Gallstone disease is a common clinical condition worldwide, with a global incidence ranging from less than 10

BackgroundImmunoglobulin G4-related disease (IgG4-RD) is an immune-mediated chronic fibroinflammatory condition that can affect multiple organ systems. IgG4-related sclerosing cholangitis (IgG4-SC) is its manifestation involving the biliary tract. Due to atypical clinical presentations in some cases and insufficient awareness among clinicians, IgG4-SC is frequently misdiagnosed as cholangiocarcinoma, and multiple instances of inappropriate treatment as a result have been documented.Case presentationHere we report a case of IgG4-SC that presented diagnostic challenges preoperatively and was followed by rare pancytopenia after surgery. The patient was a 50-year-old man who sought medical attention due to elevated transaminases for eight months, without obvious clinical symptoms. Among serum tumor markers, the level of protein induced by vitamin K absence/antagonist-II (PIVKA-II) was elevated. Examinations including magnetic resonance cholangiopancreatography (MRCP), contrast-enhanced abdominal computed tomography (CT), and positron emission tomography-computed tomography (PET-CT) all suggested malignant stricture at the hepatic hilum. A needle biopsy indicated dysplastic changes but was inconclusive for cholangiocarcinoma. Although IgG4-SC was considered, multiple serum IgG4 measurements remained within the normal range. With an initial clinical diagnosis of cholangiocarcinoma, the patient underwent surgical resection. Intraoperative frozen section analysis indicated an inflammatory process. Postoperatively, the patient developed pancytopenia that responded poorly to conventional supportive treatment. The condition was ultimately diagnosed as IgG4-SC based on postoperative histopathology. Corticosteroid therapy led to the normalization of the patient’s blood counts, transaminases, and bilirubin levels.ConclusionIgG4-SC can present with a spectrum of atypical features, such as isolated biliary strictures, absence of characteristic symptoms, normal IgG4 levels, and imaging findings resembling cholangiocarcinoma. Therefore, in cases clinically suspicious for cholangiocarcinoma, differentiating IgG4-SC warrants serious consideration. Every effort should be made to complete preoperative biopsy and histopathological assessment. For cases where differentiation remains difficult despite comprehensive evaluation, surgical intervention with intraoperative frozen section biopsy is necessary to establish a definitive diagnosis and avoid delayed treatment. Furthermore, this case suggests that IgG4-SC may also involve the hematopoietic system, manifesting as pancytopenia, which can respond effectively to corticosteroid therapy.

BackgroundIntrahepatic Cholangiocarcinoma (ICC) is a highly malignant tumor originating from the intrahepatic biliary epithelium, characterized by strong invasiveness and poor prognosis. For patients with unresectable advanced ICC, the current first-line standard treatment is the gemcitabine plus cisplatin regimen, but its efficacy is limited. In recent years, with the exploration of immunotherapy, targeted therapy, and various combination treatment modalities, new directions have been provided for the treatment of advanced ICC.Case presentationThis article reports a case of a patient with initially unresectable ICC who underwent conversion therapy with percutaneous portal vein embolization (PVE) combined with surufatinib (a multi-kinase inhibitor targeting VEGFR, FGFR, and CSF-1R), sintilimab (a PD-1 inhibitor), and the FOLFOX regimen (leucovorin, fluorouracil, and oxaliplatin). This approach successfully enabled radical liver resection and resulted in long-term disease-free survival. The patient was a 71-year-old male diagnosed via enhanced CT and MRI with a large liver mass accompanied by portal vein tumor thrombus. Pathological confirmation by needle biopsy confirmed intrahepatic cholangiocarcinoma. Due to extensive tumor invasion and insufficient future liver remnant (FLR), the tumor was assessed as unresectable. The treatment team adopted a multimodal conversion strategy: first performing PVE to promote compensatory hyperplasia of the FLR; subsequently administering 4 cycles of surufatinib, sintilimab combined with FOLFOX chemotherapy. Post-treatment imaging evaluation showed significant tumor shrinkage, along with an increase in FLR volume, meeting the criteria for safe radical surgery. Two weeks after stopping medication, the patient underwent right hemihepatectomy, caudate lobe resection, cholecystectomy, hepatoduodenal lymph node dissection and inferior vena cava repair. The patient recovered well postoperatively. At the last follow-up, he had achieved 28 months of disease-free survival with no evidence of local recurrence or distant metastasis.ConclusionFor initially unresectable ICC, conversion therapy with PVE combined with surufatinib, sintilimab, and the FOLFOX regimen can significantly increase the tumor resection rate and achieve long-term survival. This strategy combines high anti-tumor efficacy with clinical feasibility, providing a new approach for the conversion therapy of advanced ICC. Further larger sample studies are needed in the future to verify its efficacy and safety.

