Hepatocellular carcinoma (HCC) complicated by arterioportal shunt (APS) is commonly seen in clinical practice,with an incidence rate of 28.8％-63.2％.It is manifested as abdominal pain,diarrhea,and ascites and can also lead to serious complications of portal hypertension including gastrointestinal bleeding.Although there are various therapeutic methods,they tend to have poor clinical effects.APS is one of the most important causes of death in patients with HCC.This article introduces the etiology,typing,clinical manifestation,and therapies of HCC complicated by APS and points out that although there are various therapeutic methods for HCC complicated by APS,interventional treatment remains the most important method.The exploration of interventional treatment helps to improve patients' prognosis.

Hepatocellular carcinoma (HCC) is a malignant tumor with high incidence and mortality rates around the world.Radiofrequency ablation (RFA) is an effective therapy for HCC,especially in patients who experience recurrence after surgery for liver cancer,who are complicated by liver dysfunction and unable to undergo surgical resection,and who have multiple liver tumors and undergo palliative treatment.RFA can significantly improve patients' survival time and quality of life.This article reviews the mechanism of RFA in the treatment of HCC from the aspects of direct and indirect injuries and helps to further understand the role of RFA in local and systemic treatment of HCC,which has a potential value for multidisciplinary treatment of HCC in future.

Objective To investigate an effective method for the treatment of biliary ascariasis.Methods A retrospective analysis was performed for the clinical data of 32 patients with biliary ascariasis who were treated in The People's Hospital of Huangmei County from January 1994 to January 2014.All the patients were given spasmolysis,pain management,anti-infective therapy,traditional Chinese medicine syndrome differentiation-based treatment,Chinese materia medica for regulating qi and relieving pain,and ascariasis-relieving and parasite -expelling treatment.Patients were given surgical treatment due to poor response.Results Of all the 32 patients,5 (15.6％) had no response to the ascariasis-relieving treatment with Fructus Pruni Mume decoction and were given surgical treatment,and 27 (84.4％) were cured by Western medicine combined with Fructus Pruni Mume decoction.There were no complications such as acute pancreatitis,perfora tion of the gallbladder,and liver abscess.All the patients were treated with Fructus Pruni Mume decoction regularly after discharge and no patient experienced recurrence.Conclusion Integrated traditional Chinese and Western medicine therapy is effective,safe,and reliable in the treatment of biliary ascariasis and holds promise for clinical application.

Objective To investigate the risk factors for short-term residual common bile duct stones after laparoscopic cholecystectomy (LC),and to provide a reference for clinical prevention and treatment.Methods A total of 18 patients with short-term residual common bile duct stones after LC who were admitted to The First Affiliated Hospital of Nanyang Medical College from January 2014 to January 2016 were enrolled as observation group,and 320 patients without short-term residual common bile duct stones after LC who were admitted during the same period of time were enrolled as control group.The two groups were compared in terms of acute pancreatitis,alanine aminotransferase (ALT),aspartate aminotransferase (AST),emergency surgery,results of preoperative magnetic resonance cholangiopancreatography (MRCP),direct bilirubin (DBil),the gallbladder full of stones,number of gallstones,minimum stone diameter,gallbladder volume,cystic duct diameter,cystic duct length,and sand-like stones.The independent-samples t test was used for comparison of continuous data between groups,the chi-square test was used for comparison of categorical data between groups,and a logistic multivariate regression analysis was performed for variables with statistical significance.Results The univariate analysis showed that acute pancreatitis,emergency surgery,sand-like stones,retrograde cholecystectomy,preoperative MRCP,number of gallstones,minimum stone diameter,gallbladder volume,cystic duct diameter,and common bile duct diameter were associated with short-term residual common bile duct stones after LC (x2 =9.801,16.217,5.802,9.865,and 5.145,t =18.314,6.077,7.687,15.678,and 5.512,all P ＜0.05).The multivariate logistic regression analysis showed that acute pancreatitis,retrograde cholecystectomy,common bile duct diameter,and cystic duct diameter were independent risk factors for short-term residual common bile duct stones after LC,while preoperative MRCP was a protective factor.Conclusion Active intervention for risk factors for short-term residual common bile duct stones after LC can reduce the incidence of postoperative residual bile duct stones.

Objective To investigate the clinical effect of ultrasound-guided percutaneous transhepatic gallbladder drainage (PTGBD) in the treatment of acute cholecystitis.Methods A retrospective analysis was performed for the clinical data of 81 patients with acute cholecystitis who underwent ultrasound-guided PTGBD in General Hospital of Lanzhou Petrochemical Company from March 2013 to February 2016.The changes in related parameters after the placement of drainage tube were analyzed.The t-test was used for comparison of continuous data between groups.Results All the 81 patients underwent a successful one-time puncture.After the surgery,1 patient experienced tube dislodgement and 2 experienced obstructed bile drainage,while no patient experienced serious complications such as bleeding,bile leakage,and hemopneumothorax.Within 12 hours after surgery,there was a significant improvement in pain in the right upper quadrant and significant reductions in the major axis and radial width of the gallbladder (t =13.28 and 9.54,P =0.023 and 0.041),as well as significant reductions in white blood cell count and neutrophil count (t =8.70 and 8.03,P =0.028 and 0.034).Of all patients,38 achieved symptom remission after the placement of drainage tube and refused selective surgical treatment,and 43 underwent cholecystectomy within 3 months after surgery.Conclusion PTGBD is simple,convenient,visible,and safe and can effectively reduce patients' pain,increase the success rate of the treatment of acute cholecystitis,improve patients' clinical outcomes,and reduce the incidence of complications.It also provides the conditions of selective surgery for critically ill patients with acute cholecystitis,and therefore,it holds promise for clinical application.

