Abstract:It has been a decade since the concept of enhanced recovery after surgery (ERAS) was introduced to China by Academician Li jieshou and the road of exploring an ERAS conforming to China’s reality was initiated. At present time, ERAS has been extensively implemented in the field of hepatic surgery in our country, and gradually formed an ERAS clinical pathway for liver resection with Chinese characteristics. Establishing a clinical strategy for quality control and continuous improvement of liver resection ERAS based on the experience of foreign countries is an urgent new problem. By effective quality control and improvement, application of ERAS can be aggressively and effectively popularized and promoted in the field of liver surgery, and the greatest clinical benefit will be provided to the patients.

Abstract:Objective: To compare the therapeutic effects between emergency hepatectomy and emergency transcatheter arterial embolization (TAE) plus second-stage hepatectomy in treatment of spontaneous ruptured hepatocellular carcinoma (HCC). Methods: By searching several domestic and international databases, the eligible literature of studies was screened according to inclusion and exclusion criteria. Meta-analysis was performed by using StataSE 12.0 software. Results: A total of 11 studies were included, involving 581 patients, of whom, 305 cases underwent emergency hepatectomy and 276 underwent emergency TAE plus second-stage hepatectomy. In patients undergoing emergency TAE plus second-stage hepatectomy compared with those undergoing emergency hepatectomy, the incidence of perioperative complications was significantly decreased (OR=0.39, 95% CI=0.21–0.72, P=0.003), the 30-d mortality rate was significantly reduced (OR=0.21, 95% CI=0.08–0.56, P=0.002), and the 1- and 3-year survival rates were significantly increased (OR=0.48, 95% CI=0.32–0.73, P=0.001; OR=0.59, 95% CI=0.37–0.95, P=0.031). Conclusion: For resectable spontaneous ruptured HCC, emergency TAE plus second-stage hepatectomy can significantly reduce perioperative complications and mortality rate and increase survival rate of the patients compared with emergency hepatectomy.

Abstract:Objective: To investigate the application efficacy of vascular occlusion of the hepatic lobe in anatomical right hepatectomy. Methods: The clinical data of 12 patients were analyzed retrospectively. Of the patients, 8 cases were primary liver cancer and 4 cases were hepatolithiasis. In all the patients, the lesions were confined to the right lobe of the liver or one segment of the right liver. All patients underwent anatomical right hepatectomy with vascular occlusion of the hepatic lobe. Results: Operations in the 12 patients were all successfully completed, which included segment V resection in one case, segment VII resection in 2 cases, segment VIII resection in 3 cases, right posterior lobectomy in 4 cases and right anterior lobectomy in 2 cases. The average operative time was (263.33±27.99) min, and the average intraoperative blood loss was (397.50±85.29) mL. After operation, hydrothorax and bile leakage occurred in one case each, which were resolved by conservative treatment. All patients recovered and were discharged from the hospital. Conclusion: Using vascular occlusion of the hepatic lobe in anatomical right hepatectomy can effectively control the intraoperative bleeding and reduce the liver function damage, so it is safe and feasible.

Abstract:Objective: To establish a difficulty scoring system to predict the difficulty of laparoscopic liver resection (LLR) and to make a preliminary application. Methods: The clinical data of 83 patients undergoing LLR between January 2014 and May 2017 in the First Affiliated Hospital of Chongqing Medical University were retrospectively analyzed. The patients were divided into simple group and difficult group according to the operative time and whether converted to open surgery or not. The factors for surgical difficulty were determined by univariate and multivariate Logistic regression analysis. Then, the scoring system for predicting the surgical difficulty was built based on the coefficient of the regression analysis. The 83 patients were scored and the validity of the scoring system was verified through receiver operating characteristic curve (ROC). Results: The univariate analysis showed that there were significant differences in age, sex, lesion size, lesion traits, distance of the lesion from the inferior vena cava and whether the lesion was located in the left lateral lobe between simple group and difficult group (all P<0.05); multivariate analysis revealed that lesion size (OR=7.034, P=0.043), the distance between the lesion and the inferior vena cava (OR=12.881, P=0.001), and whether the lesion was located in the left lateral lobe (OR=26.774, P=0.001) were independent influential factors for surgical difficulty. The scoring system was established based on the above factors. Efficiency estimation showed that the area under the ROC curve was 0.897 (95% CI=0.826–0.968) with a cut-off value of 4, so the score of a patient equal to or larger than 4 was regarded as surgical difficulty. Conclusion: Surgical difficulty scoring system has certain guiding significance for predicting surgical difficulty in LLR. Surgeons can choose the surgical procedure by referring to the preoperative difficulty score.

