中华外科杂志最新文献

{"title":"[Real-world efficacy analysis of immuno-targeted combined protocol as neoadjuvant regimen for high-risk recurrent hepatocellular carcinoma].","authors":"Y Z Liu, H W Tang, H X Jiang, S Gao, R Yang, K Ma, S C Lu","doi":"10.3760/cma.j.cn112139-20260425-00167","DOIUrl":"10.3760/cma.j.cn112139-20260425-00167","url":null,"abstract":"<p><p><b>Objective:</b> To analyze and evaluate the real-world clinical efficacy of immuno-targeted combined protocol as a neoadjuvant regimen for high-risk recurrent hepatocellular carcinoma. <b>Methods:</b> This is a retrospective case-series study. Real-world data from patients with high-risk recurrent HCC who received neoadjuvant therapy at Faculty of Hepato-Pancreato-Biliary Surgery,the First Medical Center of Chinese People's Liberation Army General Hospital, from January 2019 to September 2025, were analyzed. The cohort included 46 patients,among which there were 38 male patients (82.6%) and 8 female patients (17.4%), with an age at initial diagnosis(<i>M</i>(IQR)) of 56.5(15.0) years (range: 35 to 73 years). According to the Barcelona Clinic Liver Cancer staging system,there were 19 cases of stage A,15 cases of stage B and 12 cases of stage C. Survival curves were plotted using the Kaplan-Meier method,and comparisons were performed using the Log-rank test. A Cox regression analysis was performed on factors that may influence postoperative recurrence in patients. <b>Results:</b> Based on the modified Response Evaluation Criteria in Solid Tumors,the results of preoperative assessment were: 10 patients achieved complete response,30 patients achieved partial response,and 6 patients achieved stable disease. Based on the proportion of residual viable tumor cells in pathological specimens,there were 28 patients achieved major pathological response or above (60.9%). For the 46 enrolled patients,the recurrence-free survival(RFS) rates at 1,2,3 years were 74.7%,54.6%,45.5%,respectively,with a median recurrence-free survival of 28 months. The overall survival rates at 1,2,3 years were 97.6%,95.1%,91.8%,respectively. Cox regression analysis indicated that preoperative alpha-fetoprotein (AFP)≥400 μg/L was an independent high-risk factor for tumor recurrence. The 46 patients were divided into two groups based on their preoperative AFP levels. The 1-and 2-year RFS rates in the AFP<400 μg/L group were significantly higher than those in the AFP≥400 μg/L group, with a statistically significant difference (<i>P</i><0.05). <b>Conclusion:</b> Immuno-targeted combined protocol as a neoadjuvant regimen can bring encouraging short-term and long-term survival outcomes to patients with high-risk recurrent hepatocellular carcinoma.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 10","pages":"1098-1104"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Cognitive reshaping and systemic reconstruction of liver surgery empowered by digital intelligence].","authors":"X W Wu, S L Zeng, C H Fang","doi":"10.3760/cma.j.cn112139-20260427-00170","DOIUrl":"10.3760/cma.j.cn112139-20260427-00170","url":null,"abstract":"<p><p>In recent years, a cluster of digital intelligence technologies, represented by artificial intelligence, three-dimensional visualization, augmented reality and optical imaging, has been reshaping the cognitive foundation and clinical practice of liver surgery. From the frontier perspective of medical-engineering integration, this article systematically reviews eight major advances and breakthroughs in digital intelligence-empowered liver surgery, encompassing preoperative precision diagnosis, intelligent three dimensional planning, augmented reality combined with fluorescence navigation, multimodal optical imaging, intraoperative dynamic perception, large language model-based decision support, personalized prognosis prediction, and standardized ecosystem development. The clinical value of these advances is thoroughly examined in terms of tumor diagnosis, navigational decision-making, postoperative management, and homogeneous promotion. This review aims to provide a theoretical reference for the intelligent transformation of hepatobiliary surgery.