Since Reich completed the first laparoscopic hepatectomy ( LH) in 1991, LH has been developed rapidly with the continuous improvement of surgeons' technique and the technological changes in devices and related processes. This article elaborates on the safety and efficacy of LH, the value of 3D visualization, 3D printing technology, and 3D laparoscopic technology in guiding precise hepatectomy, control of hemorrhage during LH, and safety and efficacy of robotic hepatectomy.

Percutaneous radiofrequency ablation ( RFA) has been widely used in the treatment of malignant hepatic tumors and has achieved satisfactory effects. Complications after RFA have been taken seriously and the risk of the development of complications is closely associated with tumor location. It is a great challenge for physicians to perform RFA for hepatic tumors in high-risk locations due to related difficulties and risks. This article reviews the complications after RFA for hepatic tumors in high-risk locations and analyzes related control strategies.

Bile duct stones are a common disease in clinical practice in China, and due to a high incidence rate of complications and complex causes, its clinical diagnosis and treatment has become a difficult problem which needs to solved urgently. With the development of science and technology and the enhanced knowledge of this disease, many treatment methods for this disease have emerged. This article summarizes the successful experience in the treatment of bile duct stones in the Center for Integrated Traditional Chinese and Western Medicine Therapy for Biliary and Pancreatic Diseases in our hospital. With reference to the type and distribution characteristics of bile duct stones, a combination of various endoscopic techniques, such as laparoscopy, choledochoscopy, and duodenoscopy, can achieve the goal of minimally invasive, diverse, and individualized diagnosis and treatment and provide feasible thoughts and strategies for the treatment of bile duct stones.

Elderly patients with biliary and pancreatic diseases are often complicated by other underlying diseases and have poor cardiopulmonary function, and most of them cannot tolerate general anesthesia. The patients aged above 80 years who have undergone bile duct exploration have high mortality rate and incidence rate of complications. Endoscopic retrograde cholangiopancreatography ( ERCP) is applicable to elderly patients with biliary and pancreatic diseases. This article elaborates on the features of perioperative treatment and technical operation of ERCP in elderly patients.

Central pancreatectomy is an ideal surgical procedure for the treatment of benign or low-grade malignant tumors in the pancreatic neck or the proximal body of the pancreas, and it can preserve more normal pancreatic tissue in order to reduce the incidence of endocrine and exocrine insufficiency after surgery. Although some clinical studies have demonstrated the feasibility and safety of this procedure, laparoscopic central pancreatectomy was technically challenging with a few number of cases. This article reviews the current status of laparoscopic central pancreatectomy and introduces our clinical experience of laparoscopic central pancreatectomy and pancreaticojejunostomy.

