中华外科杂志最新文献

{"title":"[Research progress on cerebral hypoperfusion following revascularization for carotid artery stenotic disease].","authors":"Q C Wang, L Q Teng, X N Liu, P Z Liao, G H Yang, C Y Shen","doi":"10.3760/cma.j.cn112139-20260302-00080","DOIUrl":"https://doi.org/10.3760/cma.j.cn112139-20260302-00080","url":null,"abstract":"<p><p>In clinical practice, a subset of patients with severe carotid artery stenosis fails to achieve the expected improvement in cerebral perfusion despite successful carotid revascularization and restoration of arterial patency. In these patients, cerebral ischemic symptoms persist or even deteriorate, reflecting a mismatch between macrovascular recanalization and cerebral tissue perfusion. This phenomenon is referred to as cerebral hypoperfusion syndrome (CHypoS). The pathogenesis of CHypoS is likely multifactorial, involving unfavorable cerebrovascular anatomy, persistent hemodynamic impairment, cerebrovascular vasoconstriction, and microcirculatory dysfunction, all of which may increase the risk of recurrent ischemic stroke. Currently, there is no universally accepted diagnostic criterion for CHypoS, and high-quality evidence to guide its management remains lacking. Consequently, current treatment strategies rely largely on empirical hemodynamic optimization. Future studies should focus on elucidating the underlying pathophysiological mechanisms of CHypoS and shifting the therapeutic goal of carotid revascularization from achieving anatomical vessel patency to restoring effective cerebral perfusion and improving clinically meaningful outcomes, thereby enhancing stroke prevention and long-term prognosis.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 11","pages":"1228-1232"},"PeriodicalIF":0.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149013251","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":"[Expert consensus on artificial intelligence-based risk assessment in gastrointestinal surgery (2026 edition)].","authors":"","doi":"10.3760/cma.j.cn112139-20260603-00245","DOIUrl":"https://doi.org/10.3760/cma.j.cn112139-20260603-00245","url":null,"abstract":"<p><p>Perioperative risk assessment in gastrointestinal surgery is a critical component for ensuring patient safety, optimizing therapeutic decision-making, and reducing postoperative complications. With the rapid advancement of artificial intelligence (AI) and big data technologies, intelligent risk prediction models based on machine learning and multimodal data integration have gradually become important tools for promoting precision perioperative management. However, standardized recommendations regarding input variables, predicted outcomes, validation methodologies, and clinical implementation of AI-based risk assessment models in gastrointestinal surgery remain lacking. To facilitate the standardized application of AI technologies in perioperative risk management for gastrointestinal surgery, the Colorectal Surgery Group of the Chinese Society of Surgery, Chinese Medical Association, together with experts in gastrointestinal surgery, evidence-based medicine, and artificial intelligence, developed the \"Expert consensus on artificial intelligence-based risk assessment in gastrointestinal surgery（2026 edition）\" based on currently available evidence-based medical evidence and extensive clinical experience. This consensus focuses on key issues including prediction of high-risk postoperative complications, model development and validation, dynamic risk monitoring, and perioperative intervention strategies. It systematically proposes the key input variables, major predictive outcomes, model evaluation metrics, and principles for multicenter implementation of AI-based risk assessment in gastrointestinal surgery. The consensus aims to establish a standardized AI-driven risk assessment framework applicable to gastrointestinal surgical practice in China and to promote the development of perioperative management toward greater precision and intelligence.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 11","pages":"1133-1141"},"PeriodicalIF":0.