In recent years, the incidence of hepatocellular carcinoma (HCC) has been persistently increasing , becoming one of the leading causes of cancer-related deaths worldwide. Although surgery is the only potential option for radical cure, most patients are diagnosed in the middle and advanced stage upon admission and miss the opportunity of surgery. With widespread application of immune checkpoint inhibitors (ICIs), systemic treatment modality for HCC has undergone profound changes. Combined treatment with ICIs as the core has significantly improved the survival and prognosis of advanced HCC patients. In this article, novel application strategies of immunotherapy in advanced HCC were systematically illustrated in three major directions. Firstly, stereotactic exploration of systemic therapy from "combined treatment for higher efficacy" to "drug resistance breakthrough", including TACE combined with targeted immunotherapy for extending indications, stereotactic body radiotherapy (SBRT) for reversing immune resistance and ICIs re-challenge strategies. Secondly, the paradigms of translational therapy and perioperative management have been evolved from "passive resection" to "precise prediction", emphasizing utilizing stratified guidance of postoperative AFP to assist treatment decision-making and intensified interventions for high-risk populations. Thirdly, precise prediction has been updated from image morphology to immune microenvironment. Radiomics, liquid biopsy and multi-omics integration provide prediction tools with high accessibility and strong dynamic monitoring capability for individualized treatment. These progresses jointly promote the development of advanced HCC treatment to precise treatment, offering novel ideas for realizing the full-course management of "downstaging-translation-radical treatment-maintenance".

Spleen is a vital hematopoietic and immune organ in human body. Spleen plays a complex role in hematological diseases. It is not only the site where blood cells are destroyed, but also participates in multiple physiological functions such as immune response, hematopoiesis and filtration, etc. In hematological diseases, pathological enlargement of the spleen or hypersplenism can lead to abnormal destruction of blood cells, thereby aggravating anemia, thrombocytopenia and other symptoms. Splenectomy, as an effective treatment, can mitigate the negative effect of spleen on blood components. However, with in-depth understanding of spleen function and its role in immune regulation, as well as the application of new drug therapy, partial patients with hematological diseases can also obtain favorable clinical outcomes through non-surgical treatment. Hence, the role of splenectomy in the treatment of hematological diseases has also changed. Disputes and challenges still exist in the indications, timing and postoperative management of splenectomy. In this article, clinical application, efficacy and the latest research progress in splenectomy for hematological diseases were reviewed, aiming to discuss current hot topics and future direction of splenectomy.

Portal hypertension (PH) is mainly caused by liver cirrhosis, manifested with gastroesophageal varices (GOV), ascites, hypersplenism and hepatic encephalopathy, etc. PH is a vital sign of decompensated liver cirrhosis and yields poor prognosis. The initial factor of PH is the increase in blood flow resistance in the liver, thereby leading to the formation of visceral hyperdynamic circulation and portosystemic shunts. With the progression of disease, cavernous transformation of portal vein thrombosis (PVT) may occur, which further aggravates hepatic perfusion insufficiency. Hepatic venous pressure gradient (HVPG) is the gold standard for diagnosing and evaluating the severity of PH in liver cirrhosis. HVPG≥10 mmHg (1 mmHg=0.133 kPa) is the clinically significant PH threshold, ≥12 mmHg significantly increases the risk of bleeding, ≥16 mmHg increases the risk of death, and HVPG≥20 mmHg increases the risk of treatment failure and death of esophageal varices bleeding(EVB). The treatment strategy emphasizes staged treatment and multidisciplinary team cooperation. During the compensatory stage, extensive attention is paid to etiological treatment and primary prevention of non-selective β-blocker (NSBB) or endoscopic ligation. The combination of vasoactive drugs and endoscopy is the first choice for acute EVB, and transjugular intrahepatic portosystemic shunt (TIPS) is chosen for patients with treatment failure. NSBB combined with endoscopy or TIPS is recommended for secondary prevention. For patients with recurrent bleeding and acceptable liver function, laparoscopic splenectomy has unique advantages in improving liver function and preventing rebleeding. TIPS bridging or liver transplantation is recommended at the end stage. Individual treatment options should be chosen based on the staging of PH. Efforts should be made to comprehensively consider reducing portal pressure, preventing bleeding and protecting liver function. Anticoagulation and PVT management are the keys to maintaining the continuity of treatment.

