Pancreatic cancer is also known as the " king of cancer" . It is difficult to diagnose and has a high degree of malignancy. Most patients are in advanced stage when they are found. The prognosis is very poor. Early diagnosis and treatment of pancreatic cancer are very important to improve survival rate and prognosis. In recent years, with the continuous popularization of laparoscopic technology, as well as the updating and iteration of related equipment such as 3D visualization and 4K high-definition laparoscopy, and the continuous maturity of surgical technology, laparoscopic surgery for pancreatic tumors has also made unprecedented progress. This review will discuss the application and development of laparoscopic pancreatic surgery as a treatment strategy for pancreatic cancer based on the existing research progress.

Cancer vaccines represent a promising immunotherapeutic treatment modality. The promotion of cross-presentation of extracellular tumor-associated antigens on the major histocompatibility complex (MHC) class I molecules and dendritic cell maturation at the appropriate time and place is crucial for cancer vaccines to prime cytolytic T cell response with reduced side effects. Current vaccination strategies, however, are not able to achieve the spatiotemporal control of antigen cross-presentation. Here, we report a liposomal vaccine loading the second near-infrared window (NIR-II, 1000-1700 nm) fluorophore BPBBT with an efficient photothermal conversion effect that offers an NIR-light-triggered endolysosomal escape under the imaging guidance. The NIR-II image-guided vaccination strategy specifically controls the cytosolic delivery of antigens for cross-presentation in the draining lymph nodes (DLNs). Moreover, the photothermally induced endolysosomal rupture initiates autophagy. We also find that the adjuvant simvastatin acts as an autophagy activator through inhibiting the PI3K/AKT/mTOR pathway. The light-induced autophagy in the DLNs together with simvastatin treatment cooperatively increase MHC class II expression by activating autophagy machinery for dendritic cell maturation. This study presents a paradigm of NIR-II image-guided light-triggered vaccination. The approach for remote control of antigen cross-presentation and autophagy represents a new strategy for vaccine development.

OBJECTIVE To prepare Leonurine hydrochloride tablets and evaluate the quality. METHODS The wet granulation technology was adopted ；leonurine hydrochloride was used as the crude drug ，and the types of fillers ，disintegrants，binders and lubricants were screened by single-factor experiments. Combined with orthogonal experiments ，using the cumulative dissolution rate within 15 minutes（using water as dissolution media ）as index ，the proportion of disintegrants ，the mass fraction of binder solution，and the proportion of lubricants were screened and verified. The in vitro dissolution behavior of the prepared Leonurine hydrochloride tablets （dissolution media were hydrochloric acid solution of pH 1.2，acetic acid-sodium acetate solution of pH 4.5， phosphate buffer solution of pH 6.8，water），tablet appearance ，hardness，friability and content uniformity were tested according to the general principles in 2020 edition of Chinese Pharmacopoeia （part Ⅳ）. RESULTS The optimal formulation of Leonurine hydrochloride tablets included leonurine hydrochloride crude drug of 500 mg，dextrin of 9 250 mg，crosslinking polyving y- pyrrolidone of 200 mg，magnesium stearate of 50 mg，1％ hydroxypropyl methyl cellulose solution of 4 mL. The average 15-minute cumulative dissolution rate of the three batches of tablets was 81.25％（RSD＝1.12％，n＝3）. In above 4 dissolution media，the dissolution equilibrium of prepared tablets could be reached within 30 minutes，and the cumulative dissolution rates exceeded 85％. The prepared tablets had uniform beige in color ，smooth surface ，complete edge ，no mottle ，spot，foreign matter ， etc.，hardness of 57.3 N（n＝6），weight loss rate of 0.15％. The content uniformity was in accordance with relevant provisions in 2020 edition of Chinese Pharmacopoeia （part Ⅳ）. CONCLUSIONS Leonurine hydrochloride tablets are successfully prepared ， and the quality comply with relevant regulations.

