Objective:To investigate the influencing factors for splenomegaly secondary to acute pancreatitis (AP) and construction of a nomogram prediction model.Methods:The retrospective case-control study was conducted. The clinicopathological data of 180 patients with AP who were admitted to Xuanwu Hospital of Capital Medical University from December 2017 to December 2021 were collected. There were 124 males and 56 females, aged (49±15) years. Among them, 60 AP patients who developed secondary splenomegaly were taken as the case group, including 48 males and 12 females, aged (47±13)years, and the rest of 120 cases of AP without secondary splenomegaly were taken as the control group, including 76 males and 44 females, aged (50±16)years. Observation indicators: (1) occurrence and clinical characteristics of splenomegaly secondary to AP; (2) influencing factors for splenomegaly secondary to AP; (3) construction and evaluation of a nomogram prediction model for splenomegaly secondary to AP. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was analyzed using the rank sum test. Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. The univariate analysis was performed using statistical methods appropriate to the data type. The optimal cut-off value was determined by the receiver operating characteristic curves. Multivariate analysis was conducted using the Logistic regression model with forward method. Based on the results of the multivariate analysis, a nomogram prediction model was constructed. The receiver operating characteristic curve was drawn, and the discrimination was evaluated using the area under curve. The consistency of the nomogram prediction model was evaluated using calibration curve, and its clinical benefit was evaluated using decision curve. Results:(1) Occurrence and clinical characteristics of splenomegaly secondary to AP. The first detection time of 60 patients with splenomegaly secondary to AP was 60(30,120)days after the onset of AP. Cases with persistent respiratory dysfunction, multiple organ failure, severity of illness as mild or moderately severe/severe, pancreatic and/or peripancreatic infection, surgery were 19, 17, 4, 56, 37, 32 for 60 patients with splenomegaly secondary to AP, versus 16, 19, 43, 77, 39, 29 for 120 patients without splenomegaly secondary to AP, respectively, showing significant differences in the above indicators between the two groups ( χ2=8.58, 3.91, 17.64, 13.95, 15.19, P<0.05). (2) Influencing factors for splenomegaly secondary to AP. Resuts of multivariate analysis showed that white blood cell count <5.775×10?/L within 24 hours of AP onset, revised computed tomography (CT) severity index >7 in 3-7 days after onset and the presence of local complications were independent risk factors influencing the splenomegaly secondary to AP ( odds ratio=3.85, 2.86, 6.40, 95% confidence interval as 1.68-8.85, 1.18-6.95, 1.56-26.35, P<0.05). (4) Construction and evaluation of a nomogram prediction model for splenomegaly secondary to AP. The nomogram prediction model was constructed based on white blood cell count within 24 hours of AP onset, revised CT severity index in 3-7 days after onset and local complications. The area under the receiver operating characteristic curve of the nomogram prediction model was 0.76 (95% confidence interval as 0.69-0.83, P<0.05), with a sensitivity of 0.87 and a specificity of 0.55. The calibration curve demonstrated consistency between the predicted rate from the nomogram prediction model and the actually observed rate. The decision curve analysis indicated that the nomogram prediction model had favorable clinical practicability. Conclusions:Patients with AP who develop secondary splenomegaly tend to have a higher severity of illness than those develop no secondary splenomegaly. White blood cell count <5.775×10?/L within 24 hours of AP onset, revised CT severity index >7 in 3-7 days after onset and presence of local complications are independent risk factors influencing splenomegaly secondary to AP, and its nomogram prediction model can predict incidence rate of splenomegaly secondary to AP.

Pancreatic cancer patients often have complaints such as upper abdominal pain and obstructive jaundice when seeking diagnosis and treatment. However, acute pancreatitis as a rare initial clinical manifestation of pancreatic cancer is often overlooked in clinical practice. This oversight often leads to a delayed diagnosis of pancreatic cancer, uncertainty in treatment strategies, and significantly affects patients′ quality of life and prognosis. Therefore, early diagnosis and treatment, and active follow-up are crucial for patients with acute pancreatitis as an initial symptom of pancreatic cancer. Upon admission to such patients, common causes such as gallstones, alcohol abuse, and hyperlipidemia should be initially ruled out. Evaluation with tumor markers, CT and MRI, and endoscopic ultrasound are essential to confirm the diagnosis of pancreatic cancer. For patients with mild pancreatitis, managing peripancreatic inflammation first before radical resection of pancreatic cancer could reduce postoperative complications. Moreover, pancreatitis serves as a high-risk factor for pancreatic cancer, so it is crucial to closely follow up patients with pancreatitis to detect pancreatic cancer early.

Pancreatic cancer patients often have complaints such as upper abdominal pain and obstructive jaundice when seeking diagnosis and treatment. However, acute pancreatitis as a rare initial clinical manifestation of pancreatic cancer is often overlooked in clinical practice. This oversight often leads to a delayed diagnosis of pancreatic cancer, uncertainty in treatment strategies, and significantly affects patients′ quality of life and prognosis. Therefore, early diagnosis and treatment, and active follow-up are crucial for patients with acute pancreatitis as an initial symptom of pancreatic cancer. Upon admission to such patients, common causes such as gallstones, alcohol abuse, and hyperlipidemia should be initially ruled out. Evaluation with tumor markers, CT and MRI, and endoscopic ultrasound are essential to confirm the diagnosis of pancreatic cancer. For patients with mild pancreatitis, managing peripancreatic inflammation first before radical resection of pancreatic cancer could reduce postoperative complications. Moreover, pancreatitis serves as a high-risk factor for pancreatic cancer, so it is crucial to closely follow up patients with pancreatitis to detect pancreatic cancer early.

