Objective To explore the risk factors and the predictive value of combined indexes for gallstone recurrence after gallbladder-preserving cholecystolithotomy with laparoscopy and choledochoscopy（LC-GPC）. Methods Clinical data of 44 patients undergoing LC-GPC in the First Affiliated Hospital of Gannan Medical University from September 2019 to May 2024 were retrospectively collected. Based on the 6-month gallstone recurrence after LC-GPC, patients were divided into the gallstone recurrence（GR） group （n=6） and the non-GR group （n=38）. The t-test or Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. Logistic regression analysis was used for univariate and multivariate analyses, and the receiver operating characteristic （ROC） curve was used to evaluate the predictive power of the combined indicators. Results GR occurred in 6 out of 44 patients（13.6%）. Multivariate logistic analysis showed that the Gallbladder Status Score（GSS）（OR=0.361,95%CI：0.131-0.994,P=0.049）,and total cholesterol（OR=0.215,95%CI：0.056-0.822,P=0.025） were independent risk factors for the recurrence of gallstone after LC-GPC.The area under ROC the curve（AUC） of GSS,total cholesterol and GSS+total cholesterol for predicting gallstone recurrence after LC-GPC was 0.759, 0.811 and 0.930, respectively. Conclusion GSS+total cholesterol has a good predictive value and clinical significance for gallstone recurrence after LC-GPC.

Objective To evaluate the efficacy and safety of transcatheter arterial chemoembolization（TACE） combined with hepatic arterial infusion chemotherapy（HAIC）, camrelizumab and apatinib in the treatment of unresectable hepatocellular carcinoma（uHCC） in the real world. Methods This was a multicenter, prospective,real-world study involving 135 uHCC patients treated with camrelizumab and apatinib from July 2022 to March 2025 in 19 medical centers.Patients were divided into the TACE group（58 cases） and the TACE+HAIC group（77 cases） based on the interventional treatment plan.The primary endpoints were overall survival（OS）, progression-free survival（PFS）, and treatment-related adverse events（TRAEs）.Propensity score and inverse probability treatment weighting（IPTW） were used to adjust for baseline differences between the groups. Results The median follow-up time for the overall cohort was 17.7 months. After IPTW, the Objective response rate（ORR） in the TACE+HAIC group was significantly higher than that in the TACE group（45.2% vs.31.3%,P=0.027）. Compared with the TACE group, the TACE+HAIC group showed a trend of improved PFS and OS,but the differences were not statistically significant （OS： P=0.490;PFS： P=0.425）.Subgroup analysis revealed that in patients achieving Objective response, the PFS in the TACE+HAIC group was significantly better than that in the TACE group（P=0.048）. In terms of safety, the overall rate of TRAEs in the TACE+HAIC group was significantly lower than that in the TACE group（67.5% vs. 86.2%,P=0.012）,but there was no significant difference in the rate of grade≥; 3 TRAEs（27.6% vs.28.6%,P=0.900）.No treatment-related deaths occurred in either group. Conclusion TACE combined with HAIC,camrelizumab and apatinib can significantly improve tumor response depth in uHCC patients, showing an overall high safety. However, the long-term survival benefit still needs to be verified through further follow-up.

The tumor microenvironment （TME） refers to the local environment surrounding tumor cells. Apart from tumor cells themselves, the TME encompasses a variety of non-tumor cells, extracellular matrix, blood vessels, lymphatic vessels, and an array of molecular signals. The TME plays a crucial role in the pathophysiology of tumors, thereby affecting the onset and progression of tumors. Research on the various components of the TME has been annually grown, among which immune cells have been the most extensively studied with a significant influence. Colorectal cancer （CRC） is a type of malignancy with a steadily increasing incidence rate, and TME in CRC is a hot research spotlight. Progression and metastasis of CRC often indicate a poor prognosis. This article aims to review immune cells within the TME involved in the e progression and metastasis of CRC.

Severe acute pancreatitis （SAP） remains a major clinical challenge with high mortality. Surgical management has shifted from early aggressive operations to a modern, evidence-based "delayed, minimally invasive, step-up" strategy. This article explicates the pathophysiological rationale for that shift—centered on the "two-hit" theory—and highlights the need to avoid iatrogenic second hits during the peak systemic inflammatory response. Regarding timing, we review evidence supporting delay of intervention until at least 4 weeks after onset （to allow acute necrotic collections to evolve into walled-off necrosis） as the gold standard, with abdominal compartment syndrome identified as the only one exception requiring earlier intervention. Regarding modality, we trace the development and validation of the step-up approach： Initial percutaneous catheter drainage or endoscopic transluminal drainage, followed by endoscopic or minimally invasive surgical necrosectomy. The roles of direct "single-step" necrosectomy and the redefined, limited place of open surgery in contemporary practice are also discussed. Strict adherence to this evidence-based framework can significantly improve outcomes for patients with SAP.

Objective To establish an improved mouse model of gastroesophageal reflux disease （GERD） by combining partial pyloric and forestomach ligation with postoperative dietary intervention. Methods A total of 48 C57BL/6J mice were randomly assigned to four groups： 2-week sham, 2-week model, 7-week sham, and 7-week model. Model groups underwent partial ligation at the pylorus （pyloric semi-ligation） and forestomach, followed by a high-fat diet and postoperative nutritional gel. Sham groups received laparotomy only and standard chow. Body weight and survival were monitored. At 2 and 7 weeks, esophagi were harvested for hematoxylin-eosin （HE） histology to assess reflux esophagitis, and model induction success was calculated. Inflammatory profiles were evaluated by quantitative real-time PCR （qRT-PCR） and enzyme-linked immunosorbent assay （ELISA）. Statistical analyses were performed in GraphPad Prism. Results Successful model induction rates were 83.3% at 2 weeks and 66.7% at 7 weeks （P<0.05）. Compared with shams, model mice exhibited esophageal wall thickening, basal cell hyperplasia, and inflammatory cell infiltration on HE staining. qRT-PCR and ELISA demonstrated significantly increased expression of M1 macrophage-associated mediators and markers （e.g., interleukin-6], monocyte chemoattractant protein 1, cluster of differentiation 80 [CD80], CD86） and decreased expression of M2-associated mediators and markers （e.g., interleukin-10, CD163, CD206） in model mice （all P<0.05）. Conclusion This combined surgical-dietary approach induces robust reflux esophagitis while maintaining acceptable survival. The model recapitulates key pathological features of human acid-reflux-related GERD, including M1-predominant inflammation, and provides a practical platform for mechanistic studies and preclinical therapeutic evaluation.