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 10","pages":"1051-1055"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Single-center analysis of surgery and prognosis in 927 patients with hepatocellular carcinoma at CNLC stages Ⅰa to Ⅲa].","authors":"Q X Diao, Z P Li, Z Y Wang, J Y Sun, W Q Zhong, C D Sun, W D Guo, B Y Zhang, F B Qiu, B Han","doi":"10.3760/cma.j.cn112139-20260127-00040","DOIUrl":"10.3760/cma.j.cn112139-20260127-00040","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To investigate the efficacy and prognosis of surgical treatment for hepatocellular carcinoma. &lt;b&gt;Methods:&lt;/b&gt; This is a retrospective case series study. Clinical data of 927 consecutive patients who underwent initial hepatectomy for hepatocellular carcinoma(HCC) at the Department of Hepatobiliary and Pancreatic Surgery,Affiliated Hospital of Qingdao University from January 2013 to December 2020 were retrospectively collected. There were 766 males (82.6%) and 161 females (17.4%),with an age of (57.6±9.7)years (range: 17 to 85 years). Prognostic data were obtained through outpatient follow-up visits and telephone follow-up,and follow-up was continued until December 31,2024. Kaplan-Meier method was used to estimate survival rates and plot survival curves,and Log-rank test was used to compare survival differences among different tumor stages. Cox proportional hazards model was used to identify independent prognostic factors for recurrence and survival. When comparing the prognostic impact of laparoscopic versus open hepatectomy and postoperative adjuvant transcatheter arterial chemoembolization(TACE),propensity score matching was performed using 1∶1 nearest-neighbor matching with a caliper of 0.02. &lt;b&gt;Results:&lt;/b&gt; (1) Among 927 patients,the median overall survival (OS) time was 130.5 months,and the 1-, 3-, 5-, and 10-year OS rates were 94.2%, 79.9%, 68.4%, and 52.3%, respectively. The median disease-free survival(DFS) time was 37.8 months,and the 1-, 3-, and 5-year DFS rates were 74.0%,52.0%,and 39.8%, respectively. The 5-year OS rates of patients with China Liver Cancer (CNLC) stage Ⅰa, Ⅰb, Ⅱ, and Ⅲa were 78.0%, 63.5%, 43.1%, and 43.6%,respectively,and the corresponding 5-year DFS rates were 48.5%,35.0%,16.0%,and 20.1%,respectively. (2) Univariate and multivariate Cox analyses showed that sex, age,albumin,tumor differentiation,tumor number,microvascular invasion,and macrovascular invasion were independent prognostic factors for recurrence after initial hepatectomy for HCC (all &lt;i&gt;P&lt;/i&gt;&lt;0.05); age, albumin, tumor differentiation, tumor number,microvascular invasion,liver capsule invasion,and intraoperative blood loss were independent prognostic factors for survival after initial hepatectomy for HCC (all &lt;i&gt;P&lt;/i&gt;&lt;0.05). (3) Patients were divided into an adjuvant TACE group and a non-adjuvant TACE group according to whether postoperative TACE was administered. After propensity score matching,no significant differences in DFS or OS were observed between the two groups (both &lt;i&gt;P&lt;/i&gt;&gt;0.05). After adjustment for independent prognostic factors for recurrence using multivariate Cox regression,patients with microvascular invasion,maximum tumor diameter&gt;5 cm,or multiple tumors had significantly better DFS in the adjuvant TACE group than in the non-adjuvant TACE group(all &lt;i&gt;P&lt;/i&gt;&lt;0.05). (4) Patients were divided into laparoscopic and open surgery groups according to whether laparoscopic hepatectomy was performed. After propensity score","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 10","pages":"1077-1089"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Research progress on perineural invasion and the immune microenvironment in biliary tract cancers].","authors":"J W Zhao, J Y Zhu, W Gong","doi":"10.3760/cma.j.cn112139-20251102-00510","DOIUrl":"10.3760/cma.j.cn112139-20251102-00510","url":null,"abstract":"<p><p>Biliary tract cancer (BTC) is a group of highly malignant gastrointestinal tumors with poor prognosis, whose aggressiveness and therapeutic resistance are partly attributable to the complex interplay between perineural invasion (PNI) and the tumor microenvironment (TME). In recent years, accumulating evidence has shown that PNI not only promotes local tumor invasion and distant metastasis, but may also contribute to tumor immune evasion through modulation of the TME. This review summarizes the pathological features and molecular mechanisms of PNI in biliary tract tumors, including signal transduction between nerves and tumor cells, characteristics of the TME, intratumoral neural features, and alterations in immune cell function. In addition, the interactive mechanisms between PNI and the immune microenvironment are discussed, with a particular focus on the direct regulation of immune cells by neural signaling and the reciprocal effects of immune cells on PNI. Furthermore, this article reviews PNI-related prognostic models and therapeutic strategies, with the aim of providing new insights into precision diagnosis and treatment for BTC. By synthesizing current evidence, this review seeks to provide a theoretical basis for future investigations into the interplay between PNI and the immune microenvironment, as well as for the development of combinatorial therapeutic strategies.