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    Interpretation of the 5th edition WHO classification and staging of digestive system tumors: colorectal tumors
    YU Yingyan
    Journal of Surgery Concepts & Practice    2021, 26 (04): 312-317.   DOI: 10.16139/j.1007-9610.2021.04.008
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    Chinese interpretation of Japanese Gastric Cancer Treatment Guidelines 2021 (6th edition) and Ruijin clinical practice
    YAN Chao, LU Sheng, YAN Min, ZHU Zhenggang
    Journal of Surgery Concepts & Practice    2023, 28 (04): 326-354.   DOI: 10.16139/j.1007-9610.2023.04.010
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    “Japanese Gastric Cancer Treatment Guidelines” have been important guidelines for the treatment of gastric cancer in Japan and worldwide. The English version “Japanese Gastric Cancer Treatment Guidelines 2021 (6th Edition)” published in January 2023 consists of two parts. The first part includes diagnostic and treatment methods, such as surgery, endoscopic resection, chemotherapy, follow-up. The second part addresses clinical issues, including recommendations and explanations for clinical hot topics. This article will provide a Chinese interpretation of the guidelines and briefly introduce our hospital's clinical practice in the diagnosis and treatment of gastric cancer.

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    Retrospective study on Bethesda Ⅴ thyroid nodule in diagnosis of papillary thyroid carcinoma: retrospective study
    YAN Shouyi, CHEN Hongbin, ZHANG Liyong, WANG Bo, CAI Shaojun, LIN Siying, ZHAO Wenxin
    Journal of Surgery Concepts & Practice    2021, 26 (06): 512-516.   DOI: 10.16139/j.1007-9610.2021.06.011
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    Objective To study on preoperative diagnosis of papillary thyroid carcinoma (PTC) with Bethesda Ⅴ thyroid nodules retrospectively and to explore the differences of clinical parameters between Bethesda Ⅴ and Ⅵ thyroid nodules. Methods The clinical data of 430 patients were analyzed. Results Univariate analysis showed that there were significant differences of Bethesda Ⅴ nodules in nodule boundary, tumor size and echo between PTC group of 159 cases and benign group of 20 cases (P<0.05). It was shown from multivariate analysis that nodule boundary, tumor size and echo were risk factors for malignant diagnosis of BethesdaⅤnodule. The differences were present significantly in TI-RADS grade, aspect ratio and echo between Bethesda ⅤPTC group of 159 case and Bethesda Ⅵ thyroid nodule group of 251 cases (P<0.05). Further multivariate analysis showed that TI-RADS grade, aspect ratio, relation of nodule with capsule, thyroid peroxidase antibody level and echo were the risk factors for the diagnosis of PTC. Conclusions Bethesda Ⅴ nodules with higher grade of TI-RADS are malignant more possibly and those with lower grade of TI-RADS need to be evaluated such as thyroid nodules sizes, relation of nodules with capsule and thyroid peroxidase antibody level.
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    The fifth edition of WHO classification of digestive system tumors: update and progress on biliary system tumors
    LUO Fangxiu, MA Qianchen, YUAN Fei
    Journal of Surgery Concepts & Practice    2023, 28 (02): 124-131.   DOI: 10.16139/j.1007-9610.2023.02.08
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    Overall, there was little change in biliary system tumors of the 5th edition of WHO classification of digestive system tumors after update. The three-tiered classification of biliary intraepithelial neoplasia changed to two-tiered system: high-grade and low-grade, in the section of benign tumors and precancerous lesions. And both intracholecystic and intraductal papillary tumors associated with invasive carcinoma were added. The classification of intrahepatic bile duct tumors introduced parts of bile duct adenoma and bile duct adenofibroma, which were mentioned previously in the differential diagnosis with bile duct carcinoma. Intrahepatic cholangiocarcinoma was divided into small bile duct subtype and large bile duct subtype in the 5th edition of WHO classification, and the names of cholangiocellular carcinoma and cholangiole cell carcinoma were no longer recommended to use. Extrahepatic cholangiocarcinoma was listed as a separate part for the first time, including squamous cell carcinoma, adenosquamous carcinoma and undifferentiated carcinoma in addition to common histological types. Some new contents of molecular pathology in the 5th edition of WHO classification were added, which provided the basis for precise classification and diagnosis of tumors in biliary system.

