Objective To analyze the prognostic factors and recurrence patterns of locally advanced gastric cancer （LAGC） patients who underwent D2 radical gastrectomy after receiving neoadjuvant chemotherapy combined with immunotherapy. Methods A total of 76 LAGC patients who received neoadjuvant chemotherapy combined with immunotherapy followed by D2 radical gastrectomy at the Department of Gastrointestinal Surgery, Union Hospital, Huazhong University of Science and Technology, from January 2020 to October 2023, were enrolled. According to postoperative recurrence, patients were divided into the recurrence group （22 cases） and non-recurrence group （54 cases）. Clinical and follow-up data were collected. Results There were 14 patients with a single recurrence mode （63.6%）, and the proportion of patients with local recurrence, regional recurrence, abdominal metastasis and distant metastasis was 4.5%, 4.5%, 4.5%, and 50.1%, respectively. Statistically significant differences were found between the recurrence and non-recurrence groups in terms of nerve invasion, vascular invasion, posttreatment pathological tumor （ypT） staging and posttreatment pathological lymph node （ypN） status（all P<0.05）. Univariate analysis revealed that signet-ring cell carcinoma, nerve invasion, vascular invasion, ypT stage, and ypN status were significantly related with disease-free survival （DFS） after D2 radical gastrectomy in LAGC patients receiving neoadjuvant chemotherapy and immunotherapy （all P<0.05）. Multivariate analysis showed that signet-ring cell carcinoma （P=0.048） and ypN status （P=0.035） were independent factors affecting DFS after D2 radical gastrectomy. Additionally, there was a significant difference in the incidence of double recurrence between the ypN0 group and the ypN₊ group patients. Conclusion Signet-ring cell carcinoma and ypN status are independent prognostic factors for LAGC after neoadjuvant chemotherapy combined with immunotherapy and surgery. Preventing distant recurrence after neoadjuvant chemotherapy combined with immunotherapy and surgery is an important approach to further improve the long-term prognosis of LAGC.

Objective This study aims to assess the effectiveness of a modified Chen's pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy （LPD）. Methods A retrospective analysis was conducted on the clinical data of 121 patients who underwent LPD at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology between January 2023 and October 2024. The patients were divided into two groups： traditional surgery group （63 patients） and modified Chen's pancreaticojejunostomy （modified surgery group） （58 patients）. Gender, age, body mass index （BMI）, operation time, pancreatojejunostomy time, intraoperative blood loss, postoperative hospital stay, and the incidence of postoperative complications like pancreatic fistula, abdominal infection, intra-abdominal bleeding, gastrointestinal dysfunction, and mortality were compared between groups. Additionally, moderate-to-high risk patients for pancreatic fistula were identified using the alternative pancreatic fistula risk score system （a-FRS）. The risk of pancreatic fistulas between groups was compared. Quantitative data adhering to a normal distribution were expressed as $\bar{x}±s$ ; otherwise, they were expressed as quartiles [M（Q₁,Q₃）]. Count data were presented as the number of instances. Results Patients in the modified surgery group showed significantly shorter operation time（311.8±55.0 min vs. 357.5±84.5 min,P=0.001）and pancreatojejunostomy time [15.5 （13.8,18.0） min vs. 26.0 （23.0,29.0） min,P<0.001] compared to the traditional surgery group. The incidence of clinically relevant postoperative pancreatic fistula was also significantly lower in the modified surgery group than in the traditional surgery group [3.4% （2/58） vs. 15.9% （10/63）, P=0.022]. There were no significant differences between the two groups in the age, gender, BMI, proportion of patients at moderate-to-high risk for pancreatic fistula, intraoperative blood loss, postoperative hospital stay, rates of abdominal infection, intra-abdominal bleeding, and gastrointestinal dysfunction （P>0.05）. There were no perioperative deaths in both groups. Among the 62 patients at a moderate-to-high risk for pancreatic fistula using the a-FRS model （34 in the traditional surgery group and 28 in the modified surgery group）, those in the modified surgery group still showed significantly shorter operation and pancreatojejunostomy times （P<0.05） and a lower incidence of postoperative pancreatic fistula （P=0.036）. Conclusion The modified Chen's pancreaticojejunostomy simplifies the procedure, decreases the duration of pancreatojejunostomy, and reduces the occurrence of pancreatic fistulas. This technique is effective for patients assessed as having a moderate-to-high risk of developing pancreatic fistulas.

Spontaneous rupture of hepatocellular carcinoma（HCC） is a life-threatening acute complication in HCC patients,clinically manifested as spontaneous tumor rupture and intra-abdominal hemorrhage.Although classified in T₄ by the TNM staging system,targeted treatment strategies can significantly improve the survival prognosis of spontaneous rupture of HCC.This review comprehensively analyzed the epidemiological characteristics,risk factors,pathophysiological mechanisms,and the efficacy differences of various treatment modalities for spontaneous rupture of HCC.It focused on the timing of surgery,perioperative management strategies,and the application of postoperative prognostic prediction models,aiming to provide evidence-based guidance for clinical treatment.Additionally,by integrating recent research advancements,we discussed the importance of redefining the staging of spontaneous rupture of HCC to optimize diagnostic and therapeutic strategies,thereby improving the survival and quality of life.The review also incorporated the previous experience of our center to present the clinical experience in managing spontaneous rupture of HCC at Liver Center,Tongji Hospital,Tongji Medical College of Huazhong University of Science and Technology.

Objective To establish and validate a nomogram prediction model based upon Objective factors for predicting gangrenous/perforated appendicitis （GPA） in children with acute appendicitis （AA）. Methods Between January 2010 and September 2024, the relevant clinical data were retrospectively reviewed for 350 AA children. And patients admitted between January 2010 and December 2019 were allocated into study group （n=225） while those admitted between January 2020 and September 2024 were selected as validation group（n=125）. Appendectomy was performed after a definite diagnosis. They were assigned into two groups of non-gangrenous/perforated appendicitis （N-GPA） and gangrenous/perforated appendicitis （GPA） according to the postoperative results of pathological examination. A comparison was made between two groups. And independent risk factors for GPA were identified through LASSO regression and multivariate Logistic regression analysis. Then these factors were utilized for constructing a nomogram prediction model. Internal validation of nomogram model was conducted with validation group. The area under the receiver operating characteristic curve （AUC） and Hosmer-Lemeshow （H-L） goodness-of-fit test were applied for assessing the model's discrimination and calibration. Results Preoperative computed tomography （CT） findings of fecalith within appendiceal lumen, leukocyte count, duration of symptoms, body temperature and appendiceal diameter as measured by preoperative CT were identified as independent risk factors for GPA in AA children （P< 0.05）. AUC for nomogram prediction model was 0.896 （95%CI： 0.848-0.943） in study group and 0.899 （95%CI： 0.825-0.972） in validation group, indicating an excellent discriminatory power. H-L test results were P=0.459 （χ2=6.72） for study group and P=0.272 （χ2=9.91） for validation group, indicating that nomogram model had a decent predictive accuracy. Conclusion The nomogram prediction model developed here demonstrates high accuracy and it may be readily applied for early identification and risk prediction of GPA in AA children.