Abstract:

Objective: To investigate the application efficacy of 3D printing technology in precision resection of liver tumors. Methods: Thirty patients with liver tumors admitted from May 2016 to May 2017 were enrolled and randomly designated to control group and observation group, with 15 cases in each group. Patients in control group underwent preoperative assessment and surgical treatment plan decision-making based on the image data of CT examination, those in observation group received liver 3D reconstructions of the CT images, which were imported into the 3D printer to create a 1:0.6 liver physical model, and then underwent liver anatomical analysis, preoperative simulation, and surgical plan-making. The main clinical variables between the two groups of patients were compared. Results: The preoperative data were comparable between the two groups of patients. In observation group compared with control group, the average operative time (71 min vs. 83 min), time of hepatic portal occlusion (50.1 min vs. 54.7 min), the estimated blood loss (103.9 mL vs. 121.2 mL), length of hospital stay (18.9 d vs. 20.4 d) were all significantly reduced (all P<0.05), the overall incidence of complications (6.7% vs. 20.0%) was significantly decreased (P<0.05), and all the liver function parameters showed superior values (all P<0.05). Follow-up was conducted for 1 month to 12 months, lung metastases occurred in one case, and progression-free survival was seen in all the remaining cases. Conclusion: 3D printing technology can effectively help precision treatment in patients with liver tumors, improve the surgical success rates and reduce surgical complications, and thereby facilitate the postoperative recovery of the patients.

Abstract:Objective: To investigate the clinical efficacy of laparoscopic radiofrequency ablation (LRFA) in treatment of small primary hepatocellular carcinoma (HCC). Methods: The clinical data of 30 patients with small HCC undergoing LRFA (LRFA group) during August 2011 to October 2013 along with 30 patients undergoing percutaneous radiofrequency ablation (PRFA, PRFA group) and 30 patients undergoing surgical resection for small HCC during the same period in the Second Affiliated Hospital of Nanchang University were retrospectively analyzed. The main clinical variables among the three groups of patients were compared. Results: The preoperative data of the three groups of patients were comparable, and operations in all patients were successfully completed. After operation, the AFP levels in all the three groups were significantly decreased compared with their preoperative values (all P<0.05), while AFP levels showed no significant difference among the three groups (P>0.05); the liver function parameters in all the three groups were significantly increased compared with their preoperative values (all P<0.05), but their increasing amplitudes were greatest and recoveries were slowest in surgical resection group than those in the other two groups (all P<0.05). Both LRFA group and PRFA group were superior to surgical resection group in terms of operative time, intraoperative blood loss, perioperative complications and length of hospital stay (all P<0.05), while the operative time was longer and incidence of complications was lower in LRFA group than those in PRFA group (80.7 min vs. 45.2 min; 6.7% vs. 26.7%, both P<0.05). At one month after operation, rate of complete tumor removal in either LRFA group or surgical resection group was 100%, while in PRFA group was 86.7%, and the difference had statistical significance (P<0.05). The 3-year recurrence rates were 33.3%, 60% and 26.7%, the 3-year disease-free survival rates were 66.7%, 40.0% and 73.3%, and the 3-year overall survival rates were 86.7%, 76.7% and 90.0% for LRFA group, PRFA group and surgical resection group, respectively, where, the 3-year disease-free survival rate was lower and the 3-year recurrence rate was higher in PRFA group than those in the other two groups (all P<0.05), but they showed no significant difference between the latter groups (both P>0.05); there was no statistically significant difference in 3-year overall survival rate among the three groups (P=0.302). Conclusion: For small HCC, LRFA has higher ablation rate than that of PRFA, and similar long-term efficacy to surgical resection, and meanwhile has advantages of minimal invasiveness and fast postoperative recovery. So, it can be used as one of the first treatment options for small HCC.

