Hepatolithiasis is a common disease of abdominal surgery,although its incidence appears to decline,China is still a high incidence area with millions of patients with hepatolithiasis.Because of the complex pathogenesis,progressive development and frequent recurrence,it is seriously affecting physical and mental health of patients and quality of life,as well as difficult to define the diagnosis and select treatment methods for hepatolithiasis.The Guideline of the Diagnosis and Treatments of Hepatolithiasis and the Expert Consensus of the Laparoscopic Treatments of Hepatolithiasis (2013 edition) proposed a concise and practical classification system of the hepatolithiasis and summarized the principles of surgical treatments,which includedresecting the lesions,cleaning the stones,correcting the stricture,recovering the drainage and preventing the recurrence .Meanwhile,the application of laparoscopic technique in the treatments of bepatolithiasis was proposed,which played an important role to promote the standard diagnosis and treatments of hepatolithiasis in China.Recent years,more and more evidences from evidence-based medicine further proved the importance of the anatomical hepatectomy in the treatments of hepatolithiasis.With the soaring development of laparoscopic surgery,the combination of laparoscopic hepatectomy with the assistance of other endoscopies are applied more and more frequently.The concept of precise surgery also brings new vitality to the standard diagnosis and treatments of the hepatolithiasis.

Objective To analyze the pathological features of Liver in chronic asymptomatic carrier (AsC) and to diagnose and treat AsC correctly.Methods 115 patients with AsC were examined with serological markers of B-hepatitis,liver function serum,HBV-DNA level,liver biopsy and immunohistochemistry.Results Of 115 patients with AsC,there were 8.7% patients with invisibly pathological lesions of hepatic tissue (G_0S_0),29.6% patients with chronic hepatitis,1.7% patients with cirrhosis.Through immunohistochemistry HBsAg and HBcAg test,there were 66.96% patients with HBsAg(+) and HBcAg(+),33.04% patients with single HBsAg(+).Conclusions Liver biopsy and immunohistochemistry can help to correct diagnose.It has important directional significance to treat AsC and establish treatment project of AsC.

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A total of 291 patients with genotype-1b chronic hepatitis C (CHC) admitted in Hangzhou Xixi Hospital and Jiande Second People′s Hospital between August 2018 to June 2019. All patients received sofosbuvir/daclatasvir (SOF/DCA) therapy for 12 weeks, and were followed up for 24 weeks after treatment. Data were missed in 2 cases, among remaining 289 cases, there were 238 cases without cirrhosis (non-cirrhosis group), 48 cases with compensated cirrhosis (compensated cirrhosis group) and 5 cases with decompensated cirrhosis (decompensated cirrhosis group). The biochemical indexes, blood routine test results, aspartate aminotransferase-to-platelet ratio index (APRI) , fibrosis-4 (FIB-4) and related adverse event were collected. In non-cirrhotic group, 15 cases and 41 cases were lost follow-up after 12 weeks and 24 weeks of treatment, respectively. The sustained virologic response rate on week 12 (SVR12) and SVR24 in non-cirrhotic group were 82.2% (194/236) and 81.7% (193/236) respectively; whole SVR12 and SVR24 rates in compensated cirrhosis group (48/48) and decompensated cirrhosis group (5/5) were all 100% (χ 2=0.96, χ 2=0.44, P>0.05). The blood ALT [ 14 (6, 23) and 14 (5, 72) U/L], AST[22 (14, 24) and 23 (15, 52) U/L], hemoglobin [46 (42, 48) and 46 (34, 51) g/L], globulin [ (32.6±4.0)和(31.6±3.8) g/L], PLT[ (145.0±49.7) and (142.0±47.4) ×10 9/L], APRI [0.4 (0.2, 0.4) , 0.4 (0.3, 1.5) ] of 289 cases on week 12 and 24 after treatment were significantly improved; compared with baseline values [44(8, 175) U/L, 44(23, 154)U/L, 45 (41, 49) g/L, (33.0±4.0) g/L, (150.0±53.7) ×10 9/L, 0.7(0.3, 6.3)] (Week 12: Z=-14.21, Z=-13.97, Z=-14.72, t=2.00, t=5.22, Z=-13.52; (Week 24: Z=-13.12, Z=-13.04, Z=-4.63, t=7.18, t=7.25, Z=-9.48, all P<0.05). Compared with baseline values [ (16.1±5.4) μmol/L, (5.7±1.5) ×10 9/L, 3.4(1.2, 15.2)], the total bilirubin (15.4±5.8)μmol/L, WBC (6.2±1.8)×10 9/L, FIB-4[3.2 (1.5, 13.7) ] levels were also improved ( t=2.34, t=-5.51, Z=-3.40, all P<0.05). Univariate logistic analysis did not find factors influencing the SVR24 of Sofosbuvir/Daclatasvir therapy. The most common adverse events were fatigue (14.8%,36/248), headache (9.3%,23/248), skin rash and pruritus (4.8%, 12/248), diarrhea (5.6%, 14/248), all of which were alleviated after treatment. In conclusion, SOF/DCA is the optimized selection for na?ve patients with genotype-1b CHC with high SVR12 and SVR24 rate and good safety.

The comprehensive and multiple disciplinary team therapeutic strategies of pancreatic cancer have been accepted as a consensus. Immune checkpoint inhibitors have made great breakthroughs in the treatment of various solid tumors. However, immune checkpoint inhibitors failed to elicit efficacy in patients with pancreatic cancer and how to overcome the immunosuppressive tumor microenvironment may be the crucial event. Combination regimens of immune checkpoint inhibitors with chemotherapy, radiotherapy, and molecular targeted therapy have been underway, but the sample size of the clinical trial was still limited. Considering the current research status and progress of pancreatic cancer, this article further discusses the practical problems of immune checkpoint inhibitors and makes objective evaluation of its value.

Objective:To summarize the experience and the clinical data of patients with primary hyperparathyroidism undergoing endoscopic parathyroidectomy.Methods:A total of 24 patients who underwent endoscopic parathyroidectomy for primary hyperparathyroidism in Peking Union Medical College Hospital during Feb. 2021 to May. 2022 were concluded in this study (20 cases of parathyroidectomy via axillary approach and 4 cases of parathyroidectomy via thoracic and breast approach) . The operation time, postoperative drainage, length of stay, level of parathyroid hormone and serum calcium of those patients were collected. Postoperative complications and recurrence of hyperparathyroidism were also observed.Results:The postoperative levels of serum parathyroid hormone and serum calcium were significantly reduced (over 50%) compared with preoperative level ( P<0.05) . The average operation time was (96±22) min (64-157 min) . The mean postoperative drainage volume was (47±16) ml on day 1, (46±11) ml on day 2, and (30±9) ml on day 3, respectively. The average length of postoperative hospital stay was (2.8±1.1) days (2-6 days) . In one case of parathyroidectomy via axillary approach, the operation was converted to open surgery because of the low position of lesion. Other cases completed endoscopic surgery and obtained satisfactory cosmetic results. There were no postoperative complications such as bleeding, permanent hoarseness, coughing while drinking water, or surgical site infection. The mean follow-up time was (7.4±4.2) months (1-16 months) . There was no obvious discomfort and no recurrence during follow-up. Conclusion:Endoscopic parathyroidectomy is safe and effective in the treatment of primary hyperparathyroidism, which can be used as a surgical option for patients with cosmetic requirements.