Pancreaticojejunostomy is the preferred method of pancreatic digestive tract reconstruction,serving as the most critical step in pancreaticoduodenectomy.It largely determines the occurrence of postoperative pancreatic fistula and other related complications.With the rapid development of pancreatic surgery,the method of pancreaticojejunostomy has undergone different improvements.This article reviewed the characteristics and development trends of common pancreaticojejunostomy in recent years, and proposed a modified pancreaticojejunostomy, namely parallel pancreaticojejunostomy,emphasizing the key points and advantages of the operation, and providing a certain reference for colleagues to perform pancreaticojejunostomy.

双肝外胆管畸形在临床上极为罕见,此文报道了1例由2条独立的肝外胆管相互汇合后进入十二指肠且无异位引流的双肝外胆管畸形病例,探讨双肝外胆管畸形的临床特征和超声声像图特点,并与手术、T管造影进行对照,结合相关文献进行总结分析。双肝外胆管畸形是一种少见的先天性胆道畸形,临床表现不典型,极易漏诊误诊,彩色多普勒超声等影像学检查在双肝外胆管畸形诊断方面具有重要意义。

2023年10月24日武汉大学中南医院肝胆胰外科收治1例71岁女性罕见胆囊肉瘤样癌合并Ⅰ型神经纤维瘤、胃肠间质瘤病人,该例病人因“上腹痛4 d,加重半天”就诊。腹部增强CT示,胆囊壁不均匀增厚并腔内软组织影并周围渗出、积液并脓肿形成,胆囊癌可能;左侧腹腔见类圆形软组织密度影。病人既往诊断Ⅰ型神经纤维瘤。于2023年10月31日行胆囊切除术+小肠部分切除术。术后病理及免疫组织化学诊断为胆囊肉瘤样癌、胃肠间质瘤。病人术后行放化疗及靶向治疗,2024年6月8日因肝转移瘤-结肠瘘合并腹腔感染死亡。胆囊肉瘤样癌临床罕见,与其他类型胆囊癌鉴别困难,需综合病理和免疫组织化学才能明确诊断,尚未有确切的诊疗指南,预后不佳。Ⅰ型神经纤维瘤老年病人建议常规筛查消化道肿瘤。

Intrahepatic cholangiocarcinoma（ICC） is the most common biliary malignancy, serving as the top 2 primary hepatocellular carcinoma only secondary to hepatocellular carcinoma.Its onset is insidious and progresses rapidly,and surgical resection is the only curable approach.However,ICC is featured by a high degree of malignancy, and difficulty in the early diagnosis, and many patients are found in the middle and advanced stages that cannot be surgically treated. Therefore,the long-term survival of ICC is low,showing a poor prognosis,and the 5-year survival of advanced ICC of only 5%-10%.In recent years,systemic chemotherapy,hepatic arterial perfusion chemotherapy,and hepatic arterial chemoembolization have shown good results in ICC treatment.The advent of targeted and immunotherapy has brought a new hope for unresectable ICC.This paper reviewed the research progress of chemotherapy,local therapy,radiotherapy,targeted therapy and immunotherapy in the treatment of advanced ICC,so as to provide new ideas for ICC treatment.

In recent years, the surgical management of gastrointestinal tumors has undergone progressive standardization and refinement, with increasing consensus on operative strategies and resection margins. The advent of advanced laparoscopic techniques and the Da Vinci robotic-assisted surgical system has revolutionized the surgical treatment paradigm, bringing new breakthroughs in the treatment of gastrointestinal tumors. Beyond technical advancements, the integration of perioperative chemotherapy, radiotherapy, targeted therapy, and multidisciplinary team strategies has contributed to the prognosis improvement of gastrointestinal tumors. Moreover, advancements in molecular biology have further driven the evolution of gastrointestinal oncologic surgery toward precision medicine.

Objective To investigate the short-term effect of preoperative neoadjuvant chemoradiotherapy combined with programmed cell death 1 （PD-1） inhibitors on the treatment of ulcerative colitis related colorectal cancer （UCRCC）. Methods Clinical data of UCRCC patients who received PD-1 inhibitors combined with neoadjuvant therapy and surgically operated in the Second Hospital of Nanjing from March 2021 to December 2023 were retrospectively collected. Patients were divided into the control group （n=46） and combination group （n=34） based on preoperative treatment regimens. Patients in the control group received two cycles of capecitabine + oxaliplatin chemotherapy preoperatively, followed by two cycles of radiotherapy after a 2-week rest. Those in the combination group received PD-1 inhibitors every 3 weeks for two cycles, plus clinical management as the same as in the control group. All patients underwent surgery （total colorectal resection with ileostomy or radical intestinal tumor resection） 4-6 weeks after neoadjuvant chemoradiotherapy. The effect of neoadjuvant therapy, tumor markers, drug toxicity, side effects, perioperative indicators and postoperative pathology were compared between the two groups. Results Disease control rate in the combination group was significantly higher than that of the control group （P<0.05）. The levels of carbohydrate antigen 242, carbohydrate antigen 72-4, carcinoembryonic antigen and carbohydrate antigen 199 in the combination group were significantly lower than those of the control group （P<0.05）, and the percentage of tumor regression grades 0 and 1 was significantly higher compared to the control group. There were no significant differences in the incidence of toxic and side effects and perioperative indexes between the two groups （P>0.05）. Conclusion Preoperative neoadjuvant chemoradiotherapy combined with PD-1 inhibitors demonstrates favorable efficacy in controlling UCRCC, reducing tumor marker levels, improving postoperative pathological outcomes, and exhibiting an acceptable safety profile.

With the continuous advancement of functional anatomy of the liver and the widespread use of fluorescence laparoscopic equipment, indocyanine green fluorescence imaging-assisted anatomical liver resection has gradually become a main stream for treating liver tumors. It effectively compensates for the difficulty of accurately marking deep liver segment boundaries in traditional liver resection. This article, combining domestic and international research progress, reviewed the application of indocyanine green fluorescence imaging for liver segment identification in anatomical liver resection. It also discussed the advantages and limitations of different staining techniques and provided an outlook on the future development.

