中华外科杂志最新文献

{"title":"[Current applications and prospects of artificial intelligence in perioperative comprehensive management for gastrointestinal surgery].","authors":"P Y Wang, B Liu, X Liu, M H Shan, Z X Shen, S L Li, M Z Wu, Z C Zhao, Y J Yan, W H Fu","doi":"10.3760/cma.j.cn112139-20260129-00045","DOIUrl":"10.3760/cma.j.cn112139-20260129-00045","url":null,"abstract":"<p><p>The shift from the traditional empirical approach to a more data-driven method in the diagnosis and treatment of GI cancers is significant due to advancements in overall precision medicine and digital healthcare. Artificial intelligence(AI),the driving force behind the technological revolution,is increasingly being used in screening,diagnosis,treatment,and rehabilitation in gastrointestinal surgery with its potential to use image recognition,develop a deep learning model and analyse multimodal data. This study systematically reviews how AI is currently being applied across the whole perioperative pathway in GI surgery. During pre-operation procedures,the use of AI assisted endoscopic systems and super-resolution radiomics improved early cancer detection rates and clinical stage predictions. During intraoperative procedures,augmented reality navigation,intelligent robotic systems,and the 'ultra-minimally invasive' concept have advanced surgical innovations towards improved precision and reduced invasiveness. After surgery,computational pathology and multi-omics fusion models can be used to assess prognosis and make adjuvant therapy decisions. The physical and psychological rehabilitation experience of patients undergoing perioperative management is optimized with the aid of smart cognitive behavioural therapy and intensive care warning systems. The challenges limiting the clinical translation of artificial intelligence,such as data silos,algorithmic opacity,and ethical regulations,are discussed in detail at the end. After this,possible future applications of federated learning and large language models are envisioned.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 6","pages":"606-611"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790198","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":"[Three-year survival outcomes of neoadjuvant immunotherapy for local advanced rectal cancer with pMMR: a single-center report of 140 patients from Peking University Cancer Hospital].","authors":"M H Zhao, B Y Qu, Y L Huang, J P Pei, T T Sun, X Y Xie, X Z Liu, Y J Li, P J Chen, N Chen, L Wang, T C Zhan, Y F Yao, A W Wu","doi":"10.3760/cma.j.cn112139-20251230-00618","DOIUrl":"10.3760/cma.j.cn112139-20251230-00618","url":null,"abstract":"<p><p><b>Objective:</b> To evaluate the long-term survival outcomes of neoadjuvant immunotherapy combined with chemoradiotherapy or chemotherapy in patients with mismatch repair-proficient (pMMR) local advanced rectal cancer. <b>Methods:</b> A retrospective case-series study was conducted. Clinical,pathological,and follow-up data were collected from 140 patients with pMMR local advanced rectal cancer who received neoadjuvant immunotherapy at the Gastrointestinal Cancer Center,Unit Ⅲ,Peking University Cancer Hospital,from June 2019 to September 2024. The study included 96 males and 44 females, with an age (<i>M</i> (IQR)) of 61 (13) years (range: 29 to 81 years). Among them,120 patients received neoadjuvant immunotherapy combined with chemoradiotherapy, and 20 received immunotherapy combined with chemotherapy. Follow-up was conducted through outpatient reviews and telephone interviews. The prognostic factors of overall survival (OS) and disease-free survival (DFS) were screened by univariate and multivariate Cox regression analysis. The Kaplan-Meier method was used to plot survival curves, and the Log-rank test was employed to compare survival differences between groups. <b>Results:</b> For the 140 patients with pMMR local advanced rectal cancer, the median OS and DFS time were not reached. The 1-and 3-year OS rates were 98.4% and 92.8%,respectively; the 1- and 3-year DFS rates were 89.7% and 73.2%,respectively. Postoperative pathological examination revealed that 35 patients (29.9%) achieved a pathological complete response,and 57 patients (48.7%) showed tumor regression grade 0 to 1. Univariate and multivariate Cox regression analyses indicated that postoperative lymphovascular invasion was an independent poor prognostic factor for OS in pMMR rectal cancer patients undergoing surgery after immunotherapy (<i>HR</i>=5.58,95%<i>CI</i>:1.36 to 23.0,<i>P</i>=0.017). The 3-year OS and DFS rates for patients achieving complete response (CR) after neoadjuvant therapy were 100% and 95.3%, compared to 88.5% and 60.1% for non-CR patients. The DFS of the CR group was significantly superior to that of the non-CR group (<i>P</i>=0.002). <b>Conclusion:</b> Neoadjuvant immunotherapy combined with chemoradiotherapy or chemotherapy demonstrates a favorable safety profile and high 3-year survival rates in patients with pMMR local advanced rectal cancer.