Congenital biliary atresia (CBA) is a hepatobiliary system disease caused by intrahepatic/extrahepatic biliary atresia, which is the main pathogenesis of obstructive jaundice in infants. The etiology of CBA remains unknown, which may be associated with genetic variation, virus infection and immune damage. Targeted preventive measures are lacking. At present, the core of diagnosis and treatment lies in early diagnosis and surgical intervention. However, multiple challenges remain to be resolved in clinical practice. CBA infants are manifested with persistent jaundice, or yellow discoloration of the skin and sclera recurring after physiological jaundice subsides, accompanied by dark color urine and even dark tea-colored urine. The stool color became lighter, even appearing greyish-white color. Laparoscopic or open bile duct exploration is currently considered as the "gold standard" for clinical diagnosis of CBA. In recent years, use of neonatal stool colorometric scale and novel biomarkers (such as serum matrix metalloproteinase 7) have improved the early detection rate. Kasai portoenterostomy procedure is the optimal treatment for CBA, and the ideal timing is within 45 days after birth. Baseline status, type of biliary atresia and degree of liver fibrosis of CBA infants are key factors to determine the efficacy of Kasai procedure. Long-term postoperative follow-up combined with ursodeoxycholic acid, antibiotics and nutritional support can prevent the progression of liver fibrosis.

Hepatocellular carcinoma (HCC) is one of the malignant tumors with high incidence and mortality rates worldwide, which poses severe threat to human health. In recent years, the application of artificial intelligence (AI) and multimodal imaging technology in the diagnosis and treatment of HCC has made remarkable progress. AI technologies, especially deep learning and traditional machine learning methods, have been applied in imaging big data analysis, which show high diagnostic accuracy and treatment decision support capability in early screening, staging and personalized treatment of HCC. Meantime, multimodal imaging technologies (such as CT, MRI, PET-CT, etc.) can improve the diagnostic efficiency and surgical safety in preoperative evaluation, surgical planning and intraoperative navigation. In this article, the latest progress in AI-based multimodal imaging in the diagnosis and treatment of HCC was reviewed, and its potential value and challenges in clinical practice were illustrated. In the future, with further optimization of AI model and the deepening of MDT, AI and multimodal imaging technology are expected to provide more precise treatment regimens and better prognostic evaluation for HCC patients.

In recent years, with the emergence of molecular targeting and immunotherapy, more and more patients with middle-advanced hepatocellular carcinoma (HCC) obtain benefits from translational therapy and achieve the opportunity of surgical treatment. At present, the evaluation and selection of eligible population, the formulation of the optimal translational strategy, surgical pattern and timing, precise preoperative planning and the research and development of intraoperative real-time navigation technology have become the hot spots in clinical research of HCC translational therapy. Among them, three-dimensional visualization technology is an important approach for digital medicine-assisted surgical treatment of solid tumors in recent years, which is also the core tool to realize precise planning and navigation in anatomical liver resection. Three-dimensional visualization technology utilizes three-dimensional evaluation, relies on the concept of full-course management of HCC translational treatment, precisely reflects therapeutic effect and guides treatment decision. In addition, it dynamically monitors the anatomical changes of the target liver after translational therapy, thereby formulating the optimal surgical approach. Digital medical technologies, represented by three-dimensional visualization technology, are expected to provide reliable prediction for systemic therapeutic effect by integrating novel imaging technological algorithms. In this article, the application of these technologies in the decision-making of HCC translational therapy was reviewed, and clinical practical significance was illustrated.

Hepatocellular carcinoma (HCC) is one of the malignant tumors causing severe threats to human health worldwide. Especially in China, the proportion of patients with middle-advanced HCC upon initial diagnosis exceeds 70%, and most patients miss the opportunity of surgery. High incidence and mortality rates of HCC make the study of treatment strategy become the hot spot in medical community. In recent years, conversion therapy has become an important option for inoperable patients. Through targeted drugs, immunotherapy and topical treatment, partial patients benefit from unresectable to resectable conversion and obtain favorable prognosis. With the updates and expansion of the concept of conversion therapy, it is still necessary to further investigate and analyze the scientific and individualized selection of treatment regimen and accurately grasp the timing and safety of surgery after conversion therapy.

