Objective:To explore the impact of endoscopic retrograde cholangiopancreatography (ERCP) combined with electrohydraulic lithotripsy on liver function and energy metabolism in patients with extrahepatic biliary stones.Methods:A prospective study was conducted on 85 patients with extrahepatic biliary stones treated in four tertiary grade A hospitals (the First Affiliated Hospital of Air Force Medical University, Baoji Central Hospital, Xi′an No. 1 Hospital Wenli Hospital, and Affiliated Hospital of North China University of Science and Technology) from January 2020 to January 2024. They were divided into a control group ( n=43, treated with ERCP) and a combined group ( n=42, treated with ERCP combined with electrohydraulic lithotripsy) using a random number table. The main evaluation indicators included liver function, energy metabolism parameters, stress levels, and postoperative complications. Results:There were no statistically significant differences in liver function indicators, energy metabolism parameters, or stress levels between the two groups before surgery (all P>0.05). At 3 days after surgery, liver function indicators in both groups were lower than those before surgery, and the liver function indicators in the combined group were all lower than those in the control group (all P<0.05). At 1 day after surgery, REE in both groups was higher than that before surgery, and RQ was lower than that before surgery; the REE in the combined group was lower than that in the control group, and the RQ in the combined group was higher than that in the control group (all P<0.05). At 3 days after surgery, the levels of Cor and ACTH in both groups were higher than those before surgery, and the Cor and ACTH in the combined group were lower than those in the control group (all P<0.05). The incidence of postoperative complications in the combined group was significantly lower than that in the control group ( P<0.05). Conclusions:ERCP combined with electrohydraulic lithotripsy can effectively improve liver function and energy metabolism, reduce inflammatory response in patients with extrahepatic biliary stones, and is safe for treatment, which is suitable for clinical promotion and application.

Objective:This study evaluated the efficacy of the PST technique: Preservation of the left colic artery (P), suture reinforcement (S), and transanal tube (T) combined with selective fecal diversion via end ileostomy, in preventing anastomotic leakage following laparoscopic anterior resection (LAR) for mid-to-low rectal cancer.Methods:We retrospectively collected data for this descriptive case series from patients who underwent laparoscopic LAR with complete or partial application of the PST technique, some of whom received prophylactic ileostomy, at the Department of Colorectal Surgery, Zhongshan Hospital Affiliated to Fudan University, and its Xiamen Branch between July, 2022 and December, 2024. "Partial PST" was defined as the implementation of PS (Preservation of the left colic artery + suture reinforcement), PT (Preservation of the left colic artery + transanal tube), ST (suture reinforcement + transanal tube), or a single T procedure (Transanal tube). The primary outcome measures were the proportion of patients who received the PST technique and terminal ileostomy, as well as the incidence of anastomotic leaks.Results:Among 198 patients, 145 received complete PST. Fifty-three patients underwent partial PST (PT) because anastomotic reinforcement was not feasible due to an excessively low anastomosis or obesity. All patients achieved R0 resection. Postoperative pathology showed that 108 patients (54.5%) were at T3-T4 stage, and 81 patients (40.9%) had poorly differentiated adenocarcinoma or mucinous adenocarcinoma. A total of 19.7% (39/198) of patients developed grade II or higher postoperative complications, including 11 cases (5.6%) of surgical site infection and 7 cases (3.5%) of urinary retention. Five patients were rehospitalized within 30 days after surgery, among whom 2 had intestinal obstruction, and 3 developed grade C anastomotic leaks that required reoperation for salvage enterostomy. The overall incidence of anastomotic leakage was 3.0% (6/198). Fifty-three patients (26.8%) received protective ileostomy, with an anastomotic leak incidence of 1.9% (1/53). Methylene blue leakage occurred in 20 patients (10.1%), all of whom received prophylactic ileostomy and had no anastomotic leakage postoperatively. Among 61 patients who received neoadjuvant chemoradiotherapy before surgery, 28 underwent prophylactic ileostomy, and none developed anastomotic leaks after surgery.Conclusions:Routine application of the PST technique during laparoscopic low anterior resection, along with prophylactic enterostomy for ultra-high-risk populations, can effectively control the incidence of anastomotic leakage.