The aim of this study is to establish a standardized murine model for cholesterol crystallization and deposition in the gallbladder wall and evaluate the effects of differential dietary cholesterol intake and pharmacological interventions on this pathophysiological process. A total of 45 eight-week-old C57BL/6 mice were randomly assigned to nine experimental groups (n = 5 per group) receiving different dietary and pharmacological interventions designed to modulate mucin expression and reverse cholesterol transport over a 12-week period (details in Methods ). Blood and gallbladder tissues were collected under anesthesia for serum lipid profiling and histopathological evaluation. Oil Red O staining was used to detect lipid droplet accumulation in the submucosal layer of the gallbladder wall. No lipid droplets were observed in the control group or the group receiving prostaglandin. Minimal droplet formation was noted in the high-cholesterol (HC) and HC combined with bile acid groups (p > 0.05 vs. control). A significant increase in submucosal lipid accumulation was observed in the HC + celecoxib and HC + bile acid + celecoxib groups (p < 0.05). The addition of methionine to these regimens (HC + celecoxib + methionine and HC + bile acid + methionine) further enhanced lipid droplet formation (p < 0.05), with no statistically significant difference between the two. The most substantial lipid aggregation was detected in the HC + bile acid + celecoxib + methionine group (p < 0.05 vs. all other groups). Impaired mucosal cholesterol reverse transport, particularly under combined inhibition of both mucin expression and RCT, was associated with the most pronounced submucosal lipid deposition and the highest incidence of gallstone formation. To our knowledge, this study is the first to establish an animal model of GCPs integrating mucoprotein and RCT regulation, providing a platform for mechanistic studies and potential therapeutic exploration.

Hepatoid adenocarcinoma (HAC) of the gallbladder is an exceedingly rare and highly aggressive variant of gallbladder carcinoma that is frequently associated with alpha-fetoprotein (AFP) production and typically has a poor prognosis. We report a 66-year-old male with a two-week history of right upper abdominal pain. Imaging revealed a hypermetabolic mass at the gallbladder fundus, accompanied by a significantly elevated serum AFP concentration of 1210.00 ng/mL. Histopathological and immunohistochemical analyses confirmed a diagnosis of AFP-positive HAC. Notably, next-generation sequencing (NGS) revealed a TP53 mutation and EGFR copy number amplification, providing insights into the molecular landscape of this rare tumour. The patient underwent radical resection, including cholecystectomy and wedge hepatectomy. To target the hepatoid biological features of the tumour, adjuvant transarterial chemoembolization (TACE) with epirubicin was administered one month after surgery. Following this combined approach, the patient’s serum AFP concentration normalized. As of January 2025, the patient has achieved a 68-month recurrence-free survival. This case highlights that aggressive surgical intervention combined with adjunctive TACE may significantly improve long-term outcomes in patients with AFP-positive gallbladder HAC.

BackgroundTumor-associated macrophages (TAMs) shape the tumor microenvironment and drive hepatocellular carcinoma (HCC) progression. However, the prognostic significance of TAM polarity-related genes, particularly based on the CXCL9:SPP1 signature, remains unclear.MethodsWe identified 372 TAM polarity-related genes in the TCGA-LIHC dataset. Prognostic candidates were selected using univariate Cox regression, bootstrap resampling, and the Boruta algorithm. Seven machine learning models were compared, and XGBoost was selected to construct a TAM polarity-related signature (TPS) consisting of 17 genes. TPS was validated in two external cohorts. Associations with clinical features, biological pathways, immune status, and drug sensitivity were explored. scRNA-seq and qRT-PCR were performed to investigate cellular expression and functional relevance.ResultsTPS markedly different patients into high- and low-risk groups with significantly different survival outcomes (TCGA 1-, 3-, 5-year AUCs: 0.91, 0.89, 0.88). High-risk patients showed enrichment in glycan metabolism, DNA repair, and oncogenic pathways, whereas low-risk patients displayed elevated lipid and amino acid metabolism. Immune profiling revealed greater infiltration of immunosuppressive cells and higher expression of immune checkpoints in high-risk patients. Drug sensitivity analysis identified potential therapeutic targets and candidate compounds, including CDK1, PLK1, and statins. scRNA-seq analysis highlighted disrupted macrophage-immune interactions and identified SPP1 as a key signaling mediator. Silencing of TTC1 and G6PD suppressed HCC cell proliferation.ConclusionWe developed and validated a robust TAM polarity-related signature that effectively stratifies HCC patients by prognosis. TPS provides insights into tumor immunity, metabolism, and drug response, and may serve as a valuable tool for precision medicine in HCC.

