To study the techniques of making a diagnosis through imaging in order to increase the surgeons' precision during surgery.Primarily,the surgeon must obtain the necessary information from imaging to produce an accurate diagnosis.Secondly,the surgeon can use the imaging to address the observed difference between clinical presentation and the patient's medical needs.Lastly,the methods and guidelines used by surgeons to form diagnoses by imaging were consolidated.There are four techniques developed by surgeons to produce diagnoses based off imaging.They relied on the clinical data,surgical knowledge,surgical pathology,and comparative imaging to form their clinical diagnoses.The surgeon may increase their accuracy of diagnoses and surgical decision through imaging by implementing these four techniques.

Precise diagnosis is the premise of precise surgery.Duodenal papillary carcinoma is one cause of obstructive jaundice,but the several preoperative diagnostic imaging investigations (including Ultrosonography,CT,MRI with MRCP,PTC,T-tube chalangiogrphy) can not make the correct diagnosis of the tumor in location and nature.In some cases,the error diagnoses resulted in error surgeries which led to reoperations.During a period of ten years from the beginning of 2003 to the end of 2012,29 cases with the entity made the correct diagnosis by surgeons in location and partly correct in nature.Based on the experience of these cases,comparing the data from clinic pictures,imaging findings and pathologic observations,seven common characters for the diagnostic imaging investigation were valuable to make precise diagnosis of duodenal papillary carcinoma.These common characteristics are listed as:(1) dilated gallbladder,marked intra-and extrahepatic biliary ductal dilatation in whole range,may combine dilation of pancreatic duct;(2) on cross-sectional imaging as a double-duct sign,which results from obstruction of both the distal common bile duct and the proximal pancreatic duct; (3) on cross-sectional imaging as a cyclo-dilatation at the level of renal hilum;(4) on cross-sectional imaging as a apple-stem sign,which results from dilated common bile duct and the normally proximal pancreatic duct; (5) on coronal plane imaging at the level of second lumbar vertebrae as a cutoff,or eccentricity,or irregular strcture ; (6) on cross-sectional imaging of CT imaging as a mass located at duodenum near the side of pancreas; (7) on MRCP examinations as a mass with hypointensity at the level of duodenal papilla.Any imaging examination alone,or combined examination show first characteristic with any one of the other six characteristics,the diagnosis of duodenal papillary carcinoma may be made,subsequently followed by a correct surgical decision.

To study the arts of imaging diagnosis for the surgeons to increase the precision of their surgical decision.There are essential differences between radiologists and surgeons in how they form their diagnoses through imaging.The radiologist concludes a diagnosis based on the images alone.The conclusions are primarily based on the single-faceted past examples from their specialty.Surgeons concentrate on multi-modalities addressing the images,the clinical data,pathology,and inference chip lesions to make diagnoses.The four arts of sight,cognitive association,inference,and wisdom are highlighted pillars of how surgeons form diagnoses from imaging.The surgeon may increase their accuracy of imaging diagnoses by these four arts.

At present, the general surgery is facing various challenges. In order to meet the requirement of the 21 st century,some measuresshould be adopted to solve the problems listed as follows:The most important measure is to select a capable man to be the chief of the department and to make out a strategic scheme for future development. It also needs to know the ability level of the department in surgical science so that can carry forward the department's advantages and make up its disadvantages. The senior surgeons in the department should concentrate themselves along some special branch of general surgery while the young and the middle-aged surgeons build up their fundamental knowledge as well as the surgical technique in order to make a start for a mastering higher specialized skill. All members of the department should put in their effort together to develop new technique along the front line of the medical science to get close connection with the up-to-date international progress of surgery. The “young successor" out of competition should be supported and cultivated to be an excellent surgeon in the next century.

Objective To investigate the feasibility of segmental splenectomy for treatment of splenic benign tumor. Methods The clinical data of 6 patients with splenic benign tumor treated in our hospital with spleen-preserving surgery in the past 2 years were retrospectively analyzed. Results All the 6 patients successfully underwent surgery and recovered smoothly after operation. No acute severe infection occurred. Ultrasonography showed that the blood supply of residual spleen was of no problem. The components of peripheral blood had no significant changes after operation. Conclusion As long as we know the vascular anatomy of spleen well, segmental splenectomy is safe, reliable and feasible.