Restorative proctocolectomy with ileal pouch-anal anastomosis （IPAA） is preferred for patients with medically refractory ulcerative colitis （UC） and familial adenomatous polyposis （FAP）. While many reports have discussed postoperative surgical and inflammatory complications of pouch, functional pouch disorders are poorly understood. Two complicating factors are a great variability of defining functional outcomes after IPAA and a lack of standardization for reporting symptoms. Normal pouch function has yet to be adequately defined. The underlying etiologies for poor functional outcomes are quite diverse, such as pelvic sepsis, pouchitis, anastomotic complications and pouch volvulus, etc. However, some patients manifest poor pouch function even without such complications. It is possibly due to non-optimal pouch physiology or such specific patient factors as age, gender, body mass index （BMI） and dietary habits. Therefore it is imperative to explore the normal physiological function of pouch and better manage the functional complications to enhance the postoperative quality-of-life.

As the ideal window for surgical intervention in necrotizing enterocolitis （NEC） lies between the onset of intestinal gangrene and perforation, an accurate assessment of bowel injury severity and timely surgical intervention are critical for improving outcomes. Portal venous gas（PVG） is a significant marker of advanced NEC, particularly in extremely low birth weight（ELBW） infants, where its presence correlates with a markedly increased risk of extensive intestinal necrosis（> 75%-80% bowel involvement）. Pneumatosis intestinalis（PI） is commonly associated with NEC. Besides, linear PI may indicate a benign course, whereas cystic PI with fixed bowel loops raises suspicion for necrosis. Notably, the extent of PI does not directly correlate with bowel injury severity. Fixed bowel loops（FBL）,identified on serial radiographs, are associated with higher surgical and mortality rates, necessitating close clinical and imaging monitoring. Ascites, particularly complex ascites with debris on ultrasound, may be the sole sign of perforation. Most of scoring systems for assessing surgical indications for NEC have not been widely adopted. It is essential for further developing precise, dynamic risk assessment models, thus achieving the goal of transforming the experience-driven decision mode to data-driven mode.

Abdominal hernia is a common surgical condition that is divided into primary and secondary abdominal wall hernias. The former includes umbilical hernia, white line hernia, semimeniscus hernia, and lumbar hernia, and the latter refers to incisional hernia. It is generally believed that immediate surgery should be performed even in the absence of any clinical manifestations, and surgery is the only effective treatment for abdominal wall hernias. Commonly used surgical modalities include open sublay, laparoscopic intraperitoneal onlay mesh （IPOM）, mini/less open sublay MILOS/endoscopic mini/less open sublay technique （eMILOS）, transabdominal preperitoneal （TAPP）, laparoscopic totally extra-peritoneal hernia repair （TEP）, enhanced-view totally extraperitoneal （eTEP）, and transabdominal partial extraperitoneal tape. In recent years, endoscopic sublay repair （ESR） has become widely used. It is divided into transabdominal sublay （TAS） and totally extraperitoneal sublay （TES）, which are evolved from TAPP and TEP, respectively. Its practicality and effectiveness require a large number of clinical data to verify. This article reviewed the relevant literatures on ESR in the treatment of abdominal wall hernia, discussed the application and research progress of ESR in the treatment of abdominal wall hernia, and analyzed the feasibility and superiority of ESR.

Objective To explore the impacts of laparoscopic sleeve gastrectomy （LSG） combined with jejunal-jejunal bypass （JJB） on metabolic indicators in obese patients. Methods The medical records of 36 obese patients in Xiaolan People's Hospital of Zhongshan from July 2020 to July 2023 were retrospectively analyzed. According to the different surgical methods, patients were divided into the observation group （n=18, LSG+JJB） and control group （n=18, LSG）. The weight loss-related indicators, lipid metabolism, glucose metabolism, quality of life and complications were compared between groups before surgery and 12 months after surgery. Results At 1 year postoperatively, the body mass index （BMI）, waist circumference, abdominal circumference, and hip circumference in both groups were significantly reduced compared to preoperative levels, which were significantly lower in the observation group than the control group （all P<0.05）. Postoperative lipid metabolism indicators, glucose metabolism indicators, and quality of life in both groups were significantly improved compared to preoperative levels, which were more pronounced in the observation group than the control group （all P<0.05）. Severe postoperative complications were not reported in both groups, and there was no significant difference in the incidence of complications between the two groups （P>0.05）. Conclusion For patients with obesity, LSG+JJB treatment can enhance the effect of weight loss, improve the function of glucolipid metabolism, and increase the quality of life, without increasing the risk of postoperative complications. It has a high safety profile and can be used as a good choice for weight loss surgery.

Objective To investigate the clinical characteristics， diagnostic methods， and treatment strategies for liver abscess complicating laparoscopic appendectomy in children. Methods A rare case of a boy at 6 years and 11 months with liver abscess following laparoscopic appendectomy for acute appendicitis was reported. The child was admitted to the Affiliated Children's Hospital of Xi'an Jiaotong University on August 6， 2024， presenting with fever for 4 days， and 26 days after laparoscopic appendectomy for acute appendicitis. Initial blood tests revealed a leukocyte count of 15.07×10⁹/L.Color Doppler ultrasound and CT confirmed a right hepatic lobe abscess. A literature review was conducted by searching key words of "acute appendicitis" "appendectomy" "liver/hepatic abscess" and "children" in both Chinese and English languages in the PubMed， Medline， Springer Link， The Cochrane Library， Wanfang， and CNKI databases. Articles published up to December 2024 were included for analysis， and the related cases were analyzed and summarized. Results The patient underwent ultrasound-guided percutaneous catheter drainage， anti-infective therapy， and oral traditional Chinese medicine.The liver abscess significantly resolved， and the child was discharged after 16 days of hospitalization， without a recurrence during a 3-month follow-up. Including this case， 8 pediatric cases were reviewed. In details，comprising 4 males and 4 females aged 5 to 14 years.Seven patients underwent laparoscopic appendectomy while one had open appendectomy；three cases involved gangrenous appendicitis and five involved perforated suppurative appendicitis. Diagnosis occurred between 1 week and 4 months post-appendectomy， with the primary clinical manifestations being fever and abdominal pain emerging 1 to 4 weeks after surgery， confirmed by color Doppler ultrasound or abdominal CT. In terms of treatment，4 received ultrasound-guided percutaneous drainage combined with antibiotics，2 received antibiotics alone，1 underwent anti-infective therapy + abscess drainage + exploratory laparotomy， and 1 underwent laparoscopic stone removal + drainage + antibiotics. Length of hospital stay ranged from 8-49 days， with all cases achieving a full recovery. Conclusion Postoperative liver abscess is a rare complication of acute appendicitis in children. Early ultrasound-guided percutaneous drainage combined with antibiotic therapy yields favorable outcomes.