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 10","pages":"1064-1069"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The role and evaluation of ALPPS in surgical treatment of hepatocellular carcinoma in the era of conversion therapy].","authors":"R Zhou, Y J Chen","doi":"10.3760/cma.j.cn112139-20260507-00181","DOIUrl":"10.3760/cma.j.cn112139-20260507-00181","url":null,"abstract":"<p><p>Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) offers a curative surgical opportunity for patients with initially unresectable hepatocellular carcinoma (HCC) and insufficient future liver remnant(FLR), owing to its unique advantage of rapidly inducing FLR hypertrophy. With breakthrough advances in first-line systemic therapies for advanced HCC-including immune checkpoint inhibitor-antiangiogenic combinations, dual immunotherapy regimens, and locoregional combined with systemic therapies-conversion therapy has emerged as a pivotal strategy in liver surgery, and the integration of ALPPS with HCC conversion therapy has advanced its clinical application into a more individualized era. This article systematically analyzes the evolving role of ALPPS in the era of conversion therapy and delineates four distinct clinical application modalities:(1) conventional staged ALPPS aimed at improving the surgical resection rate;(2) salvage ALPPS for patients with persistently insufficient FLR following HCC conversion therapy;(3) the \"dual conversion\" strategy, in which stage Ⅰ liver partition is followed by systemic conversion therapy prior to stage Ⅱ hepatectomy, thereby achieving concurrent oncological and surgical conversion;(4) conversion therapy followed by portal vein embolization (PVE) as a minimally invasive approach, with salvage ALPPS as a rescue option when PVE-induced hypertrophy proves insufficient. The rationale for selecting among these four modalities is further elaborated across multiple dimensions, including the severity of FLR insufficiency, tumor burden and response to conversion therapy, and patient-specific conditions. The organic integration of surgical innovation with oncological advances, together with precise and individualized decision-making within a multidisciplinary team framework, holds the promise of achieving the transition from \"unresectable\" to \"resectable\", and ultimately from \"tumor-bearing survival\" to \"tumor-free，drug-free，high-quality survival\".</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 10","pages":"1027-1034"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Day-case management of minimally invasive liver resection: a path construction from concept to reality].","authors":"Z L Li, D L Qin, X L Zhou, Z H Tang, Z W Quan","doi":"10.3760/cma.j.cn112139-20260429-00174","DOIUrl":"10.3760/cma.j.cn112139-20260429-00174","url":null,"abstract":"<p><p>With the convergence of minimally invasive surgery and enhanced recovery after surgery, day-case surgery minimally invasive liver resection (DCS-MILR) has emerged as a potential care model. Available evidence, derived predominantly from single-center retrospective case series and supplemented by database analyses, suggests that DCS-MILR may be feasible and achieve acceptable short-term safety outcomes in carefully selected patients when supported by experienced surgical teams and standardized perioperative care. It may also shorten hospital stay and provide potential health-economic benefits. However, the evidence remains limited by selection bias, heterogeneous definitions, insufficient follow-up, and a lack of prospective controlled studies. This review summarizes the available evidence and its limitations, identifies major risks including postoperative nausea and vomiting, inadequate pain control, and gaps in surveillance for delayed complications, and proposes an implementation pathway incorporating multidimensional eligibility assessment, standardized perioperative management, structured risk-stratified follow-up, and expedited access to emergency reassessment. This framework is intended to reduce post-discharge safety risks and support the stepwise implementation of DCS-MILR in appropriately resourced centers.