Lingnan Modern Clinics In Surgery

Microwave ablation and hepatectomy on prognosis in patients with AJCC stage I hepatocellular carcinoma based on the SEER database

JIANG Chuan, LIU Rui, CAI Bo, CAI Zhe-yun

2025, 25(04): 215-219. DOI: 10.3969/j.issn.1009-976X.2025.04.001

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Objective To explore the optimal management strategy for AJCC stage I hepatocellular carcinoma through a prognostic analysis of different surgical intervention strategies for patients in the SEER database. Methods Data of patients with AJCC stage I hepatocellular carcinoma from January 1, 2010, to December 31, 2015, were retrieved and screened from the SEER database. Propensity score matching （1∶1 nearest neighbor） was used to balance confounding factors, dividing them into a microwave ablation group and a hepatectomy group （165 cases each） based on different surgical intervention strategies. Kaplan-Meier survival analysis was used to plot survival curves and calculate the mean survival time. Cox regression analysis was performed to identify the influencing factors of AJCC stage I hepatocellular carcinoma-specific mortality. Results Kaplan-Meier survival curves showed that the mean survival time of the hepatic resection group was longer than that of the microwave ablation group, and the specific mortality rate of the hepatic resection group was lower than that of the microwave ablation group （P=0.046）. Cox regression analysis showed that surgical intervention, degree of differentiation, marital status, and age were independent risk factors for AJCC stage I hepatocellular carcinoma （all P<0.05）. Conclusion Surgical approach is one of the independent risk factors for patients with AJCC stage I hepatocellular carcinoma. Patients with AJCCstage I hepatocellular carcinoma who undergo liver resection have a reduced cancer specific mortality. The prognosis of patients with AJCC stage I hepatocellular carcinoma who undergo liver resection surgery is significantly higher than that of those who undergo microwave ablation surgery.

Experimental study on the comparison of encrustation of three types of ureteral stents

HUANG Chen, CHEN Hao-dong, XU Chao-zhang, CHEN Tong-quan, CHEN Chu-yi, LI Xun

2025, 25(04): 220-226. DOI: 10.3969/j.issn.1009-976X.2025.04.002

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Objective To conduct a comparative study on the encrustation of three types of ureteral stents under in vitro conditions. Methods The three groups of ureteral stents—hydrophilic-coated ureteral stents, imported non-coated ureteral stents, and domestic non-coated ureteral stents—were evenly divided into 1 cm segments. Subsequently, the segments of the three groups of ureteral stents were immersed in artificial urine for 2, 4, 6, 8, 10, and 12 weeks. After the sample preparation was completed, the outer surfaces and cross-sections of the three groups of ureteral stents were first scanned using a scanning electron microscope （SEM）. Secondly, based on the SEM, an energy-dispersive spectrometer （EDS） was used to analyze the inorganic elements in the encrustation of the regions of interest. Finally, the encrustation was fully dissolved in 5% nitric acid solution, and an automatic biochemical analyzer was employed to measure the concentrations of calcium, phosphate, magnesium, and other ions in the solution. Results The scanning electron microscopy （SEM） images and biochemical analysis results indicated that the encrustation on all three groups of ureteral stents increased with prolonged indwelling time. At the 2-week time point, there was no significant difference in the encrustation mass among the three groups of ureteral stents. Starting from the 4-week time point, the mass of inorganic elements on the hydrophilic-coated stents was significantly greater than that on the imported non-coated stents and the domestic non-coated stents （P<0.01）. Conclusion As the retention time of ureteral stents increases, the amount of crusting progressively increases. Hydrophilic coating materials may promote surface crusting of polyurethane ureteral stents. It is recommended to clinically monitor the retention time of ureteral stents.

