Mirizzi综合征是一种特殊的胆囊结石，其形成的解剖因素是胆囊管与肝总管伴行过长或胆囊管与肝总管汇合位置过低，持续嵌顿于胆囊颈部的结石和较大的胆囊管结石压迫肝总管，引起肝总管狭窄，导致反复发作的胆囊炎、胆管炎。其反复发作的炎症可导致胆囊肝总管瘘、胆囊管消失、结石部分或全部堵塞肝总管，严重者甚至可导致胆囊肠瘘及胆石性肠梗阻。Mirizzi综合征按Csendes分型可分为五型，本案病例为Ⅱ型Mirizzi综合征，由于胆囊结石长期压迫及炎症的长期刺激已形成胆囊胆管瘘，其瘘管直径小于胆总管周径的1/3。该分型的主要手术方式为腹腔镜下胆总管缺损修补+胆囊次全切除+胆道镜下胆管取石术。本视频病例因胆道镜探查发现胆总管结石过大，镜下取石困难，故术中进行胆总管切开取石术，先逆行分离胆囊，后切除大部胆囊，取出胆囊结石后胆道镜探查再行胆总管切开取石，后利用剩余的胆囊壁行胆总管缺损修补术。

双胆囊是临床罕见的胆囊变异，据相关文献报道发病率约0.02%。相关双胆囊病例报告显示，充分的术前阅片及术中辨明解剖关系对顺利切除双胆囊极为重要。本手术视频为一例儿童双胆囊变异切除。术中探查腹腔见胆囊床肝脏面隐约可见一囊性病变，先解剖胆囊三角，辨明胆囊动脉后进行离断，辨明三管关系，充分游离病变与周围肝脏之间的间隙，见膈面方向变异的双胆囊嵌入肝实质内，压迫右肝内血管及胆管，但未与肝内胆管及右胆管相通。脏面正常部位胆囊的胆囊管直接汇入胆总管，膈面变异双胆囊的胆囊管汇入脏面正常部位胆囊的胆囊管，术中探查发现两个胆囊有共同动脉血供，证实为Harlaftis胆囊畸形分类1（Y）型，遂行腹腔镜下胆囊切除术切除双胆囊。

本视频主要展示一例腹腔镜保脾胰体尾切除术（Kimura法），患者为女性，68岁，术前评估考虑无功能性胰体尾部pNET可能性大。MRI检查见肿瘤与主胰管关系密切，局部切除或胰腺中段切除均风险较大，决定采用Kimura法腹腔镜保脾胰体尾切除。Trocar布局采用五孔法，头高脚低体位、向右侧倾斜30度。打开胃结肠韧带，探查胰腺和肿瘤位置及大小，脾脏是否受侵犯。沿胰腺颈部下缘向脾门侧打开腹膜，显露胰腺下缘及背侧，脾静脉可在胰腺上背侧找寻，尽量向脾门侧游离，注意识别肠系膜下静脉。胰腺颈部上缘打开腹膜，可显露出脾动脉，仔细向脾门侧分离。贯通胰后隧道，肠系膜上静脉左侧切断胰腺，顺时针方向将胰腺体尾自脾动静脉剥离。该病例胰尾与脾门关系密切，术中应仔细分离，避免损伤脾门血管。术后病理检查示NET G1，切缘阴性。手术时间200 min，术中出血量20 ml，术后ERAS方案，6天出院。术后2个月余复查良好。

腹腔镜胆总管囊肿切除+胆肠内引流术是目前治疗小儿先天性胆总管囊肿最常用的手术方式。本视频病例采用四孔法布局，腹腔镜探查腹腔后充分悬吊肝脏，首先顺逆结合法分离并完整切除胆囊，再沿膜间隙充分游离扩张胆总管上下端，分别结扎、切断扩张胆总管上下端后，移除标本，双极电凝充分创面止血，在距离屈氏韧带15 cm处标记空肠，然后将空肠自脐孔提出体外行空肠对空肠Roux-en-Y吻合，再进入腹腔采用“降落伞”法行腹腔镜下胆管空肠后壁吻合，进而行腔镜下胆总管空肠前壁连续缝合，吻合完毕于吻合口下方留置负压引流管，术后实施加速康复措施，未出现出血、胆漏等并发症，术后随访半年恢复良好。