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149013049","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":"[Value of a CT angiography-based deep learning model for differentiating SVS grade Ⅱ and grade Ⅲ blunt thoracic aortic injury: a retrospective multicenter staged study].","authors":"Y Sun, Y Liang, Y Cao, B N Zhou, H H He, D Yuan, X H Zhou, J Xiong","doi":"10.3760/cma.j.cn112139-20260730-00329","DOIUrl":"https://doi.org/10.3760/cma.j.cn112139-20260730-00329","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objectives:&lt;/b&gt; To develop a segmentation-guided multitask deep learning model for Society for Vascular Surgery (SVS) grades Ⅰ to Ⅳ classification of blunt thoracic aortic injury (BTAI) and validate its clinical utility for differentiating SVS grades Ⅱ and Ⅲ. &lt;b&gt;Methods:&lt;/b&gt; This is a retrospective case series study. Computed tomography angiography (CTA) data were collected from 317 patients with BTAI at 12 hospitals in China, including the First Medical Center of Chinese People's Liberation Army General Hospital, West China Hospital of Sichuan University, the First Affiliated Hospital of Zhengzhou University, the Affiliated Hospital of Southwest Medical University, and other local hospitals, between January 2006 and May 2026. The cohort included 258 male and 59 female patients, with an age of (54.8±15.3) years (range:16 to 92 years). The 253-patient development cohort was divided using a patient-level random split stratified by SVS injury grade and source center at an approximate ratio of 8∶2 into a training set of 202 patients and an internal validation set of 51 patients. The 64 BTAI cases from the Affiliated Hospital of Southwest Medical University were locked in advance as an independent external test set. The model consisted of a shared encoder, a lesion-segmentation branch, and a mask-guided classification branch. The primary outcomes were the area under the receiver operating characteristic curve (AUC) and grade Ⅲ sensitivity for differentiating SVS grade Ⅱ (intramural hematoma) from grade Ⅲ (pseudoaneurysm) in the external test set. Secondary outcomes included segmentation, automated measurements, and offline reader-study results. &lt;b&gt;Results:&lt;/b&gt; The internal validation set covered SVS grades Ⅰ to Ⅳ, with an overall grading accuracy of 92.2% (47/51) and a macro-averaged F1 score of 0.919. The external test set included 31 SVS grade Ⅱ (intramural hematoma) cases and 33 SVS grade Ⅲ (pseudoaneurysm) cases. The model had an AUC of 0.968 (95%&lt;i&gt;CI&lt;/i&gt;:0.924 to 0.996), an accuracy of 92.2% (59/64), grade Ⅲ sensitivity of 93.9% (31/33), and grade Ⅱ specificity of 90.3% (28/31); two grade Ⅲ cases were misclassified as grade Ⅱ. The automated segmentation success rate was 96.9% (62/64), the overall lesion Dice similarity coefficient was 0.872±0.072 (range:0.46 to 0.99), and model inference time per case was (15.4±2.4) s (range:10.8 to 22.6 s). In the fixed-sequence reader study, six junior physicians had higher grade Ⅱ/Ⅲ accuracy and grade Ⅲ sensitivity and shorter interpretation times during the artificial intelligence-assisted phase than during the unaided phase. &lt;b&gt;Conclusions:&lt;/b&gt; The segmentation-guided CTA deep learning model developed in this study performed BTAI lesion segmentation, SVS grading, and measurement of key morphologic parameters, and maintained good discrimination between SVS grades Ⅱ and Ⅲ in the independent external test set. Model assistance may help reduce missed grade Ⅲ cases by junior physicians and shorten inter","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 11","pages":"1184-1192"},"PeriodicalIF":0.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149013294","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":"[Acute pancreatitis in pancreatic cancer: impact on prognosis:a retrospective single-center cohort study].","authors":"B Y Li, Y C Ma, W Q Lyu, Z T Guo, K Y Wei, W K Qian, Z Wang, H R He","doi":"10.3760/cma.j.cn112139-20260109-00017","DOIUrl":"https://doi.org/10.3760/cma.j.cn112139-20260109-00017","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the differences in clinical characteristics and prognosis between pancreatic ductal adenocarcinoma (PDAC) patients with and without concurrent acute pancreatitis (AP),and to analyze the impact of AP on the survival of PDAC patients. <b>Methods:</b> This is a retrospective case-control study. Clinical data of 1 030 patients with PDAC admitted to Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi'an Jiaotong University from January 2019 to December 2023 were collected. There were 578 males and 452 females, with an age of (62.2±9.7) years (range: 31 to 90 years). Patients were divided into an AP group (<i>n</i>=92) and a non-AP group (<i>n</i>=938) based on whether they had concomitant AP. In the AP group, there were 56 males (60.9%) and 36 females (39.1%); in the non-AP group, there were 522 males (55.7%) and 416 females (44.3%). A 1︰2 propensity score matching (PSM) method was used to match the clinical data of the two groups to control for baseline