To identify the risk factors of post-hepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma (HCC), and to construct a nomogram prediction model for PHLF.

Clinical data of 188 patients with HCC who underwent radical hepatectomy in the Third Affiliated Hospital of Sun Yat-sen University from January 2022 to April 2023 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 165 patients were male and 23 female, aged from 24 to 75 years, with a median age of 55 years. The independent risk factors of PHLF were determined by Logistic regression analysis. The nomogram model was constructed. The discrimination and calibration degree of the model were evaluated by using the area under the ROC curve (AUC) and calibration curve. The constructed model was compared with the actual score of comprehensive liver function.

The incidence of PHLF was 25%(47/188), including3 cases of grade A PHLF, 42 cases of grade B and 2 cases of grade C, and one of them died of PHLF. Logistic regression analysis showed that ALT (OR=1.037, 95%CI: 1.007-1.068), TB (OR=1.176, 95%CI: 1.013-1.365), maximal tumor diameter (OR=1.414, 95%CI: 1.148-1.742), ALBI score (OR=0.173, 95%CI: 0.031-0.962) and ICGR15 (OR=1.081, 95%CI: 1.005-1.162) were the independent risk factors for PHLF (P<0.05). Based on ALT, ICGR15, TB and maximal tumor diameter (ARTL), the AUC of ARTL model was 0.816 (95%CI: 0.747-0.885), indicating it had high predictive capability. The calibration curve and calibration prediction curve fit well, and the predicted value was in high agreement with the observed value. The predictive efficiency and clinical benefit of ARTL model were better than those of ALBI score (AUC=0.607), FIB-4 index (AUC=0.672) and APRI score (AUC=0.730).

ALT, ICGR15, TB, maximal tumor diameter and ALBI score are the independent risk factors for PHLF. ARTL model has high predictive capability, which is superior to the existing three comprehensive scoring systems for liver function.

To identify the risk factors of re-hemorrhage in patients with cirrhotic portal hypertension after treatments, and to construct a nomogram prediction model.

Clinical data of143 patients with cirrhotic portal hypertension treated in Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2015 to January 2020 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 77 patients were male and 66 female, aged (56±12) years on average. 109 cases were diagnosed with liver cirrhosis after hepatitis B. Baseline data, medical history and laboratory examination results upon admission were collected. Follow-up time was 3 years. Re-hemorrhage after treatments was regarded as the main outcome event. All patients were divided into the re-hemorrhage (n=32) and non-hemorrhage groups (n=111) according to the incidence of re-hemorrhage. The risk factors of re-hemorrhage were identified by Logistic univariate and multivariate regression analyses. Relevant variables were screened by stepwise regression method. Nomogram prediction model was constructed by R software, and internal verification was carried out by Bootstrap method. Finally, the prediction efficiency and clinical effectiveness of this model were analyzed and validated based on the ROC curve, calibration curve and decision curve analysis (DCA).

Logistic univariate and multivariate regression analyses showed that age, weight, Child-Pugh grading above grade A and surgical treatment were the independent influencing factors of re-hemorrhage in patients with cirrhotic portal hypertension after treatment (OR=1.048, 0.947, 5.980, 0.238; P<0.05). Based on 4 independent influencing factors, the nomogram prediction model for re-hemorrhage was constructed. The area under the ROC curve of this prediction model was 0.806 (0.811 after validation), both of which were >0.75, indicating that this prediction model yielded high discrimination. Brier score was calculated as 0.114 (0.102 after validation), equally <0.25, and R² was 0.437 (0.477 after validation), equally >0.4, suggesting that the model had high calibration. The net benefit of DCA curve of this model was higher than those of two extreme curves, indicating that the prediction model had clinical effectiveness.

Surgery is an important approach to prevent and treat re-hemorrhage in patients with cirrhotic portal hypertension. Constructing nomogram prediction model contributes to identifying high-risk post-treatment re-hemorrhage patients with cirrhotic portal hypertension at early clinical stage.

To evaluate the safety and efficacy of three-dimensional visualization technology in laparoscopic resection of huge liver tumors.

Clinical data of 50 patients who underwent huge liver tumor resection in No. 900 Hospital from July 2016 to June 2021 were retrospectively analyzed. Among them, 19 patients were male and 31 female, aged from 38 to 65 years, with a median age of 45 years. The informed consents of all patients were obtained and the local ethical committee approval was received. The tumor diameter was ranged from 10 to 17 cm, with a median diameter of 13 cm. 23 patients were diagnosed with benign tumors and 27 cases of malignant tumors. According to different surgical methods, they were divided into two groups. In the combination group, 24 cases underwent three-dimensional visualization technology combined with laparoscopic resection. In the control group, 26 cases were treated with open resection of huge liver tumors. Intraoperative and postoperative conditions of patients betweentwo groups were compared by t test or Chi-square test. Survival analysis was performed by Kaplan-Meier analysis and Log-rank test.