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 6","pages":"641-649"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790386","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":"[A comparative analysis of the short-term efficacy of single-port and multi-port robotic distal gastrectomy for gastric cancer: a propensity score matched cohort study].","authors":"H H Guo, Y Tian, J X Yang, P A Ding, X Y Tang, P G Yang, Y Liu, Z Zhang, T Zheng, J C He, X F Zhao, Y Liu, B B Tan, Z D Zhang, Y Li, Q Zhao","doi":"10.3760/cma.j.cn112139-20251231-00621","DOIUrl":"10.3760/cma.j.cn112139-20251231-00621","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To compare the short-term outcomes of distal radical gastrectomy for gastric cancer using domestically produced single-port and multi-port robotic systems. &lt;b&gt;Methods:&lt;/b&gt; This retrospective cohort study included 168 patients with gastric cancer who underwent robot-assisted radical gastrectomy at the Third Department of Surgery, the Fourth Hospital of Hebei Medical University, between September 2023 and July 2025. The initial cohort included 115 males and 53 females, with an age of (60.1±10.5) years (range: 36 to 78 years). Among them, 127 patients underwent multi-port robotic surgery (MP group) and 41 underwent single-port robotic surgery (SP group). To minimize baseline differences, 1∶1 nearest-neighbor propensity score matching was performed (the caliper value was set to 0.2), yielding 41 matched patients in each group. Intraoperative variables and early postoperative outcomes were compared using the independent-samples &lt;i&gt;t&lt;/i&gt; test, Mann-Whitney &lt;i&gt;U&lt;/i&gt; test, chi-square test, or Fisher's exact test, as appropriate. &lt;b&gt;Results:&lt;/b&gt; After matching, baseline characteristics were well-balanced. All procedures were successfully completed as R0 resections without conversion to open surgery. Compared with the MP group, the SP group had a longer total operative time (&lt;i&gt;M&lt;/i&gt;(IQR) (246.0 (52.0) min &lt;i&gt;vs&lt;/i&gt;. 198.0 (40.0) min, &lt;i&gt;Z&lt;/i&gt;=-5.862, &lt;i&gt;P&lt;/i&gt;&lt;0.01), longer instrument setup time (19.0 (3.0) min &lt;i&gt;vs&lt;/i&gt;. 15.0 (3.0) min, &lt;i&gt;Z&lt;/i&gt;=-6.986, &lt;i&gt;P&lt;/i&gt;&lt;0.01), and longer lymph node dissection time (158.0 (42.0) min &lt;i&gt;vs&lt;/i&gt;. 112.0 (24.0) min, &lt;i&gt;Z&lt;/i&gt;=-6.271, &lt;i&gt;P&lt;/i&gt;&lt;0.01). Gastrointestinal reconstruction time, intraoperative blood loss, and the number of retrieved lymph nodes did not differ significantly between the two groups (all &lt;i&gt;P&lt;/i&gt;&gt;0.05). The SP group showed earlier postoperative ambulation (1.0 (0) d &lt;i&gt;vs&lt;/i&gt;. 2.0 (1.0) d, &lt;i&gt;Z&lt;/i&gt;=-3.661, &lt;i&gt;P&lt;/i&gt;&lt;0.01) and earlier recovery of bowel function (2.0 (1.0) d &lt;i&gt;vs&lt;/i&gt;. 3.0 (1.0) d, &lt;i&gt;Z&lt;/i&gt;=-2.499, &lt;i&gt;P&lt;/i&gt;=0.012). No significant between-group differences were observed in time to first postoperative fluid intake (3.0 (1.0) d &lt;i&gt;vs&lt;/i&gt;. 3.0 (1.0) d, &lt;i&gt;Z&lt;/i&gt;=-1.278, &lt;i&gt;P&lt;/i&gt;=0.201), time to first liquid diet (5.0 (1.0) d &lt;i&gt;vs&lt;/i&gt;. 5.0 (1.0) d, &lt;i&gt;Z&lt;/i&gt;=-1.012, &lt;i&gt;P&lt;/i&gt;=0.312), or postoperative hospital stay (7.0 (2.0) d &lt;i&gt;vs&lt;/i&gt;. 7.0 (3.0) d, &lt;i&gt;Z&lt;/i&gt;=-0.442, &lt;i&gt;P&lt;/i&gt;=0.842). The SP group reported lower Scar Assessment Scale scores ((7.8±1.6) points &lt;i&gt;vs&lt;/i&gt;. (9.4±2.0) points, &lt;i&gt;t&lt;/i&gt;=-3.893, &lt;i&gt;P&lt;/i&gt;&lt;0.01) and lower pain scores on postoperative days 1 to 3 (all &lt;i&gt;P&lt;/i&gt;&lt;0.05). Additionally, inflammatory markers (neutrophil-to-lymphocyte ratio and systemic immune-inflammation index) were significantly lower in the SP group on postoperative days 1 and 3 (all &lt;i&gt;P&lt;/i&gt;&lt;0.05). Postoperative complication rates were similar between the SP and MP groups (9.8% (4/41) &lt;i&gt;vs&lt;/i&gt;. 