Gallstones represent a common yet often underappreciated complication following bariatric surgery, with reported incidence rates ranging widely from 10.4% to 52.8% within the first postoperative year. Multiple factors contribute to gallstone formation in this setting, including intraoperative injury to the hepatic branch of the vagus nerve, alterations in bile composition, reduced food intake, shifts in gastrointestinal hormone levels, and dysbiosis of the gut microbiota. Notably, the risk of cholelithiasis varies by surgical procedure, with sleeve gastrectomy (SG) generally associated with a lower incidence compared to Roux-en-Y gastric bypass (RYGB). Prophylactic cholecystectomy during bariatric surgery may benefit patients with preexisting gallstones, whereas preserving the hepatic branch of the vagus is an important technical consideration, particularly in RYGB, to mitigate postoperative gallstone risk. Pharmacological interventions, such as ursodeoxycholic acid (UDCA), have demonstrated efficacy in preventing gallstones and reducing subsequent cholecystectomy rates. However, consensus is lacking on the optimal dosing, duration, and administration frequency of UDCA across different bariatric procedures. Additionally, dietary measures, such as moderate fat intake or fish oil supplementation, have shown promise in alleviating lithogenic processes. Emerging evidence supports the use of probiotics as a safe and patient-friendly adjunct or alternative to UDCA, given their ability to improve gut dysbiosis and reduce gallstone formation. Further high-quality studies are needed to define standardized prophylactic strategies that balance efficacy with patient adherence, offering personalized gallstone prevention protocols in the era of widespread bariatric surgery.

Hilar cholangiocarcinoma (hCCA) is a malignant tumor originating from the epithelial cells of the bile ducts, and it is characterized by an aggressive nature, complex surgical management, high mortality, and poor prognosis. Despite recent advances in surgical techniques, medical devices, and related technologies, there remains a pressing need to standardize diagnostic and therapeutic pathways to improve treatment outcomes and extend long-term patient survival. To better integrate and refine these standards, this consensus was reached through a national conference held in Changsha, Hunan Province, involving multidisciplinary experts from various regions across China. This collaborative effort, drawing from various medical facilities and academic organizations nationwide, resulted in the reaching of the "Chinese Multicenter Expert Consensus on the Diagnosis and Treatment of Hilar Cholangiocarcinoma: 2025 Edition" based on current clinical studies and over 40 years of clinical practice experience in managing hCCA. The consensus provides a comprehensive overview of hCCA, including its epidemiological characteristics, diagnostic and screening methods, pathological features, staging and classification systems, and various treatment modalities, while offering specific and actionable recommendations for clinical practice that highlight well-defined indications for surgical, local, and systemic therapies and that emphasize the importance of multidisciplinary approaches to both diagnostic and therapeutic workflows.

Background T-tube cholangiography and choledochoscopy are commonly employed techniques for assessing residual bile duct stones following biliary surgery. Further investigation is warranted to determine the utility of routine cholangiography prior to T-tube removal. It is imperative to explore the diagnostic efficacy of various examination methods for detecting residual calculi post-biliary surgery. Methods The clinical data of 287 patients who underwent T-tube angiography and choledochoscopy following choledochotomy and subsequent T-tube drainage at the Department of General Surgery, Xuanwu Hospital, Capital Medical University from 2017 to 2022 were retrospectively analyzed. All patients underwent both cholangiography and choledochoscopy six to eight weeks after laparoscopic cholecystectomy combined with common bile duct exploration and T-tube drainage surgery. The results of T-tube cholangiography and choledochoscopy for each patient were recorded, followed by analysis and comparison. Results Among the cohort of 287 patients, T-tube cholangiography revealed 38 cases of residual stones, which were subsequently confirmed by choledochoscopy in 29 cases. Conversely, among the remaining 249 patients who exhibited no evidence of residual stones on T-tube angiography, a single patient was later verified to have retained stones through choledochoscopy. The results of T-tube cholangiography and choledochoscopy showed no significant difference (P = 0.82), indicating a high level of agreement between the two methods (Kappa value: 0.70). Conclusion The simultaneous performance of T-tube cholangiography and choledochoscopy after biliary surgery is recommended to enhance the diagnostic accuracy of residual stones and reduce the incidence of bile duct stone remnants.

