2026年 · 第64卷第07期

In recent years, the clinical diagnosis level of hilar cholangiocarcinoma has improved significantly, and the surgical technique has advanced rapidly. With the development and popularization of minimally invasive techniques, many hospitals have carried out laparoscopic radical resection of hilar cholangiocarcinoma, and some large-throughput centers have taken minimally invasive approach surgery as the first choice of treatment. For the treatment of hilar cholangiocarcinoma, the principle of "block resection" and "tumor-free operation" is the key to improve R0 resection of hilar cholangiocarcinoma. After continuous exploration and optimization, our center has proposed laparoscopic modular process radical resection of hilar cholangiocarcinoma, which can not only simplify the surgical operation and shorten the operation time, but also reduce the difficulty and risk of surgery and improve the R0 resection rate.

Surgical treatment is the basic treatment for papillary thyroid carcinoma (PTC) at present. Chylous fistula is one of the complications after neck lymphadenectomy for thyroid cancer, with an incidence rate of 1% ~3%. Chylothorax can lead to hypoalbuminemia, water and electrolyte disorders, etc. In severe cases, chylothorax can occur^［1］。 We treated 6 patients with chylous fistula after radical thyroidectomy + cervical lymph node dissection with fusiform shoulder strap oblique conformal compression around the axil, and achieved satisfactory results. The case data are reported as follows.

With the development of endovascular repair technology, the treatment mode of aortic lesions involving the visceral region is gradually evolving towards total endovascular repair. The safety and effectiveness of fenestration or branching endovascular repair for thoracic and abdominal aortic disease have been demonstrated^{［1, 2, 3, 4］}。 At present, the stents that can be used for visceral area fenestration or branching endoluminal repair mainly include: custom-made devices (CMD), finished branching stents represented by G-branch, and physician modified endografts (PMEG)^［5］Etc. However, the above-mentioned stents still face many limitations in clinical application. The customization cycle of CMD is long, and the clinical accessibility of the product is not high; There are limitations in the availability and anatomical suitability of finished branch stents; PMEG has some problems such as intraoperative uncertainty, potential type III endoleak and long time consumption, all of which restrict the further promotion of endovascular repair of visceral area to some extent. Shao et al.^［6］The method of reconstructing visceral artery with finished iliac-branch device (IBD) for the treatment of thoracic and abdominal aortic disease is reported, which provides a new strategy to solve the above problems. IBD in internal iliac artery reconstruction has been proven safe and reliable^［7］However, there are few reports of IBD used to reconstruct visceral branches in China. In view of this, this paper summarizes the recent efficacy and experience of using IBD reconstruction of visceral branches for endovascular repair of thoracic and abdominal aortic diseases in our hospital vascular surgery department, in order to provide reference for clinical practice.

The patient, a 36-year-old male, was admitted to our hospital in March 2025 because of "chest tumor discovery for 4 years and repeated hemoptysis for 10 months". In December 2021, the patient underwent PET-CT examination in another hospital due to "repeated right chest pain for more than half a year" and found a huge tumor in the right upper chest cavity, 15.3 cm ×10.6 cm ×14.7 cm in size, accompanied by metastases to pleura and mediastinum, abdominal cavity and supraclavicular lymph nodes. The pathology of tumor puncture biopsy was high grade sarcoma. The patient had no prior history of major disease, immunosuppression, trauma, or chemical or radiological exposure. Considering that the tumor could not be resected, he started anti-tumor drug therapy in a foreign hospital in January 2022, and received pembrolizumab + doxorubicin liposome + pazopanib for 5 cycles, anlotinib monotherapy for 2 months, and docetaxel + gemcitabine for 4 cycles. By October 2023, CT reexamination showed that the tumor was in partial remission, and a huge cavity formed in situ in the right upper thoracic tumor. Docetaxel was discontinued and maintenance therapy with gemcitabine continued. In May 2024, the patient experienced repeated hemoptysis, including two massive hemoptysis. Re-examination of PET-CT revealed multiple new lesions on the wall of the right upper thoracic cavity, multiple lymph nodes in the mediastinum, both hilum and right clavicle were enlarged compared with before, and the metabolism of each lesion was increased compared with before. He was diagnosed as tumor recurrence in another hospital. After bronchial artery embolization under radiation intervention to stop the hemorrhage, he started rescue anti-tumor drug therapy. He was given gemcitabine monotherapy, pazopanib monotherapy and rubitidine monotherapy successively, but there was no significant remission of hemoptysis. In February 2025, he suffered a recurrence of massive hemoptysis, and underwent bronchial artery embolization to stop the hemorrhage in another hospital. He was treated in our hospital for further treatment. Physical examination at admission: temperature 36.5 ℃, heart rate 84 beats/min, 20 breaths/min, blood pressure 124/86 mmHg (1 mmHg =0.133 kPa), height 171 cm, weight 68 kg. The thorax has no deformity and is symmetrical from left to right. The bilateral respiratory motility was consistent, the bilateral speech trembling was consistent, and the pleural friction was not palpable. The breathing sounds of both lungs are clear, the breathing sounds of the right lung are slightly weakened, and scattered dry rales can be heard in the right lung, which is obvious in the middle lung field, and can be reduced after cough. The admission PET-MRI results suggested that the right upper thoracic cavity was huge, about 12.6 cm ×6.8 cm ×13.3 cm in size, with multiple local thickening of the cavity wall with increased metabolism, among which the metabolism was the highest in the lower lateral thickening of the cavity (the maximum standard uptake value was 8.9) (Figure 1A), considering that the tumor is still active; Regional lymph nodes were enlarged, with the largest located under the carina (maximum diameter 2.7 cm) (Fig. 1B); Regional lymph node metabolism was increased, with the most metabolic lymph node located in the right parasternal region (maximum standard uptake of 8.5) (Fig. 1C). Further bronchoscopy revealed stenosis of the bronchial opening in the upper, middle and lower lobes of the right lung, and ultrasonic bronchoscopy revealed enlargement of the subcarina lymph nodes. endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) with bronchoalveolar lavage was performed. No tumor cells were found in postoperative cytological examination, and Aspergillus was detected in bronchoalveolar lavage fluid culture and metagenetic detection.