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    Progress of study on gallbladder adenomyomatosis: pathogenesis, diagnosis and treatment
    CHEN Xuanwu, YANG Chuanyu, JIANG Minjie, DU Weidong
    Journal of Surgery Concepts & Practice    2022, 27 (01): 87-90.   DOI: 10.16139/j.1007-9610.2022.01.020
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    Gallbladder adenomyomatosis(GA) is a relatively rare benign disease of unknown both etiology and pathogenesis. The development of imaging technology improved diagnosis of GA. Some believed that GA related to gallbladder cancer, which is still controversial. Preventive cholecystectomy was proposed to treat GA and some GA could be followed up. Therefore no consensus of treatment of GA is present now. Etiology, pathogenesis, diagnosis and treatment of GA were included in this article.

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    Efficacy of intraoperative indocyanine green fluorescence imaging evaluation for preventing anastomotic leakage after laparoscopic rectal cancer surgery
    LUO Yang, YU Minhao, YE Guangyao, LIN Haiping, GONG Tingyue, LI Hao, ZHONG Ming
    Journal of Surgery Concepts & Practice    2023, 28 (03): 249-253.   DOI: 10.16139/j.1007-9610.2023.03.012
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    Objective To investigate the effect of indocyanine green(ICG) fluorescence imaging to indicate blood supply of sigmoid-rectal anastomosis in laparoscopic anterior resection of rectal cancer. Methods Here a retrospective cohort study including 175 consecutive patients with rectal cancer scheduled for laparoscopic surgery in Department of Gastrointestinal Surgery of Renji Hospital between January 2019 and December 2022 was analysed. These patients were classified into two groups, according to using ICG or not within surgery: the ICG group (n=65) and the control group (n=110). Operation situations and complications were compared between the two groups. Results The operation time of ICG group was longer than that of control group [(151.6±4.8) min vs (139.5±3.7) min, P=0.04], and the preventive ileostomy rate was lower than that of control group (12.3% vs 34.6%, P=0.01), while the other operation data (intraoperative blood loss, number of lymph node dissection), were similar between the two groups (P>0.05). The rate of anastomotic leakage in ICG group were lower than that in control group (4.6% vs 14.6%, P=0.04), and there was no significant differences in wound infection, urinary retention and intestinal obstruction between the two groups (P>0.05). Conclusions The ICG displays that the blood supply in laparoscopic anterior resection of rectal cancer can reduce the incidence of anastomotic leakage, which improves the surgical safety and the quality of postoperative life.

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    Progress and prospect of surgical comprehensive treatment of gastric cancer
    ZHU Zhenggang
    Journal of Surgery Concepts & Practice    2023, 28 (01): 1-6.   DOI: 10.16139/j.1007-9610.2023.01.01
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    Gastric cancer is one of the leading malignancies in China and in the world. Surgery is still the most important modality to cure gastric cancer. A series of clinical researches changed the traditional concept of surgery and avoided blindly expanding the scope of surgery. Laparoscopic surgery for both early and locally advanced gastric cancer achieved the same radical effect as open surgery. The key to further improve the efficacy of minimally invasive surgery is controlling indications, establishing a training system for surgical techniques and optimizing the relation between costs and benefits. The relationship between resection of organs and preservation of organ function should be balanced in the extended surgery for gastric cancer. Perioperative treatment of locally advanced gastric cancer would be advocated actively. Conversion therapy preoperatively for far-advanced gastric cancer is advocated. Palliative resection should be strictly controlled for the patients of far-advanced gastric cancer with extensive metastasis, and comprehensive treatment should be carried to prolong the life of patients.

