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.

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 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.

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.

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.

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 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.

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 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.

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。

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 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.

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） 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.

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.

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.

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.

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.

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.

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.

Objective To identify clinical factors associated with postoperative complications after laparoscopic common bile duct exploration（LCBDE） using the Clavien-Dindo grading system, and to develop and validate a practical prediction model. Methods In this prospective study, 285 consecutive patients undergoing LCBDE at the First People's Hospital of Taicang（January 2023-May 2025） were randomly allocated 2∶1 to a training set（n=190） and a validation set（n=95）.Postoperative complications were recorded and graded by the Clavien-Dindo classification.In the training set, patients who developed Clavien-Dindo grade≥Ⅱ complications formed the even group（n=26）;the remainder constituted the complications grade 0~Ⅰ group（n=164）.Baseline characteristics, comorbidities, laboratory values, and intraoperative variables were compared. Independent predictors of grade≥Ⅱ complications were identified by multivariable logistic regression and used to construct a predictive model. Model discrimination was assessed by receiver operator characteristic（ROC） curve; calibration was evaluated with calibration plots and the Hosmer-Lemeshow test. Results Compared with complications grade 0~Ⅰ patients, those who developed grade≥Ⅱ complications had higher rates of ASA≥Ⅲ, more frequent moderate/severe acute cholangitis, higher Charlson comorbidity index（CCI） scores, and greater intraoperative blood loss; they also had lower serum albumin （all P<0.05）.Multivariable analysis showed ASA≥Ⅲ（OR=3.550, 95%CI： 1.271-9.915）, CCI（OR=2.617, 95%CI： 1.151-5.949）, moderate/severe acute cholangitis（OR=2.171, 95%CI：1.296-3.635）, and intraoperative blood loss（OR=2.872, 95%CI：1.322-6.241） were independent risk factors, while higher albumin was protective（OR=0.426, 95%CI：0.200-0.904）.The final logistic model：logit [P（complication≥Ⅱ）] = -12.874-0.854X₁（albumin） + 1.267X₂（ASA≥Ⅲ） +0.962X₃（CCI） +0.775X₄（moderate/severe cholangitis） + 1.055X₅（intraoperative blood loss）.（For binary predictors, code 1 if present, 0 if absent; continuous predictors are entered as measured.） Model performance was strong： training set area under the curve（AUC）=0.929 （sensitivity 84.62%, specificity 98.17%）; validation set AUC= 0.920 （sensitivity 92.31%, specificity 81.71%）.Hosmer-Lemeshow tests showed good calibration in both sets （training χ²=6.036, P=0.702;validation χ²=7.254, P=0.512）. Conclusion Higher ASA class（≥Ⅲ）, greater comorbidity burden（CCI）, concomitant moderate/severe acute cholangitis, and larger intraoperative blood loss increase the risk of postoperative Clavien-Dindo grade≥Ⅱ complications after LCBDE;higher serum albumin is protective.The internally validated prediction model demonstrates excellent discrimination and calibration and may help identify high-risk patients who would benefit from intensified postoperative management.

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.

