The concept of minimally invasive surgery is adopted in the diagnosis and treatment of biliary diseases,while during the process,the biological function of the sphincter of Oddi is ignored,and blind expansion of indications of endoscopic sphincterotomy (EST) severely affected the function of the sphincter of Oddi.In this condition,protection of the sphincter of Oddi should be attached great importance.Proper selection of diagnosis method,strictly control of the indications of EST,timely repair the injured sphincter of Oddi are important for a better prognosis of patients with biliary diseases with preservation of the function of the sphincter of Oddi.

Esophageal variceal hemorrhage is a severe complication of portal hypertension.Non selective-blockers and endoscopic variceal ligation have been utilized to prevent variceal hemorrhage as the first line therapeutic measures.The role of surgical approaches in the treatment of portal hypertension is still controversy.The selective shunt operation,devascularization operation,transjugular intrahepatic portosystemic shunt and liver transplantation have their own indications and limitations.Based on the precision surgical therapy,individualized selection of suitable surgical management on portal hypertension should be advocated to minimize invasiveness and cost-effect ration,maximize organ saving and outcome.For patients with extrahepatic portal hypertension,Meso-Rex bypass operation could be the preventive treatment method,surgical treatment could be applied to patients with regional portal hypertension.

The principles of “precise liver surgery”include to absolutely clearing target lesions,ensuring structural　integrity of residual liver,maximizing the volume of remnant　liver,controlling bleed as well as minimizing hepatic parenchymal damage and surgical invasiveness.This theory serves the　whole procedure of liver surgery for the optimal recovery of　patients.The major strategies consist of accurate preoperative　evaluation:rigorous surgical planning,refined surgical operation　and meticulous perioperative care.The construction of “recise　liver surgery” system requires the combination of modern technology and traditional surgery,and the breakthrough in the core　theory and key techniques of liver surgery.

With the progress in muhimodality therapy, the management of hepatocellular carcinoma (HCC) comes to an era of diversification. Dudng the last 2 decades, the increased understanding of biological behaviors of HCC and innovations of various treatment modalities has led to dramatic changes in concepts and strategies of treatment for HCC. The changes include the shifts from experience-based medicine to evidence-based medicine, from rough treatment to precise treatment and from single therapy to integrated therapy. The implementation of these concepts and therapies will further improve the chance of survival and the quality of life for HCC patients.

With inheritance of scientific spirit of Huang Zhiqiang,depending on the modern science and technology of evidence-based medicine methods,digital surgical technique,molecular imaging technique,minimally invasive technology,genomics and proteomics technology and Big Data analytics,giving full play to the characteristics of precision surgery,which include evidence-base,quantification,visualization and controllability,a new era of biliary surgery in China is inaugurated.

Continnous theoretical and technological progress in the face of increasing expectations for quality of health care and progress in medical technology has transformed the surgical paradigm.Based on the historical trends and technique advances,a novel paradigm ofPrecision Surgery has been proposed,which is featuring certainty-based practice to ensure the best results for each patient with multi-objective optimization of therapeutic effectiveness,surgical safety and minimal invasiveness.The main characteristics of precision surgery may be summarized as determinacy,predictability,controllability,integration,standardization and individualization.The strategy of precision hepatic surgery is to seek a balance of maximizing the removal of the target lesions,while maximizing the functional remnant liver and minimizing surgical invasiveness.The concept of precision surgery should be considered for wider application in liver surgery and other fields as a step toward the ultimate goal of perfect surgery.

Objective To observe whether coagulation zones can be produced by intraductal radiofrequency ablation (RFA) in vivo and investigate the effect of portal blood flow on the sizes of coagulation zones. Methods Fourteen bile duct targets in hepatic hilar from 6 swines were equally divided into non-Pringle manoeuvre group and Pringle manoeuvre group. A 13mm segment of non-insulated mono-electrode was inserted into the bile duct, then RFA was performed under the condition of 5 W power output for 4 minutes. The pathological changes of bile duct and adjacent hepatic tissues were observed. Results Semi-oval offwhite coagulation zones in the sections were observed in both groups, with obvious dark-red rims around them. Necrosis and denaturation of mucosal and submucosal layers of bile duct and denaturation of adjacent hepatic tissue in coagulation zones were observed under optical microscope. The dark-red rims revealed hepatic hemorrhage. The mean long axial diameter of coagulation zones in the non-Pringle manoeuvre group and Pringle manoeuvre group was (13.29±1.38)mm and (13.29±1.1 1)mm, respectively, with no statistical difference (t=0.000, P>0.05). The mean short axial diameter of coagulation zones in the non-Pringle manoeuvre group and Pringle manoeuvre group was (3.14±1.07)mm and (4.57±0.98)mm, respectively, with statistical difference (t=2.611, P<0.05). Conclusions Intraductal RFA can produce a typical ablation zone. The portal blood flow affects the short axial diameter of coagulation zone but does not affect the long axial diameter.

Anatomic segmental hepatectomy,as an important part ofprecision surgery,has been accepted and widely applied as the promotion of precision hepatectomy.Anatomic segmental hepatectomy is superior to non-anatomical hepatectomy in clinical efficacy,application scope and operation techniques.There are many operation techniques developed by surgeons to accomplish segmental hepatectomy,and it is worthy for spreading in clinical practice.

The sphincter of Oddi is a valve that controls the biliopancreatic duct and plays an irreplaceable role in maintaining normal physiological functions of the biliopancreatic duct.However,sphincteroplasty and sphincterotomy may cause varying degrees of damage to the function of the sphincter of Oddi,which may further result in postoperative reflux of duodenal fluids and bacterial contamination in bile and increase the risks of recurrent common bile duct stones,reflux cholangitis,and even cholangiocarcinoma.Therefore,clinical physicians should protect the structure and function of the sphincter of Oddi.Based on our experience,under the premise that the extrahepatic bile duct can be preserved,patients with iatrogenic injury of the sphincter of Oddi can be treated with transduodenal sphincteroplasty to restore the structural integrity of the sphincter of Oddi and reduce biliopancreatic duct complications secondary to loss of function.

Objective To explore the expression of cathepsin L in hepatocellular carcinoma and to analyze its relationship with clinical and pathological features. Methods Fifty-eight specimens of hepatocellular carcinoma were studied, including 18 well-differentiated, 18 moderately differentiated and 22 poorly differentiated. Classified by TNM clinical stage, 26 were in Ⅰ/Ⅱ stage and 32 in Ⅲ/Ⅳ stage. The expressions of cathepsin L were detected with immunohistochemistry and RT-PCR. Their relationship with the clinical and pathological features of hepatocellular carcinoma was analyzed. Results The positive rate of cathepsin L protein was 72.4% (42/58), and the expressions of cathepsin L protein were significantly different among the specimens of pathological grades of tumor, of TNM clinical stages and with/without metastasis. The positive rate of cathepsin L mRNA was 65.5% (38/58). The expression of cathepsin L mRNA in hepatocellular carcinoma was correlated with pathological grades of tumor, TNM clinical stages and lymph node metastasis. Conclusion Cathepsin L plays an important role in the occurrence of hepatocellular carcinoma for its correlation with infiltration and metastasis of hepatocellular carcinoma. Cathepsin L can be used as a useful marker for the prognosis of hepatocellular carcinoma patients.