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    Advances in diagnosis and molecular detection of EBV-positive gastric cancer and gastric cancer with lymphoid stroma
    DENG Shijie, YUAN Fei
    Journal of Surgery Concepts & Practice    2023, 28 (01): 53-57.   DOI: 10.16139/j.1007-9610.2023.01.09
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    Epstein-Barr virus-positive gastric cancer, as well as gastric cancer with lymphoid stroma, are the special pathological subtypes of gastric cancer. The histological morphology, immunological and genetic characteristics between two subtypes are overlapped to some extent, however, they are not identical. Therefore, there were not only the confusion in the diagnosis for pathologists but also perplexity in clinical treatment and following research caused by two subtypes of gastric cancer. In this article, the two cancers and other similar diagnostic terms were introduced and compared in detail. The clinicopathological features, genetic variation, molecular detection, and treatment progress were summarized combined with both current controversies and future directions of research.

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    New progression of radiomics in diagnosis of gastric cancer
    ZHANG Huan, CHEN Yong
    Journal of Surgery Concepts & Practice    2023, 28 (01): 42-48.   DOI: 10.16139/j.1007-9610.2023.01.07
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    Gastric cancer is a common entity of malignant tumor in China with the third cause of mortality and morbidity among all malignancies. In recent years, radiomics has emerged as a quantitative tool for imaging analysis with the rise of artificial intelligence. Currently, radiomics has been applied in many aspects of gastric cancer. In this review, we will focus on the progression of radiomics in diagnosis of gastric cancer, and describe the role of radiomics in differential diagnosis, staging and detection of histopathological biomarkers in detail, to reveal the value of radiomics in the precision medicine of gastric cancer.

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    Diagnosis and treatment of medullary thyroid carcinoma-an update
    CHEN Chengkun, GUO Bomin, DENG Xianzhao, WU Bo, FAN Youben
    Journal of Surgery Concepts & Practice    2022, 27 (03): 276-280.   DOI: 10.16139/j.1007-9610.2022.03.019
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    Medullary thyroid carcinoma (MTC) arising from the parafollicular cell (C cell) of the thyroid gland, is an aggressive neuroendocrine tumor and a special rare thyroid malignancy. Calcitonin and carcinoembryonic antigen are still commonly used markers now, whose elevation can reliably diagnose MTC. The preoperative value and postoperative doubling time of these markers are of great significance for range of lymph node dissection and evaluation of prognosis. It is recommended that total thyroidectomy and central lymph node dissection would be needed and lateral lymph node dissection would be added when necessary. Routine detection of RET gene is recommended. Targeted therapy is considered for non-operable patients or the patients with distant metastasis. The pathological mechanism of MTC still needs to be paid attention.

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    Controversy over the medial border of lymph node dissection during CME/D3 surgery of right colon cancer
    SUN Yueming, ZHANG Dongsheng
    Journal of Surgery Concepts & Practice    2023, 28 (03): 202-207.   DOI: 10.16139/j.1007-9610.2023.03.005
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    Radical surgery is the most important treatment for colon cancer. The development and application of complete mesentery excision (CME)/D3 lymph node dissection has promoted the standardization of surgical techniques for colon cancer. Right colon cancer surgery is relatively complicated, and is a research hotspot currently. The issues involved the range of lymph node dissection, the range of bowel resection, and the method of bowel reconstruction. The medial border of lymph node dissection for right colon cancer is one of the controversies. The left side of the superior mesenteric vein is generally considered to be the medial border of CME/D3 dissection in right colon cancer surgery. However, with the in-depth development of related research, some scholars believed that the left side of the superior mesenteric artery should be used as the medial border for lymph node dissection. This approach is more consistent with the principle of CME, and can achieve complete lymph node dissection. However, its clinical significance still needs to be evaluated with further research. This article discusses the selection of medial border of lymph node dissection for right colon cancer, hoping to provide reference for clinical practice.