For most patients with obesity, metabolic and bariatric surgery （MBS） is the most effective option after failure of non-surgical treatment.These procedures achieve weight loss through restrictive and/or malabsorptive mechanisms that reduce gastric volume and intestinal absorptive area. However, rapid weight loss, preoperative nutritional status, procedure-specific anatomical changes, and decreased intake and absorption of key micronutrients can predispose patients to adverse outcomes, notably anemia. This review summarizes the current landscape of anemia following different MBS procedures, examines patient- and procedure-related factors associated with its development, and outlines practical screening, prevention, and treatment strategies. Proactive identification and management of anemia in the postoperative period are essential to mitigate surgical morbidity and improve patients'quality of life.

Objective To evaluate the safety and efficacy of pre-procedural magnesium sulfate in preventing post-endoscopic retrograde cholangiopancreatography （post-ERCP） pancreatitis （PEP） using propensity score matching （PSM）. Methods We retrospectively analyzed patients with common bile duct stones who underwent ERCP in the Department of General Surgery at the Second People's Hospital of Hefei from January 2022 to October 2024. Patients receiving magnesium sulfate before ERCP were compared with those receiving normal saline. Data were processed with SPSS 22. PSM （1∶1） was used to balance measured confounders. The effects of pre-procedural magnesium sulfate on postoperative inflammatory markers, liver function indexes, amylase, and pancreatitis in ERCP patients were analyzed. Results Before matching, the groups differed by sex and number of cannulation attempts （P<0.05）. After PSM, 128 patients were matched （64 per group） with balanced baseline characteristics （all P>0.05）. At 24 hours, liver function tests （total and direct bilirubin, aspartate transaminase, alanine aminotransferase） did not differ between groups （all P>0.05）. In contrast, white blood cell count, C-reactive protein, and interleukin-6 were significantly lower in the magnesium sulfate group than in controls （all P<0.05）. The incidences of hyperamylasemia and PEP at 12 and 24 hours were also significantly lower in the magnesium sulfate group （P<0.05）. Conclusion Pre-procedural magnesium sulfate was associated with a reduced early inflammatory response and a lower incidence of hyperamylasemia and post-ERCP pancreatitis.

Cholangitis is highly prevalent after Kasai surgery for biliary atresia. The occurrence of cholangitis accelerates the failure of liver function and seriously affects the survival rate of the autologous liver. The diagnosis of cholangitis is lack of specificity, and early diagnosis can be made from multiple perspectives according to the diagnostic criteria at home and abroad. Reasonable, sufficient and sufficient antibiotic application is very critical to the treatment of cholangitis. Before identifying the pathogenic bacteria, the third-generation cephalosporins or carbapenems can be empirically selected for treatment. The treatment courses and antibiotic types of different types of cholangitis vary a lot. It is generally accepted that prophylactic antibiotics within 6 months are used to prevent cholangitis, although the efficacy is not clear.

Severe acute pancreatitis （SAP） is an urgent abdominal condition characterized by a critical clinical course, multiple complications, and high mortality. Treatment strategies have evolved from early aggressive surgery to conservative care and now to a multidisciplinary, comprehensive model integrating minimally invasive and open procedures. Surgical decision-making for SAP is primarily guided by multi-disciplinary team （MDT） discussion. Recent studies have demonstrated that minimally invasive, stepwise strategies significantly improve patient outcomes. In addition, optimizing individualized timing of intervention and applying machine learning-based prediction models offer promising directions for more precise, tailored treatment.

Objective To identify early risk factors for failure of conservative （nonoperative） management in acute appendicitis during pregnancy （AAP） and to determine optimal diagnostic thresholds to inform individualized treatment strategies. Methods We retrospectively analyzed 80 pregnant patients with AAP treated at Baoding No.1 Central Hospital from January 2013 to June 2023. Cases were categorized as successful conservative management （n=48） or failed conservative management （n=32）. Univariate analyses and multivariable logistic regression were used to identify independent predictors of failure. Receiver operating characteristic （ROC） analysis with the Youden index was applied to determine optimal cutoffs for continuous predictors. Results Univariate analysis showed that compared with the success group, the failure group had significantly longer hospital stays （t=-3.450, P<0.05）, higher proportion with fever （body temperature >37.3 °C; χ² =8.437, P<0.05）, higher neutrophil percentage （NEUT%; t=-3.370, P<0.05）, and longer symptom duration prior to conservative treatment （t=-3.161, P<0.05）. In multivariable logistic regression analysis, longer symptom duration, fever, and higher NEUT% were independent predictors of conservative management failure. The areas under the ROC curve for symptom duration and NEUT% were 0.810 and 0.775, respectively （both P<0.05 versus 0.5）. The optimal cutoffs were 27 hours for symptom duration and 88.96% for NEUT%, yielding Youden indices of 0.562 and 0.502, sensitivities of 87.5% and 75.0%, and specificities of 31.3% and 18.8%, respectively. Conclusions ymptom duration >27 hours, fever, and NEUT% >88.96% are early predictors of failure of conservative management in AAP. Early surgical intervention should be considered for patients meeting these criteria to improve outcomes.

Objective To evaluate the clinical effectiveness of an APR triangle-guided Glissonean pedicle approach in laparoscopic anatomical right hemihepatectomy for primary hepatocellular carcinoma （HCC）. Methods This retrospective study included 46 patients with primary HCC who underwent laparoscopic anatomical right hemihepatectomy at Taihe Hospital of Shiyan City from January 2020 to October 2022. Patients were stratified into two groups： APR group （n=23）： Glissonean pedicle transection via the APR triangle. Conventional group （n=23）： Standard extrahepatic （hilar） approach. Outcomes included operative time, hepatic inflow occlusion duration （Pringle maneuver）, intraoperative blood loss, postoperative liver function recovery, intraoperative and postoperative complications, and length of hospital stay. Results Compared with the conventional approach, the APR triangle-guided technique was associated with shorter operative time （P<0.05）, reduced hepatic inflow occlusion duration （P<0.05）, and less intraoperative blood loss （P<0.05）. Postoperatively, the APR group showed faster hepatic recovery, with significantly lower alanine aminotransferase （ALT） and aspartate transaminase （AST） at 1, 3 and 5 days postoperatively, and lower total bilirubin （TBIL） at 1 and 3 days postoperatively （all P<0.05）. The overall rate of complications （including bile leak, pleural effusion, and ascites） was significantly lower in the APR group [13.04%（3/23） vs 43.48%（10/23）, P<0.05], and hospital stay was significantly shorter （P<0.05）. Conclusion Compared with conventional technique, the APR triangle-guided Glissonean pedicle approach in laparoscopic anatomical right hemihepatectomy appears safe and effective, with shorter operative time, reduced surgical risk, faster postoperative hepatic recovery, fewer complications, and a shorter length of stay.

