ObjectiveTo systematically review the effectiveness and safety of anatomic landmarks positioning method (ALM) and real-time two-dimensional ultrasound (RTUS) guidance in the internal jugular vein cannulation. MethodsWe searched PubMed, EMbase, Web of Knowledge, CBM, WanFang Data and CNKI for randomized controlled trials (RCTs) concerning the effectiveness and safety of ALM and RTUS in the internal jugular vein catheterization up to May 1st, 2014. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assess methodological quality of included studies. Then meta-analysis was performed using RevMan 5.3 software. ResultsA total of 10 RCTs involving 1 973 cases were included in the metaanalysis. The results of meta-analysis showed that, compared with the ALM method, the RTUS method reduced puncture failure rate (OR=0.08, 95%CI 0.05 to 0.15, P<0.000 01). For safety, compared with the ALM method, the RTUS method was significantly lower in arterial injury rate (peto-OR=0.22, 95%CI 0.14 to 0.37, P<0.000 01), and the incidence of pneumothorax (peto-OR=0.13, 95%CI 0.04 to 0.40, P=0.000 3). ConclusionCompared to the ALM method, the RTUS method has characteristics such as causing fewer traumas, and having higher success rate and fewer complications. Due to limited quantity and quality of the included studies, the above conclusion still needs to be verified by conducting more studies.
ObjectiveTo compare the diagnostic accuracy, sampling satisfaction, and safety of ultrasound-guided core needle biopsy (CNB) and fine needle aspiration biopsy (FNA) for thyroid nodules.MethodsThe databases of PubMed, Medline, Web of Science, Cochrane Library, Wanfang, CNKI, and CBM were searched to collect the relevant studies on the diagnostic performance, sampling satisfaction, and safety of ultrasound-guided CNB and FNA for thyroid nodules. Revman 5.3 and Stata 15 software were used for meta-analysis.ResultsA total of 24 studies involving 25 388 patients were included. Meta analysis showed that: compared with CNB, FNA had poor diagnostic accuracy ［OR=0.26, 95%CI (0.15, 0.46), P<0.000 01］, poor sampling satisfaction ［OR=0.20, 95%CI (0.12, 0.33), P<0.000 01］, lower incidence of total complications ［OR=0.28, 95%CI (0.16, 0.50), P<0.000 1］, and lower incidence of bleeding after biopsy ［OR=0.62, 95%CI (0.48, 0.81), P=0.000 3］. However, there was no significant difference in the pain score ［WMD=–0.21, 95%CI (–0.57, 0.15), P=0.26］ between the two groups. Subgroup analysis showed that there was no significant difference in the accuracy of biopsy diagnosis of thyroid nodules with diameter less than 10 mm between the two groups ［OR=0.52, 95%CI (0.15, 1.81), P=0.30］, however, the accuracy of CNB in the diagnosis of thyroid nodules with diameter ≥ 10 mm was still better than FNA ［OR=0.26, 95%CI (0.12, 0.56), P=0.000 5］.ConclusionsCompared with FNA, ultrasound-guided CNB has a certain advantages in sampling satisfaction and the diagnosis accuracy of thyroid nodules with diameter ≥ 10 mm. CNB is better than FNA, but will bring higher risk of complication.
Objective To compare the effectiveness of poly ether ether ketone (PEEK) positioning devices combined with mixed reality technology versus color doppler ultrasound guidance for the localization of vessels in anterolateral thigh perforator flap. Methods A retrospective analysis was conducted on 40 patients with tissue defects after oral cancer resection who underwent repair using the anterolateral thigh perforator flap between January 2022 and June 2023. According to the different intraoperative positioning methods of the anterolateral thigh perforator flap, they were randomly divided into PEEK group (mixed reality technology positioning with PEEK positioning device combined with CTA data) and color ultrasound group (using color ultrasound guided positioning), with 20 cases in each group. There was no significant difference in gender, age, etiology, and disease duration in the two groups (P>0.05). The number of perforator vessels actually detected in the two groups of regions of interest was recorded, and compared them with the intraoperative identified number to calculate the success rate of perforator vessels; the distance between the perforating point and the actual puncture point was measured, the operation time of the two groups of flaps was recorded. ResultsP In the PEEK group, 32 perforator vessels were identified, 34 were found by intraoperative exploration, and the success rate was 94.1% (32/34); in the color ultrasound group, 29 perforator vessels were identified, 33 were found by intraoperative exploration, and the success rate was 87.8% (29/33); there was a significant difference in the success rate of identifying perforator vessels between the two groups (P<0.05). The distance between the perforating point and the actual puncture point and the operation time in PEEK group were significantly shorter than those in color ultrasound group (P<0.05). Patients in both groups were followed up 6-30 months, with a median of 17 months; there was no significant difference in the follow-up time between the two groups (P>0.05). In the PEEK group, there was 1 case of flap necrosis at the distal edge and delayed healing after trimming and dressing change. In the color ultrasound group, there was 1 case of flap necrosis at 7 days after operation and pectoralis major myocutaneous flap was selected for repair after removal of the necrotic flap. In the rest, the flap survived and the incision healed by first intention. Donor site infection occurred in 1 case in PEEK group and healed after anti-inflammatory treatment. The maxillofacial appearance of the two groups was good, the flap was not obviously bloated, and the patients were satisfied with the repair effect. Conclusion Compared with the traditional color ultrasound positioning, the positioning marker made of PEEK combined with CTA data to locate the vessels in anterolateral thigh perforator flap has higher success rate and positioning accuracy, and the flap production time is short, which has high clinical application value.