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.

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.

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.

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.

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.

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 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 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 predictive values of combining serum levels of retinol binding protein 4 （RBP4） and cholecystokinin A receptor （CCKAR） for postoperative recurrence of intrahepatic choledocholithiasis. Methods Between April 2021 and March 2022,100 patients hospitalized with intrahepatic choledocholithiasis were selected as study subjects. According to whether or not recurrence occurred at 24 months post-operation, they were assigned into two groups of recurrence（n=36） and non-recurrence（n=64）. Serum levels of RBP4 and CCKAR were measured by enzyme-linked immunosorbent assay（ELISA）. The correlation of serum level of RBP4/CCKAR with total bilirubin（TBIL） and tumor necrosis factor-alpha（TNF-α） in recurrence group was examined by Pearson’s correlation analysis. Multiple logistic regression was utilized for examining the influencing factors of postoperative recurrence.Predictive value of subjects was analyzed by plotting receiver operating characteristic curves and the area under the curve（AUC） compared by Z-test. Results The levels of TBIL, TNF-α and RBP4 were obviously higher in recurrence group than those in non-recurrence group [（9.97±2.85） vs.（7.81±2.19） mg/L,P<0.05].And CCKAR was obviously lower than that in non-recurrence group [（91.56±26.49） vs.（116.40±29.69） ng/L,P<0.05]. Serum level of RBP4 in recurrence group was correlated positively with TBIL and TNF-α（r=0.543, 0.498,P<0.05） while CCKAR level was correlated negatively with TBIL and TNF-α （r=-0.511,-0.576,P<0.05）. TNF-α and RBP4 were risk factors for postoperative recurrence （OR：4.168, 4.550, P<0.05）. CCKAR was a protective factor of postoperative recurrence （OR=0.301,P<0.05）.Combining serum levels of RBP4 and CCKAR in predicting postoperative recurrence had an AUC of 0.905 （95%CI： 0.835-0.975）. AUC of RBP4 or CCKAR alone in predicting postoperative recurrence was 0.787 （95%CI： 0.696-0.879） or 0.802 （95%CI： 0.715-0.890） respectively. Combined predictive value of both was higher than RBP4（Z=1.993, P=0.023） or CCKAR （Z=1.787,P=0.037） alone. Conclusion Serum level of RBP4 rises while that of CCKAR declines in patients with postoperative recurrence of intrahepatic choledocholithiasis. A combination of both has a high value in predicting postoperative recurrence in patients with intrahepatic choledocholithiasis.

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 explore the influencing factors of achievement rate of textbook outcome （TO） after colorectal cancer surgery and propose a standardized definition. Methods A systematic literature search was conducted through the databases of PubMed, Embase, Cochrane and Web of Science according to the PRISMA guidelines. Then the authors extracted the relevant articles fulfilling the inclusion criteria. Results Overall, 15 articles were included with a total of 1 345 149 patients undergoing colorectal cancer surgery.The average TO rate was 57.4%.The average TO rate was 60.1% for colon cancer and 52.3% for rectal cancer.Advanced age, male, high ASA score, high CCI score, open surgery, emergency surgery, tumor complications, higher tumor stage, additional local tumor invasive resection, longer operative duration,lack of preoperative antibiotic bowel preparation,frailty,nursing dependent survival state, concurrent basal diseases and BMI≥30 kg/㎡ were negative factors for achieving TO.Youth, female gender,owning private insurance, mini-invasive surgery,independent functional status, preoperative mechanical preparation, bowel preparation with antibiotics and higher preoperative hematocrit were associated with attaining TO. Conclusion TO is a quality indicator for measuring surgical outcomes. For colorectal cancer surgery, the definition of TO should include no death, R0 resection, no postoperative comeplications, length of hospitalization stay, no unplanned readmission and lymph node dissection.

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.

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.