Abstract:Objective: To investigate the feasibility and clinical efficacy of using controlled low central venous pressure (CLCVP) in laparoscopic hepatic lobectomy. Methods: The clinical data of 97 patients undergoing laparoscopic hepatic lobectomy in the First Af?liated Hospital of Zhengzhou University from September 2013 to July 2017 were retrospectively analyzed. Of the patients, CLCVP was applied in 53 cases (CLCVP group) and not used in 44 cases (control group). Patients in both groups were further divided into simple laparoscopic hepatic lobectomy subgroup (left lateral lobectomy or irregular marginal lobectomy) and complex laparoscopic hepatic lobectomy subgroup (left hemihepatectomy, right hemihepatectomy, or mesohepatectomy). The main clinical variables were compared between the two groups and their subgroups. Results: Operations were successfully performed in all patients and no perioperative death occurred. Either in whole or subgroup comparison, the intraoperative urine output and liver and renal function parameters showed no significant difference between patients in CLCVP group and control group (all P>0.05). In whole comparison, the hepatic resection time and length of postoperative hospital stay showed no significant difference between the two groups (both P>0.05), but the intraoperative blood loss, number of cases requiring blood transfusion and amount of blood transfusion in CLCVP group were significantly less than those in control group (all P<0.05); in subgroup comparison, all above variables showed no significant difference in patients undergoing simple laparoscopic hepatic lobectomy between the two groups (all P>0.05), but the intraoperative blood loss, number of cases requiring blood transfusion and amount of blood transfusion in patients undergoing complex laparoscopic hepatic lobectomy in CLCVP group were significantly reduced compared with their counterparts in control group (all P<0.05). The complications above Clavien-Dindo grade III occurred in 6 patients in CLCVP group and 5 patients in control group respectively (P>0.05); no symptomic pulmonary embolism occurred in any of the patients during or after surgery. Conclusion: For patients undergoing complex laparoscopic hepatic lobectomy, using CLCVP can effectively reduce the amount of intraoperative blood loss and blood transfusion, and with no increase of risk for pulmonary embolism.

Abstract:Objective: To investigate the expression of long non-coding RNA MALAT1 in hepatocellular carcinoma (HCC) tissue and its significance. Methods: The MALAT1 expressions in 85 paired specimens of HCC and adjacent tissues were determined by qRT-PCR, and the relations of MALAT1 expression with clinicopathologic factors of the patients were analyzed. The changes in abilities of proliferation and invasion/metastasis in HCC SMMC-7721 cells after MALAT1 overexpression or knock-down were examined by CCK-8 and Transwell assay, respectively. Results: The MALAT1 expression in HCC tissue was significantly higher than that in cancer-adjacent normal tissue (P<0.01; the MALAT1 expression was significantly related to the tumor size, differentiation, TNM stage and lymph node metastasis of the patients (all P<0.05). In SMMC-7721 cells, the abilities of proliferation and invasion/metastasis were significantly enhanced after MALAT1 overexpression, and were significantly reduced after MALAT1 knock-down (all P<0.05). Conclusion: MALAT1 expression is up-regulated in HCC tissue, and it can promote proliferation and invasion/metastasis of HCC cells, so it may be closely associated with the occurrence and development of HCC.

Abstract:Objective: To investigate the effect of blueberry anthocyanin on apoptosis and histone acetylation modification in human hepatocellular carcinoma HepG2 cells. Methods: The anthocyanin was extracted from blueberries native to Majiang county of Guizhou province, and the content determination and identification of anthocyanin were performed by high performance liquid chromatography. In HepG2 cells after incubation with blueberry anthocyanin, the morphological changes, cell proliferation and apoptosis as well as the acetylation of histone H3K9, H3K14, H3K18, and H3K27 were observed. Results: Compared with untreated control HepG2 cells, in HepG2 cells after incubation with different concentrations of blueberry anthocyanin (50, 100, 150, 200, and 300 μg/mL) for 48 h, the cell volume was obviously reduced, proliferation was significantly inhibited (all P<0.05) and apoptosis was remarkably increased, and all these effects were increased with increasing concentration of blueberry anthocyanin; the acetylation of histone H3K9, H3K14, H3K18 and H3K27 were significantly enhanced in HepG2 after treatment with different concentrations of blueberry anthocyanin (50, 100 and 200 μg/mL) for 48 h (all P<0.05), with a concentration-dependent manner. Conclusion: Blueberry anthocyanin has inhibitory effect on the proliferation of HepG2 cells, and the mechanism may probably be related to its enhancing histone acetylation and thereby promoting cell apoptosis.