肝尾状叶是位于肝脏背侧的一个独立的肝段，其解剖位置深在，毗邻结构复杂，位于肝内大血管之间，包括下腔静脉、肝中静脉和肝右静脉以及门静脉等重要血管。目前临床上广泛沿用1985年Kumon提出的肝尾状叶分段方法，把肝尾状叶分为Spiegel叶（Spiegel lobe，SL）、腔静脉旁部（paracaval portion，PP）和尾状突（caudate process，CP）3个部分。单独的肝尾状叶切除术存在操作空间狭窄、极易大量出血、解剖及毗邻结构复杂等问题，被认为是一种极具挑战性的肝脏手术。随着腔镜技术以及手术器械等的发展进步，腹腔镜手术为尾状叶切除提供了一个较开放手术更具优势的观察角度，其放大的影像和清晰的视野使尾状叶的精细结构能在术中被精确辨认并处理。可依据切除病变所在的亚段选择不同的手术入路，常用的手术入路包括左侧入路、右侧入路、中间入路及联合入路等。本视频为1例位于肝尾状叶的肝细胞癌，行腹腔镜下肝全尾状叶切除及胆囊切除术，采用左侧入路为主的方式，对肝尾状叶及其毗邻血管进行精细解剖及切除，供广大同道学习探讨。

肝蒂处理是解剖性肝切除的关键步骤，然而，如何有效、快捷地对第一肝门肝蒂进行解剖处理仍存在许多争议。因此，我们提出一种全新的运用钝头针（俗称肝针）对肝蒂进行一并缝合处理的方法，称为“肝针一针法”，此法具有出血少、组织损伤小的优点，简化了第一肝门Glisson鞘外解剖的步骤，缩短了手术时间，缩短了解剖性肝切除技术的学习曲线，具有较高的应用价值，值得推广。本视频以腹腔镜下左肝外叶肝蒂处理为例，展示“肝针一针法”步骤与过程。

目前肝囊肿的主要治疗方法有经皮肝囊肿穿刺抽吸硬化术及腹腔镜下肝囊肿开窗引流术等，但这些方法均无法从根本上避免囊腔的再形成及囊液的继续分泌，容易发生肝囊肿复发。随着腹腔镜技术的进步，腹腔镜下肝囊肿剥除术已成为治疗肝囊肿的方式之一，完整剥除囊肿壁可最大程度降低复发风险，但巨大囊肿常挤压肝内重要脉管结构，剥除过程中需警惕重要结构损伤，且深部囊肿的囊壁易因解剖层次不清导致囊壁残留，或损伤血管、胆管，术中关键步骤是沿囊肿与正常肝组织之间的解剖间隙，可先抽吸囊液缩小体积，降低张力后再剥离，解剖间隙更容易把握。另外腹腔镜手术与开腹手术相比，腹腔镜肝囊肿剥除术具有创伤小、术后疼痛轻、住院时间短等优势，同时能最大程度保留正常肝组织，适用于囊肿邻近膈顶部、合并感染出血或开窗术后复发的患者，在保留正常肝组织的同时实现根治性切除，适合在有经验的肝胆中心进一步推广。

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.

肝门部胆管癌是胆道恶性肿瘤的常见类型，其根治性手术是肝胆外科诊疗难度最大、技术要求最高的手术之一。肝门部胆管癌起病隐匿，其生长特点是多维度浸润性生长，既往胆管树方向轴向浸润，又向胆管壁侧方浸润，导致相邻的门静脉、肝动脉、肝实质受累；此外，其易发生区域淋巴结转移和神经丛转移。因此，肝门部胆管癌的根治性手术强调术前准确临床分期和分型、可切除性评估、手术规划和精细的围手术期管理。本例为55岁男性患者，因体检发现肝功能异常入院，伴中度黄疸，肝功能及CA19-9、铁蛋白显著升高，术前诊断为肝门部胆管癌cT1N0M0Ⅰ期，Bismuth-CorletteⅢa型。经全身状况、肿瘤累及范围及剩余肝体积系统评估，患者具备手术指征且剩余肝体积充足。遂行腹腔镜下肝门部胆管癌根治术，包括区域淋巴结清扫、右半肝切除、全尾状叶切除及左肝管-空肠Roux-en-Y吻合。术后病理确诊为肝门部胆管癌pT2bN0M0Ⅱ期。