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    Development and prospects of ERCP in China
    LI Wen
    Journal of Surgery Concepts & Practice    2023, 28 (04): 279-282.   DOI: 10.16139/j.1007-9610.2023.04.001
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    Endoscopic retrograde cholangio-pancreatography (ERCP) is an interventional endoscopic technique aimed at the diagnoses and treatment of biliary and pancreatic diseases under the guidance of endoscopy and X-ray ima-ging. ERCP was introduced into China from the 1970s. In the 1990s, ERCP was gradually popularized and applied in China with the development of medical technique and improvement of equipment, more medical institutions started to carry out ERCP. After 2000, ERCP technology and equipment were further upgraded and improved in China. Many secondary and tertiary hospitals began to establish the ERCP centers. Meanwhile, workshops and training also facilitated the teaching and practice of ERCP and cultivated more professionals of ERCP. In recent years, the technical level of ERCP in China has been continuously improved, and technologies and equipments are constantly updated and iterated. Currently, ERCP has become one of important techniques in the endoscopic field, playing an important role in the diagnosis and treatment of biliary and pancreatic diseases. The vigorous development of ERCP in China is attributed to the advancement of medical science, the improvement of technology and the efforts of generations of ERCP specialists.

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    Classification and surgical treatment of congential biliary dilatation
    WANG Jin, WU Shuodong
    Journal of Surgery Concepts & Practice    2023, 28 (02): 166-170.   DOI: 10.16139/j.1007-9610.2023.02.15
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    Congential biliary dilitation (CBD) is rare biliary tract disease in clinic. Clinical classification and disease characteristics of CBD is the key of accurate treatment. Surgical treatment was regarded as the first choice for adult patients with CBD including traditional surgery. There is still a controversy in the strategy of reconstruction of bile duct during operation. In this article the progress in diagnosis and treatment of CBD was reviewed.

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    Expression of B7S1 related with immune infiltration in colorectal cancer
    WANG Changgang, LIU Kun, FENG Haoran, JIANG Yimei, SHI Yiqing, CHEN Xianze, SONG Zijia, LI Jun, LI You, CAI Dongli, ZHAO Ren
    Journal of Surgery Concepts & Practice    2021, 26 (04): 336-342.   DOI: 10.16139/j.1007-9610.2021.04.011
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    Objective To investigate the expression of B7S1 mRNA which is encoded by VTCN1 and protein levels in colorectal cancer(CRC) with the analysis of relation to clinicopathological characteristics, immune cell infiltration, and prognosis for the evaluation as a immunotherapeutic target in CRC. Methods Both Oncomine and TIMER databases were used to review the expression of VTCN1 in a variety of human solid tumors. The relationship between the expression of VTCN1 and the clinicopathological characteristics of CRC was analyzed using UALCAN and LinkedOmics databases. The expression of VTCN1 which is related with immune infiltration and clinical prognosis was evaluated using Human Protein Atlas database, Kaplan-Meier Plotter and TIMER database. A total of 24 patients with CRC in Ruijin Hospital (North) were collected and the expression of B7S1 protein in both CRC and normal intestinal tissues was detected by immunofluorescence staining. Results It was found in database that VTCN1 was expressed in many human solid tumors. VTCN1 was highly expressed in various subtypes of CRC when compared with that in normal intestinal tissues. The up-regulated VTCN1 was related to tumor stage, lymph node metastasis, distant metastasis, mismatch repair and overall survival rate. VTCN1 was also related to the immune cell infiltration. Immunofluorescence analysis showed that the protein of B7S1 was up-regulated in CRC when compared with that in normal intestinal tissues, and it was expressed in CD45- cells and CD45+ cells. Conclusions As co-inhibitory immune checkpoint molecule, B7S1 may be a potential prognostic factor and might become the target of immunotherapy for CRC.