Objective To evaluate the effects of laparoscopic total extraperitoneal hernia repair （TEP） in elderly patients with inguinal hernia, focusing on clinical outcomes, perioperative serum gastrin and motilin levels, and postoperative pain management. Methods From April 2023 to April 2024, 112 elderly patients with inguinal hernia were enrolled and randomized using a random number table into two equal groups （n=56 each）. The control group underwent laparoscopic transabdominal preperitoneal repair （TAPP）, while the TEP group received laparoscopic total extraperitoneal repair （TEP）. Postoperative recovery parameters, intraoperative variables, respiratory indicators after pneumoperitoneum, hormonal and gastrointestinal peptide levels, pain, and complications were compared between groups. Results There were no statistically significant differences between groups in intraoperative blood loss, operative time, length of hospital stay, or overall postoperative complication rate （P>0.05）. The TEP group had earlier recovery of gastrointestinal function, as shown by shorter times to first oral intake, first flatus, and return of bowel sounds （P<0.05）. Airway pressure and end-tidal CO₂ （P_ETCO₂） measured at 10 and 30 minutes after pneumoperitoneum were higher in the TEP group than in the TAPP group （P<0.05）. At postoperative day 3, the TEP group showed lower levels of gastrin, plasma motilin, cortisol, adrenocorticotropic hormone （ACTH）, epinephrine, and norepinephrine compared with the TAPP group （P<0.05）. Conclusions In elderly patients with inguinal hernia, TEP repair more effectively minimizes impairment of gastrointestinal function, produces less postoperative pain, and promotes faster recovery, although it may adversely affect intraoperative respiratory parameters.

Aggressive fibromatosis （AF） is a rare, benign yet locally invasive fibroblastic neoplasm. Intra-abdominal aggressive fibromatosis （IAF） is the least common subtype and generally carries a poorer prognosis due to its proximity to mesenteric vessels and bowel. IAF occurs sporadically—most often driven by activating CTNNB1 mutations—or as part of hereditary syndromes associated with familial adenomatous polyposis （FAP） due to germline APC mutations. Imaging with ultrasound, CT, and MRI aids lesion characterization and delineation of extent, while definitive diagnosis is supported by histopathology demonstrating nuclear β-catenin expression. Management has shifted from routine upfront surgery to a risk-adapted strategy prioritizing active surveillance for asymptomatic or stable disease, given high local recurrence rates after resection. Among pharmacologic options, cytotoxic chemotherapy, tyrosine kinase inhibitors, and γ-secretase inhibitors have shown clinical activity, though optimal sequencing and long-term safety require further study. Despite ongoing challenges, multidisciplinary management enhances diagnostic accuracy, treatment selection, and outcomes. Future work should focus on validating prognostic biomarkers, elucidating biological mechanisms of response and resistance, and defining evidence-based algorithms that balance efficacy with safety.

Objective To investigate the effect of skeletal muscle density （SMD） on blood glucose levels during supplemental parenteral nutrition （SPN） after laparoscopic total gastrectomy. Methods We retrospectively analyzed 258 patients who received SPN following laparoscopic total gastrectomy at Baoding No.1 Central Hospital from February 2018 to February 2021. Demographic and clinical data, nutritional and inflammatory markers, SMD, and postoperative blood glucose were collected. Patients were categorized by SMD into SMD-H （high SMD; males ≥38.5 HU, females ≥28.6 HU; n=208） and SMD-L （low SMD; males <38.5 HU, females <28.6 HU; n=50）. Risk factors for hyperglycemia during SPN were assessed by multivariable logistic regression, and postoperative glucose metrics and complication rates were compared between groups. Results Compared with the SMD-H group, the SMD-L group had a significantly higher incidence of hyperglycemia （χ²=8.066, P=0.005） and postoperative complications （χ²=18.391, P<0.001）. Mean （t=3.944, P<0.001）and maximum （t=5.134, P<0.001） venous plasma glucose values during SPN were higher in the SMD-L group, and glucose variability during SPN was greater（t=5.134, P<0.001）. Multivariable analysis identified age >60 years （OR=2.21, P=0.011）, anemia （OR=3.676, P<0.001）, and low SMD （OR=0.343, P=0.004） as independent predictors of hyperglycemia during SPN. Conclusion Low skeletal muscle density is associated with increased risk of hyperglycemia during SPN after laparoscopic total gastrectomy, suggesting that lower SMD may be related to greater insulin resistance.

With advances in hepatobiliary surgery, procedures such as hemihepatectomy, caudate lobectomy, and partial portal vein resection with anastomosis are being performed with increasing frequency. Consequently, intraoperative dissection of the portal vein bifurcation and the left or right portal vein trunks at the hepatic hilum has become increasingly common. The principal technical challenge in this dissection is the safe management of the small, short portal venous branches （short hepatic portal veins） that arise from the portal vein bifurcation or from the left or right trunks. The team led by Prof. Jiang Xiaoqing conducted an anatomical study of these short portal veins and proposed the concept of the "fourth hepatic hilum", which provides a structured framework for this region and has important implications for operations involving it.

Objective To evaluate whether preoperative diffuse reduction of spleen density on computed tomography （CT） predicts overall survival （OS） in patients with intrahepatic cholangiocarcinoma （ICC） undergoing surgical resection. Methods We retrospectively analyzed 106 consecutive ICC patients who underwent curative resection at the Department of Hepatobiliary Surgery, Affiliated Hospital of Qinghai University, from April 2017 to June 2020. Spleen density was measured on CT cross-sectional images for each patient. Receiver operating characteristic （ROC） analysis identified the optimal CT threshold for spleen density; patients were then classified as having diffuse reduction of spleen density （DRSD） or non-DRSD based on that cutoff. Median OS was estimated by the Kaplan-Meier method and compared with the log-rank test. Univariate and multivariate Cox proportional hazards models were used to identify independent predictors of OS. Results The optimal CT cutoff for spleen density predicting survival yielded an area under the curve （AUC） of 0.667 （95% CI： 0.560-0.774）. Using the identified threshold （44.9 HU）, 39 patients （36.8%） were classified as DRSD （CT<44.9 HU）. Baseline characteristics did not differ significantly between DRSD and non-DRSD groups （P> 0.05）. Median OS was 13.5 months （95%CI： 6.5-20.5） in the DRSD group versus 37.0 months （95%CI： 31.5-42.5） in the non-DRSD group （χ²=12.444, P<0.001）. Subgroup analysis by stage showed that DRSD was strongly associated with worse OS in stage Ⅰ-Ⅱ patients： median OS 13.5 months （95%CI： 1.5-26.5） versus 46.6 months （95%CI： 31.5-42.5） in non-DRSD （χ² =19.941, P<0.001）. For stage Ⅲ-Ⅳ patients, median OS was 12.0 months （95%CI： 2.4-21.6） in the DRSD group and 28.0 months （95%CI： 12.3-43.2） in the non-DRSD group, but this difference was not statistically significant （χ²=0.242, P=0.623）. In multivariate Cox analysis, DRSD （HR=2.898, 95%CI： 1.722-4.876, P<0.001）, lymph node metastasis （HR=2.193, 95%CI：1.280-3.756, P=0.004）, and microvascular invasion （HR=4.577, 95%CI： 2.419-8.658, P<0.001） were independent predictors of poorer OS. Conclusions Preoperative diffuse reduction of spleen density on CT is an independent predictor of worse overall survival in patients with stage Ⅰ-Ⅱ intrahepatic cholangiocarcinoma undergoing surgical resection. CT-based measurement of spleen density may provide a simple, noninvasive imaging biomarker to aid prognostic stratification in ICC.