Objective:To study the safety and efficacy of laparoscopic subtotal distal pancreatectomy using the arterial first approach in treatment of patients with pancreatic neck-body cancer after neoadjuvant chemotherapy.Methods:The clinical data of patients who underwent laparoscopic subtotal distal pancreatectomy after neoadjuvant chemotherapy at the Department of Pancreatic Surgery, Hunan Provincial People's Hospital from January 2019 to June 2021 were analyzed retrospectively. Seven patients were included in this study. There were 3 males and 4 females, aged 55(46, 67) years old. The clinical data analysed included chemotherapy, preoperative, intraoperative, postoperative and follow-up data. Follow up was done by outpatient visits, or contact using wechat or telephone.Results:Five borderline staged patients were treated with the AG chemotherapy regimen (gemcitabine+ albumin-bound paclitaxel), and two patients with locally advanced stage were treated with the mFOLFIRINOX chemotherapy regimen (oxaliplatin+ irinotecan+ calcium folate+ fluorouracil). All the 7 patients underwent portal vein/superior mesenteric vein resection and reconstruction using the superior mesenteric artery priority approach. The operation time was 400(350, 440) min, and the intraoperative blood loss was 300(150, 400) ml. Postoperative complications occurred in 2 patients with grade B pancreatic fistula and refractory ascites in 1 patient each. The postoperative hospital stay was 11(10, 14) days. All 7 patients underwent R 0 resection. During a follow-up period of 9 to 33 months, 5 patients were still alive without tumor, 1 patient survived with tumor, and 1 patient had died of recurrence. Conclusion:In selected cases, laparoscopic subtotal distal pancreatectomy for pancreatic neck-body cancer after neoadjuvant chemotherapy was safe and feasible.

Objective:To study the value of metastatic positivety in lymph nodes group 8a in deciding on extended lymph node dissection in pancreaticoduodenectomy(PD) for pancreatic head cancer.Methods:A retrospective study on 165 patients with pancreatic head cancer treated with PD at the Department of Pancreas and Spleen Surgery, Hepatobiliary Hospital of Hunan Provincial People's Hospital between January 2014 to June 2019 was performed. There were 101 males and 64 females with ages ranging from 38 to 75 (median 57) years. Patients who underwent standard lymph node dissection were included in the standard group ( n=88), and extended lymph node dissection in the extended group ( n=77). These patients were further divided into 4 subgroup. Subgroup A (standard PD in patients with negative nodes in group 8a, n=61), Subgroup B (extended PD in patients with negative nodes in group 8a, n=47), Subgroup C (standard PD in patients with positive nodes in group 8a, n=27), and Subgroup D (extended PD in patients with positive nodes in group 8a, n=30). The operation time, intraoperative blood loss, postoperative survival rates, complications were compared among the groups and subgroups. Results:The operation time and intraoperative blood loss of the standard group were (456.8±30.4) min and (264.28±101.14) ml, respectively, which were significantly lower than the extended group of (507.1±45.7) min and (388.9±155.3) ml (all P<0.05). The incidence of postoperative complications in the extended group (31.2%, 24/77) was significantly higher than that in the standard group (14.8%, 13/88) ( P<0.05). When compared with subgroup B, the cumulative survival rate of patients in subgroup A was not significantly different ( P>0.05). However, the cumulative survival rate of patients in subgroup C was significantly lower than that in subgroup D ( P<0.05). The cumulative survival rate of subgroup A was also significantly better than that of subgroup C ( P<0.05). There was no significant difference in the cumulative survival rates between group B and group D ( P>0.05). Conclusions:PD with extended lymph node dissection improved the survival rates in patients with cancer of the head of the pancreas with positive lymph nodes in group 8a. For these patients, extended lymph node dissection is recommended. With negative lymph nodes in group 8a, standard lymph node dissection is recommended.