All patients in two groups successfully completed the surgery, and no conversion to open surgery was reported in the combination group. In the combination group, the median C-reactive protein level at postoperative 1 d was 26(18, 72) mg/L, significantly lower than 57(44, 81) mg/L in the control group (Z=-2.700, P<0.05). At postoperative 1 d, the average time to first flatus, postoperative ambulation time and the length of postoperative hospital stay were (2.6±0.8), (3.1±1.3) and (13±4) d, significantly shorter than (3.1±1.1), (4.4±1.6) and (16±6) d in the control group (t= -2.180, -3.137, -2.062; P<0.05). The incidence of postoperative complications in the combination group was 25% (6/24) and 42% (11/26) in the control group, with no statistical significance between two groups (χ²=1.666, P>0.05). The postoperative 1-, 3- and 5-year overall survival and disease-free survival rates in the combination group were 78.8%, 52.5%, 26.3% and 57.1%, 28.6%, 0, and 70.6%, 36.4%, 12.1% and 51.3%, 22.0%, 0 in the control group, with no statistical significance between two groups (χ²=0.292, 0.764; P>0.05).

Three-dimensional visualization technology can be utilized to deliver accurate preoperative evaluation for patients undergoing laparoscopic resection of huge liver tumors, and to guide accurate intraoperative operation, thus mitigating inflammatory reactions and accelerating postoperative rehabilitation.

To investigate the prognostic value of platelet-related parameters in patients with intrahepatic cholangiocarcinoma (ICC) undergoing radical resection.

Clinical data of63 patients with ICC who underwent radical resection in No.909 Hospital from January 1, 2016 to December 31, 2019 were retrospectively analyzed. Among them, 41 patients were male and 22 female, aged from 39 to 65 years, with a median age of 52 years. The informed consents of all patients were obtained and the local ethical committee approval was received. Prognostic factors of ICC patients were identified by univariate and multivariate Cox regression models. Survival analysis of ICC patients with different platelet-related parameters was conducted by using Kaplan-Meier method and Log-rank test. Receiver operating characteristic (ROC) curve was drawn to evaluate the predictive efficiency of Plt, platelet distribution width (PDW) and mean platelet volume (MPV) on disease-free survival (DFS) and overall survival (OS).

Univariate and multivariate Cox analyses showed that Plt≥185×10⁹/L, PDW≥16.5%, MPV≤9.25 fl and hilar invasion were the independent risk factors for DFS in ICC patients (HR=2.384, 2.546, 2.853, 3.933; P<0.05). Plt≥185×10⁹/L, PDW≥16.5%, MPV≤9.25 fl, hilar invasion and vascular invasion were the independent risk factors for OS (HR=3.100, 2.617, 3.313, 3.708, 3.685; P<0.05). Survival analysis showed that the postoperative 3-year DFS rates of patients with Plt≥185×10⁹/L, PDW≥16.5% and MPV≤9.25 fl were respectively 18.74%, 19.54%, 23.54%, and 89.34%, 78.21%, 85.45% in the control group (χ²=41.500, 29.545, 19.973; P<0.05). The postoperative 3-year OS of patients with Plt≥185×10⁹/L,PDW≥16.5% and MPV≤9.25 fl were respectively 19.53%, 18.64%, 20.43%, and 91.53%, 77.64%, 87.94% in the control group (χ²=41.352, 30.128, 19.909; P<0.05). ROC curve analysis revealed that the area under the ROC curve of Plt for predicting postoperative 3-year OS was 0.942, 0.968 for the sensitivity and 0.744 for the specificity, and 0.843, 0.742, 0.875 for PDW, and 0.886, 0.781, 0.935 for MPV, respectively.

Preoperative platelet-related parameters including Plt, PDW and MPV are the independent prognostic factors for ICC patients undergoing radical resection, which possess a great predictive value for survival and prognosis of ICC patients.

To analyze the relationship between cholecystectomy and colorectal and anal cancers based on two-sample Mendelian randomization (TSMR).

The data of single nucleotide polymorphism (SNP) related to colorectal and anal cancers after cholecystectomy were obtained from open biological databases, and all retrieved data were analyzed based on genome-wide association studies (GWAS) database. The genetic loci closely associated with cholecystectomy were selected as instrumental variables. TSMR analysis was performed by using MR-Egger regression method, median weighted (MW) and inverse-variance weighted (IVW) methods, respectively. The causal relationship between cholecystectomy and the risk of colorectal and anal cancers was evaluated by P value.

A total of 32 SNPs related to cholecystectomy were screened. There was no causal relationship between cholecystectomy and cecum cancer (OR=22.222, 95%CI: 6.280e-02, 7.864e+03; P=0.300), no causal relationship between cholecystectomy and the ascending colon cancer (OR=3.176, 95%CI: 1.939e-03, 5.204e+03; P=0.760), and no causal relationship between cholecystectomy and transverse colon cancer (OR=0.093, 95%CI: 6.683e-06, 1.297e+03; P=0.626), and no causal relationship between cholecystectomy and the descending colon cancer (OR=0.093, 95%CI: 6.683e-06, 1.297e+03; P=0.626), and no causal relationship between cholecystectomy and sigmoid colon cancer (OR=2.737, 95%CI: 4.24e-02, 176.696; P=0.636), and no causal relationship between cholecystectomy and rectal cancer (OR=0.306, 95%CI: 7.153e-03, 13.099; P=0.537), and no causal relationship between cholecystectomy and anal cancer (OR=13.14, 95%CI: 6.683e-07, 2.600e+06, P=0.764), respectively. Subsequent sensitivity analysis confirmed the robustness of the correlation.