Objective:This study evaluated the efficacy of the PST technique: Preservation of the left colic artery (P), suture reinforcement (S), and transanal tube (T) combined with selective fecal diversion via end ileostomy, in preventing anastomotic leakage following laparoscopic anterior resection (LAR) for mid-to-low rectal cancer.Methods:We retrospectively collected data for this descriptive case series from patients who underwent laparoscopic LAR with complete or partial application of the PST technique, some of whom received prophylactic ileostomy, at the Department of Colorectal Surgery, Zhongshan Hospital Affiliated to Fudan University, and its Xiamen Branch between July, 2022 and December, 2024. "Partial PST" was defined as the implementation of PS (Preservation of the left colic artery + suture reinforcement), PT (Preservation of the left colic artery + transanal tube), ST (suture reinforcement + transanal tube), or a single T procedure (Transanal tube). The primary outcome measures were the proportion of patients who received the PST technique and terminal ileostomy, as well as the incidence of anastomotic leaks.Results:Among 198 patients, 145 received complete PST. Fifty-three patients underwent partial PST (PT) because anastomotic reinforcement was not feasible due to an excessively low anastomosis or obesity. All patients achieved R0 resection. Postoperative pathology showed that 108 patients (54.5%) were at T3-T4 stage, and 81 patients (40.9%) had poorly differentiated adenocarcinoma or mucinous adenocarcinoma. A total of 19.7% (39/198) of patients developed grade II or higher postoperative complications, including 11 cases (5.6%) of surgical site infection and 7 cases (3.5%) of urinary retention. Five patients were rehospitalized within 30 days after surgery, among whom 2 had intestinal obstruction, and 3 developed grade C anastomotic leaks that required reoperation for salvage enterostomy. The overall incidence of anastomotic leakage was 3.0% (6/198). Fifty-three patients (26.8%) received protective ileostomy, with an anastomotic leak incidence of 1.9% (1/53). Methylene blue leakage occurred in 20 patients (10.1%), all of whom received prophylactic ileostomy and had no anastomotic leakage postoperatively. Among 61 patients who received neoadjuvant chemoradiotherapy before surgery, 28 underwent prophylactic ileostomy, and none developed anastomotic leaks after surgery.Conclusions:Routine application of the PST technique during laparoscopic low anterior resection, along with prophylactic enterostomy for ultra-high-risk populations, can effectively control the incidence of anastomotic leakage.

Objective:To explore the impact of endoscopic retrograde cholangiopancreatography (ERCP) combined with electrohydraulic lithotripsy on liver function and energy metabolism in patients with extrahepatic biliary stones.Methods:A prospective study was conducted on 85 patients with extrahepatic biliary stones treated in four tertiary grade A hospitals (the First Affiliated Hospital of Air Force Medical University, Baoji Central Hospital, Xi′an No. 1 Hospital Wenli Hospital, and Affiliated Hospital of North China University of Science and Technology) from January 2020 to January 2024. They were divided into a control group ( n=43, treated with ERCP) and a combined group ( n=42, treated with ERCP combined with electrohydraulic lithotripsy) using a random number table. The main evaluation indicators included liver function, energy metabolism parameters, stress levels, and postoperative complications. Results:There were no statistically significant differences in liver function indicators, energy metabolism parameters, or stress levels between the two groups before surgery (all P>0.05). At 3 days after surgery, liver function indicators in both groups were lower than those before surgery, and the liver function indicators in the combined group were all lower than those in the control group (all P<0.05). At 1 day after surgery, REE in both groups was higher than that before surgery, and RQ was lower than that before surgery; the REE in the combined group was lower than that in the control group, and the RQ in the combined group was higher than that in the control group (all P<0.05). At 3 days after surgery, the levels of Cor and ACTH in both groups were higher than those before surgery, and the Cor and ACTH in the combined group were lower than those in the control group (all P<0.05). The incidence of postoperative complications in the combined group was significantly lower than that in the control group ( P<0.05). Conclusions:ERCP combined with electrohydraulic lithotripsy can effectively improve liver function and energy metabolism, reduce inflammatory response in patients with extrahepatic biliary stones, and is safe for treatment, which is suitable for clinical promotion and application.