confounders. Subgroup analyses were performed based on whether patients underwent radical surgery and whether they received chemotherapy. Survival curves before and after PSM were plotted using the Kaplan-Meier method, and the Log-rank test was used to compare the overall survival (OS) time between the two groups. <b>Results:</b> Survival analysis showed that, both before and after PSM, there was no statistically significant difference in OS between the AP group and the non-AP group (both <i>P</i>>0.05). Subgroup analysis results revealed that there was no statistically significant difference in OS between the two groups across all subgroups (all <i>P</i>>0.05). When stratified by whether patients received radical surgery,among those who underwent surgery,patients in the AP group were younger than those in the non-AP group,had a higher proportion of N0 stage,a higher proportion of tumors located in the body and tail of the pancreas,and lower levels of AST, alkaline phosphatase, GGT, direct bilirubin, and preoperative carcinoembryonic antigen compared to the non-AP group (all <i>P</i><0.05). Among patients who did not undergo surgery, the AP group had a higher proportion of T1 stage (<i>P</i><0.05), while no statistically significant differences were observed for other variables (all <i>P</i>>0.05). Patients in both groups who received radical surgery and concurrent chemotherapy had the best prognosis,while those who did not receive surgery or chemotherapy had the worst prognosis (<i>P</i><0.05). <b>Conclusion:</b> The presence of AP is not an independent predictor for long-term survival in PDAC patients; yet, among those undergoing radical surgery, PDAC patients with AP are younger, have earlier N stage, and show lower liver function and carcinoembryonic antigen levels.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 11","pages":"1208-1216"},"PeriodicalIF":0.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149013328","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":"[Dominant false lumen flow and abnormally high shear stress: a hemodynamic analysis of multichanneled aortic dissection].","authors":"J Z Yang, J Y Luan, Y M Yang, L Mao, F R He, T Zhu","doi":"10.3760/cma.j.cn112139-20260325-00128","DOIUrl":"https://doi.org/10.3760/cma.j.cn112139-20260325-00128","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To explore the hemodynamic characteristics of multichanneled aortic dissection (MCAD). &lt;b&gt;Methods:&lt;/b&gt; This is a retrospective cohort study. Patients with acute uncomplicated Stanford-type B aortic dissection who presented at Zhongshan Hospital, Fudan University between January 2019 and December 2023 were enrolled. Patients were diagnosed as having either double-channeled aortic dissection (DCAD) or MCAD based on preoperative standardized computed-tomography angiography (CTA). Centered on 4 MCAD cases with preprocedural death, 4 non-preprocedural-death MCAD patients and 4 non-preprocedural-death DCAD patients with balanced baseline characteristics, complete preoperative CTA datasets and well-defined outcomes were matched, yielding a total of 12 male patients. The ages of patients in preprocedural-death MCAD group, non-preprocedural-death MCAD group and non-preprocedural- death DCAD group were (62.0±5.7) years (range:54 to 66 years), (61.5±5.8) years (range:54 to 67 years) and (61.3±8.1) years (range:52 to 71 years), respectively. Using computational fluid dynamics (CFD) and patient-specific aortic models, preoperative hemodynamic indices were quantitatively analyzed, including blood flow velocity, pressure distribution, flow distribution, wall shear stress (WSS) and time-averaged wall shear stress (TAWSS). &lt;b&gt;Results:&lt;/b&gt; Hemodynamic analyses revealed a stepwise decreasing trend of false lumen (FL) flow rate across the three groups. The preoperative death MCAD group exhibited a significantly higher FL flow ((62.81±7.59)ml/s (range: 56.29 to 73.78 ml/s)) than the non-preoperative death MCAD group ((24.84±9.25)ml/s (range: 17.23 to 36.84 ml/s)) and the non-preoperative death DCAD group ((11.86±5.62)ml/s (range: 6.72 to 19.84 ml/s)). The intergroup variation patterns of FL flow ratio and maximum FL TAWSS were highly consistent. The preoperative death MCAD group yielded values of 0.77±0.16 (range: 0.56 to 0.93) and (34.44±6.50)Pa (range: 27.54 to 41.38 Pa),which were elevated compared with the non-preoperative death MCAD group (0.44±0.17(range: 0.33 to 0.70), (15.46±7.75)Pa (range: 6.69 to 25.01 Pa)) and the non-preoperative death DCAD group (0.22±0.11(range: 0.14 to 0.37), (20.80±7.34)Pa (range: 15.23 to 