Based on TSMR analysis, there is no genetic evidence supporting the correlation between cholecystectomy and the risk of colorectal and anal cancers. Cholecystectomy does not lead to the incidence of colorectal and anal cancers.

To visualized analysis the overall trend of immunotherapy for gallbladder cancer by scientometrics.

Relevant studies (articles or reviews) related to immunotherapy for gallbladder cancer were searched in the Web of Science Core Collection (WoSCC) database from January 1, 2000 to December 31, 2021, and input into VOSviewer 1.6.18.0 and CiteSpace 5.1.R8 SE (32-bit) software in plain-text format. All data were processed by using scientometrics. Authors, countries, institutions, highly cited publication, co-citation, keywords and references were subject to visualization analysis, and the research hotspots and trends were obtained.

121 studies were retrieved, including 860 authors, 306 institutions, 21 countries/regions and 82 journals. The data showed that the United States was the country with the largest number of published articles in the field of immunotherapy for gallbladder cancer (n=40), followed by China (n=36) and Japan (n=14). The top three authors with the largest number of published articles were Valle JW (n=5), Javle M (n=4) and Zhu AX (n=4). Chinese Academy of Medical Sciences (Peking Union Medical College), Christie NHS Foundation Trust, Nanjing Medical University and the University of Manchester were the institutions with the largest number of published articles. Cancers was the journal with the largest number of published articles in this field. Keyword analysis indicated that "immunotherapy", "cholangiocarcinoma" and "gallbladder cancer" were the high-frequency keywords. Current research hotspots gradually focused on immunotherapy, targeted therapy and drug use for gallbladder cancer.

In recent 21 years, the number of published articles in the field of immunotherapy for gallbladder cancer has been gradually increased, which has become a potential hotspot. The United States, China and Japan occupy a central position in this field.

To evaluate the application of intelligent auxiliary real-time image defogging technology in laparoscopic cholecystectomy (LC).

Clinical data of 128 patients with gallstones treated with LC in the First Affiliated Hospital of Xi'an Jiaotong University from September 2022 to April 2023 were retrospectively analyzed. Among them, 78 patients were male and 40 female, aged from 31 to 66 years, with a median age of 53 years. The informed consents of all patients were obtained and the local ethical committee approval was received. Intelligent auxiliary technology was adopted to identify and process the images. The grades and duration of different levels of fog identified by intelligent equipment were recorded. The defogging time was also recorded. The actual duration of fog and that identified by intelligent images were compared by the rank-sum test.

The duration of fog was ranged from 8 to 17 min, with a median duration of 13 min. Intraoperatively, the laparoscope was wiped for 3-11 times, with a median of6 times. The overall used time was 69-230 s, with a median time of 141 s. Application of intelligent defogging system could effectively identify the grade of fog generated during LC, and remove the fog as required. The processing time of single-frame image was 0.02-0.08 s, with a median time of 0.04 s. The success rate of image processing was 97%(15 522/16 000), which effectively shortened intraoperative image defogging time (Z=-2.167, P<0.05).

Intelligent auxiliary real-time image defogging technology is safe and feasible in LC, which can effectively process intraoperative fog, assist the surgeons to identify surgical margins, enhance surgical efficiency and lower the incidence of complications.

To evaluate the safety and efficacy of transumbilical single-port laparoscopic cholecystectomy (LC) in the treatment of cholecystolithiasis.

Clinical data of 201 patients with cholecystolithiasis who underwent LC in Hainan Cancer Hospital from June 2018 to June 2022 were retrospectively analyzed. Among them, 91 patients were male and 110 female, aged from 27 to 74 years, with a median age of 51 years. The informed consents of all patients were obtained and the local ethical committee approval was received. According to surgical methods, all patients were divided into single-port LC group (single-port group, n=107) and three-port LC group (three-port group, n=94). Operation time and satisfaction score between two groups were compared by t test. The incidence of complications and the conversion rate to open surgery were compared by using Chi-square test or Fisher's exact test.

All patients intwo groups successfully completed the surgery. 1 patient in the single-port group was converted to open surgery, and none in the three-port group, with no statistical significance between two groups (P=0.347). No statistical significance was found in intraoperative blood loss, operation time, length of hospital stay and hospitalization expenses between two groups (P>0.05). Subgroup analysis showed that for patients with cholecystolithiasis of >2 cm, the average operation time in the single-port group was (44±8) min, significantly shorter than (55±7) min in the three-port group (t=-12.685, P<0.05). The incidence of postoperative complications in the single-port group was 1.9%(2/107), and 2.1%(2/94) in the three-port group, with no statistical significance (χ²=0.418, P>0.05). In single-port group, the satisfaction score of patients was 42.8±2.8, significantly higher than 33.7±4.9 in the three-port group (t=32.710, P<0.05).