Objective To investigate the expression patterns, prognostic value, and immune relevance of cuproptosis-related genes （CRGs） in colon cancer. Methods Bioinformatics analysis was performed to assess differentially expressed CRGs between colon cancer and normal tissues and their functional enrichment.A risk scoring model was constructed using least absolute shrinkage and selection operator（LASSO） and Cox regression, and the prognostic performance was assessed. The association between CRGs and immune cell infiltration/checkpoints was explored via the Tumor Immune Estimation Resource（TIMER） database. Key CRGs were validated by quantitative reverse transcription-polymerase chain reaction （qRT-PCR）. Results Thirty-five differentially expressed CRGs in colon cancer were identified via analyzing the transcriptome of colon cancer （P<0.05）.The CDKN2A gene exhibited the highest mutation frequency （17%）. Based on LASSO regression, independent risk factors were screened as follows： DAXX（HR=1.523,95% CI：1.075-2.158,P<0.05）, PRNP（HR=1.523,95% CI：1.075-2.158,P<0.05）, COX19（HR=1.523,95% CI：1.075-2.158,P<0.05）,CDKN2A（HR=1.523,95% CI：1.075-2.158,P<0.05）, and DLAT（HR=1.523,95% CI：1.075-2.158,P<0.05）. A CRGs-based risk scoring model for the prognosis of colon cancer incorporating the above independent risk factors was created. Based on the median score, patients were divided into the high-risk and low-risk groups. Those in the high-risk group had a significantly shortened survival. This model had a good prognostic value, with an area under the curve （AUC） exceeding 0.7. It was significantly correlated with immune cell infiltration/checkpoints.qRT-PCR confirmed upregulation of DAXX, COX19, and CDKN2A, and downregulation of PRNP and DLAT in colon cancer cells. Conclusion The CRGs-based risk scoring model effectively predicts colon cancer prognosis, and its close association with the tumor immune microenvironment suggests potential therapeutic targets for immunotherapy.These findings provide a theoretical foundation for prognostic assessment and personalized treatment strategies.

肠梗阻术后感染多为肠杆菌科细菌所致,主要包括手术切口感染和腹腔内感染,严重时可发展为脓毒症或感染性休克。2025年6月1日南京中医药大学附属医院收治1例53岁女性病人,由罕见的“侧腹膜裂孔疝”引起的肠梗阻,手术后继发由嗜水气单胞菌与豚鼠气单胞菌引起的广泛性坏死性筋膜炎。术后当晚出现感染性休克,感染由切口沿筋膜层扩散上至乳头、下至会阴、后至背部,范围广,病情危重。药敏结果显示其对三代头孢菌素及喹诺酮类药物敏感,对碳青霉烯类药物却耐药。经敏感抗生素（头孢他啶）联合外科清创、切口放置多根双套管持续冲洗、负压引流,联合营养支持治疗后病情好转。

梅州市人民医院2024年6月收治1例恶性心包积液病人[男性,77岁,曾因早期胃癌（中分化腺癌,pT_1bN₀M₀ ⅠA期）于2020年8月行腹腔镜辅助下全胃根治性切除术],本文对其临床资料及诊治方案进行了总结。该病人此次因“反复气促1月余,加重3 d”就诊,急诊心脏彩色多普勒超声及胸部CT提示大量心包积液。入院后急诊超声引导下心包穿刺术,共引流出615 mL血性心包积液,细胞学检查可见癌细胞。术后行FOLFOX方案（亚叶酸钙+5-氟尿嘧啶+奥沙利铂）化疗两次后病人自行放弃治疗,于发现心包积液3个月后死亡。早期胃癌根治术后出现恶性心包积液较罕见,预后极差,对于中至大量心包积液病人行心包穿刺术可减轻呼吸困难等症状,避免发展为心包填塞,而全身化疗有助于改善预后。

In recent years, increasing attention has been paid to the role of the gut microbiota in host energy metabolism, inflammatory regulation, and the maintenance of internal homeostasis. Accumulating evidence indicates that dysbiosis is closely associated with obesity, insulin resistance, type 2 diabetes, nonalcoholic fatty liver disease, and metabolic syndrome. The gut microbiota may participate in metabolic regulation through multiple mechanisms, including effects on energy intake and storage, short-chain fatty acid and bile acid metabolism, gut barrier homeostasis, chronic low-grade inflammation, and gut-brain axis signaling. As a representative intervention for reconstructing the gut microbiota, fecal microbiota transplantation （FMT） has demonstrated definitive efficacy in recurrent Clostridioides difficile infection and has gradually been extended to obesity, metabolic syndrome, constipation, and depressive disorders. Current evidence suggests that the direct effect of FMT on weight loss remains inconsistent; however, it shows potential in improving insulin sensitivity, body fat distribution, certain lipid parameters, and chronic low-grade inflammation. Its efficacy is influenced by multiple factors, including donor screening, the recipient's baseline microbiota, transplantation route, and dietary habits. This review summarizes the relationship between the gut microbiota and obesity/metabolic disorders, the mechanisms of FMT, and its current applications in related diseases.