Abstract:Objective: To investigate the influence of cucurbitacin I on growth of hepatocellular carcinoma (HCC) cells and the mechanism. Methods: The influences of cucurbitacin I on proliferative activities of different types of HCC cells (HepG2, QGY-7703 and SMMC-7721) were measured by CCK-8 assay. In HepG2 cells after treatment with cucurbitacin I, the colony formation, cell cycle profile and apoptosis were examined by plate colony-forming assay, flow cytometry and Hochest 33342 staining, and the protein and mRNA expressions of anti-apoptotic factors and their related signaling molecules were determined by Western blot analysis and qRT-PCR method, respectively. Results: The proliferations of all the selected HCC cells were significantly inhibited by cucurbitacin I treatment, with a time- and concentration-dependent manner (all P<0.05), and the 48-h IC50 value of cucurbitacin I for HepG2, QGY-7703 and SMMC-7721 was 0.19, 4.16 and 1.13 μmol/L, respectively. In HepG2 cells after cucurbitacin I treatment for 24 h, the clone formation was almost completely suppressed, typical apoptotic morphological changes and evident G2-phase arrest were presented, and both protein and mRNA expressions of the anti-apoptotic factors Mcl-1 and survivin as well as the transcription factor STAT3 were markedly down-regulated, and the semi-quantitative analysis of mRNA expressions showed all differences had statistical significance (all P<0.05). Conclusion: Cucurbitacin I can suppress the growth of HCC cells, and the mechanism may be associated with its down-regulating the expressions of anti-apoptotic factors through STAT3 signaling pathway, and thereby inducing cell apoptosis.

Abstract:Objective: To investigate the miR-449a expression in hepatocellular carcinoma (HCC) cells and its effect on biological behaviors of HCC cells. Methods: The miR-449a expressions in normal hepatic L02 cells and 4 types of HCC lines (HepG2, Hep3B, SMMC-7721 and Bel-7402) were determined by qRT-PCR method. HCC cells were transfected with miR-449a mimics or scrambled sequences via lipofection, and then, the changes in cell proliferation, cell cycle and invasion ability were detected by CCK-8 assay, flow cytometry and Transwell assay respectively; moreover, the tumor formations of the HCC cells with above transfections in nude mice were observed. Results: The miR-449a expression levels in the 4 HCC cells were all significantly lower than those in L02 cells (all P<0.05), and showed the lowest level in Bel-7402 cells. Compared with Bel-7402 cells transfected with scrambled sequences, the proliferative activity was significantly inhibited, G1/S phase arrest was significantly increased, and the number of migrating cells was significantly decreased in Bel-7402 cells transfected with miR-449a mimics (all P<0.05). The weight and volume of xenografts derived from Bel-7402 cells transfected with miR-449a mimics in nude mice were all decreased compared with those derived from Bel-7402 cells transfected with scrambled sequences (0.748 g vs. 1.234 g; 33.667 mm3vs. 1 400.500 mm3, both P<0.05). Conclusion: The miR-449a expression is decreased in HCC cells, and up-regulating miR-449a expression can suppress the growth of HCC cells in vivo and in vitro.

Abstract:Objective: To investigate the TUSC3 gene expression in hepatocellular carcinoma (HCC) and its clinical significance. Methods: The paraffin-embedded tissue specimens and clinicopathologic data of 92 patients with HCC confirmed by postoperative pathology were collected, and the TUSC3 expressions in HCC and the adjacent tissues were detected by immunohistochemical staining and the relations of TUSC3 expression with clinicopathologic factors of the patients were analyzed. The mRNA and protein expressions of TUSC3 in 20 paired frozen tissue samples of HCC and adjacent tissues were determined by qRT-PCR and Western blot analysis, respectively. Results: Results of immunohistochemical staining for the 92 paraffin-embedded tissue specimens showed TUSC3 expression down-regulated in 56 cases (60.9%) in HCC tissues, and only in 33 cases (35.9%) in adjacent tissues, and the difference was statistically significant (P<0.001); low TUSC3 expression was significantly related to Edmondson grade (P=0.008), TNM stage (P=0.031) and tumor size (P=0.020). Results of qRT-PCR and Western blot analysis of the 20 paired fresh samples showed that the relative expression levels of both TUSC3 mRNA [(0.99±1.46) vs. (1.96±2.18)] and protein [(0.49±0.35) vs. (1.04±0.43)] in HCC tissue were significantly lower than those in adjacent tissue (both P<0.05). Conclusion: The TUSC3 gene expression is down-regulated in HCC tissue and the low TUSC3 expression may be closely related to the malignant process of HCC.

