Intraductal papillary mucinous neoplasm (IPMN) is a kind of epithelial neoplasms of mucin-producing cells arising in the main duct and/or branch ducts of the pancreas,and it is one of the precancerous lesions of the pancreatic cancer.With the development of pathology and radiology,the diagnostic rate of IPMN has been gradually increased and given a new understanding on the pathological characteristics,clinical diagnosis and treatment of IPMN.This review overviewed the classification,diagnosis,management and prognosis of IPMN,aiming to deepen the understanding of IPMN and improve the level of diagnosis and treatment.

Objective To investigate the pathogen distribution and drug resistance of biliary tract infection in patients with cholelithiasis, and to summarize the clinical experience.Methods160 patients with cholelithiasis were analyzed.The proportion of patients with biliary tract infection was counted.The bile and venous blood were collected and the distribution of pathogens was detected.The patients were also analyzed for the drug resistance.ResultsThe incidence of biliary tract infection was 62.5%, the positive rate of bile culture was 62.5%, and the positive rate of blood test was 37.5% for 160 patients with cholelithiasis.Gram-positive bacteria include Escherichia coli, Enterococcus faecium, Staphylococcus, Gram-negative bacteria, including Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, etc.;Gram-positive bacteria for the large Methicillin and erythromycin resistance is higher, Gram-negative bacteria for ampicillin and levofloxacin higher resistance.ConclusionThe pathogen distribution and drug resistance of biliary tract infection in patients with cholelithiasis are analyzed.The clinical pathogens are widely distributed.At the same time, the pathogens have different resistance to different antimicrobial agents.Therefore, clinical use should be reasonable choice when using antimicrobial agents, With a view to give full play to drug effects.

Objective To assess the effect of three different liver vascular exclusions on prognosis of patients undergoing hemihepatectomy.Methods Clinical data of 216 patients undergoing hemihepatectomy were analyzed retrospectively.Ninety-eight out of 216 patients received Pringle maneuver during hepatectomy in group A,71 patients of selective liver inflow and outflow vascular exclusions in group B,47 patients using liver hanging maneuver combining with selective liver inflow and outflow vascular exclusions were in group C.Results There was no difference in operation time between the three groups ( t =0.72,0.83,and 0.67,P ＞ 0.05 ).The intraoperative blood loss and transfusion in group B and C were less than that in group A (t =3.72,3.83 and 4.11,4.07,P ＜0.05).Serum albumin level on day 1 and day 3 in group B and C were higher than that in group A (t =3.65,3.77,and 3.90,3.74,P ＜0.05 ).Serum total bilirubin level on day 3 and 5 in group B and C were lower than that in group A ( t =4.13,5.01,and 4.09,3.99,P ＜0.05).Serum alanine aminotransferase on day 1,3 and 5 in group B and C were lower than that in group A ( t =5.36,6.14,and 5.70,7.01,and 4.94,3.98,P ＜ 0.05 ).Postoperative complication rate in group A was higher than that in group B and C ( x2 =13.71 and 23.56,P ＜ 0.05 ).The 3-year survival rate of patients with malignant tumor in the three groups were not significantly different (t =2.38,P ＞ 0.05 ).Conclusions Intraoperative blood loss and transfusion and postoperative complication rate can be reduced,and liver injury can be diminished in hemihepatectomy using selective liver inflow and outflow vascular exclusion alone and or in combination with a liver hanging maneuver.

