中华外科杂志最新文献

{"title":"[Analysis of adjuvant chemotherapy efficacy based on GLUT1 expression levels after radical resection of pancreatic cancer].","authors":"X H Shi, Y S Zhang, H Jiang, S W Guo, G Jin","doi":"10.3760/cma.j.cn112139-20251221-00599","DOIUrl":"10.3760/cma.j.cn112139-20251221-00599","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the impact of glucose transporter 1 (GLUT1) expression levels on adjuvant chemotherapy efficacy following radical resection of pancreatic cancer and its prognostic significance. <b>Methods:</b> This is a retrospective cohort study. A total of 200 patients who underwent radical resection and adjuvant chemotherapy for pancreatic cancer at the First Affiliated Hospital of Naval Medical University between July 2021 and October 2023 were enrolled. There were 103 males and 97 females, with an age(<i>M</i>(IQR)) of 63 (13) years (range: 33 to 80 years). Tumors were located in the pancreatic head and neck in 126 cases (63.0%) and in the pancreatic body and tail in 74 cases(37.0%). Clinicopathological data and adjuvant chemotherapy regimens were collected. GLUT1 expression in tumor tissues was detected by immunohistochemistry and categorized into high-expression group and low-expression group. A 1∶1 propensity score matching (PSM) was performed to balance confounding factors between groups. Disease-free survival (DFS) and overall survival (OS) were analyzed using the Kaplan-Meier method and Cox proportional hazards regression model. <b>Results:</b> In the original cohort, both DFS and OS in the high GLUT1 expression group were significantly inferior to those in the low expression group (DFS: 13.6 months <i>vs.</i> 21.1 months, <i>P</i><0.01;OS: 25.0 months <i>vs.</i> 31.4 months, <i>P</i><0.01). After PSM, 71 cases were included in each group with balanced baseline characteristics (all <i>P</i>>0.05). Univariate and multivariate analyses revealed that high GLUT1 expression was an independent adverse prognostic factor for DFS (<i>HR</i>=4.742, 95%<i>CI:</i> 2.978 to 7.551) and OS (<i>HR</i>=5.042, 95%<i>CI:</i> 2.673 to 9.513). Subgroup analysis demonstrated that among patients receiving mFOLFIRINOX or gemcitabine-based combination regimens as adjuvant chemotherapy, both DFS and OS were significantly better in the low GLUT1 expression group compared with the high expression group (all <i>P</i><0.05). <b>Conclusion:</b> GLUT1 expression level affects adjuvant chemotherapy efficacy after radical resection of pancreatic cancer, and its high expression is an independent adverse prognostic factor.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 8","pages":"904-911"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148334883","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":"[Blood flow control techniques in pancreatic surgery].","authors":"Z J Tan, Y X Huang, C J Qiu, Q S Chen, J X Chen, Z Y Z Liu, Z T Shen","doi":"10.3760/cma.j.cn112139-20260417-00160","DOIUrl":"10.3760/cma.j.cn112139-20260417-00160","url":null,"abstract":"<p><p>Pancreatic surgery faces severe challenges regarding intraoperative bleeding risk due to complex anatomy and dense vascularity, which is a common difficulty in both open and minimally invasive procedures. Based on the blood supply characteristics of the pancreatic region, this article systematically proposes a blood flow control technical system covering three regions: the pancreatic head, the mid-pancreas, and the pancreatic body-tail. It emphasizes the strategy of \"priority devascularization and pre-blocking\" to prioritize the identification and control of critical vessels, thereby creating a bloodless or low-bleeding surgical field, improving surgical safety and oncological radicality, and promoting blood flow control technology as a new paradigm in pancreatic surgery.