In recent years, the prevalence rate of nonalcoholic fatty liver disease (NAFLD) has increased significantly and NAFLD has gradually become one of the common chronic liver diseases in China. Patients with NAFLD-related end-stage or deteriorative liver diseases have become one of the main populations for liver transplantation. The increasing prevalence rate of NAFLD and the severe outcomes of nonalcoholic steatohepatitis (NASH) make it necessary to use effective methods to identify NAFLD. Therefore, this article summarizes the current serological methods for the diagnosis of NAFLD, including steatosis, NASH, and liver fibrosis, and discusses their advantages and disadvantages. Although most of the serum markers have limited clinical value, serum marker models have a good application prospect in the diagnosis of hepatic steatosis, the evaluation of fibrosis degree, and preliminary screening. Since a combination of different serological models can improve the accuracy of diagnosis, multi-angle and multicenter joint diagnosis will be a research hotspot in the future.

Objective To explore the value of round ligament approach in the bile duct benign stricture near porta hepatis.Methods Data of 62 patients treated in Hunan Provincial People's Hospital from Mar 2016 to Mar 2018 were retrospectively analyzed.Results Hepatolithiasis was the cause of bile duct benign stricture in 37 cases,followed by iatrogenic injury (12 cases),cholangio-intestinal anastomotic restenosis (7 cases),cystic dilatation of bile duct (4 cases) and bridge-shaped calculus (2 cases).We get access to the strictured bile duct near porta hepatis by way of round ligament,and hilar cholangioplasty and bilioenteric anastomosis was done at the porta hepatis.The surgery lasted an average of 230.3 minutes and with an average 196.8 ml blood loss.By Clavien-Dindo scoring system,there were Grade Ⅰ complications in 32 cases,Grade Ⅱ complications in 3.On follow-up survey,there were 3 patients with reflux cholangitis.Condclsion Round ligament is a gateway to hilar bile duct benign stricture in an attempt to make hilar cholangioplasty.

Objective:To evaluate fibrotic border guided anatomical hepatectomy in the treatment of hepatolithiasis complicated with atrophy-hypertrophy complex.Methods:One hundred and sixty-seven cases undergoing hepatectomy guided by the boundary of liver fibrosis in the treatment of hepatolithiasis complicated with atrophy-hypertrophy complex from Jan 2011 to Dec 2019 in Hunan Province Peopole's Hospital were reviewed.Results:All patients were successfully treated by anatomical hepatectomy under the guidance of the liver fibrosis boundary with intraoperative choledochoscopy,the operation time was (231.5±37.1) min and the average blood loss was (375.7±52.6) ml,the average hospital stay was (10.2±1.1) days,the residual stone rate was 8.9%, according to the scoring system of Clavien-Dindo, Grade Ⅰ complications occured in 86 cases, Grade Ⅱ complications occured in 35.Follow-up ranged from 3 to 107 months, 15 cases had recurrent stones,four were reoperated.Conclusions:Fibrotic border guided anatomical hepatectomy in the treatment of hepatolithiasis complicated with atrophy-hypertrophy complex is safe and effective.

Objective:To explore the value of " internal anastomosis" of bile duct , ie intrahepatic duct stricture resection, cholangioplasty and bilioenteric anastomasis, in the treatment of hepatolithiasis with stricture of bile duct orifice.Methods:The clinical data of 74 patients undergoing this procedure from Dec 2017 to Dec 2019 at Hu′nan Provincial Peopole′s Hospital were retrospectively analysed.Results:All 74 patients received intraoperative choledochoscopy lithotomy, and 26 cases had a hepatectomy for atrophic fibrosis. There were 27 cases with orifice stricture of left-lateral bile duct or its major branchs; 22 cases with that of caudate lobe ducts. 3 cases with that of right anterior ducts; 8 cases with that of right posterior bileduct; and 14 cases with that of bilateral multiple bile ducts . The average operation time was (243±31) min (ranging from 180 to 360 min), the average intraoperative blood loss was (150±26) ml (ranging from 100 to 600 ml). The average postoperative hospital stay was (10.0±2.2) d. The occurrence rate of residual stone was 8.1%. 14 cases (18.9%) had postoperative complications , including 2 cases with bleeding, 1 case with bile leakage, 4 cases with wound infection, 13 cases with pleural effusion. All were cured by conservative therapy, and no complications of grading Ⅲa or above happened according to Clavien Dindo grading system. All 74 cases were followed up, the average follow-up time was (10.2±3.6) months (ranging from 6 to 18months) with good result.Conclusion:" internal anastomosis" is an effective method to remove the narrow openings of intrahepatic bile ducts , thus helps to preserve much possible liver parenchyma, while decreasing the rate of residual stone.

Objective:To evaluate short-term therapeutic effect of surgical treatment for complicated hepatolithiasis under the guidance of 3D reconstruction.Methods:We retrospectively analyzed the clinical data of 56 patients with complicated hepatolithiasis undergoing surgical treatment with the guidance of 3D reconstruction at the Department of Hepatobiliary Surgery of Hunan Province People′s Hospital from Jan 2011 to Jun 2019.Results:All the patients were successfully operated on under the guidance of three-dimensional reconstruction and extraction of residual stones by choledochoscope. The average duration of operation was 210.3 minutes and the average blood loss was 350.6 ml. According to the scoring system of Clavien-Dindo, Grade Ⅰ complications occurred in 36 cases, Grade Ⅱ complications in 5 cases and there were no complications of Grade Ⅲ or higher. As found by an average follow-up of 3.6 years (range from 5 months to 8 years) , only one patient had reflux cholangitis .Although the rate of residual stone was 68.8%, most stones remained only in the end branch of bile duct, hence do not interfere much with the patients′ living status.Conclusions:The surgical treatment with the guidance of 3D reconstruction is of satisfactory short-term curative effect in complicated hepatolithiasis.