中华外科杂志最新文献

{"title":"[Clinical value of secondary surgical resection for recurrent or metastatic pancreatic cancer after initial surgery].","authors":"X C Kang, Z D Fu, X H Shi, H Wang, L Y Gu, J Du, X Y Li, H Y Ma, S W Guo, G Jin","doi":"10.3760/cma.j.cn112139-20250730-00378","DOIUrl":"10.3760/cma.j.cn112139-20250730-00378","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the clinical value of secondary surgical resection in patients with recurrent or metastatic pancreatic cancer after radical resection. <b>Methods:</b> A retrospective cohort study was conducted, analyzing clinical data from patients with postoperative recurrence of pancreatic cancer treated at the Department of Hepatobiliary and Pancreatic Surgery,the First Affiliated Hospital of Naval Medical University between January 2016 and June 2024. Among them, there were 202 males and 120 females, with an age (<i>M</i>(IQR)) of 59(13) years (range: 33 to 80 years). Based on common recurrence patterns,patients were divided into three cohorts:local recurrence,liver metastasis,and lung metastasis. The liver metastasis cohort was further stratified into two subgroups based on the number of metastatic lesions (≤2 <i>vs.</i>>2). Differences between different groups were compared using the Wilcoxon rank-sum test, <i>χ</i>² test, or Fisher's exact test, as appropriate. Kaplan-Meier analysis was used to compare overall survival (OS) and post-recurrence survival (PRS) among different recurrence patterns and between patients who underwent secondary resection versus those who did not within each subgroup. Univariate and multivariate Cox regression analyses were used to identify independent prognostic factors. <b>Results:</b> Regarding recurrence patterns, 102 patients had local recurrence, with 43 undergoing secondary resection; 138 had liver metastases, with 32 receiving metastasectomy; and 28 had lung metastases, with 14 receiving metastasectomy.The lung metastasis group demonstrated significantly better OS (68.3 months <i>vs.</i> 44.8 months; 68.3 months <i>vs.</i> 28.4 months) and PRS (30.9 months <i>vs.</i> 19.7 months; 30.9 months <i>vs.</i> 14.2 months) compared to the local recurrence and liver metastasis groups (all <i>P</i><0.05). Secondary surgical resection significantly improved both OS and PRS in patients with local recurrence and liver metastasis (all <i>P</i><0.05),but showed no significant survival benefit in lung metastasis patients (<i>P</i>>0.05). Multivariate Cox regression analysis revealed that initial surgical margin status,and secondary resection were independent prognostic factors for local recurrence patients. Initial pathological differentiation,metastatic site,post-recurrence systemic chemotherapy,and secondary resection were significant prognostic factors for liver and lung metastasis patients. Among liver metastasis patients,those with ≤2 metastatic lesions had significantly longer PRS than those with >2 lesions (24.0 months <i>vs.</i> 9.8 months, <i>P</i>=0.012), while the PRS of the >2 lesions group was comparable to that of the non-resection group (9.8 months <i>vs.</i> 11.0 months,<i>P</i>=0.733). <b>Conclusions:</b> The prognosis of patients with recurrent or metastatic pancreatic cancer is closely associated with recurrence patterns,with lung metastasis patients exhibiting significantly bette","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 ","pages":"515-523"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Emphasize the standardized diagnosis and treatment of pancreatic segment choledochal cyst].","authors":"J Wang","doi":"10.3760/cma.j.cn112139-20250127-00041","DOIUrl":"10.3760/cma.j.cn112139-20250127-00041","url":null,"abstract":"<p><p>The pancreatic segment choledochal cyst is deeply located, prone to recurrent inflammation and adhesions with surrounding tissues, and exhibits various confluence patterns between the cyst terminus and the main pancreatic duct. Therefore, the safe and complete resection of the diseased bile duct in the pancreatic segment represents the core challenge in treating this condition. Accurate preoperative assessment is essential for surgical safety and should