ObjectiveTo explore the clinical efficacy and summarize the experience of intracapsular approach used in laparoscopic duodenum-preserving total pancreatic head resection (LDPPHRt). MethodThe clinical data of patients (from April 2020 to June 2024), including preoperative, intraoperative, and postoperative details who underwent LDPPHRt in Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology were collected and analyzed. ResultsSeventy-five patients were collected in this study, including 35 males (46.7%) and 40 females (53.3%). The age was (38.3±7.9) years old, and 35 patients (46.7%) presented without symptoms. The main symptoms were abdominal pain (21 cases, 28.0%), repeated diarrhea (15 cases, 20.0%), weight loss (4 cases, 5.3%). The diameter of the pancreatic head lesions was (3.2±0.8) cm. The operative time was (210.6±23.8) min, and the blood loss was (62.4±38.1) mL. There were 18 cases (24.0%) of postoperative complications, including 6 cases (8.0%) of postoperative pancreatic fistula, 5 cases (6.7%) of haemorrhage, 4 cases (5.3%) of biliary leakage, 2 cases (2.7%) of lymphatic leakage, 4 cases (5.3%) of delayed gastric emptying, 2 cases (2.7%) of abdominal infection, 1 case (1.3%) of pulmonary infection and 2 cases (2.7%) of wound infection. The length of postoperative hospital stay was (11.7±3.3) d, and no one died within 90 d after surgery. ConclusionsThe intracapsular approach is a feasible and safe surgical procedure in LDPPHRt for patients with benign, borderline or low grade malignant tumors.
Objective To explore the impact of anemia on the incidence of perioperative lower limb deep vein thrombosis (DVT) in patients undergoing total hip arthroplasty (THA). Methods A retrospective analysis was conducted on clinical data of 1 916 non-fracture patients who underwent THA between September 2015 and December 2021, meeting the selection criteria. Among them, there were 811 male and 1 105 female patients, aged between 18 and 94 years with an average of 59.2 years. Among the patients, 213 were diagnosed with anemia, while 1 703 were not. Preoperative DVT was observed in 55 patients, while 1 861 patients did not have DVT preoperatively (of which 75 patients developed new-onset DVT postoperatively). Univariate analysis was performed on variables including age, gender, body mass index (BMI), diabetes, hypertension, history of tumors, history of thrombosis, history of smoking, revision surgery, preoperative D-dimer positivity (≥0.5 mg/L), presence of anemia, operation time, intraoperative blood loss, transfusion requirement, and pre- and post-operative levels of red blood cells, hemoglobin, hematocrit, and platelets. Furthermore, logistic regression was utilized for multivariate analysis to identify risk factors associated with DVT formation. Results Univariate analysis showed that age, gender, hypertension, revision surgery, preoperative levels of red blood cells, preoperative hemoglobin, preoperative D-dimer positivity, and anemia were influencing factors for preoperative DVT (P<0.05). Further logistic regression analysis indicated that age (>60 years old), female, preoperative D-dimer positivity, and anemia were risk factors for preoperative DVT (P<0.05). Univariate analysis also revealed that age, female, revision surgery, preoperative D-dimer positivity, anemia, transfusion requirement, postoperative level of red blood cells, and postoperative hemoglobin level were influencing factors for postoperative new-onset DVT (P<0.05). Further logistic regression analysis indicated that age (>60 years old), female, and revision surgery were risk factors for postoperative new-onset DVT (P<0.05). Conclusion The incidence of anemia is higher among patients with preoperative DVT for THA, and anemia is an independent risk factor for preoperative DVT occurrence in THA. While anemia may not be an independent risk factor for THA postoperative new-onset DVT, the incidence of anemia is higher among patients with postoperative new-onset DVT.