肝细胞癌沿门静脉进行传播的侵袭特性已经被广泛论证，因此，经典解剖性肝切除理念提出，对肝细胞癌的荷瘤门静脉流域应进行系统性切除。解剖性肝切除术根据少数特定肝静脉走行来获取门静脉流域间面，并不完全符合生理肝裂的实际情况。ICG荧光影像技术被广泛应用于指引肝实质深部的断肝面，追溯门静脉流域间面。腹腔镜左半肝切除因其解剖结构较容易把控，层面相对清晰，已成为一项标准成熟的术式，联合ICG荧光导航及肝中静脉显露技术，成为可推广、标准化的门静脉流域解剖性肝切除“起手术式”。本视频病例被诊断为“左肝原发性肝癌（CNLC Ⅰa期）”，行全身麻醉下ICG荧光导航腹腔镜左半肝切除术。手术亮点：（1）循Laennec膜分离Gate Ⅲ、Gate Ⅰ，鞘外法分离出左肝蒂并阻断后获得缺血线；确认左半肝缺血线后离断左肝蒂，经外周静脉注射1‰ ICG溶液5 ml进行荧光负染；（2）循肝中静脉离断肝实质，依次显露肝中静脉各分支、肝中静脉左侧壁、肝左静脉主干等重要解剖标志，安全离断相应脉管后获得充分空间再切割闭合肝左静脉；（3）术后采用快速康复。

早期肝癌的首选治疗方式是手术治疗，结合术前三维可视化技术、ICG荧光成像技术和术中超声的精准肝切除术是继解剖性肝切除术后的全新外科理念与技术体系。本病例手术断面较大，需要精准离断的管道多（G3/4、G5v1/8v、MHV、UFV、LHV），手术风险高，仅依靠缺血线及解剖标志来确定切面难以实现精准切除，且容易误将需要保留的管道离断，进一步增加手术风险。因此本手术通过术前三维重建技术模拟出需要离断的管道及位置，在术中通过超声精准定位管道，沿Laennec膜间隙Glisson鞘外分离并阻断Ⅲ、Ⅳ及右前叶腹侧段肝蒂，然后在外周静脉注射2.5 mg ICG，根据实际缺血线及荧光负染后显影，准确标记切面。结合术中超声及肝门血流阻断技术，实施精准的肝Ⅲ、Ⅳ+右前叶腹侧段切除术，避免了右前叶的全部切除，在保证切缘阴性的情况下，尽量保留正常肝组织。术中对肝蒂进行镜下缝合加固，避免术后胆漏的发生。患者术后采用加速康复管理，随访1年恢复良好。

累及腔静脉旁部肝癌的手术是公认较为复杂的手术类型，肿瘤多位于尾状叶或Ⅶ段肝实质，由于空间狭小、暴露困难、无明显解剖学边界、难以获得宽切缘、紧邻下腔静脉或肝右静脉易出血等原因，其手术难度高、风险高。我中心采用荧光导航下双主刀模式实施腹腔镜解剖性右半肝切除，通过术中肿瘤显影技术和荧光反染技术有效解决肿瘤边界定位问题，降低肿瘤破裂的风险，同时使用超声吸引刀（CUSA）在解剖肝实质过程中有效减少了术中出血和避免肝静脉、下腔静脉的损伤，显著提高手术安全性。