Splenic tumors are rarely encountered in clinical settings, including benign tumors, malignant tumors and borderline tumors of the spleen. It is challenging to make a differential diagnosis due to non-specific clinical manifestations. Minimally invasive laparoscopic total or partial splenectomy for splenic tumors can achieve favorable prognosis. Splenic tumor is rare but unneglectable, which poses a challenge to the diagnosis and management of hematology, oncology and general surgery. It is necessary to continuously deepen the understanding of splenic tumors, thereby achieving early detection, diagnosis and treatment. Meantime, the classification and staging of splenic tumors should be refined to minimize spleen injury, maximize the preservation of spleen function and reduce the incidence of complications. In this article, clinical manifestations, related malignant tumors and hierarchical diagnosis and treatment of splenic tumors were explicitly reviewed. The diagnosis and treatment strategies of splenic tumors were sorted out according to relevant guidelines and clinical experience.

Portal hypertension (PH) refers to a type of comprehensive disease with abnormally elevated pressure in the portal vein system, which is primarily caused by liver diseases (such as liver cirrhosis) or blockage of portal vein blood flow, leading to collateral circulation and serious, even life-threatening complications. The management of PH has evolved from a single treatment modality to multidisciplinary comprehensive treatment. Multiple diagnosis and treatment approaches are integrated to reduce portal hypertension, thus lowering the mortality caused by venous bleeding, achieving effective treatment of PH and obtaining complementary advantages. In this article, research progress in the diagnosis and treatment of PH and its complications was illustrated.

Spleen is an important immune organ of human body. With the development of surgical technologies, partial splenectomy has gradually become the primary option for patients with benign spleen diseases due to its advantages of preserving spleen function. Laparoscopic partial splenectomy (LPS) has served as the mainstream surgical procedure for patients with benign spleen lesions due to mild trauma, slight pain, rapid recovery and preservation of spleen function, etc. Along with rapid development of robot-assisted surgery system in medical field in recent years, robot-assisted partial splenectomy (RPS) has gradually become a novel alternative to LPS. At present, the indications of minimally invasive partial splenectomy have been constantly expanded, the key surgical procedures have been continually modified, and surgical efficacy and safety have been significantly improved. With the integration of artificial intelligence (AI), augmented reality (AR), 3D printing and other digital intelligence and virtual reality technologies, spleen surgery will develop in a more individualized, precise and intelligent direction in the future, further improving clinical prognosis and quality of life of patients.

Spleen surgery has experienced a hundred years of controversy from "disposable organs" to functional preservation. Single-incision laparoscopic partial splenectomy (SILPS) has revolutionized the paradigm of spleen-preserving surgery. Based on the anatomical characteristics of segmental blood supply of the spleen, precise partial splenectomy can be achieved by a single concealed incision, maintaining immune and circulatory homeostasis in minimally invasive surgery. However, surgical precision in limited visual field, steep learning curve and physical limitation of surgical instruments are major barriers preventing its clinical application. In the future, robot-assisted and intelligent navigation will probably resolve these challenges, pushing spleen surgery into the era of "millimeter-level" precision and shedding light on the balance between resection and preservation.

To explore the efficacy and safety of multiple first-line systemic therapies in Chinese patients with advanced hepatocellular carcinoma (HCC).

Phase Ⅲ RCTs of first-line treatment regimen for advanced HCC reporting Chinese population subgroup data were searched from PubMed, Web of Science and abstracts of important international conferences from the inception date of databases to February 1, 2026. Two independent researchers screened the literature, extracted the data and evaluated the risk of bias. Netmeta package of R software was used for network meta-analysis. HR, OR and 95%CI were calculated. The advantages and disadvantages of each regimen were ranked by using the surface under the cumulative ranking curve (SUCRA).

Twelve phase Ⅲ RCTs were finally included, including 13 study groups, with a total of 4643 patients and 13 treatment regimens. The analysis of clinical efficacy showed that the overall survival (OS) of durvalumab + tremelimumab (HR=0.44, 95%CI: 0.26-0.76) and atezolizumab + bevacizumab (HR=0.44, 95%CI: 0.25-0.77) was significantly better than that of sorafenib (both P<0.05), with higher SUCRA rankings of 86.3% and 86.0%. In terms of progression-free survival (PFS) and objective response rate (ORR), nivolumab + ipilimumab yielded better PFS (HR=0.40, 95%CI: 0.26-0.63) and ORR (OR=11.10, 95%CI: 4.14-29.75) compared with those of sorafenib (all P<0.05), with the highest SUCRA rankings of 90.3% and 82.4%. The safety analysis revealed that the single use of tislelizumab and durvalumab yielded the highest safety in reducing the risk of ≥grade 3 and any grade of treatment-related adverse events. However, camrelizumab+apatinib regimen caused the highest risk of ≥grade 3 TRAE and drug withdrawal.

For Chinese patients with advanced HCC, durvalumab + tremelimumab and atezolizumab + bevacizumab can prolong the OS. Nivolumab + ipilimumab has advantages in controlling disease progression and reducing tumor size, which significantly improves PFS and ORR. However, immune monotherapy with single use of tislelizumab or durvalumab yields high safety.