Hepatocellular carcinoma (HCC) is a malignancy with high incidence and mortality rates. In recent years, with in-depth study of immune microenvironment and widespread application of immunotherapy in advanced HCC, immunotherapy strategies based on immune checkpoint inhibitors have been gradually employed in perioperative period, and other immunotherapy strategies (such as adoptive cell therapy and oncolytic virus) have also made significant progress. The purpose of perioperative immunotherapy is to improve tumor resectability, reduce the risk of recurrence and metastasis, and make partial unresectable HCC resectable. However, challenges in suitable population of immunotherapy and the optimal immunotherapy regimen remain to be resolved. In this article, the progresses in immunotherapy strategy for HCC, perioperative immunotherapy and prediction of immunotherapy efficacy were illustrated.

To evaluate the efficacy and safety of drug-eluting beads transarterial chemoembolization (DEB-TACE) in the conversion therapy for massive hepatocellular carcinoma (HCC).

Clinicopathological data of 19 patients with massive HCC receiving conversion therapy of DEB-TACE in the First Affiliated Hospital of Nanjing Medical University from January to December 2023 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among 19 patients, 13 were male and 6 female, aged (63±11) years. The study included 12 patients of China Liver Cancer Staging (CNLC) stage Ⅰb, 4 cases of CNLC stage Ⅱb and 3 cases of CNLC stage Ⅲa. The tumor diameter was (12.1±1.9) cm. Retrospective descriptive and cohort study methods were adopted. Tumor status and general conditions of patients, DEB-TACE, conversion treatment, surgery, and follow-up data and survival in success and failure groups were observed. Kaplan-Meier method and Log-rank test were used for survival analysis.

All 19 patients successfully completed DEB-TACE, with high safety and tolerance. Among them, 6 patients obtained successful conversion treatment (success group), and the success rate of conversion treatment was 32%. 5 patients underwent radical surgery, and 1 patient evaluated as complete remission (CR) refused surgery. The remaining 13 patients were assessed as unsuccessful conversion treatment (68%, failure group), including 9 patients were assessed as stable disease (SD) and 4 as progressive disease (PD). The median overall survival (OS) was not achieved in the success group and 6 months in the failure group, with statistical significance between two groups (χ²=8.054, P=0.005). The median progression-free survival (PFS) was not achieved in the success group and 4 months in the failure group, with statistical significance between two groups (χ²=8.625, P=0.003).

DEB-TACE conversion treatment yields high conversion rate, high safety and tolerance. Successful conversion treatment can significantly prolong PFS and OS. This protocol is worthy of clinical application.

To construct a nomogram model based on machine learning of MRI radiomics to predict the risk of microvascular invasion (MVI) of hepatocellular carcinoma (HCC) before surgery, and to assist the selection of individualized treatment.

Clinical data of 176 patients pathologically diagnosed with HCC who underwent surgical resection in the First Affiliated Hospital of China Medical University from June 2019 to December 2022 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 148 patients were male and 28 female, aged from 32 to 82 years, with a median age of 61 years. Clinicopathological data of 176 HCC patients were collected and analyzed. All patients were randomly divided into the training set (n=123) and test set (n=53) according to a ratio of 7∶3 (simple random sampling method). The sklearn software package in Python was used to fit five machine learning models: K-nearest neighbor, random forest, logistic regression, support vector machine and naive Bayes in the training set. The accuracy, sensitivity, specificity, F1 score and the area under the ROC curve (AUC) were compared between the training and test sets to evaluate the prediction efficiency of each machine learning model, and the model with the optimal comprehensive performance was selected to generate the radiomics score. Clinicopathological features of MVI-positive patients were analyzed by Chi-square test. Multivariate Logistic regression analysis was employed to analyze the risk factors of MVI and establish a nomogram prediction model. ROC, decision curve and calibration curve were utilized to evaluate the predictive ability and clinical value of these models.

