Objective To investigate and validate the effect of relevant parameters of pancreatic anatomic structure under standard pancreatic neck transection in predicting postoperative pancreatic fistula (POPF). Methods A total of 140 patients who underwent pancreaticoduodenectomy (PD) in The General Hospital of Western Theater Command from June 2016 to December 2019 were enrolled as prediction group, and 82 patients who underwent PD in the same hospital from January 2020 to March 2021 were enrolled as validation group. Baseline levels were compared between the two groups. A univariate analysis was performed for the prediction group to screen out the risk factors for POPF, and in the validation group, the interclass correlation coefficient (ICC) was used to compare the consistency between preoperative imaging measurements and actual intraoperative measurements. The risk factors for POPF were validated in each group. The t -test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of continuous data with skewed distribution between groups; the chi-square test was used for comparison of categorical data between groups. The multivariate logistic regression analysis was used to investigate the risk factors for POPF. Youden index was calculated, GraphPad Prism was used to plot the receiver operating characteristic (ROC) curve, and the area under the ROC curve (AUC) was calculated. ICC was used for the reliability analysis of preoperative imaging measurements and actual intraoperative measurements. Results Pancreatic duct diameter at the pancreatic neck (odds ratio [ OR ]=0.347, 95% confidence interval [ CI ]: 0.192-0.626, P < 0.001), the major axis of the pancreatic neck parenchyma ( OR =1.127, 95% CI : 1.031-1.231, P =0.008), and the minor axis of the pancreatic neck parenchyma ( OR =1.350, 95% CI : 1.137-1.602, P =0.001) were risk factors for POPF. Pancreatic duct diameter at the pancreatic neck had an AUC of 0.785 (95% CI : 0.128-0.302, P < 0.001) and a cut-off value of 2.7 mm; the major axis of the pancreatic neck parenchyma had an AUC of 0.669 (95% CI : 0.564-0.774, P =0.006) and a cut-off value of 19.3 mm, and the minor axis of the pancreatic neck parenchyma had an AUC of 0.720 (95% CI : 0.627-0.813, P < 0.001) and a cut-off value of 9.9 mm. Preoperative imaging measurements were highly consistent with actual intraoperative measurements for 30 patients in the validation group, with an ICC of > 0.75 ( P < 0.001). Grouping validation of cut-off values showed that there was a significant different in the incidence rate of POPF between the high-risk group and the low-risk group based on pancreatic duct diameter at the pancreatic neck ( χ 2 =0.645, P =0.011), as well as between the high-risk group and the low-risk group based on the minor axis of the pancreatic neck parenchyma ( χ 2 =5.901, P =0.015). Conclusion Structural features of the pancreatic neck under standard pancreatic neck transection are risk factors for POPF, which can be differentiated by preoperative CT, and the method is easy and convenient in clinical practice.

BACKGROUND: A few devices have been reported to be used for studies on trauma, but these devices are unavailable for establishing the animal models of trauma because of their limited application range. OBJECTIVE: To develop a multifunctional impact system and evaluate its application effect, thus paying ways for establishing the animal models of trauma and basic experiments.METHODS: The multifunctional impact system was designed based on the theory of energy storage device, simple multifunctional impact device and impact parameter measuring equipment, and its effectiveness and stability were detected. The rat chest and different visceral organs were subjected to the closed impact experiment using a 5 cm2 impact at the predetermined parameter of 200, 300, 400, 500 kPa, respectively. Afterwards, the rats were sacrificed for morphological observation.RESULTS AND CONCLUSION: The multifunctional impactor was successfully developed, of which the maximum impact stress could be adjusted from 0 to 200 kg and compressive and extrusion stress also could be continuously adjusted from 0 to 100 kg. The experimental results showed that the impactor made certain damage to the rat lung, liver and spleen suggesting its favorable effectiveness (P < 0.05) and repeatability (P > 0.05). These findings suggest that the impactor is easy to operate in various ways and holds good effectiveness and stability, and its impact parameters can be detected in real time. Therefore, the impactor is suitable for both establishing the animal model of trauma and basic experiments.