Objective To compare the clinical efficacy of surgical resection and microwave ablation in patients with multifocal hepatocellular carcinoma at China Liver Cancer（CNLC） stage Ⅰb and Ⅱa, and to provide evidence for treatment selection. Methods A retrospective analysis was performed on 112 patients with CNLC stage Ⅰb/Ⅱa multifocal hepatocellular carcinoma who were treated at Shengjing Hospital of China Medical University from December 2013 to December 2023 and met the inclusion and exclusion criteria. According to treatment modality, patients were assigned to the resection group （85 cases） or the ablation group （27 cases）. Propensity score matching（PSM） was used to compare overall survival, disease-free survival, and perioperative outcomes, including postoperative hospital stay, hospitalization costs, and postoperative complications. Results After 1∶3 matching by PSM, 22 patients remained in the ablation group and 66 in the resection group. There were no statistically significant differences in baseline characteristics between the two groups （all P>0.05）. Regarding long-term survival outcomes,the 1-, 3-, and 5-year overall survival rates were 89.4%,77.2%, and 59.7% in the resection group and 100%, 84.2%, and 33.1% in the ablation group, respectively, with no significant difference between the groups （P>0.05）. The 1-, 3-, and 5-year disease-free survival rates were 62.1%,40.9%, and 23.5% in the resection group and 72.7%, 43.8%, and 26.3% in the ablation group, respectively, also with no significant difference （P>0.05）. In terms of perioperative outcomes, compared with the resection group, the ablation group had significantly shorter postoperative hospital stay （median：7.0 d vs 11.5 d） and lower hospitalization costs （median：38 509.5 yuan vs 62 346.5 yuan） （both P<0.05）. There was no significant difference in the incidence of postoperative complications of Clavien-Dindo grade Ⅱ or higher between the two groups（all P>0.05）, indicating comparable safety between the two treatment modalities. Conclusion For patients with CNLC stage Ⅰb/Ⅱa multifocal hepatocellular carcinoma, microwave ablation achieves long-term survival outcomes comparable to those of surgical resection and offers advantages in postoperative hospital stay, hospitalization costs, and postoperative complications.

Objective To assess the clinical effectiveness and technical benefits of a laparoscopic ultrasound‑guided microwave ablation technique, referred to here as the "thermo‑shrinkage" method, for the treatment of giant hepatic hemangiomas, and to inform individualized surgical decision‑making. Methods We performed a retrospective review of 87 patients with hepatic hemangiomas treated at the Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College,Huazhong University of Science and Technology, from May 2023 to December 2024. Patients underwent either thermo‑shrinkage ablation alone （n=45） or thermo‑shrinkage ablation combined with resection（n=42）. Both groups employed the same core thermo‑shrinkage technique. We compared perioperative metrics, complication rates, and long-term efficacy. Results Baseline tumor size was comparable between groups （combined：[9.5±3.4] cm vs ablation alone：[9.0±2.9] cm;P>0.05）. The ablation‑only group demonstrated significantly shorter operative time （[49.8±20.5] min vs [128.7±46.3] min）, shorter postoperative hospital stay（[5.0±1.0] d vs [5.7±1.6] d）, faster recovery of bowel function（[1.8±1.0] d vs [2.6±1.3] d）, and shorter duration of postoperative Ⅳ analgesia（[1.6±1.1] d vs [2.7±1.2] d）（all P<0.05）. Systemic inflammatory response, measured by interleukin-6, was lower after ablation alone （[18.3±3.5] pg/L） than after combined treatment（[24.9±4.7] pg/L）（t=-8.364,P=0.041）.Radiological complete response（rCR） was achieved in 100% of patients in the combined group （42/42） versus 80.0% in the ablation‑only group （36/45）（χ²=6.305,P<0.05）.Neither group experienced severe complications,and overall complication rates （42.9% vs 26.7%） were not significantly different（χ²=2.135,P>0.05）. Conclusion The thermo‑shrinkage technique,through a proposed dual mechanism of surface "armoring" and internal tumor contraction, enables safe, efficient, and visually guided treatment of giant hepatic hemangiomas. Ablation alone provides a clear minimally invasive benefit with faster postoperative recovery and lower immediate inflammatory response,while combining ablation with resection yields higher radiologic complete response rates and potentially more definitive tumor control.