31.60 Pa)),whereas no obvious disparities were observed between the latter two groups. In addition,the maximum FL WSS in the preoperative death MCAD group reached (125.76±26.57)Pa (range: 87.55 to 147.91 Pa),markedly exceeding that of the non-preoperative death MCAD group ((64.89±30.45)Pa (range: 28.62 to 102.40 Pa)) and the non-preoperative death DCAD group ((91.15±28.16)Pa (range: 61.51 to 126.41 Pa)). &lt;b&gt;Conclusions:&lt;/b&gt; Elevated FL flow and abnormally high shear stress may correlate with poor outcomes in patients with MCAD,and these parameters could serve as potential biomechanical biomarkers. CFD simulation can act as an auxiliary tool to identify high-risk aortic dissection patients,which helps refine clinical managemen","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 11","pages":"1193-1199"},"PeriodicalIF":0.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012892","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":"[Expert consensus on immunotherapy-based combination conversion therapy followed by sequential surgery for advanced hepatocellular carcinoma(2026 edition)].","authors":"","doi":"10.3760/cma.j.cn112139-20260803-00334","DOIUrl":"https://doi.org/10.3760/cma.j.cn112139-20260803-00334","url":null,"abstract":"<p><p>Patients diagnosed with hepatocellular carcinoma (HCC) are often already at an advanced stage at the time of initial diagnosis, with limited effective curative treatment options available and a generally poor overall prognosis. In recent years, combination therapy regimens incorporating immune checkpoint inhibitors have demonstrated clinical advantages in improving the objective response rate and prolonging patient survival. Following standardized transition therapy, some patients with initially unresectable advanced HCC may subsequently undergo curative hepatectomy or liver transplantation, ultimately achieving stable long-term survival benefits. To further standardize the comprehensive management of the sequential surgical treatment approach in the immunotherapy-based transition therapy for advanced HCC, relevant academic organizations have convened multidisciplinary experts to revise and update the content of this consensus, drawing upon the latest evidence-based data since the publication of the \"Expert consensus on the sequential surgery following conversion therapy based on the combination of immune checkpoint inhibitors and antiangiogenic targeted drugs for advanced hepatocellular carcinoma（2024 edition）\" and incorporating domestic clinical practice experience. This initiative aims to guide clinicians in making informed diagnostic and therapeutic decisions, maximize patient treatment benefits, and contribute to the continuous advancement of comprehensive HCC management standards in China.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 11","pages":"1142-1156"},"PeriodicalIF":0.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149013162","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 brief discussion on the progress and development directions of clinical research in vascular surgery].","authors":"S M Wang, S W Wang","doi":"10.3760/cma.j.cn112139-20260803-00335","DOIUrl":"https://doi.org/10.3760/cma.j.cn112139-20260803-00335","url":null,"abstract":"<p><p>Vascular surgery has experienced rapid development over the past three decades. With the application of minimally invasive and interventional techniques in the diagnosis and treatment of vascular diseases, clinical research and technological innovation in vascular surgery have expanded significantly. As populations aging accelerates globally-including in China-and the number of patients with cardiovascular and cerebrovascular disease within the existing healthcare system becomes increasingly evident. The future of vascular surgery will center on three core principles: minimization, precision, and intelligence. By integrating breakthroughs in basic science, engineering, and artificial intelligence, clinical translation will be accelerated. The discipline will shift from \"disease treatment\" to \"health management\", and from a \"surgery-centered\" single model to a \"patient-centered\" integrated approach model. Future developments will further incorporate artificial intelligence, big data models, precision medicine, more advanced and comprehensive minimally invasive technologies, enhancing multidisciplinary collaboration and preventive care. These advancements are expected to significantly improve diagnostic accuracy, treatment outcomes, and quality of life for patients with vascular diseases.