Abstract:Objective: To investigate the inhibitory effect of matrine against hepatic ischemia-reperfusion injury (HIRI) in rats and the mechanism. Methods: HIRI in rats was induced by 60 min hepatic ischemia followed by 120 min reperfusion. Forty SD rats were equally randomized into sham operation group, HIRI model group (model group), low dose matrine (25 mg/kg) pretreatment plus HIRI model group (low dose matrine group) and high dose matrine (50 mg/kg) pretreatment plus HIRI model group (high dose matrine group). Rats in low and high dose matrine groups were injected with matrine of respective dose via the main trunk of the portal vein 30 min before hepatic ischemia, while those in sham operation group and model group received the same volume of normal saline by the same fashion. After the 120 min reperfusion, blood samples were drawn for measuring the serum levels of transaminases and inflammatory factors, and liver tissue samples were harvested for histopathological examination and analysis of hepatic cell apoptosis as well as determination of the protein expressions of TRAIL, BAX and activated caspase-3 (cleaved caspase-3). Results: The results of histopathological examination showed that there were liver injuries in all groups except in sham operation group, but the injuries varied in degree from severe to mild (model group>low dose matrine group>high dose matrine group). Compared with sham operation group, the serum levels of transaminases and inflammatory factors were significantly increased, the liver cell apoptosis was increased, and the protein expressions of TRAIL, BAX and cleaved caspase-3 were all up-regulated in the remaining groups (all P<0.05), but the changing amplitudes in above parameters in low and high dose group matrine groups were significantly milder than those in model group, and were more evident in high dose matrine group (all P<0.05). Conclusion: Matrine has inhibitory effect against HIRI in rats, and the mechanism may probably be associated with its inhibiting TRAIL expression and then reducing BAX and caspase-3 activation, and thereby suppressing liver cell apoptosis.

Abstract:Objective: To investigate the efficacy of using selective cyclooxygenase-2 (COX-2) inhibitor parecoxib for postoperative analgesia of open liver surgery. Methods: Fifty-six patients undergoing open liver resection for cavernous hemangioma of the liver in Peking Union Medical College Hospital from September 2014 to December 2016 were enrolled and were randomly designated to control group and observation group, with 28 cases in each group. Patients in control group underwent patient-controlled analgesia (PCA), and those in observation group received PCA plus parecoxib treatment. The relevant perioperative variables, postoperative analgesic effects, recovery variables and adverse effects were compared between the two groups of patients. Results: There were no significant differences in preoperative data and intraoperative variables between the two groups of patients (all P>0.05). After operation, the blood ammonia levels and portal vein velocities showed no significant changes (both P>0.05) while the erythrocyte sedimentation rates and levels of high-sensitivity C-reactive protein were significantly increased in both groups after operation compared with their preoperative values (both P<0.05), but all these parameters showed no significance between the two groups (all P>0.05). The postoperative day (POD) 1 and 2 resting and exertion pain VAS scores, POD 3 resting pain VAS score and dose of analgesics used were all significantly reduced in observation group compared with control group (all P<0.05); the number of cases requiring additional pain relief was significantly decreased in observation group compared with control group (5 cases vs. 17 cases, P=0.001), and the incidence of postoperative vomiting was significantly decreased in observation group compared with control group (17.8% vs. 46.4%, P<0.05). No significant differences were noted in incidence of postoperative nausea, recovery variables and hospitalization costs between the two groups (all P>0.05). Conclusion: For postoperative analgesia of open liver surgery, combined use of parecoxib is safe and can effectively relieve pain and reduce the dose of opioids and the adverse effects, and meanwhile will not increase the hospitalization costs.