Among 176 patients, 54 cases (30.7%) were positive for MVI, including 42 cases of grade M1 and 12 of grade M2. 122 patients (69.3%) were negative for MVI. Positive MVI was associated with age ≤50 years, increased AFP, the maximum tumor diameter >5 cm, multiple tumors, peritumoral enhancement in arterial phase and intra-tumoral necrosis (χ²=0.049, 0.047, 0.002, 0.049, 0.031, 0.016; all P<0.05). The maximum tumor diameter >5 cm, peritumoral enhancement in arterial phase and radiomics score were the independent risk factors for MVI in HCC (OR=3.733,3.130, 2.007; all P<0.05). The AUC of each nomogram model was 0.856 (training set) and 0.772 (test set). The decision curve and calibration curve indicated that the models possessed high clinical practicability.

The nomogram model based on machine learning of MRI radiomics has high clinical value for predicting the risk of MVI of HCC before surgery and guiding decision-making of diagnosis and treatment.

To investigate the prediction value of CT-based radiomics model for microvascular invasion (MVI) in hepatocellular carcinoma (HCC).

Clinical data of 129 patients who underwent surgical resection in the Affiliated Hospital of Kunming University of Science and Technology from 2015 to 2022 were retrospectively analyzed. Among them, 108 patients were male and 21 female, aged from 25 to 83 years, with a median age of 52 years. According to the 3: 1 ratio using random number table method, all cases were divided into the training (n=96) and test sets (n=33). All patients received enhanced CT scan within preoperative 1 month. Through the artificial intelligence big-data analysis platform of imaging radiomics, Lasso algorithm was used to screen the optimal features from clinical and imaging radiomic features. Using enhanced CT images, a single clinical model (C model) and a single imaging radiomic model (R model) were constructed based on preoperative CT scan of tumors and peritumoral 0-1, 1-2 and 2-3 cm. According to the weighted coefficient corresponding to the optimal features, the radiomic score (Rad-score) of each model was obtained, and the area under the ROC curve (AUC) of each model was calculated according to the Rad-score. The prediction capability of the model was evaluated by the consistency index (C-index). The higher the index, the higher the prediction ability.

Lasso algorithm was employed to screen 3, 9, 15 and 50 optimal features of tumor and peritumoral 0-1, 1-2 and 2-3 cm from 1818 clinical and imaging radiomic features. In the training set, the penalty parameters were optimized by 5-fold cross-validation, and Lasso-Logistic regression model was constructed. In the test set, R model could better predict the risk of MVI than C model (AUC=0.883, 0.848, 0.800, 0.848 and 0.500, 0.704, 0.500 and 0.639). High consistency was found between the risk estimated by 4 R models in the training and test sets and the actual risk of MVI, indicating R models yielded good predictive ability (C-index=0.746 and 0.883, 0.738 and 0.848, 0.732 and 0.800, 0.672 and 0.848) and favorable correction performance.

In this study, R models of tumor and peritumoral 0-1, 1-2 and 2-3 cm are established based on preoperative CT scan. R models perform better than C models. Rad-score transformed by R models can be used as an independent predictor of MVI.

To construct a Nomogram model for predicting the survival of patients with hepatocellular carcinoma (HCC) based on preoperative CT imaging data.

Clinical imaging data of 243 patients with HCC who underwent surgical treatment in the Affiliated Hospital of Qingdao University from January 2018 to December 2020 were retrospectively analyzed. Among them, 206 patients were male and 37 female, aged from 49 to 70 years, with a median age of 59 years. Multi-modal data of preoperative contrast-enhanced CT were collected. Multi-dimensional quantitative radiomic features were extracted by Pyradiomics, including tumor morphological features, signal intensity distribution, texture features and signal intensity-volume histogram, etc. All patient datasets were divided into the training (n=158) and validation sets (n=85). Univariate and multivariate Cox regression analyses were used to screen the independent factors affecting the survival and prognosis of HCC patients. Nomogram model was constructed based on these factors.

