Abstract:Liver is the most important target organ for hematogenous metastasis of colorectal cancer, and liver metastasis of colorectal cancer is one of the big challenges in the treatment of colorectal cancer. In order to improve the diagnosis and comprehensive treatment of liver metastases of colorectal cancer in China, the members of guideline development group kept pace with the changing times, collected and summarized the advanced experience and latest achievements in this field at home and abroad, and updated and developed the Chinese guidelines for the diagnosis and comprehensive treatment of colorectal liver metastases (2023 edition), so as to provide continuous guidance and support for the diagnosis and treatment practice of colorectal liver metastases in China.

Abstract:Background and Aims Anatomic hepatectomy (AH) is a type of liver resection targeting the tumor-bearing portal territory. It conforms to precise hepatectomy and has gradually become the mainstream laparoscopic hepatectomy for patients with hepatocellular carcinoma (HCC). However, for a long time, the academic community has debated whether AH is superior to non-anatomic hepatectomy (NAH) in terms of oncological benefits for patients with HCC. This controversy may be due to the anatomical deviation of the traditional segmentation method (Couinaud's system) from the patient's actual liver vascular anatomy, which may fail to remove all tumor-bearing portal territory completely. The popularization of three-dimensional (3D) visualization technology can help surgeons more intuitively and fully understand the patient's intrahepatic vascular course and variations before surgery, make the most realistic analysis of the tumor-bearing portal territory, and guide the development of individualized and accurate AH. In this article, the authors discuss the above problems based on clinical experience and describe the procedural steps and experience of implementing AH under laparoscopy.Methods The clinical data of 2 patients with HCC treated in the Department of Liver Surgery, Xiangya Hospital, Central South University in 2022 were retrospectively analyzed. Both patients had single tumor lesions involving two adjacent liver segments. The 3D imaging analysis of the liver and mass was carried out by professional software before surgery. The tumor-bearing portal territory was set as the resection range while taking into account that the surgical specimen to meet the minimum safe margin (1 cm), otherwise it was necessary to include the adjacent 1-2 portal tributaries and their territories to expand the resection range to achieve the safe margin appropriately. During the operation, 3D laparoscopy was used. The liver membrane structure was entirely used to help dissect the tumor-bearing hepatic pedicle under low central venous pressure and temporary total hepatic blood inflow blockade (if necessary, liver parenchyma was split to facilitate the exposure of the liver pedicle). Then the liver blood inflow was restored. The ischemia/resection range was marked on the liver surface. After that, the resection range and the distance between the resection margin and the mass were determined again by intraoperative ultrasound to confirm whether the resection margin was consistent with the preoperative plan.Results Both patients had successful operations, and after the target liver pedicles were dissected and ligated, the scope of the ischemia area was in line with the preoperative plan, which was confirmed by laparoscopic ultrasound. Postoperative specimen autopsy revealed that the distance between the resection margin and the mass was at least 1 cm. Pathological examination confirmed that both patients had well-differentiated HCC and no tumor microvascular invasion. There was no tumor recurrence during 6-8 months of postoperative follow-up, and their quality of life was satisfactory.Conclusion 3D visualization combined with tumor-bearing portal territory analysis can help clinicians clarify the range of AH in HCC patients before surgery. Meanwhile, considering the safety margin of at least 1 cm, the minimum range of AH that is clinically acceptable can be achieved. This approach is particularly useful when a single mass simultaneously involves 2 adjacent liver segments. However, if the mass is close to large intrahepatic vessels (e.g., the middle or right hepatic vein), a wider range of AH may provide better oncological benefits.