Objective To study the relationships between tissue damage and the ability of the pancreatic cells to regenerate ,and analyze the alteration of the pancreatic cells regeneration .Methods Sixty rats were divided into two groups :impact group(the pan‐creas was injured by a BIM‐Ⅲ biotical impact machine ,40 rats) and control group(sham operated ,20 rats) .All rats were sacrificed at 6 h ,24 h ,72 h ,7 d after operation .The level of AMS ,LPS in the serum were detected by spectrophotometry ,pancreatic cells re‐generation were examined and analyzed by TUNEL staining and flow cytomertry ,and the Bcl‐2 and Bax expression were measured by Western blot .Results In the impact groups ,LPS was activated later than AMS ,and lasted persistently .The results from TUNEL stain ,flow cytometry and Western blot indicated that pancreatic trauma induces cell death and the compensatory prolifera‐tion of pancreatic cells .The characteristics of pancreatic cells regeneration in the animal model of isolated pancreatic trauma indicate that the proper remedial time is in the first 24h after the pancreatic trauma .Conclusion Detecting AMS and LPS at the same time can help us to determine the exocrine function of pancrease .

Objective To investigate the efficacy of holmium laser coagulation under choledochoscope for the treatment of intrahepatic hemobilia.Methods The clinical data of 55 patients with intrahepatic hemobilia who received holmium laser coagulation under choledochoscope at the General Hospital of Chengdu Military Area from June 2003 to August 2011 were retrospectively analyzed.After the hemobilia was confirmed with choledochoscopy,an optical fiber of holmium laser was inserted into the intrahepatic bile duct from the hole of choledochoscope.The top of the optical fiber was posed close to the bleeding region,and then the laser was stimulated for coagulation under direct vision.If the observation of the bleeding area was influenced by the bleeding,the porta hepatis was temporarily occluded with a rubber hose combined with pressurized liquid injection bag.For patients with distal bile duct stenosis and bleeding,the narrow area was first expanded by biliary balloon or laser,then hemostasis was completed after the flow of bile duct was restored.Results The hemorrhage of the 55 patients was controlled,with an average time of 5.5 minutes (range,2-15 minutes).Temporary hepatic portal clamping was applied for 16 patients (27 times),and the average blocking time was 2.2 minutes (range,1-4 minutes).Biliary rehaemorrahagia occurred after operation in 2 patients,and they were cured by non-surgical treatment.All patients were discharged after successful hemostasis.The time of follow-up was 35-49 days.The epithelium of the bile duct coagulated by intraoperative holmium laser restored flat in 41 patients,and new biliary stricture was not found in the other 14 patients.Conclusion Holmium laser coagulation under choledochoscope for intrahepatic hemobilia is simple and effective.

Objective To explore a new method of parapancreatic abscess treatment and establish an idea of minimally invasive technologies for parapancreatic abscess to improve the recovery rate of acute pancreatitis. Methods The patients had experienced percutaneous puncture and placed drainage tube under the ultrasound guidance first, then the sinus tract was expanded gradually to 24F perimeter by Cook's fascia expender. Finally, the necrotic tissue and pyogenic membrane was removed and repeatedly washed under guidance of choledochoscopy. Results The recovery rate was 91.1 %(33/36). The complication incidence was 10.7% (hemorrage:2 cases, external intestinal fistula:3 cases, and fatal MOF: 1 case). Conclusions The viewpoint which parapancreatic abscess only can be cured by drainage operation can be changed by associating debridement by choledochoscope with percutaneous puncture drainage under the ultrasound guidance. It is a simple, safe and effective method. It can be used to reduce the patients' damage, complication and mortality and accomplish the idea of damage control by minimally invasive technologies.