Based on the standardized feature data, 30 key imaging features were eventually determined. Cox regression analysis identified three independent key radiomic features including glcm_MCC, glszm_Zone Percentage and shape_Sphericity. The area under the ROC curve (AUC) of the training set in Cox regression model was 0.82. All patients were divided into the high-risk and low-risk groups based on the risk score of multivariate Cox regression analysis. Kaplan-Meier survival analysis showed that the difference in the survival between the low-risk and high-risk groups in the training set was statistically significant (χ²=7.353, P<0.05). A Nomogram model of survival and prognosis of patients with liver cancer was constructed. The AUC of the Nomogram model in the validation set was 0.78. The difference in the survival between the low-risk and high-risk groups in the validation set was statistically significant (χ²=2.38, P<0.05), which further validated the effectiveness and reliability of the Nomogram model.

Nomogram model constructed based on preoperative CT imaging data can effectively predict the survival of HCC patients, which can effectively assist early prediction and provide decision-making support for clinicians.

To evaluate clinical application value of head-mounted naked-eye 3D endoscopic display system in laparoscopic hepatectomy.

Clinical data of 71 patients undergoing laparoscopic hepatectomy in Yuebei People's Hospital from January 2020 to June 2021 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 40 patients were male and 31 female, aged from 33 to 70 years, with a median age of 54 years. According to intraoperative use of different 3D laparoscopic devices, all patients were divided into the traditional 3D laparoscopic group (traditional group, n=31) and head-mounted naked-eye 3D endoscopic display system group (study group, n=40). Perioperative data of patients and the subjective feeling score of the chief surgeon and the first assistant surgeon in two groups were observed and analyzed.

All patients successfully completed laparoscopic hepatectomy, and there was no conversion to open surgery. The operation time in the study group was (177±59) min, significantly shorter than (207±60) min in the traditional group, and the difference was statistically significant (t=-2.098, P<0.05). In the study group, the subjective feeling scores of degree of immersion, shoulder and neck fatigue, hand-eye coordination and eye fatigue of the chief surgeon and the first assistant surgeon were (4.0±0.4) and (4.2±0.3), (4.0±0.3) and (4.0±0.4), (4.1±0.4) and (4.1±0.4), and (4.0±0.4) and (4.0±0.3), higher than (3.4±0.7) and (3.1±0.3), (3.5±0.4) and (3.7±0.3), (3.2±0.3) and (3.4±0.3), (3.5±0.4) and (3.7±0.3) in the traditional group (t=4.189 and 15.609, 7.335 and 13.812, 10.544 and 8.912, 5.399 and 4.492, all P<0.05). However, no significant differences were observed in image clarity, sharpness, color reproduction, depth positioning, depth resolution, depth movement and dizziness between two groups (all P>0.05).

Head-mounted naked-eye 3D endoscopic display system can provide surgeons with immersive visual experience, relieve visual and neck fatigue, improve hand-eye coordination, shorten operation time, enhance surgical efficiency and maintain surgical safety in laparoscopic hepatectomy.

To evaluate clinical efficacy and safety of avatrombopag in adult patients with chronic liver disease-associated thrombocytopenia (CHRT) undergoing elective high-risk invasive procedures.

In this prospective clinical trial, 68 patients with CHRT undergoing elective invasive procedures in the PLA General Hospital were enrolled. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 49 patients were male and 19 female, aged 50 years on average. According to different treatment regimens, they were divided into the study group (n=17) and routine group (n=51). Patients in the study group were given with avatrombopag orally at preoperative 10 to 13 d, once a day for 5 consecutive d. The dosage was selected according to platelet (Plt) count: the dosage was 60 mg/d when Plt was <40×10⁹/L, and 40 mg/d when Plt was ranged from 40 to 50×10⁹/L. In the routine group, observation or other Plt-elevating treatment methods were mainly used, including Plt transfusion and use of recombinant human thrombopoietin, recombinant human IL-11, eltrombopag and romiplostim, etc. The changes of Plt count, liver function indexes and the incidence of adverse reactions were observed between two groups.