Abstract:Objective: To investigate the changes in serum transforming growth factor β1 (TGF-β1) level in patients with advanced primary hepatic carcinoma (PHC) before and after transcatheter arterial chemoembolization (TACE) and its prognostic significance. Methods: One-hundred and sixteen patients with advanced PHC undergoing TACE in the People’s Hospital of Zhengzhou from June 2012 to January 2016 were enrolled. The serum TGF-β1 levels of the patients were determined at 1 d before and 1, 7 and 30 d after TACE. The relations of serum TGF-β1 level with recurrence/metastasis and survival time of the patients were analyzed according to the follow-up findings and TGF-β1 level at each defined time point. Results: In the entire group of patients, the TGF-β1 level was significantly higher at 1 d after TACE, while it was significantly lower at 7 or 30 d after TACE than that of preoperative value (all P<0.05); the TGF-β1 level in patients with postoperative recurrence/metastasis (75 cases) showed no significant difference with that in patients with progression-free survival (41 cases) at either preoperative or postoperative 1 or 7 d assessment (all P>0.05), but was significantly higher than that in patients with progression-free survival 30 d after TACE (268.3 pg/mL vs. 200.4 pg/mL, P=0.001). The results of Kaplan-Meier analysis showed that the TGF-β1 level before and 30 d after TACE along with the maximum diameter of the tumor and lesion number were the influential factors for survival time of the patients (all P<0.05), and the results of multivariate Cox regression analysis showed that the postoperative 30 d TGF-β1 level (OR=2.820, 95% CI=1.559–5.102, P=0.001) together with the maximum diameter of the tumor (OR=2.063, 95% CI=1.152–3.694, P=0.015) were the independent prognostic factors. Conclusion: The change in TGF-β1 level is closely related to the outcomes of patients with advanced PHC after TACE. The preoperative and postoperative day 30 TGF-β1 levels have certain implications for prognosis, and patients with high TGF-β1 level may have a higher risk of poor prognosis than those with low TGF-β1 level.

Abstract:Objective: To investigate the clinical features of cystic hepatic lymphangioma and its diagnosis and treatment methods, so as to improve the diagnostic rate and therapeutic efficacy. Methods: The clinical data as well as diagnosis and treatment process of two adult patients with cystic hepatic lymphangioma in Affiliated Hospital of Guangdong Medical University were retrospectively analyzed. The literature on cystic hepatic lymphangioma in periodical databases was retrieved and reviewed. Results: Both patients treated by the authors were female, and were diagnosed as cystic space occupying lesion of the liver and hepatic cyst on admission respectively; then both patients received surgical treatment after completion of the relevant examinations, and were finally diagnosed as cystic hepatic lymphangioma by postoperative pathology; no recurrence occurred in either of them during follow-up and the treatment results were satisfactory. A total of 6 patients with cystic hepatic lymphangioma were reported in China from 1984 to 2017, of whom, 4 cases were male and 2 cases were female; two cases were diagnosed as hepatic cystic lymphangioma (2/6) and all the others (4/6) were misdiagnosed at admission. After surgical resection, the diagnosis was confirmed to be cystic hepatic lymphangioma in all of the 6 cases and they all recovered satisfactorily after operation. Conclusion: Cystic hepatic lymphangioma is a rare benign liver disease, which has no specific clinical symptoms, signs and imaging characteristics, and is likely to be misdiagnosed as liver cysts and other cystic diseases of the liver in clinical practice. MRI can help in differential diagnosis. Treatment plan should be based on the individual conditions of the patients with definite symptoms and signs or if malignancy cannot be excluded. Pathological examination is the only way to make the definite diagnosis.

Abstract:Hepatocellular carcinoma (HCC) is one of the most common types of tumors of the digestive system. Recent studies have established that keratin 19 (K19) positive HCC is associated with the malignant biological behaviors such as early metastasis, poor differentiation and higher aggressiveness. For better understanding the role of K19 in cancer stem cells, angiogenesis, invasiveness and apoptosis of HCC and its relevant impacts, the authors address the biological actions of K19 in HCC.

Abstract:Cholangioenterostomy is a most commonly used procedure for biliary reconstruction and widely used in treatment of biliary obstruction caused by benign and malignant biliary tract diseases. Because any type of cholangio-intestinal anastomosis will change the body's normal gastrointestinal anatomy and physiological structure, once biliary tract disease re-occurs in these patients, the repeated operation is dangerous, difficult and also unacceptable by them, which pose a great challenge in clinical practice. The development of minimally invasive technologies, especially the development and perfection of percutaneous transhepatic cholangioscopy (PTCS) in recent years provides a safe, feasible and effective strategy for dealing with such conditions. The authors present the application and research progress of PTCS in diagnosis and treatment of biliary tract diseases after cholangioenterostomy.