Objective:To study the clinical application of laparoscopic combined with multi-video debridement in treatment of complicated infectious pancreatic necrosis (CIPN).Methods:The clinical data of 34 patients with CIPN who were treated at the Department of General Surgery, Xuanwu Hospital, Capital Medical University from August 2017 to December 2019 were retrospectively studied. Based on the different video methods used, these patients were divided into 3 groups: the laparoscopic combined with intraoperative ultrasound group, the laparoscopic combined with choledochoscopy group and the laparoscopic group. The number of operations, operation time, blood loss, postoperative complication rates, mortality rates and total length of hospital stay were compared.Results:There were 13 patients in the laparoscopic combined with intraoperative ultrasound group, with age of (56.4±13.4) years. There were 7 patients in the laparoscopic combined with choledochoscopy group, with age of (48.0±8.4) years. There were 14 patients in the laparoscopic group with age of (51.4±15.6) years. The number of operations of the laparoscopic combined with intraoperative ultrasound group, the laparoscopic combined with choledochoscopy group and the laparoscopic group were (2.2±1.1), (1.6±0.8), (2.9±1.4), respectively. The number of operations of the laparoscopic combined with choledochoscopy group were significantly less than that of the laparoscopic group ( P<0.05), but there were no significant differences among the other groups ( P>0.05). The operation time of the laparoscopic combined with intraoperative ultrasound group, the laparoscopic combined with choledochoscopy group and the laparoscopic group were (70.5±22.9) min, (65.7±19.9) min, (51.5±15.4) min, respectively. The operation time of the laparoscopic combined with intraoperative ultrasound group was significantly longer than that of the laparoscopic group ( P<0.05), but there were no significant differences among the other groups ( P>0.05). There were no differences in blood loss, postoperative complication rate, mortality rates and total lengths of hospital stay among the three groups ( P>0.05). Conclusion:Laparoscopic combined with multi-video debridement after making full use of the advantages of each of the video methods, can be used to improve treatment outcomes of patients with CIPN.

Lavage has been used in the treatment of infected pancreatic necrosis(IPN) for a long time.It can be divided into peritoneal lavage and necrotic cavity lavage according to different parts of lavage.At present,peritoneal lavage is rarely used,while necrotic cavity lavage is widely used in laparotomy,minimally invasive surgery and endoscopic debridement and drainage for IPN patients.However,there is no unified standard for the type,method,duration and indication of stopping lavage.The application of lavage is controversial: proponents think that necrotic cavity lavage can dilute and remove residual or new necrotic tissue,remove inflammatory mediators and reduce the times of debridement,etc.While opponents think that lavage can not significantly reduce the concentration of phospholipase A2 and other bioactive substances,and is easy to form abscess and peripancreatic sepsis and cause infection to spread into the abdominal cavity and form peritonitis.In conclusion,necrotic cavity lavage can benefit some patients,especially those with smaller drainage diameter who underwent endoscopic debridement and percutaneous catheter drainage.However,whether it is necessary for patients with larger drainage diameter who underwent laparotomy or video-assisted debridement still needs to be further studied by randomized controlled trials.

Lavage has been used in the treatment of infected pancreatic necrosis(IPN) for a long time.It can be divided into peritoneal lavage and necrotic cavity lavage according to different parts of lavage.At present,peritoneal lavage is rarely used,while necrotic cavity lavage is widely used in laparotomy,minimally invasive surgery and endoscopic debridement and drainage for IPN patients.However,there is no unified standard for the type,method,duration and indication of stopping lavage.The application of lavage is controversial: proponents think that necrotic cavity lavage can dilute and remove residual or new necrotic tissue,remove inflammatory mediators and reduce the times of debridement,etc.While opponents think that lavage can not significantly reduce the concentration of phospholipase A2 and other bioactive substances,and is easy to form abscess and peripancreatic sepsis and cause infection to spread into the abdominal cavity and form peritonitis.In conclusion,necrotic cavity lavage can benefit some patients,especially those with smaller drainage diameter who underwent endoscopic debridement and percutaneous catheter drainage.However,whether it is necessary for patients with larger drainage diameter who underwent laparotomy or video-assisted debridement still needs to be further studied by randomized controlled trials.