The conversion therapy is an important strategy to provide surgical opportunities for patients with unresectable hepatocellular carcinoma at the initial stage. With the advancement of combination therapy， some patients can achieve radiographic complete response（rCR） or even pathological complete response（pCR）. Whether surgical resection is still necessary at this time point has become a difficult part in clinical decision-making. Based on existing evidence-based research， this article suggested that surgical decision-making should be based on multidimensional evaluation： tumor biological behavior， liver function tolerance， and anatomical feasibility assessment. For high-risk patients with recurrence or progression（e. g. ，high tumor burden， pathological evidence of residual activity， circulating tumor DNA［ctDNA］ positivity）， an active surgery can bring survival benefits. For low-risk patients （e. g. ，rCR with continuous negative ctDNA and normal tumor markers）， close observation and follow-up may be a reasonable choice. The final decision should follow the principle of individualization and be made within the framework of a multidisciplinary team（ MDT）.

正中弓状韧带综合征发病率低,症状体征不明显,主要表现为餐后腹痛、体重下降和上腹部压痛。诊断主要是排除性诊断,超声、CT血管造影、磁共振血管成像、数字减影血管造影等影像学检查对诊断有帮助。正中弓状韧带松解术或联合腹腔神经节切除术是治疗该病的主要术式。此文报道1例正中弓状韧带综合征诊治流程,并复习相关文献,旨在为临床医师诊治提供帮助。

Objective To evaluate the expression of recombination signal binding protein for immunoglobulin kappa J region （RBPJ） and tripartite motif protein 25 （TRIM25） in colorectal cancer （CRC） and to assess their diagnostic value. Methods We prospectively selected 112 CRC patients who underwent surgical resection at the No.2 Hospital of Baoding between June 2021 and June 2023. Tumor and matched adjacent non-tumor tissues were collected intraoperatively. Fifty healthy adults who underwent routine physical examinations during the same period served as the healthy control group for serum analyses. Tissue expression of RBPJ and TRIM25 was assessed by immunohistochemistry. Associations between marker expression and clinicopathological features were examined, and correlations between the two markers were evaluated using Spearman's rank correlation. Receiver operating characteristic （ROC） curve analysis was performed to assess the diagnostic performance of serum RBPJ and TRIM25 levels individually and in combination. Results The positive expression rates of RBPJ and TRIM25 in CRC tissues （70.54% and 68.75%, respectively） were significantly higher than those in adjacent tissues （27.68% and 33.04%; P<0.05）. Spearman's rank correlation analysis showed that the RBPJ and TRIM25 expression levels in tumor tissues were positively correlated （r=0.663, P<0.05）. Higher expression of both markers was significantly associated with advanced TNM stage, lymph node metastasis, and greater depth of invasion （all P<0.05）. Serum levels of RBPJ and TRIM25 were significantly higher in CRC patients than in healthy controls （both P<0.05）. For the diagnosis of CRC, the areas under the ROC curve （AUCs） for serum RBPJ and TRIM25 were 0.878 and 0.708, with sensitivities of 75.89% and 91.96% and specificities of 92.00% and 54.00%, respectively. The combined use of both markers yielded an AUC of 0.930, with 77.68% sensitivity and 96.00% specificity. Conclusion RBPJ and TRIM25 are overexpressed in CRC tissues and correlate with adverse clinicopathological features. Elevated serum levels of these markers—especially when combined—show promise for the diagnostic evaluation of CRC.

Objective To investigate the role of systemic immune inflammation index （SII） and C-reactive protein/albumin ratio（CRP/ALB） in evaluating the progression of acute pancreatitis. Methods The clinical data of 166 patients with acute pancreatitis admitted to the Dongnan Hospital of Xiamen University from January 2020 to December 2021 were retrospectively analyzed. Patients were divided into progressive group（n=41） and non-progressive group（n=125） based on whether they were diagnosed with progression of severe acute pancreatitis upon admission.The correlation of SII and CRP/ALB with the Acute Physiologic Assessment and Chronic Health Evaluation Ⅱ（APACHE Ⅱ） score, modified Marshall score, modified CT severity index（MCTSI） score, CRP, blood urea nitrogen （BUN）, blood calcium, serum calcium,creatinine （Cr） and procalcitonin （PCT） was analyzed.Univariate and multivariate analyses were performed to identify to influencing factors in patients of progression group.Receiver operating characteristic（ROC） curve were plotted to evaluate the predictive performance of SII,and CRP/ALB for severe acute pancreatitis. Results There were no significant differences in general data between the two groups（all P>; 0.05）.SII and CRP/ALB significantly increased in patients with APACHE Ⅱ score ≥; 8,modified Marshall score ≥; 2 and MCTSI score ≥; 4 （P<; 0.05）. SII was positively correlated with CRP,BUN,Cr and PCT（r=0.784,0.736,0.714 and 0.773,respectively; all P<; 0.05）.CRP/ALB was positively correlated with CRP, BUN, Cr and PCT（r=0.856,0.775,0.737 and 0.790,respectively;all P<; 0.05）. CRP（OR=13.144,95%CI 2.653-22.365）, PCT（OR=38.206,95%CI 2.436-57.364）,SII （OR=14.673,95%CI 1.536-24.364）,CRP/ALB（OR=11.257,95%CI 2.042-20.536） and APACHE Ⅱ scores（OR=16.232,95%CI 1.464-28.362） were independent influencing factors of disease progression（all P<; 0.05）. Conclusions Increased SII and CRP/ALB are correlated with the severity of pancreatitis,which can predict the progression of the disease and has certain clinical application value.