In the screening and baseline phases, the Plt count in the study group was (34±8)×10⁹/L and (34±7)×10⁹/L, significantly lower than (42±7)×10⁹/L and (41±8)×10⁹/L in the routine group (t=-4.134, -3.206, both P<0.05). At postoperative 10 d, the Plt count in the study group was (80±31)×10⁹/L, significantly higher than (49±18)×10⁹/L in the routine group (t=3.738, P<0.05). No significant differences were found in the levels of ALT, AST and TB at baseline, postoperative 1 and 10 d (all P>0.05). There was no statistical significance difference in the incidence of adverse drug reactions between two groups (P>0.05).

As a Plt-elevating agent, avatrombopag can elevate Plt and reduce the risk of surgery-related bleeding. In addition, it possesses high safety, showing potential clinical benefits in patients with CHRT undergoing elective high-risk invasive procedures.

To investigate clinical characteristics and risk factors of liver metastasis from pancreatic cancer, aiming to provide scientific evidence for prevention, screening and treatment of this population.

Clinical data of 593 patients with pancreatic cancer admitted to Peking Union Medical College Hospital from January 2013 to December 2023 were retrospectively analyzed. Among them, 275 patients were male and 318 female, aged from 25 to 85 years, with a median age of 62 years. All patients were divided into the liver metastasis group (n=157) and control group (n=436). Clinical characteristics of liver metastasis from pancreatic cancer were summarized. The influencing factors of liver metastasis from pancreatic cancer were assessed by multivariate Logistic regression analysis. Multiple covariates consisting of gender, age, smoking, drinking, diabetes mellitus, surgery, metabolism-associated fatty liver disease (MAFLD), WBC, neutrophils, lymphocytes, ALT, AST, TB, DB, GGT, ALP, Scr, ALB, CA19-9 and CEA were included.

The incidence of liver metastasis from pancreatic cancer was 26.5%(157/593). The proportion of patients with liver metastasis from pancreatic cancer who smoked and were complicated with MAFLD was increased significantly, while the proportion of patients undergoing surgery was relatively low (χ²= 5.18,108.04,40.50; all P<0.05). ALT, ALT/AST, GGT, ALP and CA19-9 levels were significantly increased, and blood urea nitrogen level was significantly decreased (Z=2.97, 3.21, 3.48, 2.35, 3.43, 2.78; all P<0.05). Multivariate Logistic analysis showed that smoking (OR=1.703, 95%CI: 1.046-2.771) and MAFLD (OR=9.153, 95%CI: 5.732-14.617) were the independent risk factors for liver metastasis in patients with pancreatic cancer (both P<0.05). Surgery is an important protective factor for pancreatic cancer patients with liver metastasis (OR=0.260, 95%CI: 0.166-0.407, P<0.05).

The incidence of liver metastasis from pancreatic cancer is relatively high. MAFLD and smoking are the independent risk factors, whereas surgery is a protective factor for for liver metastasis from pancreatic cancer. Surgical resection is recommended for patients with resectable pancreatic cancer. Smoking cessation should be included in the whole management of pancreatic cancer patients. Extensive attention should be diverted to the screening of pancreatic cancer patients with high-risk MAFLD. Health education on MAFLD and smoking risk knowledge should be strengthened.

To investigate the potential causal relationship between gut microbiota (GM) and primary liver cancer (PLC) in East Asian population by Mendelian randomization (MR) analysis.