Objective:To study the indications and clinical efficacy of video assisted small incision in treatment of infected pancreatic necrosis.Methods:A retrospective study was conducted on 27 patients with infected pancreatic necrosis treated by video assisted small incision at the Department of Pancreatic and Splenic Surgery, Hunan Provincial People's Hospital, from January 2018 to December 2019. The surgical approach, operation time, intraoperative blood loss, postoperative hospital stay and complications were analysed. Postoperative follow-up was carried out at outpatients’ clinic, and the patient's time to full recovery and long-term complications were studied.Results:The 27 patients successfully underwent the operations. There were 22 males and 5 females, aged (50.6±6.2) years. The treatment results were analyzed according to the different surgical approaches: the retroperitoneal approach group ( n=4); the omental sac approach group (n=14); the intercostal space approach group ( n=2); and the combined approach group ( n=7). The operation time was (85.3±31.6)min. The intraoperative blood loss was 65.0(45.2, 121.4)ml. The postoperative hospital stay was 23.0(12.5, 36.1)days. The incidence of complications (Clavien-Dindo grade Ⅲ and above) was 14.8%(4/27). There were 2 patients in this study who were admitted to the intensive care unit due to postoperative hemorrhage: 1 patient responded well to conservative treatment and the remaining patient required interventional treatment. Another patient because of poor results, underwent debridement by laparotomy 2 weeks after the operation. There was 1 patient who developed grade C pancreatic fistula which was cured by surgical treatment 6 months later. On follow-up, 2 patients developed colonic fistula 2 weeks after surgery and 2 patients gastric fistula 1 week and 3 weeks after surgery. These patients responded to conservative treatment. Conclusion:With proper case selection, video assisted small incision could safely and effectively be used to treat infected pancreatic necrosis.

Objective:To investigate the clinical efficacy of perihilar surgical techniques for diffuse hepatolithiasis.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 122 patients with diffuse hepatolithiasis who were admitted to Hunan Provincial People's Hospital from January 2010 to December 2015 were collected. There were 39 males and 83 females, aged from 21 to 82 years, with a median age of 51 years. After perihilar hepatectomy, the first, second and third divisions of hepatic ducts were opened longitudinally. Strictures in the bile ducts were relieved by stricturoplasty and internal bile duct anastomosis, and stones were removed by multiple methods under direct vision. After resection of severe atrophic liver segment along the plane of hepatic atrophy or bile duct stricture, T-tube or hepaticojejunos-tomy was used for internal drainage. Observation indicators: (1) surgical situations; (2) stricture relief and stone removal. (3) Follow-up. Follow-up was conducted by Wechat, telephone interview or outpatient examination. Patients were followed up once every 3 months in the postoperative 1 year through liver function and abdominal B-ultrasound examination. Subsequently, liver function and abdominal B-ultrasound were reexamined once a year. Magnetic resonance cholangiopancreato-graphy and computed tomography were performed when cholangitis or stone recurrence was suspected to analyze stone recurrence and patient survival. The follow-up was up to July 2020. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were expressed as absolute numbers or percentages. Results:(1) Surgical situations: for the 122 patients, the operation time, hepatic portal occlusion time, volume of intraoperative blood loss, duration of postoperative hospital stay were (253±71)minutes, 15 minutes(range, 14?38 minutes), 200 mL(range, 100?1 100 mL), (12±5)days. Postoperative complications occurred to 40 of 122 patients. There were 9 cases of incision infection, 8 cases of bile leakage (5 cases of bile leakage at hepatic section, 3 cases of choledochojejunostomy leakage), 8 cases of septicemia, 7 cases of pleural effusion, 5 cases of abdominal abscess, 3 cases of liver failure, 1 case of biliary bleeding. Some patients had multiple complications. Among the 122 patients, 2 cases died after operation, including 1 case of postoperative liver failure and 1 case of disseminated intravascular coagulation caused by biliary-intestinal anastomotic leakage complicated with sepsis. Patients with bile leakage and abdominal abscess were improved after puncture and drainage under the guidance of B-ultrasound. Patients with cholangiojejunal anastomotic bleeding were embolized through the right hepatic artery. The other complications were improved after conservative treatment. (2) Stricture relief and stone removal: 85 of 88 patients with biliary stricture were relieved, with the stricture relief rate of 96.59%(85/88). Among the 122 patients, 103 cases had stones completely removed and 19 cases had residual stones. The immediate stone clearance rate was 84.43%(103/122). Of the 19 patients with residual stones, choledochoscopy was refused in 3 cases and choledochoscope lithotripsy was performed in 16 cases, of which 7 cases were removed and 9 cases were still residual stones. Of the 122 patients, 110 cases were finally removed stones, 12 cases were eventually residual stones, and the final stone clearance rate was 90.16%(110/122). (3) Follow-up: among the 122 patients, 120 cases including 110 cases with find stone removal and 10 cases with residual stones were followed up for (78±14)months. The 1-, 3, 5-year stone recurrence rates of 120 patients were 0.83%(1/120), 6.67%(8/120), 9.17%(11/120), respectively. The 1-, 3-, 5-year stone recurrence rates of 110 patients with final stone removal were 0, 5.45%(6/110), 5.45%(6/110), respectively. The number of cases with stone recurrence at postoperative 1-, 3- and 5-year of 10 patients with residual stones were 1, 2, 5 cases, respectively. Of 120 patients with follow-up, 1 case died of end-stage liver disease, and the other patients had good survival.Conclusion:Perihilar surgical techniques for diffuse hepatolithiasis is safe and effective.