focus on delineating the location and extent of cyst, the anatomy of the hepatic artery and portal vein, as well as the confluence pattern of the biliary and pancreatic ducts. Meticulous intraoperative technique is key to ensuring therapeutic efficacy and safety. The intrapancreatic plate lowering technique should be employed to fully expose the pancreatic segment bile duct, achieve complete cyst resection, and perform a high-quality choledochojejunostomy to ensure long-term patency and improve the patient's quality of life. Predictive management of postoperative complications is a critical aspect of enhancing overall outcomes. The standardized diagnosis and treatment of pancreatic segment choledochal cysts must integrate preoperative evaluation, intraoperative techniques, and postoperative management to achieve a balance between radical cure and safety.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 ","pages":"423-427"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Analysis of the efficacy of halo-pelvic traction combined with posterior osteotomy in the treatment of severe rigid neurofibromatosis type 1 kyphoscoliosis].","authors":"Y Yue, Z H Zhang, F Zhu, H H Xu, H J Ma, S Z Liu, C T Meng, W Mei","doi":"10.3760/cma.j.cn112139-20260121-00031","DOIUrl":"10.3760/cma.j.cn112139-20260121-00031","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To explore the clinical efficacy of halo-pelvic traction combined with posterior osteotomy in the treatment of severe rigid type I neurofibromatosis (NF-1) scoliosis. &lt;b&gt;Methods:&lt;/b&gt; This is a retrospective case series study. The clinical data of 13 patients with severe rigid NF-1 scoliosis admitted to the Department of Pediatric Orthopedics Ⅱ (Scoliosis Specialty) of Zhengzhou Orthopedic Hospital from March 2017 to June 2024 were retrospectively analyzed. There were 6 males and 7 females, with an age of (17.5±7.2) years (range: 11 to 39 years). After 6 to 9 weeks of halo-pelvic traction, all patients underwent posterior spinal corrective surgery. The traction time, height, coronal Cobb angle of the main curve, sagittal Cobb angle, trunk balance indicators, and pulmonary function before and after traction and after corrective surgery were collected. The comparison of repeated measurement data was conducted using repeated measures analysis of variance, and pairwise comparisons were performed using the LSD-&lt;i&gt;t&lt;/i&gt; test. &lt;b&gt;Results:&lt;/b&gt; The traction time of the 13 patients was (55.5±5.8) d(range: 47 to 65 d). All 13 patients underwent posterior osteotomy in the apical vertebra area with Ponte osteotomy and non-apical vertebra area with facet osteotomy for correction. The height increased from (149.1±3.1) cm (range: 132 to 153 cm) before traction to (158.8±2.9) cm (range: 139 to 162 cm) after traction and (157.0±3.1) cm (range: 149 to 160 cm) after corrective surgery (&lt;i&gt;F&lt;/i&gt;=37.641, &lt;i&gt;P&lt;/i&gt;&lt;0.01). The coronal Cobb angle of the main curve decreased from (111.4±15.6)° (range: 96° to 150°) before traction to (77.3±4.6)° (range: 68° to 83°) after traction and (58.2±4.1)° (range: 52° to 64°) after corrective surgery (&lt;i&gt;F&lt;/i&gt;=100.637, &lt;i&gt;P&lt;/i&gt;&lt;0.01); the sagittal Cobb angle decreased from (97.8±11.2)° (range: 90° to 135°) before traction to (69.6±4.8)° (range: 63° to 77°) after traction and (54.5±2.6)° (range: 50° to 58°) after corrective surgery (&lt;i&gt;F&lt;/i&gt;=119.930, &lt;i&gt;P&lt;/i&gt;&lt;0.01). All patients showed varying degrees of improvement in pulmonary function. The vital capacity increased from (1.1±0.1) L before traction to (1.2±0.1) L after traction,and (1.4±0.1)L after corrective surgery (&lt;i&gt;F&lt;/i&gt;=75.004,&lt;i&gt;P&lt;/i&gt;&lt;0.01); the forced expiratory volume in one second increased from (0.9±0.1) L before traction to (1.1±0.1) L after traction,and (1.3±0.1)L after corrective surgery (&lt;i&gt;F&lt;/i&gt;=92.937,&lt;i&gt;P&lt;/i&gt;&lt;0.01). No complications such as pin tract loosening or infection occurred during traction. Two patients developed brachial plexus nerve injury symptoms in the later stage of traction, which