Transumbilical single-port LC is safe and efficacious treatment of cholecystolithiasis, which has the advantages of better cosmetic effect and higher satisfaction score. For patients with cholecystolithiasis of >2 cm, the operation time of single-port LC is shorter.

To investigate the incidence of postoperative complications and influencing factors after duodenum, common bile duct and sphincter of Oddi-preserving pancreatic head total resection (DCOPPHTR).

Clinical data of 32 patients with pancreatic tumors who underwent DCOPPHTR in Chongqing General Hospital from June 2020 to November 2022 were retrospectively analyzed. Among them,19 patients were male and 13 female, aged (44±16) years on average. The informed consents of all patients were obtained and the local ethical committee approval was received. According to the incidence of postoperative complications, all patients were divided into the complication (n=12) and non-complication groups (n=20). The influencing factors of postoperative complications were analyzed. Studies related to DCOPPHTR were retrieved. The incidence of postoperative complications was analyzed. The risk factors of complications were identified by multivariate Logistic regression analysis.

All patients successfully completed DCOPPHTR. The operation time was (469±81) min, and intraoperative blood loss was (195±120) ml.Postoperative complications occurred in 12 patients, including pancreatic fistula in 6, bile leakage in 1, postoperative bleeding in 2, abdominal infection in 2 and delayed gastric emptying in 1, respectively. According to Clavien-Dindo classification system, 7 patients developed gradeⅠcomplications, 1 case of grade Ⅱand 4 cases of grade Ⅲa. No grade Ⅲb, Ⅳand Ⅴcomplications were reported. In the complication group, preoperative diameter of main pancreatic duct was (6±3) mm, significantly shorter than (9±4) mm in thenon-complication group (t=-2.070, P<0.05). In the complication group, the length of hospital stay was (31±10) d, significantly longer than (17±5) d in the non-complication group (t=4.551, P<0.05). Multivariate Logistic regression analysis indicated that preoperative diameter of main pancreatic duct (OR=0.74, 95%CI: 0.56-0.99) and operation time (OR=1.01, 95%CI: 1.00-1.03) were the independent influencing factors for postoperative complications of DCOPPHTR in patients with pancreatic tumors (P<0.05).

DCOPPHTR is an ideal surgical treatment for inflammatory masses and benign or low-grade malignant tumors in pancreatic head. Preoperative diameter of main pancreatic duct and operation time are the independent influencing factors for postoperative complications of DCOPPTR in patients with pancreatic tumors.

To evaluate the effect of microvascular invasion (MVI) and surgical margin on postoperative survival and prognosis of hepatocellular carcinoma (HCC) patients.

Clinical data of 513 patients with HCC admitted to the First People's Hospital of Foshan from January 2016 to December 2020 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 419 patients were male and 94 female, aged from 25 to 86 years, with a median age of 54 years. MVI was divided into three grades: M0 (non-MVI group), M1 (low-risk group) and M2 (high-risk group). The tumor surgical margin was divided into narrow surgical margin (<1 cm) and wide surgical margin (≥1 cm). The influencing factors of MVI in HCC patients were identified by Chi-square test and Logistic regression analysis. Survival analysis was conducted by Kaplan-Meier method and Log-rank test.

Univariate analysis showed that AFP, tumor diameter, number of tumors and China liver cancer (CNLC) staging system were correlated with the incidence of MVI in HCC patients (χ²=28.068, 29.657, 4.375, 10.208; P<0.05). Multivariate Logistic regression analysis showed that AFP and tumor diameter were the independent influencing factors of MVI in HCC patients (OR=0.408, 0.394; P<0.05). In the M0 group, the postoperative 1-,2- and 3-year disease-free survival rates were 79.6%, 71.0% and 63.4%, and 59.6%, 48.0% and 43.3% in the M1 group, and 31.0%, 27.5% and 25.2% in theM2 group, respectively. The differences were statistically significant (χ²=61.889, P<0.05). In the M0 group, the postoperative 1-, 2- and 3-year overall survival rates were 97.3%, 88.2% and 84.6%, 87.0%, 71.5% and 66.1% in the M1 group, and 79.3%, 61.9% and 52.6% in the M2 group, respectively. The differences were statistically significant (χ²=44.138, P<0.05). For MVI-negative patients, the postoperative 1-,2- and 3-year disease-free survival rates in the wide margin group were 82.6%, 70.7% and 65.4%, and 79.4%, 64.7% and 60.5% in the narrow margin group, with no statistical significance (χ²=0.983, P>0.05). In the wide margin group, the 1-, 2- and 3-year overall survival rates were 97.5%, 89.6% and 85.2%, and 97.1%, 86.0% and 82.8% in the narrow margin group, with no statistical significance (χ²=0.051, P>0.05). For MVI-positive patients, the postoperative 1-, 2- and 3-year disease-free survival rates in the wide margin group were 58.1%, 45.4% and 40.3%, and 42.9%, 37.3% and 36.1% in the narrow margin group. The differences were statistically significant (χ²=4.874, P<0.05). In the wide margin group, the postoperative 1-, 2- and 3-year overall survival rates were 88.8%, 71.9% and 64.3%, and 82.6%, 64.8% and 61.0% in the narrow margin group. The differences were statistically significant (χ²=4.604, P<0.05).

