Objective To investigate the role of DWI in differentiating autoimmune pancreatitis ( AIP) from pancreatic cancer ( PC) , and in the therapeutic effect evaluation of AIP.Methods DWI data of 26 cases with AIP , 29 cases with PC and 30 cases with normal pancreas ( NP ) were analyzed retrospectively.The distribution type and signal feature of lesions in cases with AIP or PC were evaluated by Chi-squared test.ADC values were measured and compared among 3 groups by Kruskal-Wallis test.ADC values of AIP and PC were analyzed by using ROC curve to determine the optimal threshold and diagnostic efficiency.ADC values were compared in AIP ( n=15 ) before and after steroid therapy by paired t test.Results Diffuse lesions were detected in 21 cases with AIP and 3 cases with PC, while focal lesions in 5 cases with AIP and 26 cases with PC (χ2 =27.64, P<0.01).On DWI, most of AIP (n=19) and PC (n=24) showed hyper-intense signal, while a few of AIP (n=7) and PC (n =5) showed iso-intense signal (χ2 =0.75, P>0.05).The median ADC values of AIP, PC and NP were 1.15 ×10 -3,1.35 × 10 -3 ,1.59 ×10-3 mm2/s, respectively; and the difference was statistically significant ( H=45.60, P <0.01).ROC analysis yielded an optimal ADC cutoff value of 1.255 ×10 -3 mm2/s (80.8% sensitivity, 79.3%specificity and 0.871 area under curve for the diagnosis of AIP ).ADC values of AIP ( n=15) were markedly increased from the baseline (1.10 ±0.19) ×10 -3 to (1.57 ±0.12) ×10 -3 mm2/s after steroid therapy (t=-10.14, P<0.01).Conclusions DWI may be useful for diagnosing and evaluating the effect of steroid therapy in AIP.ADC values of AIP were significantly lower than those of pancreatic cancer and normal pancreas.After steroid therapy , ADC values were markedly increased in AIP.

The gastroduodenal artery (GDA) has an important role in pancreatic surgery. Relevant literature was reviewed and sum-marized in this article, along with practical experiences from our center, in order to provide references for surgeons in dealing with anatomical variations of the GDA and postoperative bleeding. GDA has close relationships with the blood supply of surroun-ding organs and is the most common vessel associated with intra-abdominal bleeding after pancreatic surgery. Therefore, the GDA plays a crucial anatomical role that affects the strategies and approaches of pancreatic surgery . Preoperative assessment of GDA variations can be achieved through CT angio-graphy. During surgery, it is important to identify and dissect the GDA properly and protect its remnants. In cases of residual bleeding from the GDA, endovascular treatment or secondary laparo-tomy can be conducted.

Objective To explore the clinical characteristics of laparoscopic cholecystectomy(LC)in the elderly and evaluate the safety of LC.Methods A total of 182 patients who underwent LC in our hospital from Jan.2020 to Jan.2022 were enrolled.The clinical data of the course of disease,underlying diseases,operation time,blood loss,complications,length of hospital stay and other clinical data of the elderly group(age≥60 years)and the non-elderly group(age＜60 years)were compared,and the characteristics of gallbladder diseases and the experience of safe operation in the elderly were summarized.Results There were 80 elderly patients,including 34 males and 46 females;there were 102 non-elderly patients,including 53 males and 49 females.Compared with the non-elderly group,the operation time in the elderly group was significantly longer([69.04±31.57]min vs[55.29±21.22]min,P＜0.05),with more underlying diseases(71.25%[57/80]vs 20.59%[21/102],P＜0.05),more patients with previous upper abdominal surgery[7.50%(6/80)vs 0(0/102),P＜0.05],more intraoperative blood loss(30.00[10.00,30.00]mL vs 20.00[20.00,50.00]mL,P＜0.05),and greater total length of hospital stay([6.10±3.97]d vs[4.89±2.53]d,P＜0.05).There was no significant difference in postoperative complications or postoperative hospital stay between the 2 groups(all P＞0.05).Postoperative pathology showed that 2 cases in the elderly group were gallbladder adenomatous hyperplasia with high-grade intraepithelial neoplasia,without gallbladder malignant tumor.Conclusion There are many underlying diseases in elderly patients.Controlling the surgical indications properly,careful operation and nursing are important factors for the success of LC in the elderly.