ObjectiveThyroid nodules are an exceptionally common thyroid disorder. Past studies suggested a possible link between thyroid diseases and breast neoplasms. However, few studies have delved into the causal relationship between thyroid nodules and breast neoplasms. This study conducted a Mendelian randomization (MR) analysis to further investigate the causal relationship between them. MethodsThis study was conducted using data sourced from genome-wide association study (GWAS) summary datasets. The study focused on thyroid nodules, benign breast tumors, and malignant breast cancers as the research objects, and relevant single nucleotide polymorphisms (SNPs) were selected as instrumental variables (IVs). The inverse-variance weighted (IVW) was primarily used to assess the causal relationship between thyroid nodules and breast neoplasms. Cochran’s Q test was employed to detect heterogeneity, while MR-Egger intercept and MR-PRESSO were used to test for pleiotropy. Sensitivity analysis was conducted using the leave-one-out method. ResultsThere was a significant causal relationship between thyroid nodules and malignant neoplasm of breast (OR=0.88, 95%CI 0.83 to 0.95, P<0.01), with no evidence of reverse causality between them (OR=1.01, 95%CI 0.99 to 1.03, P=0.16). No causal relationship was found between thyroid nodules and benign neoplasm of breast, as indicated by both forward MR analysis (OR=0.97, 95%CI 0.89 to 1.06, P=0.51) and reverse MR analysis (OR=0.97, 95%CI 0.92 to 1.04, P=0.40). Sensitivity analyses suggested that the study findings were accurate and reliable. ConclusionThe present study identifies thyroid nodules as a potential protective factor for malignant neoplasm of breast.
ObjectiveTo compare efficacy of laparoscopic or open hepatectomy in benign liver tumors patients with different difficult operations. MethodsAccording to the inclusion and exclusion criteria, the patients with benign liver tumors who underwent hepatectomy in the Affiliated Hospital of Xuzhou Medical University from September 2014 to March 2021 were collected. The enrolled patients were assigned into low, medium, and high difficulties by the Hasegawa liver resection surgical difficulty score model, then the patients were matched by propensity score matching. The liver function and inflammatory indexes, intraoperative bleeding, operative time, total hospital stay, postoperative complications, and hospitalization expenses of patients with benign liver tumors after laparoscopic (laparoscope group) or open (open group) hepatectomy were compared. ResultsA total of 209 patients who met the inclusion and exclusion criteria were enrolled in this study. According to the Hasegawa criteria, there were 59, 89, and 61 patients with low, medium, and high difficulties respectively. After 1∶1 propensity score matching, 18, 34, and 14 patients in the laparoscope group and open group were matched respectively. There were no statistic differences in the baseline data between the laparoscope group and open group (P>0.05). ① For the patients with low and medium difficulties, compared with the open group, the different values of alanine aminotransferase, aspartate aminotransferase, white blood cell count, and neutrophil percentage were lower (P<0.05), the intraoperative bleeding and total hospital stay were less or shorter (P<0.05), and the albumin were higher (P<0.05) in the laparoscope group. There were no statistic differences in these indexes among the patients with high difficulty (P>0.05). ② Compared with the open group, the operative time of the laparoscope group was shorter in the patients with low difficulty (P<0.05) and longer in the patients with high difficulty (P<0.05), and there was no statistic difference in patients with medium difficulty (P>0.05). ③ The postoperative complications had no statistic differences between the two groups for the patients with low and high difficulties (P>0.05), while which in the laparoscope group were lower than in the open group for the patients with medium difficulty (P<0.05). ④ The hospitalization expenses of the laparoscope group was higher than the open group for the patients with high difficulty (P<0.05), while which had no statistic differences between the two groups for the patients with low and medium difficulties (P>0.05). ⑤ The total hospital stay of the laparoscope group was shorter than the open group (P<0.05) no matter which difficult operation.ConclusionsAccording to results of this study, laparoscopic hepatectomy has more obvious advantages as compared with open hepatectomy for patients with low or medium difficulty, which could greatly shorten hospital stay and accelerate rehabilitation of patients. Even for patients with high difficulty, laparoscopic hepatectomy still shows an advantage of shortening hospital stay.
Duodenum-preserving pancreatic head resection (DPPHR) is a surgical approach indicated for benign or low-grade malignant tumors of the pancreatic head, pancreatic duct stones in the pancreatic head, chronic pancreatitis, and related pathologies. Compared to traditional pancreaticoduodenectomy (PD), its core principle lies in preserving the integrity of the stomach, duodenum, and biliary tract, thereby reducing postoperative digestive dysfunction and metabolic complications to improve patients’ quality of life. With the continuous advancement of laparoscopic techniques, laparoscopic duodenum-preserving pancreatic head resection (LDPPHR) has emerged as a significant refinement of conventional PD, achieving an optimal integration of minimally invasive laparoscopy and organ function preservation. This article synthesizes recent Chinese and English literature to provide a systematic review of surgical indications, technical nuances, complication management, and clinical outcomes of LDPPHR.