Abstract:Background and Aims Hepatic perivascular epithelioid cell neoplasm (PEComa) is a rare primary tumor of the liver and is easily misdiagnosed as hepatocellular carcinoma and hepatic hemangioma due to the lack of specific symptoms and imaging features, which affects clinical treatment. To investigate the disease characteristics and treatment of hepatic PEComa, this study analyzed the clinical diagnosis and prognosis by summarizing the clinicopathologic data of previous patients with hepatic PEComa in our hospital to improve the diagnosis and treatment of this disease.Methods The clinicopathologic data of 38 patients with hepatic PEComa treated in Department of General Surgery, Xiangya Hospital, Central South University between July 2010 and June 2021 were reviewed, and the dataset that included clinical features, imaging manifestations, pathological features, treatment, and prognosis was analyzed.Results Of the 38 patients, 28 cases were (73.7%) females, and 10 cases (26.3%) were males, with a median age of 46 (21-66) years. A total of 40 liver nodules were detected in the 38 patients, and the size of lesions ranged from 1.0 to 20.0 cm, with a mean of (6.02±4.84) cm, among which 21 (52.5%) were located in the right liver, 17 (42.5%) in the left liver, and 2 (5%) in the caudate lobe. Ten patients presented with clinical symptoms such as abdominal distension and pain or chills with fever. Thirty-five patients underwent preoperative liver ultrasonography, and the lesions appeared as hyperechoic (18 cases), mixed echogenic (12 cases), or hypoechoic (5 cases) texture. Twenty-three patients underwent preoperative enhanced CT, and all lesions were enhanced in the arterial phase after enhancement. Nineteen presented hypointense in the portal and delayed phases, and 4 had a prolonged enhancement in the portal and delayed phases. Ten patients underwent magnetic resonance imaging examination, of whom, the lesion showed low signal intensity on T1-weighted images showed and high signal intensity on T2-weighted images in 6 cases, showed high signal intensity on T1 images and low signal intensity on T2 images in 3 cases, and showed equal signal intensity on both T1 and T2 images in one case; the lesions in all cases showed high signal on diffusion-weighted images. One patient underwent 18F-FDG PET/CT scan, on which low glucose metabolism and abnormally increased uptake of 18F-choline of the lesion was observed, and was misdiagnosed as hepatocellular carcinoma before operation. All patients underwent hepatectomy, including 2 cases, diagnosed with hepatic hemangioma and suffered rupture and bleeding after treatment with transcatheter arterial embolization in other hospitals. The lesions in all patients were diagnosed as hepatic PEComa by postoperative pathological examination. The positive rates of immunohistochemical staining for various tumor markers were 100% for HMB-45 (38/38), 47.4% for CD34 (18/38), 44.7% for melan-A (17/38), and 21.1% for SMA (8/38). Complete follow-up information was obtained in 34 cases of the 38 patients. The median follow-up time was 60.5 months. Only one case died 3 years after surgery, and no tumor recurrence or metastasis was observed in all the other patients during the follow-up period.Conclusion PEComa of the liver lacks specific clinical manifestations and imaging features, and postoperative histopathological examination is the gold standard for diagnosis. Surgical resection should be performed as early as possible for those with the development of symptoms and lesion challenging to be identified as benign or malignant.

Abstract:Background and Aims Although many animal experiments have confirmed that remote ischemic preconditioning (RIPC) can significantly improve the early tissue perfusion and oxygenation of the residual liver after hepatectomy, reduce the hepatic ischemia-reperfusion injury (HIRI), accelerate the surgical prognosis, and improve the survival rate. However, there is still controversy over the role of RIPC in relieving HIRI in clinical studies. Therefore, this study was conducted to evaluate the efficacy and safety of RIPC in hepatectomy through Meta-analysis to provide evidence-based information for clinical decision-making.Methods Randomized controlled trials (RCTs) evaluating the efficacy and safety of RIPC strategy were collected by searching several national and international literature databases. The search spanned the period from the inception of each database to May 2022. After data extraction and quality evaluation of the included studies, Meta-analysis was performed using RevMan 5.3 software. The main evaluation indicators were postoperative liver function parameters, operative time, intraoperative blood loss, length of postoperative hospital stay, and the major postoperative complications.Results A total of 11 RCTs were included, involving 851 patients, with 422 cases in the RIPC group and 429 cases in the control group. The results of Meta-analysis showed that there was no significant difference in each liver function parameter before operation between the two groups (all P>0.05); the levels of alanine transaminase (ALT) and aspartate transaminase (AST) on postoperative day (POD) 1 were significantly lower in RIPC group than those in control group (WMD=-74.92, 95% CI=-126.18--23.67, P=0.004; WMD=-66.37, 95% CI=-106.47--26.27, P=0.001), but significant heterogeneity existed among the studies (I2=98%; I2=95%), there were no significant differences in ALT and AST levels on POD 3 and 7 between the two groups (all P>0.05), and there were no significant differences in levels of total bilirubin and albumin on POD 1, 3 and 7 between the two groups (all P>0.05); no statistical differences were noted in other evaluation indicators between the two groups (all P>0.05).Conclusion The application of RIPC in hepatectomy offers limited clinical benefit and cannot alleviate liver injury caused by HIRI after hepatectomy. However, more high-quality multicenter RCT studies still need to verify the above conclusions. In addition, all current clinical studies are performed under propofol anesthesia or propofol combined with inhalation anesthesia, which is also a hot topic of debate.