Pancreatic cancer is a highly aggressive malignancy of the digestive system. Over 80% of patients are diagnosed at an advanced stage. The majority of pancreatic cancer patients progresses to cancer cachexia, characterized by uncontrolled weight loss, muscle wasting, and a systemic inflammatory response. To date, effective therapeutic strategies for managing cancer cachexia are scant.This article aims to provide an in-depth review of the latest research advancements both domestically and internationally, systematically elucidate the pathophysiological mechanisms and etiology of pancreatic cancer-associated cachexia.

Objective To summarize the evidence and indicators related to perioperative pain management in patients of laparoscopic hepatectomy and provide references for standardized and systematic pain management in this group. Methods According to 6S evidence pyramid model, the relevant guideline websites at home and abroad and Chinese and English databases were systematically searched until April 15,2024.The quality of the literature was evaluated separately by two researchers. Then evidence extraction was completed. Results Among 16 articles, 19 pieces of evidence were summarized with 4 dimensions,including pain education （3 pieces of evidence）,contained education content, forms and subjects; pain evaluation（4 pieces of evidence）, such as preoperative evaluation, evaluation timing and evaluation content; management team（3 pieces of evidence）, including team composition, member responsibilities and continuing education; analgesic strategies（9 pieces of evidence）,contained preventive analgesia,multi-modal analgesia and personalized analgesia. Conclusion Based upon the guidance of evidence-based methodology, this paper systematically summarizes the best evidence of perioperative pain management in patients of laparoscopic hepatectomy. It provides references for medical professionals to carry out the relevant practices.

Objective To explore the risk factors of acute appendicitis （AA） with perforation. Methods From January to June 2023, a total of 212 hospitalized AA patients were selected as study subjects. According to the observation of appendix and pathological results, they were assigned into two groups of non-perforated （n=169） and perforated （n=43）. Demographic profiles （e.g. gender, age & duration of onset）, blood test parameters （e.g. blood routine, total bilirubin & D-dimer） and imaging findings （whether or not fecalith within appendix and ascites in abdominal cavity） were compared between two groups. The influencing factors of perforated AA were examined by multivariate Logistic regression analysis and receiver operating characteristic （ROC） curve. Results There were 43 cases of perforated AA with a perforation rate of 20.3%. Longer symptomatic duration, fever （axillary temperature ≥ 38 ℃）, appendiceal fecalith on imaging, ascites on imaging and elevated level of C-reactive protein （CRP） were independent risk factors for perforated AA were examined by single factor and multiple factor Logistic regression （P< 0.05）. The area under the ROC curve of longer symptomatic duration, ascites and CRP level were 0.827, 0.853 and 0.810 （P< 0.05）. When all parameters were combined for prediction, AUC was 0.962 with a sensitivity of 0.884 and a specificity of 0.893. Conclusion Longer symptomatic duration, fever （axillary temperature ≥ 38 ℃）, appendiceal fecalith on imaging, ascites on imaging and elevated CRP level are independent risk factors for perforated AA. There is a higher value when all parameters are combined for assessments.

Objective To observe the efficiency of ultrasound-guided percutaneous transhepatic gallbladder drainage（PTGBD） and laparoscopic cholecystectomy（LC） in patients with moderate-level acute moderate cholecystitis. Methods Clinical data of patients with moderate-level acute cholecystitis in the Qingdao Municipal Hospital from March 2021 to December 2023 were retrospectively analyzed. According to the different treatment methods, they were divided into the LC group（LC treatment） and PTGBD+LC group （LC treatment after PTGBD）.The propensity score matching （PSM） at 1∶ 1 matching was performed with a caliper of 0.01,and 65 cases were included in each group. The surgical indicators, incidence rates of complications, liver function indicators （alkaline phosphatase [ALP], indirect bilirubin [IBIL], direct bilirubin [DBIL]）, serum inflammatory factors（tumor necrosis factor-α[TNF-α],C-reactive protein [CRP], interleukin-6[IL-6]） and 30-day mortality before and after treatment were compared between groups. Results In comparison to LC group,the intraoperative blood loss （31.13± 7.95 mL vs.44.86± 9.63 mL）,surgical time（62.47± 11.13 min vs.81.32± 10.52 min）,rate of intraoperative drainage （80.00% [52/65] vs.98.46%[64/65]）,and rate of LC conversion to laparotomy（0 vs.9.23% [6/65]） were significantly lower in the PTGBD+LC group （all P< 0.05）.The incidence of surgical complications in the PTGBD+LC group was significantly lower than that of the LC group （4.62%[3/65] vs.15.38%[10/65],P< 0.05）.Compared with preoperative values,ALP,IBIL,DBIL,CRP,and IL-6 at 72 h postoperatively were significantly reduced in both groups （all P< 0.05）. The above liver function indexes and serum inflammatory factors in the PTGBD+LC group at 72 h postoperatively were significantly lower than those of the LC group （all P< 0.05）. There was no significant difference in the 30-day mortality rate between the two groups（P> 0.05）.No cholecystitis recurred during the follow-up period. No significant difference in the 36-Item Short Form Health Survey （SF-36） score was found between groups （P> 0.05）. Conclusion PTGBD combined with LC can reduce intraoperative bleeding and shorten operation time, promote the postoperative recovery of AC patients, quickly relieve the inflammatory state, and improve the liver function. It has few surgical related complications, good therapeutic effect and important clinical application value.

The clinical application of immune checkpoint inhibitors （ICIs） has significantly improved cancer treatment outcomes, yet ICI-induced hyperprogressive disease （HPD） has become a critical issue affecting the prognosis. This review systematically summarized research advances in HPD, focusing on controversies in its definition, underlying mechanisms, and clinical management strategies. Currently, the absence of unified diagnostic criteria for HPD leads to substantial heterogeneity in evaluation systems based on tumor growth kinetics and imaging characteristics, resulting in incidence variations ranging from 4.8% to 37.3% across studies. Mechanistic investigations revealed that HPD development is closely associated with multifactorial interactions involving oncogenic pathway abnormalities, immune microenvironment remodeling, and cytokine dysregulation. We proposed establishing multidimensional predictive models that integrate clinical features, genomic biomarkers, and radiomics, and exploring targeted intervention strategies to optimize immunotherapy decision-making.

Hepatocellular carcinoma（HCC） is a prevalent tumor of digestive system. Surgical removal has been a primary treatment. However, HCC patients have a high postoperative risk of recurrence, particularly within 2 years. Therefore elucidating the signaling pathways for early recurrence after HCC surgery aids in formulating early and effective intervention measures.Counter-measures help to prevent or delay early recurrences of HCC,thereby enhancing patient survival.This review focused upon primary signaling pathways for early recurrence after HCC surgery, aiming to enhance understanding and refine precise prevention and intervention strategies for early recurrence of HCC.

