Objective To study the reasons for conversion to laparotomy in laparoscopic pancreaticoduodenectomy (LPD).Methods Of the 74 patients who underwent LPD in Yi Jishan Hospital,Wan Nan Medical College from May 2012 to Dec 2016,7 patients were converted to laparotomy.The clinical and operative data of the 7 patients were reviewed.Results There were 6 males and 1 female.The age ranged was 51 to 66 years.The pathologies included tumor of pancreatic head in 5 patients,chronic inflammation of pancreas in 1 patient and duodenum papilla cancer in 1 patient.The reasons for conversion were:uncontrollable bleeding in 4 patients with superior mesenteric vein injury in 1 patient,portal vein injury in 1 patient and first jejunal vein injury in 2 patients,respectively.The bleeding was controlled successfully after laparotomy in all the 4 patients.The conversion in the remaining 3 patients were due to difficulty in the operative procedures which resulted from severe adhesions between the tumor and the major vessels.There were 2 patients who had invasion of the SMV by tumor.They underwent vascular resection after laparotomy.The remaining patient had chronic inflammation and the lesion was resected successfully after careful dissection.Of the 7 patients,1 patient developed pancreatic fistula,1 patient developed delayed gastric emptying and 1 patient developed both bile leakage and delayed gastric emptying.They were all treated conservatively.There was no peri-operative death in the study.Conclusion Uncontrollable bleeding and severe adhesions between the lesion and major vessels were the major reasons in LPD for conversion to laparotomy.

Objective To assess and understand the service capabilities and existing problems of radiation health technical service institutions in Jiangsu Province, China, and provide a basis for improving in-process and post-process supervision as well as enhancing radiation health technical service capabilities. Methods Thirty radiation health technical service institutions in Jiangsu Province were selected as quality monitoring objects from the National Occupational Health Technical Service Institution Management Information System. Evaluations were conducted using a standardized national assessment checklist, and a comprehensive risk assessment was performed by combining the results of laboratory test capability comparisons. Results The 30 institutions all passed the quality monitoring, with an average score of （76.62 ± 5.07）. Comprehensive risk assessment identified 8 (26.67%) high-risk institutions, 22 (73.33%) medium-risk institutions, and 0 (0%) low-risk institutions. Conclusion The overall service quality of radiation health technical service institutions in Jiangsu Province is acceptable. However, further training and supervision are needed to improve technical service capacity and reduce service risks.