Abstract Background Radical resection is still the most cost-effectiveness curative strategy for intrahepatic cholangiocarcinoma (ICC), but it remains controversial on the survival benefit of anatomic resection (AR). In this study, we sought to compare the oncologic outcomes between AR versus non-AR (NAR) as the primary treatment for early-stage ICC patients. Methods Data of ICC patients who underwent hepatectomy and staged at AJCC I were retrospectively collected from 12 hepatobiliary centers in China between Dec 2012 and Dec 2015. Propensity score matching (PSM) and stabilized inverse probability of treatment weighting (IPTW) analysis were performed to minimize the effect of potential confounders, and the perioperative and long-term outcomes between AR and NAR groups were compared. Results Two hundred seventy-eight ICC patients staged at AJCC I were eligible for this study, including 126 patients receiving AR and 152 patients receiving NAR. Compared to the NAR group, the AR group experienced more intraoperative blood loss before and after PSM or stabilized IPTW (all P > 0.05); AR group also experienced more intraoperative transfusion after stabilized IPTW (P > 0.05). In terms of disease-free survival (DFS) and overall survival (OS), no significant differences were observed between the two groups before and after PSM or stabilized IPTW (all P > 0.05). Multivariable Cox regression analyses found that AR was not an independent prognostic factor for either DFS or OS (all P > 0.05). Further analysis also showed that the survival benefit of AR was not found in any subgroup stratified by Child–Pugh grade (A or B), cirrhosis (presence or absence), tumor diameter (≤ 5 cm or > 5 cm) and pathological type (mass-forming or non-mass-forming) with all P > 0.05. Conclusion Surgical approach does not influence the prognosis of patients with stage I primary ICC, and NAR might be acceptable and oncological safety.

Objective:To explore the pathogenesis of gallbladder cholesteryl polyps (GCP) and gallbladder cholesterol calculus (GCC) by studying the different changes of mucin (MUC) expression and reverse cholesterol transporter (RCT) in gallbladder mucosa epithelium.Methods:The data of 10 GCP patients (GCP group), 10 GCC patients (GCC group) and 5 patients with normal gallbladder resection (control group) were retrospectively analyzed, who underwent cholecystectomy in the Department of General Surgery, Xuanwu Hospital, Capital Medical University from January to December 2021. Among the 10 patients in the GCP group, there were 5 males and 5 females, aged (43.40±9.59) years old. Among the 10 patients in the GCC group, 5 males and 5 female, aged (45.00±8.13) years old. Among the 5 patients in the control group, there were 3 males and 2 females, aged (43.80±6.01) years old. Immunohistochemical analysis was used to investigate the expression differences of various subtypes of MUC and RCT [ATP binding cassette transporter G1 (ABCG1) and B group type I scavenger receptor (SR-BI)] among each group.Results:Compared with the control group, the expression of MUC1 (3.40±0.70 vs. 0), MUC5AC (1.50±0.53 vs. 0), MUC6 (4.70±0.48 vs. 0), and ABCG1 (3.50±0.53 vs. 1.60±0.55) in the gallbladder mucosa of the GCP group increased, while the expression score of SR-BI decreased (1.70±0.48 vs. 3.40±0.55), with statistical significance (all P<0.001). Compared with the control group, the expression of MUC1 (4.80±0.42 vs. 0), MUC5AC (4.70±0.48 vs. 0), MUC6 (3.30±0.67 vs. 0), and ABCG1 (3.40±0.52 vs. 1.60±0.55) in the gallbladder mucosa of the GCC group increased, while the expression score of SR-BI decreased (0 vs. 3.40±0.55), with statistically significant differences (all P<0.001). Conclusion:The different expression levels of MUC1, MUC5AC, MUC6, and RCT proteins lead to the differential formation of GCP and GCC on the basis of the co-pathogenesis in high cholesterol in bile.