12.2% (5/41), &lt;i&gt;P&lt;/i&gt;=1). No Clavien-Dindo classification of surgical complications grade","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 6","pages":"657-666"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790414","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":"[Clinical practice, quality control, and training in robot-assisted gastric cancer surgery].","authors":"Q Zhong, S Q Hu, D Wu, Z Q Zhang, Q Y Chen, Z H Zheng, C M Huang","doi":"10.3760/cma.j.cn112139-20260113-00021","DOIUrl":"10.3760/cma.j.cn112139-20260113-00021","url":null,"abstract":"<p><p>Robot-assisted gastric cancer surgery is significantly superior to traditional laparoscopic surgery in terms of three-dimensional visualization, improved operational precision, and reduced intraoperative blood loss, with particularly outstanding performance in complex anatomical regions. However, the widespread adoption of this technology still faces practical challenges, including high equipment costs, a prolonged learning curve, and the lack of a standardized training system. This article systematically reviews the current status of clinical practice, core technical advantages, training system construction, team collaboration mechanisms, and future development trends of robot-assisted gastrectomy. This article systematically reviews the current status of clinical practice and the construction of a systematic training system for robot-assisted gastric cancer surgery. It further explores the necessity of a structured training system and proposes a training pathway based on simulation training, supported by objective assessment, and extended to cross-platform compatibility. The importance of standardized operating procedures and improved emergency response plans is clarified, with team collaboration and effective communication emphasized as core roles in robotic surgery.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 6","pages":"622-627"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789995","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":"[Machine learning models to predict intestinal necrosis in acute mesenteric venous thrombosis].","authors":"B Liu, Z Liu, P Y Wang, P Y Chen, Y J Yan, W H Fu, T Liu","doi":"10.3760/cma.j.cn112139-20251222-00602","DOIUrl":"10.3760/cma.j.cn112139-20251222-00602","url":null,"abstract":"<p><p><b>Objective:</b> To develop and validate machine learning-based models for predicting the risk of transmural irreversible intestinal necrosis (ITIN) in patients with acute mesenteric venous thrombosis (AMVT). <b>Methods:</b> A retrospective case series analysis was conducted on 156 patients with AMVT admitted to the Department of General Surgery,Tianjin Medical University General Hospital,between January 2015 and December 2024. There were 106 males and 50 females, and 62 patients aged ≥60 years and 94 patients aged <60 years. Patients were randomly assigned by the random number table method to a training set (<i>n</i>=115) and a validation set (<i>n</i>=41) at a 7∶3 ratio. No significant differences were found between the two sets regarding clinical characteristics,laboratory findings,imaging results,or the incidence of ITIN (all <i>P</i>>0.05). Independent risk factors for ITIN identified via multivariable logistic regression in the training set were used to construct seven machine learning models (Logistic regression,K-nearest neighbors,support vector machine,random forest, decision tree, BP neural network,and AdaBoost) using Python 3.9. The predictive performance was assessed using receiver operating characteristic (ROC) curves,sensitivity, specificity, accuracy, area under the curve (AUC), Brier score, F1 score, and Cohen's kappa coefficient. Decision curve analysis (DCA) was performed to evaluate clinical utility,and internal validation was conducted using the validation set. <b>Results:</b> Multivariable Logistic regression analysis identified that onset duration ≤4 d,body temperature ≥39 ℃,intestinal obstruction on contrast-enhanced CT, and serum lactate ≥2.0 mmol/L as independent risk factors for ITIN in patients with AMVT (all <i>P</i><0.05), machine learning models were constructed based on these factors. In the training set, the AUC values were 0.913, 0.937, 0.921, 0.937, 0.939, 0.938, and 0.936, respectively. The Brier scores,F1 scores, kappa coefficients, and DCA demonstrated favorable predictive performance for all seven models in the training set, although performance in the validation set was slightly lower. <b>Conclusions:</b> Short onset duration,high fever,intestinal obstruction on contrast-enhanced CT, and elevated serum lactate are critical predictors of ITIN in AMVT patients. The machine learning models based on these indicators exhibit robust predictive performance in the training cohort,though further external validation is required to confirm their generalizability.