Hepatocellular carcinoma（HCC） is one of the most common malignancies worldwide, and liver transplantation remains the definitive treatment for appropriately selected early‑stage patients. However, limited donor organ availability and prolonged waiting times place candidates at risk of tumor progression, creating an unmet need for effective bridge therapies to maintain transplant eligibility. Yttrium-90（Y‑90） microsphere radioembolization and transcatheter arterial chemoembolization（TACE） are the principal locoregional modalities used as bridging strategies.Although both modalities achieve meaningful local tumor control,they differ substantially in mechanisms of action,efficacy profiles,safety considerations, and indications, and monotherapy may not address the heterogeneity of current clinical scenarios. This review synthesizes the contemporary clinical evidence on Y‑90 radioembolization and TACE as bridging treatments prior to liver transplantation.We compare their biological mechanisms along with relative advantages.In addition,we discuss how advances in biomarkers and radiomics can refine candidate stratification and predict response,enabling more personalized bridging strategies.This review aims to provide a practical framework to improve patient outcomes and maximize transplant success.

Objective To examine the association between inflammatory markers and complicated appendicitis, develop machine‑learning prediction models using selected biomarkers and demographic data, and evaluate their predictive performance to support early diagnosis and management. Methods We performed a retrospective study of 330 consecutive patients with acute appendicitis admitted to the Hepatobiliary and Pancreatic Surgery Department of Nanjing Jiangning Hospital from January 2024 to June 2025. Patients were classified as non‑complicated appendicitis（n=151） or complicated appendicitis（n=179） based on intraoperative findings and pathology. Demographic and laboratory inflammatory variables were collected. Using a hold‑out approach, patients were randomly split 7∶3 into a training set（n=230） and a test set（n=100）. Training and test set demographics： training set, including 116 males, 114 females,125 complicated cases; test set, including 55 males, 45 females, 54 complicated cases.Feature selection was performed by least absolute shrinkage and selection operator（LASSO） regression followed by multivariable logistic regression to identify variables significantly associated with complicated appendicitis. Seven machine‑learning models were then trained on the selected features： logistic regression（LR）, decision tree（DT）, random forest（RF）, extreme gradient boosting（XGBoost）,light gradient boosting machine（LightGBM）, support vector machine （SVM）, and artificial neural network （ANN）. Model performance on the test set was assessed by area under the curve （AUC）, F1 score, sensitivity, specificity and accuracy. Model interpretability and variable importance were examined with SHAP （Shapley additive explanations）. Results LASSO and multivariable logistic regression identified five predictive features： systemic immune‑inflammation index （SII）,C‑reactive protein/albumin ratio（CAR）, neutrophil percentage/albumin ratio（NPAR）,platelet‑to‑lymphocyte ratio（PLR）,and age.Among the seven models evaluated on the independent test set,XGBoost achieved the best performance with an AUC of 0.786（95%CI：0.686-0.876）, specificity 91.11%, accuracy 75.52%, and F1 score 0.733. SHAP analysis indicated that CAR, age, and NPAR contributed most to model predictions. Conclusion Models based on SII, CAR, NPAR, PLR and age can discriminate complicated from non‑complicated appendicitis; among them, the XGBoost model demonstrated the best predictive performance. This approach shows promise as an early, laboratory‑based decision support tool to aid triage and management of patients with suspected complicated appendicitis.