Objective:To evaluate the clinical characteristics and prognosis of elderly patients with infected pancreatic necrosis (IPN).Methods:Clinical data of IPN patients admitted in the Acute Pancreatitis Clinical Center of Xuanwu Hospital of Capital Medical University from January 1, 2014 to October 30, 2018 were retrospectively collected analyzed. These patients were separated into elderly group (older than 65 years old) and young group (less than 65 years old). These clinical data were analyzed between the two groups, including age, sex, comorbidities, laboratory and imaging examinations, treatment methods and outcomes, length of hospital stay, length of ICU stay and mortality.Results:A total of 163 patients were included. In the elderly group, there were 42 patients aged 67.00(65.50, 77.00), with 22 males and 20 females. In the young group, there were 121 patients aged 44.00(33.25, 52.00), with 90 males and 31 females. The ratio of male to female in the elderly group was 47.62% (20/42), which was significantly higher than that in the young group [25.62% (31/121), P<0.05]. The etiological cause of acute pancreatitis for 83.33% (35/42) elderly IPN patients were biliary diseases, while only 43.80% (53/121) of young IPN patients were caused by biliary diseases ( P<0.05). Elderly IPN patients had higher rates of coronary artery disease and hypertension co-morbidities compared to those of the young patients (all P<0.05). The level of aspartate aminotransferase and blood urea nitrogen in the elderly group were significantly higher than those of the young group [37.00 (27.50, 58.00) IU/L vs. 28.00 (18.50, 44.00) IU/L; 6.36 (4.23, 10.89) mmol/L vs. 4.68 (3.23, 7.15) mmol/L, P<0.05]. However, the level of triglyceride was significantly lower [1.05 (0.78, 1.35) mmol/L vs. 2.26 (1.32, 18.55) mmol/L, P<0.05]. There were no significant differences in local complications, but the rate of persistent organ failure was significantly higher in the elderly group than that of the young group [30.95% (13/42) vs. 12.40% (15/121), P<0.05]. The duration of total parenteral nutrition for elderly IPN patients were significantly longer than those of young patients [22.00 (13.25, 43.50) d vs. 17.00 (9.00, 26.00) d, P<0.05]. However, the rate of patients that received surgery intervention was more than twice which was significantly lower in the elderly group than that of the young group [26.19% (11/42) vs. 43.80% (52/121), P<0.05]. The mortality rate for elderly IPN patients was significantly higher than those of young patients [21.43% (9/42) vs. 7.44% (9/121), P<0.05]. Conclusions:Elderly IPN patients were associated with a higher proportion of female than the young IPN patients. Elderly IPN patients usually have a higher proportion of cardiovascular comorbidities, and are associated with higher persistent organ failure rates and mortality rates.

The application of minimally invasive technique in infected pancreatic necrosis has been matured gradually but has controversy and challenges in the same time. This paper further discusses the advantages, timing, combination of multi-video-assisted debridement and post-operative management of minimally invasive surgery. The greatest advantage of minimally invasive surgery lies in "No intervention for normal abdominal space" which not only can reduce unnecessary injury and complication but also promote intestinal function recovery after operation. The principle of delayed operation is controversial. Early PCD and "one-step" minimally invasive laparoscopic debridement and drainage have both achieved good results. The combination of multi-video-assisted minimally invasive technique can make up for the shortage of single technique to shorten the operation time and improve the debridement efficiency of patients with complicated infected pancreatic necrosis and provide new ideas for video-assisted debridement. Fully debridement and drainage are the key points and standardization for post-operative management. It′s a difficult problem and an important research direction to apply minimally invasive technique for patients with infected pancreatic necrosis reasonably and scientifically.

Objective: To examine the indications and effects of different surgical approaches in laparoscopic debridement for patients with infected pancreatic necrosis(IPN). Methods: The clinical data of 213 IPN patients treated by laparoscopic debridement at Department of General Surgery, Xuanwu Hospital, Capital Medical University from June 2012 to February 2019 were retrospectively analyzed.The therapeutic effects were summarized and analyzed according to different surgical approaches. There were 123 cases in retroperitoneal approach group, including 73 males and 50 females, aging of (51.3±12.4) years; 59 cases in omental sac approach group, including 32 males and 27 females, aging of (48.3±14.2) years; 23 cases in combined approach group, including 13 males and 10 females, aging of (54.3±19.7) years; 8 cases in digestive tract approach group, including 5 males and 3 females, aging of (50.2±12.5) years. Results: The time from onset to operation in retro-peritoneal, omental sac, combined and digestive tract approach groups were (44.3±22.8), (47.3±24.3), (52.6±21.2), (51.2±30.1) days, respectively; the operation time was (52.3±26.4), (64.3±29.2), (82.8±24.7), (78.2±38.1) minutes respectively; the median bleeding volume was 18, 33, 42 and 30 ml, respectively; and the first time to eat after operation was (2.5±1.6), (3.8±1.8), (3.7±2.0), (8.4±3.9) days, respectively.The incidence of complications (Clavien-Dindo grade Ⅲ and above) was 10.6%(13/123), 10.2%(6/59), 17.4%(4/23), 1/8 and the mortality was 4.9%(6/123), 3.4%(2/59), 4.3%(1/23) and 0, respectively.The overall mortality of all patients was 4.2%(9/213). The levels of inflammatory factors were significantly lower in all groups 7 days after operation than before, and no patients was converted to open surgery. Conclusion Individualized selection of the optimal laparoscopic debridement approach of pancreatic necrosis plays an important role in improving the efficacy and prognosis of IPN patients.