To compare perioperative safety and efficacy of robot-assisted spleen-preserving distal pancreatectomy (RSPDP) and laparoscopic spleen-preserving distal pancreatectomy (LSPDP) for benign or low-grade malignant lesions of pancreatic body and tail, and to evaluate clinical benefits of RSPDP patients.

Clinical data of 35 patients with benign or low-grade malignant lesions of pancreatic body and tail undergoing spleen-preserving distal splenectomy in the Affiliated Hospital of Guizhou Medical University from January 2019 to December 2024 were analyzed retrospectively. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 12 patients were male and 23 female, aged (51±19) years on average. According to different surgical methods, all patients were divided into the RSPDP group (n=14) and LSPDP group (n=21). According to specific conditions during the surgery, spleen-preserving distal pancreatectomy was performed using Kimura or Warshaw technique. Perioperative indexes between two groups were compared by rank-sum test, and the incidence of complications was compared by Fisher's exact test.

All patients in two groups successfully completed the surgery, and no perioperative death occurred. In the RSPDP group, Kimura technique was adopted in 9 cases, and 14 cases in the LSPDP group. The splenic vessel-preserving rates in two groups were 64%(9/14) and 67%(14/21), with no statistical significance (P>0.999). The median intraoperative blood loss in the RSPDP group was 40(20,63) ml, significantly less than 100(50,300) ml in the LSPDP group (Z=-2.638, P=0.007). No significant difference was observed in operation time and blood transfusion amount between two groups (all P>0.05). No significant difference was found in the amount of amylase in drainage fluid, extubation time and the incidence of splenic infarction, pancreatic fistula and abdominal infection rate between two groups (all P>0.05).

Both RSPDP and LSPDP are safe for patients with benign or low-grade malignant lesions of pancreatic body and tail. No significant difference is observed in operation time and postoperative recovery between two groups. Compared with LSPDP, RSPDP leads to a lower amount of intraoperative bleeding.

To investigate clinical characteristics of collateral circulation compensation pathway and evaluate clinical efficacy of meso-rex bypass (Rex shunt) in children with cavernous transformation of portal vein (CTPV).

Clinical data of 36 children with CTPV who underwent Rex shunt in Hunan Children's Hospital from May 2018 to March 2025 were analyzed retrospectively. The informed consents of the guardians of all children were obtained and the local ethical committee approval was received. Among them, 15 patients were male and 21 female, aged from 1.0 to 15.0 years, with a median age of 4.6 years. 33 children were diagnosed with primary CTPV and 3 cases of secondary CTPV. Regarding clinical manifestations, 3 cases had pancytopenia, 14 cases of pancytopenia complicated with splenomegaly, 18 cases of gastrointestinal bleeding, and 1 case without any symptoms. The diagnosis of CTPV was confirmed by preoperative abdominal ultrasound and enhanced CT scan. Preoperative wedged hepatic venous portography (WHVP) was performed to evaluate the development of intra-and extra-hepatic portal veins. Classical and modified Rex shunts were performed by portal vein sheath-free anastomosis and individualized vascular graft selection. Standardized anticoagulation and follow-up management were given after surgery. Children's conditions and surgical efficacy of Rex shunts were observed. Extra-hepatic portal vein pressure before and after Rex shunts was compared by t-test.

36 children successfully underwent Rex shunts, including 28 cases of classic Rex shunts and 8 cases of modified Rex shunts. Postoperative extra-hepatic portal vein pressure was decreased from (30.4±2.6) mmHg (1 mmHg=0.133 kPa) before surgery to (17.4±1.1) mmHg (t=30.66, P<0.001). Two children developed postoperative chylous leakage, which were cured after nutritional support, anti-infection and proper drainage. The remaining children were discharged after recovery. Three-dimensional CT reconstruction showed the patency of the portal veins. The follow-up duration was 5-84 months, with a median follow-up of 26 months. 4 children developed postoperative bypass graft embolization, and 2 of them underwent secondary Rex shunts, using internal jugular vein and inferior mesenteric vein as vascular grafts. The other 2 cases were observed during outpatient follow-up. 3 children were complicated with postoperative bypass graft stenosis, 2 of them received interventional balloon dilatation and 1 underwent stent implantation. In 34 children, the symptoms of portal hypertension were significantly relieved and absent within half a month. In the remaining 2 cases, Plt and WBC were not restored to normal, and no variceal bleeding in the lower esophageal fundus was observed.

Rex shunt can effectively reconstruct portal vein blood flow into the liver in children with CTPV, and significantly reduce extra-hepatic portal hypertension. Portal vein sheath-free anastomosis technique and individualized vascular graft selection determine surgical success, which evidently improve the success rate and patency rate of vascular anastomosis.

To evaluate the application of cholangiopancreatography system in endoscopic retrograde cholangiopancreatography (ERCP) for patients with common bile duct stones.