Objective To evaluate the effects of selective hepatic vascular occlusion SHVO) on the prognosis of patients undergoing hepatic resection for huge liver cancer.Methods The clinical data of 49 patients who received huge liver cancer resection at the Zhejiang People's Hospital from January 2005 to January 2010 were retrospectively analyzed.Based on the type of hepatic vascular occlusion,all patients were divided into Pringle's maneuver group (24 patients) and SHVO group (25 patients).The intraoperative condition,postoperative recovery of hepatic and renal function,incidence of complications,survival rate and recurrence rate of liver cancer of the 2 groups were compared.All data were analyzed by using the t test or Fisher exact probability.The survival curve was drawn by using the Kaplan-Meier method and the survival of the 2 groups was compared by using the Log-rank test.Results Hepatectomy was successfully performed on all the patients.Time for blood occlusion were (32 ±19) minutes in the Pringle's maneuver group and (34 ± 22)minutes in the SHVO group,with no significant difference between the 2 groups (t =2.45,P ＞ 0.05).The volume of blood loss of the Pringle's maneuver group was (736 ± 543) ml,which was significantly greater than (273 ± 298) ml of the SHVO group (t =6.87,P ＜0.05).The incidences of hepatic vein rupture were 21％ (5/24) in the Pringle's maneuver group and 24％ (6/25)in the SHVO group,with no significant difference (x2=1.45,P＞0.05).The course of 3 patients was complicated by hepatic vein rupture and hemorrhage and 1 by air embolism in the Pringle's maneuver group,while no hemorrhage or air embolism happened in the SHVO group.Four patients in the Pringle's maneuver group and 3 in the SHVO group were found with vascular invasion,while the resection margins were negative.There was no significant difference in the hepatic function in the 2 groups before operation.The levels of alanine aminotransferase in the SHVO group at postoperative day 1 and 3 were significantly lower than those in the Pringle's maneuver group (t=7.12,6.35,P ＜ 0.05).There was no significant difference in the levels of blood urea nitrogen and creatinine between the 2 groups (P ＞ 0.05).Acute hepatic dysfunction was found in 4 patients in the Pringle's maneuver group,but no patients with acute hepatic dysfunction was found in the SHVO group.The 1-and 3-year tumor-free survival rates were 58％ and 21％ in the Pringle's maneuver group,which were significantly lower than 72％ and 30％ in the SHVO group (x2 =5.32,6.07,P ＜ 0.05).The 5-year tumor-free survival rates were 21％ in the Pringle's maneuver group and 20％ in the SHVO group,with no significant difference between the 2 groups (x2 =1.78,P ＞ 0.05).Conclusion SHVO is safe,feasible and effective to prevent hemorrhage and postoperative acute hepatic dysfunction,and it is also helpful in reducing early-stage tumor recurrence and improving the tumor-free survival rate in patients with huge liver cancer.

Objective:To compare the treatment outcomes between laparoscopic versus open radical resection for hilar cholangiocarcinoma (HCCA).Methods:From January 2017 to January 2020, the clinical data of 34 patients who underwent radical resection for HCCA were retrospectively collected and analyzed. These patients were divided into the laparotomy group ( n=17) and the laparoscopic group ( n=17) based on the operation they received. Clinical data including perioperative outcomes, oral re-intake time, first out-of-bed activity time, drainage tube removal time, postoperative hospital stay, 30-day and 90-day mortality rates were compared between groups. Results:Of 34 patients who underwent radical for HCCA in the study, there were 16 males and 18 females, aged (64.3±1.7) years. The mean operation time of the laparotomy group was significantly less than those in the laparoscopic group [(436.2±33.4) vs (522.1±24.0) min, P<0.05]. The 2 groups showed comparable results in extent of operation, intraoperative bleeding, incidences of portal vein reconstruction, yields of lymph nodes, and tumor diameter. The laparoscopic group showed advantage trends over the laparotomy group in incidences oral re-intake time [(4.7±0.3) vs (4.6±0.3) days], first out-of-bed activity time [(2.9±0.4) vs (2.2±0.3) days], drainage tube removal time [(12.7±1.3) vs (11.1±1.0) days] and postoperative hospital stay [(18.3±1.7) vs (15.8±1.3) days], but the differences failed to reach statistical significance ( P>0.05). Conclusion:Compared with open surgery, laparoscopic radical resection of HCCA in properly selected patients, was safe and feasible. There were comparable clinical outcomes.

Objective To explore the feasibility and safety of laparoscopic right hemihepatectomy (LRH) via anterior approach for larger tumors in the right lobe of the liver.Methods A retrospective study was conducted based on the clinical data of ten consecutive patients with large right liver cancer undergoing LRH through anterior approach and thirty-seven patients undergoing open hemihepatectomy by anterior approach in recent 6 years.Results Between the two groups there were no significant difference in gender,average age,the mean tumor size,preoperative liver reserve function,cut margin and intraoperative blood transfusion.The LRH group had less average intraoperative blood loss [(408 ± 158)ml vs.(520 ± 153)ml,t =2.047,P =0.046] and shorter postoperative hospital stay [(11.5 ±2.8)d vs.(16.2 ±4.6) d,t=3.091,P=0.003],longer operation time [(302 ±38)min vs.(251±55)min,t=2.732,P=0.009].There was no perioperative death and no significant difference in complications (20.0％ vs.35.1％,x2 =0.812,P =0.367) and similar median survival time (36 mon vs.29 mon,x2 =1.266,P =0.261).Conclusions LRH via anterior approach for larger tumors in the right lobe of the liver is safe and feasible.