Gallbladder stone (GS) is a common disease. There are no obvious symptoms at early stage for the patient with GS. Obstruction will cause acute cholecystitis. Secondary obstructive cholangitis of GS, biliary pancreatitis, gallbladder cancer due to GS would be serious. Many guidelines and consensuses have been published in the world and from many professional organizations, promoting the normative diagnosis and treatment of GS. However, there are still a lot of controversial issues. Currenly, there is a lack of study on the whole course of GS with large samples. Prevention and early diagnosis with treatment of GS are neglected. It results in insufficient personalized diagnosis and treatment. In order to have the prevention, diagnosis, treatment, prognosis and follow-up which are carried out better, the authors divided the course of GS into four stages according to the pathophysiological characteristics of the occurrence, development and outcome of GS. There are: ①stage of stone forming; ②asymptomatic period without obstruction; ③inflammation and infection stage, inclu-ding obstructive inflammation, pyogenic gangrene, perforation abscess; ④stage of secondary lesions, including abnormal gallbladder morphology and function, GS shift, gallbladder carcinoma. According to the pathophysiological staging, it is beneficial to the personalized diagnosis and treatment based on the standard management for the patients who can benefit more.

Objective:To explore the pathogenesis and risk factors of gallstone formation.Methods:The findings of hepatobiliary ultrasound and related data were collected from healthy subjects who underwent a physical examination at Xuanwu Hospital of Capital Medical University from January 2012 to December 2021. A total of 98 344 healthy subjects were included in the study,including 48 241 males and 50 103 females,with a ratio of 1∶1.03,aged (42.0±15.6)years(range:14 to 97 years). The gender,age,body mass index,waist circumference,systolic pressure,diastolic pressure,ALT,AST,total bilirubin,fasting blood glucose,triglyceride,total cholesterol,low-density lipoprotein,high-density lipoprotein were collected.Healthy subjects were required to sit for at least 10 minutes before blood pressure was measured.Rresults of fasting venous blood were collected after 8 to 12 hours on an empty stomach.According to the presence of gallstones by ultrasound results, healthy subjects were divided into study group and control group. Data were analyzed by rank-sum tests and χ 2 test, and risk factors for gallstone formation were explored by Logistic regression analysis. Results:The incidence of gallstones in this group was 5.42%(5 333/98 344). Among them,the incidence of gallstones in people aged 60 years and above was significantly higher than that in people under 60 years old(15.31%(2 348/15 334) vs. 3.60%(2 985/83 010), χ 2=3 473.46, P<0.05).The healthy subjects were divided by age for every 10 years,and the results showed that the incidence of gallstones increased with age. The incidence of gallstones in females was 5.68%(2 844/50 103),greater than 5.16%(2 489/48 241) in males( χ 2=11.81, P<0.05). Among them,1 478 cases underwent gallbladder surgical resection due to gallstones,and the operation rate was 27.71%. The operation rate reached the peak between 60 and <70 years old,and decreased after 70 years old. The results of the multivariate analysis showed that,female( OR=1.38, P<0.01),age( OR=1.58, P<0.01),body mass index≥24 kg/m 2( OR=1.31, P<0.01),waist circumference≥85 cm( OR=1.24, P<0.01),fasting blood glucose>6.1 mmol/L( OR=1.18, P<0.01),total cholesterol≥5.18 mmol/L( OR=0.87, P=0.019),low-density lipoprotein≥3.37 mmol/L( OR=1.15, P=0.001) were the risk factors for gallstone formation;high-density lipoprotein≥1.55 mmol/L( OR=0.87, P<0.01) was a protective factor for gallstone formation. Conclusions:The incidence of gallstones increases with age in male and female. Gender,age,body mass index,waist circumferenc,fasting blood glucose,total cholesterol,LDL,and HDL are related factors with gallstone formation.

