Pancreatic neuroendocrine tumor (p-NET) is a kind of neoplasm originating from neuroendocrine cell of pancreas.The morbidity of p-NET increased 5 times in the past 40 years and threatened people's life.However,the key points of diagnosis and treatment for p-NET are still unclear.There were no special and easy blood tests or imaging scanning for p-NET.The TNM classification remains controversial.Surgery is the most effective method to cure p-NET.But we still need to clarify which is the best time or method for surgery.In this review,we try to answer above questions based on our experiences and studies.

Eighty percent of patients with chronic pancreatitis were presented with symptoms of intractable pain.Patients with chronic pancreatitis were at risk of losing the endocrine and exocrine function of the pancreas as the advance of the disease.The main objective of surgical management of chronic pancreatitis includes pain alleviation and pancreatic endocrine and exocrine function improvement.This paper analyzes the strategics of surgical procedure selcction and thc time,indication for surgical intervention.

Objective To investigate the relationship between the development of pancreatic cancer and inflammation, and the therapy strategy.Methods Related articles were reviewed.Results The pathogenesis of inflammation in pancreatic cancer development involves cytokines, NF ?B, COX 2, PPAR ?, DNA damage, gene changes,etc. Based on these mechanisms some medications are under developing.Conclusion Accumulative effects of pancreatic inflammation may lead to DNA changes, and even pancreatic cancer development. Medications aimed at suppressing pancreatic inflammation may help with prevention and treatment of pancreatic cancer.

Objective To introduce the role of pancreatic stellate cells in pancreatic fibrosis and the progress in treatment of pancreatic fibrosis. Methods Relevant literatures were collected and reviewed. Results Pancreatic stellate cells activation was closely related to pancreatic fibrosis. Inhibition of pancreatic stellate cells activation could provide a new approach in clinical treatment of chronic pancreatitis. Conclusion Pancreatic stellate cells are the key to pancreatic fibrosis,which are becoming the target for anti-fibrosis of the pancreas and treatment of chronic pancreatitis.

Objective To compare the survival conditions of patients with insulinoma after enucleation of insulinoma or partial resection of pancreas.Methods The clinical data of 99 patients with insulinoma,treated with surgery from May.2003 to Aug.2015 were retrospectively analyzed.Of the 99 patients,38 received enucleation of insulinoma alone and 61 received partial resection of pancreas.The overall data were analyzed by SPSS 21.0 software.Results Average survival of patients after enucleation of insulinoma (103.3 months) was longer than that of patients after partial resection of pancreas (77.5 months),and the difference had statistical significance (P=0.006).The difference of the incidence of most chronic or temporary complications had no statistical significance between the two groups (P＞0.05),except for new-onset diabetes (P=0.004).Conclusion Enucleation of insulinoma should be firstly recommended for patients with insulinoma in suitable size,which can provide patients with better survival condition.

Objectives The study aims were to analyze the clinical features and to explore the management of intrapancreatic pseudocysts after acute pancreatitis.Methods A retrospective study was conducted on 151 patients who received surgical treatment from Dec,2008 to Feb,2012 after acute pancreatitis.Based on CT/MRI findings and clinical data,there were 17 patients with intrapancreatic pseudocysts (11.3％).The clinical manifestations,diagnoses and treatments for these 17 patients were retrospectively analyzed,and the outcome after operations were followed.Results For the 17 patients,obstructive jaundice was present in 3 patients,pancreatic portal hypertension (PPH) in 7,pseudoaneurysm in 2.All 17 patients underwent operation.The surgical procedures included internal drainage (n=8),external drainage (n=5),distal pancreatic resection with splenectomy (n=3),and local resection (n=1).All patients recovered after the operations.Conclusions Intrapancreatic pseudocysts after acute pancreatitis had a high incidence of local complication.The diagnosis of these pseudocysts was difficult.The treatment should be performed early for those patients who had developed complications.