Ampullary tumors mainly manifest as obstructive jaundice and ampullary mass in clinical practice and are difficult to be identified in early stage due to a complex structure of the anatomical site,a deep location,and hidden symptoms.Sometimes a qualitative diagnosis cannot be made.Based on the experience in the treatment of ampullary tumors for many years in our center,this article summarizes the features of ampullary tumors from the aspects of clinical manifestations,diagnosis,treatment,and prognosis,especially the issues regarding imaging evaluation of ampullary tumors,selection of surgical procedure,and prognosis.An early diagnosis is the key to the treatment of ampullary tumors,and early identification and treatment of lesions have great impacts on patients' prognosis.Accurate preoperative imaging evaluation,a professional diagnosis and treatment team,accurate preoperative and intraoperative pathological analysis,and implementation of reasonable therapeutic strategy are the key to patients' recovery.

Congenital bile duct dilatation may occur in any part of the biliary tree,and the diagnosis and treatment of lesions involving the intrahepatic bile duct is the most challenging issue.Surgical operation plays a dominant role in the management of congenital bile duct dilatation,with the purposes of relieving symptoms and preventing disease progression and malignant transformation.Surgical principles are radical resection of lesions and reconstruction of unobstructed bile drainage.Hepatectomy is the main surgical procedure for congenital bile duct dilatation with involvement of the intrahepatic bile duct,and liver transplantation can be used for diffuse lesions.Therefore,we believe that hepatectomy and early intervention will maximize patients' benefits.

Inappropriate treatment of bile duct injury and traumatic biliary stricture may cause serious consequences such as recurrent cholangitis,formation of hepatolithiasis,and biliary cirrhosis.This article elaborates on the influencing factors for the effect of the repair of bile duct injtry and traumatic biliary stricture,repair principles,timing of repair or reconstruction,and related methods and techniques.It is pointed out that if there is no significant local infection and the bile duct wall defect is ＜ 2 cm,end-to-end anastomosis should be used for repair;if the bile duct wall defect is ＞ 2 cm,Roux-en-Y hepaticojejunostomy should be used for reconstruction.If the upper wall of the bile duct had a large defect and the lower wall has an integral structure,pedicled umbilical vein graft,pedicled jejunal wall seromuscular flap,or gastric wall seromuscular flap should be used for repair.The patients with severe congestion and edema at the site of injury should be treated with sufficient external drainage of the injured bile duct and then selective repair or reconstruction.Patients with hepatic duct stenosis in the liver lobe or hepatic segments and liver tissue atrophy can be treated with hepalobectomy or segmental hepatectomy.The key to successful repair is exposure and removal of high hilar bile duct stricture,while segmental hepatectomy of the Ⅳb segment can fully expose the left and right hepatic pedicles and help with the incision of the left and right hepatic ducts and secondary hepatic ducts,and therefore,it is a good method for exposing high bile duct stricture.

This article introduces the explorations in improving minimally invasive therapies and techniques for intra-and extrahepatic bile duct stones in this center,including laparoscopic choledocholithotomy without the placement of T tube,laparoscopic partial hepatectomy for the treatment of intrahepatic bile duct stones using an anastomosis stapler for liver partition,and modification of percutaneous transhepatic cholangioscopy.The improved therapies and techniques above have achieved good clinical effects,and a scientific judgment of their clinical effects still depends on a large number of cases and randomized controlled clinical trials.

Xanthogranulomatous cholecystitis (XGC) is a rare type of chronic cholecystitis characterized by severe proliferative fibrosis with infihration of macrophages and foamy cells in the gallbladder wall.Since XGC and gallbladder carcinoma have similar clinical manifestations and radiological features,XGC is often misdiagnosed as gallbladder carcinoma in clinical practice,which leads to unnecessary extensive surgical resection and has an adverse effect on patients.At present,the preoperative diagnosis of XGC is still based on imaging results (ultrasound,computed tomography,and magnetic resonance imaging),and a definite diagnosis of this disease relies on intraoperative frozen biopsy or postoperative pathological examination.Meanwhile,XGC should be differentiated from gallbladder adenomyomatosis,gallbladder carcinoma,and gallbladder actinomycosis.Laparotomy or laparoscopic cholecystectomy is the major method for the treatment of XGC,but laparoscopic cholecystectomy is associated with a longer time of operation,more complications,and a higher rate of conversion to laparotomy.Therefore,surgeons are facing difficulties in preoperative diagnosis and intraoperative decision-making process of XGC.