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 8","pages":"882-885"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148334891","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":"[Reshaping surgical strategies for pancreatic cancer in the era of neoadjuvant therapy: challenges and opportunities].","authors":"J He, Z Li","doi":"10.3760/cma.j.cn112139-20260311-00097","DOIUrl":"10.3760/cma.j.cn112139-20260311-00097","url":null,"abstract":"<p><p>With the widespread adoption of neoadjuvant therapy in pancreatic cancer, the traditional surgery-centered treatment paradigm is undergoing a profound shift. Against the background of upfront systemic therapy, surgery no longer naturally occupies the starting point of the treatment sequence; instead, its indications, timing, and expected benefits must be re-evaluated and redefined within the new treatment framework. By improving completion of the entire treatment course, enabling biological selection, and optimizing patient selection for surgical intervention, neoadjuvant therapy has driven a shift in resectability assessment from a purely anatomical judgment toward a comprehensive decision-making model that integrates tumor biology and treatment response. Nevertheless, surgical practice faces multiple challenges, including blurred boundaries of surgical indications, greater complexity in determining the optimal timing of surgery, evolving technical difficulty and perioperative risk, and the limitations of traditional evaluation frameworks. On this basis, the role of surgeons is evolving from executors of surgical techniques to central decision-makers within multidisciplinary teams, accompanied by increasing refinement of surgical strategies and ongoing innovation in surgical techniques and assessment concepts. Overall, the reshaping of surgical strategies for pancreatic cancer in the era of neoadjuvant therapy is not centered on the binary question of whether to operate, but rather on determining for whom, when, and how surgery should be performed, with the ultimate goal of achieving precise surgical decision-making oriented toward long-term survival benefit for patients.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 8","pages":"850-855"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148334902","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":"[Efficacy and safety of unilateral biportal endoscopic technique for the treatment of thoracic myelopathy caused by short-segment ossification of the ligamentum flavum].","authors":"Y P Wang, Z X Tang, Q Tang, W Niu, L Jian, B C Xia, T L Chen, M K Shen, H J Yang","doi":"10.3760/cma.j.cn112139-20260508-0186","DOIUrl":"https://doi.org/10.3760/cma.j.cn112139-20260508-0186","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To investigate the efficacy and safety of unilateral biportal endoscopy (UBE) for the treatment of thoracic myelopathy caused by thoracic ossification of the ligamentum flavum (TOLF). &lt;b&gt;Methods:&lt;/b&gt; A retrospective case series analysis was conducted on the clinical data of 80 patients with short-segment (≤2 levels) TOLF who underwent UBE surgery at our institution between January 2020 and December 2024. The cohort comprised 44 males and 36 females with an age of (55.8±10.7) years (range: 34 to 76 years). Fifty-nine cases involved a single segment, and 21 cases involved two segments; 27 cases had concomitant dural ossification. Intraoperatively, a diamond burr was used to perform full-thickness drilling of the ossified ligamentum flavum, and the \"floating technique\" was applied in cases with dural ossification. Operative time, length of hospital stays, and perioperative complications were recorded. Spinal canal area and sagittal diameter were measured preoperatively, at postoperative day 3, and at the final follow-up. The Oswestry disability index (ODI) and Japanese Orthopaedic Association (JOA) score were assessed preoperatively, at postoperative day 3 and 3 months, and at the final follow-up. Repeated measures ANOVA was used to compare pre- and postoperative data, with pairwise comparisons adjusted using Bonferroni post-hoc tests. &lt;b&gt;Results:&lt;/b&gt; All procedures were completed successfully without conversion to open surgery. The operative time was (141.4±44.6) min (range: 80 to 220 min), and the length of hospital stay was (11.7±5.5) d (range: 7 to 28 d). The follow-up period was (33.5±13.1)months (range: 12 to 60 months). Postoperative cerebrospinal fluid leakage occurred in 20 cases (25.0%, 20/80), all of which were associated with concomitant dural ossification or severe dural adhesion, and after conservative treatment, no cerebrospinal fluid leakage occurred. Epidural hematoma occurred in 3 cases (3.8%, 3/80), all of which were successfully managed by emergency endoscopic hematoma evacuation with subsequent recovery of muscle strength. Neurological deterioration due to improper drain placement occurred in 4 cases (5.0%, 4/80), all of which recovered to preoperative muscle strength levels by the final follow-up. Compared with preoperative