Hepatoblastomas（HB） are usually found in a large size. Due to the immature, vulnerable tissues in children, a precise anatomy is particularly important that increases the surgical challenges. In recent years, artificial intelligence （AI） has played an important role in preoperative planning and intraoperative navigation of HB surgery. This article reviewed the development status of intelligent planning and surgical navigation of HB surgery, mainly including the following aspects： （1）AI-guidedsurgical planning： three-dimensional reconstruction and virtual simulation of medical images, and optimization of AI-driven resection path; （2）Surgery planning： Augmented reality （AR） navigation, intraoperative multimodal real-time navigation fusion and intelligent navigation of robotic surgery; （3）AI-guidedsurgical planning and navigation of HB in special sites： HB in the second hepatic portal and in the caudate lobe of the liver were mainly discussed.

Gastric cancer is one of the most common malignancies worldwide, and standardized surgical treatment plays a crucial role in improving its survival and prognosis. Clinical research provides scientific evidence for establishing standardized surgical treatment systems, while clinical practice continuously validates and refines research outcomes during their practical application. This article explored the core value of clinical research in driving the evolution of surgical approaches in gastric surgery, and highlighting the core value of clinical research in clinical practice. Moreover, we discussed implementation strategies for high-quality clinical research in surgery, and identified challenges and future directions in clinical research. Furthermore, this article elucidated the significant role clinical research plays in developing standardized treatment systems, aiming to provide theoretical support and practical references for designing and conducting future high-quality clinical research.

Objective To explore the efficacy of ultrasound-guided percutaneous dilatation catheter drainage for complicated intra-abdominal infection（cIAI） due to digestive tract perforation（DTP） in elders. Methods From October 2021 to June 2024, retrospective review was performed for 31 elders aged ≥80 year with cIAI due to DTP. After ultrasound-guided puncture, fascia dilator with gradually larger diameter（F8-F30） was successively utilized for expansion and followed by double-tube irrigation and negative pressure drainage. The changes of disappearance time of clinical symptom, body temperature and laboratory inflammatory parameters were recorded before and after drainage. Results Ultrasound-guided percutaneous dilatation and catheter drainage were performed.Average hospitalization stay was （31.12±9.13） day and average extubation time （26.91±7.84） day.Body temperature and leucocyte count dropped after the third day of puncture and the differences were statistically significant（P<0.05）. Eighteen patients（58.06%） recovered after ultrasound-guided puncture dilatation catheter drainage alone. Clinical symptoms were relieved（n=6,19.35%） and cured after sequential surgery. Five patients （16.13%） died from multiple organ failure due to septicemia and 2 patients（6.45%） were automatically discharged. For one case of massive abdominal hemorrhage,family members gave up further treatment. Another case requested to return to a local hospital for further measures due to economic reasons. Conclusion Ultrasound-guided puncture dilatation and catheter drainage may effectively improve clinical symptoms and rapidly lower inflammatory parameters for cIAI due to DTP in elders. With the advantages of easy handling, economy, mini-invasiveness and few complications, it is ideal for patients with relative surgical contraindications.

Objective To investigate the clinical efficacy of totally laparoscopic surgery in the treatment of neonates with type I high jejunal atresia. Methods A total of 46 neonates with type I high jejunal atresia （within 10 cm of the ligament of Treitz） admitted to the Third Affiliated Hospital of Zhengzhou University from January 2017 to September 2024 were retrospectively analyzed. According to whether laparoscopic surgery was used or not, they were divided into laparoscopic procedure（LP） group （n=16） and open procedure （OP） group （n=30）.The general data, perioperative inflammation,operation time, intraoperative bleeding, the first defecation time,the first postoperative oral feeding time, postoperative full oral feeding time, postoperative abdominal drain removal time, postoperative complications, unexpected second operations,the length of hospital stay, and mortality were compared between the two groups. Continuous variables that followed or approximately followed a normal distribution were expressed as x±s, and compared by the t-test.Continuous variables that did not conform to a normal distribution were expressed as the median（Q1,Q3）.Count data were compared by the chi-square test. Results The operation was successfully completed in both groups. There were no significant differences in the gender,gestational age,weight,preterm birth rate,and abnormal prenatal diagnosis between groups（all P> 0.05）. Compared to the OP group, the LP group had significantly less intraoperative bleeding （2.00 [1.00,2.38] mL vs. 2.00 [2.00,5.25] mL）, shorter time to first defecation （2.25± 1.24 d vs. 3.20± 1.37 d）, shorter time to first postoperative oral feeding （7.19± 2.07 d vs. 9.00± 3.18 d）, shorter time to postoperative full oral feeding （15.56± 6.77 d vs. 23.43± 14.94 d）, shorter time to abdominal drain removal（10.43± 3.67 d vs.13.47± 4.98 d）, and shorter length of hospital stay （21.50± 7.30 d vs. 29.50± 14.21 d） （all P< 0.05）.There were no significant differences between the two groups in C-reactive protein（CRP）,operation time, postoperative complications, unexpected second operations, and mortality（all P> 0.05）. Conclusion Totally laparoscopy is safe and feasible in the treatment of neonatal type Ⅰ high jejunal atresia, and offering significant advantages in reducing bleeding, restoring gastrointestinal function as soon as possible, and shortening hospital stay.

Most patients with hepatocellular carcinoma （HCC） in China are diagnosed in the middle-stage and advanced stage, responding to a poor therapeutic outcome. With the progress in the targeted and immune drugs, and the advance made in interventional technology, hepatic arterial infusion chemotherapy （HAIC） through various scheme synergies show good treatment results and safety . However, how to choose the optimal combination scheme to achieve the maximum treatment benefit of different patient groups is still a challenge. In addition,how to accurately screen the target population of HAIC therapy and perform scientific and individualized neoadjuvant therapy is a research direction. How to effectively realize the transformation treatment of patients with HCC, and accurately grasp the best time of surgery are also important. These issues are the focus of current clinical concerns and research. This article aimed to review the research status of HAIC combined with other treatment methods for middle stage and advanced HCC at home and abroad in recent years, and analyzed the current problems and future development direction.