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 6","pages":"667-673"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790350","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":"[Clinicopathological characteristics and prognostic significance of steatotic hepatocellular carcinoma with HBV-related cirrhosis: a propensity score-matched study].","authors":"Y B Wei, Q X Diao, Z P Li, J Y Sun, W Q Zhong, B Xu, Z Y Zhao, L T Liang, M Zhang, D A Luo, Y P Wang, B Han","doi":"10.3760/cma.j.cn112139-20260204-00056","DOIUrl":"10.3760/cma.j.cn112139-20260204-00056","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To investigate the clinicopathological characteristics of steatotic hepatocellular carcinoma with HBV-related cirrhosis (SBC-HCC) and its prognostic impact after curative resection. &lt;b&gt;Methods:&lt;/b&gt; This is a retrospective cohort study. Data were retrospectively collected from 877 patients who underwent hepatectomy and were postoperatively confirmed as hepatocellular carcinoma (HCC) by pathological examination at Department of Hepatobiliary and Pancreatic Surgery, Qingdao University Affiliated Hospital between January 2014 and December 2020. After screening based on inclusion and exclusion criteria, a total of 689 patients were included in the subsequent analysis. There were 563 male cases (82.1%) and 126 female cases (17.9%); the age (&lt;i&gt;M&lt;/i&gt;(IQR)) was 58 (13) years (range: 17 to 85 years). SBC-HCC was defined by digital pathology quantitative assessment as an intratumoral lipid vacuole proportion &gt;5% in tumor cells. Patients were grouped by SBC-HCC status, and 1∶3 propensity score matching (PSM; caliper 0.02) was performed to balance baseline characteristics. Clinicopathological variables, overall survival (OS), and disease-free survival (DFS) were compared between groups. The clinical and pathological characteristics of patients in the two groups were compared using the &lt;i&gt;χ²&lt;/i&gt; test, Fisher's exact probability method, independent samples &lt;i&gt;t&lt;/i&gt;-test, or Mann-Whitney &lt;i&gt;U&lt;/i&gt; test,respectively.Cox proportional hazards models were used to identify independent prognostic factors, and subgroup analyses were conducted. &lt;b&gt;Results:&lt;/b&gt; Among the 689 patients, 107 patients (15.5%) were classified as SBC-HCC. After PSM, 79 patients with SBC-HCC and 237 patients without SBC-HCC were included. Major demographic and tumor-related variables were well balanced between groups; however, SBC-HCC patients had higher levels of total bile acids, total cholesterol, low-density lipoprotein cholesterol, and creatinine than non-SBC-HCC patients (all &lt;i&gt;P&lt;/i&gt;&lt;0.05). The follow-up time was 51(34) months(range:1 to 139 months). The median OS time was 90.8 months in the SBC-HCC group and was not reached in the non-SBC-HCC group (&lt;i&gt;P&lt;/i&gt;=0.012). The SBC-HCC group had significantly lower 5-year OS rate (69.2% &lt;i&gt;vs.&lt;/i&gt; 72.9%) and 5-year DFS rate (34.4% &lt;i&gt;vs.&lt;/i&gt; 44.5%) than the non-SBC-HCC group (both &lt;i&gt;P&lt;/i&gt;&lt;0.05). In multivariable Cox analysis for overall survival, SBC-HCC (&lt;i&gt;HR&lt;/i&gt;=1.939, 95%&lt;i&gt;CI&lt;/i&gt;: 1.291 to 2.913,&lt;i&gt;P&lt;/i&gt;&lt;0.01), increased tumor number (&lt;i&gt;HR&lt;/i&gt;=1.694, 95%&lt;i&gt;CI&lt;/i&gt;: 1.321 to 2.172, &lt;i&gt;P&lt;/i&gt;&lt;0.01), microvascular invasion (&lt;i&gt;HR&lt;/i&gt;=1.880, 95%&lt;i&gt;CI&lt;/i&gt;: 1.133 to 3.122,&lt;i&gt;P&lt;/i&gt;=0.015), and tumor size ≥5 cm (&lt;i&gt;HR=&lt;/i&gt;3.479, 95%&lt;i&gt;CI&lt;/i&gt;: 2.256 to 5.364, &lt;i&gt;P&lt;/i&gt;&lt;0.01) emerged as independent risk factors for poor OS. For DFS, elevated LDL-C (&lt;i&gt;HR&lt;/i&gt;=1.242, 95%&lt;i&gt;CI&lt;/i&gt;: 1.022 to 1.510, &lt;i&gt;P&lt;/i&gt;=0.029), microvascular invasion (&lt;i&gt;HR&lt;/i&gt;=1.866, 95%&lt;i&gt;CI&lt;/i&gt;: 1.251 to 2.785, &lt;i&gt;P&lt;/i&gt;&lt;0.01), and macrovascular invasion (&lt;i","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 