values, spinal canal area and sagittal diameter were significantly increased at postoperative day 3 and at the final follow-up (all &lt;i&gt;P&lt;/i&gt;&lt;0.05). ODI and JOA scores showed significant improvement at all postoperative time points compared with preoperative values (all &lt;i&gt;P&lt;/i&gt;&lt;0.05). No symptom recurrence or neurological deterioration was observed at the final follow-up. &lt;b&gt;Conclusions:&lt;/b&gt; UBE is an effective technique for the treatment of thoracic myelopathy caused by short-segment TOLF, achieving adequate spinal canal decompression and significant improvement in neurological function. Appropriate preoperative surgical approach planning and correct intraoperative decompression stra","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 9","pages":"979-986"},"PeriodicalIF":0.0,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148610625","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":"[Independent factors for testicular salvage failure after pediatric testicular torsion surgery].","authors":"Y C Yang, S Dai, Z G Feng, X M Yan, T Zhang, Z C Yu, G C Chen, X Cao","doi":"10.3760/cma.j.cn112139-20260417-00157","DOIUrl":"10.3760/cma.j.cn112139-20260417-00157","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the factors affecting testicular salvage effect in pediatric patients after testicular torsion. <b>Methods:</b> A retrospective case control analysis was performed on the clinical data of 262 pediatric patients after surgery for testicular torsion from January 2011 to December 2023 at Department of Urology, Children's Hospital Affiliated to Soochow University. Their age (<i>M</i>(IQR)) was 12.0 (5.7) years(range:0.1 to 16.0 years). Based on the type of surgery and follow-up results of more than 6 months, the patients were divided into a testicular salvage success group and testicular salvage failure group (including those who underwent orchiectomy or developed atrophy after orchiopexy). Univariate and multivariate Cox regression analyses were used to screen for independent factors associated with testicular salvage success, and receiver operating characteristic (ROC) curves were used to evaluate the predictive performance of each independent risk factor. <b>Results:</b> A total of 84 children were included in the testicular salvage success group, and 178 were included in the testicular salvage failure group. Univariate and multivariate Cox regression analysis showed that age (<i>HR</i>=0.962, <i>P=</i>0.030), symptom duration (<i>HR</i>=1.005, <i>P<</i>0.01), degree of torsion (<i>HR</i>=1.001, <i>P<</i>0.01), positive intratesticular blood flow signal on ultrasound (<i>HR</i>=0.418, <i>P=</i>0.001), monocyte count (<i>HR</i>=1.716, <i>P=</i>0.021), C-reactive protein (CRP) concentration (<i>HR</i>=1.012, <i>P=</i>0.010), and urine ketone bodies (<i>HR</i>=1.478, <i>P=</i>0.048) were independent factors for testicular salvage effect. ROC curve analysis showed the area under the curve for each factor: symptom duration 0.826 (cut-off value 8 h), degree of torsion 0.773, CRP concentration 0.781, and monocyte count 0.706. <b>Conclusions:</b> Symptom duration, degree of torsion, intratesticular blood flow signal on ultrasound, monocyte count, CRP concentration, and urine ketone bodies are independent factors for predicting the prognosis of testicular torsion. Evaluation of these indicators helps to more accurately assess testicular viability before and during surgery, guide surgical decision-making.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 7","pages":"778-784"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148044621","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":"[Stratified application of CA19-9 in the surveillance of postoperative recurrence of pancreatic cancer].","authors":"Y T Bing, T Zhao, Q Chen, L Li, C H Yuan","doi":"10.3760/cma.j.cn112139-20250722-00364","DOIUrl":"10.3760/cma.j.cn112139-20250722-00364","url":null,"abstract":"<p><p>Pancreatic cancer is characterized by high postoperative metastasis and recurrence rates, making the identification of early recurrence markers with high sensitivity and specificity critically important. CA19-9 is closely associated with pancreatic cancer recurrence, metastasis, and patient survival. This study systematically explores the application of CA19-9 in stratified monitoring, aiming to provide a theoretical basis for developing personalized follow-up