Intersphincteric resection （ISR） has emerged as a pivotal sphincter-preserving procedure for low-level rectal cancer, demonstrating significant improvements in anal preservation rates while maintaining optimal oncological outcomes. This technique necessitates concomitant rectal resection with partial or complete internal anal sphincter excision, followed by ultra-low anastomotic reconstruction. This substantially elevates the risk of postoperative low anterior resection syndrome （LARS）. Characterized by increased stool frequency, urgency, and bowel dysfunction, LARS has garnered escalating clinical attention in recent years. However, perioperative interventions for preventing and managing LARS remain inadequately standardized. This article systematically reviewed current evidence to elucidate critical technical elements for perioperative anal function preservation following ISR.

Objective To assess the clinical value of platelet-albumin-bilirubin（PALBI）score combined with neutrophil lymphocyte ratio （NLR） in predicting the occurrence of post-hepatectomy liver failure （PHLF） in hepatocellular carcinoma patients. Methods A total of 328 hepatocellular carcinoma patients who underwent radical resection treatment in the First Hospital of Harbin Medical University from January 2019 to December 2023 were retrospectively included. They were divided into the PHLF group （62 cases, 18.90%） and non-PHLF group （266 cases, 81.10%）. Risk factors for PHLF were analyzed using univariate and multivariate logistic regression, and the efficacy of PALBI score combined with NLR in predicting PHLF was assessed using receiver operator characteristic （ROC） curve. Results The proportion of cirrhosis, prothrombin time, NLR, PALBI score and number of lesions as multiple were significantly higher in the PHLF group than the non-PHLF group, while the albumin and remaining liver volume were significantly lower （all P<0.05）. The results of multivariate logistic regression showed that cirrhosis （OR=1.436 95% CI：1.118-1.845）,NLR（OR=1.346,95% CI：1.047-1.730）,and PALBI score（OR=1.516, 95%CI： 1.164-1.974） were the independent risk factors for PHLF,while residual liver volume（OR=0.725, 95%CI： 0.535-0.984） was a protective factor.The ROC curve showed that PALBI score and NLR predicted PHLF with an area under the curve （AUC） of 0.864（95%CI： 0.815-0.913）,a sensitivity of 80.65%, and a specificity of 81.58%,which was superior to the predictive efficacy of a single detection. Conclusion Elevated PALBI score and NLR are risk factors for PHLF after radical resection in hepatocellular carcinoma patients, and the combination of the two has good predictive value for PHLF.

Laparoscopic sleeve gastrectomy （LSG） is currently the most common bariatric surgery procedure. However, gastroesophageal reflux disease （GERD） caused by post-operative intrathoracic sleeve migration（ITSM） is the most concerned long-term complication. This article discussed the morbidity and possible mechanisms, clinical manifestation and diagnosis, prevention and treatment of ITSM. It is crucial to take feasible measures during the initial LSG to prevent ITSM. The possible approaches include avoiding damage to the phrenoesophageal ligament and fixing the left crus to the upper part of stomach. For patients with preoperative GERD symptoms, grade B or C esophagitis on endoscopy, or Hill grade Ⅲ or Ⅳ, simultaneous hiatal exploration, repair, and proper fixation should be considered. Regardless of the surgical approach, the fundamental measure for treating ITSM is to return the distal esophagus from the mediastinum to the abdominal cavity. Comprehensive hiatal repair and proper fixation around the gastro-esophageal junction are essential measures to ensure efficacy and prevent recurrences. Adding a gastroileal anastomosis can decrease the pressure in the sleeve which is favoring to GERD symptom, and simultaneously improve constipation and weight regain caused by ITSM.

Objective Peritoneal metastasis is the most common site of distant metastasis in gastric cancer and associated with poor prognosis. Occult peritoneal metastasis （OPM）, characterized by the absence of imaging signs, is challenging to diagnose preoperatively, posing difficulties for clinical decision-making. This study aims to develop a prediction tool for OPM in gastric cancer based on clinical features using a decision tree model. Methods This was a retrospective study involving gastric cancer patients who underwent contrast-enhanced CT and laparoscopic exploration at the Gastrointestinal Oncology Center of Peking University Cancer Hospital from 2015 to 2019. Univariate and multivariate analyses were conducted to identify clinicopathological features associated with OPM. A decision tree model was constructed and its diagnostic performance was evaluated in both the training and validation sets. Results A total of 414 patients were included, of whom 63 （15.22%） had peritoneal metastasis. Multivariate logistic regression analysis identified that tumor long diameter （OR=1.023,95%CI：1.003-1.044;P=0.026）, cN3 staging （OR=6.587,95%CI： 1.362-31.846;P=0.019）, Borrmann type Ⅳ （OR=47.012,95%CI：4.903-1521.541;P=0.005）, and CA125 level （OR=1.014,95%CI：1.002-1.027;P=0.021） were independent risk factors for OPM in gastric cancer. The decision tree model incorporated six classification variables, including the tumor long diameter, cN stage, Borrmann classification, CA125 level, CA19-9 level, and Lauren classification. In the validation set, the model achieved a diagnostic accuracy of 87.2%, sensitivity of 68.3%, specificity of 90.6%, an area under the curve （AUC） of 0.807 （95% CI：0.766-0.847;P<0.001）, and a negative predictive value of 0.941. Conclusion This study developed a decision tree model based on clinical features, demonstrating good diagnostic performance for OPM in gastric cancer with negative CT findings.

Objective To evaluate the feasibility and effectiveness of methylene blue staining via nasopancreatic tube during pancreatic enucleation. Methods A retrospective analysis was conducted on the medical records and follow-up data of 18 patients who underwent pancreatic enucleation with intraoperative methylene blue staining via nasopancreatic tube at the Pancreatic Surgery Department of Renmin Hospital of Wuhan University from May 2020 to September 2024. Among these patients,15 had tumors located in the pancreatic head and neck,and 3 in the body and tail.The maximum tumor diameter was 2.3±0.7 cm, and the shortest distance between the tumor margin and the main pancreatic duct was 2.2±0.6 mm. All patients had nasopancreatic tubes placed preoperatively under endoscopic guidance.During surgery,methylene blue solution was injected through the nasopancreatic tube after tumor enucleation to observe the staining of the pancreatic wound surface.Appropriate repair methods were selected based on the location of pancreatic juice leakage,and postoperative short-and long-term complications were recorded and analyzed,with a particular focus on the occurrence of postoperative pancreatic fistula（POPF）. Results Intraoperative injection of methylene blue solution revealed staining of the wound surface in 6 cases. According to the International Study Group on Pancreatic Fistula （ISGPF） criteria for POPF, a total of 10 patients experienced pancreatic fistula and biochemical leak postoperatively. Among these, there were 7 cases of biochemical leak and 3 cases of grade B POPF, without occurrences of grade C POPF. Conclusion The application of methylene blue staining via nasopancreatic tube during pancreatic enucleation is safe and feasible.It facilitates the timely and accurate detection of pancreatic juice leakage that may not be visible to the naked eye,enabling immediate repair and reducing the risk of postoperative complications, particularly pancreatic fistula.

