As the ideal window for surgical intervention in necrotizing enterocolitis （NEC） lies between the onset of intestinal gangrene and perforation, an accurate assessment of bowel injury severity and timely surgical intervention are critical for improving outcomes. Portal venous gas（PVG） is a significant marker of advanced NEC, particularly in extremely low birth weight（ELBW） infants, where its presence correlates with a markedly increased risk of extensive intestinal necrosis（> 75%-80% bowel involvement）. Pneumatosis intestinalis（PI） is commonly associated with NEC. Besides, linear PI may indicate a benign course, whereas cystic PI with fixed bowel loops raises suspicion for necrosis. Notably, the extent of PI does not directly correlate with bowel injury severity. Fixed bowel loops（FBL）,identified on serial radiographs, are associated with higher surgical and mortality rates, necessitating close clinical and imaging monitoring. Ascites, particularly complex ascites with debris on ultrasound, may be the sole sign of perforation. Most of scoring systems for assessing surgical indications for NEC have not been widely adopted. It is essential for further developing precise, dynamic risk assessment models, thus achieving the goal of transforming the experience-driven decision mode to data-driven mode.

Pancreatic cancer is a highly aggressive malignancy of the digestive system. Over 80% of patients are diagnosed at an advanced stage. The majority of pancreatic cancer patients progresses to cancer cachexia, characterized by uncontrolled weight loss, muscle wasting, and a systemic inflammatory response. To date, effective therapeutic strategies for managing cancer cachexia are scant.This article aims to provide an in-depth review of the latest research advancements both domestically and internationally, systematically elucidate the pathophysiological mechanisms and etiology of pancreatic cancer-associated cachexia.

Objective To investigate the clinical characteristics， diagnostic methods， and treatment strategies for liver abscess complicating laparoscopic appendectomy in children. Methods A rare case of a boy at 6 years and 11 months with liver abscess following laparoscopic appendectomy for acute appendicitis was reported. The child was admitted to the Affiliated Children's Hospital of Xi'an Jiaotong University on August 6， 2024， presenting with fever for 4 days， and 26 days after laparoscopic appendectomy for acute appendicitis. Initial blood tests revealed a leukocyte count of 15.07×10⁹/L.Color Doppler ultrasound and CT confirmed a right hepatic lobe abscess. A literature review was conducted by searching key words of "acute appendicitis" "appendectomy" "liver/hepatic abscess" and "children" in both Chinese and English languages in the PubMed， Medline， Springer Link， The Cochrane Library， Wanfang， and CNKI databases. Articles published up to December 2024 were included for analysis， and the related cases were analyzed and summarized. Results The patient underwent ultrasound-guided percutaneous catheter drainage， anti-infective therapy， and oral traditional Chinese medicine.The liver abscess significantly resolved， and the child was discharged after 16 days of hospitalization， without a recurrence during a 3-month follow-up. Including this case， 8 pediatric cases were reviewed. In details，comprising 4 males and 4 females aged 5 to 14 years.Seven patients underwent laparoscopic appendectomy while one had open appendectomy；three cases involved gangrenous appendicitis and five involved perforated suppurative appendicitis. Diagnosis occurred between 1 week and 4 months post-appendectomy， with the primary clinical manifestations being fever and abdominal pain emerging 1 to 4 weeks after surgery， confirmed by color Doppler ultrasound or abdominal CT. In terms of treatment，4 received ultrasound-guided percutaneous drainage combined with antibiotics，2 received antibiotics alone，1 underwent anti-infective therapy + abscess drainage + exploratory laparotomy， and 1 underwent laparoscopic stone removal + drainage + antibiotics. Length of hospital stay ranged from 8-49 days， with all cases achieving a full recovery. Conclusion Postoperative liver abscess is a rare complication of acute appendicitis in children. Early ultrasound-guided percutaneous drainage combined with antibiotic therapy yields favorable outcomes.

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.

Hepatoblastomas（HB） are usually found in a large size. Due to the immature, vulnerable tissues in children, a precise anatomy is particularly important that increases the surgical challenges. In recent years, artificial intelligence （AI） has played an important role in preoperative planning and intraoperative navigation of HB surgery. This article reviewed the development status of intelligent planning and surgical navigation of HB surgery, mainly including the following aspects： （1）AI-guidedsurgical planning： three-dimensional reconstruction and virtual simulation of medical images, and optimization of AI-driven resection path; （2）Surgery planning： Augmented reality （AR） navigation, intraoperative multimodal real-time navigation fusion and intelligent navigation of robotic surgery; （3）AI-guidedsurgical planning and navigation of HB in special sites： HB in the second hepatic portal and in the caudate lobe of the liver were mainly discussed.