Hepatocellular carcinoma（HCC） is a globally prevalent malignancy with a high mortality rate.Curative resection remains the cornerstone for achieving the long-term survival of HCC. However,the majority of HCC patients are diagnosed at an advanced stage that lose the opportunity for surgery.With the development of targeted therapies, immune checkpoint inhibitors, and locoregional treatments, some patients with initially unresectable HCC can now achieve oncological downstaging through combination therapy,thereby becoming eligible for curative surgery and gaining long-term survival benefits.Nevertheless,oncological conversion for HCC is in its developmental stage,and a comprehensive, standardized system for its assessment and treatment has yet to be established. Numerous issues closely related to clinical practice remain to be addressed.This article aims to systematically review the current status of conversion therapy in HCC, focusing on target populations, efficacy evaluation,and key challenges, and to explore several core issues in depth.

骶前囊肿是位于骶尾骨与直肠之间的囊性或囊实性肿块,与骶尾骨筋膜、直肠及肛门括约肌等盆底组织关系密切,多数为良性疾病。骶前囊肿早期一般无任何症状,当囊肿逐渐增大压迫周围邻近脏器或组织时出现相应压迫症状,直肠指检易发现,确诊需行超声、CT、磁共振成像等影像学检查,经充分评估后确定手术方案及手术入路,术中主动减压使囊肿体积变小有助于囊肿暴露和完全切除。该文报告1例经腹入路骶前囊肿切除术的诊治经过,为类似病人诊治提供临床参考。

Objective To investigate the clinical effect of using different surgical approaches to place mesh in the treatment of lumbar hernia. Methods The clinical data of 7 patients with lumbar hernia who were admitted in the 901th Hospital, PLA from May 2015 to September 2023 and treated by mesh repair were retrospectively analyzed, and the efficacy of different surgical methods was observed. Results All the 7 patients completed operation successfully, including 2 cases of open operation,2 cases of laparoscopic transabdominal approach,and 3 cases of laparoscopic complete extraperitoneal approach. The operation time ranged from 40 min to 170 minutes. The visual analogue scale（VAS） score was 2-4 points at 24 h postoperatively, and 1-3 points at 48 h postoperatively. The postoperative hospital stay ranged from 1 day to 6 days, with 3 patients who underwent the laparoscopic complete extraperitoneal approach staying for 1 to 2 days. The average hospitalization cost was 23 442 Yuan, and the average cost for patients undergoing the laparoscopic complete extraperitoneal approach was 14,156 Yuan. No complications such as incision infection and effusion in the operation area were reported. The follow-up time ranged from 12 months to 84 months.All patients with postoperative pain relieved within 3 months, and there was no recurrence during the follow-up period. Conclusion Mesh repair is an effective surgical method for the treatment of lumbar hernia. Complete extraperitoneal approach by laparoscopy has the advantages of minimal invasiveness and quick postoperative recovery. It should be promoted in appropriate patients.

Biliary tract cancers（BTC） are a group of malignancies originating from the biliary system, including intrahepatic cholangiocarcinomas（ICC）, extrahepatic cholangiocarcinomas（ECC）, and gallbladder carcinomas（GBC）. Due to their insidious onset, most BTC patients are diagnosed at an advanced stage and have lost the opportunity for curative surgical resection. Patients with advanced BTC have a poor prognosis, and the efficacy of traditional chemotherapy regimens is limited. In recent years, with the deepening understanding of tumor biological characteristics and the continuous development of clinical research, a variety of new therapeutic drugs and combined treatment regimens have emerged, bringing new hope for the treatment of advanced BTC.This article aims to review the research progress of chemotherapy combined with immunotherapy/targeted therapy for advanced BTC, in order to provide references for clinical practice.

Objective To compare the efficacy and safety of delayed coloanal anastomosis （DCA） versus immediate coloanal anastomosis （ICA） with temporary ostomy following surgery for low rectal cancer （LRC）, thus providing valuable references for clinical surgical decision-making. Methods Articles reporting LRC surgery by DCA and ICA in English and Chinese language published from October 2013 to October 2023 were searched in the databases such as PubMed, Elsevier, Cochrane Library, CNKI, and Wanfang.The Revman 5.4 software was used to assess the quality of included literatures, and forest plots were created for meta-analysis of the corresponding observed indicators. Funnel plots were used to assess publication bias. Results A total of 15 studies（n=1 503） were included, with 937 cases in the ICA group and 566 cases in the DCA group. Compared to ICA with temporary prophylactic ostomy, patients undergoing DCA had a significantly lower incidence of overall postoperative complications（OR=0.63, 95%CI：0.41-0.96, P=0.03） and anastomotic leaks（OR=0.37, 95% CI：0.23-0.58, P<; 0.001）.No significant differences were found between DCA and ICA in terms of local tumor recurrence（OR=0.94, 95%CI：0.41-2.16, P=0.89）, distant tumor metastasis（OR=0.86, 95%CI：0.38-1.94, P=0.72）, postoperative anastomotic stenosis（OR=0.74, 95%CI： 0.19-2.80, P=0.65）, postoperative anastomotic bleeding（OR=0.35, 95% CI：0.07-1.70, P=0.19）, postoperative pelvic infection（OR=0.64, 95%CI：0.35-1.18, P=0.15）, postoperative sepsis（OR=1.30, 95%CI：0.36-4.72, P=0.69）, postoperative intestinal obstruction （OR=0.72, 95%CI：0.15-3.35, P=0.67）, postoperative dysuria （OR=0.63, 95%CI：0.25-1.56, P=0.32）, and postoperative pulmonary infection （OR=1.46, 95%CI： 0.33-6.56, P=0.62）. Conclusion DCA is associated with a lower incidence of overall complications and anastomotic leaks, but the rates of local tumor recurrence, distant tumor metastasis, and postoperative anastomotic stenosis, anastomotic bleeding, pelvic infection, sepsis, intestinal obstruction, dysuria, and pulmonary infection are similar to those of ICA.Therefore, DCA appears to be safe and feasible, and may serve as a safe alternative to ICA.However, further validation is required through more high-quality randomized controlled trials.