Objective To compare the efficacy of subsegmental radiofrequency ablation（SS-RFA） and conventional radiofrequency ablation （RFA） in the treatment of solitary early hepatocellular carcinoma（HCC）. Methods A prospective non-randomized cohort study was conducted. A total of 34 patients with solitary lesions and a maximum tumor diameter of <5 cm admitted to the Department of Hepatobiliary Surgery, the First Affiliated Hospital of Army Medical University, from October 2022 to July 2024 were enrolled. Seventeen patients received SS-RFA, and the remaining 17 patients received conventional RFA. Postoperative complications, postoperative changes in liver function indicators, and long-term recurrence were compared between the two groups. Results All patients successfully underwent ablation, and no severe postoperative complications occurred. Both groups showed similar transient postoperative fluctuations in liver function indicators. Compared with the RFA group, the ablation zone diameter in the SS-RFA group was significantly larger at 15 min after ablation （[47.85±7.32] mm vs [38.18±5.84] mm, P<0.001） and at 2 d after ablation （[54.85±10.2] mm vs [42.24±5.29] mm, P<0.001）. The 1-year recurrence-free survival （RFS） rate in the SS-RFA group was 94.1% and the 2-year RFS rate was 88.2%; in the RFA group, the corresponding 1- and 2-year RFS rates were 82.4% and 50.2%, respectively. The RFS rate was significantly higher in the SS-RFA group than in the RFA group （P=0.011）. Conclusion SS-RFA is safe and effective for patients with solitary early HCC. Compared with conventional RFA, it provides a longer recurrence-free survival period.

Objective To evaluate prognostic differences after radiofrequency ablation（RFA） for newly diagnosed hepatocellular carcinoma（HCC） according to tumor location. Methods A retrospective analysis was performed on the clinical data of 70 patients with tumors adjacent to major vessels and 111 patients with tumors distant from major vessels who underwent RFA at the First Affiliated Hospital of Zhengzhou University from January 2015 to December 2022. After propensity score matching（PSM）, 62 matched pairs of patients were included. Kaplan-Meier analysis and the log-rank test were used for survival analysis, and the Cox proportional hazards model was used to analyze factors influencing recurrence-free survival（RFS）.Liver function was also assessed in the two groups after PSM. Results After PSM, each group included 62 patients. In the group with tumors adjacent to major vessels, the 1-,2-,and 3-year RFS rates were 82.2%, 69.3%, and 56.4%, respectively, and the median follow-up period was 42 months. In the group with tumors distant from major vessels, the corresponding 1-,2-,and 3-year RFS rates were 90.3%, 85.4%, and 85.4%, respectively, and the median follow-up period was 60 months. The postoperative RFS rate was significantly better in the group with tumors distant from major vessels than in the group with tumors adjacent to major vessels（P<0.05）.Multivariate analysis after PSM showed that tumor number（HR=2.243,95%CI：1.578-3.187,P<0.001）, maximum tumor diameter（HR=1.793, 95%CI：1.056-3.469,P=0.030）, tumor location（HR=2.458,95%CI：1.015-5.595,P=0.046）,and alanine aminotransferase（HR=1.014, 95% CI：1.001-1.028,P=0.031） were independent risk factors for tumor recurrence. Postoperatively, alanine aminotransferase and aspartate aminotransferase levels were significantly higher in the group with tumors adjacent to major vessels than in the group with tumors distant from major vessels, and the differences were statistically significant（all P<0.05）. Conclusions Tumor location, multifocality, maximum tumor diameter,and alanine aminotransferase are high-risk factors for early recurrence after RFA in patients with HCC,and patients with tumors adjacent to major vessels have a higher postoperative recurrence rate.