Tumor size and AFP are the independent risk factors for MVI in HCC patients. The higher the MVI grade, the worse the prognosis. For patients with positive MVI, long-term prognosis of patients with wide surgical margin is better than that of those with narrow surgical margin. However, for patients with negative MVI, tumor surgical margin exerts no significant effect upon clinical prognosis.

To evaluate the effect of difference of central venous pressure (ΔCVP) before and during liver transection on intraoperative blood loss in laparoscopic hepatectomy for hepatocellular carcinoma (HCC).

Clinical data of 57 HCC patients who underwent laparoscopic hepatectomy in the No.909 Hospital from June 2021 to December 2022 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. 57 patients were treated with controlled low central venous pressure (LCVP), and the ΔCVP before and during liver transection was calculated. According to the median intraoperative blood loss of 215 ml, 57 patients were divided into group A (intraoperative blood loss of≥215 ml, n=29) and group B (intraoperative blood loss of<215 ml, n=28). The predictive effect of ΔCVP on intraoperative blood loss was assessed by the ROC curve. The correlation between ΔCVP and intraoperative blood loss was determined by Pearson's linear analysis. The influencing factors of intraoperative blood loss were identified by univariate and multivariate Logistic regression analyses.

ROC curve analysis showed that the area under the ROC curve (AUC) of ΔCVP for predicting intraoperative blood loss was 0.867. The maximum value of Youden's index was 0.648. The optimal threshold value of ΔCVP was 5.5 cmH₂O (1 cmH₂O=0.098 kPa). The sensitivity was 0.786 and the specificity was 0.862 (95%CI: 0.765-0.969, P<0.05). Pearson's correlation analysis indicated that ΔCVP was negatively correlated with intraoperative blood loss (r=-0.781, P<0.05). Univariate analysis showed that the incidence of intraoperative bleeding in patients with ΔCVP <5.5 cmH₂O, liver cirrhosis, fatty liver, tumor diameter of ≥10 cm, space-occupying effect and HCC at difficult sites in group A were significantly higher than those in group B (χ²=24.097, 6.908, 5.179, 5.695, 5.221, 8.211; P<0.05). Multivariate Logistic analysis showed that ΔCVP of<5.5 cmH₂O, liver cirrhosis and HCC at difficult sites were the independent risk factors for intraoperative bleeding of laparoscopic hepatectomy (OR=38.812, 12.127, 12.573; P<0.05).

The amount of blood loss during laparoscopic hepatectomy is correlated with ΔCVP before and during liver transection. Maintaining CVP at a reasonable level during liver transection by evaluating the CVP before liver transection contributes to reducing the amount of blood loss during hepatectomy.

To evaluate the value of preoperative platelet-to-lymphocyte ratio (PLR) combined with CA19-9 in evaluating postoperative prognosis of patients with gallbladder cancer.

Clinical data of 67 patients with gallbladder cancer admitted to Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from December 2015 to December 2020 were retrospectively analyzed. Among them, 28 patients were male and 39 female, aged (58±10) years on average. The informed consents of all patients were obtained and the local ethical committee approval was received. Survival analysis was performed by Kaplan-Meier method and Log-rank test. The independent risk factors of postoperative prognosis of patients with gallbladder cancer were identified by multivariate Cox regression analysis. The efficiency of PLR + CA19-9 for predicting postoperative prognosis of patients with gallbladder cancer was assessed by delineating the area under ROC curve (AUC).

ROC curve analysis showed that the optimal thresholds of PLR, CA19-9 and PLR + CA19-9 for predicting 3-year overall survival (OS) of patients with gallbladder cancer were 162, 38 and 0.65, respectively. Multivariate Cox regression analysis indicated that PLR≥162 and CA19-9≥38 kU/L were the independent risk factors for postoperative prognosis of patients with gallbladder cancer (HR=3.093, 3.852; P<0.05). The median OS in the low and high PLR + CA19-9 groups was 43 and 15 months, and the difference was statistically significant (χ²=44.342, P<0.05). The AUC of PLR in predicting postoperative 1- and 3-year progression-free survival of patients with gallbladder cancer was 0.741 and 0.777, 0.838 and 0.780 for CA19-9, and 0.901 and 0.882 for PLR + CA19-9, respectively.

Preoperative PLR combined with CA19-9 has higher value in predicting postoperative prognosis of patients with gallbladder cancer compared with PLR or CA19-9alone, which is of certain value in clinical application.

To evaluate the value of constellation shuttling imaging (Ucs) and gradient- and spin-echo (GRASE) technique in the application of magnetic resonance cholangiopancreatography (MRCP).