Objective To investigate the impact of different HBV DNA detection methods on evaluating the clinical effect of PEG-IFNα-2b in the treatment of HBeAg-positive chronic hepatitis B (CHB) .Methods A total of 83 CHB patients who were admitted to Tianjin Second People's Hospital from September 2014 to January 2016 and treated with PEG-IFNa-2b for less than 24 weeks with clearance for the first time detected by HBV DNA low-sensitivity method (the lower limit of detection was 500 IU/ml) and negative results within 36 weeks obtained by low-sensitivity detection.Among these patients, 33 patients with negative results within 36 weeks obtained by high-sensitivity detection (the lower limit of detection was 20 IU/ml) were enrolled in negative group, and 50 with positive results were enrolled in positive group.The reductions in HBeAg and HBsAg and HBeAg seroconversion rate at 12, 24, and 36 weeks were compared between the two groups.The independent-samples t test was used for comparison of normally distributed continuous data between groups, the Mann-Whitney U rank sum test was used for comparison of non-normally distributed continuous data between groups, and the chi-square test was used for comparison of categorical data between groups.Results At 12, 24, and 36 weeks after negative results were obtained by HBV DNA low-sensitivity detection, the negative group had a significant reduction in HBeAg than the positive group[12 weeks:0.32 (0.16-0.92) log10 COI vs 0.14 (0.01-0.30) log10 COI, Z=-3.061, P =0.002;24 weeks:0.44 (0.19-1.15) log10 COI vs 0.16 (0.04-0.35) log10 COI, Z=-3.043, P =0.002;36 weeka:0.51 (0.36-1.21) log10 COI vs 0.24 (0.10-0.46) log10 COI, Z=-3.880, P< 0.001].At 12 weeka after negative reaulta were obtained by HBV DNA low-aenaitivity detection, there waa no aignificant difference in the reduction in HBaAg (P-0.067) , while at 24 and 36 weeka, the negative group had a aignificant reduction in HBaAg than the poaitive group[24 weeka:0.13 (-0.02-0.33) log10 IU/ml vs 0.08 (-0.02-0.16) log10 IU/ml, Z =-2.207, P =0.021;36 weeka:0.16 (0.03-0.47) log10 IU/ml va 0.03 (-0.08-0.20) log10 IU/ml, Z =-2.363, P =0.018].At 12 weeka after negative reaulta were obtained by HBV DNA low-aenaitivity detection, there waa no aignificant difference in the HBeAg aeroconveraion rate between the negative group and the poaitive group (30.30%va 16.00%, P = 0.174) , while at 24 and 36 weeka, there were aignificant differencea between the two groupa (36.36%val6.00%and39.39%val8.00%, x2=4.507 and 4.671, P =0.040 and 0.042) .Conclusion In the treatment of HBeAg-poaitive CHB uaing PEG-IFN, high-aenaitivity detection methoda ahould be uaed to accurately evaluate the effect of antiviral therapy.

Objective To investigate the risk factors for poor short-term prognosis of patients with hepatic encephalopathy (HE) .Methods A retrospective analysis was performed for the clinical data of 316 patients with HE who were hospitalized and treated in The First Hospital of Jilin University from January 2013 to December 2015, and according to their prognosis, they were divided into survival group (229patients) and death group (87 patients) .The univariate and multivariate analyses were performed for their general data and biochemical parameters to screen out the risk factors for poor prognosis of HE.The t-test or Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups.The multivariate logistic regression analysis was performed for the variables with statistical significance identified in the univariate analysis.Results All the patients were followed up for 30 days, and 87 patients died, resulting in a mortality rate of 27.5%.The male/female ratio was 1.72∶ 1, and 269 patients (85.13%) were aged ≥45 years.The univariate analysis showed that there were significant differences between the two groups in age, a combination of primary liver cancer, HE stage, white blood cell count, neutrophil count, hemoglobin, platelet count, international normalized ratio, prothrombin time, prothrombin time activity (PTA) , blood urea nitrogen, creatinine, serum sodium, serum potassium, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transpeptidase, albumin, indirect bilirubin, total bilirubin (TBil) , and prealbumin (all P<0.05) .The multivariate analysis showed that a combination of primary liver cancer (OR=3.278, 95% CI: 1.494-7.194, P=0.003) , HE stage (OR=2.402, 95% CI: 1.711-3.372, P<0.001) , PTA (OR=0.969, 95% CI:0.951-0.988, P=0.001) , serum sodium (OR=0.956, 95% CI: 0.922-0.992, P=0.018) , and TBil (OR=1.004, 95% CI:1.003-1.006, P<0.001) were independent risk factors for the prognosis of patients with HE.Conclusion A combination of primary liver cancer, advanced HE stage, low serum sodium, low PTA, and increased TBil are independent risk factors for poor prognosis of HE, and the equation based on these indices has a certain reference value in clinical practice.