Abstract:Background and Aims Hepatocellular carcinoma (HCC) is the most common type of liver cancer. The prognosis of HCC patients is poor, and its effective prognosis prediction is also facing significant challenges. Several studies have shown that the genetic markers associated with the E2F gene family and immune microenvironment are important prognostic factors for cancers. Therefore, this study was conducted to screen the HCC gene signatures related to the E2F gene family and immune microenvironment using the TCGA database, establish a new risk assessment model for HCC and predict the potential therapeutic targets for HCC.Methods A large HCC (LIHC) dataset (n=424) from the TCGA database was downloaded. Gene set enrichment analysis, single sample gene set enrichment analysis, and differential gene expression analysis was performed, marker genes were screened and modeled by Lasso regression, patient scores were calculated according to the model, and patients were divided into high-risk and low-risk groups. Multiple statistical methods, such as the receiver operating characteristic (ROC) curve, Kaplan-Meier survival curve, and Cox regression analysis, were used to verify the model's reliability. R language software was used for all statistical analyses. Finally, genetic alterations of the marker genes from the risk model were queried in the TCGA-HCC samples in the Cbioportal database. The protein interaction information was downloaded from the String database and visualized in Cytoscape software.Results After identification of the E2F target genome and immune-related differential genes which were closely related to HCC, seven genes (CYR61, fbln5, LPA, SAA1, SDC3, serpine1, ssrp1) significantly associated with the overall survival rate of HCC patients were screened, and a prognostic 7-mRNA signature model was established: risk score=-0.55×CYR61 expression-0.18×FBLN5 expression-0.17×LPA expression -0.06×SAA1 expression +0.31×SDC3 expression+0.38 ×SERPINE1 expression+1.08×SSRP1 expression The ROC AUC value of the model was 0.846. Kaplan-Meier survival curve showed that patients with high-risk scores had a poor prognosis (P<0.001). The degree of discrimination for prognosis of high and low-risk scores was similar to those of tumor size and UICC stage and higher than those of lymph node metastasis, distant metastasis, and BMI. Multivariate Cox regression analysis showed that the predictive ability of the 7-mRNA signature model was independent of clinical factors. In addition, the key genes SERPINE1 and LPA in the 7 genes were found by combining proteomics, which predicted that inhibiting plasminogen activation was probably a new target approach for treating HCC.Conclusion This study reveals the correlation between seven genes and E2F targets and immunity, provides new biomarkers for poor prognosis of HCC patients and establishes a prognostic risk score model with high predictive accuracy. However, the predictive ability of the polygenic prognosis model still needs to be confirmed by many evidence-based medical practices from multiple centers, and the gene function and participation mechanism of the included polygenic models still need to be further studied.