30 patients receiving MRCP in the Third Affiliated Hospital of Sun Yat-sen University from November 2022 to December 2022 were enrolled. Among them, 15 patients were male and 15 female, aged (52±17) years on average. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients received 3 different scanning protocols. Conventional scanning was conducted using 3D fast spin-echo (FSE) technique combined with parallel acquisition and respiratory-triggered (RT) technique. Ucs was performed using 3D-Ucs technique combined with MRCP using RT technique. Fast GRASE was delivered by using 3D FSE sequence combined with GRASE and breath-hold technique. Objective evaluation indexes included signal-to-noise ratio (SNR), contrast ratio (CR) and contrast-to-noise ratio (CNR) of common bile duct. Subjective evaluation: the scores (5-point scale) of bile ductal visibility, motion artifact, background suppression, image clarity and overall image quality of the cholangiopancreatography were assessed by two independent radiologists with more than 10-year experience in abdominal MRI diagnosis who were blind to the study, and the average score of 5 indexes was calculated. Meantime, the data acquisition time was recorded.

Objective evaluation showed that the median SNR in the Ucs group was 13(9,18), significantly higher than 8(5,11) in the conventional group (Z=-3.73, P<0.05). The CNR in the Ucs group was 18(14, 25), significantly higher than 12(7, 15) in the conventional group (Z=-3.61, P<0.05). Subjective evaluation indicated that for patients with normal breathing, the scores of 5 indexes in the Ucs group were significantly higher than those in other two groups (P<0.05). For patients with respiratory disorders, bile ductal visibility, motion artifact, background suppression and overall image quality in the GRASE group were superior to those in the conventional group (P<0.05). High degree of agreement was observed between two radiologists (κ>0.8, P<0.05). For patients with normal breathing, the data acquisition time in the Ucs group was 19% shorter than that in the conventional group. For patients with respiratory disorders, the data acquisition time in the GRASE group was shortened by nearly 92% and 90% compared with those in the conventional and Ucs groups, respectively.

Compared with conventional scans, the image quality and data acquisition time in the Ucs group are significantly better for patients with normal breathing. For patients with respiratory disorders, rapid GRASE is recommended. MRCP sequence mainly based on Ucs assisted by fast GRASE is superior to conventional scans.

To evaluate the efficacy of rivaroxaban in the treatment of portal vein thrombosis (PVT) after splenectomy combined with pericardial devascularization.

Clinical data of 37 patients with liver cirrhosis complicated with PVT who underwent splenectomy combined with pericardial devascularization in Fifth Medical Center of PLA General Hospital from June 1, 2019 to June 1, 2022 were retrospectively analyzed. Among them, 10 patients were male and 27 female, aged (52±4) years on average. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 27 patients were diagnosed with hepatitis B virus cirrhosis, 8 cases of autoimmune cirrhosis and 2 cases of alcoholic cirrhosis. 12 cases were diagnosed with PVT complicated with gastrointestinal bleeding and 25 cases of upper gastrointestinal bleeding alone before surgery. 37 patients were treated with low-molecular-weight heparin at postoperative 1 to 3 d, and then changed to oral intake of rivaroxaban. The dosage of rivaroxaban was adjusted according to drug reactions and prothrombin activation. At postoperative 3-5 d, routine color Doppler ultrasound or enhanced CT scan of upper abdomen were performed to assess the changes of PVT. At postoperative 1 month, enhanced CT scan was performed to evaluate clinical efficacy.

At postoperative 1 week, the incidence of de novo PVT was 38%(14/37), including8 cases of grade Ⅰ, 3 cases of grade Ⅱ, 2 cases of grade Ⅲ and 1 case of grade Ⅳ. The incidence of de novo PVT in patients with old PVT before surgery was approximately 58% (7/12), including 3 cases of complete thrombolysis of de novo PVT, 3 cases of partial thrombolysis of de novo PVT, and 1 case of cavernous transformation of the portal vein who suffered grade Ⅳ PVT postoperatively. Thrombolysis combined with embolectomy through internal jugular vein yielded no efficacy, and oral intake of rivaroxaban was given. For patients with old PVT before surgery, PVT could not be treated, considering the possibility of thrombosis organization. The incidence of PVT in patients with upper gastrointestinal bleeding alone was 28% (7/25), including 4 cases of complete thrombolysis of de novo PVT and 3 cases of partial thrombolysis of de novo PVT. 6 patients developed gingival and subcutaneous bleeding after oral intake of rivaroxaban, which was alleviated after reducing the dosage of rivaroxaban. All patients were given with oral intake of rivaroxaban for 6 months after PVT thrombolysis.

Rivaroxaban after splenectomy combined with pericardial devascularization is safe and efficacious protocol in preventing de novo PVT, which can bring benefits to patients after splenectomy combined with pericardial devascularization.

To evaluate clinical efficacy of a novel type of laparoscopic pneumoperitoneum-free rigid endoscopic holmium laser lithotripsy in the treatment of hepatolithiasis.

Clinical data of 6 patients with hepatolithiasis who underwent laparoscopic pneumoperitoneum-free rigid endoscopic holmium laser lithotripsy in People's Hospital of Hunan Province from March 2023 to May 2023 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 1 patient was male and 5 female, aged 46-68 years, with a median age of 62 years. A new type of laparoscopic rigid endoscopic holmium laser lithotripsy was self-designed, and pneumoperitoneum was not required intraoperatively. Perioperative conditions and complications were observed.