Clinical data of 70 patients with common bile duct stones admitted to the Third Affiliated Hospital of Sun Yat-sen University from January to December 2024 were analyzed retrospectively. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 45 patients were male and 25 female, aged from 25 to 88 years, with a median age of 57 years. All patients were divided into the ERCP group (ERCP group, n=35) and eyeMax cholangiopancreatography system-assisted ERCP group (eyeMax group, n=35). The incidence of postoperative complications and overall stone removal rate between two groups were compared by Chi-square test or Fisher's exact test. Operation time, cumulative radiation dose, air kerma (AK) and hospitalization expenses were compared by t-test.

The operation time and cumulative AK of radiation dose in the eyeMax group were (82±36) min and (111±56) mGy, significantly higher than (36±15) min and (55±31) mGy in the ERCP group (t=6.903, 5.169; both P<0.001). The hospitalization expense in the eyeMax group was (3.5±0.7)×10⁴ yuan, significantly higher than (2.6±0.5)×10⁴ yuan in the ERCP group (t=6.136, P<0.001). The procedures were successfully completed in two groups. The difficult intubation rates in the eyeMax and ERCP groups were 14%(5/35) and 23%(8/35), with no statistical significance (χ²=0.850, P=0.356). The overall stone removal rates in the eyeMax and ERCP groups were 97%(34/35) and 86%(30/35), with no statistical significance (P=0.198). Subgroup analysis showed that the residual rate of multiple stones in the eyeMax group was 4%(1/23), significantly lower than 31%(5/16) in the ERCP group (P=0.033). The recurrence rates of common bile duct stones in the eyeMax and ERCP groups were 9%(5/35) and 14%(3/35), with no statistical significance (P=0.710). No severe complications such as perforation and severe pancreatitis occurred in two groups. In the eyeMax group, 4 patients developed mild pancreatitis, 3 cases of hyperamylasemia, 3 cases of cholangitis and 1 case of hemorrhage, and 3,2,4 and 0 in the ERCP group, with no statistical significance (all P>0.05).

The cholangiopancreatography system-assisted ERCP can improve the removal rate of multiple common bile duct stones. This system enhances the visualization and precision of ERCP procedures without increasing the risk of severe complications. However, extensive attention should be paid to the radiation exposure, equipment cost and technical issues.

To evaluate clinical efficacy of interventional therapy for patients with different types of hepatic vein-type Budd-Chiari syndrome (BCS).

Clinical data of 189 patients with hepatic vein-type BCS admitted to the Affiliated Hospital of Xuzhou Medical University from January 2014 to December 2024 were analyzed retrospectively. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 89 patients were male and 100 female, aged from 20 to 79 years, with a median age of 46 years. According to different types of hepatic venous lesions, all patients were divided into the membranous obstruction group (n=65), segmental obstruction group (n=53), extensive obstruction group (n=39) and thrombus group (n=32). In the membranous and segmental obstruction groups, balloon dilatation and/or stent implantation were performed. In the extensive obstruction group, transjugular intrahepatic portosystemic shunt (TIPS) was adopted. In the thrombus group, thrombi were removed, followed by angioplasty or TIPS. Postoperative color Doppler ultrasound, magnetic resonance venography (MRV) or CT venography were used to monitor the patency of blood vessels. The changes of venous pressure before and after treatment were compared by paired t-test. Child-Pugh scores of liver function were compared by Chi-square test. The first cumulative patency rate was calculated by Kaplan-Meier method and compared with Log-rank test.