Objectives:To examine the influence of adjuvant chemotherapy after radical resection on the survival of patients with intrahepatic cholangiocarcinoma(ICC) and to identify patients who may benefit from it.Methods:The clinical and pathological data of 654 patients with ICC diagnosed by postoperative pathology from December 2011 to December 2017 at 13 hospitals in China were collected retrospectively. According to the inclusion and exclusion criteria,455 patients were included in this study,including 69 patients (15.2%) who received adjuvant chemotherapy and 386 patients (84.8%) who did not receive adjuvant chemotherapy. There were 278 males and 177 females,with age of 59 (16) years ( M(IQR))(range:23 to 88 years). Propensity score matching (PSM) method was used to balance the difference between adjuvant chemotherapy group and non-adjuvant chemotherapy group. Kaplan-Meier method was used to plot the survival curve,the Log-rank test was used to compare the difference of overall survival(OS) and recurrence free survival(RFS)between the two groups. Univariate analysis was used to determine prognostic factors for OS. Multivariate Cox proportional hazards models were then performed for prognostic factors with P<0.10 to identify potential independent risk factors. The study population were stratified by included study variables and the AJCC staging system,and a subgroup analysis was performed using the Kaplan-Meier method to explore the potential benefit subgroup population of adjuvant chemotherapy. Results:After 1∶1 PSM matching,69 patients were obtained in each group. There was no significant difference in baseline data between the two groups (all P>0.05). After PSM,Cox multivariate analysis showed that lymph node metastasis ( HR=3.06,95% CI:1.52 to 6.16, P=0.039),width of resection margin ( HR=0.56,95% CI:0.32 to 0.99, P=0.044) and adjuvant chemotherapy ( HR=0.51,95% CI:0.29 to 0.91, P=0.022) were independent prognostic factors for OS. Kaplan-Meier analysis showed that the median OS time of adjuvant chemotherapy group was significantly longer than that of non-adjuvant chemotherapy group ( P<0.05). There was no significant difference in RFS time between the adjuvant chemotherapy group and the non-adjuvant chemotherapy group ( P>0.05). Subgroup analysis showed that,the OS of female patients,without HBV infection,carcinoembryonic antigen<9.6 μg/L,CA19-9≥200 U/ml,intraoperative bleeding<400 ml,tumor diameter>5 cm,microvascular invasion negative,without lymph node metastasis,and AJCC stage Ⅲ patients could benefit from adjuvant chemotherapy (all P<0.05). Conclusion:Adjuvant chemotherapy can prolong the OS of patients with ICC after radical resection,and patients with tumor diameter>5 cm,without lymph node metastasis,AJCC stage Ⅲ,and microvascular invasion negative are more likely to benefit from adjuvant chemotherapy.

医学生担负着国家医疗卫生事业的未来,是健康中国战略成功施行的中流砥柱.临床实习期是医学生向临床医生角色转变的重要阶段,加强临床实习期课程思政教育,是培养医学生救死扶伤、敬业奉献、勇于担当等职业素养的根本保障.提高临床教师对课程思政探索和实践的能力、将课程思政贯穿于临床教学中的言传身教、灵活运用多种教学方法、培养学生积极实践和自我反思的能力等措施是提升医学生临床实习期课程思政教育成效的有效路径.

目的 探索肝胆外科临床实习教学活动中,网络辅助临床案例问题为导向(CBL-PBL)的教学模式提高临床思维能力的教学效果.方法 选取2020年9月至2021年4月在首都医科大学宣武医院肝胆外科病区实习的临床医学系5年级医学生50名作为研究对象,使用随机数字表法将其分为研究组和对照组,每组各25名.研究组采用网络辅助CBL-PBL教学模式,包括网络化的组织管理、CBL为基础的教案设计、PBL为中心的教学实施和网络化课后管理.对照组采用传统教学模式.比较两组学生对临床思维能力学习的满意度.使用临床思维能力教学评估量通用量表评分评估临床思维教学效果.结果 研究组学生对临床思维能力教学满意度高于对照组(P<0.05).研究组学生批评思维、系统思维、循证思维及临床思维能力及总分高于对照组(P<0.01).结论 应用网络辅助CBL-PBL教学模式,在临床医学生肝胆外科的实习中,可以提高学生满意度,改善临床思维能力教学效果,值得深入研究、完善和推广.