All patients successfully completed the surgery, and no conversion to open surgery occurred. The average operation time was (145±22) min, and intraoperative blood loss was 5-50 ml, witha median blood loss of 10 ml. The length of postoperative hospital stay was (5.0±0.6) d. No death occurred during perioperative period. No complications, such as hypercapnia, air embolism, subcutaneous emphysema, abdominal infection and biliary bleeding, occurred during and after surgery. All patients were recovered and discharged. CT scan at postoperative 3 d showed no residual hepatolithiasis.

The self-designed novel type of laparoscopic pneumoperitoneum-free rigid endoscopic holmium laser lithotripsy is a safe and efficacious treatment for hepatolithiasis, which can effectively reduce the incidence of intraoperative pneumoperitoneum-related complications, improve surgical efficiency and shorten operation time.

To compare the safety and efficacy of extrathecal and intrathecal transection of Glisson's pedicle in laparoscopic anatomic hepatectomy.

Clinical data of 192 patients who underwent laparoscopic anatomic hepatectomy in the 900^th Hospital from January 2019 to June 2022 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 110 patients were male, 82 female, aged from 17 to 81 years, with a median age of 56 years. 96 patients were diagnosed with primary liver cancer (PLC), 96 cases of other malignant tumors and benign diseases. According to different treatment methods of Glisson's pedicle, all patients were divided into extrathecal anatomical Glisson pedicle (extrathecal group, n=65) and intrathecal anatomical Glisson pedicle (intrathecal group, n=127). Perioperative conditions, postoperative complications and postoperative survival and recurrence were observed in two groups. The operation time and postoperative length of hospital stay between two groups were compared by t test or rank-sum test. The rate comparison was conducted by Chi-square test. Survival analysis was performed by Kaplan-Meier analysis and Log-rank test.

All patients successfully underwent surgery in two groups and no perioperative death was reported. In the extrathecal group, the mean operation time and pedicle treatment time were (212±79) and (18±5) min, which were significantly shorter than (236±68) and (21±5) min in the intrathecal group (t=-2.097, -3.927; P<0.05). The incidence of postoperative complications was 7.6%(5/65) and 6.3%(8/127) in the extrathecal and intrathecal groups, and no significant difference was found between two groups (χ²=0.132, P>0.05). Postoperative length of hospital stay in two groups was 12(10, 13) and 11(8, 14) d, and no significant difference was found (Z=1.626, P>0.05). All 96 PLC patients were followed up for1-42 months, with a median follow-up of 28 months. No significant difference was observed in overall survival and tumor-free survival between two groups (χ²=0.894, 0.154; P>0.05).

Both extrathecal and intrathecal Glisson's pedicle transection are feasible and safe in laparoscopic anatomic hepatectomy. No significant difference is noted in oncology benefits between two procedures. However, extrathecal transection of Glisson's pedicle can improve surgical efficiency.

To investigate the risk factors of portal vein thrombosis (PVT) after splenectomy in patients with cirrhotic hyperplenism.

Clinical data of 136 cirrhosis patients complicated with hypersplenism who underwent splenectomy in the Third Affiliated Hospital of Sun Yat-senUniversity from July 2016 to April 2019 were retrospectively analyzed. Among them, 101 patients were male and 35 female, aged (48±11) years on average. 113 cases were diagnosed with viral hepatitis and 8 cases of hepatolenticular degeneration. The informed consents of all patients were obtained and the local ethical committee approval was received. According to postoperative incidence of PVT, all patients were divided into the PVT (n=77) and non-PVT groups (n=59). Clinical indexes were collected during perioperative period. The risk factors of PVT were analyzed by univariate and multivariate Logistic regression analyses, and the optimal diagnostic threshold values of risk factors were analyzed by the ROC curve.

The incidence of PVT was 57%(77/136) after splenectomy in patients with cirrhotic hyperplenism, and 75%(58/136) occurred within 10 d after splenectomy. Univariate analysis showed that endoscopic treatment history, preoperative thrombin time (TT), splenic maximum diameter, splenic intercostal thickness, portal vein diameter, preoperative splenic vein diameter and postoperative portal vein diameter, RBC on the day of surgery and 5-6 d after surgery, Plt on the day of surgery, and TT on 2-4 d after surgery were correlated with the incidence of postoperative PVT (P<0.05). Multivariate Logistic analysis showed that endoscopic treatment history, Plt on the day of surgery, and portal vein diameter were the independent factors influencing the incidence of postoperative PVT (OR=3.556, 1.020, 1.449; P<0.05). ROC curve revealed that the sensitivity and specificity of Plt>62×10⁹/L on the day of surgery in the diagnosis of postoperative PVT were 0.597 and 0.593. The sensitivity and specificity of postoperative portal vein diameter>13.5 mm in the diagnosis of postoperative PVT were 0.390 and 0.864.

The incidence of PVT after splenectomy in patients with cirrhotic hyperplenism is relatively high. Postoperative portal vein diameter>13.5 mm, Plt>62×10⁹/L on the day of surgery and endoscopic treatment history are the independent risk factors for PVT after splenectomy.

