摘要:目的:總結巨大垂體腺瘤水鈉代謝紊亂的圍手術期處理經驗。方法:對71例巨大垂體腺瘤患者術前及術后1周內每日檢測血、尿電解質水平,以及血、尿滲透壓,判斷失鈉及失水類型。總結不同瘤體大小與手術入路和水鈉紊亂發生率、程度、時間之間的關系。結果:71例巨大垂體腺瘤患者中,出現水鈉代謝紊亂52例,發生率73.2%。腫瘤大小與水鈉紊亂發生率、嚴重程度、發生時間成正比,而手術入路選擇與水鈉代謝紊亂發生無明顯相關。結論:巨大垂體腺瘤患者術后水鈉代謝紊亂的發生與瘤體大小成正相關,其出現時間和表現形式復雜。對水鈉代謝紊亂嚴重患者可適當予以預防性治療,以減少臨床癥狀和不良后果。Abstract: Objective: To summarize the preioperative management experience of metabolic disturbance of water and natrium for patients with giant pituitary adenomas. Methods: The electrolyte and osmotic pressure of blood and urine in patients with giant pituitary adenomas were detected within preoperative and postoperative one week and the type of the metabolic disturbance of water and natrium were determined. The correlation of the different tumor size and surgical approach with the incidence rate, extent and time of the metabolic disturbance was summarized. Results: There were 52 cases with different extent metabolic disturbance of water and natrium in 71 cases of giant pituitary adenomas(73.2%). There were a positive correlation of tumor size with the incidence rate, extent and time of the metabolic disturbance, and a negative correlation of surgical approach with that of the metabolic disturbance. Conclusion: The metabolic disturbance of water and natrium in giant pituitary adenomas was positive correlation with the tumor size, which. is various in emergence time and pattern of manifestation. To reduce the clinical symptoms and adverse consequences, prophylactic treatment may be used in patients with serious metabolic disorder of water and natrium.
Giant thoracic tumor is currently one of the diagnostic and therapeutic challenges of thoracic surgery, with no established guideline or standard for diagnosis and treatment. The quality control of individualized surgical strategy and perioperative management with multi-disciplinary participation is the key to ensure the safety and improve the prognosis of patients. Based on the clinical experience of our institution and others, we hereby discussed and summarized the basic principles, surgical strategies and perioperative management of giant thoracic tumor, aiming to provide a reference of quality control.
ObjectiveTo summarize the individualized selection of surgical treatment strategies and the key points of perioperative management for patients with heart valve disease complicated with severe chronic heart failure.MethodsThe clinical characteristics of 5 male patients with valvular heart disease complicated with severe chronic heart failure (CHF) were analyzed retrospectively from June 2017 to October 2018 in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, with an average age of 60.21 years.ResultsFive patients were given angiotensin receptor and neprilysin inhibitor (ARNI)-based anti-heart failure treatment after admission. The operation mode of these patients was decided to be valve replacement under cardiopulmonary bypass after individualized evaluation of patients’ improving symptoms. Three patients were treated with intra-aortic balloon pump (IABP) and continuous renal replacement therapy (CRRT) early after operation to assist patients in improving cardiac function. Five patients recovered oral anti-heart failure after awakening. All patients were discharged smoothly 2 weeks after operation.ConclusionIndividualized evaluation is needed for the choice of operation timing and mode, standardized preoperative treatment for heart failure, shortening the aortic blocking time during cardiopulmonary bypass, and early application of left ventricular adjuvant drugs or instruments are all important measures to help patients recover smoothly.
Lung transplantation has been proved to be an effective treatment after more than forty years of fast development, while more than 4000 cases of lung transplantation performed globally each year. Recently, lung transplantation in China has been advanced rapidly, and the number of transplants has increased year by year. Respiratory and Critical Care Medicine team has been recognized to play a crucial role in lung transplantation. It has an irreplaceable role and status in promoting lung transplantation, improving the preoperative evaluation of lung transplantation and the maintenance of donors, and carrying out perioperative management, as well as long-term follow-up. Lung transplantation is a systematic project, requiring the perfect cooperation and collaboration of team members and contributing to recipients’ recovery.