Abstract:Background and Aims Hepatocellular carcinoma (HCC) is a common malignancy with a high recurrence and mortality rate. Cuproptosis is a new type of programmed cell death involved in tumor cells' proliferation, growth, angiogenesis, and metastasis. Therefore, this study aims to investigate the relationship between the expression of cuproptosis-related genes (CRGs) and the prognosis in HCC, establish a prognosis-related nomogram model, and analyze the association of CRGs with the immune cell infiltration in HCC.Methods Differential expression analysis of CRGs in the TCGA database was performed using the R language "limma" package; the "clusterProfiler" package was used for GO and KEGG analysis; the prognostic CRGs were screened by univariate Cox regression analysis; the prognostic scoring model based on CRGs for HCC was constructed by Lasso-Cox regression analysis; the "ggsurvplot" package drew the Kaplan-Meier survival curve draws using overall survival (OS) as the outcome variable; the "survival ROC" package created the ROC curve for assessing the accuracy of the prognostic score; the nomogram and the calibration curves were drawn by the 'regplot' and 'rms' packages; the associations between the expression of CRGs and the abundance of six immune cells were analyzed using the TIMER database.Results Among the 19 CRGs, there were 16 differentially expressed ones in HCC tissue compared with normal tissue (up-regulation: PDHB, PDHA1, MTF1, LIPT1, LIPT2, LIAS, GLS, DLD, DLST, DLAT, CDKN2A, and ATP7A; down-regulation: SLC31A1, GCSH, DBT, and NLRP3), and NLRP 2 had the highest mutation frequency of 12%. GO, and KEGG analyses showed that CRGs were enriched in signaling pathways such as the tricarboxylic acid cycle, carbon metabolism, pyruvate metabolism, glycolysis/gluconeogenesis, and platinum drug resistance. Three CRGs (CDKN2A, GLS, and DLAT) that affected the OS were screened by univariate Cox regression analysis and LASSO Cox regression analysis for the construction of the prognostic model, and the prognostic score was constructed using regression coefficient: risk score=0.22×DLAT (expression level) + 0.11×CDKN2A (expression level) + 0.03×GLS (expression level). The Kaplan-Meier curve analysis showed that the HCC patients with high-risk scores had a poor prognosis (P<0.05), and the model prediction performance was evaluated by the time-dependent ROC curve of the risk model, and the AUC at 1, 3, and 5 years was 0.741,0.657 and 0.633, respectively. The nomogram was constructed by incorporating age, sex, T stage, N stage, M stage, pathological classification, CDKN2A, GLS, and DLAT. The calibration map showed good consistency between the nomogram prediction and the actual observation. There were positive correlations of GLS, DLAT, and CDKN2A with HCC immune cell infiltration and a significant correlation with immune checkpoints PDCD 1, CD274, and HAVCR2 (all P<0.05). Further analysis indicated that the higher CDKN2A, GLS, and DLAT expression in HCC tissue, the later the Barcelona pathological stage, the worse the histological grade in patients (all P<0.05).Conclusion Gene signatures associated with cuproptosis can be used as potential prognostic predictors for HCC patients and may provide new insights into the treatment of HCC.

Abstract:Background and Aims Many studies have demonstrated that the regulation mode of endogenous competition between the long noncoding RNAs (lncRNAs) and the microRNAs (miRNAs), as well as their target genes, is closely related to the occurrence and development of malignant tumors. The authors' team has previously found a binding site between lncRNA GAS8-AS1 and miR-135b through software prediction. However, it is unclear whether there is competition between them in hepatocellular carcinoma (HCC) and their actions. Therefore, this study aims to investigate the expressions of lncRNA GAS8-AS1 and miR-135b in HCC tissue and their clinical significance.Methods The specimens of cancer and adjacent tissues from 110 patients with HCC undergoing surgical resection in Qinghai University Affiliated Hospital from February 2017 to February 2019 were collected. qRT-PCR was used to detect the expressions of lncRNA GAS8-AS1 and miR-135b, and their associations with clinicopathologic features and the prognosis of patients were analyzed.Results The expression of lncRNA GAS8-AS1 in HCC tissue was significantly lower, while the expression of miR-135b was significantly higher in HCC tissue than in paracancerous tissue (both P<0.05). Their expression levels were all related to the Edmondson stage, TNM stage, degree of differentiation and lymph node metastasis in HCC patients (all P<0.05). The 3-year overall survival rate of patients with low expression of lncRNA GAS8-AS1 or high expression of miR-135b was significantly lower than that of patients with high expression of lncRNA GAS8-AS1 or low expression of miR-135b, respectively (both P<0.05). Low expression of lncRNA GAS8-AS1 and high expression of miR-135b together with high Edmondson grade, advanced TNM stage, and history of hepatitis B were independent risk factors for the prognosis of HCC patients (all P<0.05).Conclusion There is low expression of lncRNA GAS8-AS1 and high expression of miR-135b in HCC tissue, and the competitive state of their expressions may be closely associated with the initiation and progression of HCC as well as the prognosis of patients.