To systematically evaluate the safety and efficacy of laparoscopic cholecystectomy (LC) combined with laparoscopic common bile duct exploration (LCBDE) and LC combined with endoscopic retrograde cholangiopancreatography (ERCP)/endoscopic sphincterotomy (EST) in the treatment of gallbladder stones complicated with common bile duct stones.

Literature review was performed from CNKI, VIP and Wanfang Data, PubMed, Embase, Medline and Cochrane Library using the searching keywords of gallbladder stones, common bile duct stones, endoscopy, duodenal sphincterotomy, laparoscopic choledochotomy in both English and Chinese from January 1, 2005 to January 1, 2022. According to the inclusion and exclusion criteria, two researchers screened the retrieved literatures and extracted data. Meta-analysis was conducted by RevMan 5.4 software.

1 701 patients from 11 RCTs were included, including 883 patients in the LC + LCBDE group and 818 in the ERCP/EST + LC group. No significant differences were observed in stone clearance rate (OR=0.85, 95%CI: 0.59-1.22) and surgical conversion rate (OR=1.46, 95%CI: 0.81-2.62) between two groups (P>0.05). No significant differences were noted in the operation time (WMD=11.26, 95%CI: -13.38-35.89) and length of hospital stay (WMD=-0.65, 95%CI: -1.55-0.16) between two groups (P>0.05). The incidence of postoperative bile leakage (OR=4.89, 95%CI: 2.13-11.21) and pancreatitis (OR=0.15, 95%CI: 0.06-0.37) significantly differed between two groups (P<0.05).

Both two surgical procedures are safe and effective treatment for gallbladder stones complicated with common bile duct stones. The incidence of pancreatitis after LC combined with LCBDE is lower, whereas the incidence of bile leakage after LC combined with ERCP/EST is lower.

To evaluate the predictive value of prognostic nutritional index (PNI) for prognosis of patients with borderline resectable pancreatic cancer.

Clinical data of 77 patients with borderline resectable pancreatic cancer who underwent surgical treatment in Beijing Chaoyang Hospital, Capital Medical University from March 2013 to December 2021 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 34 patients were male and 43 female, aged (61±11) years on average. 61 patients underwent radical pancreaticoduodenectomy and 16 cases of radical total pancreaticoduodenectomy. According to preoperative serum ALB and peripheral blood lymphocyte count, preoperative PNI was calculated as 45±5. All patients were divided into low (n=39) and high PNI groups (n=38) with PNI of 45 as the cut-off value. Survival analysis was performed by Kaplan-Meier analysis and Log-rank test. The risk factors affecting the long-term prognosis of patients were screened by multivariate Cox's model.

All patients successfully completed the surgery. The incidence of postoperative complications was 30%(23/77). The median survival of patients in the low and high PNI groups was 8.0 and 15.5 months. The postoperative 6-month, 1-year and 2-year overall survival rates in two groups were 76.7%, 40.1%, 17.2% and 91.8%, 65.3%, 49.8%, and the differences were statistically significant (χ²=5.826, P<0.05). Multivariate Cox's model showed that low PNI (HR=1.864, 95%CI:1.089-3.190, P=0.023) and low degree of tumor differentiation (HR=2.166, 95%CI:1.225-3.828, P=0.008) were the independent risk factors for postoperative long-term survival.

PNI can be utilized as an effective index to predict the overall survival of patients with borderline resectable pancreatic cancer. Patients with low PNI obtain poor prognosis.

To evaluate the effect of the number of dissected lymph nodes on the safety and prognosis of pancreaticoduodenectomy for distal cholangiocarcinoma.

Clinical data of 104 patients with distal cholangiocarcinoma who underwent pancreatoduodenectomy in Beijing Chaoyang Hospital Affiliated to Capital Medical University from January 2015 to December 2021 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 60 patients were male and 44 female, aged from 29 to 84 years, with a median age of 66 years. The effect of the number of dissected lymph nodes on perioperative complications and survival was evaluated. The threshold value of lymph node number was determined by X-tile software. All patients were divided into two groups according to the threshold value. The number of lymph nodes between two groups was compared by t test, and the incidence of complications was compared by Chi-square test. Survival analysis was performed by Kaplan-Meier method and Log-rank test.

The number of dissected lymph nodes was 3-45. According to the threshold value of 24 lymph nodes, all patients were divided into the <24 (n=80) and ≥24 groups (n=24). The number of dissected lymph nodes in the <24 group and ≥24 group was 15±5 and 31±6, and the difference was statistically significant (t=-13.101, P<0.05). The incidence of postoperative complications and perioperative mortality rate in two groups were 21%(5/24), 4%(1/24) and 21%(26/80), 5%(4/80), and the differences were not statistically significant (χ²=1.201, 0.142; P>0.05). The postoperative 1-, 3- and 5-year overall survival rates of patients in two groups were 72.6%, 33.2%, 25.9% and 87.1%, 63.7%, 63.7%, respectively, and the differences were statistically significant (χ²=6.170, P<0.05).

For patients with distal cholangiocarcinoma undergoing pancreatoduodenectomy, the number of dissected lymph nodes ≥24 can significantly improve clinical prognosis without sacrificing perioperative safety.