Dorsal pancreatic artery (DPA) is one of the most commonly studied arteries in the pancreas. The management of DPA during pancreatic standard resection/radical surgery (pancreaticoduodenectomy, distal pancreatectomy, and total pancreatectomy) is closely related to complications such as late bleeding caused by pancreatic fistula erosion after surgery. This article collected data from patients who underwent open/minimally invasive standard pancreatic resection/radical surgery from August 2024 to July 2025, displayed different origins of DPA, and discussed the management of DPA during standard pancreatic resection/radical surgery. This article updated and improved the latest classification of DPA, and highlighted the importance of programmatic management of DPA in pancreatic surgery to reduce the risk of late postoperative bleeding.

Objective To observe the value of artificial intelligence iterative reconstruction(AIIR)for abdominal and pelvic CT examination after total hip arthroplasty(THA).Methods Totally 64 patients after THA who underwent abdominal and pelvic CT examinations were retrospectively collected,including 31 patients received routine CT scanning and 33 patients received dual-energy CT scanning.AIIR and hybrid iterative reconstruction(HIR)algorithms were used to obtain AIIR and HIR images based on conventional CT images,respectively,while 70-140 keV(interval of 5 keV)virtual monoenergetic images(VMI)were reconstructed based on dual-energy CT images.VMI with the best comprehensive imaging qualities were selected for analysis.Subjective scores and objective evaluation results of imaging quality were compared among different kinds of images.Results The subjective scores of artifacts,bones,diagnostic confidence,as well as displaying of pelvic organs and blood vessels on both AIIR images and VMI were all higher than those of HIR images(all P＜0.001),while no significant difference was found between AIIR images and VMI(all P＞0.017).Pairwise comparison of high-density artifact fraction and skeletal artifact fraction on AIIR,HIR images and VMI showed significant differences(all P＜0.001).No significant difference of low density artifact fraction nor high density noise fraction was detected between AIIR image and VMI(both P＞0.017),and the objective evaluation results were different from those of HIR images(both P＜0.017).The low density noise fraction of AIIR images was lower than that of HIR images(P＜0.017),while no significant difference was found between AIIR or HIR images and VMI(both P＞0.017).The bone noise fraction of AIIR and HIR images were both higher than that of VMI(both P＜0.017),while no significant difference was found between these two kinds of images(P＞0.017).Conclusion AIIR could reduce artifacts and image noise of abdominal and pelvic CT examination after THA and improve imaging quality.

Background and Aims:Laparoscopic pancreaticoduodenectomy(LPD)is one of the most technically demanding procedures in general surgery.Its development remains controversial,particularly regarding adherence to oncological principles.In situ LPD,based on the"no-touch"principle,offers a treatment option for pancreatic tumors.However,ensuring surgical safety remains a key challenge due to its technical complexity.This study explored the surgical techniques of in situ LPD performed via the left-sided combined middle approach and evaluated its safety and efficacy.Methods:A retrospective analysis was conducted on the clinical data of four patients who underwent in situ LPD using the left-sided combined middle approach between July 2023 and November 2023 at the Department of Pancreatic Surgery of Fudan University Shanghai Cancer Center and the Department of Hepatobiliary Surgery of Yijishan Hospital,Wannan Medical College.Results:All 4 patients were female,with an average age of 58 and a mean BMI of 22.1 kg/m2.Among them,two had pancreatic head cancer,one had ampullary carcinoma,and one had distal common bile duct carcinoma.Preoperative laboratory indicators,including white blood cell count,platelet count,prothrombin time,alanine aminotransferase,aspartate aminotransferase,albumin,total bilirubin,and direct bilirubin,were all within normal ranges.All patients successfully underwent in situ LPD via the left-sided combined middle approach.The mean operative time was 385 min,with an average intraoperative blood loss of 87.5 mL.After operation,the average drainage tube removal time was 10.3 d,and the mean hospital stay was 10.8 d.One patient developed biochemical leakage,and another experienced abdominal effusion,while no cases of biliary stricture,diarrhea,or chylous leakage were observed.Conclusion:In situ LPD via the left-sided combined middle approach allows for thorough lymph node dissection and radical tumor resection while adhering to the"no-touch"principle.This approach is simple to perform and master and does not lead to significant postoperative complications.It is a safe and feasible technique with promise for broader clinical application.Future research should focus on multicenter studies with larger sample sizes to validate its safety and efficacy.