This study was conducted following the STROBE-MR guidelines. MR analysis was performed based on the assumptions of relevance, independence and exclusion restriction. The exposure data were collected from genome-wide association study (GWAS) summary statistics in 3 432 Chinese, covering 500 GM features. The data of PLC were obtained from Japanese Database (n=161 323) and IEU Open GWAS platform (n=197 611). The inverse variance weighted (IVW), weighted median, MR-Egger and Bayesian weighted MR methods were used to evaluate the causal relationship between GM and PLC.

Specific GM such as Selenomonas, Porphyromonas endodontalis, Gemella sanguinis and Clostridium butyricum were associated the increased risk of PLC. However, Alistipes shahii and Bifidobacterium catenulatum-Bifidobacterium pseudotenatum complex might exert protective effects. The application of multiple MR analysis methods enhanced the reliability and robustness of the research results.

This study provides novel understanding of the role of GM in the incidence and progression of PLC from the genetic perspective and highlights the key role of GM in the pathogenesis of PLC.

To evaluate the safety, short-term outcome and long-term efficacy of cytoreductive surgery for neuroendocrine tumor liver metastases (NETLM).

Clinical data of 31 patients with NETLM undergoing cytoreductive surgery in Fudan University Shanghai Cancer Center from September 2021 to April 2023 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 14 patients were male and 17 female, with a median age of 55(46,60) years. Gastrointestinal pancreas was the primary lesion site of NETLM patients (n=25, 80.6%). Patients with NETLM of G2 accounted for 81%(25/31), and 94%(29/31) of non-functional NETLM. 27 patients received preoperative medication therapy, 21 cases of preoperative transcatheter arterial embolization, and 16 cases of resection of primary lesions, respectively. The operation time, intraoperative blood loss and blood transfusion were observed. The short-term postoperative outcomes included postoperative length of hospital stay, incidence of postoperative complications and mortality rate. The long-term prognosis was progression-free survival (PFS). Kaplan-Meier survival curve was used for survival analysis.

The tumor burden of liver metastases was (40±3)%, and the maximal diameter of liver metastases was 10.0(8.5, 13.5) cm. The operation time was 168 (135,235) min. The intraoperative blood loss was 800 (300,1 000) ml, and 17 cases required blood transfusion. The length of postoperative hospital stay was 6 (5,7) d. The incidence of postoperative complications was 48%(15/31), and no perioperative death was found. Postoperatively, tumor grade was increased in 6 cases. The median PFS was 12.0 (95%CI: 6.9-17.1) months. The 6-, 12- and 18-month PFS rate was 85%, 56% and 37%, respectively.

Cytoreductive surgery is relatively safe for NETLM patients, which can obtain favorable survival benefits and provide guidance for subsequent treatment.

To investigate the clinicopathological features of non-alcoholic fatty liver disease (NAFLD)-associated hepatocellular carcinoma (HCC) in a single center.

Clinicopathological data of 10 patients with NAFLD-associated HCC admitted to Department of Hepatobiliary Surgery, Affiliated Hospital of Jiangnan University from January 2020 to October 2024 were retrospectively analyzed. Among them, 7 patients were male and 3 female, aged from 44 to 80 years, with a median age of 71 years. The informed consents of all patients were obtained and the local ethical committee approval was received. Medical history, laboratory examination, imaging features, treatment methods and clinical prognosis were analyzed.

Among 10 patients, 7 cases were diagnosed with liver space-occupying lesions by physical examination, and no evident clinical symptoms were detected. One patient developed the upper abdominal pain accompanied with fever of unknown origin, and two patients had the upper abdominal pain complicated with jaundice of unknown origin. All 10 patients had a history of fatty liver disease, neither hepatitis B, hepatitis C nor excessive drinking, including 1 case of mild fatty liver disease, 4 moderate fatty liver disease and 5 severe fatty liver disease, respectively. Four patients were complicated with elevated AFP, highest up to 3 000 μg/L. Among them, 4 patients were diagnosed with hypertension, 2 cases of hypertension complicated with diabetes mellitus, 1 case of hypertension complicated with cerebral infarction. Preoperative imaging revealed two patients were diagnosed with hepatic hemangioma, and 2 cases of atypical benign tumors. All 7 patients underwent laparoscopic radical resection of HCC. Postoperative pathological examination showed 1 case of well-differentiated HCC, 2 moderately-and well-differentiated HCC, 3 moderately-differentiated HCC, 1 moderately-and poorly-differentiated HCC and 3 poorly-differentiated HCC, respectively. One case experienced postoperative bile leakage, and the remaining patients were recovered. The length of hospital stay was (14±4) d. Follow-up endured for 3 months to 2 years. Only 1 patient recurred.