Objective To explore the management strategy of damage control operation(DCO) for extrahepatic bile duct injury.Methods Clinical data of 15 cases with extrahepatic bile duct injury from June 2002 to September 2007 were selected as the object of this study.Results DCO was performed in all of 15 patients,then all cases were underwent reoperation after surgery intensive care unit resuscitation.All cases survived.Two cases(13.3%) occurred biliary fistula and 1 case(6.7%) occurred intestinal fistula of colon after reoperation,2 cases(13.3%)occurred infection and disruption of incisional wound,and 1 case(6.7%) occurred acute liver function failure.All complications were cured by drainage,symptomatic and supportive treatment.The cure rate of these 15 cases was 100%.There were no stricture of bile duct and correlative complications during 28 months of median follow-up.Conclusion To increase survival rate and reduce complications,severe trauma patients with extrahepatic bile duct injury should be made positively under DCO and choose eligible operations modus.

0.05).But there were significant difference in operation time,blood loss,time of resumption of food,time of intestinal function recovery,length of hospital stay and complications between OC group and LC group(P

0.05). At time points of end of cold preservation, 10, 30 and 60 min of reperfusion, the activity of p38MAPK in control group was significantly higher than that at the time points of before resection and 120 min of reperfusion (P0.05). The expressions of TNF-? mRNA and ICAM1 mRNA at the time points of before resection, end of cold preservation, and 10 and 30 min of reperfusion were significantly lower than those in 60 and 120 min of reperfusion in both two groups (P

Objective To expand the utilization of minimally invasive technologies for parapancreatic abscess,and summarize the application experience of choledochoscope for treatment of parapancreatic abscess.Methods The clinical data and treatment effectiveness of 36 patients with parapancreatic abscess from Dec.2000 to Dec.2008 were analyzed retrospectively.These patients had experienced percutaneous puncture and been placed drainage tube under the ultrasound guidance first,then expanded the sinus tract gradually,and performed debridement by choledochoscope.The flexibility of choledochoscope was used to remove the necrotic tissue and pyogenic membrane repeatedly by clamping,netting and vacuum aspiration in every domain.Results Thirty-six patients were performed percutaneous puncture and placed drainage tube,3 cases were given canalis singularis,7 cases were double tube,26 cases were over three tube.The debridement times were 3-14 by choledochoscope,average 5.6 times.There were 6 cases with improving systemic symptoms,blood routine and temperature recovering normal,and drink and food recovering,then discharged from hospital with tube after 1-2 times of debridement.Length of stay was 25-132 d,average 76 d.The curing rate was 91.7% (33/36).Two cases were turned into open surgery because of broad necrotic tissue range combined with many abdominal cavity abscess with good postoperative recovery and cured.One case was dead of severe multiple organ failure combination.There were 2 patients with hemorrhage,3 patients with external intestinal fistula.Conclusions The debridement of choledochoscope for parapancreatic abscess treatment is a simple,flexible and effective method.It changes the viewpoint that parapancreatic abscess can be cured only by operation drainage,decreases the patients’ trauma and accomplishes the idea of damage control by minimally invasive technologies.

Objective: To explore the application experiences and effects of emergency damage contro(lDC)treatment for severe abdomen trauma. Methods: The clinical data of 192 patients with severe abdomen trauma were selected as the object of this study. A retrospective analysis was done on therapy condition and effects of emergency damage control treatments. Results: Pre-hospital emergency care was performed in all 192 patients, damage control operations (DCO)were done in 186 cases, 184 cases entered surgical intensive care unit (SICU)for resuscitation, and 177 cases were adopted corresponding reoperations after SICU resuscitation. The abnomal DCO indices recovered gradually in the 72 hours after DCO. The cure rate was 90.7% with 174 cases, and the incidence of complication was as low as 2.3% with 4 cases after reoperations, and the 4 cases all healed by conservative treatments. Mortality rate was 6.2% with 12 cases, and it caused by associated organs injuries, severe primary disease and secondary infection of other organs. Conclusion: Emergency damage control treatment modus should be chosen positively and eligibly under indication to severe abdomen trauma patients. According to the difference of location and degree of injury, eligible therapies by stages are the key managements.