Objective To observe the efficiency of ultrasound-guided percutaneous transhepatic gallbladder drainage（PTGBD） and laparoscopic cholecystectomy（LC） in patients with moderate-level acute moderate cholecystitis. Methods Clinical data of patients with moderate-level acute cholecystitis in the Qingdao Municipal Hospital from March 2021 to December 2023 were retrospectively analyzed. According to the different treatment methods, they were divided into the LC group（LC treatment） and PTGBD+LC group （LC treatment after PTGBD）.The propensity score matching （PSM） at 1∶ 1 matching was performed with a caliper of 0.01,and 65 cases were included in each group. The surgical indicators, incidence rates of complications, liver function indicators （alkaline phosphatase [ALP], indirect bilirubin [IBIL], direct bilirubin [DBIL]）, serum inflammatory factors（tumor necrosis factor-α[TNF-α],C-reactive protein [CRP], interleukin-6[IL-6]） and 30-day mortality before and after treatment were compared between groups. Results In comparison to LC group,the intraoperative blood loss （31.13± 7.95 mL vs.44.86± 9.63 mL）,surgical time（62.47± 11.13 min vs.81.32± 10.52 min）,rate of intraoperative drainage （80.00% [52/65] vs.98.46%[64/65]）,and rate of LC conversion to laparotomy（0 vs.9.23% [6/65]） were significantly lower in the PTGBD+LC group （all P< 0.05）.The incidence of surgical complications in the PTGBD+LC group was significantly lower than that of the LC group （4.62%[3/65] vs.15.38%[10/65],P< 0.05）.Compared with preoperative values,ALP,IBIL,DBIL,CRP,and IL-6 at 72 h postoperatively were significantly reduced in both groups （all P< 0.05）. The above liver function indexes and serum inflammatory factors in the PTGBD+LC group at 72 h postoperatively were significantly lower than those of the LC group （all P< 0.05）. There was no significant difference in the 30-day mortality rate between the two groups（P> 0.05）.No cholecystitis recurred during the follow-up period. No significant difference in the 36-Item Short Form Health Survey （SF-36） score was found between groups （P> 0.05）. Conclusion PTGBD combined with LC can reduce intraoperative bleeding and shorten operation time, promote the postoperative recovery of AC patients, quickly relieve the inflammatory state, and improve the liver function. It has few surgical related complications, good therapeutic effect and important clinical application value.

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.

Objective To analyze the clinical features of congenital intestinal malrotation （CIM） combined with Hirschsprung's disease （HD）, thus improving its clinical diagnosis and treatment. Methods Clinical data of neonates with CIM plus HD were collected, including birth weight, gestational age, initial symptoms, age at onset, meconium passage status, physical examination findings, imaging data, pathological diagnoses, and surgical approaches. A retrospective analysis was conducted to evaluate clinical characteristics and diagnostic/therapeutic outcomes. Results Eight neonates with combined CIM and HD were included,including 5 males and 3 females. The gestational age ranged from 34 to 40 weeks, and the birth weight was between 2 400 and 3 500 g. The age at disease onset was （13.9± 4.3） days （range：2-26 days）. Four cases were preoperatively diagnosed and underwent elective Ladd's procedure combined with stage-one radical surgery for HD （all short-segment type）. In the remaining four cases, three were diagnosed intraoperatively with transitional zones in the colon during exploratory surgery for CIM .Then, enterostomy and colonic biopsies confirmed HD, and they were treated with stage-two radical HD surgery（short-segment type）. One case showed no colonic dilation intraoperatively but developed recurrent postoperative abdominal distension, leading to a subsequent diagnosis of long-segment HD requiring subtotal colectomy.Among the seven cases with short-segment HD,abdominal upright X-rays revealed fixed dilated mid-abdominal bowel loops, while this sign was absent in the long-segment HD case. Conclusions In cases of CIM combined with HD, a miss diagnosis of HD is common. The presence of fixed dilated mid-abdominal bowel loops on preoperative abdominal upright X-rays differs from isolated CIM, which should raise suspicion for concurrent HD. Stage-one surgery for CIM combined with HD is safe and effective.

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.

Objective To summarize the experience of laparoscopic management for choledochoenterostomy anastomotic stricture after choledochal cyst excision in children. Methods Clinical data of 8 pediatric patients who were re-examined by surgery for choledochoenterostomy anastomotic stricture after laparoscopic treatment for choledochal cysts at the Pediatric Surgery Department of Fujian Medical University Union Hospital from July 2016 to June 2024 were retrospectively analyzed. underwent laparoscopic biliary-enteric anastomotic reconstruction for postoperative biliary-enteric anastomotic stenosis. The operation time, intraoperative blood loss, time to first flatus, postoperative hospital stay, and complications were collected. Results All 8 children successfully underwent complete laparoscopic biliary-enteric anastomotic reconstruction. The operation time ranged from 120 minutes to 270 minutes,with an average of 188.5± 47.5 minutes. Blood loss ranged from 15 mL to 185 mL, with an average of 99.1± 62.1 mL. The postoperative hospital stay ranged from 7 days to 14 days, with an average of 9.2± 1.8 days. There were no cases of postoperative intra-abdominal bleeding, intra-abdominal infection, need for reoperation, or mortality. The follow-up period ranged from 6 months to 60 months, with an average of 30.2± 16.1 months. None of the followed-up children experienced recurrent biliary-enteric anastomotic stenosis. One child developed postoperative cholangitis, which was successfully treated with conservative management including anti-inflammatory and gallbladder-soothing medications, as well as traditional Chinese medicine. Conclusion Laparoscopic reconstruction of the choledochoenterostomy anastomotic stricture following choledochal cyst excision is safe and effective.