NAFLD-associated HCC patients are primarily complicated with fatty liver disease. For NAFLD patients complicated with liver masses, the possibility of liver cancer should be considered. Intimate observation and regular reexamination are needed. Prompt surgical treatment should be performed upon diagnosis.

To evaluate the safety and efficacy of high-temperature wet coagulation in laparoscopic partial splenectomy (LPS) for the treatment of benign splenic lesions.

Clinical data of 47 patients with benign splenic lesions who underwent LPS in the First Affiliated Hospital of Air Military Medical University from January 2015 to December 2024 were retrospectively analyzed. The informed consents of all patients or family members were obtained and the local ethical committee approval was received. Among them, 26 patients were male and 21 female, aged from 13 to 65 years, with a median age of 29 years. All patients were diagnosed with space-occupying lesions of the spleen by CT scan and other imaging examinations before operation. According to different hemostasis methods, they were divided into three groups: high-temperature wet coagulation, bipolar electrocoagulation and cutting stapler groups. Hemostasis effects were compared among three groups.

47 patients successfully underwent LPS, with no conversion to open surgery. Intraoperative blood loss was 100(88) ml in high-temperature wet coagulation group, 300(480) ml in bipolar electrocoagulation group and 100(148) ml in cutting stapler group, with no statistical significance (H=0.914, all P>0.05). Postoperatively, 5 patients experienced a slight amount of pleural effusion and 3 cases of mild pelvic effusion, which healed spontaneously without additional treatment. No postoperative complications such as infection, pancreatic leakage, bleeding, thrombosis and splenic ischemic infarction were observed. All patients were successfully discharged. Postoperative pathological examination revealed that 32 cases developed splenic cyst, 10 cases of splenic hemangioma, 2 cases of splenic angioma and 3 cases of splenic lymphangioma, respectively.

Three different hemostasis methods are safe and efficacious in LPS for benign splenic lesions. Compared with traditional hemostasis methods of cutting stapler and bipolar electrocoagulation, high-temperature wet coagulation hemostasis is a more universal procedure.

To investigate the clinical diagnosis and treatment characteristics and prognosis of hepatic lipoma.

Clinical data of a 32-year-old male patient with hepatic lipoma admitted to Department of Hepatobiliary and Pancreatic Surgery of the Second Affiliated Hospital of Kunming Medical University in November 2023 were retrospectively analyzed. He was hospitalized due to a liver-occupying mass during physical examination. Physical examination revealed nontender abdomen. Complete blood count, blood biochemistry, coagulation function and AFP level was detected normal, while CA50 level was increased. Abdominal ultrasound showed hyperechoic area in the space between liver and kidney. Contrast-enhanced ultrasound revealed that the lesions showed uneven and slight hypoenhancement in the early stage and hypoenhancement in the late stage. Abdominal contrast-enhanced CT showed subcapsular fat density shadow in the right posterior lobe of liver. MRI showed round-like long T1 and long T2 signal shadows in the subcapsular area of the right posterior lobe, without enhancement. Spleen was significantly enlarged. No abnormality was found in parenchymal signals, and no enhancement was observed. MRCP showed no dilatation was seen in the intra-and extra-hepatic bile ducts. Literature review about liver lipoma was conducted and the experience of diagnosis and treatments was summarized.