were relieved after symptomatic treatment. The postoperative follow-up period was (47.8±24.7) months (range: 12 to 87 months). The patient's bone graft has healed well, and there is no loosening, fracture or displacement of the spinal internal fixation. &lt;b&gt;Conclusion:&lt;/b&gt; Halo-pelvic traction combined with posterior low-level osteotomy is effective in ","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 ","pages":"524-530"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Chinese expert consensus on endovascular treatment of ischemic lesions in the diabetic foot].","authors":"","doi":"10.3760/cma.j.cn112139-20251217-00594","DOIUrl":"10.3760/cma.j.cn112139-20251217-00594","url":null,"abstract":"<p><p>Ischemic diabetic foot is one of the severe chronic complications of diabetes mellitus. Without standardized treatment, it may progressively lead to ulceration, gangrene, and subsequent amputation, and may even result in patient mortality. Patients with ischemic diabetic foot often present with complex lower extremity vascular pathologies, such as diffuse calcification and occlusion of below-the-knee small arteries. In clinical practice, there is significant variability among diagnostic and treatment centers in the selection of therapeutic strategies and technical procedures. To standardize the clinical practice of ischemic diabetic foot in China and improve the level of diagnosis and treatment, the Peripheral Vascular Medicine Branch of the China International Exchange and Promotive Association for Medical and Healthcare, together with the Clinical Diagnosis, Treatment and Research Center for Lower Extremity Arteriosclerosis Obliterans of Capital Medical University, has organized relevant domestic experts to develop this consensus. Based on the latest evidence-based medical research and clinical experience, this consensus aims to provide standardized practical guidance for relevant clinicians.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 ","pages":"428-448"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Redo sternotomy open heart surgery with cardiopulmonary bypass: challenge and strategy].","authors":"Z B Qiu, F H Huang, X Chen","doi":"10.3760/cma.j.cn112139-20260119-00030","DOIUrl":"10.3760/cma.j.cn112139-20260119-00030","url":null,"abstract":"<p><p>Open heart surgery with redo sternotomy is more common recently along with the advanced surgical techniques and better long term patient survival. The mortality can be three times higher than the first time surgery because of the difficulties of re-entry. This article summarizes the experiences of sternal re-entry and mediastinal dissection to decrease the incidence of devastating bleeding, to share all tips and tricks of how to prevent and how to take care of bleeding while doing redo sternotomy and to safely establish cardiopulmonary bypass with all the cannular strategy. An experienced surgical team with preoperative careful planning, meticulous surgical technique, myocardial protection, are critical for optimal outcomes.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 ","pages":"419-422"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147516688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[A comparative study on perioperative outcomes and learning curves of domestic robot-assisted versus Da Vinci Xi robot-assisted partial nephrectomy].","authors":"J Q Li, Y Y Su, Y Yuan, M Nie, Z Y Dong, Y Qu, Y L Sun, Y H Cui, Z Q Wang, H L Wang","doi":"10.3760/cma.j.cn112139-20250801-00386","DOIUrl":"10.3760/cma.j.cn112139-20250801-00386","url":null,"abstract":"<p><p><b>Objective:</b> To compare perioperative outcomes of robot-assisted partial nephrectomy (RAPN) performed with a China-made robotic surgical system versus the Da Vinci Xi system, and to evaluate the learning curve of the domestic system. <b>Methods:</b> This single-center, prospective, randomized controlled study enrolled patients scheduled for RAPN at Harbin Medical University Cancer Hospital from August 2024 to May 2025 who met predefined inclusion and exclusion criteria. Using simple randomization, patients were assigned to the domestic robotic