医源性胆管损伤(BDI)是腹腔镜胆囊切除术（LC）最常见的严重并发症。吲哚菁绿（ICG）荧光成像技术目前已成为预防BDI的重要手段，但关于BDI的治疗目前仅有个案报道，缺少循证医学依据，文献研究相对匮乏。本视频病例为院外LC术后发生BDI患者，经多学科讨论后，决定采取BDI的延迟修复，即穿刺置管后延期行外科手术治疗。经抗感染、护肝利胆等治疗以及多次超声穿刺置管引流后，患者炎症指标逐渐下降，带管出院3个月后返院行ICG荧光导航腹腔镜胆管损伤修复（胆肠吻合）术。术前30分钟外周静脉推注0.25 mg ICG。术中发现胆管周围组织粘连严重，解剖结构不清，借助ICG荧光成像技术，顺利找到胆管断端并且成功施行胆管空肠高位吻合术。手术过程顺利，患者术后7天康复出院，2个月后复查TB无异常，顺利拔除T管。本手术优点：（1）腹腔镜可进行多角度观察，同时可以放大术野，利于寻找损伤胆管和术中精细操作；（2）ICG荧光显像技术能可视化胆道系统结构，减少手术时间，避免不必要的出血和胆管再损伤；（3）术后恢复快，住院时间短，减轻患者痛苦。

To evaluate the effect of early off-bed activity on the safety and level of comfort of patients with liver cancer during hepatic arterial infusion chemotherapy (HAIC).

In this prospective study, 102 patients with liver cancer who underwent HAIC in the Third Affiliated Hospital of Naval Military Medical University from December 2023 to March 2024 were enrolled. Among them, 92 patients were male and 10 female, aged from 38 to 66 years, with a median age of 55 years. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients were divided into the control (n=51) and study groups (n=51) based on convenient sampling method. Patients in the control group received TACE routine nursing. In the study group, the optimal evidence-based medical evidence was obtained through literature retrieval. Combined with the actual status of patients, they were advised for first off-bed activity at 12 h after HAIC. The incidence of adverse events, complications, level of comfort and degree of satisfaction were observed and compared between two groups. Fatigue and level of comfort scores were compared by t-test. The degree of satisfaction was compared by Chi-square test.

There was no statistically significant difference in the incidence of adverse events between the study groups and the control group. In the study and control groups, 2, 3, 2, 1, 2 and 11, 14, 21, 7 and 9 patients developed pain, insomnia, low back pain, urine retention and constipation, and the differences were statistically significant (χ²=7.141, 8.541, 20.265, 4.883, 4.993; all P<0.05). The scores of fatigue and level of comfort in the study group were 54.6±2.7 and 89.1±0.7, while 78.1±3.2 and 71.5±1.2 in the control group, and the differences were statistically significant (t=-9.255, 6.176; both P<0.05). The degree of satisfaction of patients in the study group was 98%(50/51), significantly higher than 78%(40/51) in the control group (χ²=9.444, P<0.05).

Off-bed activity at 12 h after HAIC exerts no effects on the safety of patients with liver cancer during HAIC. Changing bed rest duration can elevate the level of comfort, and improve the degree of satisfaction of patients.

Surgical records are the core components of medical documents in clinical centers of surgery. Standardization of surgical records contributes to standardizing surgical procedures, improving the quality of surgery, and ensuring patient safety. To ensure that surgical records more objectively, visually, and comprehensively reflect the actual surgical process, numerous high-level university hospitals' surgical centers have long adhered to the good tradition of documenting surgical records in a “combination of text and images” format. Graphic surgical records not only benefit postoperative review and structured data collection but also facilitate the implementation of high-quality clinical research and surgical training. As early as 2015, Group of Operative Surgery, Chinese Society of Surgery, Chinese Medical Association already formulated the “Expert Consensus on Advocating the use of graphic surgical records”. In recent years, rapid development of information technology has provided technical support for the further promotion of graphical surgical records. After extensive and multiple rounds of professional discussions and investigations, and based on a thorough consideration of relevant national policy requirements, information standards, the 2025 edition of the “Expert Consensus” is intended to be revised, aiming to enhance the standardization of graphical surgical records, improve the quality of surgery and training system, as well as clinical researches, thereby contributing to the development of Healthy China.

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.

To investigate the efficacy and safety of different treatments for unresectable intrahepatic cholangiocarcinoma (ICC).