Preoperatively, the patient was diagnosed with subcapsular lipoma. He showed unexplained splenomegaly. Genetic test revealed β-thalassemia with 654 site mutation, and the folic acid level was decreased (2.69 ng/ml). Preoperatively, Department of Hematology assisted the diagnosis and treatment. The possibility of β-thalassemia was considered. No splenectomy was required. On November 30, 2023, a 7 cm×3 cm×2 cm mass with slightly hard texture and lipomatous changes of the right posterior lobe was resected. Postoperative pathological examination confirmed the diagnosis of hepatic lipoma. Postoperatively, hemoglobin level was progressively decreased. The possibility of postoperative secondary bleeding was excluded, which was considered to be induced by β-thalassemia. Transfusion of suspended red blood cells was given to treat anemia. The patient was recovered well without bile leakage, abdominal infection, liver failure or incision infection.

Hepatic lipoma is a rare benign tumor derived from mesenchymal tissues, and the incidence of malignancy is low. The diagnosis and differential diagnosis of hepatic lipoma should be made by comprehensively considering clinical manifestations, imaging examination and histopathological characteristics of patients. Active surgical resection remains the optimal treatment with favorable prognosis.

In this report, a 63-year-old male patient was admitted due to "dull pain in the right upper abdomen for 2 months". Imaging and pathological examination confirmed the diagnosis of synchronous hepatocellular carcinoma (CNLC Ⅰa stage) and duodenal papillary carcinoma (moderately-poorly differentiated adenocarcinoma complicated with signet ring cell carcinoma). The patient had a history of chronic hepatitis B. After Multidisciplinary team (MDT) consultation, laparoscopic local resection of segment 5 of the liver combined with pancreatoduodenectomy were performed to achieve R0 resection. Liver metastasis occurred 2 months after operation, and it was completely relieved after TACE, tirelizumab immunotherapy and FOLFOX4 chemotherapy. Postoperative survival time has exceeded 16 months. This case of synchronous double primary carcinoma of the liver and duodenal papilla is extremely rare, and it is likely to miss the diagnosis in clinical practice, suggesting that after the diagnosis of one type of malignant tumor, comprehensive evaluation is still needed to exclude other primary lesions. PET-CT shows important value in the early identification of such multiple primary cancers. Through multi-mode strategy of individualized comprehensive treatment and whole-course management, this patient achieved favorable tumor control effect, providing reference for clinical diagnosis and treatment of such rare cases.

In recent years, contrast-enhanced ultrasound (CEUS) acts as an ultrasound examination technique widely applied in the diagnosis and treatment of vital organ diseases such as pancreas, liver and kidney, providing clinicians with more detailed and comprehensive information to guide subsequent diagnosis and treatment. CEUS is applied in pancreatic diseases, mainly including pancreatitis, pancreatic tumor, pancreatic biopsy and interventional therapy, etc. In this article, research progress in the application of CEUS for pancreatic diseases was reviewed.

Pancreatic ductal adenocarcinoma (PDAC) is a type of digestive tract carcinoma with extremely high degree of malignancy and poor prognosis. At present, relevant research mainly focuses on the core driver gene mutation (such as KRAS/TP53), dense fibrotic microenvironment characterized by abnormal activation and immunosuppression of cancer-associated fibroblasts (CAFs), and the mechanism of chemotherapy resistance. The frontier exploration directions cover targeted therapy (such as KRAS inhibitors), immune microenvironment regulation, metabolic pathway intervention and screening of early diagnostic biomarkers. In this article, biological characteristics of CAFs were illustrated, including cell origin, functional phenotype classification and molecular heterogeneity. The key role of CAFs in the progression of PDAC was unraveled from the perspectives of regulating malignant biological behavior, constructing dynamic microenvironment network and mediating angiogenesis and immunosuppression, etc. Based on the development of spatial transcriptome and multiplex immunofluorescence imaging, analysis of epigenetic regulation mechanism and optimization of combined treatment regimens, this study was designed to provide novel ideas for precise treatment and improve clinical prognosis of PDAC patients.