Objective:To study and analyse the results of postoperative hemorrhage after laparoscopic pancreaticoduodenectomy (LPD).Methods:The clinical data of patients who underwent LPD from May 2011 to December 2019 at Hunan Provincial People's Hospital were retrospectively analyzed. The clinical characteristics of patients, onset time of postoperative hemorrhage, location of postoperative hemorrhage, postoperative biliary fistula, pancreatic fistula, infection and other short-term complications, reoperation and mortality rates were analyzed.Results:Of 356 patients who underwent LPD in this study, there were 200 males and 156 females, aged (58.0±10.5) years. The postoperative complication rate was 33.1% (118/356), the reoperation rate was 6.5% (23/356), and the mortality rate was 2.5% (9/356). The most common complications were postoperative hemorrhage [15.2% (54/356)], pancreatic fistula [14.6%(52/356)] and abdominal infection [13.8%(49/356)]. The onset time of postoperative hemorrhage was usually in the 1st - 14th day, and the highest rate of postoperative hemorrhage was 3.9% (14/356) on the first day after surgery. The postoperative hemorrhage rate then showed a downward trend, but increased again on the 7th day. The extraluminal hemorrhage locations were relatively widely distributed, and the incidence of gastrointestinal anastomotic hemorrhage in patients with intraluminal hemorrhage was the highest [67.9%(19/28)]. Of the 9 patients who died, 7 were related to postoperative bleeding.Conclusions:LPD resulted in a high incidence of complications. Postoperative hemorrhage was a complication that had the greatest impact on short-term recovery of patients. It was also an important cause of reoperation and death. In addition to postoperative bleeding caused by pancreatic fistula, gastrointestinal anastomotic bleeding was also clinically important.

Objective:To investigate the classification and surgical management of chronic calcifying pancreatitis.Methods:The retrospective and descriptive study was conducted. The clinical data of 121 patients with chronic calcifying pancreatitis who were admitted to Hunan Provincial People′s Hospital from January 2015 to December 2019 were collected. There were 99 males and 22 females, aged from 10 to 78 years, with a median age of 43 years. The patients with type Ⅰ chronic calcifying pancreatitis underwent pancreaticoduodenectomy, duodenum-preserving pancreatic head total resection, or duodenum-preserving pancreatic head spoon-type resection respectively, and external drainage when combined with peripancreatic pseudocyst. Patients with type Ⅱ chronic calcifying pancreatitis underwent resection of pancreatic body and tail combined with splenectomy or dissection of pancreatic duct combined with pancreato-jejunum Roux-en-Y anastomosis. Patients with type Ⅲ chronic calcifying pancreatitis underwent pancreaticoduodenectomy or duodenum-preserving pancreatic head spoon-type resection, and external drainage when combined with peripancreatic pseudocyst. Patients with type Ⅳ chronic calcifying pancreatitis underwent basin-type internal drainage. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect the recurrence of pain or chronic pancreatitis, the data of blood glucose, the morbidity of diabetes and diarrhea after surgery up to January 2020. Measurement data with normal distribution were represented as Mean± SD and measurement data with skewed distribution were described as M (range). Count data were represented as absolute numbers. Results:(1) Surgical situations: of the 48 patients with type Ⅰ chronic calcifying pancreatitis, 15 patients underwent pancreaticoduodenectomy with the operation time of (6.8±1.9)hours and volume of intraoperative blood loss of (398±110)mL, 8 patients underwent duodenum-preserving pancreatic head total resection due to no dilation of pancreatic duct with the operation time of (3.7±0.8)hours and volume of intraoperative blood loss of (137±62)mL, 25 patients underwent duodenum-preserving pancreatic head spoon-type resection due to dilation of pancreatic duct with the operation time of (3.9±1.5)hours and volume of intraoperative blood loss of (123±58)mL. Of the 8 patients