Perihilar cholangiocarcinoma is the common type of malignant tumor in the biliary tract.The diagnosis and treatment of perihilar cholangiocarcinoma involve multiple aspects such as epidemiology，clinical diagnosis， imaging examination， clinical classification and staging， pathology， resectability evaluation，perioperative management， surgical planning， systematic treatment， and follow-up monitoring， which make it as one of the difficult and technically demanding fields in hepatobiliary surgery. In order to guide the more standardized， safe， and effective treatment of hilar cholangiocarcinoma in China， the Society for Hepatopancreato-biliary Surgery of Chinese Research Hospital Association and Editorial Board of Chinese Journal of Digestive Surgery have organized experts in the field of hilar cholangiocarcinoma nationwide to develop the Guideline for diagnosis and treatment of perihilar cholangiocarcinoma （2025 edition）. The aim is to provide standardized diagnosis and treatment plans for perihilar cholangiocarcinoma based on the latest clinical practice and evidence-based medicine principles， to improve diagnosis and treatment levels and patient prognosis， and to provide scientific guidance and reference for surgeons in China.

胆道系统的医源性损伤是一种潜在的严重并发症，是肝胆外科医师处理各种肝胆疾病的过程中无法回避的问题。既往有关胆道损伤的报道多集中于腹腔镜胆囊切除术（LC）^[1,2]。然而，这种并发症并不限于腹腔镜或开腹胆囊切除^[3]。接受部分肝切除术的患者也可能发生胆道损伤。既往研究报道开腹肝切除术胆道损伤发生率为3.6%~17%^[4]。目前，腹腔镜技术已广泛应用于各种肝胆外科手术，但鲜有腹腔镜肝切除术中医源性胆道损伤的相关报道。由于缺乏触觉反馈、视野狭窄、器械运动程度有限及失去自然的手眼协调能力等因素，腹腔镜肝切除术中医源性胆道损伤发生率可能高于开腹肝切除术，如同LC胆道损伤发生率高于开腹胆囊切除一样^[5,6]。本文就腹腔镜肝切除术中医源性胆道损伤的临床特点、原因及防治策略进行探讨，旨在为其临床处理提供参考。

目前，肝细胞癌（肝癌）的发病率、病死率仍居高不下，在肿瘤相关死亡原因中排第3位，我国肝癌初诊患者仍以中晚期居多^[1]。随着靶向药物和免疫治疗药物的出现并在肝癌中的应用，中晚期肝癌疗效得到逐步提升。中晚期肝癌的治疗目的是减轻肿瘤负荷，延缓肿瘤进展，延长患者生存，部分患者可通过局部治疗和系统治疗达到缓解，甚至获得二期手术切除^[2]。然而，中晚期肝癌患者的系统治疗有效率、生存时间仍不容乐观。研究表明，PD-1单克隆抗体免疫治疗的有效率仅20%，接受阿特珠单抗、贝伐珠单抗联合治疗的中晚期肝癌患者中位生存时间仅19.2个月^[3,4]。因此，当前肝癌的系统治疗挑战与机遇并存，新药研发和精准预测肝癌药物应答是改善肝癌患者预后的重要手段。目前，可供选择的肝癌疗效预测体系包括基因测序、体外细胞系建立与药物筛选模型、人源肿瘤异种移植（patient-derived tumor xenograft，PDX）模型、肝癌免疫治疗疗效预测模型和类器官模型等。

Over the years of exploration and development，the surgical techniques and prognosis of liver transplantation in China have been significantly improved，resulting in a notable decrease in the prevalence of postoperative complications. However，ischemic-type biliary lesion remain a non-negligible issue.The Third AffiliatedHospital of Sun Yat-sen University formulated and published the "Expert Consensus on the Diagnosis and Treatment of Ischemic-Type Biliary Lesions after Liver Transplantation in Mainland China"in 2015，which has now been updated into aguideline based on current conditions and literature reports. This guideline elaborates in detail on the definition，incidence，pathogenesis，diagnosis，prevention of high-risk factors，and treatment of ischemic-type biliary lesion，aiming to providestandardized and normative guidance for the diagnosis and treatment of ischemic-type biliary lesion after liver transplantation，thereby reducing the rate of re-transplantation and fatality，and to improve the overall quality of life of liver transplant recipients.

