.05),R0切除(OR=1.49,95%CI0.89-2.50,P>0.05),30d死亡率(OR=1.68,95%CI0.43~6.65,P>0.05)和并发症(OR=0.76,95%CI0.30~1.95,P>0.05)。机器人辅助下CCA根治术是可行和安全的,其长期疗效和肿瘤结局需要进一步研究证实.
    To compare the clinical efficacy and safety of robot-assisted resection and open surgery for cholangiocarcinoma (CCA). We conducted a comprehensive search of PubMed, the Cochrane Library, and Embase databases for studies comparing treatment for CCA, covering the period from database inception to January 30, 2024. Two researchers will independently screen literature and extract data, followed by meta-analysis using Review Manager 5.3 software. A total of 5 articles with 513 patients were finally included. Among them, 231 in the robotic group, and 282 in the open group. The Meta-analysis revealed that the robotic group had a significant advantage in terms of intraoperative blood loss (MD =  - 101.44, 95% CI - 135.73 to - 67.15, P < 0.05), lymph node harvest(MD = 1.03, 95% CI 0.30- 1.76, P < 0.05) and length of hospital stay(MD =  - 1.92, 95% CI - 2.87 to- 0.97, P < 0.05). However, there were no statistically significant differences between the two groups in terms of transfusion rate (OR = 0.62, 95% CI 0.31-1.23, P > 0.05), R0 resection (OR = 1.49, 95% CI 0.89- 2.50, P > 0.05), 30-day mortality (OR = 1.68, 95% CI 0.43-6.65, P > 0.05) and complications (OR = 0.76, 95% CI 0.30- 1.95, P > 0.05). Robotic-assisted radical resection for CCA is feasible and safe, and its long-term efficacy and oncological outcomes need to be confirmed by further studies.
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  • 文章类型: Journal Article
    背景:随着所有专业的机器人辅助手术的增加,需要确定适当的培训和认证策略,以确保患者安全。荟萃分析评估了腹腔镜手术之间技术手术技能的可转移性,开放手术,和机器人辅助手术。
    方法:在Medline进行了系统搜索,Cochrane中央控制试验登记册,和WebofScience。结果被归类为时间,process,产品,和复合结果测量值,并使用Hedges\'g(标准化平均差[SMD])单独汇总。进行亚组分析以评估研究设计的效果,虚拟现实平台和任务难度。
    结果:在14,120项筛选研究中,在定性合成中包括30个,在定量合成中包括26个。已证明从腹腔镜手术到机器人辅助手术的技术手术技能转移(复合:SMD0.40,95%-置信区间[CI][0.19;0.62],时间:SMD0.62,CI[0.33;0.91]),反之亦然(复合:SMD0.66,CI[0.33;0.99],时间[基本技能]:SMD0.36,CI[0.01;0.72])。在可用数据有限的情况下,没有从开放到机器人辅助手术的技能转移。
    结论:技术手术技能可以从腹腔镜转移到机器人辅助手术,反之亦然。机器人辅助和腹腔镜手术技能培训和认证不应单独考虑,但是合理的组合可以缩短整体训练时间并提高效率。以前的开放手术经验不应被视为机器人辅助手术培训的必要条件。提出了评估技能转移的研究建议,以增加可比性和未来研究的意义。
    PROSPEROCRD42018104507。
    With an increase in robot-assisted surgery across all specialties, adequate training and credentialing strategies need to be identified to ensure patients safety. The meta-analysis assesses the transferability of technical surgical skills between laparoscopic surgery, open surgery, and robot-assisted surgery.
    A systematic search was conducted in Medline, Cochrane Central Register of Controlled Trials, and Web of Science. Outcomes were categorized into time, process, product, and composite outcome measures and pooled separately using Hedges\'g (standardized mean difference [SMD]). Subgroup analyses were performed to assess the effect of study design, virtual reality platforms and task difficulty.
    Out of 14,120 screened studies, 30 were included in the qualitative synthesis and 26 in the quantitative synthesis. Technical surgical skill transfer was demonstrated from laparoscopic to robot-assisted surgery (composite: SMD 0.40, 95%-confidence interval [CI] [0.19; 0.62], time: SMD 0.62, CI [0.33; 0.91]) and vice versa (composite: SMD 0.66, CI [0.33; 0.99], time [basic skills]: SMD 0.36, CI [0.01; 0.72]). No skill transfer was seen from open to robot-assisted surgery with limited available data.
    Technical surgical skills can be transferred from laparoscopic to robot-assisted surgery and vice versa. Robot-assisted and laparoscopic surgical skills training and credentialing should not be regarded separately, but a reasonable combination could shorten overall training times and increase efficiency. Previous experience in open surgery should not be considered as an imperative prerequisite for training in robot-assisted surgery. Recommendations for studies assessing skill transfer are proposed to increase comparability and significance of future studies.
    PROSPERO CRD42018104507.