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 10","pages":"1040-1045"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Efficacy of percutaneous mechanical thrombectomy combined with transjugular intrahepatic portosystemic shunt for acute non-cirrhotic portal vein thrombosis].","authors":"Z H Hua, W H Xue, Y D Guo, J Q Sun, Y N Zhou, S R Liu, P Xu, Z Y Jiao, H Cao, Z Li","doi":"10.3760/cma.j.cn112139-20260429-00172","DOIUrl":"https://doi.org/10.3760/cma.j.cn112139-20260429-00172","url":null,"abstract":"<p><p><b>Objective:</b> To evaluate the efficacy of percutaneous mechanical thrombectomy combined with transjugular intrahepatic portosystemic shunt (PMT-TIPS) in patients with acute non-cirrhotic portal vein thrombosis (NCPVT). <b>Methods:</b> This is a retrospective case series study. The clinical data of 61 patients with acute NCPVT who underwent PMT combined with TIPS at Department of Endovascular Surgery, the First Affiliated Hospital of Zhengzhou University between June 2017 and June 2023 were retrospectively analyzed. There were 39 males and 22 females, with an age (<i>M</i>(IQR) of 49.0(24.5)years (range:21 to 73 years). Paired sample <i>t</i>-test or Wilcoxon signed-rank test were used to compare liver volume and biochemical parameters before treatment and at 1 year after treatment. Independent sample <i>t</i>-test was used to compare changes in liver volume between patients with different stent patency statuses. Kaplan-Meier analysis was used to estimate stent patency and symptom recurrence. Univariate and multivariate Cox proportional hazards regression models were used to analyze the factors associated with stent occlusion. <b>Results:</b> Among the 61 patients, 7 (11.5%) died during hospitalization and 5 (8.2%) died within 30 days after discharge, most commonly due to bowel necrosis. The remaining 49 patients were followed up for 43(34) months (range:4 to 94 months). During follow-up, stent occlusion occurred in 35 patients (71.4%), with a median primary patency of 13.0 months (95%<i>CI</i>: 7.3 to 18.7). Among the 35 patients with primary stent occlusion, 21 developed symptom recurrence, whereas symptom recurrence occurred in 4 of the 14 patients with sustained patency. Ten patients with stent occlusion underwent stent recanalization, with a median secondary patency of 21.0 months (95%<i>CI</i>: 16.8 to 25.2 months). Univariate Cox regression analysis showed that myeloproliferative neoplasms (<i>HR</i>=3.08, 95%<i>CI</i>: 1.48 to 6.42, <i>P</i>=0.003) and dual-stent implantation (<i>HR</i>=2.26, 95%<i>CI</i>: 1.09 to 4.70, <i>P</i>=0.036) were associated with an increased risk of stent occlusion (both <i>P</i><0.05); multivariate Cox regression further revealed that only myeloproliferative neoplasms (<i>HR</i>=2.75, 95%<i>CI</i>: 1.31 to 5.78, <i>P</i>=0.008) was an independent risk factor. At one year post-procedure, inflammatory and coagulation markers improved, total liver volume decreased compared with baseline (<i>P</i>=0.005), and the reduction in liver volume was greater in patients with patent stents than in those with stent occlusion ((-215.6±205.5)cm³ <i>vs.</i>(-3.5±236.5) cm³,<i>t</i>=-3.505,<i>P</i>=0.001). <b>Conclusions:</b> In patients with acute NCPVT, the PMT-TIPS technique is feasible, but long-term stent patency is limited. This technique can be used as a rescue strategy rather than a definitive treatment.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 11","pages":"1200-1207"},"PeriodicalIF":0.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149013033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Is there still a role for manual deployment techniques in the era of fenestrated/branched endovascular aortic repair? Normative boundaries and practical value in the management of hostile aortic landing zones].","authors":"Z G Li, M Q Zhang, J Cai, T Qiao","doi":"10.3760/cma.j.cn112139-20260608-00253","DOIUrl":"https://doi.org/10.3760/cma.j.cn112139-20260608-00253","url":null,"abstract":"<p><p>Standard endovascular aortic repair has been widely used for the treatment of abdominal aortic aneurysms and selected complex aortic diseases because of its minimally invasive nature, rapid recovery, and favorable perioperative safety profile. However, in hostile aortic landing zones characterized by a short neck, severe angulation, conical neck configuration, mural thrombus, or circumferential calcification, standard endovascular repair remains associated with inadequate proximal apposition, type I endoleak, endograft migration, and secondary intervention. Manual deployment techniques, including the push-up technique, reverse slider technique, Kabedon technique, and stepwise controlled deployment, may improve endograft axial alignment, proximal edge positioning, and local wall apposition to some extent; however, their role is mainly limited to optimization of the deployment process and cannot replace the principle of a durable sealing zone. This review summarizes the anatomical characteristics of hostile aortic landing zones, the mechanisms and clinical evidence of manual deployment techniques, the standardized value of fenestrated/branched endovascular aortic repair and physician-modified endografts, adjunctive fixation and intraoperative bailout techniques, and application scenarios in emergency repair of ruptured abdominal aortic aneurysms. The aim is to provide a practical reference for rational selection between optimized deployment of standard endografts and complex sealing-zone reconstruction in complex endovascular aortic repair.