Objective To investigate the correlation of the changing rate of forkhead box transcription factor P1（FOXP1） and epithelial cell adhesion molecule （EpCAM） with the decreasing rate of tumor markers in patients with intrahepatic cholangiocarcinoma （ICC） after surgery, as well as their early warning role in disease progression in the early postoperative period. Methods This was a prospective study involving 209 patients who were diagnosed with ICC and underwent surgical resection in Handan First Hospital from January 2022 to February 2024 as the research subjects. Patients were divided into the progression group and non-progression group based on the postoperative progression.The changes in FOXP1,EpCAM, carbohydrate antigen （CA） 19-9,carcinoembryonic antigen （CEA）,and CA242 before and after surgery were compared between the two groups. Pearson correlation was used to analyze the correlation of the changing rate of FOXP1 and EpCAM after surgery with the decreasing rate of tumor markers. Variables were screened by multicollinearity. Multivariate logistic regression was used to analyze the impact of changing rates of FOXP1 and EpCAM and the decreasing rate of tumor markers on early postoperative progression of ICC.The receiver operating characteristic （ROC） curve was used to analyze the value of changing rates of FOXP1 and EpCAM and the decreasing rate of tumor markers in predicting the early postoperative progression of ICC. A nomogram was constructed for early warning of the risk of early postoperative progression of ICC, and the predictive performance of the nomogram was tested. Results During the follow-up period, 5 cases were lost, and 204 cases were finally included in the study. Among them, 91 cases were included in the progression group and 113 cases were included in the non-progression group.FOXP1 at 1 month postoperatively was significantly elevated, and postoperative EpCAM,CA19-9, CEA and CA242 were significantly reduced than pre-surgical levels （all P<; 0.05）.FOXP1 level at 1 month postoperatively was significantly lower, and postoperative levels of EpCAM, CA19-9, CEA and CA242 were significantly higher in the progression group than the non-progression group （all P<; 0.05）.Changing rates of FOXP1 and EpCAM, and the decreasing rates of CA19-9,CEA and CA242 were significantly lower in the progression group than the non-progression group （all P<; 0.05）. Pearson correlation analysis revealed that the changing rates of FOXP1 and EpCAM were positively correlated with the decreasing rates of CA19-9（r=0.816 and 0.772, respectively）,CEA（r=0.763 and 0.854, respectively） and CA242（r=0.795 and 0.806, respectively）（all P<; 0.05）.Logistic regression showed that the changing rates of FOXP1 and EpCAM, and decreasing rates of CA19-9, CEA and CA242 were independent influencing factors for postoperative early progression of ICC （all P<; 0.05）. The area under the curve （AUC） of the changing rates of FOXP1 and EpCAM, and decreasing rates of CA19-9,CEA and CA242 in predicting the postoperative early progression of ICC was 0.747,0.769,0.761,0.751 and 0.789,respectively（P<; 0.001）. Based on the above five indicators, a nomogram was constructed with a C-index of 0.897. The AUC of the nomogram in predicting the postoperative early progression of ICC was 0.897 （95% CI 0.854, 0.939）,which was significantly greater than that of changing rates of FOXP1 and EpCAM, and decreasing rates of CA19-9,CEA and CA242（P<; 0.05）.The prediction results were in good agreement with the actual results, and there was a significant positive clinical net benefit. Conclusions Changing rates of FOXP1 and EpCAM after surgery for ICC are positively correlated with the decreasing rates of CA19-9, CEA and CA242.They are independent risk factors for the postoperative early progression.A nomogram created based these variables has good predictive performance and positive clinical net benefit for early postoperative progression of ICC, and can be used as an effective model for clinical prediction of early postoperative disease progression and to guide clinical decision-making.

Objective To evaluate the effect of vascular skeletonization anatomy in Kasai surgery for type Ⅲ biliary atresia （BA） patients. Methods Clinical data of 140 BA patients admitted to Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, from January 2020 to December 2024 were retrospectively analyzed. The data included patient gender, age at surgery, weight, surgery time, hepatic portal dissection time, intraoperative blood loss, and postoperative complication rates. From January 2020 to December 2021, 55 patients underwent conventional Kasai surgery（C-K group） From January 2022 to December 2024,85 patients underwent Kasai surgery with vascular skeletonization（VS-K group）. Results There were no significant differences in gender, operative age, weight,portal vein dissection time,and blood loss between the C-K group and the VS-K group（all P>; 0.05）.All patients underwent complete removal of the extrahepatic bile duct and hepatic fibrous plate, with no short-term postoperative complications like bleeding or bile leakage.Compared to the C-K group, patients in the VS-K group had significantly longer operation duration（192±; 19 min vs.133±; 22 min,P=0.032）and lower jaundice clearance rate at 6 months of surgery（34.5% vs.52.9%,P=0.033）. Conclusion Vascular skeletonization anatomy in Kasai surgery for BA patients can improve surgical safety while completely removing the hepatic fibrous plate and shortening surgery time.

Objective To summarize the unique clinical presentation of Meckel's diverticulum （MD） in pediatric patients in the Tibetan Plateau, and to evaluate the safety and efficacy of laparoscopic-assisted surgical management. Methods Clinical data of 33 children with MD admitted to Lhasa People's Hospital from September 2021 to October 2024 were retrospectively analyzed, including clinical manifestations, diagnostic methods, surgical approaches, perioperative indicators, and follow-up data. Among them, there were 17 males and 16 females, with an average age of 4.8±; 4.1 years. Results Clinical symptoms of MD in children mainly included hematochezia（36.3%,12/33）,intestinal obstruction （27.3%,9/33）,and peritonitis（27.3%,9/33）.Preoperative diagnosis rate by ultrasound was 50.0%（14/28）.Five （15.2%） were misdiagnosed as perforated appendicitis. Laparoscopic-assisted small-incision resection was successfully completed in 30（90.9%） cases, while 3 required open conversion due to severe adhesions.The mean operative time was 1.6±; 0.5 hours, and 14.9±; 8.4 mL of blood loss was quantified. Postoperative hospitalization averaged 12.0±; 3.4 days. Follow-up was completed for all patients, spanning 5-43 months. Complications included 5 cases of ascites （15.2%） and 2 cases of intestinal obstruction （6.1%）. No mortality occurred. Conclusion Pediatric MD in the Tibetan Plateau demonstrates high complication rates and diagnostic challenges. Laparoscopic-assisted small-incision surgery is a safe, effective first-line intervention for this population.

此文回顾性分析了1例51岁男性罕见特大肝血管瘤病人的临床特点及治疗过程。该例病人入院完善CT三维重建检查后行肝S1、S2、S3、S4、S5和部分S6段切除+胆囊切除术+肝S7段血管瘤硬化剂注射治疗,术后未出现并发症,恢复良好,于术后第8天出院。术后3个月复查肝脏CT未见复发。此类病人罕见,手术难度大,术后并发症凶险,术前需充分评估病人全身状态、肿瘤位置及与肝内血管及胆管的解剖关系,准确评估剩余肝脏体积及肝脏储备功能是手术成功的关键。