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  • 文章类型: Systematic Review
    脑动静脉畸形(bAVM)是罕见但高风险的血管系统发育异常。通过开颅手术进行的显微外科手术被认为是许多等级bAVM的主要标准治疗方法。然而,在现有的bAVM开放手术临床研究中出现了一个重大挑战:缺乏可重复性和可比性.本研究旨在评估报告开放手术治疗的bAVM的临床和手术结果的研究质量,并制定报告指南清单,重点关注基本要素,以确保可比性和可重复性。这是一个系统的文献综述,遵循PRISMA指南,在Medline中进行搜索,Embase,和WebofScience数据库,适用于2018年1月1日至2023年12月1日之间发表的研究。对纳入的研究进行了审查,重点关注七个领域:(1)评估研究如何报告患者样本的基线特征;(2)评估和报告bAVM分级,解剖学特征,和放射学方面;(3)血管结构评估和报告;(4)关于关键概念定义的报告;(5)关于神经外科医生和工作人员特征的报告;(6)关于手术细节的报告;(7)评估和报告临床和手术结果以及AE。共纳入47项研究,包括5,884名患者。对研究的审查发现,目前的文献在bAVM开放手术在许多方面都存在缺陷,从基本的方法学信息到纳入患者的基线特征和数据报告。纳入的研究表明缺乏可重复性,这阻碍了累积证据的建立。制定了bAVM开放手术报告指南,其中有65个项目分布在八个领域,并在本研究中提出,旨在解决这些缺点。本系统综述确定了有关bAVM治疗的显微外科手术的可用文献,特别是在报告临床和手术结果的研究中,报告缺乏严格的科学方法和质量。拟议的bAVM开放手术报告指南涵盖了所有基本方面,是解决这些缺点和提高透明度的潜在解决方案,可比性,在这种情况下的可重复性。该提案旨在提高证据水平并增强有关bAVM的开放手术治疗的知识。
    Brain Arteriovenous Malformations (bAVMs) are rare but high-risk developmental anomalies of the vascular system. Microsurgery through craniotomy is believed to be the mainstay standard treatment for many grades of bAVMs. However, a significant challenge emerges in the existing body of clinical studies on open surgery for bAVMs: the lack of reproducibility and comparability. This study aims to assess the quality of studies reporting clinical and surgical outcomes for bAVMs treated by open surgery and develop a reporting guideline checklist focusing on essential elements to ensure comparability and reproducibility. This is a systematic literature review that followed the PRISMA guidelines with the search in Medline, Embase, and Web of Science databases, for studies published between January 1, 2018, and December 1, 2023. Included studies were scrutinized focusing on seven domains: (1) Assessment of How Studies Reported on the Baseline Characteristics of the Patient Sample; (2) Assessment and reporting on bAVMs grading, anatomical characteristics, and radiological aspects; (3) Angioarchitecture Assessment and Reporting; (4) Reporting on Pivotal Concepts Definitions; (5) Reporting on Neurosurgeon(s) and Staff Characteristics; (6) Reporting on Surgical Details; (7) Assessing and Reporting Clinical and Surgical Outcomes and AEs. A total of 47 studies comprising 5,884 patients were included. The scrutiny of the studies identified that the current literature in bAVM open surgery is deficient in many aspects, ranging from fundamental pieces of information of methodology to baseline characteristics of included patients and data reporting. Included studies demonstrated a lack of reproducibility that hinders building cumulative evidence. A bAVM Open Surgery Reporting Guideline with 65 items distributed across eight domains was developed and is proposed in this study aiming to address these shortcomings. This systematic review identified that the available literature regarding microsurgery for bAVM treatment, particularly in studies reporting clinical and surgical outcomes, lacks rigorous scientific methodology and quality in reporting. The proposed bAVM Open Surgery Reporting Guideline covers all essential aspects and is a potential solution to address these shortcomings and increase transparency, comparability, and reproducibility in this scenario. This proposal aims to advance the level of evidence and enhance knowledge regarding the Open Surgery treatment for bAVMs.
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  • 文章类型: Journal Article
    代谢和减肥手术(MBS)后静脉血栓栓塞事件(VTE)累积发生率的系统评价/荟萃分析。在电子数据库中搜索原始研究。比例荟萃分析评估累积VTE发生率。(PROSPEROID:CRD42020184529)。总共3066条记录,并纳入87项研究(N例患者=4,991,683)。主要是腹腔镜研究的住院VTE=0.15%(95%CI=0.13-0.18%);合并累积发生率增加至0.50%(95%CI=0.33-0.70%);0.51%(95%CI=0.38-0.65%);0.72%(95%CI=0.13-1.52%);0.78%(95%CI=0-3.49%)分别。主要使用开放方法的研究显示出比腹腔镜研究更高的发生率。在第一个月内,60%的VTE发生在放电后。北美和早期研究的发病率高于非北美和最近的研究。这项研究是第一个对MBS后VTE的发生率和模式进行详细估计的研究。MBS后VTE的发生率较低。VTE的改进估计和时间变化需要更长期的设计,特征的非汇总报告,并且必须考虑许多因素和数据注册表的使用。需要在MBS后对VTE进行扩展监测。
    Systematic review/meta-analysis of cumulative incidences of venous thromboembolic events (VTE) after metabolic and bariatric surgery (MBS). Electronic databases were searched for original studies. Proportional meta-analysis assessed cumulative VTE incidences. (PROSPERO ID:CRD42020184529). A total of 3066 records, and 87 studies were included (N patients = 4,991,683). Pooled in-hospital VTE of mainly laparoscopic studies = 0.15% (95% CI = 0.13-0.18%); pooled cumulative incidence increased to 0.50% (95% CI = 0.33-0.70%); 0.51% (95% CI = 0.38-0.65%); 0.72% (95% CI = 0.13-1.52%); 0.78% (95% CI = 0-3.49%) at 30 days and 3, 6, and 12 months, respectively. Studies using predominantly open approach exhibited higher incidence than laparoscopic studies. Within the first month, 60% of VTE occurred after discharge. North American and earlier studies had higher incidence than non-North American and more recent studies. This study is the first to generate detailed estimates of the incidence and patterns of VTE after MBS over time. The incidence of VTE after MBS is low. Improved estimates and time variations of VTE require longer-term designs, non-aggregated reporting of characteristics, and must consider many factors and the use of data registries. Extended surveillance of VTE after MBS is required.
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