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 11","pages":"1169-1176"},"PeriodicalIF":0.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149013270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[From critical evaluation based on the gold standard to precision full-process management: advances in the diagnosis and treatment framework for aortic arch artery pathologies].","authors":"Z Chen, Y G Yang","doi":"10.3760/cma.j.cn112139-20260517-00206","DOIUrl":"https://doi.org/10.3760/cma.j.cn112139-20260517-00206","url":null,"abstract":"<p><p>Supra-aortic arch artery diseases,including lesions of the carotid,subclavian,and vertebral arteries,represent major causes of cerebral and upper extremity ischemia. The diagnostic and therapeutic strategies for these conditions are undergoing a profound transformation-from conventional open surgery toward minimally invasive endovascular treatment,and further to individualized precision medicine. Recent advances in imaging assessment have substantially improved lesion characterization and risk stratification. The iterative evolution of endovascular devices has enhanced procedural safety. Meanwhile,several topics have become research hotspots,the evidence-based comparison between transcarotid artery revascularization and transfemoral carotid stenting;the renewed pathophysiological understanding of subclavian steal syndrome and vertebral artery diseases;and the construction of individualized treatment decision-making frameworks. Nevertheless,current clinical practice still faces challenges such as controversies over optimal surgical approaches,insufficient prevention and management of complications,and a lack of robust long-term outcome data. From the perspective of vascular surgery,this article systematically reviews recent advances in endovascular devices,surgical techniques,and treatment concepts,aiming to provide front-line clinicians with up-to-date,practical,and actionable insights into the management of supra-aortic arch artery diseases.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 11","pages":"1157-1162"},"PeriodicalIF":0.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149013175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Technical considerations and advances in distal bypass for chronic limb-threatening ischemia of the lower extremities].","authors":"M Zhou, J N Yue, W G Fu","doi":"10.3760/cma.j.cn112139-20260430-00175","DOIUrl":"https://doi.org/10.3760/cma.j.cn112139-20260430-00175","url":null,"abstract":"<p><p>Chronic limb-threatening ischemia (CLTI) represents the end stage of lower extremity arterial disease and is associated with high rates of disability and mortality. With the rapid advancement of endovascular techniques, an \"endovascular-first\" strategy has become widely adopted. However, for patients with complex, long-segment, heavily calcified, diffuse, inflammatory lesions, or those with repeated endovascular failure, distal bypass surgery remains an indispensable option for limb salvage. The success of distal bypass depends not only on advanced surgical expertise but also on appropriate patient selection, accurate assessment of inflow and outflow tracts, optimal conduit choice, and meticulous perioperative management. Based on recent international guidelines and clinical evidence, this review focuses on key technical aspects of distal bypass, including inflow selection, target artery assessment, conduit selection, graft tunneling, distal anastomosis, intraoperative flow assessment, postoperative antithrombotic therapy and wound management. It also discusses the appropriate role of these techniques in the comprehensive treatment of CLTI based on recent evidence-based medical findings. In addition, emerging developments such as alternative conduits, perfusion assessment technologies, and gene/cell therapy are discussed, aiming to provide insights into optimizing revascularization strategies for patients with CLTI.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 11","pages":"1163-1168"},"PeriodicalIF":0.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149013326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}