Literature search was performed from PubMed database to find all studies in English related to the treatment of unresectable ICC by subject words combined with free words. The key words were cholangiocarcinoma, cholangiocellular carcinoma, unresectable, advanced, hepatic arterial infusion chemotherapy/HAIC, chemotherapy, radiotherapy, transarterial radioembolization/TARE, transarterial chemoembolization/TACE, PD-1/PD-L1 and protein kinase inhibitors, etc. The retrieval time was from January 1 to June 1, 2024. The primary endpoints were 1-, 2- and 3-year overall survival (OS) rate, and the secondary endpoints were objective response rate (ORR), median progression-free survival (PFS) and incidence rate of adverse reactions. Meta-analysis was carried out by Stata 17.0 software. Treatment methods included chemotherapy, combination therapy, FOLFOX-hepatic arterial infusion chemotherapy (HAIC), immunotherapy, radiotherapy, TACE and yttrium-90 (Y-90).

A total of 43 articles comprising 8 538 patients were included for meta-analysis. Meta-analysis showed that the 1-, 2- and 3-year OS rates in the HAIC and combination therapy groups were 70.2%, 44.4%, 16.9%, and 65.0%, 27.8%, 19.9%, respectively. The 1-, 2- and 3-year OS rates in the TACE, Y-90 and chemotherapy groups were 43.0%, 24.4%, 19.9%, and 45.4%, 19.3%, 10.3%, and 38.0%, 12.6% and 4.9%, respectively. The 1- and 2-year OS rates in the immunotherapy and radiotherapy groups were 65.0%, 19.0%, and 3.6%, 1.5%, respectively. Patients in the TACE, combination therapy and HAIC groups obtained the highest ORR of 50.8%, 47.4% and 45.3%, respectively. The median PFS in the combination therapy group was the longest up to 6.76 months, followed by 4.39 and 4.09 months in the chemotherapy and HAIC groups. The most common adverse reaction was elevated AST/ALT ratio, accounting for 56.6%. Severe adverse reactions were cholestasis (3.0%) and peptic ulcer (0.8%).

For patients with unresectable ICC, FOLFOX-HAIC yields higher efficacy, similar adverse reactions, less severe adverse reactions and high safety compared with alternative treatment options.

肝门部胆管癌因其横向浸润的生物学特性，使得进展期胆管癌侵犯门静脉和（或）肝动脉较早出现。近年来，越来越多的证据表明对存在门静脉侵犯的肝门部胆管癌进行门静脉切除重建可以提高R0切除率和改善术后生存。而联合肝动脉切除虽也能提高R0切除率，但由于肝动脉重建手术复杂，术后重建动脉血管长期通畅率低，并发症（如出血、血栓和动脉瘤）发生率高，故其临床意义目前存在争议。腹腔镜下血管切除与重建是一项具有挑战性的手术。本视频首次展示了全腹腔镜下肝动脉联合门静脉切除重建治疗肝门部胆管癌术式。术后患者恢复顺利，未发生胆漏、出血或胃肠功能障碍，肝功能恢复良好。术后复查腹部增强CT及腹部超声均示肝动脉、门静脉血流通畅。本团队结果表明，在腹腔镜技术成熟的肝胆中心，通过精准术前评估及围术期管理，可以安全、有效施行全腹腔镜下肝动脉联合门静脉切除重建治疗Ⅳ型肝门部胆管癌。

Severe acute pancreatitis (SAP) is one of the most dangerous abdominal emergencies in digestive system diseases, characterized by rapid onset, serious complications and high mortality rate. SAP constantly leads to peripancreatic/pancreatic necrosis, severe systemic inflammatory response and multiple organ failure, among which gastrointestinal failure and intestinal flora disorder are the key links during the aggravation of acute pancreatitis (AP). With the increasing incidence of SAP year by year, it becomes urgent to identify more effective treatment for early-stage SAP. Intestinal cleansing is an effective treatment for SAP. The main mechanisms include reducing the levels of intestinal inflammatory cytokines, decreasing gut pathogenic microorganisms, limiting the displacement of intestinal flora, increasing the abundance of probiotics to maintain flora balance, protecting the integrity of intestinal barrier function, and further lowering the occurrence of complications such as systemic inflammatory response syndrome, thereby preventing the incidence and progression of SAP and improving clinical prognosis. In this article, research progress in intestinal cleansing for improving intestinal function and treating SAP was illustrated.