Objective To investigate the clinical features, diagnosis and treatment methods and prognosis of hepatic hemolymphangioma. Methods A case of hepatic hemolymphangioma in Xiantao First People's Hospital was analyzed. Clinical symptoms, imaging examination, treatment and prognosis of the patient in our hospital plus 5 cases reported in domestic and foreign literature were reviewed and summarized. Results A 58-year-old male admitted due to intermittent distending pain and discomfort in the upper abdomen for more than 6 months. The computed tomography（CT） scan of the upper abdomen showed a space-occupying lesion in the left lobe of the liver, mostly considered as a cystadenoma, but cystadenocarcinoma was not excluded. He underwent left hemihepatectomy. The postoperative pathology showed a large number of lymphatic vessels and blood vessels,suggesting a hepatic hemolymphangioma. There was no recurrence during the six-month follow-up.Literature review of 5 cases and this case,totaling 6 cases, was summarized.There were 4 males and 2 females, with a male-to-female ratio of 2∶; 1. The oldest was 60 years old, the youngest was 6 months old, with a median age of 32 years. Abdominal pain, masses, and distension were the main manifestations, partly due to the huge mass compression of the gastrointestinal tract leading to nausea and discomfort, accompanied by loss of appetite. One patient presented with severe anemia, and most patients showed a large mass in the right upper abdomen with tenderness on physical examination, which was medium in texture and could not be pushed. Laboratory examinations were summarized. Two patients had slightly low albumin, and grade A Child-pugh score of liver function. One patient had severe anemia, with hemoglobin levels of 65 g/L. In all patients, the alpha-fetoprotein （AFP） was normal. carcinoembryonic antigen（CEA） and cancer antigen 125（CA125） were slightly elevated in 2 patients, and CA19-9 was slightly elevated in 1 patient. Imaging examination showed that all patients in this group underwent abdominal contrast-enhanced CT or magnetic resonance imaging （MRI） before surgery. Five patients had the masses located in the right lobe of liver, and one had the mass located in the left lobe of liver. Abdominal CT examination showed mostly multilocular cystic low-density shadows with internal separation and slight enhancement of the cyst wall, and the enhancement in the venous phase and delayed phase was more obvious than that in the arterial phase.Abdominal MRI showed that the tumor was in the mixture of cystic-solid component, and the signal of cystic component of the lesion was mainly low on T1-weighted images（T1WI）, and high on T2-weighted images（T2WI）. Sometimes they appeared as liquid-liquid flat. Treatment and prognosis showed that three patients underwent right hemihepatectomy, two underwent partial hepatectomy, and one underwent left hemihepatectomy. The postoperative pathological report was hepatic hemolymphangioma. No special treatment was given after surgery, and no signs of recurrence were found during follow-up. Conclusion Hepatic hemolymphangioma is a rare benign tumor of liver.Preoperative diagnosis of hepatic hemolymphangioma can be made according to the history, signs and auxiliary examination. Improving the understanding of this disease can guide the correct diagnosis and treatment,and improve the coincidence rate of disease diagnosis.

Cholangiocarcinoma（CCA）, a highly aggressive malignancy arising from biliary epithelium, is characterized by insidious clinical presentation and poor therapeutic outcomes. The tumor's limited responsiveness to current treatments is tightly linked to its distinctive immune microenvironment. Within CCA tumors, diverse tumor‑associated cells produce an array of immunomodulatory factors and interact through complex networks to facilitate immune escape and drive tumor progression and invasion. Although immunotherapy has transformed oncology, immune checkpoint inhibitor monotherapy yields modest results in CCA; greater clinical benefit has been observed with rational combinations of ICIs with chemotherapy or targeted agents. Emerging approaches, such as chimeric antigen receptor （CAR）‑T cell therapy and tumor vaccines, also show early promise. Because of the complexity and context‑dependence of the CCA immune milieu, future research must prioritize detailed characterization of the microenvironment, identification and validation of novel immunotherapeutic targets, and the development of biomarker‑driven, personalized combination strategies to improve patient outcomes. This review outlines the key features of the CCA immune microenvironment, examines its implications for immunotherapy, and surveys emerging therapeutic directions.

Biliary tract cancer（BTC）, which encompasses intrahepatic cholangiocarcinoma, extrahepatic cholangiocarcinoma, and gallbladder cancer, is a biologically heterogeneous, highly invasive malignancy with generally poor outcomes.Although immune checkpoint inhibitors and other immunotherapies have revolutionized treatment for many solid tumors, responses in BTC are highly variable and overall response rates remain modest.This discrepancy is largely attributed to the complex and diverse tumor immune microenvironment（TIME） in BTC. The BTC TIME is a dynamic, interactive network formed by malignant cells, multiple immune cell populations, stromal elements, the vascular network, and a milieu of cytokines and chemokines. Its composition and functional state are shaped by multiple, interdependent factors, including tumor anatomical origin, molecular and genetic subtype, underlying etiology, host immune status, and prior therapies, leading to pronounced intra-and inter-tumoral heterogeneity. Here, we systematically review current knowledge on BTC TIME heterogeneity, dissecting its manifestations across cellular composition, spatial organization, molecular signatures, and functional phenotypes; we discuss how this heterogeneity influences tumor progression, clinical prognosis, and differential responses to immunotherapy; and we consider pathways to translate basic discoveries into clinically actionable strategies to provide a theoretical rationale and actionable translational pathways to enhance the efficacy of immunotherapy for BTC.

Biliary tract cancer（BTC） remains a formidable clinical problem due to its aggressive biology, low rates of curative resection, high recurrence, and poor prognosis. Chemotherapy combined with immunotherapy has emerged as a cornerstone for patients with advanced or initially unresectable BTC. Immune checkpoint inhibitors（ICIs） have produced important breakthroughs in advanced disease, and their application in the perioperative setting, including neoadjuvant and adjuvant approaches, and in conversion（downstaging） therapy is increasingly the focus of investigation.This review synthesizes evidence on： the unmet needs in perioperative BTC management; immunotherapy mechanisms relevant to the perioperative context; neoadjuvant and adjuvant immunotherapeutic strategies; immunotherapy-driven conversion regimens; predictive biomarkers of response; and future research directions. Preliminary data suggest that neoadjuvant immunotherapy combined with chemotherapy may raise complete/pathologic complete response rates and lower recurrence risk among initially resectable patients, although confirmation in high-level randomized trials is needed. In the conversion setting,intensified regimens（triplet or four‑drug combinations incorporating ICIs） can render some initially unresectable tumors operable and appear to markedly improve survival.As phase Ⅲ trial results emerge, novel biomarkers are validated,and combination strategies are optimized, perioperative chemotherapy plus immunotherapy is expected to further enhance long-term outcomes in BTC.

Hirschsprung's disease（HD）, or congenital megacolon, is a relatively common congenital malformation of the gastrointestinal tract.The condition, characterized by severe constipation,abdominal pain, and complications such as necrotizing enterocolitis, causes substantial morbidity for affected children and distress for their families.Because early surgical intervention is the treatment of choice, timely diagnosis and accurate identification of the diseased（aganglionic） bowel segment are critical.Rapid advances in artificial intelligence, medical imaging, and related technologies have produced a variety of novel diagnostic approaches for HD with promising performance. This review systematically summarizes the application of machine learning to HD diagnosis across multiple data modalities, including histopathology from rectal biopsy, body‑fluid biomarkers, imaging data, and intraoperative signals, and examines emerging methods for intraoperative identification of aganglionic segments, aiming to inform future research priorities and support translation of machine‑learning tools into clinical practice.