ObjectiveTo explore the correlation between the Barthel index score and other factors with the preoperative occurrence of deep vein thrombosis (DVT) in patients undergoing total hip arthroplasty (THA) revision surgery. MethodsA retrospective analysis was conducted on clinical data from 122 patients who met the inclusion criteria and underwent THA revision surgery between April 2017 and November 2020. Among them, 61 were male and 61 were female, with an age range of 32-85 years (mean, 65.3 years). The reasons for revision included prosthetic joint infection in 7 cases, periprosthetic fracture in 4 cases, prosthetic dislocation in 6 cases, and aseptic loosening in 105 cases. The Barthel index score was 76.4±17.7, with 10 cases classified as level 1, 57 as level 2, 37 as level 3, and 18 as level 4. Univariate analysis was performed on variables such as age, gender, body mass index, Barthel index score, preoperative D-dimer positivity, history of diabetes, hypertension, cancer, cerebral infarction, smoking, and thrombosis in patients with and without preoperative DVT. Furthermore, logistic regression was used to identify risk factors for preoperative DVT in THA revision surgery. The incidence of preoperative DVT was compared among different Barthel index score groups. ResultsPreoperative DVT was detected in 11 patients (9.02%), all of whom had intermuscular venous thrombosis. Among them, 1 had prosthetic joint infection, 1 had periprosthetic fracture, 1 had prosthetic dislocation, and 8 had aseptic loosening. Univariate analysis showed significant differences between the two groups in terms of age, gender, and Barthel index score (P<0.05). logistic regression further revealed that female, age ≥70 years, and Barthel index score<60 were independent risk factors for preoperative DVT in patients undergoing THA revision surgery (P<0.05). The incidence of preoperative DVT in patients with Barthel index scores of levels 1, 2, 3, and 4 were 0 case (0%), 2 cases (3.5%), 3 cases (8.1%), and 6 cases (33.3%), respectively. A significant correlation was found between Barthel index score classification and the incidence of preoperative DVT in patients undergoing THA revision surgery (χ2=10.843, P=0.001). ConclusionIn patients undergoing THA revision surgery, older age, female, and lower Barthel index scores are associated with higher preoperative DVT incidence. For patients with low preoperative Barthel index scores, preoperative thrombosis screening should be emphasized.
ObjectiveTo investigate the incidence and risk factors of preoperative deep vein thrombosis (DVT) in patients with periprosthetic hip fractures. Methods This retrospective clinical cohort study enrolled 95 patients with periprosthetic hip fractures who met predefined inclusion and exclusion criteria between January 2016 and December 2025. The cohort included 28 males and 67 females, with a mean age of 72.9 years (range, 39-96 years). According to Vancouver classification, there were 1 case of type A, 32 cases of type B1, 59 cases of type B2, 1 case of type B3, and 2 cases of type C. The interval from injury to hospital admission ranged from 1 to 150 days (mean, 10.9 days). All patients received bilateral lower-extremity venous ultrasonography for preoperative DVT screening. Patients were divided into DVT-positive and DVT-negative groups according to ultrasound findings. Univariate analyses were conducted to compare demographic data (age, gender), underlying comorbidities (hypertension, diabetes mellitus, coronary atherosclerotic heart disease, cerebral infarction, etc.), Vancouver fracture type, injury-to-admission interval, and laboratory indicators (prothrombin time, activated partial thromboplastin time, thrombin time, international normalized ratio, D-dimer, fibrinogen, hemoglobin, red blood cell count, hematocrit, platelet count, serum albumin, triglycerides, total cholesterol, apolipoprotein, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol) between the two groups. The risk factors of preoperative DVT in periprosthetic hip fractures were further screened by logistic regression analysis. Results The overall preoperative prevalence of DVT was 28.42% (27/95) among patients with periprosthetic hip fractures. Subgroup analysis stratified by thrombus location showed 1 case (1.05%) of proximal DVT, 2 cases (2.11%) of distal axial DVT, and 24 cases (25.26%) of calf muscular vein thrombosis. Univariate analysis revealed significant intergroup differences in the prevalence of history of coronary atherosclerotic heart disease and preoperative D-dimer levels between DVT-positive and DVT-negative groups (P<0.05). Receiver operating characteristic curve analysis was performed to assess the predictive efficacy of preoperative D-dimer for preoperative DVT. The area under the curve was 0.667 (95%CI: 0.545, 0.772) (P=0.016). The optimal D-dimer cutoff value was 5.26 mg/L, with a sensitivity of 0.667 and specificity of 0.618. Stratified analysis based on this cutoff demonstrated that patients with D-dimer≥5.26 mg/L had a markedly higher incidence of DVT than those with D-dimer<5.26 mg/L [40.91% (18/44) vs. 17.65% (9/51); χ2=6.283, P=0.012]. logistic regression analysis further verified that history of coronary atherosclerotic heart disease and preoperative D-dimer≥5.26 mg/L were independent risk factors for preoperative DVT (P<0.05). ConclusionThe incidence of preoperative DVT is considerably high in patients with periprosthetic hip fractures. History of coronary atherosclerotic heart disease and elevated preoperative D-dimer (≥5.26 mg/L) are independent risk factors for preoperative DVT in patients with periprosthetic hip fractures, which should be paid great attention to clinically.