Abstract:Background and Aims Intrahepatic ectopic splenosis (ES) is relatively rare in clinical practice. In most patients, the intrahepatic lesions are accidentally found during physical examination, often misdiagnosed as benign or malignant liver tumors, and may be given inappropriate treatment. Therefore, this study was conducted to investigate the clinical characteristics of intrahepatic ES and its diagnosis and treatment methods.Methods The clinical data of 6 patients with intrahepatic ES treated in Shanghai Eastern Hepatobiliary Surgery Hospital from January 2015 to January 2022 were retrospectively analyzed and summarized, and the relevant literature review was performed.Results Of the 6 patients with intrahepatic ES, 4 cases were males, and 2 cases were females, aged 39-78 years, with a median age of 51 years; all cases had a history of splenectomy for traumatic splenic rupture and hemorrhage, and the time from splenectomy to initial diagnosis of intrahepatic ES was 20-33 years, with a median time of 27 years; 4 cases were pure intrahepatic ES, and 2 cases were multiple ES of the liver and diaphragm; one case was accompanied by discomfort of the right upper abdomen, and all the other 5 cases were found in physical examination; 5 cases were initially diagnosed as liver cancer, and 1 case was as initially diagnosed as angiomyolipoma by preoperative MRI or CT. All 6 patients underwent hepatectomy. Postoperative pathological examination confirmed that all the specimens were ectopic splenic tissue. The size of the intrahepatic splenic implant was 1.5-5.9 cm, with a median diameter of 3.2 cm. In one patient, the two lesions were ES and hepatocellular carcinoma, respectively, as determined by pathological examination. All 6 patients recovered uneventfully after the operation, and no new ES lesions were found during half a year follow-up period. The results of literature review showed that 90% of the ES occur in the abdominal cavity, which is frequently found in the serosa of the small intestine, the greater omentum, the parietal peritoneum, the mesentery, and the pelvic cavity, but rarely detected in the liver, the diaphragm, and other remote organs.Conclusion In individuals with a previous history of splenectomy for splenic trauma, the possibility of heterotopic ES should be considered after detecting intrahepatic lesions; Intrahepatic ES grows slowly, and most of them have no clinical symptoms. No special treatment is needed for those without clinical symptoms after a definite diagnosis.

Abstract:Background and Aims Portal hypertension is characterized by an increased portal pressure gradient (PPG). However, the conventional method for PPG measurement is difficult and risky, so it is challenging to implement in a clinical setting routinely. Previous animal experiments and human tests have shown the feasibility and accuracy of the endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) measurement techniques. A recent prospective study involving patients with subacute portal hypertension caused by occlusion of the small hepatic veins verified the consistency between EUS-PPG and hepatic venous pressure gradient (HVPG). However, there is no report assessing EUS-PPG measurement in patients with cirrhotic portal hypertension in China. Therefore, this study was performed to investigate the accuracy, feasibility, and safety of EUS-PPG measurement in cirrhotic portal hypertension.Methods A total of 52 patients with cirrhotic portal hypertension admitted to the Third Xiangya Hospital of Central South University from March 2022 to August 2022 were enrolled for EUS-PPG measurement. The EUS-PPG measurement results and their associations with the clinical features of patients were analyzed.Results In the 52 patients, 47 cases had a previous or recent history of esophageal and gastric variceal bleeding (14 cases had previous devascularization and splenectomy). EUS-PPG was successfully performed in 51 cases (98%), and technical failure occurred in one case. The approaches for portal vein puncture included that through the gastric wall (42 cases) or the duodenum (9 cases) and punch of the hepatic vein (10 cases) or retrohepatic inferior vena cava (41 cases) through the gastric wall. The operative time was (15.5±3.4) min. Of the 51 patients, the average portal vein pressure was (21.0±7.1) mmHg, the hepatic vein pressure was (5.7±5.5) mmHg and the PPG was (15.3±4.9) mmHg. Five patients underwent simultaneous portal vein and left gastric vein puncture for pressure measurement, and the results showed that the two pressure values were highly correlated (r=0.99, P=0.000 66). No adverse events were observed in all patients. The PPG value in patients who had previously undergone devascularization and splenectomy was significantly lower than that in those who had not undergone this procedure (12.8 mmHg vs. 16.3 mmHg, P<0.05), the PPG value in patients with a history of esophageal and gastric variceal bleeding was significantly higher than that in those with no history of this complication (16.8 mmHg vs. 11.8 mmHg, P<0.05), and there was no significant difference in PPG value among patients with different Child-Pugh classifications (P>0.05).Conclusion EUS-PPG is a new method for directly determining the pressure difference between the portal vein and hepatic vein, which is accurate, reliable, safe, and feasible. Transduodenal portal vein puncture or puncture of the dilated main branches of the portal vein can be performed instead when technical difficulties occur during conventional portal vein puncture.