system group (domestic group) or the Da Vinci Xi group. Perioperative variables were analyzed and compared between groups using the independent-samples <i>t</i> test, Mann-Whitney <i>U</i> test, or Fisher's exact test, as appropriate. A cumulative sum (CUSUM) analysis of operative time in the domestic group was performed to determine the number of cases required for a surgeon to achieve proficiency when transitioning from the Da Vinci Xi to the SR2000 system. <b>Results:</b> Ninety patients undergoing robot-assisted laparoscopic RAPN were included and randomized (domestic group, <i>n</i>=45; Da Vinci Xi group, <i>n</i>=45). There were 56 males and 34 females,aged (<i>M</i>(IQR)) 57(48)years (range:31 to 79 years). TNM stages were T1N0M0 in 80 cases and T2N0M0 in 10 cases. All 90 procedures were successfully completed with robotic assistance, and no positive surgical margins occurred. Between-group differences in operative time, docking time, length of hospital stay, and intraoperative blood loss were not statistically significant (all <i>P</i>>0.05). The warm ischemia time of the domestic group was shorter than that of the Da Vinci Xi group(23 (10) min <i>vs.</i> 24 (8) min, <i>Z</i>=0.167, <i>P</i><0.05). The CUSUM learning-curve fit for operative time in the domestic group showed an inflection at the 18th case, indicating that approximately 18 cases were required to complete the learning curve. When the domestic group was divided into a learning phase (cases 1 to 18) and a proficiency phase (cases 19 to 45), perioperative outcomes did not differ significantly between phases (all <i>P</i>>0.05). <b>Conclusions:</b> The domestic robotic surgical system can be used safely and effectively for partial nephrectomy. For surgeons already experienced with the Da Vinci Xi system, approximately 18 cases are required to attain proficiency with the SR2000 system.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 ","pages":"531-537"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Comprehensive diagnosis and treatment of distal biliary strictures: multidisciplinary collaboration and precision surgical strategies].","authors":"F L Xing, J Sun, C Li, X Wu, B L Li","doi":"10.3760/cma.j.cn112139-20260128-00043","DOIUrl":"10.3760/cma.j.cn112139-20260128-00043","url":null,"abstract":"<p><p>Distal biliary strictures (DBS) are a common and complex clinical problem in pancreaticobiliary diseases,with etiologies involving multiple factors such as inflammation,benign fibrous strictures,and malignant tumors. Differentiating between benign and malignant DBS is challenging,and clinical decision-making often requires a collaborative approach involving imaging,endoscopic techniques,histopathology,and molecular diagnostics. In recent years,with the development of endoscopic ultrasound-guided fine-needle aspiration/biopsy,endoscopic retrograde cholangiopancreatography biopsy,molecular biomarkers,radiomics,and artificial intelligence,the accuracy of etiological diagnosis of DBS has significantly improved. Simultaneously,the multidisciplinary team (MDT) approach has gradually become the standard procedure. This article systematically describes the etiology,diagnostic process, and treatment strategies of DBS,focusing on the crucial role of precision surgery within the MDT framework,aiming to promote the standardization and homogenization of clinical diagnosis and treatment.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 ","pages":"472-477"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Mid-term efficacy evaluation of transcatheter mitral valve \"valve-in-valve\" replacement with different access approaches for degenerated bioprosthesis at single-center].","authors":"S Liu, Y Yang, Y Wang, J M Chen, Y T Lu, W Y Song, G G Fu, L L Dong, X Yang, S Pan, C S Wang, L Wei","doi":"10.3760/cma.j.cn112139-20251202-00557","DOIUrl":"10.3760/cma.j.cn112139-20251202-00557","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To evaluate the mid-term outcomes of transcatheter \"valve-in-valve\" replacement techniques for biological valve failure using different access approaches. &lt;b&gt;Methods:&lt;/b&gt; This study is a