Objective To analyze the etiologic composition and age distribution of acute abdomen cases registered in the Surgical Rescue Network, and to provide evidence for stratified management of acute abdomen and the development of a regional acute care surgery （ACS） system. Methods A retrospective analysis was performed using registry data from the Surgical Rescue Network from January 2024 to December 2025. Case contributions from participating centers and the composition of ACS-related cases were described. Diagnoses of acute abdomen were standardized and categorized. The major etiologies, baseline characteristics, and etiologic composition across different age groups were compared. Continuous variables are presented as median （interquartile range）, and categorical variables are presented as number of cases and percentage. Results A total of 24,877 ACS-related cases were registered, including 21,098 cases of acute abdomen （84.8%）. Acute appendicitis-related diseases were the most common （13,082 cases, 62.0%）, followed by gallbladder and biliary emergencies （2,915 cases, 13.8%）, gastrointestinal perforation （2,170 cases, 10.3%）, intestinal obstruction and hernia-related emergencies （1,857 cases, 8.8%）, and acute pancreatitis （591 cases, 2.8%）. These five categories accounted for 97.7% of all cases. Among 21,070 patients with non-missing age data, the proportion of acute appendicitis-related diseases decreased with increasing age, whereas the combined proportion of gallbladder and biliary emergencies, gastrointestinal perforation, and intestinal obstruction and hernia-related emergencies increased from 6.1% in the < 18-year group to 67.7% in the ≥ 80-year group. Etiologic groups such as perforation and intestinal obstruction/hernia-related emergencies carried a relatively higher anesthesia risk burden. Conclusion The acute abdomen cases registered in the Surgical Rescue Network exhibit two distinct features： a concentration of high-frequency diseases and an increased burden of complex etiologies and risk in older patients. Acute appendicitis-related diseases predominate in younger patients, whereas perforation, obstruction, and gallbladder/biliary emergencies increase markedly in older patients. These findings may inform stratified management of acute abdomen, pathway design for abdominal pain centers, and allocation of regional ACS resources.

Local therapy is an important treatment modality for hepatocellular carcinoma （HCC）. The rapid development of imaging has made it a core support throughout the full-course management of local therapy. This article systematically describes the current status and latest advances in imaging applications in HCC local therapy, following the timeline from pre-treatment to precise postoperative assessment, as well as long-term surveillance and recurrence management, and the extended value of imaging in the era of combination therapy. It focuses on the application value and suitable scenarios of different imaging techniques, such as computed tomography （CT） and magnetic resonance imaging （MRI）, at each stage, and discusses the transformative role of cutting-edge technologies such as radiomics and artificial intelligence in efficacy prediction, precise guidance, and recurrence monitoring. At the same time, it highlights the current challenges in imaging assessment and future development directions.

Objective To evaluate the safety and feasibility of a single‑incision synchronous triple‑endoscope approach, i.e., laparoscopy combined with duodenoscopy and peroral cholangioscopy, for the treatment of gallbladder stones concurrent with small‑diameter common bile duct stones. Methods We retrospectively analyzed 96 patients with gallbladder stones concurrent with small‑diameter common bile duct stones meeting inclusion criteria who were treated at the Affiliated Puren Hospital of Wuhan University of Science and Technology between September 2023 and December 2024. Patients were assigned according to the surgical method： the single‑incision triple‑endoscope group （observation,n=35） and the conventional multi‑port/endoscope triple‑approach group （control,n=61）. We compared intraoperative parameters, postoperative complications, liver function tests （preoperative and on postoperative days 3 and 7）, pain scores （preoperative and on postoperative days 3 and 7）, and patient satisfaction at postoperative day 7 and 1 month. Results There were no statistically significant differences between groups in intraoperative blood loss （[18.20±13.08] mL vs [20.98±10.68] mL）,operative time（[106.83±43.09] min vs [104.66±30.62] min）,or overall postoperative complication rate （5.7% [2/35] vs 3.3% [2/61]）（all P>0.05）.The observation group demonstrated significantly faster postoperative recovery markers than the control group： shorter time to first flatus （[21.97±9.24] h vs [26.77±9.27] h）,shorter time to first bowel movement （[46.26±15.23] h vs [55.70±12.60] h）, and shorter postoperative hospital stay （[5.26±2.05] d vs [6.56±3.05] d）（all P<0.05）.By postoperative day 3, both groups showed significant reductions in serum alanine aminotransferase, aspartate aminotransferase,and total bilirubin compared with preoperative values（all P<0.05）;between‑group differences in these liver function indices were not statistically significant （P>0.05）. Pain assessed by the visual analogue scale（VAS） was significantly lower in the observation group（P<0.05）.Patient satisfaction at postoperative day 7 and at 1 month improved more markedly in the observation group（P<0.05）. Conclusion The single‑incision synchronous triple‑endoscope approach for gallbladder stones with concomitant small‑diameter common bile duct stones appears safe and feasible. Compared with the conventional approach, it provides reduced postoperative pain, faster recovery, superior cosmetic results, and a low complication rate.