strategies. Currently, there is no consensus on postoperative recurrence monitoring protocols for pancreatic cancer, and the use of CA19-9 alone for recurrence monitoring faces dual challenges at both biological and clinical levels. Stratified monitoring strategies based on CA19-9 phenotypes can partially address these issues, but they also encounter challenges such as the lack of consensus on specific follow-up strategies, inconsistent dynamic monitoring thresholds for CA19-9, and low adoption of genotyping. Future efforts should focus on exploring optimal dynamic CA19-9 thresholds, integrating artificial intelligence and big data to establish personalized models, and promoting multicenter collaboration to validate their clinical value, thereby making CA19-9 a more precise and reliable tool for postoperative recurrence monitoring.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 7","pages":"701-707"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148044752","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":"[Research progress on the role of tertiary lymphoid structures in the perioperative comprehensive therapy of biliary tract cancer].","authors":"X L Zhou, D L Qin, Z L Li, J L Chen, Y Tang, Z H Tang, Z W Quan","doi":"10.3760/cma.j.cn112139-20251102-00511","DOIUrl":"10.3760/cma.j.cn112139-20251102-00511","url":null,"abstract":"<p><p>Tertiary lymphoid structures (TLS), which are ectopic lymphocyte aggregates formed during chronic inflammation, are widely present in the tumor microenvironment of solid malignancies. By regulating anti-tumor immune responses, TLS is increasingly recognized as a key focus in cancer therapeutic research. However, systematic investigations into its role in biliary tract cancer (BTC) remain scarce. This essay outlines the fundamental characteristics, heterogeneity, and prognostic significance of TLS, and explores its potential role in perioperative comprehensive treatment and therapy sensitivity assessment for BTC. It provides novel perspectives and a theoretical foundation for TLS-guided precision therapy in biliary tract cancer.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 7","pages":"722-727"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148044809","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":"[Applications and prospects of artificial intelligence for decision-making in spinal surgery].","authors":"Y D Fang, H J Zhou, J H Xu, W Mo","doi":"10.3760/cma.j.cn112139-20251127-00549","DOIUrl":"10.3760/cma.j.cn112139-20251127-00549","url":null,"abstract":"<p><p>The application of artificial intelligence in decision support for spinal surgery has developed rapidly and now widely covers key steps such as automatic segmentation and classification of spinal imaging, determination of surgical indications, pedicle screw trajectory planning, and prediction of postoperative prognosis and complication risks. However, most current studies remain limited to single-center retrospective analyses, and the external validation, interpretability, and clinical implementation of these models are still inadequate. In the future, it will be necessary to leverage multi-center, multimodal, high-quality clinical data resources to strengthen the evaluation of model robustness and clinical effectiveness, improve assessment frameworks and reporting standards, and promote the deep integration of artificial intelligence with intraoperative navigation systems, robotic platforms, and wearable devices, thereby gradually transforming experience-based decisions into data-driven decision-making and prediction, so as to better assist spine surgeons in making safe, precise, and clinically implementable decisions.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 7","pages":"740-744"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148044629","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 central role of multimodal brain monitoring-guided general anesthesia management in preventing postoperative neurological complications in elderly patients].","authors":"S Y Yang, W Xiao, T L Wang","doi":"10.3760/cma.j.cn112139-20251230-00617","DOIUrl":"10.3760/cma.j.cn112139-20251230-00617","url":null,"abstract":"<p><p>With the acceleration of population aging, the proportion of elderly patients undergoing surgical procedures continues to increase. The incidence of postoperative neurological complications, including postoperative delirium and