retrospective cohort analysis. Clinical data were retrospectively analyzed for 101 patients with biological mitral valve failure who underwent transcatheter balloon-expandable \"valve-in-valve\" replacement at the Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University between May 2021 and July 2025. There were 35 males and 66 females, with an age of (74.5±6.3) years (range: 55 to 86 years). The transapical group comprised 33 patients (32.7%), while the transvenous group included 68 patients (67.3%). Postoperative outcomes were assessed using catheterization, transesophageal echocardiography, and CT scans, with surgical complications and adverse events recorded. Data comparisons were conducted using independent sample &lt;i&gt;t&lt;/i&gt;-tests, &lt;i&gt;χ&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; tests or Fisher's exact probability method. &lt;b&gt;Results:&lt;/b&gt; Among the 101 patients, 22 underwent post-implantation annuloplasty. Annuloplasty was performed on 19 (27.9%) patients in the transvenous group versus 3 (9.1%) in the transapical group, showing a statistically significant difference (&lt;i&gt;χ&lt;/i&gt;²=8.471, &lt;i&gt;P&lt;/i&gt;=0.031). No statistically significant differences were observed between groups in the incidence of wound infection, stroke, or third-degree atrioventricular block (all &lt;i&gt;P&gt;&lt;/i&gt;0.031). However, the acrosternal approach group showed significantly higher rates of postoperative pleural effusion (6.1%(2/33) &lt;i&gt;vs.&lt;/i&gt; 0, &lt;i&gt;P&lt;/i&gt;=0.040) and postoperative bleeding complications (9.1%(3/33) &lt;i&gt;vs.&lt;/i&gt; 0, &lt;i&gt;P&lt;/i&gt;=0.012) compared to the transvenous approach group. The peak and mean left atrial pressures in the transvenous femoral group after surgery were (23.9±4.8) mmHg (1 mmHg=0.133 kPa) and (15.8±3.2) mmHg, respectively, which were lower than those in the acrosternal approach group (29.2±6.5) mmHg and (20.4±5.6) mmHg,the differences were statistically significant (&lt;i&gt;t&lt;/i&gt;=1.624, &lt;i&gt;P&lt;/i&gt;=0.008; &lt;i&gt;t&lt;/i&gt;=1.598, &lt;i&gt;P&lt;/i&gt;=0.007). The postoperative follow-up period was (18±10) months (range: 1 to 36 months). During follow-up, 15 patients (14.9%, 15/101) died. Five deaths (15.1%, 5/101) occurred in the transapical group, including 3 due to heart failure and 2 due to pulmonary infection. Ten patients (14.7%,10/68) died in the transapical group, including 5 due to heart failure, 3 due to pulmonary infection, and 2 due to cerebrovascular accidents. There were no statistically significant differences in all-cause mortality or major adverse cardiovascular events between the two groups (all &lt;i&gt;P&lt;/i&gt;&gt;0.05). &lt;b&gt;Conclusions:&lt;/b&gt; Transcatheter \"valve-in-valve\" mitral valve replacement is a viable clinical option for treating biological mitral valve failure, significantly improving hemodynamic status. Compared to the transapical approach, the transvenous approach resulted in fewe","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 ","pages":"494-501"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147516641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The value of endoscopic ultrasonography in the diagnosis and treatment of diseases at the choledocho-pancreatico-duodenal junction].","authors":"L He, Q Chen","doi":"10.3760/cma.j.cn112139-20260204-00055","DOIUrl":"10.3760/cma.j.cn112139-20260204-00055","url":null,"abstract":"<p><p>The choledocho-pancreatico-duodenal junction (CPDJ) is the core area where the biliary tract, pancreas, and duodenum converge. Diseases at this area could be difficult either to diagnose at early stage or to distinguish with each other. Endoscopic ultrasonography (EUS) can play an important role in the diagnosis of CPDJ diseases. First, EUS enables close and dynamic scanning and visualization of minor lesions and fine structures in this area. Second, EUS guided fine-needle aspiration is a significant method to obtain tissue for pathological examination. EUS is of great value especially for CPDJ tumors, minor choledocholithiasis, common bile duct and(or) pancreatic duct dilation of unknown reason, pancreatic divisum and anomalous junction of pancreaticobiliary duct. On the other hand, EUS-guided interventional techniques, including EUS-guided biliary drainage and EUS-guided gastroenterostomy, are evolving rapidly, with technical innovations in CPDJ disease treatment modality. This article introduces the value of EUS in the diagnosis and treatment of CPDJ diseases.