All patients were successfully treated by interventional therapy without severe complications. Before and after interventional therapy, the pressure difference between hepatic vein and inferior vena cava was decreased from (13.6±3.7) mmHg (1 mmHg=0.133 kPa) to (4.1±1.6) mmHg in the membranous obstruction group, from (11.7±2.3) mmHg to (4.7±2.4) mmHg in the segmental obstruction group , and from (14.2±3.1) mmHg to (4.9±2.7) mmHg in the thrombus group (t=15.649, 16.537, 17.341; all P<0.05). Portal pressure gradient (PPG) was decreased from (24.7±3.5) mmHg to (9.8±2.8) mmHg in the extensive obstruction group (t=18.036, P<0.05). The follow-up time was 3.0-134.0 months. The median follow-up time was 65.3 months. 8 cases were lost to follow-up. Among 62 patients in the membranous obstruction group, 51 cases achieved the patency of hepatic veins and 11 cases developed restenosis. The restenosis rate of patients undergoing stent implantation was significantly higher than that of those receiving balloon dilatation (χ²=9.605, P=0.002). Among 51 cases in the segmental obstruction group, 34 patients achieved the patency of hepatic veins and 17 cases had restenosis. The restenosis rate of patients with stent implantation was significantly higher than that of those receiving balloon dilatation (χ²=6.951, P=0.008). In the extensive obstruction group (n=37), 21 cases had vessel patency after TIPS and 16 cases had in-stent restenosis. 3 patients were diagnosed with hepatic encephalopathy after operation. 2 patients died of liver failure at postoperative 17 and 68 months,respectively. In the thrombus group, 12 of 26 patients undergoing angioplasty experienced hepatic venous restenosis, 1 of 5 cases receiving TIPS had in-stent restenosis, and 1 case died at postoperative 105 month, which was unrelated to BCS. According to preoperative Child-Pugh classification of liver function, 58, 76 and 47 patients were classified as Child-Pugh A, Child-Pugh B and Child-Pugh C, and 98, 68 and 15 cases of Child-Pugh A, Child-Pugh B and Child-Pugh C at postoperative 3 months, respectively. The liver function was significantly improved (χ²=27.217, P<0.001). The first cumulative patency rates at postoperative 1, 3, 5 and 10 years were 92.2%, 83.5%, 75.4% and 61.8% in the membranous obstruction group, 90.8%, 81.1%, 63.3% and 51.4% in the segmental obstruction group, 91.6%, 81.6%, 72.7% and 52.2% in the extensive occlusion group, and 84.7%, 78.9%, 67.3% and 55.1% in the thrombus group, respectively. No significant difference was observed in the first cumulative patency rate among four groups (χ²=1.094, P=0.778).

According to different types of hepatic vein-type BCS, corresponding interventional therapies can achieve favorable middle-and long-term efficacy. In the membranous obstruction group, balloon dilatation alone is recommended. Segmental obstruction is mainly treated by balloon dilatation, and stent implantation can be used as a remedial treatment. TIPS is recommended for extensive obstruction. For thrombosis patients, thrombi should be removed first, followed by angioplasty or TIPS according to individual conditions.

To investigate the timing of gastroscopy for gastrointestinal bleeding induced by portal hypertension and the application value of antithrombin Ⅲ in predicting active bleeding.

Clinical data of 152 cirrhosis-induced portal hypertension patients experiencing gastrointestinal bleeding who underwent emergency gastroscopy in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from August 2018 to March 2025 were analyzed retrospectively. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 104 patients were male and 48 female, aged from 32 to 74 years, with a median age of 57 years. All patients were divided into two groups according to whether active bleeding was found. Emergency detection rate of gastrointestinal bleeding, implementation rate of anesthesia, re-treatment rate, rebleeding rate, hemostasis success rate and incidence of complications were analyzed. All patients were divided into two groups according to whether they were anesthetized or not. The impact of anesthesia on emergency gastroscopy for gastrointestinal bleeding was assessed in portal hypertension patients. The relationship between the main indexes of coagulation function and active bleeding was analyzed.

The detection rate of gastrointestinal bleeding in 152 patients was 48.0%(73/152). The implementation rate of anesthesia in the active bleeding group was 30.1%(22/73), significantly lower than 60.8%(48/79) in the non-active bleeding group (χ²=14.321, P<0.05). The re-treatment rate in the active bleeding group was 84.9%(62/73), significantly higher than 40.5%(32/79) in the non-active bleeding group (χ²=31.732, P<0.05). The rebleeding rate was 23.3%(17/73), significantly higher than 10.1%(8/79) in the non-active bleeding group (χ²=4.782, P<0.05). In the anesthesia group, the re-treatment rate was 42.9%(30/70), significantly lower than 70.0%(64/82) in the non-anesthesia group (χ²=19.819, P<0.05). The rebleeding rate was 8.6%(6/70), significantly lower than 23.2%(19/82) in the non-anesthesia group (χ²=5.857, P<0.05). In the active bleeding group, the antithrombin Ⅲ was 44.3(29.1, 48.4)%, significantly lower than 75.8 (55.9, 88.3)% in the non-active bleeding group, and the difference was statistically significant (Z=-6.095, P<0.05). ROC curve analysis showed that antithrombin Ⅲ had certain predictive and diagnostic value for active bleeding, with an AUC of 0.786, a sensitivity of 0.899, a specificity of 0.784 and an accuracy of 84.2%, respectively. The optimal cut-off value of antithrombin Ⅲ diagnosis was 50.9%.

For patients with gastrointestinal bleeding induced by portal hypertension, significant clinical benefits can be obtained from emergency gastroscopy after full preoperative preparation and anesthesia evaluation when vital signs are stable. Antithrombin Ⅲ has certain predictive value for patients with active bleeding, which can be used as a reference marker for the timing of gastroscopy.

To investigate the influencing factors and to construct a prediction model for refractory hypersplenism after liver transplantation for benign end-stage liver diseases.