postoperative cognitive dysfunction, has risen significantly. These complications have become major factors affecting patient prognosis and healthcare resource utilization. The aging brain exhibits vulnerability-associated changes across its structural, functional, metabolic, and inflammatory levels. These alterations heighten the sensitivity of elderly patients to anesthetic agents, nociceptive stimuli, and hemodynamic instability. Conventional single-modality monitoring techniques are insufficient to comprehensively assess cerebral functional status. Multimodal brain monitoring-guided general anesthesia management refers to the combined use of techniques that assess sedation depth, analgesia depth, and cerebral oxygen supply-demand balance through brain bioinformatic analysis, in response to anesthesia-related stressors such as noxious stimulation, inflammatory responses, and cerebral ischemia or hypoxia. This approach may be integrated with anti-inflammatory management strategies. Multimodal brain monitoring may help optimize perioperative anesthetic management and potentially reduce the risk of postoperative neurological complications in elderly patients. This article reviews the pathophysiological basis of vulnerable brain function in elderly patients and the clinical value of multimodal brain monitoring-guided general anesthesia management, with the aim of providing references for perioperative neuroprotection in the elderly patients.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 7","pages":"745-751"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148044785","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 risk factors for acute kidney injury following reoperative cardiac surgery].","authors":"L Hong, C Zhang, X C Song, X Wang, Q K Shi, W Chen, C C Cao, X Chen","doi":"10.3760/cma.j.cn112139-20251202-00561","DOIUrl":"10.3760/cma.j.cn112139-20251202-00561","url":null,"abstract":"<p><p><b>Objective:</b> To identify perioperative risk factors associated with postoperative acute kidney injury (AKI) following redo cardiac surgery, with an emphasis on the roles of operative strategies. <b>Methods:</b> This is a retrospective case control study. A retrospective analysis was conducted on the clinical data of 293 patients who underwent redo cardiac surgery at Nanjing First Hospital between January 2016 and September 2025. There were 140 male cases, 153 female cases, aged (<i>M</i>(IQR)) 61(17) years (range:22 to 82 years). Patients were divided into AKI (<i>n=</i>158) group and non-AKI group (<i>n=</i>135). The comparison of data between the two groups was conducted using independent sample <i>t</i> test, Mann-Whitney <i>U</i>, <i>χ</i>² test or Fisher's exact probability method,respectively. Univariable and multivariable Logistic regression analyses were performed to identify potential risk factors for AKI and to assess their independent associations. A mediation model was further established to explore whether prolonged cardiopulmonary bypass (CPB) time mediated the relationship, aiming to elucidate mechanisms in the context of redo cardiac surgery. <b>Results:</b> Advanced age (<i>OR=</i>1.03,95<i>%CI</i>:1.01 to 1.05,<i>P=</i>0.008), history of diabetes (<i>OR=</i>3.95,95<i>%CI</i>:1.66 to 9.37,<i>P=</i>0.002) and atrial fibrillation (<i>OR=</i>1.94,95<i>%CI</i>:1.10 to 3.42,<i>P=</i>0.022), prolonged CPB time (<i>OR=</i>2.09,95<i>%CI</i>:1.53 to 2.86,<i>P<</i>0.01), increased intraoperative blood transfusion volume (per 100 ml,<i>OR=</i>1.06,95<i>%CI</i>:1.03 to 1.10,<i>P=</i>0.011) were identified as independent risk factors for AKI. Increased intraoperative urine output was identified as an independent protective factor against postoperative AKI (per 100 ml, <i>OR=</i>0.96,95<i>%CI</i>:0.92 to 0.99,<i>P=</i>0.032). Mediation analysis indicated that the relationship between early CPB institution before sternal re-entry and AKI may be partially mediated by prolonged CPB duration, the average causal mediation effect was 0.041(95<i>%CI</i>: 0.012 to 0.080,<i>P=</i>0.004). <b>Conclusions:</b> The incidence of AKI is relatively high after redo cardiac surgery. Minimizing CPB time, reducing transfusion during surgery may serve as an important strategy to reduce the risk of AKI.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 7","pages":"785-792"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148044643","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}