The technique of transcatheter aortic valve implantation has become increasingly mature. Although the transapical approach has a certain degree of minimally invasive trauma, it still has the characteristics such as heart beating without cardiopulmonary bypass, and the low technical requirements of catheter guide wire. In particular, the valve path is short and coaxial, which is easy to manipulate, and pure regurgitation and stenosis can be easily operated and are not subject to the limit of peripheral artery stenosis. It is still one of China's main approaches for transcatheter aortic valve replacement. Its perioperative management still has specific features and differs from the femoral artery approach. In addition, there is little relevant literature abroad. Therefore, domestic experts in this field were organized to discuss the development of perioperative management specifications to provide reference and techniques support for developing this field in China and further improve the quality of clinical operation and perioperative management. It will provide more safe and more effective medical services to these patients.
With the widespread adoption of lung cancer screening and growing public awareness, the detection rate of pulmonary nodules has increased substantially, posing new challenges for clinical management. Artificial intelligence (AI) has emerged as a powerful tool across the entire management spectrum of pulmonary nodules. Beyond improving detection sensitivity and consistency in chest radiographs and low-dose CT, AI has demonstrated promising applications in malignancy risk assessment, molecular subtype prediction, preoperative 3D planning, intraoperative navigation, and postoperative monitoring. This review summarizes recent advances in the application of AI to pulmonary nodule screening, longitudinal evaluation, pathology prediction, multi-omics integration, and perioperative management. It also discusses the technical characteristics, clinical performance, current limitations, and future prospects of various AI models. The continuous development of AI is reshaping the clinical pathway of pulmonary nodules toward more efficient and individualized care.
ObjectiveTo summarize the recent research progress of artificial intelligence (AI) for perioperative management of colorectal cancer (CRC), and to explore its clinical application value and future development direction. MethodThe relevant research on AI in the perioperative management of CRC surgery from China National Knowledge Infrastructure, Wanfang, PubMed, and Google Scholar databases in the past 5 years was retrieved and reviewed. ResultsCurrently, AI had been applied throughout the entire process related to CRC surgery. Preoperatively, AI-assisted analysis of CT or MRI images facilitated precise tumor staging assessment, prediction of neoadjuvant therapy response, and surgical planning optimization. Intraoperatively, real-time endoscopic vision integrated with AI enabled tumor localization, tracking, and tissue identification accuracy, enhancing procedural safety. Postoperatively, AI-supported rehabilitation protocols optimized early mobilization, enabled continuous complication monitoring, and refined follow-up management, providing personalized intervention strategies for early clinical intervention to improve patient outcomes. ConclusionsCurrent research demonstrates promising outcomes of AI applications in CRC perioperative management, yet reveals a significant imbalance in research focus with predominant investigations concentrated on preoperative assistance. Notably, postoperative domains, including fall prevention, medication error detection, complication mitigation, adjuvant therapy decision support, psychosocial support, recurrence surveillance, and survival follow-up, exhibit marked deficiencies in AI exploration and clinical translation, constituting a critical weakness in establishing comprehensive intelligent support throughout the perioperative continuum. Future research must extend beyond addressing intraoperative AI challenges to prioritize AI-augmented prediction of short-/long-term complications, optimization of personalized rehabilitation pathways, precision adjuvant therapy decision support, intelligent follow-up systems, and applications enhancing postoperative quality of life and long-term survival outcomes.
ObjectiveTo optimize the perioperative management experiences for breast cancer patients undergoing direct-to-implant-based breast reconstruction, and provide reference for clinical practice. Methods A comprehensive review of recent domestic and international literature was conducted to systematically summarize the key points of perioperative management for direct-to-implant-based breast reconstruction, including preoperative health education, intraoperative strategies, and postoperative management measures, along with an introduction to the clinical experiences of West China Hospital of Sichuan University. ResultsStandardized perioperative management can effectively reduce the incidence of complications and achieve excellent cosmetic outcomes and quality of life after operation. Preoperative management includes proactive health education to alleviate patients’ anxiety and improve treatment compliance, as well as comprehensive assessment by surgeons of the patient’s physical condition and reconstructive expectations to select the most appropriate implant. Intraoperative management consists of strict aseptic technique, minimizing implant exposure, preserving blood supply to the nipple-areola complex (e.g., by using minimally invasive techniques or indocyanine green angiography, etc), and meticulous hemostasis. Postoperative management encompasses multimodal analgesia, individualized drain management (such as early removal or retaining a small amount of fluid to optimize contour), infection prevention and control (including topical and systemic antibiotics, ultrasound-guided minimally invasive drainage), guidance on rehabilitation exercises (early activity restriction followed by gradual recovery), and regular follow-up to evaluate aesthetic results and monitor for complications. ConclusionEstablishing a standardized, multidisciplinary perioperative management framework markedly enhances surgical safety and patient satisfaction, thereby providing a replicable benchmark for direct-to-implant-based breast reconstruction across diverse clinical settings.
