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Standard pancreatoduodenectomy versus extended pancreatoduodenectomy with modified retroperitoneal nerve resection in patients with pancreatic head cancer:a multicenter randomized controlled trial

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Cancer Communications 2023年第2期43卷 257-275页

作者： Qing lin Shangyou Zheng Xianjun Yu Meifu Chen Yu Zhou Quanbo Zhou Chonghui Hu Jing Gu Zhongdong Xu linWang Yimin liu Qingyu liu MinWang Guolin li He Cheng Dongkai Zhou Guodong liu Zhiqiang Fu Yu Long yixiong li Weilin Wang Renyi Qin Zhihua li Rufu Chen Department of Pancreas Center Department of General SurgeryGuangdong Provincial People’s HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdongPeople’s Republic of China Department of Pancreatobiliary Surgery Sun Yat-sen Memorial HospitalSun Yat-sen UniversityGuangzhouGuangdongPeople’s Republic of China Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation Medical Research Center Sun Yat-Sen Memorial HospitalSun Yat-Sen UniversityGuangzhouGuangdongPeople’s Republic of China Department of Pancreatic Surgery Fudan University Shanghai Cancer CenterShanghaiPeople’s Republic of China Hunan Research Center of Biliary Disease/Department of Hepatobiliary Surgery Hunan Provincial People’s Hospital/The First Affiliated Hospital of Hunan Normal UniversityChangshaHunanPeople’s Republic of China Department of Medical Statistics School of Public HealthSun Yat-sen UniversityGuangzhouGuangdongPeople’s Republic of China Department of Anesthesiology Sun Yat-sen Memorial HospitalSun Yat-sen UniversityGuangzhouGuangdongPeople’s Republic of China Department of Pathology Sun Yat-sen Memorial HospitalGuangzhouGuangdongPeople’s Republic of China Department of Oncology Sun Yat-sen Memorial HospitalSun Yat-sen University GuangzhouGuangdongPeople’s Republic of China Department of Radiology Sun Yat-sen Memorial HospitalSun Yat-sen UniversityGuangzhouGuangdongPeople’s Republic of China Department of Biliary-Pancreatic Surgery Affiliated Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiPeople’s Republic of China Department of Hepatobiliary Pancreatic and Splenic surgerythe Sixth Affiliated Hospital of Sun Yat-sen UniversityGuangzhouGuangdongPeople’s Republic of China Hepatobiliary and Pancreatic Interventional Treatment Center Division of Hepatobiliary and Pancreatic SurgeryThe First Affiliated HospitalCollege of MedicineZhejiang UniversityHangzhouZhejiangPeople’s Republic of China Department of General Surge

Background:The extent of pancreatoduodenectomy for pancreatic head cancer remains controversial,and more high-level clinical evidence is needed.This study aimed to evaluate the outcome of extended pancreatoduodenectomy(EPD)with retroperitoneal nerve resection in pancreatic head cancer.Methods:This multicenter randomized trial was performed at 6 Chinese highvolume hospitals that enrolled patients between October 3,2012,and September 21,2017.Four hundred patients with stage I or II pancreatic head cancer and without specific pancreatic cancer treatments(preoperative chemotherapy or chemoradiation)within three months were randomly assigned to undergo standard pancreatoduodenectomy(SPD)or EPD,with the latter followed by dissection of additional lymph nodes(LNs),nerves and soft tissues 270◦on the right side surrounding the superior mesenteric artery and celiac axis.The primary endpoint was overall survival(OS)by intention-to-treat(ITT).The secondary endpoints were disease-free survival(DFS),mortality,morbidity,and postoperative pain intensity.Results:TheR1 ratewas slightly lower with EPD(8.46%)thanwith SPD(12.56%).The morbidity and mortality rates were similar between the two groups.The median OS was similar in the EPD and SPD groups by ITT in the whole study cohort(23.0 vs.20.2 months,P=0.100),while the median DFS was superior in the EPD group(16.1 vs.13.2 months,P=0.031).Patients with preoperative CA19–9<200.0 U/mL had significantly improved OS and DFS with EPD(EPD vs.SPD,30.8 vs.20.9 months,P=0.009;23.4 vs.13.5 months,P<0.001).The EPD group exhibited significantly lower locoregional(16.48%vs.35.20%,P<0.001)andmesenteric LNrecurrence rates(3.98%vs.10.06%,P=0.022).The EPD group exhibited less back pain 6 months postoperation than the SPD group.Conclusions:EPD for pancreatic head cancer did not significantly improve OS,but patients with EPD treatment had significantly improved DFS.In the subgroup analysis,improvements in bothOS and DFS in the EPD armwere observed in patients with preoperative CA19–9<200.0 U/mL.EPD cou