Background and Aims:Laparoscopic pancreaticoduodenectomy(LPD)is one of the most technically demanding procedures in general surgery.Its development remains controversial,particularly regarding adherence to oncological principles.In situ LPD,based on the"no-touch"principle,offers a treatment option for pancreatic tumors.However,ensuring surgical safety remains a key challenge due to its technical complexity.This study explored the surgical techniques of in situ LPD performed via the left-sided combined middle approach and evaluated its safety and efficacy.Methods:A retrospective analysis was conducted on the clinical data of four patients who underwent in situ LPD using the left-sided combined middle approach between July 2023 and November 2023 at the Department of Pancreatic Surgery of Fudan University Shanghai Cancer Center and the Department of Hepatobiliary Surgery of Yijishan Hospital,Wannan Medical College.Results:All 4 patients were female,with an average age of 58 and a mean BMI of 22.1 kg/m2.Among them,two had pancreatic head cancer,one had ampullary carcinoma,and one had distal common bile duct carcinoma.Preoperative laboratory indicators,including white blood cell count,platelet count,prothrombin time,alanine aminotransferase,aspartate aminotransferase,albumin,total bilirubin,and direct bilirubin,were all within normal ranges.All patients successfully underwent in situ LPD via the left-sided combined middle approach.The mean operative time was 385 min,with an average intraoperative blood loss of 87.5 mL.After operation,the average drainage tube removal time was 10.3 d,and the mean hospital stay was 10.8 d.One patient developed biochemical leakage,and another experienced abdominal effusion,while no cases of biliary stricture,diarrhea,or chylous leakage were observed.Conclusion:In situ LPD via the left-sided combined middle approach allows for thorough lymph node dissection and radical tumor resection while adhering to the"no-touch"principle.This approach is simple to perform and master and does not lead to significant postoperative complications.It is a safe and feasible technique with promise for broader clinical application.Future research should focus on multicenter studies with larger sample sizes to validate its safety and efficacy.

Objective To observe the value of artificial intelligence iterative reconstruction(AIIR)for abdominal and pelvic CT examination after total hip arthroplasty(THA).Methods Totally 64 patients after THA who underwent abdominal and pelvic CT examinations were retrospectively collected,including 31 patients received routine CT scanning and 33 patients received dual-energy CT scanning.AIIR and hybrid iterative reconstruction(HIR)algorithms were used to obtain AIIR and HIR images based on conventional CT images,respectively,while 70-140 keV(interval of 5 keV)virtual monoenergetic images(VMI)were reconstructed based on dual-energy CT images.VMI with the best comprehensive imaging qualities were selected for analysis.Subjective scores and objective evaluation results of imaging quality were compared among different kinds of images.Results The subjective scores of artifacts,bones,diagnostic confidence,as well as displaying of pelvic organs and blood vessels on both AIIR images and VMI were all higher than those of HIR images(all P＜0.001),while no significant difference was found between AIIR images and VMI(all P＞0.017).Pairwise comparison of high-density artifact fraction and skeletal artifact fraction on AIIR,HIR images and VMI showed significant differences(all P＜0.001).No significant difference of low density artifact fraction nor high density noise fraction was detected between AIIR image and VMI(both P＞0.017),and the objective evaluation results were different from those of HIR images(both P＜0.017).The low density noise fraction of AIIR images was lower than that of HIR images(P＜0.017),while no significant difference was found between AIIR or HIR images and VMI(both P＞0.017).The bone noise fraction of AIIR and HIR images were both higher than that of VMI(both P＜0.017),while no significant difference was found between these two kinds of images(P＞0.017).Conclusion AIIR could reduce artifacts and image noise of abdominal and pelvic CT examination after THA and improve imaging quality.