Remote robotic surgery has become a promising direction in minimally invasive surgery; however, its application across multiple specialties under different distance and latency conditions remains insufficiently explored. Based on the platform of the 2026 Annual Meeting of the Chinese Chapter of the International Hepato-Pancreato-Biliary Association, this study included 21 patients who underwent remote robotic surgery using the domestic EDGE or Toumai robotic surgical system over a 5G/dedicated line network. The procedures covered hepatobiliary and pancreatic surgery （10 cases）, urology （7 cases）, gastrointestinal surgery （3 cases）, and thoracic surgery （1 case）, with a distance gradient ranging from the same city （22 km） to intercontinental transmission （17,000 km）. All 21 procedures were successfully completed, with no conversion to open surgery or local surgery. According to network latency stratification, 16 cases （76.2%） had latency < 100 ms, and the surgeons reported smooth operation without obvious lag; 2 cases （9.5%） had latency of 100-200 ms; and 3 cases （14.3%） had latency > 200 ms, with perceptible delay （0.5-1.0 s）, yet all procedures remained technically feasible. Packet loss occurred in 5 cases but did not affect surgical completion. The results indicate that domestic remote robotic surgery systems demonstrated reliable safety and feasibility across multiple specialties and under a wide range of distance and latency conditions. A latency of ≤ 200 ms ensured optimal surgical performance, whereas for latency > 200 ms, low-complexity procedures could still be completed with appropriate compensatory strategies. This study provides empirical support for the broader clinical application of remote surgery.

目的 总结腹腔镜治疗先天性巨结肠患儿的手术方案并分析其预后。方法 回顾性收集2021年1月至2024年7月拉萨市人民医院收治的11例先天性巨结肠患儿临床资料,其中男性8例,女性3例,年龄（7.2±4.2）个月（2~16个月）。疾病类型：短段型2例,常见型9例。手术均采用腹腔镜辅助巨结肠根治术,肛门采用直肠黏膜切除术+内括约肌部分切除术技术。分析其手术并发症及术后排便功能情况。结果 全部患儿顺利完成手术,其中腹腔镜手术10例,1例因结肠巨大粪石,无法从肛门拖出而中转开腹。手术时间为90~200 min,术中出血量为5~30 mL。术后无出血,无吻合口瘘、肠梗阻等严重并发症,3例术后半年内存在肛周糜烂,后逐步恢复。患儿均获得随访,随访时间为（39.0±13.7）个月（12~51个月）。大便次数每天1~4次,大便性状均为糊状,无完全性大便失禁,污粪偶发1例,频发1例;小肠结肠炎偶发3例,频发1例;轻度便秘2例,饮食调节可恢复;无尿潴留发生。9例患儿（>3岁）肠道功能评分（Bowel function score,BFS）为（16.9±2.8）分。结论 在医疗援藏背景下,西藏地区小儿巨结肠微创手术水平得到提升,但还应根据当地疾病特点进一步改进技术。