Influence of laparoscopic enucleation based on 3D visualization reconstruction on surgical blood loss, liver and kidney function and traumatic stress in patients with renal angiomyolipoma

ZHANG Fa-biao, LIAO Shang-fan, ZHOU Wen-hu, LIAN Zhou-biao, ZHU Ren-wen

2025, 25(04): 227-231. DOI: 10.3969/j.issn.1009-976X.2025.04.003

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Objective To explore the influence of laparoscopic enucleation based on 3D visualization reconstruction on surgical blood loss, liver-kidney function and traumatic stress in patients with renal angiomyolipoma. Methods The clinical data of patients with renal angiomyolipoma admitted to the hospital from January 2020 to January 2025 were retrospectively analyzed. 42 patients with renal angiomyolipoma who received conventional laparoscopic surgery were included in control group, and 40 patients with renal angiomyolipoma who underwent laparoscopic enucleation based on 3D visualization reconstruction were included in study group. The surgery-related indexes and occurrence of postoperative complications were compared between the two groups, and the liver function indexes [alanine aminotransferase （ALT）, aspartate aminotransferase （AST）], renal function indexes [serum creatinine （SCr）, glomerular filtration rate （eGFR）] and serum traumatic stress indexes [total antioxidant capacity （TAC）, serum ischemia modified albumin （IMA）, myoglobin （MYO）] were evaluated in the two groups of patients before surgery and at 24 hours after surgery. Results The surgical time and hospitalization time in study group were significantly shortened compared with than those in control group （all P<0.05）. There were no statistical differences in the renal artery clamping time and blood loss during surgery between the two groups （all P>0.05）. At 24 hours after surgery, serum ALT, AST, SCr, IMA and MYO in the two groups were higher than those before surgery, and the levels of serum SCr, IMA and MYO in study group were lower than those in control group （all P<0.05）. However, there were no statistical differences in serum ALT and AST between study group and control group （P>0.05）. The eGFR and TAC in the two groups were lower than those before surgery, and the eGFR and TAC were higher in study group than those in control group （all P<0.05）. There was no statistical significance in the incidence of postoperative complications between the two groups （P>0.05）. Conclusion Laparoscopic enucleation under 3D visualization reconstruction is helpful to relieve the renal injury and traumatic stress response caused by surgery in patients with renal angiomyolipoma, and has a positive effect on shortening the surgical time and hospitalization time. As an auxiliary surgical technique, 3D visualization reconstruction technology has promotion value.

Jianshen Zhuanggu Tang targets TGF β Gene in regulation of Wnt3a/β-catenin signaling pathway on osteoblasts

ZHANG Zhen-feng, CHEN Jian-cong, ZHANG Xun, WANG Guo-liang

2025, 25(04): 232-238. DOI: 10.3969/j.issn.1009-976X.2025.04.004

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Objective To investigate the mechanism and effect of TGFβ1-mediated Jianshen Zhuanggu Tang （JSZGT） in regulating the Wnt3a/β-catenin signaling pathway on osteoblasts. Methods Osteoblast cell lines C518 and MC3T3-E1 were co-incubated with JSZGT and DKK1 （an inhibitor of the Wnt3a/β-catenin signaling pathway）. The differences in mRNA and protein levels of Wnt3a, TGFβ1, OPG, and RANKL in the cells were detected, and rescue experiments and RNA-seq analysis were conducted. Results After treating C518 and MC3T3-E1 cells with DKK1, the expression levels of TGFβ1, OPG, and RANKL were significantly downregulated （P<0.05）. DKK1 significantly reduced the mRNA and protein levels of Wnt3a, TGFβ1, OPG, and RANKL in both the sh TGFβ1 group and the TGFβ1 overexpression （TGFβ1OE） group （P<0.05）. In the C518 cell model, the knocked down expression of OPG gene inhibited the promoting effect of TGFβ1 on OPG expression; however, JSZGT treatment could restore this promoting effect of TGFβ1 on OPG expression. RNA-Seq results showed that TGFβ1, OPG, and RANKL were significantly differentially expressed genes. Conclusion The TGFβ1 gene mediates JSZGT to regulate the Wnt3a/β-catenin signaling pathway and thus modulate the expression of OPG/RANKL. The TGFβ1 gene may be an important target for the treatment of osteoporosis.