目的 探讨十二指肠良性肿瘤的诊断与治疗。方法 对1992~1998年间收治的10例患者的临床资料行回顾性总结分析。 结果术前经纤维十二指肠镜确诊7例 ，上消化道X线钡餐确诊3例。肿瘤位于十二指肠降部7例，球部3例。其中6例行手术治疗，4例因心肺脑等严重合并症行保守治疗。手术为十二指肠肿瘤局部切除连同周围肠壁组织部分切除。术后病理报告2例为平滑肌瘤，2例为布鲁氏纳氏腺瘤，2例为间质瘤。结论 十二指肠良性肿瘤可引发严重并发症，如出血、腹痛、肠梗阻、穿孔等，并约有15%的病例可发生恶变。一经诊断，应及早手术治疗，手术一般宜行局部切除。
ObjectiveTo explore the advantages and disadvantages of duodenum-preserving pancreatic head resection (DPPHR) in the clinical application of pancreatic surgical diseases, and to summarize the progress of minimally invasive application of DPPHR combined with the current application of laparoscopy and robot surgery in pancreatic surgery. MethodThe related research literatures about DPPHR at home and abroad in recent years were searched and reviewed. ResultsThe effect of DPPHR compared with traditional pancreaticoduodenectomy (PD) for treatment of benign pancreatic diseases was still controversial, and the postoperative remission effect, perioperative period, occurrence of long-term complications and improvement of quality of life were not very advantageous compared with PD, and the prognosis of minimally invasive surgery was poor. ConclusionDPPHR remains highly controversial for surgical intervention in benign pancreatic disease and has enormous scope for advances in minimally invasive surgical applications in pancreatic surgery, but more clinical studies are needed to verify its clinical efficacy.
Objective To evaluate the therapeutic effect and complications of modified surgical treatment for parotid benign tumors. Methods Forty-nine patients with parotid tumors treated between February 2007 and February 2013 were randomly divided improved surgery group (trial group,n=24) and traditional surgery group (control group,n=25). Follow-up lasted from two months to two years after surgery. Postoperative complications (facial paralysis, Fery’s syndrome, local deformity, and salivary fistula) and recurrence were observed and compared between the two groups. Results All the 49 patients were followed up from two months to one year after surgery. Two years after surgery, three patients in the trial group and four in the control group were missing during the follow-up. No recurrence occurred in all the patients. There were no permanent facial paralysis cases in both groups. No temporary facial paralysis occurred in the trial group, while there were five such cases in the control group with an incidence rate of 20.0%. The trial group had one case of Fery’s syndrome with an incidence rate of 4.2%, and the control group had 4 such cases with an incidence rate of 16.0%. After surgery, the 24 patients in the trail group achieved general facial symmetry without any facial depression deformity, while there were 3 cases of mild facial depression and 1 obvious facial depression in the control group with an incidence rate of 16.0%. Five patients in the control group had saliva fistula with an incidence rate of 24.0% while one in the trail group (4.2%). The differences in the total rate of complications occurrence between the two groups were statistically significant (P<0.05). Conclusion The improved surgical treatment can effectively reduce complications after surgery for parotid benign tumors, which is worthy of clinical promotion.
目的 分析肝脏良性肿瘤的临床诊断、治疗及治疗效果。方法 对川北医学院附属医院2008年2月至2011年2月期间收治并经术后病理学检查证实为肝脏良性肿瘤的156例患者的临床资料进行回顾性分析。结果 156例患者中肝血管瘤119例，肝细胞腺瘤13例，肝内胆管囊腺瘤3例，肝局灶结节性增生9例，肝淋巴管瘤4例，肝血管平滑肌脂肪瘤3例，肝炎性假瘤5例。3例肝局灶结节性增生患者行保守治疗，随访1年，其肿瘤大小和肝功能均无明显变化； 余153例患者行手术治疗，全部切除了病灶，病灶切除率为100％，术后随访6～48个月，平均24个月，均无死亡及复发。结论 肝脏良性肿瘤的症状不典型，缺乏特异性表现，易误诊，应完善超声、CT及MRI检查，并结合病史进行综合分析。对于具有临床症状、肿瘤体积较大（肿瘤直径＞5cm）的肝脏良性肿瘤患者，应积极行手术治疗，术后密切随访。
Our clinical experiences in reconstruction of the defects from excision of benign tumors with expanded skin flap were reported. Since 1987 we have applied this method 23 cases with satisfactory results. When we decided to use this technique, the expander was placed in a pocket adjacent to a benign tumor planned to be excised. Once the skin flap was expanded fully, the tissue expanders were removed. After excision of the benign tumor, the defect was than be covered with the expanded skin flap. The problems related to treatment were discussed in detail.
From 1976 to 1991, 34 cases of benign tumors of femoral neck were received in our department and 29 cases were treated surgically with either free bone graft (18 cases) or vascularized bone graft (11 cases). Fibrous dysplasia of bone and bone cyst had a high incidence in this group (75%)and most of the patients were over 30 years old. Because the femoral neck had its own anatomical characteristics and was biomechanically important and in order to accelerate. The graft healing and prevent the occurrence of pathological fracture, the choice of operations should depend on the extent of the lesion, the thickness of the cortical bone of the affected past,and the presence or absence of complications.