Clinical data of 97 patients with benign end-stage liver diseases complicated with hypersplenism who underwent liver transplantation in Beijing Chaoyang Hospital, Capital Medical University from January 2013 to December 2023 were analyzed retrospectively. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 70 patients were male and 27 female, aged (52±9) years on average. Before operation, 7 patients were classified with Child-Pugh A, 30 cases of Child-Pugh B and 60 cases of Child-Pugh C. 63 patients underwent modified piggyback liver transplantation and 34 cases of classic orthotopic liver transplantation. According to the recovery of hypersplenism at postoperative 6 months, all patients were divided into the remission group and refractory hypersplenism group. The risk factors of refractory hypersplenism after liver transplantation were analyzed by t-test and rank-sum test. The independent risk factors for refractory hypersplenism were identified by Logistic multivariate regression analysis. Based on the independent risk factors, the prediction model was constructed. The prediction efficiency of these independent risk factors was determined by the ROC curve.

Univariate analysis showed that preoperative Plt (Z=3.201), TB (Z=2.036), DB (Z=2.085), bipolar spleen diameter (t=3.291), thick spleen diameter (t=4.441), long spleen diameter (Z=3.309) and splenic artery diameter (t=3.634), splenic vein diameter (Z=3.494) and portal vein diameter (t=3.379) were associated with the incidence of refractory hypersplenism (all P<0.05).Lower preoperative Plt (OR=0.971, 95%CI: 0.945-0.997), longer preoperative thick spleen diameter (OR=1.080, 95%CI: 1.014-1.151) and preoperative splenic artery diameter (OR=1.472, 95%CI: 1.010-2.145) were the independent risk factors for patients with postoperative refractory hypersplenism (all P<0.05). Based on preoperative Plt, preoperative thick spleen diameter and preoperative splenic artery diameter, a prediction model was constructed. The prediction model yielded a high prediction efficiency for patients with postoperative refractory hypersplenism (ROC AUC=0.888, 95%CI: 0.823-0.953, P<0.001), with a sensitivity of 0.771 and a specificity of 0.855.

For benign end-stage liver disease patients with refractory hypersplenism after liver transplantation, the recovery of spleen function can be predicted by evaluating preoperative Plt, thick spleen diameter and splenic artery diameter.

To evaluate the application and efficacy of prospective interventional strategies based on multi-dimensional evaluation in the perioperative period of liver transplantation for liver cancer.

Clinical data of 100 liver cancer patients who underwent liver transplantation in the Third Affiliated Hospital of Sun Yat-sen University from February 2023 to March 2025 were analyzed retrospectively. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 79 patients were male and 21 female, aged from 16 to 70 years, with a median age of 53 years. All patients were divided into the perioperative prospective intervention group (intervention group, n=50) and control group (n=50). In the control group, patients received conventional management in perioperative period of liver transplantation, and their counterparts in the intervention group were additionally given with perioperative prospective interventions besides those in the control group. The core of prospective interventions during perioperative period was to build a specialized management team, integrate multidisciplinary team resources such as surgeons, anesthesiologists, ICU physicians, nursing teams, rehabilitation physicians, nutrition physicians and psychologists, and jointly formulate definite and standardized objectives and procedures. Sequential organ failure assessment (SOFA score), venous thromboembolism risk assessment (Caprini score), fall risk assessment (Morse fall scale), Braden scale for predicting pressure ulcer risk (Braden scale), independence in activities of daily living (Barthel index), psychological stress assessment (PHQ-9), nutritional risk score (NRS 2002) and the length of hospital stay between two groups were compared using t-test. The incidence of postoperative complications was compared by Chi-square test.

In the intervention group, the SOFA, Caprini, Morse, PHQ-9 and NRS 2002 scores were 4.9±2.7, 3.1±0.8, 36±11, 2.5±2.0 and 2.5±1.1, significantly lower than 6.6±3.0, 3.5±0.9, 45±8, 3.5±2.8 and 3.5±1.2 in the control group (t=-2.946,-2.628,-4.304,-2.053,-4.543; all P<0.05). In the intervention group, the Braden pressure ulcer score was 17.4±1.4, significantly higher than 16.7±1.5 in the control group (t=2.258, P<0.05). However, the Barthel indexes in the intervention and control groups were 83±16 and 77±16, and the difference was not statistically significant (t=1.968, P>0.05). In the intervention group, the length of hospital stay was (28±9) d, significantly shorter than (41±22) d in the control group (t=-3.929, P<0.05). The incidence of postoperative complications in the intervention group was 28%(14/50), significantly lower than 48%(24/50) in the control group(χ²=4.244, P<0.05).

For liver transplantation recipients with liver cancer, perioperative prospective interventions based on multi-dimensional comprehensive evaluation contribute to improving physiological and psychological status, reducing the incidence of postoperative complications, shortening the length of hospital stay, accelerating postoperative recovery and significantly enhancing clinical prognosis.