Analysis of efficacy and complications of unilateral biportal endoscopy in the treatment of lumbar spinal stenosis

HUANG Zhi-mou, MIAO Hai-xiong

2025, 25(04): 239-245. DOI: 10.3969/j.issn.1009-976X.2025.04.005

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Objective To evaluate the clinical efficacy, safety, and complications of unilateral biportal endoscopy （UBE） in the treatment of lumbar spinal stenosis. Methods A retrospective analysis was conducted on 80 patients with lumbar spinal stenosis who underwent UBE surgery from December 2022 to December 2023. Perioperative data, including operative time and intraoperative blood loss, were collected and analyzed. Clinical outcomes were assessed using the Visual Analogue Scale （VAS） and Oswestry Disability Index （ODI） at baseline and 3 months postoperatively. Postoperative complications were also documented. Results All procedures were successfully completed. The mean operative time was 3.35±1.18 hours, and the mean intraoperative blood loss was 49.44±53.27 mL. At 3 months post-surgery, both VAS scores （from 7.28±0.98 to 1.68±0.94） and ODI scores （from 0.63±0.10 to 0.16±0.07） showed significant improvement compared to preoperative levels （all P<0.001）. The overall complication rate was 8.75%, which included delayed wound healing （3.75%）, cerebrospinal fluid leakage （2.5%）, epidural hematoma （1.25%）, and recurrence （1.25%）. All complications were resolved with appropriate management and no severe adverse events occurred. Conclusion UBE is a minimally invasive technique that demonstrates definite efficacy in treating lumbar spinal stenosis. It significantly alleviates pain and improves function with a low and manageable complication rate.

New-onset myasthenia gravis crisis in the early postoperative period after simple thymoma： a case report and review of the literature

YANG Lian-kai, GONG Wei-yong

2025, 25(04): 246-249. DOI: 10.3969/j.issn.1009-976X.2025.04.006

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Objective To investigate the risk factors and preventive measures for new-onset myasthenic crisis （MC） early after thymoma surgery. Methods Retrospective analysis of the clinicopathological data of a case of new MC in the early postoperative period after surgery for simple thymoma in Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine, and review of the relevant literature. Results A young patient underwent surgical treatment for a mediastinal tumor, and the postoperative pathology showed type B2 thymoma, and immediately after the operation he had difficulty in lifting his four limbs and head, respiratory weakness, and was unable to be taken off the machine. On the first day after surgery, he was fully conscious but still unable to be taken off the machine. The Neostigmine test （+） diagnosed a new onset of MC after surgery. He was cured by a combination of bromostigmine and intravenous injection of human immunoglobulin （pH4）. Conclusion Early new-onset MC in the postoperative period of simple thymoma is rare, and the key to ensuring the life safety of patients is early diagnosis and rational treatment, and the high-risk factors of postoperative MC in simple thymoma should also be avoided in the perioperative period.

Exploration of the pathogenic causes of a child with congenital hypospadias

CHENG Bing, PENG Xiao-fang, XIAO Xiao-qin, LIAO Rong-huang, SUN Xi, LIANG Li-yang