6","pages":"681-690"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790219","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":"[Clinical application status and development trends of robot-assisted gastrointestinal tumor surgery].","authors":"P W Yu, Z Y Li, F Zhang","doi":"10.3760/cma.j.cn112139-20260206-00060","DOIUrl":"10.3760/cma.j.cn112139-20260206-00060","url":null,"abstract":"<p><p>In recent years, robot-assisted gastrointestinal tumor surgery has developed rapidly, with a continuous increase in surgical volume, increasingly mature surgical techniques, a growing variety of surgical procedures, and in-depth clinical research. It has become an important development direction of minimally invasive treatment for gastrointestinal tumors. Increasing evidence suggests that robotic surgery could confer significant advantages over laparoscopic surgery in terms of precise dissection, damage control, and organ function preservation. This review focuses on robot-assisted radical surgery for gastric and colorectal cancers, systematically elaborates its development and current status of clinical application, compares the differences in the definition of surgical indications for gastric and colorectal cancers between domestic and international guidelines, analyzes the technical advantages of robotic surgical systems in lymph node dissection, digestive tract reconstruction, and organ function protection, as well as the application progress integrated with indocyanine green fluorescence imaging, 5G telemedicine, and single-port technology. This review further explores emerging trends including equipment innovation, intelligent integration, and smart advancement. Robot-assisted gastrointestinal tumor surgery is evolving toward greater precision, intelligence, and efficiency. In the future, robot-assisted surgery will become the mainstream surgical approach for gastrointestinal tumor treatment.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 6","pages":"589-595"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789966","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":"[Interpretation of the consensus on standardized diagnosis and treatment of diseases at the choledocho-pancreatico-duodenal junction(2026)].","authors":"J Wang, Z W Quan, Y P Zhao","doi":"10.3760/cma.j.cn112139-20260127-00042","DOIUrl":"10.3760/cma.j.cn112139-20260127-00042","url":null,"abstract":"<p><p>The \"Consensus on standardized diagnosis and treatment of choledocho-pancreatico-duodenal junction diseases（2026）\" is the first expert consensus worldwide to focus on the standardized diagnosis and treatment of diseases in this region. This article interprets the consensus from four dimensions: in terms of background and significance, the consensus has been developed to enhance the understanding of the integrity and importance of the choledocho-pancreatico-duodenal junction, standardize the diagnostic and therapeutic processes for complex and difficult diseases in this area, and establish a research platform to guide future in-depth clinical and basic research. Regarding the core principles,it explicitly proposes five key principles: emphasizing the preservation of sphincter of Oddi function,prioritizing pathological evidence in treatment decisions,stressing the rational application of minimally invasive techniques,underscoring the necessity of standardized follow-up,and standardizing the procedures for the diagnosis and treatment of functional diseases. Concerning the controversial focal points,the discussion centers on the safety and necessity of transduodenal ampullectomy (TSA). Data from the literature confirms that TSA offers significant advantages in pathological diagnosis and the treatment of benign diseases. Regarding the limitations of the consensus,the recommendations are primarily based on retrospective clinical studies and expert experience. In the future,leveraging the advantages of China's abundant clinical case resources through national multicenter prospective or real-world studies could provide more robust and reliable data to support or refine the recommendations of this consensus.