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 ","pages":"478-485"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147516864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Reasons for surgical reintervention and its prognosis after prosthesis valve replacement].","authors":"W W Wang, F Xiang, L M Wang, M Xu, F H Huang, Z B Qiu, Y S Jiang, P S Liu, R Wang, X Chen","doi":"10.3760/cma.j.cn112139-20251209-00583","DOIUrl":"10.3760/cma.j.cn112139-20251209-00583","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To investigate the causes of surgical reintervention after prosthetic valve replacement and to evaluate the safety and effectiveness of valve reoperation. &lt;b&gt;Methods:&lt;/b&gt; This retrospective case series study consecutively included 144 patients who underwent repeat cardiac valve surgery at the Department of Cardiothoracic Surgery, Nanjing First Hospital between July 2020 and July 2025. Patients were excluded if their initial procedure involved valve repair or transcatheter valve implantation, or if the previously implanted prosthetic valve was not treated during the reoperation. There were 80 males and 64 females. The age (&lt;i&gt;M&lt;/i&gt;(IQR)) was 63(14) years (range:29 to 78 years).One hundred and forty patients (97.2%,140/144) underwent a second cardiac surgery, while 4 patients(2.8%,4/144) underwent a third operation.In the previous surgery, mitral, aortic and tricuspid valve replacement had been performed on 71.5%(103/144), 56.3%(81/144) and 2.1%(3/144) patients respectively, and 28.5%(41/144) patients had undergone concomitant mitral and aortic valve replacement. A total of 78 patients had previously received bioprosthetic valves (bioprosthetic group), and 66 patients had previously received mechanical valves (mechanical group). The causes of reintervention, all-cause mortality after reoperation, and the incidence of major perioperative complications were analyzed. Independent sample &lt;i&gt;t&lt;/i&gt;-test, Mann-Whitney &lt;i&gt;U&lt;/i&gt; test, Chi-square test or Fisher's exact test was used in between-group analysis. Kaplan-Meier method was performed on survival analysis. Univariate and multivariate Cox regression analyses were used to identify the risk factors for all-cause mortality after surgery in patients. &lt;b&gt;Results:&lt;/b&gt; The interval from the previous surgerymedian was 11(9) years (range:3 months to 32 years). In the bioprosthetic group, the main causes of reintervention were structural valve deterioration (71.8%, 56/78) and prosthetic valve endocarditis (21.8%, 17/78). In the mechanical group, the leading causes were pannus or valve thrombosis (69.7%, 46/66) and paravalvular leak (22.7%, 15/66). Reoperations involved the mitral valve in 88 cases, the aortic valve in 62 cases, and the tricuspid valve in 3 cases. All patients underwent reoperation via median sternotomy, and 72.2% (104/144) received peripheral cannulation. The 30-day mortality rate was 6.3% (9/144). The incidences of low cardiac output syndrome, permanent pacemaker implantation, and prolonged mechanical ventilation were 10.4% (15/144), 8.3% (12/144), and 22.2% (32/144), respectively. The follow-up time was 12(12) months(range:0 to 42 months), 5 patients died during the follow-up period, among whom 4 died of cardiac causes and 1 died of non-cardiac causes. The Kaplan-Meier survival analysis showed that the 1-year survival rate of the patients after surgery was 90.8% (95%&lt;i&gt;CI&lt;/i&gt;: 86.2% to 95.7%). The univariate and multivariate Cox regression analysis results indicated th","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 ","pages":"508-514"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147516571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}