2025, 25(04): 250-257. DOI: 10.3969/j.issn.1009-976X.2025.04.007

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This article provides a detailed account of the complete diagnosis and treatment process of a child with congenital hypospadias and growth retardation, and thoroughly analyzes the pathogenic factors that led to the clinical phenotype of this child. The article systematically reviews the entire process of the child's visit due to hypospadias, including the results of specialized physical examinations, various laboratory test data, and the implementation of subsequent surgical treatment; at the same time, it dynamically tracks the imaging examination results, laboratory biochemical and endocrine-related detection indicators, as well as the detection data of whole exome sequencing （Whole Exome Sequencing, WES） and chromosomal microarray analysis （Chromosomal Microarray Analysis, CMA） after the surgery. Through the systematic analysis of the above detection results, combined with the latest literature in related fields at home and abroad, a comprehensive judgment is made, and finally, it is determined that this child is a patient with SRY-negative 46,XX developmental abnormality caused by duplication of the upstream enhancer region of the SOX9 gene. This study aims to report this case of SRY-negative 46,XX developmental abnormality combined with hypospadias and growth retardation caused by duplication of the upstream enhancer region of the SOX9 gene, to deeply explore the association between the clinical phenotype and genotype, provide specific case references for the precise diagnosis of similar complex developmental abnormalities, and emphasize the key role of comprehensive genetic testing in the diagnosis and treatment process.

Pyroptosis in thyroid cancer： dual roles and advances in therapeutic interventions

JIN Xin-ru, ZHAO Zi-yi, ZHONG Shu-wen, WU Xian-jiang

2025, 25(04): 258-266. DOI: 10.3969/j.issn.1009-976X.2025.04.008

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Pyroptosis is a novel type of programmed cell death mode. It mediates membrane pore formation and pro-inflammatory factor release through Gasdermin family proteins and shows a bidirectional effect of promoting and inhibiting cancer in thyroid cancer. The standard therapeutic effect of thyroid cancer is still limited. Exploring the application of pyroptosis mechanism in tumor suppression and immune activation has become a new research direction. This article summarizes the differences in the role of pyroptosis in different thyroid cancer subtypes and the tumor immune microenvironment, Outlines the research progress of drug-induced pyroptosis such as chemotherapy, targeted therapy, and traditional Chinese medicine components, and looks forward to the potential of pyroptosis regulation in precision treatment.

Research advances in female sexual dysfunction among breast cancer patients

ZHONG You-xian, YAN Jing-wen

2025, 25(04): 267-272. DOI: 10.3969/j.issn.1009-976X.2025.04.009

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Breast cancer is the most common malignancy among women worldwide. Female sexual dysfunction （FSD） frequently occurs during the diagnosis and treatment of breast cancer, manifesting as decreased sexual desire, difficulties in arousal, orgasmic disorders, and dyspareunia. FSD not only affects patients′ psychological well-being and intimate relationships but also significantly reduces their overall quality of life. The development of FSD in breast cancer patients is influenced by a combination of sociodemographic characteristics, treatment modalities, and cognitive-emotional factors. Various assessment tools have been employed to identify the presence and severity of FSD, providing a clinical basis for evaluation. Psychological interventions have gradually emerged as an important approach to alleviating FSD-related distress and have shown positive effects in improving sexual function. This review systematically summarizes the assessment tools, influencing factors, and psychological interventions for FSD in breast cancer patients, aiming to offer theoretical support for clinical practice and improve the sexual health of this population.

Research progress on surgical omission after neoadjuvant therapy for breast cancer

YAN Meng-xin, CHEN Xiang

2025, 25(04): 273-280. DOI: 10.3969/j.issn.1009-976X.2025.04.010

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In the context of modern multidisciplinary therapy, the improvement of neoadjuvant therapy （NAT） has increased the pathologic complete response （pCR） rate in breast cancer patients. Compared to patients with residual disease, those achieving pCR demonstrate superior prognosis. Accurate non-surgical identification of pCR patients may allow for the omission of breast surgery, but the success of this strategy hinges on diagnostic precision. Preliminary data exist regarding the accuracy of vacuum-assisted breast biopsy （VABB） for assessing tumor response after neoadjuvant therapy in early-stage breast cancer, as well as the feasibility of omitting surgery based on biopsy findings. However, several unresolved issues remain regarding breast surgery omission after NAT, and further clinical trial validation is needed. This review aims to explore the feasibility of omitting breastsurgery in patients who achieve pCR after neoadjuvant therapy.

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