在胆囊结石临床诊治中,对于无症状胆囊结石的治疗很考验临床医生的决策,其中难以回避的问题就是能否选择胆囊结石清除手术,也就是"保胆取石"手术.我们应该正视"保胆取石"的社会需求.腹腔镜微创技术的发展也使"保胆取石"有了一定的技术保障.然而,"保胆取石"的学术争议从业内扩展到了业外,各种论点、论调、论据纷繁复杂,势必给广大患者造成治疗选择的巨大困惑.

Objective:To compare the efficacy and safety of providing nasogastric (NG), nasojejunal (NJ), and parenteral nutrition (PN) support to pancreatitis patients who were intolerant to oral feeding.Methods:One hundred pancreatitis patients who were intolerant to oral feeding treated at the Xuanwu Hospital of the Capital Medical University from October 2018 to September 2020 were retrospectively studied. They were divided into three groups based on the nutritional support given to them: the NG group, NJ group, and PN group. The acute physiology and chronic health evaluation Ⅱ(APACHEⅡ), nutritional risk screening 2002 (NRS2002), hemoglobin, albumin, pre-albumin and other clinical data were recorded and compared among the three groups.Results:After nutrition support treatments, the hemoglobin, albumin and pre-albumin levels were significantly better than before giving nutrition support, and the APACHE Ⅱ scores were significantly improved in all the groups. The NRS2002 scores were significantly better in the NJ group ( Z=2.28, P=0.023) and the NG group ( Z=1.99, P=0.046). With compared to the PN group, the albumin and pre-albumin levels were significantly higher in the NG and NJ groups, and the NRS2002 score after giving nutrition support treatment was significantly lower ( P<0.05). Compared with the PN group, the APACHE Ⅱ score ( t=2.18) and the hemoglobin levels ( t=2.04) were significantly better in the NJ group ( P<0.05). The overall incidence of complications in the NJ group was 41.2% (14/34), which was significantly lower than the NG group [78.8%(26/33), χ 2=5.41, P=0.020] and the PN group [66.7% (22/33), χ 2=4.35, P=0.037]. Conclusion:Enteral nutrition support through NG and NJ are better than PN in acute pancreatitis patients who were intolerant to oral feeding.

Gallstones and acute calculous cholecystitis are common diseases in surgery. China has entered an aging society. Elderly patients are a high incidence group of gallstones and acute calculous cholecystitis. Their surgical diagnosis and treatment strategies need to be formulated individually, and reasonable diagnosis and treatment methods should be comprehensively selected according to the patient′s condition and the medical level of the medical institution. For those who are in good physical condition and can tolerate the operation, it is recommended to give priority to surgical treatment, and the minimally invasive surgery mainly suitable for laparoscopic cholecystectomy (LC) is preferred. Open surgery is more appropriate for complicated conditions or patients whose general conditions are not suitable for laparoscopic surgery. Other minimally invasive treatment measures can be applied at the same time. For patients who can not tolerate surgical treatment, puncture, endoscopy, intervention and other means can be selected, combined with drugs for conservative treatment, so as to obtain the opportunity of surgical treatment or improve the prognosis. In this paper, the latest research literature at home and abroad has been collected to review and summarize the latest research progress in the physiology and aging characteristics of the biliary tract in the elderly, the diagnosis and treatment of gallstones and acute calculous cholecystitis. It is hoped that this paper can provide reference for the clinical diagnosis and treatment of such diseases, and think and prospect the future research.

目的:探究镁离子(Mg2+)对肝癌细胞的作用机制.方法:氯化镁溶液提供Mg2+,设置空白对照组、20 mmol/L、40 mmol/L和80 mmol/L的Mg2+溶液培养基培养肝癌Huh-7细胞,检测细胞生长增殖、细胞凋亡、细胞周期,对细胞丝裂原活化蛋白激酶激酶2(MEK2)RNA产物行基因测序,Western Blot检测蛋白.结果:随着Mg2+浓度升高,肿瘤细胞的生存率明显下降,细胞周期G1延长,MAP2K2 RNA上调;Western Blot检测发现在Mg2+作用下Huh-7细胞的MEK2升高,与对照组比较,差异有统计学意义(P＜0.05).结论:(1)Mg2+可以抑制肝癌细胞Huh-7的生长繁殖,延长肝癌细胞Huh-7的细胞周期G1;(2)MEK2有可能是Mg2+抗肿瘤机制中的一个重要蛋白.