with type Ⅱchronic calcifying pancreatitis, 2 patients underwent resection of pancreatic body and tail combined with splenectomy with an average operation time of 5.1 hours and an average volume of intraoperative blood loss of 200 mL, 6 patients underwent dissection of pancreatic duct combined with pancreato-jejunum Roux-en-Y anastomosis with the operation time of (2.7±0.8)hours and volume of intraoperative blood loss of (145±39)mL. Of the 49 patients with type Ⅲ chronic calcifying pancreatitis, 4 patients were underwent pancreaticoduodenectomy with the operation time of (7.2±1.4)hours and volume of intraoperative blood loss of (415±98)mL, 45 patients underwent duodenum-preserving pancreatic head spoon-type resection due to dilation of pancreatic duct with the operation time of (4.3±1.1)hours and volume of intraoperative blood loss of (135±47)mL. Sixteen patients with type Ⅳ chronic calcifying pancreatitis underwent basin-type internal drainage with the operation time of (3.3±1.3)hours and volume of intraoperative blood loss of (150±27)mL. (2) Postoperative situations: 15 of the 48 patients with type Ⅰ chronic calcifying pancreatitis who underwent pancreaticoduodenectomy had the time to first anal flatus of (2.9±1.1)days, time to initial fluid diet intake of (3.5±1.1)days, and duration of hospital stay of (14.8±2.7)days, respectively. Of the 3 patients who had postoperative complications, 2 had gastrointestinal hemorrhage (1 case was cured after hemostasis under gastroscope and the other was cured after interventional therapy), 1 with grade A pancreatic fistula was cured after delaying the time of extubation, no biliary fistula occurred. Eight patients undergoing duodenum-preserving pancreatic head total resection had the time to first anal flatus of (2.0±0.5)days, time to initial fluid diet intake of (2.5±0.4)days, and duration of hospital stay of (9.5±2.5)days, respectively. One case with postoperative grade A pancreatic fistula was cured after delaying the time of extubation. Twenty-five patients undergoing duodenum-preserving pancreatic head spoon-type resection had the time to first anal flatus of (2.4±0.8)days, time to initial fluid diet intake of (2.5±1.3)days, and duration of hospital stay of (9.8±3.1)days, respectively. One case with postoperative gastrointestinal hemorrhage was cured after interventional therapy and 1 case with grade A pancreatic fistula was cured after delaying the time of extubation. Two of the 8 patients with type Ⅱ chronic calcifying pancreatitis who underwent resection of pancreatic body and tail combined with splenectomy had an average time to first anal flatus of 3.0 days, an average time to initial fluid diet intake of 3.5 days, and an average duration of hospital stay of 14.0 days, respectively.There was no complication during perioperative period. Six of the 8 patients with type Ⅱ chronic calcifying pancreatitis who underwent dissection of the pancreatic duct combined with pancerato-jejunum Roux-en-Y anastomosis had the time to first anal flatus of (2.5±0.5)days, time to initial fluid diet intake of (2.5±0.7)days, and duration of hospital stay of (8.5±1.5)days, respectively. Two cases with postoperative grade A pancreatic fistula were cured after delaying the time of extubation. Four of the 49 patients with type Ⅲ pancreatic duct stone who underwent pancreaticoduodenectomy had the time to first anal flatus of (3.2±0.8)days, time to initial fluid diet intake of (4.1±1.2)days, and duration of hospital stay of (15.3±2.4)days, respectively. One case with postoperative grade A pancreatic fistula was cured after delaying the time of extubation without hemorrhage or biliary fistula. Forty-five of the 49 patients with type Ⅲ chronic calcifying pancreatitis who underwent duodenum-preserving pancreatic head spoon-type resection had the time to first anal flatus of (2.5±1.6)days, time to initial fluid diet intake of (2.8±0.9)days, and duration of hospital stay of (10.1±2.8)days, respectively. One case with postoperative anastomotic bleeding was cured after reoperation. One case with grade A pancreatic fistula was cured after delaying the time of extubation and 1 case with postoperative grade B