关键词： disease-free survival extended lymph nodes nerve resection overall survival pancreatic head cancer pancreatoduodenectomy standard

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Chinese Medical Association consensus for standardized diagnosis and treatment of pancreatic neuroendocrine neoplasms

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Chinese Medical Journal 2023年第20期136卷 2397-2411页

作者： Feng Jiao Jiujie Cui Deliang Fu Qi li Zheng Wu Zan Teng Hongmei Zhang Jun Zhou Zhihong Zhang Xiaobing Chen Yuhong Zhou yixiong li Yiping Mou Renyi Qin Yongwei Sun Gang Jin Yuejuan Cheng Jian Wang Gang Ren Jiang Yue Guangxin Jin Xiuying Xiao liwei Wang on behalf of Pancreatic Tumor Group,Society of Oncology,Chinese Medical Association Department of Oncology State Key Laboratory of Systems Medicine for CancerShanghai Cancer InstituteRenji HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghai 200127China Department of Pancreatic Surgery Huashan HospitalFudan UniversityShanghai 200040China Department of Oncology Shanghai General HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghai 200080China Department of Hepatobiliary Surgery The First Affiliated Hospital of Xi’an Jiao Tong UniversityXi’anShaanxi 710061China Department of Oncology The First Hospital of China Medical UniversityShenyangLiaoning 110801China Department of Medical Oncology The First Affiliated Hospital of Air Force Medical UniversityXi’anShaanxi 710032China Department of Gastrointestinal Oncology Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing)Peking University Cancer Hospital and InstituteBeijing 100142China Department of Pathology The First Affiliated Hospital of Nanjing Medical UniversityNanjingJiangsu 210029China Department of Oncology The Affiliated Cancer Hospital of Zhengzhou UniversityHenan Cancer HospitalZhengzhouHenan 450003China Department of Medical Oncology Zhongshan HospitalFudan UniversityShanghai 200032China Department of General Surgery Xiangya HospitalCentral South UniversityChangshaHunan 410008China Department of Gastrointestinal and Pancreatic Surgery Zhejiang Provincial People’s HospitalAffiliated People’s HospitalHangzhou Medical CollegeHangzhouZhejiang 310014China Department of Biliary-Pancreatic Surgery Affiliated Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubei 430030China Department of Biliary-Pancreatic Surgery Renji HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghai 200127China Department of Hepatobiliary Pancreatic Surgery Changhai HospitalNaval Medical UniversityShanghai 200433China Department of Medical Oncology Peking Union Medical College HospitalChinese Academy of Medical Sci

Pancreatic neuroendocrine neoplasms(pNENs)are rare and highly heterogeneous tumors originating from pluripotent stem cells with neuroendocrine differentiation in the pancreas,constituting approximately 3%of all pancreatic tumors.^([1])The global incidence of pNENs has been increasing recently,and most cases are sporadic and more common in women.^([1,2])pNENs are clinically divided into functioning and nonfunctioning tumors depending on whether the tumors are accompanied by a clinical syndrome related to specific hormone overproduction.

关键词： neoplasms neuroendocrine diagnosis

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Comparative proteomic study of colorectal carcinoma with different clinical stages

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The Chinese-German Journal of Clinical Oncology 2008年第1期7卷 17-21页

作者： liang Zeng Zhihong liu Yaping Deng Hong Zhu Haiping Pei yixiong li Department of Pathology Hunan Tumor Hospital Changsha 410013 China Department of Radiotherapy Xiangya Hospital Central South University Changsha 410008 China Department of General Surgery Xiangya Hospital central South University Changsha 410008 China