Abstract:Early metastasis is a significant cause of postoperative recurrence and high mortality of hepatocellular carcinoma (HCC). Vessels encapsulating tumor clusters (VETC), a unique vascular metastasis pattern independent of the traditional epithelial-mesenchymal transitions metastatic mode, has been discovered through recent studies. It is associated with a higher degree of metastasis and worse prognosis and poses a more significant challenge to the proper treatment for HCC patients. Herein, the authors summarize the research status, mechanism, and clinical significance of the VETC pattern in HCC, to serve as a reference for the clinical and basic research in HCC.

Abstract:The fair allocation of liver transplants to alcoholics has been a subject of great controversy in the field of bioethics. These heated debates cluster around the themes that mainly include considering alcoholism to be a disease or a moral vice, the responsibility of liver transplant allocation on alcoholics (medical responsibility, moral responsibility, and whether responsibility can be used as a criterion for the allocation of scarce medical resources), and the role of public opinion in liver transplant allocation for alcoholics. The investigations found that the consideration of absolutely excluding alcoholics from eligibility for liver transplantation is not supported in the current debate, and ethical arguments are more inclined to support the decision to give a lower priority to liver transplantation for alcoholics. To further achieve the equity in liver allocation in China, it is imperative to strengthen case assessment of liver transplantation in alcoholics, strictly control alcohol intake after liver transplantation, and put more emphasis on the role of public opinion in the establishment of national guidelines for organ allocation. Here, the authors summarize the current controversial status of fair and equitable allocation of liver transplantation in alcoholics, so as to provide some reference for clinical organ allocation and national guidelines for liver allocation.

Abstract:Peritoneal adhesions (PAs) are abnormal fibrous bands between damaged tissues and organs in the abdominal cavity caused by surgery, peritoneal inflammation, peritoneal dialysis, etc. Among them, surgery is the leading cause of PAs. PAs can cause infertility, intestinal obstruction, intestinal perforation, and other clinical complications. Secondary adhesiolysis surgery is the primary treatment option, but it is prone to recurrence and has various complications and risks. In recent years, a series of drugs and barrier materials have been developed to prevent and treat PAs, but the effect is not satisfactory. PA-resistant drugs increase the risk of bleeding and inhibit normal immune function. Although barrier materials can alleviate the progress of PAs to a certain extent, they cannot achieve the ideal effect of anti-PAs because they cannot cover the peritoneal injury site for a long time, and the degradation is not complete. Therefore, breakthroughs are needed in the prevention and treatment of PAs. Recent studies have shown that PAs result from various events, including vascular injury, platelet aggregation, coagulation cascade, and fibrin deposition. Eventually, fibrin and extracellular matrix deposition form adhesion bands and later develop contractile scarring and cause clinical symptoms. In the above events, various cells involved in PAs play a crucial role. Peritoneal mesothelial cells (PMCs), neutrophils, eosinophils, T lymphocytes, macrophages, mast cells, etc., are distributed in the peritoneal microenvironment. Under physiological conditions, these cellular components are significant for the dynamic stabilization of the peritoneal microenvironment. When bacteria and foreign bodies invade the peritoneal cavity, fibrin and inflammatory cells exude with the peritoneal fluid to limit, remove, and absorb foreign bodies. Finally, the fibrin is absorbed, and the peritoneal injury usually heals. Under pathological conditions, the above cells are dysfunctional, promoting the progression of PAs. Dysfunction of PMC function promotes initial PA formation, expanded inflammatory response, and excessive fibrin deposition; neutrophils and peritoneal resident macrophages are first recruited to the peritoneal injury site, the former mediates the inflammatory response, and the latter covers the injury site for a transient protective effect; intermediate and advanced neutrophils of PAs form neutrophil extracellular traps and synergize with other cells to promote fibrosis progression and lead to PA formation. Here, the authors review the action mechanisms of various cells in the peritoneal microenvironment in the pathogenesis and development of PAs and the connections and interactions of multiple cells in the progression of PAs. In addition, the main measures for the prevention and treatment of PAs, which have been widely studied in recent years are introduced, and the prevention and treatment strategies focused on the cells involved in PAs are summarized, hoping to provide new ideas for the clinical prevention and treatment of PAs.