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    Rouviere′s sulcus guided retro-gallbladder tunnel dissection in difficult laparoscopic cholecystectomy
    MAN Gaoya, DANG Tongke, WU Qingsong, FENG Feiling
    Journal of Surgery Concepts & Practice    2022, 27 (03): 239-243.   DOI: 10.16139/j.1007-9610.2022.03.011
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    Objective To explore Rouviere′s sulcus guided retro-gallbladder tunnel dissection cholecystectomy used in difficult laparoscopic cholecystectomy. Methods A retrospective analysis of 1 081 patients with laparoscopic cholecystectomy in Tengzhou Central People′s Hospital from January 2019 to October 2020 was done. A total of 125 cases had scores ≥6 indicating difficult laparoscopic cholecystectomy based on preoperative scoring system to predict difficult laparoscopic cholecystectomy by Gupta. There were 65 cases(study group) with laparoscopic cholecystectomy using Rouviere′s sulcus guided retro-gallbladder tunnel dissection and 60 cases(control group) with routine laparoscopic cholecystectomy. Clinical data with operation and postoperative complication were compared between two groups. Results Operative time of two groups was [(61±23) min vs. (88±24) min], operative blood loss [(46±16) mL vs. (62±23) mL, hospital length of stay [(3.5±1.5) d vs. (5.8±2.2) d] and hospital cost [(12 236±316) yuan vs. (14 199±552) yuan] with statistical significant difference (P<0.05). Visual analog scale at 12 h and 24 h after operation in study group were (2.7±1.1) and (3.0±1.1), less than those in control group (5.9±1.0) and (6.4±1.5) significantly(P<0.05). One case with conversion of laparotomy was present in study group and 6 cases in control group (P<0.05). There was no case with bile leakage in study group and 4 cases in control group (P<0.05). Liver function was more improved significantly 72 hours postoperative in study group than in control group (P<0.05). There was no bile duct injury in study group and 1 bile duct injury in control group (P>0.05). Conclusions Rouviere′s sulcus guided retro-gallbladder tunnel dissection in difficult cholecystectomy could be safe laparoscopic cholecystectomy.

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    Study on myopectineal orifice anatomy using CT three-dimensional imaging
    YAO Junliang, YU Jianping, JIANG Xiaoming, GU Chao, SUN Rongxun
    Journal of Surgery Concepts & Practice    2022, 27 (03): 249-252.   DOI: 10.16139/j.1007-9610.2022.03.013
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    Objective To study myopectineal orifice anatomy of the patients with inguinal groin hernia using three-dimensional imaging technology after reconstructing of myopectineal orifice. Methods Preoperative CT images of 90 patients with inguinal hernia including 79 cases with indirect, 9 cases with direct and 2 cases with femoral were collected in our hospital from March 2019 to December 2019. The data of CT imaging were imported into software for three-dimensional reconstruction. The data of myopectineal orifice anatomy after reconstruction were measured and compared after grouping of age, gender and body mass index. Results The mean total width of myopectineal orifice was(7.67±0.75) cm, length (7.34±0.38) cm, length of upper edge(5.79±0.79) cm, length of lower edge(6.57±0.50) cm, and the upper lower angle (120.10±9.36) °. Difference in total width, length, and upper edge length was statistically significant between male group and female group (P<0.05). There was difference in upper edge length between adult group and old group (P<0.05) and in upper lower angle between body mass index low group and high group (P<0.05). Conclusions Three-dimensional CT ima-ging technology could be feasible to measure the morphology of myopectineal orifice. The data of myopectineal orifice collected in this study would be used to direct prosthetic mesh of inguinal hernia according to different age, gender and body mass index.