To construct a simplified scoring model for the risk of early postoperative infection after liver transplantation based on objective nursing indexes within postoperative 24 h, and to evaluate its application value in hierarchical nursing strategies.

Clinical data of 156 recipients who underwent allogeneic liver transplantation at Sun Yat-sen Memorial Hospital from January 2021 to December 2023 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 133 patients were male and 23 female, aged from 18 to 74 years, and a median age of 52 years. Lasso regression was used to screen key characteristic indexes early after liver transplantation. Multivariate Logistic regression was adopted to construct a prediction model for early postoperative infection and convert it into a simple scoring of postoperative infection. Receiver operating characteristic (ROC) curve analysis and Bootstrap internal validation were used to evaluate the efficiency of this prediction model, and stratified nursing strategies were formulated based on the cut-off value.

60 recipients developed infection early after liver transplantation, with an infection rate of 38.5%(60/156). The variables with the top four standardized coefficients screened by Lasso regression included drainage volume on postoperative day 1 (POD1), POD1-WBC, intraoperative blood transfusion and body mass index (BMI). The cut-off value of POD1 drainage volume was ≥600 ml, POD1-WBC≥9.0×10⁹/L, intraoperative blood transfusion≥1 800 ml and BMI≥24 kg/m², respectively. Multivariate Logistic regression analysis showed that POD1 drainage volume≥600 ml (OR=4.06, 95%CI: 1.92-8.59), POD1-WB≥9.0×10⁹/L (OR=2.12, 95%CI: 1.03-4.37), and intraoperative blood transfusion≥1 800 ml (OR=2.43, 95%CI: 1.15-5.15) were the independent risk factors for postoperative infection (all P<0.05). BMI≥24 kg/m² was marginally correlated with postoperative infection (OR=2.04, 95%CI: 0.96-4.32, P=0.063), which was included in the scoring for enhancing bedside operability. ROC curve analysis of the simplified scoring model showed that the area under the ROC curve (AUC) was 0.70 (95%CI: 0.62-0.77) with a high degree of calibration (Brier score=0.211). Trend test showed that the infection rate was increased with the increase of the score (χ²=28.15, P<0.001). The infection rate was 8.0% in the score=0 group and 71.4% in score=3-4 group. When score≥1 was taken as the cut-off value of initial screening, the sensitivity was 0.97. Taking the score≥3 as the cut-off value of intensified interventions, the specificity was 0.94.

The simplified scoring model is simple, objective and has high risk stratification capability. Nursing strategies stratified based on double cut-off value grading of "score=1 for initial screening and score=3 for intensified intervention" contribute to achieving precise allocation and early warning of ICU nursing resources for liver transplantation.

To explore the classification of splenic trauma and methods for treatment selection.

Clinical data of 260 patients with splenic trauma admitted to the First People's Hospital of Chenzhou from January 2020 to January 2025 were analyzed retrospectively. Among them, 188 patients were male and 72 female, aged from 2 to 75 years, with a median age of 39 years. Among 188 patients, 161 cases experienced traffic accident injuries, 48 cases of falling injuries, 12 cases of stab injuries and 39 cases of blunt injuries. 69 patients were diagnosed with splenic rupture alone, 163 cases of spleen rupture complicated with brain trauma, multiple fractures, chest trauma and other extraperitoneal organ injuries, 16 cases of splenic rupture complicated with liver rupture, 8 cases of splenic rupture complicated with pancreatic rupture and 4 cases of splenic rupture complicated with gastrointestinal perforation. The splenic trauma was graded to the grading standards of splenic injury of Chinese Medical Association, according to the grading, kinetic energy of patients' injury, the changes of vital signs after injury and the involved organs, the diagnosis and treatment regimens for splenic trauma were formulated. Treatment methods included conservative treatment, interventional treatment, laparoscopic and open splenectomy, etc. For those complicated with other organ injuries, corresponding surgery or conservative treatments were performed.

Twelve patients were assessed as grade Ⅰ, 24 cases of grade Ⅱ, 159 cases of grade Ⅲ and 65 cases of grade Ⅳ, respectively. The success rate of treatment for splenic trauma was 98.8%(257/260), including 226 cases of surgery, 32 cases of conservative treatment and 2 cases of interventional treatment. Surgical methods included splenectomy combined with splenic tissue autotransplantation in 191 cases, partial splenectomy in 3 cases, laparoscopic splenectomy in 29 cases and laparoscopic partial splenectomy in 3 cases, respectively. 16 patients complicated with liver rupture were simultaneously treated with partial hepatectomy and repair of liver rupture, 8 cases complicated with pancreatic rupture were simultaneously treated with partial pancreatectomy and repair, and 4 cases complicated with gastrointestinal perforation were simultaneously treated with gastrointestinal repair.