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 ","pages":"449-453"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147516638","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":"[Evolution of diagnosis and treatment strategies for Oddi's sphincter dysfunction: an analysis of basic and clinical research evidence].","authors":"D Zhou","doi":"10.3760/cma.j.cn112139-20260123-00035","DOIUrl":"10.3760/cma.j.cn112139-20260123-00035","url":null,"abstract":"<p><p>Sphincter of Oddi dysfunction (SOD) can lead to increased intra-biliary-pancreatic duct pressure,manifesting as persistent biliary pain or recurrent pancreatitis. Currently,the diagnosis and treatment of SOD still face numerous challenges. Previously,the method of guiding endoscopic sphincterotomy based on the results of sphincter of Oddi manometry was only effective for some patients with modified Milwaukee type Ⅱ SOD,and it was associated with multiple complications,raising concerns about its safety. The main reason for this is the complex pathophysiology of SOD. Research on SOD has mainly focused on biliary manometry,and the evidence is mostly derived from early animal experiments. Therefore,further real-world research related to SOD should be strengthened to explore the overall regulatory mechanisms of sphincter of Oddi involving the gastrointestinal tract,biliary-pancreatic system,nervous system,and hormone endocrine system. Additionally,clinical collaboration across specialties such as endoscopy,imaging,nuclear medicine,and digestive surgery should be enhanced,with the aim of finding more convenient,safe,and minimally invasive methods for the diagnosis and treatment of SOD.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 ","pages":"461-465"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147516312","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 and safety of rapamycin-eluting stents for vertebral artery stenosis in the V1 segment: a real-world retrospective cohort study].","authors":"K Q Zhao, J L Zhao, C Jiang, S Guo, T Zhang, Z J Cao, Y Yang, R R Zhu, W W Wu","doi":"10.3760/cma.j.cn112139-20250820-00409","DOIUrl":"10.3760/cma.j.cn112139-20250820-00409","url":null,"abstract":"<p><p><b>Objective:</b> To evaluate the efficacy and safety of rapamycin-eluting stents in treating stenosis of the vertebral artery V1 segment. <b>Methods:</b> This retrospective cohort study analyzed 191 patients with vertebral artery V1 segment stenosis who underwent stent implantation at our institution between January 2023 and August 2024. There were 161 male cases and 30 female cases. The age of the cohort was (68±8) years (range: 47 to 86 years). Patients were divided into two groups based on the stent type: the rapamycin-eluting stent (DES) group (<i>n</i>=93) and the bare-metal stent (BMS) group (<i>n</i>=98). Baseline characteristics showed no significant differences between the groups. Outcome measures included technical success rate, periprocedural (30-day) complications (stroke, mortality), and follow-up outcomes at 12 months (stent patency, stroke recurrence). Statistical analyses were performed using the independent sample <i>t</i> test, <i>χ</i>² test, or Fisher's exact test, as appropriate. Survival analysis was conducted using the Kaplan-Meier method. <b>Results:</b> The operation time of patients in the DES group was (63±31) min (range: 24 to 120 min), with a technical success rate of 98.9% (92/93), and the periprocedural stroke rate within 30 d was 1.1% (1/93). The operation time of the BMS group was (58±24) min (range: 26 to 110 min), with a technical success rate of 100%, and the incidence of stroke within 30 d of the operation was 2.0% (2/98). There were no statistically significant differences in operation time, technical success rate, and the periprocedural stroke rates between the two groups (all <i>P</i>>0.05), and no deaths occurred in either group. A total of 91 cases in DES group and 95 cases in BMS group were followed up for more than 12 months. The Kaplan-Meier survival analysis results showed that the patency rate at 12 months after operation, the DES group demonstrated significantly higher stent patency rates (94.5%(86/91) <i>vs.</i> 83.2%(79/95), <i>χ²</i>=5.838,<i>P</i>=0.016) and a higher stroke-free survival rate (97.8%(89/91) <i>vs.</i> 89.5%(85/95), <i>χ²</i>=5.410,<i>P</i>=0.020) compared to the BMS group. <b>Conclusions:</b> In the treatment of V1 segment vertebral artery stenosis, DES demonstrates a favorable perioperative safety profile, significantly higher stent patency and a lower stroke recurrence rate compared to BMS at 12 months follow-up. Further extended follow-up is required to evaluate their long-term efficacy.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 ","pages":"538-544"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517212","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}