Chronic pancreatitis (CP) is a kind of disease with the sustainable and irreversible damage of the tissue structure and function of pancreas,which may be caused by alcohol,gene,gallstone,metabolism,deformity and other factors.The clinical manifestations are intractable abdominal pain and disorder of the internal and external secretion of pancreas.At present,the main purpose of the treatment for chronic pancreatitis is to relieve patients' pain,and to maintain the secretion function of pancreas as far as possible.The main surgical procedures for chronic pancreatitis includes the pancreatic resection,nerve block and decompression drainage of the pancreatic duct.In recent years,people hve paid more attenntion to the whole pancreas resection combined autologous transplantation due to retaining some functions of the islet cells.After whole pancreas resection combined autologous transplantation,the abdominal pain will relieve and the life quality will improved significantly.At the same time,it will effectively reduce the occurrence of pancretogenic diabetes since the surgery retains some function of the islet cells.

Pancreatic neuroendocrine tumors (P-NETs) are a group of heterogeneous tumors,including functional and nonfunctional ones.With the enhancement of clinicians' awareness about this disease and the improvement of imaging diagnostic techniques,the incidence of P-NETs has obviously increased in the past years.Based on the mitotic counting and Ki-67 positive index,the grading classification is of great value for the diagnosis,treatment and even prognosis of P-NETs.P-NETs are a group of malignant tumors with inert biological behaviors,whose surgical resection rate and long-term survival is much better than those of pancreatic ductal adenocarcinoma.P-NETs have different malignant potentials.Clinicians need to develop a comprehensive treatment plan in combination with the patient's symptoms,tumor grading classification and TNM staging information.Surgery is the only curable way to cure P-NETs.Even if radical resection is not suitable,palliative surgery may alleviate the patients,symptoms,and even prolong their survival time.According to the tumor location,size,quantity,degree of grading,local invasion and distant metastasis,different surgical procedures should be selected.

Objective To investigate and summarize the clinical characteristic of autoimmune pancreati-tis(AIP).Methods Clinical data of 13 patients with AIP, admitted to the West China Hospital from 2009 to 2013, were retrospectively analyzed .Results The median age of the 13 patients was 48 years old.The main clinical manifestations included epigastric pain or discomfort (8 cases), obstructive jaundice(7 cases)and weight loss(10 cases).Diffuse enlargement of pancreas and localized pancreatic enlargement were observed in 6 cases, pseudocyst and pancreatic stones were observed in 1 case.Dilation of pancreatic duct was found in 4 cases.Bili-ary stricture and thickened wall of bile duct were detected in 8 cases, dilated gallbladder with delayed enhance-ment of the thickened wall in 7 cases, retroperitoneal fibrosis surrounding the aorta in 1 case, abdominal lymph-adenopathy in 6 cases, stenosis of splenic vein in 4 cases, and Sjogren's disease and ulcerative colitis in 1 case. The positive rate of serum IgG, RF, ANA was 71.43%(5/7), 42.86%(3/7), and 42.86%(3/7), respec-tively.8 patients were misdiagnosed and underwent surgery .Steroid therapy was administered in all patients with satisfactory response.Conclusions AIP is a rare and autoimmune disease ,without speci? c symptoms,and often be misdiagnosed as pancreatic cancer or bile duct carcinoma .We must give more attention to AIP and keep pa-tients from undergoing unnecessary surgery .

Objective To analyse clinical efficacy of Frey and Bger procedures for chronic pancreatitis. Methods Clinical data of seventy patients of chronic pancreatitis undergoing Frey (32 cases) and Beger Procedures (38 cases) in our hospital from January 1999 to June 2009 were retrospectively analyzed,the rate of pain relief and endocrine and exocrine function of the pancreas in longterm follow-up were compared with each other. Results Overall perioperative morbidity for Frey group and Beger group was 12. 5% and 7.9% respectively (P =0. 52); Total pain relief rate in long-term follow-up was 96. 8% and 94. 7% respectively (P =0. 57). Postoperative de novo diabetes mellitus was 12. 5% and 21% ( x2 = 0. 90, P = 0. 34), Rate of steatorrhea was 12. 5% and 18.6% respectively ( x2 = 0. 15, P =0. 70). Conclusions Frey and Beger procedures were equally effective in improving symptoms of chronic pancreatitis and there were no significant differences in perioperative morbidity, rate of pain relief and function of endocrine and exocrine of the pancreas.