With the widespread adoption of antiretroviral therapy, vast improvements in the life expectancy of individuals infected with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) were seen, and the liver disease of this population has become a leading cause of mortality. Although liver transplantation is as an effective treatment for end-stage liver disease, it remains in its nascent stage for the patients with HIV/AIDS in China, lacking standardized protocols and substantial clinical experience. Therefore, a “Multicenter expert consensus on perioperative management of liver transplantation in patients with human immunodeficiency virus infection” was formulated. This expert consensus aims to standardize and optimize the diagnosis and treatment process for liver transplantation in HIV-infected patients, providing systematic guidance for this procedure in China and fostering multidisciplinary collaboration and development in the field. This expert consensus clearly delineates the indications and contraindications for liver transplantation in HIV-infected patients, emphasizing comprehensive preoperative evaluations of both donors and recipients. These evaluations include infection control measures, immune function monitoring, and management of comorbidities. In terms of surgical procedures, strategies to prevent occupational exposure and intraoperative guidelines are outlined. Postoperatively, the focus is on antiviral therapy, individualized immunosuppression management, and vigilant monitoring of complications to ensure patient recovery and long-term survival. The long-term follow-up management prioritizes regular assessments of liver function, immune status, and HIV-related indicators to adjust treatment plans and enhance patient survival rates and quality of life. With the continuous enrichment of clinical experience and the progress of clinical research, this consensus will be continuously updated.
ObjectiveTo explore the influence of enhanced recovery after surgery (ERAS) on intestinal flora in patients with colorectal cancer.MethodsBy convenient sampling method, 60 patients with colorectal cancer were selected from August 2018 to December 2019 in the Department of Gastrointestinal Surgery of West China Hospital of Sichuan University and randomly divided into ERAS group and traditional treatment group (traditional group). Among them, the perioperative clinical management was carried out according to the ERAS management and traditional treatment process in the the ERAS group and in the traditional group, respectively. The fresh fecal samples were collected within 24 h after admission and the first natural defecation after operation. The bacterial 16 Sr DNA V3–V4 region was sequenced by Illumina MiSeq sequencer, and the results were analyzed by bioinformatics.ResultsA total of 60 patients with colorectal cancer were included, 30 cases in the traditional group and 27 cases in the ERAS group (3 people temporarily withdrew from the study). There were no significant differences in the basic informations between the two groups (P>0.05). ① Before or after operation, there were no significant differences in Shannon index and Simpson index between the two groups. The difference between preoperative and postoperative comparison in the same group was also not statistically significant (P>0.05). ② Beta diversity analysis showed that there was no significant difference in community composition between the traditional group and the ERAS group before operation, and there was a clear boundary between the traditional group and the ERAS group after operation. ③ At the phylum level, compared with the preoperative abundance, the postoperative abundance Firmicutes decreased by 26.5% and 5.5% in the traditional and ERAS group, respectively; Bacteroidetes increased by 21.6% and 4.7% in the traditional and ERAS group, respectively; Proteobacteria increased by 7.2% and 2.2% in the traditional and ERAS group, respectively. At the genus level, compared with the preoperative abundance, the postoperative abundance of Bacteroides in the traditional group increased by 17.6% and in the ERAS group decreased by 1.6%; Bifidobacterium decreased by 1.8% and 1.3% in the traditional group and in the ERAS group, respectively.ConclusionsERAS does not affect species diversity of intestinal flora. Although ERAS has some damage to structure of intestinal flora, it is weaker than traditional process, so it is more conducive to reconstruction and restoration of intestinal microecological environment.