Objective To analyze the clinical features of congenital intestinal malrotation （CIM） combined with Hirschsprung's disease （HD）, thus improving its clinical diagnosis and treatment. Methods Clinical data of neonates with CIM plus HD were collected, including birth weight, gestational age, initial symptoms, age at onset, meconium passage status, physical examination findings, imaging data, pathological diagnoses, and surgical approaches. A retrospective analysis was conducted to evaluate clinical characteristics and diagnostic/therapeutic outcomes. Results Eight neonates with combined CIM and HD were included,including 5 males and 3 females. The gestational age ranged from 34 to 40 weeks, and the birth weight was between 2 400 and 3 500 g. The age at disease onset was （13.9± 4.3） days （range：2-26 days）. Four cases were preoperatively diagnosed and underwent elective Ladd's procedure combined with stage-one radical surgery for HD （all short-segment type）. In the remaining four cases, three were diagnosed intraoperatively with transitional zones in the colon during exploratory surgery for CIM .Then, enterostomy and colonic biopsies confirmed HD, and they were treated with stage-two radical HD surgery（short-segment type）. One case showed no colonic dilation intraoperatively but developed recurrent postoperative abdominal distension, leading to a subsequent diagnosis of long-segment HD requiring subtotal colectomy.Among the seven cases with short-segment HD,abdominal upright X-rays revealed fixed dilated mid-abdominal bowel loops, while this sign was absent in the long-segment HD case. Conclusions In cases of CIM combined with HD, a miss diagnosis of HD is common. The presence of fixed dilated mid-abdominal bowel loops on preoperative abdominal upright X-rays differs from isolated CIM, which should raise suspicion for concurrent HD. Stage-one surgery for CIM combined with HD is safe and effective.

With a rapidly aging population, the incidence rate of emergency surgical diseases is rising. Currently the incidence and mortality rate of complications in emergency surgery are much higher than those in elective surgery. Emergency surgical diseases have become a global disease burden. China is actively exploring the establishment of critical care center dedicated to acute abdomen, abdominal trauma and postoperative complications. Internationally, some established trauma clinics have already provided acute care surgery （ACS）. And ACS has been offered initially by surgical rescue teams in China. To promote the development of ACS on a large scale, starting emergency abdominal, trauma and surgical rescue from the construction of ACS is an efficient step. ACS focusing upon acute abdomen is an emerging discipline of integrating surgery and intensive care unit （ICU） within one ward. ACS can only flourish under the technical and human resource supports of general surgery. Ultimately well-trained specialized surgeons specializing in ACS shall emerge.

Objective To evaluate the correlation between triglyceride glucose （TyG）index and postoperative prognosis in colorectal cancer （CRC） patients. Methods From January 2012 to December 2015, 376 CRC patients undergoing radical resection were retrospectively reviewed. R Project for Statistical Computing （Version 4.3.3） was utilized for constructing a nomogram prediction model and its differentiation and accuracy were evaluated by calculating consistency index （C-index） and plotting calibration curves. From January 2016 to December 2018, the clinical data of 137 patients undergoing radical resection for rectal cancer were collected for external validation. Results TyG index, preoperative age, prognostic nutritional index （PNI） score, tumor stage, differentiation degree and postoperative complications were independent prognostic factors （all P< 0.05）. According to the results of log-rank test, risk ratio between high TYG and low TyG index groups was 1.847 （95%CI： 1.205-2.831, P=0.010 9） and C-index of nomogram model was 0.742 in training cohort. Calibration curve indicated that survival rate as predicted by nomogram accorded well with actual survival rate. External verification was conducted by time period verification. C-index of column-line was 0.769 in verification cohort. Calibration curve indicated that column-line predicted survival rate accorded well with actual survival rate. Conclusion TyG index is an independent risk factor for the postoperative prognosis of CRC patients. The higher the TyG index, the worse the postoperative prognosis of patients.

Objective To investigate the areas where postoperative abdominal fluid is most likely to accumulate after pancreaticoduodenectomy （PD）. Methods Postoperative drainage, ascitic amylase levels, and postoperative imaging data, including CT scans in 106 patients who underwent PD at the 2nd Hospital of Harbin Medical University between October 2022 and August 2024 were prospectively analyzed. Patients were categorized into three groups based on the placement of abdominal drains： Group Ⅰ, Group Ⅱ, and Group Ⅲ. The difference between Group Ⅰ and Group Ⅱ was the placement of the second drainage tube, which in Group Ⅱ was positioned at the dorsal side of the pancreaticojejunostomy, and the oral side in Group Ⅰ. The difference between Group Ⅰ and Group Ⅲ was the placement of an additional drain at the ventral side of the pancreaticojejunostomy in Group Ⅰ. Finally, Group Ⅰ consisted of 28 patients, Group Ⅱ had 33 patients, and Group Ⅲ included 45 patients. Postoperative drainage, abdominal fluid accumulation, and ascitic amylase levels were compared across these groups. The Shapiro-Wilk test was performed for testing the normality. Continuous variables that followed or approximately followed a normal distribution were expressed as $\bar{x}±s$, and compared by the t-test. Continuous variables did not conform to a normal distribution were expressed as median （Q₁,Q₃） and compared by the chi-square test. Repeated measures analysis of variance （ANOVA） was applied to assess the interaction effects across different time points and groups. For comparisons among three or more groups, one-way ANOVA was used. Results Group Ⅰ showed the least total postoperative fluid accumulation in the biliary-enteric anastomosis （region A） （239.08±168.68 mL） and the most fluid accumulation in the head side of the pancreatic-enteric anastomosis （region B）（627.32±195.56 mL） （P< 0.05）. In Group Ⅱ, the least total postoperative fluid accumulation was found in region A （227.52±129.35 mL）, and the most accumulation was detected in the back side of the pancreatic-enteric anastomosis （region D） （646.19±250.92 mL） （P< 0.05）. In Group Ⅲ, a significant less total postoperative fluid accumulation was found in region A （111.83±52.62 mL） than region B （563.12±275.73 mL） （P<0.05）. In Group Ⅰ, the lowest ascitic amylase index was detected in region A [40.5 （15.75, 104.5） U/L], and the highest was detected in the ventral side of the pancreatic-enteric anastomosis （region C） [187.5 （58.5,2 118.25） U/L] （P<0.05）. The lowest ascitic amylase index in Group Ⅱ was detected in region A [88.0 （29.5, 173.0） U/L], and the higher value was detected in region C [510.0 （65.0, 1 850.0） U/L] and region D [406.0 （75.5, 1 342.5） U/L],There is a statistically significant difference between the three regions （P<0.05）. However, no significant difference was observed between regions C and D （P>0.05）. In Group Ⅲ, the ascitic amylase index was significantly lower in region A [75.0 （33.5, 344.5） U/L] than region B [409.0 （79.5, 898.0） U/L] （P<0.05）. Conclusion The area on the oral side of the pancreaticojejunostomy tends to accumulate the most abdominal fluid after PD, due to its lower position and the dissection of multiple lymph nodes.The amylase levels in the ascitic fluid are higher in both the ventral and dorsal regions near the pancreaticojejunostomy.Therefore,it is recommended to routinely place a prophylactic drainage tube in the oral side of the pancreaticojejunostomy.For patients at higher risk of pancreatic fistula,it is advisable to place an additional drainage tube in the ventral region of the pancreaticojejunostomy.