Objective: Colorectal carcinoma clinical stage associated proteins would be found by comparing differential expressed proteins from colorectal carcinoma tissues with different clinical stages. Methods: Total protein from colorectal carcinoma tissues were extracted; differential proteome profiles were established and analyzed by means of immobilized pH gradient-based two-dimensional polyacrylamide gel electrophoresis (2-DE) and matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF-MS). Results: Well-resolved, reproducible 2-DE profiles of human colorectal carcinoma tissues were obtained. Average protein spots were 970 ± 41, 980 ± 32, 1010 ± 43, 1240 ± 34 in stage I, stage II, stage III, stage IV respectively; Compared to stage I, differential expressed protein spots was 52.00 ± 12 in stage II, 42.00 ± 11 in stage III, 72.00 ± 15 in stage IV; Part of differential expressing proteins were analyzed by mass spectrometry and bioinformation, 19 of them were well characterized. Three proteins were overexpressed in stage I, stage III, stage IV, and one protein were overexpressed in stage IV exclusively. Conclusion: Differential expressed proteins exist in clinical stage of colorectal carcinoma, which would be biomarkers for diagnosis and prediction of prognosis.

关键词：临床分期大肠癌癌组织蛋白质组学

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清江河多鳞白甲鱼人工繁殖技术

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河南水产 2024年第1期 19-20,29页

作者：李松张明建连建平袁张勇雷龙辉李义雄夏银琼广元市农业农村局四川广元628000 四川北新天曌投资发展有限公司四川广元628000 四川龙洋渔业有限公司四川广元628000

在多鳞白甲鱼胚胎发育观察的基础上,结合生产实际,对清江河多鳞白甲鱼的人工繁殖技术进行总结,旨在为此品种的产业化发展提供参考,助推乡村振兴。

关键词：多鳞白甲鱼人工繁殖技术

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Guidelines for the diagnosis and treatment of acute pancreatitis in China (2021)

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Journal of Pancreatology 2021年第2期4卷 67-75页

作者： Fei li Shouwang Cai Feng Cao Rufu Chen Deliang Fu Chunlin Ge Chunyi Hao Jihui Hao Heguang Huang Zhixiang Jian Gang Jin Ang li Haimin li Shengping li Weiqin li yixiong li Tingbo liang Xubao liu Wenhui Lou Yi Miao Yiping Mou Chenghong Peng Renyi Qin Chenghao Shao Bei Sun Guang Tan Xiaodong Tian Huaizhi Wang Lei Wang Wei Wang Weilin Wang Junmin Wei Heshui Wu Wenming Wu Zheng Wu Changqing Yan Yinmo Yang Xiaoyu Yin Xianjun Yu Chunhui Yuan Taiping Zhang Yupei Zhao on behalf of the Chinese Pancreatic Surgery Association Department of General Surgery Xuanwu HospitalCapital Medical UniversityBeijing Department of Hepatobiliary and Pancreatic Surgery the First Medical CenterChinese PLA General HospitalBeijing Pancreatic Center Guangdong Provincial People’s HospitalGuangzhouGuangdong Province Department of Pancreatic Surgery Huashan HospitalFudan UniversityShanghai Department of Pancreatic and Biliary Surgery The First Affiliated Hospital of China Medical UniversityShenyangLiaoning Province Department of Hepatopancreatobiliary Surgery Peking University Cancer HospitalBeijing Department of Pancreatic Cancer Tianjin Medical University Cancer Institute and HospitalTianjin Department of General Surgery Fujian Medical University Union HospitalFuzhouFujian Province Department of General Surgery Guangdong Provincial People’s HospitalGuangzhouGuangdong Province Department of Hepatobiliary Pancreatic Surgery Changhai Hospital Affiliated to Navy Medical UniversityShanghai Department of Hepatobiliary Surgery Xijing HospitalFourth Military Medical UniversityXi’anShaanxi Province Department of Pancreatobiliary Surgery Sun Yat-sen University Cancer CenterGuangzhouGuangdong Province Department of General Surgery Jinling HospitalMedical School of Nanjing UniversityNanjingJiangsu Province Department of General Surgery Xiangya HospitalCentral South UniversityChangshaHunan Province Department of Hepatobiliary and Pancreatic Surgery the First Affiliated Hospital of Medical CollegeZhejiang UniversityHangzhouZhejiang Province Department of Pancreatic Surgery West China HospitalSichuan UniversityChengduSichuan Province Department of General Surgery Zhongshan HospitalFudan UniversityShanghai Pancreas Center The First Affiliated Hospital of Nanjing Medical UniversityNanjingJiangsu Province Department of Gastrointestinal and Pancreatic Surgery Zhejiang Provincial People’s HospitalHangzhouZhejiang Province Department of General Surgery Pancreatic Disease CenterRuijin HospitalShanghai Jiao Tong University School of Med