Objective To characterize the clinicopathological features of malignant tumors in family members with Lynch syndrome（LS）. Methods Malignant cancer occurrence within a single LS pedigree（14 affected individuals in four generations） were retrospectively analyzed. Six patients were treated in the Colorectal Tumor Center, the Affiliated Hospital of Guizhou Medical University, and the remaining cases were treated in other medical institutions. Family history was systematically collected to construct the intrafamilial malignancy distribution across four generations. Continuous variables that did not meet normality assumptions were summarized as median （Q₁,Q₃）. Results Among the 14 affected individuals （male-to-female ratio,1∶1）, age at onset declined markedly across generations by 45.3 years （generation Ⅱ：69.0 years; generation Ⅲ：23.7 years）. Colorectal cancer was the predominant type of malignant tumors（8/14）, and the proportion of multiple primary cancers was unusually high（5/14）.Of the six patients treated in our center,five exhibited a microsatellite instability-high（MSI-H） phenotype, strongly supporting germline mismatch repair （MMR） gene mutations. Together with LS-spectrum tumors such as endometrial carcinoma （n=2） and glioma, the family members fulfilled the Amsterdam II criteria and exceeded the molecular testing threshold of the Bethesda guidelines. Survival was significantly longer for colorectal cancer than for extracolonic tumors （102.0[36.3,141.0] months vs 12.00[9.80,13.50] months,P<0.001）. Extracolonic tumors showed a higher case-fatality rate （4 deaths among 6 patients）, indicating heterogeneous progression risks among MMR-deficient malignancies. Conclusion This LS pedigree shows a high frequency of multiple primary cancers, a characteristic tumor spectrum, and a trend toward earlier onset across generations.With successive generations, age at onset decreased and the proportion of multiple primaries increased. Overall, the family was characterized by MSI-H. Notably,colorectal cancer outcomes were significantly better than those of extracolonic tumors, which may relate to improved health awareness, regular surveillance,and earlier diagnosis and treatment.The elevated incidence of multiple primaries highlights the need for strengthened dynamic management of high-risk family members.

Immune checkpoint inhibitors（ICIs） have reshaped the therapeutic landscape of biliary tract cancer（BTC）, yet both primary and acquired resistance substantially limit their clinical impact.These resistance phenomena reduce overall response rates and restrict the population of BTC patients who can derive durable benefit. Understanding the multifactorial mechanisms underlying immunotherapy failure is therefore a pressing clinical and scientific priority.This article systematically summarizes the multi‑level causes of immunotherapy resistance in BTC and discusses corresponding countermeasures, and proposes integrated directions for future research to provide a theoretical basis and ideas for developing precise and effective combination treatment regimens.

Biliary tract cancer（BTC） is characterized by insidious onset and high invasiveness, with most patients diagnosed at an advanced stage, thereby losing the opportunity for curative resection. The distinct biological features of BTC significantly contribute to the limited efficacy of targeted and immunotherapeutic approaches. Enhancing early diagnosis and treatment rates, as well as improving R0 resection rates, represents a critical strategy to overcome current therapeutic challenges. With advancing research into tumor biology and resistance mechanisms, future efforts should focus on harnessing the synergistic effects of targeted therapy,immunotherapy,and chemotherapy.This will facilitate the development of combined regimens with more precise patient selection,improved efficacy, and reduced toxicity, ultimately leading to better long-term survival outcomes for patients with biliary tract malignancies.

Objective To explore the feasibility of day-care laparoscopic appendectomy in college students with acute appendicitis and to develop a nomogram to predict the probability of achieving this model. Methods A prospective cohort study design was adopted, and 82 college students with acute appendicitis admitted from December 2023 to December 2024 were included. All patients underwent laparoscopic appendectomy and integrated traditional Chinese and Western medicine management of enhanced recovery after surgery （ERAS）. They were grouped according to the achievement of the day surgery model. Independent predictors were screened by multivariate logistic regression, and a nomogram was constructed and validated through a triple validation （discrimination-calibration-clinical utility）. Results Among the 82 patients, 46 （56.0%） cases achieved the day surgery model. The hospital stay was 41.37±6.33 hours, and no serious complications were observed during the 30-day postoperative follow-up. The independent influencing factors for achieving this model were C-reactive protein≤13.9 mg/L （OR=1.100, 95% CI：1.005-1.204, P<0.05）, abdominal pain duration≤22 hours （OR=1.160, 95% CI：1.022-1.316, P<0.05）, appendiceal diameter≤10 mm （OR=13.683, 95% CI：1.671-112.073, P<0.05）, no drainage tube placement （OR=6.058,95%CI：1.066-34.428, P<0.05）, and postoperative visual analogue scale （VAS） score≤2.5 points （OR=10.493,95%CI：2.696-40.835, P<0.05）. Based on the logistic regression analysis, these five independent predictive factors were selected to construct a nomogram. The area under the curve （AUC） of this nomogram was 0.905 （95% CI：0.845-0.966）. The calibration curve showed high consistency, and the decision curve confirmed significant clinical net benefit. Conclusion The day-care laparoscopic appendectomy model is safe and feasible for college students. The created nomogram has good predictive ability and can assist in early identification of eligible patients and timely intervention to improve the achievement rate of this model.

Advances in systemic and multimodal therapies have materially improved outcomes for primary liver cancer. Consequently, clinicians are increasingly challenged to define the appropriate role and timing of surgical resection within whole‑course management so as to maximize survival benefit. Certain adverse oncologic features, including multifocal disease, tumor thrombus involving hepatic or portal veins or the bile duct, markedly elevated serum tumor markers, positive circulating tumor biomarkers （for example, circulating tumor cells or circulating tumor DNA）, or tumors immediately adjacent to essential hepatic structures to be preserved, are associated with aggressive biology and a high risk of recurrence. When such features coexist with lesions that are technically resectable or can be rendered resectable through conversion （downstaging） therapy, the central clinical question is whether immediate aggressive resection （or aggressive resection following successful conversion） will reliably yield superior survival outcomes. This question remains contested. Based on the author's clinical experience, this paper outlines a structured approach to clinical reasoning for individualized surgical decisions： it analyzes the oncologic principles and the surgical trade‑offs that drive the controversy and proposes a decision‑making framework adaptable to different clinical contexts. The goal is to support precision, patient‑tailored surgical strategies that appropriately balance technical feasibility, oncologic benefit, and overall patient outcome.