Objective To further observe the exact morphology of the jejunal atresia and the development of ganglion cells within it, thus providing morphological reference for the involvement of vacuolar epithelial cells and mesenchymal cells in forming the diaphragm. Methods The segment of jejunal atresia was intraoperatively harvested from a child with type I jejunal atresia. Tissue sections were prepared along the longitudinal axis of the jejunal atresia for hematoxylin and eosin（H&E） and immunohistochemical staining. Images were captured by scanning tissue slices using the digital section system. Results Bilateral sides of the jejunal atresia were covered by intestinal mucosa,with complete epithelial layer, propria and muscularis mucosae. The mucosa derived from the distal and proximal intestinal mucosa of the diaphragm, where the submucosal tissue situated in the center and continued with the submucosal layer of the intestinal wall. The muscle layer of the intestinal wall traveled distally close to the diaphragm, without a further disclosure into the diaphragm. Immunohistochemical staining showed positive expressions of PGP9.5 and PHOX2B adjacent to the normal intestinal wall, between the medial ring and lateral longitudinal muscles, and in the septal membrane.Ganglion cells in the adjacent intestinal wall continued with each other. Conclusions The jejunal atresia is mainly composed of submucosal tissue and continues with the submucosal layer adjacent to the normal intestinal wall, where the bilateral sides are covered with mucosa. Ganglion cells develop in the diaphragm and continue with those adjacent to the submucosal layer of the normal intestinal wall. Vacuum epithelial cells and mesenchymal cells are involved in the formation of jejunal atresia.

Objective To summarize the experience of laparoscopic management for choledochoenterostomy anastomotic stricture after choledochal cyst excision in children. Methods Clinical data of 8 pediatric patients who were re-examined by surgery for choledochoenterostomy anastomotic stricture after laparoscopic treatment for choledochal cysts at the Pediatric Surgery Department of Fujian Medical University Union Hospital from July 2016 to June 2024 were retrospectively analyzed. underwent laparoscopic biliary-enteric anastomotic reconstruction for postoperative biliary-enteric anastomotic stenosis. The operation time, intraoperative blood loss, time to first flatus, postoperative hospital stay, and complications were collected. Results All 8 children successfully underwent complete laparoscopic biliary-enteric anastomotic reconstruction. The operation time ranged from 120 minutes to 270 minutes,with an average of 188.5± 47.5 minutes. Blood loss ranged from 15 mL to 185 mL, with an average of 99.1± 62.1 mL. The postoperative hospital stay ranged from 7 days to 14 days, with an average of 9.2± 1.8 days. There were no cases of postoperative intra-abdominal bleeding, intra-abdominal infection, need for reoperation, or mortality. The follow-up period ranged from 6 months to 60 months, with an average of 30.2± 16.1 months. None of the followed-up children experienced recurrent biliary-enteric anastomotic stenosis. One child developed postoperative cholangitis, which was successfully treated with conservative management including anti-inflammatory and gallbladder-soothing medications, as well as traditional Chinese medicine. Conclusion Laparoscopic reconstruction of the choledochoenterostomy anastomotic stricture following choledochal cyst excision is safe and effective.

Objective To explore the impact of abdominal pain green channel （Abdominal Fast-Track, AFT） on the efficiency of treatment and prognosis of patients with acute abdomen （AA）. Methods From June 2021 to April 2024, the relevant clinical data were retrospectively reviewed for 513 hospitalized AA patients. They were assigned into two groups of consultation （n=197） and AFT （n=316）. Baseline profiles, time from admission to emergency clinic for requesting consultation, time from admission to hospitalization, time from admission to surgery, length of hospitalization stay, complications and 30-day postoperative morbidity/mortality were compared between two groups. Results As compared with before establishing AFT, median time from emergency to surgery was significantly shorter after establishing AFT （19.25 vs 11.58 h, P< 0.001）, median time from admission to requesting surgery was shorter （0.83 vs 0.74 h, P=0.047） and overall length of hospital stay declined significantly （7.95 vs 4.56 day, P< 0.001）, a significantly lower incidence of pulmonary （P=0.031） and abdominal （P=0.011） infections and a lower rate of severe complications （16.8% vs 5.1%, P< 0.001）. The proportion of nighttime （18：00-8：00） surgeries was significantly higher in AFT group （44.7% vs 67.1%, P< 0.001）. There was a higher rate of surgeries performed by attending physicians under the supervision of senior physicians and physicians below attending level （74.0% vs 89.9%, P< 0.001）. Conclusion AFT may shorten preoperative waiting time and improve overall outcomes in AA patients.

回顾性分析 2018年8月至2022年12月青海红十字医院肝胆胰疝外科收治的42例胆囊结石合并胆总管细小结石单纯行腹腔镜下胆囊切除术病人的临床资料,其中男性20例,女性22例,年龄（48.9±13.6）岁,体重指数（23.57±2.93） kg/m²。42例病人胆总管直径（0.87±0.25） cm,胆总管结石直径（0.35±0.14）cm;胆总管泥沙样结石6例,单发结石36例;术前肝功能异常3例,其余均为无症状胆总管结石。术后3个月复查磁共振胰胆管成像,结石排出率78.57%（33/42）,均为无症状排石,其中2例为术前有症状的病例。9名胆总管结石未排出的病人,给予牛黄熊去氧胆酸胶囊口服,服药半年后复查磁共振胰胆管成像,所有病例胆总管结石均已排出;其中1例有排石症状,出现上腹痛,持续数小时后自行缓解、无黄疸,伴有肝酶升高,口服保肝药物后好转。该研究中所有病人的胆总管结石均在胆囊切除术后自动排出,无严重并发症发生,提示胆总管细小结石行观察处理的排出率高,且绝大多数病人均为无症状排石,同时可保留Oddi括约肌及胆总管的完整性。