Objective To investigate morbidity, mortality and survival of patients with adenocarcinoma of the pancreas who underwent pancreaticoduodenectomy with en bloc portal vein resection, and to evaluate its effect on radical resection of pancreatic carcinoma. Methods Between 1999 and 2003, 32 patients with ductal adenocarcinoma of the head of the pancreas who underwent pancreaticoduodenectomy with SMPV resection were retrospectively analyzed. Patients were divided into two groups with group A(n = 12) in which the wall of portal vein was surrounded by carcinoma without true invasion,and group B(n = 20) , by tumor transmural invasion. Results The overall morbidity was 31% , there was no operative mortality, the 1,3-year survival rate was 59% and 22% respectively. The mean survival time of patients with microscopically positive margin was 5. 6 months as compared with 20 months with microscopically negative margin. There was no difference in tumor size, margin positivity, nodal positivity, and 1,3-year survival rate between the two groups. Conclusions Pancreaticoduodenectomy combined with SMPV resection can be performed safely, without increasing the morbidity and mortality. SMPV resection should be performed only when a margin-negative resection is expected. SMPV invasion is not associated with histologic parameters suggesting a poor prognosis.

Objective To explore the safety of the left anterior pararenal space approach in laparoscopic distal pancreatectomy with splenic preservation.Methods 30 patients operated between August 2008 and September 2013 were retrospectively reviewed.Results Of the 30 patients,28 underwent laparoscopic distal pancreatectomy with preservation of splenic artery and vein,2 underwent laparoscopic distal pancreatectomy with division of the splenic artery and vein and preservation of the short gastric vessels.All the 30 patients had their operations carried out successfully with an average operative time of (55 ± 38) min,blood loss (100 ± 48) ml and duration of hospitalization 7.8 d.Pancreatic fistula occurred in 2 patients and it healed spontaneously on drainage.Partial splenic infarction occurred in 1 patient.The pathological lesions were serous cystadenoma in 6 patients,mucinous cystadenoma in 6 patients,insulinoma in 5 patients,solid pseudopapillary tumor in 6 patients,chronic pancreatitis presenting as a mass in 3 patients,and pancreatic cyst in 4 patients.Conclusions The left anterior pararenal space approach was safe and efficacious in distal pancreatectomy with splenic preservation.If the pancreatic lesion was big and compressed the splenic artery and vein,laparoscopic distal pancreatectomy with division of the splenic artery and vein and preservation of the short gastric vessels was the procedure of choice.

Objective To evaluate the result of multiple segmentectomy under selective occlusion of hepatic inflow for complicated intrahepatic cholangiolithiasis. Methods In this study 12 cases of complicated intrahepatic cholangiolithiasis receiving multiple segmentectomy under selective occlusion of hepatic inflow during 2004. 1 - 2010. 10 were reviewed retrospectively. The short-term and long-term outcomes of the patients were analyzed. Results There was no surgical mortality in this group. The segmentectomy performed were Ⅱ + Ⅲ + Ⅴ in 1 case; Ⅱ + Ⅲ + Ⅵ in 2 cases; Ⅱ + Ⅲ + Ⅴ + Ⅵ in 1 case;Ⅱ +Ⅲ+Ⅵ +Ⅶ in4 cases; Ⅱ +Ⅲ +Ⅳ +Ⅵ in 3 cases and Ⅱ + Ⅲ +Ⅳ +Ⅵ +Ⅶ in 1 case. The average intraoperative blood loss was 560 ± 291 ml. Postoperative complications were wound infection in 2 cases, bile leakage in 1 case, abdominal infection in 1 case. There were no liver failure, intrabdominal hemorrhage or hemobilia; stone clearance rate at 10 days after operation was 83% (10/12) and 92%(11/12) at 6 weeks after operation following postoperative choledochoscopic lithotripsy. 92% (11/12) cases were followed-up with the median follow-up period of 31 months. The result was excellent or good in 92% (11/12) cases. Conclusions Multiple segmentectomy was the choice for complicated intrahepatic cholangiolithasis, and the procedure could be safely performed under selective occlusion of the hepatic inflow.

Objective To evaluate the surgical treatment of Nevin′s stage Ⅳ and Ⅴ gallbladder carcinoma. Methods A retrospective analysis was made on 62 cases of Nevin′s stage Ⅳ and Ⅴ gallbladder carcinoma patients undergoing surgical treatment from Jan. 1993 to Dec. 2002. Results There were 17 cases of stage Ⅳ and 45 of stage Ⅴ. Cholecystectomy was performed in 32 cases with a resection rate of 52%, 7 cases received radical resection, 10 extended radical resection and 15 palliative resection. The total surgical morbidity rate was 35.3%. Postoperative 1-, 3-, 5-year survival rate of radical and palliative resection were 61%, 31%, 11% and 27%, 13%, 0 respectively (P