The diagnosis and treatment regimen of splenic trauma should be formulated based on the grading, kinetic energy of splenic injury, the changes of patients' vital signs after injury and the involved organs, and appropriate treatment methods should be adopted. Splenectomy is the most effective treatment for emergent patients.

To evaluate the application of preoperative preventive splenic artery embolization (PSAE) in splenectomy for left portal hypertension.

Clinical data of 1 patient with left portal hypertension admitted to the Department of Hepatobiliary and Pancreatic Surgery of the First Affiliated Hospital of Anhui Medical University in March 2025 were analyzed retrospectively. The 47-year-old male patient was hospitalized due to "recurrent epigastric pain for more than 10 years". Physical examination showed abdominal distension, evident tender in the upper abdomen, accompanied with muscle tension and rebound pain, shifting dullness (+) and weak bowel sounds. Laboratory examination revealed WBC was 2.1×10⁹/L, RBC 5.78×10¹²/L, Hb 169 g/L, Plt 42×10⁹/L, ALT 12.0 U/L, AST 18.4 U/L, TB 15.57 μmol/L, DB 3.88 μmol/L and ALB 45.8 g/L, respectively. CT scan showed enlargement of the spleen, embolism or stenosis of splenic vein. Endoscopic examination revealed isolated varices of the gastric fundus in tortuosity and earthworm shape. The initial diagnosis was left portal hypertension. After active preoperative preparations, PSAE was performed on March 25, 2025. The right femoral artery puncture was performed using Seldinger technique. Superselective catheterization of the main splenic artery was conducted using the microcatheter. The left portal hypertension patients were subject to staged embolization to limit blood flow, followed by complete embolization of the main splenic artery by using tissue glue and iodized oil in a ratio of 1∶2. Splenectomy was performed on March 26, 2025.

At postoperative 3 d, CT scan showed that isolated varices of the gastric fundus were significantly alleviated and original tortuous and thickened venous masses were absent, confirming that splenectomy effectively relieved regional portal hypertension. DSA during follow-up showed that the splenic artery trunk was completely occluded and no evident collateral circulation was established. Postoperative pathological examination showed that the resected spleen was significantly enlarged, weighing 850 g, and the capsule was thickened and the tension was increased. The section was dark red with tough texture, presenting with extensive fibrotic changes. Postoperative Plt was increased from 42×10⁹/L before operation to 210×10⁹/L, WBC was increased from 2.1×10⁹/L to 6.5×10⁹/L, and hypersplenism was completely treated. No postoperative complications, such as bleeding and infection, were reported. The patient was recovered well and discharged at postoperative 7 d.

PSAE can block the blood flow of splenic artery by preoperative intervention, reduce the risk of bleeding during splenectomy, decrease the size of spleen and improve the exposure of surgical field. PSAE can also adjust the hemodynamic stability of portal vein system, especially suitable for patients with pancreatic or splenic vein obstruction-induced portal hypertension.

Liver cirrhosis can cause multiple severe complications, including portal hypertension-induced hypersplenism and oesophageal variceal bleeding. In recent years, with widespread application of different treatments such as drug therapy, splenic artery embolization and transjugular intrahepatic portosystemic shunt, the role of surgical resection in the management of portal hypertension has been gradually weakened. However, combined with the actual clinical situation in China, splenectomy, as the main surgical treatment for portal hypertension, is still of significance, which can not be completely replaced by alternative options.Splenectomy combined with selective pericardial devascularization is the most common procedure to treat hypersplenism and oesophageal variceal bleeding caused by portal hypertension, which has been widely applied in Chinese hospitals at all levels and saved the lives of patients. However, complications post-splenectomy limit further improvement in the quality of life of patients with portal hypertension. In this review, the complications after splenectomy were systematically analyzed, aiming to provide theoretical basis for refined management of patients with portal hypertension.

As a novel type of post-translational modification, protein lactylation has captivated extensive attention in the field of tumor biology in recent years. Hepatobiliary and pancreatic tumors are a type of malignant tumors in the digestive system with high incidence and poor prognosis. The complicated mechanism of incidence and development remains to be urgently unraveled. By regulating the metabolic reprogramming of tumor cells, promoting cell proliferation and mediating immune escape, protein lactylation has gradually become an important breakthrough point to understand the biological characteristics of hepatobiliary and pancreatic tumors. In this article, the molecular mechanism and detection methods of protein lactylation were systematically reviewed. The functional role and the potential of clinical application in hepatobiliary and pancreatic tumors were highlighted. Combined with the latest research progress, the challenges and future development trends in this field were illustrated, aiming to provide theoretical basis and novel ideas for optimizing basic research and clinical treatment strategies.