Objective To investigate the clinical effect of plasma perfusion (PP) combined with plasma exchange (PE) in the treatment of acute-on-chronic liver failure (ACLF) .Methods A total of 72 patients with ACLF who were admitted to The Second People's Hospital of Lanzhou from January 2014 to December 2015 were enrolled.In addition to internal medication, all the patients were treated with the artificial liver support system (once every 3-4 days based on the patients' conditions, 1-3 times on average for each patient) .According to the difference in therapies, the patients were divided into combination group with 40 patients (PP combined with PE and a total of 107 case times) and control group with 32 patients (PE alone and a total of 85 case times) .Total bilirubin (TBil) , alanine aminotransferase (ALT) , and prothrombin time were recorded before treatment, after surgery, and at 72 hours after surgery.Clinical outcome was evaluated after 4 weeks of treatment.The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups.Results The overall response rate of all patients was 63.89% (46/72) .At 72 hours after surgery, there was a significant difference in the level of ALT between the combination group and the control group (319.54 ± 86.23 U/L vs354.75 ± 100.76 U/L, t=2.60, P<0.05) .Both groups had significant reductions in TBil and ALT after surgery (combination group: t =6.69 and 15.84, P<0.05; control group: t=5.34 and 14.38, P<0.05) and at 72 hours after surgery (combination group: t=3.24 and8.83, P<0.05; control group: t=2.40 and 4.61, P<0.05) .Both groups had significant changes in prothrombin time activity after surgery (t=4.83 and 5.01, both P<0.05) .There were no significant differences in the incidence rates of pruritus and rash between the two groups, while there was a significant difference in the incidence rate of perioral or limb numbness between the two groups (10.28% vs31.76%, χ2=9.11, P<0.05) .Conclusion Both PE combined with PP and PE alone can effectively improve the clinical outcome of ACLF patients with similar response rates; however, PE combined with PP can save the amount of plasma by 40%-50% and reduce the incidence of the adverse effects of PE and has higher safety.Meanwhile, it is in accordance with the social reality of a shortage of blood resources.Therefore, it is a better choice in clinical treatment.

Objective To investigate the influencing factors for spontaneous bacterial peritonitis (SBP) in patients with acute-on-chronic liver failure (ACLF) , and to provide a reference for clinical diagnosis and prognosis evaluation.Methods A retrospective analysis was performed for the clinical data of 667 patients with ACLF who were hospitalized and treated in our hospital from January 2009 to December2014, and according to the presence or absence of SBP, they were divided into ACLF group (n=232) and ACLF-SBP group (n=435) .The general information, laboratory markers, and incidence of complications were compared between the two groups.The t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups, and a logistic regression analysis was used to identify independent risk factors for ACLF complicated by SBP.Results The comparison of laboratory markers and comorbidities showed that there were significant differences between the two groups in albumin (Alb) (t=-4.110, P<0.001) , alanine aminotransferase (U=-6.653, P<0.001) , aspartate aminotransferase (t=-8.045, P<0.001) , blood sodium (t=-2.879, P=0.006) , prothrombin time activity (t=-2.140, P=0.037) , international normalized ratio (t=1.453, P=0.042) , hemoglobin (t=-3.446, P=0.001) , upper gastrointestinal bleeding (χ2=48.252, P=0.002) , hepatorenal syndrome (χ2=16.244, P=0.031) , and pulmonary infection (χ2=13.564, P<0.001) .The multivariate logistic regression analysis showed that there were significant differences in Alb (OR=1.119, 95% CI: 1.052 ~ 1.189) , platelet count (PLT) (OR=1.035, 95% CI: 0.755 ~ 1.084) , upper gastrointestinal bleeding (OR=1.117, 95% CI: 0.072 ~ 1.135) , and pulmonary infection (OR=2.275, 95% CI: 0.978 ~ 5.292) (P=0.002, 0.038, 0.022, and0.036) .Conclusion In the treatment of ACLF patients, risk factors including low Alb, low PLT, upper gastrointestinal bleeding, and pulmonary infection should be prevented, and early diagnosis and intervention of these risk factors helps to reduce the incidence of SBP.