Objective:To explore the clinical efficacy of the splenic vessel-oriented anatomical plane priority strategy in Da Vinci robotic Kimura distal pancreatectomy.Methods:A retrospective analysis was conducted on 26 patients who underwent robotic-assisted distal pancreatectomy at Zhejiang Provincial People’s Hospital from January 2019 to September 2024. The cohort included 7 male and 19 female patients, aged (49.3±16.7) years. Surgical outcomes, including operative time, intraoperative blood loss, postoperative complications, and hospital stay, were analyzed, and surgical techniques were summarized.Results:All 26 patients successfully completed the surgery. Pathological diagnoses included 5 cases of intraductal papillary mucinous neoplasm, 5 serous cystadenomas, 1 pancreatic neuroendocrine tumor, 6 solid pseudopapillary neoplasms, 4 mucinous cystic neoplasms, and 5 neuroendocrine tumors. The maximum tumor diameter was (2.3±1.1) cm, and the operative time was (183.2±77.4) min. The spleen preservation rate was 100% (26/26). Intraoperative blood loss was 50.0 (17.5, 125) ml, and postoperative hospital stay was (10.1±3.7) d. No Clavien-Dindo grade III or higher complications occurred. The post-operative pancreatic fistula (POPF) rate was 53.8% (14/26), including 38.5% (10/26) biochemical leak and 15.3% (4/26) grade B POPF, with no grade C POPF.Conclusion:The splenic vessel-oriented anatomical plane priority strategy in robotic-assisted spleen-preserving distal pancreatectomy (Kimura technique) is safe and feasible, significantly improving the spleen preservation rate.

In the tumor microenvironment,tumor-associated macrophages construct complex interaction networks through highly plasticity,promoting the dynamic evolution of the cancer ecosystem.With the innovation of single-cell sequencing technology,the heterogeneity,functional diversity,and interaction mechanisms of tumor-associated macrophages with tumor microenvironment have been revealed.This suggests that tumor-associated macrophages may become a new target for tumor targeted therapy,driving the development of precision anti-cancer strategies.This review summarizes the relevant research progress,explores the interaction mechanisms,describes the classification and clinical therapeutic potential,aiming to provide new perspectives and guidance for tumor research and clinical practice.

In the tumor microenvironment,tumor-associated macrophages construct complex interaction networks through highly plasticity,promoting the dynamic evolution of the cancer ecosystem.With the innovation of single-cell sequencing technology,the heterogeneity,functional diversity,and interaction mechanisms of tumor-associated macrophages with tumor microenvironment have been revealed.This suggests that tumor-associated macrophages may become a new target for tumor targeted therapy,driving the development of precision anti-cancer strategies.This review summarizes the relevant research progress,explores the interaction mechanisms,describes the classification and clinical therapeutic potential,aiming to provide new perspectives and guidance for tumor research and clinical practice.

Objective:To explore the clinical efficacy of the splenic vessel-oriented anatomical plane priority strategy in Da Vinci robotic Kimura distal pancreatectomy.Methods:A retrospective analysis was conducted on 26 patients who underwent robotic-assisted distal pancreatectomy at Zhejiang Provincial People’s Hospital from January 2019 to September 2024. The cohort included 7 male and 19 female patients, aged (49.3±16.7) years. Surgical outcomes, including operative time, intraoperative blood loss, postoperative complications, and hospital stay, were analyzed, and surgical techniques were summarized.Results:All 26 patients successfully completed the surgery. Pathological diagnoses included 5 cases of intraductal papillary mucinous neoplasm, 5 serous cystadenomas, 1 pancreatic neuroendocrine tumor, 6 solid pseudopapillary neoplasms, 4 mucinous cystic neoplasms, and 5 neuroendocrine tumors. The maximum tumor diameter was (2.3±1.1) cm, and the operative time was (183.2±77.4) min. The spleen preservation rate was 100% (26/26). Intraoperative blood loss was 50.0 (17.5, 125) ml, and postoperative hospital stay was (10.1±3.7) d. No Clavien-Dindo grade III or higher complications occurred. The post-operative pancreatic fistula (POPF) rate was 53.8% (14/26), including 38.5% (10/26) biochemical leak and 15.3% (4/26) grade B POPF, with no grade C POPF.Conclusion:The splenic vessel-oriented anatomical plane priority strategy in robotic-assisted spleen-preserving distal pancreatectomy (Kimura technique) is safe and feasible, significantly improving the spleen preservation rate.