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 11","pages":"1129-1132"},"PeriodicalIF":0.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149013330","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":"[Interpretation of updated guidelines on diagnosis of hemangiomas and vascular anomalies].","authors":"Q Q Nie, Z D Ye, X X Fan","doi":"10.3760/cma.j.cn112139-20260626-00283","DOIUrl":"https://doi.org/10.3760/cma.j.cn112139-20260626-00283","url":null,"abstract":"<p><p>The International Society for the Study of Vascular Anomalies (ISSVA) classification is an internationally accepted framework for the diagnosis and communication of vascular tumors and vascular malformations. Since the tumor-versus-malformation dichotomy was established in 1996, the classification underwent major revisions in 2014 and 2018. In June 2025, the ISSVA Classification Group published an updated classification in the Journal of Vascular Anomalies and positioned it as a continuously updated \"living document\", representing the most substantial revision to date. Key updates include: at the top level, the new category \"potentially unique vascular anomaly\" replaces the former \"provisionally unclassified vascular anomalies\"; a two-tier structure comprising a landing page and a full classification table is introduced, together with an independent glossary; for vascular malformations, vessel type (simple versus combined) is no longer the primary organizing criterion, and the classification is now organized by flow velocity (fast-flow versus slow-flow) together with developmental anomalies of named vessels; and molecular genetic information has been systematically incorporated. Using the 2018 version as a reference, this article reviews the key updates of the 2025 version and interprets them in the context of advances in molecular genetics, targeted therapy, and the practice of vascular anomaly diagnosis and treatment in China, aiming to provide a reference for standardized diagnosis, multidisciplinary communication, and individualized treatment decisions.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 11","pages":"1177-1183"},"PeriodicalIF":0.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149013206","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":"[Preoperative levator ani complex volume predicts severe low anterior resection syndrome after intersphincteric resection: development and validation of a nomogram model].","authors":"B L Hu, Y F Zheng, B Y Kang, A H Ti, Y N Zhu, X J Li","doi":"10.3760/cma.j.cn112139-20260130-00049","DOIUrl":"https://doi.org/10.3760/cma.j.cn112139-20260130-00049","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objectives:&lt;/b&gt; To investigate the predictive value of preoperative levator ani complex volume measured by magnetic resonance imaging for severe low anterior resection syndrome after intersphincteric resection, and to develop a nomogram prediction model. &lt;b&gt;Methods:&lt;/b&gt; This is a retrospective case series study. Clinical data of 134 patients who underwent intersphincteric resection for low rectal cancer at Shaanxi Provincial People's Hospital from January 2016 to December 2023, and 43 patients from the First Affiliated Hospital of Air Force Medical University from January 2021 to December 2022, were retrospectively collected. The cohort included 110 males and 67 females, with an age of (64.7±8.6) years(range:32 to 78 years). Patients from Shaanxi Provincial People's Hospital were randomly divided into a training cohort (94 cases) and an internal validation cohort (40 cases) in a 7∶3 ratio using computer-generated random numbers, while 43 patients from the First Affiliated Hospital of Air Force Medical University served as the external validation cohort. Clinical data were collected, and the volumes of defecation-related muscles, including the levator ani complex, were segmented and normalized using 3D Slicer software based on preoperative magnetic resonance imaging. Severe low anterior resection syndrome was defined as a low anterior resection syndrome score≥30 at six months after stoma closure. Univariate and multivariate Logistic regression analyses were performed to identify independent risk factors for severe low anterior resection syndrome, and a nomogram model was established. Model performance was evaluated by receiver operating characteristic curve, calibration curve, and decision curve analysis. &lt;b&gt;Results:&lt;/b&gt; In the training cohort of 94 patients, 41 (43.6%) developed severe low anterior resection syndrome. Multivariate analysis revealed that preoperative chemoradiotherapy (&lt;i&gt;OR&lt;/i&gt;=4.901, 95%&lt;i&gt;CI&lt;/i&gt;:1.806 to 13.300, &lt;i&gt;P&lt;/i&gt;=0.002), total intersphincteric resection (versus partial intersphincteric resection, &lt;i&gt;OR&lt;/i&gt;=7.001, 95%&lt;i&gt;CI&lt;/i&gt;:1.679 to 29.197, &lt;i&gt;P&lt;/i&gt;=0.008), and smaller normalized levator ani complex volume (&lt;i&gt;OR&lt;/i&gt;=0.665, 95%&lt;i&gt;CI&lt;/i&gt;:0.458 to 0.964, &lt;i&gt;P&lt;/i&gt;=0.032) were independent risk factors for postoperative severe low anterior resection syndrome. The nomogram model achieved an area under the receiver operating characteristic curve of 0.778 in the training cohort, which was 0.761 after 1 000 Bootstrap corrections; the area under the curve was 0.759 in the internal validation cohort and 0.707 in the external validation cohort. The calibration curves demonstrated good agreement between predicted and observed probabilities, and decision curve analysis indicated clinical net benefit. &lt;b&gt;Conclusions:&lt;/b&gt; Levator ani complex volume, preoperative chemoradiotherapy, and ISR classification are independent predictors of severe low anterior resection syndrome after intersphincteric resection. The nomogram model c","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 11","pages":"1217-1227"},"PeriodicalIF":0.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149013281","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 clinical effect of total hip arthroplasty through direct anterior approach in the lateral decubitus position combined with proximal femur osteotomy for Hartofilakidis type C developmental dysplasia of the hip].","authors":"G Y Li, X Q Zhang, Z L Luo, M Chen, Y Dai, Z Ni, C Zhu, X F Shang","doi":"10.3760/cma.j.cn112139-20260509-00189","DOIUrl":"10.3760/cma.j.cn112139-20260509-00189","url":null,"abstract":"<p><p><b>Objective:</b> To evaluate the clinical effect of total hip arthroplasty through direct anterior approach in the lateral decubitus position combined with proximal femur osteotomy in the treatment of Hartofilakidis type C developmental dysplasia of the hip(DDH). <b>Methods:</b> A retrospective case series analysis of 134 patients (163 hips) with Hartofilakidis type C developmental dysplasia of the hip who underwent total hip arthroplasty at the Department of Orthopaedics, the First Affiliated Hospital of University of Science and Technology of China from January 2017 to December 2024 was performed. There were 10 males (11 hips) and 124 females (152 hips), aged (44.5±12.3) years (range:22 to 81 years), with the body mass index of (22.6±3.5) kg/m² (range:13.9 to 34.2 kg/m²). Harris hip scores and lower limb length discrepancy were compared between preoperative and final follow-up. Imaging stability of the prosthesis was evaluated by X-ray, and postoperative complications were recorded. The paired sample <i>t</i>-test or Mann-Whitney <i>U</i> test was used to compare data before and after surgery. <b>Results:</b> All patients successfully completed the surgery. The operation time(<i>M</i>(IQR)) was 125(35) min (range:80 to 200 min) and intraoperative bleeding loss was 200(100)ml (range:100 to 1 000 ml). All the patients were followed up for 36(22)months (range:16 to 100 months). Harris hip score increased from preoperative (44.7±5.6) points to (85.2±5.2) points at the last follow-up, and the difference was statistically significant (<i>t</i>=65.677, <i>P</i><0.01). Lower limb length discrepancy decreased from preoperative 5(2)cm to 1(2) cm, and the difference was statistically significant (<i>Z</i>=15.777, <i>P</i><0.01). All acetabular components were stable and free of displacement on imaging during follow-up. In 2 hips, the femoral osteotomy fragment had loosening and displacement after surgery and underwent revision surgery. In 2 hips, Vancouver type C periprosthetic fracture occurred, and they underwent open reduction and internal fixation. In 6 hips, dislocation occurred after surgery and all prostheses were in good position after closed reduction. At the last follow-up, 4 hips had local sensory abnormality in the affected lower limb. No dislocation, loosening, fracture, infection or neurovascular injury occurred in other patients. <b>Conclusion:</b> Total hip arthroplasty through direct anterior approach combined with proximal femur osteotomy for Hartofilakidis type C DDH can effectively improve hip joint function with satisfactory short-to-mid-term outcomes.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 9","pages":"954-960"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148610765","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}