Abstract:背景与目的 新辅助治疗可显著降低可切除肝细胞癌（HCC）患者的术后复发率，特别是对于伴有高危复发因素的患者，目前已有不少学者在探索HCC新辅助治疗方案。笔者报告1例行新辅助治疗后手术切除的局部晚期HCC患者诊疗经过，以期为HCC的新辅助治疗方案提供参考。方法 回顾性分析1例行新辅助治疗后手术切除的HCC（CNLC Ⅲa期）伴门静脉癌栓（Vp3型）患者临床资料，并进行相关文献复习。结果 患者，男，61岁。CT提示“肝左叶（12.4 cm×7.9 cm×6.6 cm）、肝右叶（11.5 cm×9.8 cm× 9.5 cm）巨大占位性病变，考虑HCC伴门静脉左支癌栓形成”。入院诊断为HCC（CNLC Ⅲa期）伴门静脉癌栓（Vp3型），并经MDT讨论考虑行新辅助治疗。具体方案为肝动脉灌注化疗（HAIC-FOLFOX4）联合仑伐替尼和替雷利珠单抗。经治疗瘤体明显缩小，甲胎蛋白转阴，可行手术切除，但患者及家属拒绝手术治疗。随后采用仑伐替尼和替雷利珠单抗维持治疗5个月余，患者左叶病灶及癌栓完全缓解，右叶病灶疾病进展，目前为CNLCⅡa期/BCLC B期。完善术前评估，患者行左半肝切除术+肝右叶部分切除术+门静脉左支取栓术，术后以仑伐替尼联合替雷利珠单抗辅助治疗，随访至今，共13个月，仍无瘤生存。结论 对于伴有门静脉癌栓等高危复发因素的可切除HCC患者，HAIC-FOLFOX4联合仑伐替尼和替雷利珠单抗可能是一种安全有效的新辅助治疗方案。

Abstract:背景与目的 横纹肌肉瘤（RMS）是具有横纹肌分化特征的恶性肿瘤，是儿童和青少年最常见的软组织肉瘤，在成年人中罕见。本文回顾1例成人肝脏腺泡状横纹肌肉瘤（ARMS）诊治经过，结合既往文献对本病特点进行复习，以期为临床工作提供经验借鉴。方法 回顾中国人民解放军联勤保障部队第九二〇医院病理科会诊的1例肝脏ARMS，分析该患者的临床资料、病理组织形态以及免疫组织化学染色结果，结合前期文献资料进行总结。结果 患者，男，43岁。因肝脏占位就诊于当地医院肝胆外科，术前腹部CT示肝S8段占位性病变并肝门区、腹膜后及腹主动脉旁多发淋巴结转移，于外院行中肝肿瘤及腹腔结节切除术。镜下见肿瘤细胞排列成巢状、实性片状，部分为腺泡状结构，腺泡间为纤维血管间隔。瘤细胞圆形或卵圆形，大小较一致，胞质较少，核深染，部分瘤细胞具有纤细的空泡状染色质和小的核仁，核分裂象易见。免疫组化结果显示瘤细胞表达myogenin、MyoD1、desmin。病理诊断为ARMS，术后患者未接受辅助放化疗，术后7个月因肝脏ARMS复发并出现输尿管、脊柱及全身多发淋巴结转移死亡。结论 在临床诊疗过程中，若发现影像学和甲胎蛋白水平不能完全符合肝细胞癌诊断时，应考虑肝脏转移瘤和肝脏肉瘤的可能性，明确诊断需要病理检查。肝脏ARMS是一种罕见的侵袭性恶性肿瘤，形态学特征易与多种小圆细胞肿瘤混淆，通过免疫组化及分子检测等综合分析可资鉴别。