Pancreatic cancer is a highly malignant digestive tract tumor with hidden symptoms,limited treatment options and rapid progression.With an increasing incidence rate year by year,pancreatic cancer has increasingly become a prominent issue endangering public health,causing a huge social burden.Although there was no significant improvement in survival rates for pancreatic cancer patients in the past two decades,recent progress in epidemiology,basic research and clinical research of pancreatic cancer has accelerated significantly compared to the past.Some findings have already enabled a small proportion of pancreatic cancer patients to achieve better survival.This article provided a review of the significant progress made in research,diagnosis and treatment of pancreatic cancer in 2023.

Objective:To study the causes of hemorrhage after laparoscopic pancreaticoduodenectomy (LPD) and to develop countermeasures in its prevention.Methods:The clinical data of 215 patients who underwent LPD at the Department of Hepatobiliary and Pancreatic Surgery of Zhejiang Provincial People's Hospital from December 2013 to May 2020 were reviewed. The patients’ clinical data including gender, age, comorbidities and postoperative complications such as bleeding, pancreatic fistula, biliary fistula and intraperitoneal infection were studied, with the aims to analyze the causes, clinical manifestations and treatment results of post-pancreaticoduodenectomy hemorrhage (PPH) after LPD.Results:Of 215 patients, there were 132 males and 83 females, aged (60.7±10.3) years. PPH occurred in 20 patients, incidence rate was 9.30%(20/215). Early hemorrhage was mainly caused by inadequate hemostasis or loosening of vascular clips, while delayed hemorrhage was mainly caused by gastrointestinal fistula with vascular erosion, arterial injury by intraoperative energy instruments or pseudoaneurysms. Among the 20 patients, 6 patients had early hemorrhage and 14 delayed hemorrhage. There was 1 patient with grade A, 10 with grade B and 9 with grade C hemorrhage. Thirteen patients developed pancreatic fistula, 1 biliary fistula, and 2 intraperitoneal infection. One patient responded well to conservative treatment. Hemostasis was successfully achieved by gastroscopy ( n=1) and interventional therapy ( n=7). Eleven patients required laparotomy for hemostasis. In this study, 14 of 20 patients survivied PPH and 6 patients died. The mortality rate was 30% (6 of 20 patients with PPH). Conclusions:Early hemorrhage was caused by inadequate hemostasis or loosening vascular clips, while delayed hemorrhage was related to gastrointestinal fistula with vascular erosion, arterial injury by intraoperative energy instrument or pseudoaneurysm. Careful hemostasis, adequate protection of blood vessels, and accurate anastomosis should be performed in LPD. DSA angiography should be used for arterial hemorrhage which progressed very rapidly. Interventional therapy including embolism and stenting were means to control arterial bleeding in PPH. Decisive surgical exploration when interventional therapy failed was important in reducing the mortality rate of these patients.

Objective:To study the technical and essential steps in laparoscopic selective devascularization with paraesophageal veins-preservation.Methods:To retrospectively analyze the clinical data of 13 cirrhotic patients who underwent laparoscopic selective pericardial devascularization for portal hypertension at the Department of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People's Hospital from January 2019 to March 2020. There were 9 males and 4 females with age ranging from 41 to 83 years (median 51 years). The operative time, intraoperative blood loss, postoperative complications and follow-up data were analyzed.Results:All the 13 patients completed theoperation, no patient stopped the operation or transferred to laparotomy. The operation time was (170±32) min.The intraoperative bleeding was (160±30) ml. The postoperative hospital stay was (6.1±1.1) days. There were no complications, including pancreatic leakage and intra-abdominal infection. On follow-up which ranged from 1 to 15 months, one patient developed portal vein thrombosis, no upper gastrointestinal rebleeding.Conclusions:Preservation of esophageal veins in laparoscopic selective devascularization is an accurate surgery which requires close teamwork and rich experience in laparoscopic surgery. The preservation of the main trunk of the gastric coronary vein and integrity of the esophageal veins are the keys to the surgery which is safe and feasible.

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.

Pancreatic duct stone is a rare pancreatic disease in clinic, which is often associated with chronic pancreatitis, and could seriously damage the quality of life of patients, and even induce pancreatic cancer. The diagnosis is mainly based on imaging examination, and the treatment methods are diverse. It is necessary to follow the principle of individualized treatment and treat it as soon as possible. This article reviewed the etiology, mechanism, diagnosis, classification and treatment of the disease.