Hepatocellular carcinoma（HCC） is a prevalent tumor of digestive system. Surgical removal has been a primary treatment. However, HCC patients have a high postoperative risk of recurrence, particularly within 2 years. Therefore elucidating the signaling pathways for early recurrence after HCC surgery aids in formulating early and effective intervention measures.Counter-measures help to prevent or delay early recurrences of HCC,thereby enhancing patient survival.This review focused upon primary signaling pathways for early recurrence after HCC surgery, aiming to enhance understanding and refine precise prevention and intervention strategies for early recurrence of HCC.

Laparoscopic sleeve gastrectomy （LSG） is currently the most common bariatric surgery procedure. However, gastroesophageal reflux disease （GERD） caused by post-operative intrathoracic sleeve migration（ITSM） is the most concerned long-term complication. This article discussed the morbidity and possible mechanisms, clinical manifestation and diagnosis, prevention and treatment of ITSM. It is crucial to take feasible measures during the initial LSG to prevent ITSM. The possible approaches include avoiding damage to the phrenoesophageal ligament and fixing the left crus to the upper part of stomach. For patients with preoperative GERD symptoms, grade B or C esophagitis on endoscopy, or Hill grade Ⅲ or Ⅳ, simultaneous hiatal exploration, repair, and proper fixation should be considered. Regardless of the surgical approach, the fundamental measure for treating ITSM is to return the distal esophagus from the mediastinum to the abdominal cavity. Comprehensive hiatal repair and proper fixation around the gastro-esophageal junction are essential measures to ensure efficacy and prevent recurrences. Adding a gastroileal anastomosis can decrease the pressure in the sleeve which is favoring to GERD symptom, and simultaneously improve constipation and weight regain caused by ITSM.

目前加速术后康复（enhanced recovery after surgery,ERAS）已应用于肝切除术,但在右肝巨大肿瘤切除术中应用较少。此文对1例右肝巨大肿瘤（大小为27.0 cm×20.0 cm×15.0 cm）切除术病人（17岁,女性）,采用一系列围手术期优化处理措施,减少了病人术后并发症,加速了病人康复进程,病人于术后第7天出院。通过此例病人围手术期中的ERAS实践,显示出ERAS管理路径在右肝巨大肿瘤切除术围手术期中安全可行,值得进一步探索和优化。

Objective To investigate the clinical efficacy of totally laparoscopic surgery in the treatment of neonates with type I high jejunal atresia. Methods A total of 46 neonates with type I high jejunal atresia （within 10 cm of the ligament of Treitz） admitted to the Third Affiliated Hospital of Zhengzhou University from January 2017 to September 2024 were retrospectively analyzed. According to whether laparoscopic surgery was used or not, they were divided into laparoscopic procedure（LP） group （n=16） and open procedure （OP） group （n=30）.The general data, perioperative inflammation,operation time, intraoperative bleeding, the first defecation time,the first postoperative oral feeding time, postoperative full oral feeding time, postoperative abdominal drain removal time, postoperative complications, unexpected second operations,the length of hospital stay, and mortality were compared between the two groups. Continuous variables that followed or approximately followed a normal distribution were expressed as x±s, and compared by the t-test.Continuous variables that did not conform to a normal distribution were expressed as the median（Q1,Q3）.Count data were compared by the chi-square test. Results The operation was successfully completed in both groups. There were no significant differences in the gender,gestational age,weight,preterm birth rate,and abnormal prenatal diagnosis between groups（all P> 0.05）. Compared to the OP group, the LP group had significantly less intraoperative bleeding （2.00 [1.00,2.38] mL vs. 2.00 [2.00,5.25] mL）, shorter time to first defecation （2.25± 1.24 d vs. 3.20± 1.37 d）, shorter time to first postoperative oral feeding （7.19± 2.07 d vs. 9.00± 3.18 d）, shorter time to postoperative full oral feeding （15.56± 6.77 d vs. 23.43± 14.94 d）, shorter time to abdominal drain removal（10.43± 3.67 d vs.13.47± 4.98 d）, and shorter length of hospital stay （21.50± 7.30 d vs. 29.50± 14.21 d） （all P< 0.05）.There were no significant differences between the two groups in C-reactive protein（CRP）,operation time, postoperative complications, unexpected second operations, and mortality（all P> 0.05）. Conclusion Totally laparoscopy is safe and feasible in the treatment of neonatal type Ⅰ high jejunal atresia, and offering significant advantages in reducing bleeding, restoring gastrointestinal function as soon as possible, and shortening hospital stay.

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.

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 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.

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 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.

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.

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.

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.

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 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.

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。

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.

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.