神经内分泌肿瘤（neuroendocrine neoplasm, NEN）是一类少见的，起源于神经内分泌细胞和肽能神经元的恶性肿瘤。每年NEN发病率约6.98/10万，女性略多，占52.7%^[1]。NEN可发生于身体的任何部位，最常见于胃、肠、胰等消化系统器官。肝脏是神经内分泌肿瘤最常见的转移部位，28%~77%的NEN患者会发生肝转移^[2]。神经内分泌肿瘤肝转移（neuroendocrine liver metastases，NELM）严重影响患者的生活质量和预后。近年来，病理学和影像学诊断技术的发展，多学科综合治疗理念的推广以及新的治疗手段和治疗策略的改进，极大提高了NELM的诊治水平，改善了患者的生活质量，延长了患者的总生存期。

随着腹腔镜外科技术的发展和成熟，腹腔镜肝切除术已在临床广泛开展，尤其是腹腔镜肝左外叶切除因操作难度较低、简单易行，已成为肝左外叶良恶性病变外科切除的标准手术方式^[1,2]。目前肝左外叶切除大多采用五孔法建立戳孔，也有少数腔镜外科医师采用经脐单孔腹腔镜完成肝左外叶切除术^[3]。然而，由于单孔腹腔镜操作存在不可避免的"筷子效应"，使术者操作体验下降，增加操作难度，因此，该术式的普及受到限制^[4]。如何消除"筷子效应"，提高术者操作体验是普及单孔腹腔镜技术的关键。基于磁锚定技术（magnetic anchor technique，MAT）原理，通过使用特殊设计的磁锚定装置可在很大程度上改善单孔腹腔镜术中器械间的相互干扰，降低操作难度，改善术者操作体验。本文利用自主设计研发的MAT辅助成功实施了国际首例磁锚定经脐单孔腹腔镜肝左外叶切除术，现报道如下。

胆道肿瘤（biliary tract carcinoma，BTC）是一组高度异质性、起源于胆囊及胆管上皮的癌症。根据解剖学部位的不同，可分为肝内胆管癌（intrahepatic cholangiocarcinoma，iCCA）、肝门部胆管癌（perihilar cholangiocarcinoma，pCCA）、远端胆管癌（distal cholangiocarcinoma，dCCA）及胆囊癌（gallbladder cancer，GBC）^[1]。BTC起病隐匿且恶性程度高，近年来全球发病率有上升趋势，尤其在亚洲及拉丁美洲国家^[2]。因缺乏早期诊断特异性标志物，约70%的患者一经发现即为晚期，手术切除率低，患者预后差，5年总体生存率5%~15%^[3,4]。根治性手术是治愈BTC的有效方法，但肿瘤复发和转移概率高，BTC术后患者复发的风险高于50%^[5,6]。ABC-02临床试验确立了吉西他滨联合顺铂为目前晚期BTC的一线化疗方案，但治疗组中位总体生存期（median overall survival，mOS）和中位无进展生存期（median progression-free survival，mPFS）均不足1年，对于BTC的其他化疗方案效果不尽如人意^[7]。近年来，免疫治疗在BTC的探索和应用逐渐展开，取得了不少令人鼓舞的重要进展^[8]。本文就免疫治疗在BTC中的应用和发展进行综述。

Graft-versus-host disease (GVHD) after liver transplantation is a rare but fatal complication, with the incidence rate ＜ 1% and mortality of 85%.The occurrence of GVHD is due to the cellular immune response of donor T lymphocytes to recipient tissues, which may involve the skin,gastrointestinal tract, and bone marrow.The typical clinical manifestations of GVHD include rash, fever,diarrhea, and decreased whole blood cells.The Branch of Organ Transplant of China Medical Association,combined with Branch of Organ Transplant Physicians of Chinese Medical Doctor Association organize experts to develop the Chinese Expert Consensus On The Diagnosis And Treatment Of Acute Graft-Versus-Host Disease After Liver Transplantation (2024 edition), which elaborates on the pathogenesis, risk factors,clinical manifestations, diagnosis and treatment of GVHD.The aim is to standardize and optimize the clinical diagnosis and treatment of GVHD after liver transplantation, and to propose diagnostic processes and treatment suggestions to improve the prognosis of GVHD recipients after liver transplantation.

胆道恶性肿瘤（biliary tract cancers，BTCs）是起源于胆道系统的异质性明显的一组肿瘤，根据解剖部位可分为肝内胆管细胞癌、肝门部胆管癌、远端胆管癌及胆囊癌。绝大多数BTCs为腺癌，侵袭性强，预后极差。在世界范围内，BTCs是第二大肝胆胰肿瘤，占所有消化道恶性肿瘤的3%，近年来发病率呈上升趋势，从1973年至2012年的大数据中可见肝内胆管细胞癌发病率大幅上升（350%），肝外胆管细胞癌发病率则稳步升高（20%）^[1]。由于BTCs起病隐匿，早期诊断率低，临床就诊时往往已到中晚期，5年总生存率5%~15%，即使相对早期发现能够手术治疗的患者，术后复发率仍高于50%^[2]。随着手术技术、手术器械及围手术期处理的进步，BTCs的手术范围不断扩大，胆囊癌扩大根治术尝试了包括肝外胆管切除、半肝切除、肝胰十二指肠切除等术式，肝内胆管细胞癌及肝门部胆管癌施行大范围肝切除及扩大淋巴结清扫、肝移植等术式，肝外胆管细胞癌施行扩大胰十二指肠切除，但不幸的是对提高生存率无任何帮助。BTCs与其它肿瘤一样是一种全身性疾病，单纯的外科手术不能治愈，故必须有综合治疗的理念。