Abstract:背景与目的 原发性肝脏神经内分泌肿瘤（PHNEN）临床罕见、误诊率高。本文通过分析中国人民解放军海军军医大学第三附属医院收治的42例PHNEN的临床资料，探讨PHNEN的临床病理特点、治疗及预后，以期提高对该病的认识和诊治水平。方法 回顾性分析2008年1月—2020年12月间收治的42例PHNEN患者的临床资料。结果 患者临床症状和影像学表现缺乏特异性，NSE、CgA、Syn、CD56、CK等多呈高表达。患者通过切除（27例）或肝穿刺活检（15例）获得病理诊断，其中G1级12例、G2级19例、G3级6例、神经内分泌癌（NEC）5例。随访7~116个月，24例患者出现复发，其中3例接受再次手术切除，2例接受MWA，14例接受TACE，其余接受放疗或化疗。手术患者（n=27）和非手术患者（不可切除）（n=15）在分级上差异无统计学意义（P=0.992），其平均生存时间分别为（60.78±30.89）个月、（34.27±21.76）个月，差异有统计学意义（P<0.05）。G1、G2、G3级和NEC患者的平均生存时间分别为（69.42±33.63）个月、（53.11±24.70）个月、（35.33±25.34）个月、（20.20±17.46）个月，G1、G2级患者的平均生存时间长于G3级、NEC患者（均P<0.05）。结论 PHNEN的实验室及影像学表现缺乏特异性，确诊需依靠病理学检查。治疗首选根治性切除，手术患者的生存时间长于非手术患者。G1、G2级患者的预后优于G3级、NEC患者。对于无法手术切除的患者，尚缺乏标准的一线治疗方案。

Abstract:背景与目的 目前腹腔镜腹部外科微创技术日益成熟，腹腔镜全脾切除术已在各大医疗中心及基层医院广泛开展。但全脾切除术后导致的血栓形成、免疫功能低下、爆发性感染等并发症的出现使得外科医生进行新的思考，比如腹腔镜下脾脏部分切除术因保存了脾脏部分功能而成为新开展的外科技术。然而，腹腔镜脾脏部分切除术因切除平面难以评估、术中出血难以控制，又是许多外科医师仍不敢轻易尝试的手术方式。笔者就近年来开展的腹腔镜脾脏部分切除术患者资料进行总结，探讨其安全性及疗效。方法 回顾性收集湖南省人民医院2018年1月—2021年7月8例行腹腔镜脾脏部分切除术患者的临床资料。患者术前常规检查诊断为原发性脾脏良性肿瘤或诊断为脾脏外伤（Ⅰ~Ⅲ级），经讨论后认为有手术指征和条件。术中采用二级脾蒂分离技术行腹腔镜脾脏部分切除术。结果 8例患者均顺利完成腹腔镜脾脏部分切除术，脾上极切除2例，脾下极切除6例。手术时间150~350 min，平均（227.5±70.0）min；术中出血量200（50~1 000）mL。术后腹腔引流管引流量为5~120 mL，平均为（84.4±24.1）mL，引流管均于3~5 d拔除。术后出现1例血小板增多，予以血小板单采治疗后血小板降至正常，其余7例患者出院前复查血小板计数平均为（308.3±56.0）×109/L。术后所有患者均未发生出血、胰瘘、感染、脾梗死等并发症。住院时间为5~12 d，平均（5.9±2.6）d。术后病理为假性囊肿2例，真性上皮囊肿4例，血管瘤1例，外伤1例。8例患者均在门诊进行随访，复查血小板均在正常范围，平均（218.1±29.2）×109/L；CT检查均未发现肿瘤复发、静脉血栓及脾梗死情况发生。结论 对于脾脏良性疾病或外伤，术前严格掌握手术适应证，术中控制入脾的动脉血流与掌控切除平面，术后定期随访，如此联合手术技巧进行腹腔镜脾脏部分切除术安全、有效。