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    Efficacy with prognostic value of postoperative prophylactic hyperthermic intraperitoneal chemotherapy for locally advanced gastric cancer
    SUN Qi, HUANG Wenbo, HE Bingliang, LIU Chang, XU Yuhang, ZHAO Wei
    Journal of Surgery Concepts & Practice    2023, 28 (04): 366-370.   DOI: 10.16139/j.1007-9610.2023.04.013
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    Objective To explore the efficacy with prognostic value of postoperative prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) for locally advanced gastric cancer with clinical stage cT3-4NxM0. Methods A retrospective collection and analysis of clinical data was conducted from 60 patients with locally advanced gastric cancer (cT3-4NxM0) who underwent D2 radical surgery between January 2016 and December 2021 at our department. Patients who underwent prophylactic HIPEC were classified into the HIPEC group (n=30), while patients who did not undergo prophylactic HIPEC were clssified into the control group (n=30). Both groups of patients routinely were treated with postoperative adjuvant systemic chemotherapy. The median survival time, and overall survival rate of the two groups were compared through follow-up, and the risk factors affecting the overall survival rate were analyzed. Results The median survival time of the HIPEC group was 51.0 months (95% CI: 40.7-61.3), which was higher than that of the control group with 30.0 months (95% CI: 16.3-43.7). The 3-year and 5-year overall survival rates of the HIPEC group (66.7%, 53.3%)were higher than those of the control group(56.7%, 43.3%) (P=0.019). Prophylactic HIPEC was the protective factor affecting the overall survival rate of postoperative patients with locally advanced gastric cancer (P=0.021). Conclusions For patients with locally advanced cT3-4NxM0 gastric cancer, prophylactic HIPEC plays an important role in prolonging the median survival time, hence impro-ving the overall survival rate of patients.

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    Pulmonary metastasis of hepatocellular carcinoma: pathogenesis and therapeutic advances
    GUAN Tao, ZHANG Ti, WANG Lu
    Journal of Surgery Concepts & Practice    2022, 27 (02): 180-184.   DOI: 10.16139/j.1007-9610.2022.02.018
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    In recent years, the survival of patients increased with development of treatment modalities for hepatocellular carcinoma(HCC). However, the incidence of distant metastasis was gradually increasing to make the prognosis of patients with HCC worse. Lungs are the most common distant metastatic organs from HCC. Therapy of pulmonary metastasis from HCC was still disappointing with the median overall survival less than 1 year for individual differences in patients and tumor heterogeneity. Currently, there was without standard treatment for pulmonary metastases from HCC, and the patients were treated according to the treatment guidelines of advanced HCC combined with lung cancer. Although studies on invasion and metastasis of HCC emerged in a few decades, the detail pathogenesis of lung metastasis remains unclear. This article will summarize the pathogenesis and therapeutic advances of pulmonary metastasis from HCC and emphasize the importance of intrahepatic lesion control and management of pulmonary metastases.

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    Factors related to intestine have a role in prevention and treatment for gallstone disease
    JIANG Zhaoyan, SHEN Weiyi, HU Hai
    Journal of Surgery Concepts & Practice    2023, 28 (02): 91-93.   DOI: 10.16139/j.1007-9610.2023.02.01
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    Gallstone is a common surgical disease. The factors which related to intestine during the process of gallstone formation have attracted increasing attention. The main factors affecting the formation of cholesterol gallstone including cholesterol absorption, bile acid concentration, gut microbiota changing, are all related to the intestine. A correct understanding of the factors related to intestine during gallstone formation is helpful for the prevention and treatment of gallstone disease. In future, different targets related to intestine may play an important role in both prevention of gallstone disease and post-cholecystectomy management.

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    Vascular reconstruction in radical resection for hilar cholangiocarcinoma
    LI Xiangcheng, CHEN Yananlan, LI Changxian
    Journal of Surgery Concepts & Practice    2023, 28 (02): 104-109.   DOI: 10.16139/j.1007-9610.2023.02.04
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    Radical resection is the only option of curative treatment for hilar cholangiocarcinoma. Microscopically negative resection margin of bile duct (R0 resection) is critical for long-term survival of patients. However, both portal vein and hepatic artery invasions from hilar cholangiocarcinoma were often found, the negative resection margin could not be gotten. Combined vascular resection and reconstruction provide a possible way to solve this problem. At present, the clinical value of resection of portal vein and hepatic artery combining with reconstruction has been fully recognized. The technique of reconstruction for both portal vein and hepatic artery combined with the clinical significance, preoperative evaluation of imaging and postoperative complications for hilar cholangiocarcinoma were included in this article.

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