pancreatic fistula was cured after puncture-duct-douch treatment. Sixteen patients with type Ⅳ chronic calcifying pancreatitis who underwent basin-type internal drainage had the time to first anal flatus of (2.6±0.7)days, time to initial fluid diet intake of (3.3±0.5)days, and duration of hospital stay of (10.4±3.0)days respectively. One case with intraperitoneal hemorrhage which represented as small amount of dark red liquid in the drainage tube of jejunum loop was cured after puncture-duct-douch treatment with noradrenaline sodium chloride solution. (3) Follow-up: Of the 121 patients, 113 (44 of type Ⅰ, 7 of type Ⅱ, 46 of type Ⅲ, 16 of type Ⅳ) were followed up for 3-58 months, with an average time of 34 months. During the follow-up, 13 patients (5 of type Ⅰ, 1 of type Ⅱ, 6 of type Ⅲ, 1 of type Ⅳ) had the recurrence of pain or pancreatitis, 55 patients (15 of type Ⅰ, 40 of type Ⅲ) with abdominal pain were improved significantly, and 45 patients (24 of type Ⅰ, 6 of type Ⅱ, 15 of type Ⅳ) did not have abdominal pain. Of the 37 patients (13 of type Ⅰ, 2 of type Ⅱ, 17 of type Ⅲ, 5 of type Ⅳ) with diabetes , 20 (6 of type Ⅰ, 2 of type Ⅱ, 12 of type Ⅲ) had blood glucose returned to normal and 17 (7 of type Ⅰ, 5 of type Ⅲ, 5 of type Ⅳ) needed controlling blood sugar with medicine. There were 5 patients (4 of type Ⅰ, 1 of type Ⅲ) diagnosed with diabetes and 3 patients (1 of type Ⅱ, 2 of type Ⅲ) with diarrhea postoperatively. Two patients of type Ⅲ chronic calcifying pancreatitis died, including 1 died of pancreatic cancer at 18 months after pancreaticoduodenectomy and 1 died of severe acute pancreatitis at 5 months after duodenum-preserving pancreatic head spoon-type resection.Conclusions:Chronic calcifying pancreatitis is a benign disease and should be treated to preserve functional tissues. Different surgical procedures should be adopted to treat different types of calcifying pancreatitis.

Objective To evaluate the imaging changes of the arterial wall and lumen at the site of intracranial large artery lesions with high-resolution magnetic resonance imaging (HR-MRI) before and after Wingspan stent implantation.Methods From December 2013 to December 2014,9 patients with symptomatic intracranial arterial stenosis (stenosis rate:70%-99%) admitted to the Department of Interventional Neuroradiology,Xuanwu Hospital,Capital Medical University were enrolled retrospectively.The sites of the lesions included middle cerebral arteries,basilar artery,and intracranial segment of vertebral artery.Head 3D HR-MRI technique was used to analyze and compare the changes of the tube-wall enhancement areas in the lesion sites through image registration and matching.The consistency of stenosis rates measured by HR-MRI and DSA was compared through Pearson correlation analysis and Bland-Altman Plot.Results The success rate of technique was 100% without related complications.(1) After Wingspan stent implantation,the gadolinium enhancement in the vascular walls of the stenosis sites was decreased significantly compared with that before procedure.The area of enhancement decreased was 87±16% after stent implantation compared with before implantation,and the difference was statistically significant (t=2.325,P=0.049).(2) Before stent implantation,the mean stenosis rates of the HR-MRI and DSA measurements were 82±6% and 82±8% respectively,and the difference was not statistically significant (t=0.051,P=0.961);after procedure,the mean stenosis rates of HR-MRI and DSA measurements were 16±12% and 21±12% respectively,and the difference was not statistically significant (t=1.345,P=0.216).(3) The Pearson correlation coefficients of HR-MRI and DSA for stenosis rate measurement before and after stent implantation were 0.347 (P=0.361) and 0.545 (P=0.129) respectively.Bland-Altman statistical images showed that most of the data points were within the consistency limit (x-±1.96 s).Conclusions As an in vivo noninvasive imaging means,HR-MRI can be used to assess the changes of vascular walls of the lesion sites,the vascular lumen,and the original plaques after the intracranial stent release.It can also be used to evaluate the reconstruction of intracranial arterial walls.