Objective:Based on " the surveillance, epidemiology, and end results" (SEER) database, we constructed a nomogram model for predicting cancer-specific survival time (CSST) in patients with T2 stage gallbladder cancer.Methods:Clinical data on 486 patients with T2 stage gallbladder cancer between 2018 and 2020 were retrospectively collected from the SEER database. The cohort comprised 147 male and 339 female patients with the age at diagnosis of (70±13) years. Clinical information including age, gender, tumor size, tumor stage, surgical type, number of lymph node dissection, postoperative treatment, and patients prognosis were extracted from the SEER database. We analyzed the factors influencing CSST in patients with T2 stage gallbladder cancer using Cox risk-proportional regression. The nomogram model was constructed based on independent risk factors obtained from multivariate Cox regression analysis, and the area under curve (AUC) of receiver operating characteristic curves (ROC) were used to evaluate the predictive accuracy of the nomogram model, while calibration plots, decision curve analysis, and clinical impact curves were used to evaluate the model's practicality and effectiveness.Results:The results of multivariate Cox regression analysis showed that patients with tumor size ≥30 mm ( HR=1.775, 95% CI: 1.123-2.806), AJCC stage ⅢB ( HR=6.083, 95% CI: 2.961-12.495), 1-3 lymph node dissection ( HR=6.139, 95% CI: 2.876-13.106), no postoperative chemotherapy ( HR=1.743, 95% CI: 1.096-2.771) had a higher risk of short CSST (all P<0.05). A nomogram model for predicting CSST was constructed based on the above risk factors, and the AUC of the ROC of which for predicting 1-year and 2-year CSST in patients with T2 stage gallbladder cancer was 0.778 and 0.696, respectively. Calibration plots demonstrated excellent collinearity between predicted and actual probabilities. Decision curve analysis and clinical impact curves confirmed high net benefit and clinical validity of the nomogram model. Conclusions:The tumor size ≥30 mm, AJCC stage ⅢB, 1-3 lymph node dissection and no postoperative chemotherapy are risk factors for short CSST in patients with T2 gallbladder cancer. The nomogram model based on the above risk factors have excellent performance in predicting CSST in patients with T2 stage gallbladder cancer.

Objective:Based on " the surveillance, epidemiology, and end results" (SEER) database, we constructed a nomogram model for predicting cancer-specific survival time (CSST) in patients with T2 stage gallbladder cancer.Methods:Clinical data on 486 patients with T2 stage gallbladder cancer between 2018 and 2020 were retrospectively collected from the SEER database. The cohort comprised 147 male and 339 female patients with the age at diagnosis of (70±13) years. Clinical information including age, gender, tumor size, tumor stage, surgical type, number of lymph node dissection, postoperative treatment, and patients prognosis were extracted from the SEER database. We analyzed the factors influencing CSST in patients with T2 stage gallbladder cancer using Cox risk-proportional regression. The nomogram model was constructed based on independent risk factors obtained from multivariate Cox regression analysis, and the area under curve (AUC) of receiver operating characteristic curves (ROC) were used to evaluate the predictive accuracy of the nomogram model, while calibration plots, decision curve analysis, and clinical impact curves were used to evaluate the model's practicality and effectiveness.Results:The results of multivariate Cox regression analysis showed that patients with tumor size ≥30 mm ( HR=1.775, 95% CI: 1.123-2.806), AJCC stage ⅢB ( HR=6.083, 95% CI: 2.961-12.495), 1-3 lymph node dissection ( HR=6.139, 95% CI: 2.876-13.106), no postoperative chemotherapy ( HR=1.743, 95% CI: 1.096-2.771) had a higher risk of short CSST (all P<0.05). A nomogram model for predicting CSST was constructed based on the above risk factors, and the AUC of the ROC of which for predicting 1-year and 2-year CSST in patients with T2 stage gallbladder cancer was 0.778 and 0.696, respectively. Calibration plots demonstrated excellent collinearity between predicted and actual probabilities. Decision curve analysis and clinical impact curves confirmed high net benefit and clinical validity of the nomogram model. Conclusions:The tumor size ≥30 mm, AJCC stage ⅢB, 1-3 lymph node dissection and no postoperative chemotherapy are risk factors for short CSST in patients with T2 gallbladder cancer. The nomogram model based on the above risk factors have excellent performance in predicting CSST in patients with T2 stage gallbladder cancer.

Objective To observe the difference of anoreetal dynamics between Milligan-Morgan hemorrhoidectomy plus internal sphinctemtomy and simple Milligan-Morgan bemorrhoidectomy in the treatment of annulus mixed hemorrhoids.Method Measured the anal resting pressure,maximal anal contractive pressure,rectal sensation thresholds,maximal rectal tolerable dose and maximal rectal compliance 1 day before and 3 months after Milligan-Morgan hemorrhoidectomy plus internal sphincterotomy (therapy group,50 cases)and simple Milligan-Morgan bemorrhoidectomy(control group,52 cases)by anorectal manometric device made in Sweden.Results The anal resting pressures of therapy group and eontrol group reduced signifieanfly 3 months after operation compared with that 1 day before operation(P＜ 0.01 or ＜ 0.05),but there was significant difference between the two groups in 3 months after operation(P＜0.05).The maximal anal contractive pressure,reetal sensation thresholds,maximal rectal tolerable dose and maximal rectal compliance were no significant difference between the two groups in 3 months after operation (P ＞0.05).Conclusion Anal sphineterotomy can change the high anal pressure significantly in the treatment of annulus hemorrhoids without copracrasia,it is a proper operation method.