Acute pancreatitis(AP)is a common acute abdominal condition of the digestive system.In recent years,treatment concepts,methods,and strategies for the diagnosis of AP have advanced,and this has played an important role in promoting the standardization of AP diagnosis and treatment and improving the treatment quality of AP patients.On the basis of previous guidelines and expert consensus,this guideline adopts an evidence-based,problem-based expression;synthesizes important clinical research data at home and abroad in the most recent 5 years;and forms 29 recommendations through multidisciplinary expert discussion,including diagnosis,treatment,and follow-up.It is expected to provide evidence support for the treatment of AP in the clinical setting in China.

关键词： Acute pancreatitis Diagnosis Follow-up Guideline Treatment

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Guidelines for the diagnosis and treatment of pancreatic cancer in China (2021)

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Journal of Pancreatology 2021年第2期4卷 49-66页

作者： Yinmo Yang Xueli Bai Dapeng Bian Shouwang Cai Rufu Chen Feng Cao Menghua Dai Chihua Fang Deliang Fu Chunlin Ge Xiaochao Guo Chunyi Hao Jihui Hao Heguang Huang Zhixiang Jian Gang Jin Fei li Haimin li Shengping li Weiqin li yixiong li Hongzhen li Tingbo liang Xubao liu Wenhui Lou Yi Miao Yiping Mou Chenghong Peng Renyi Qin Chenghao Shao Bei Sun Guang Tan Xiaodong Tian Huaizhi Wang Lei Wang Wei Wang Weilin Wang Junmin Wei Heshui Wu Wenming Wu Zheng Wu Jingyong Xu Changqing Yan Xiaoyu Yin Xianjun Yu Chunhui Yuan Taiping Zhang Jixin Zhang Jun Zhou Yupei Zhao on behalf of the Chinese Pancreatic Surgery Association Department of General Surgery Peking University First HospitalBeijing Department of Hepatobiliary and Pancreatic Surgery the First Affiliated Hospital of Medical CollegeZhejiang UniversityHangzhouZhejiang Province Departments of Endoscopy Peking University First HospitalBeijing Institute of Hepatobiliary Surgery of PLA Chinese PLA General HospitalBeijing Department of Pancreatobiliary Surgery Sun Yat-sen Memorial HospitalSun Yat-sen UniversityGuangzhouGuangdong Province Department of General Surgery Xuanwu HospitalCapital Medical UniversityBeijing Department of General Surgery Peking Union Medical College HospitalChinese Academy of Medical Science&Peking Union Medical CollegeBeijing Department of Hepatobiliary Surgery Zhujiang HospitalSouthern Medical UniversityGuangzhouGuangdong Province Department of Pancreatic Surgery Huashan Hospital Fudan UniversityShanghai Department of General Surgery The First Affiliated Hospital of China Medical UniversityShenyangLiaoning Province Department of Imaging Peking University First HospitalBeijing Department of Hepato-Pancreato-Biliary Surgery Peking University Cancer Hospital&InstituteBeijing Department of Pancreatic Cancer Tianjin Medical University Cancer Institute and HospitalTianjin Department of General Surgery Fujian Medical University Union HospitalFuzhouFujian Province Department of General Surgery Guangdong Provincial People’s HospitalGuangzhouGuangdong Province Department of Hepatobiliary Pancreatic Surgery Changhai Hospital Affiliated to Navy Medical UniversityShanghai Department of Hepatobiliary Surgery Xijing HospitalFourth Military Medical UniversityXi’anShaanxi Province Department of Pancreatobiliary Surgery Sun Yat-sen University Cancer CenterGuangzhouGuangdong Province Department of General Surgery Jinling HospitalMedical School of Nanjing UniversityNanjingJiangsu Province Department of General Surgery Xiangya HospitalCentral South UniversityChangshaHunan Province Department of Radiation Oncology Peking University First H

The incidence of pancreatic cancer has been rising worldwide,and its clinical diagnosis and treatment remain a great challenge.To present the update and improvements in the clinical diagnosis and treatment of pancreatic cancer in recent years,Chinese Pancreatic Association,the Chinese Society of Surgery,Chinese Medical Association revised the Guidelines for the Diagnosis and Treatment of Pancreatic Cancer in China(2014)after reviewing evidence-based and problem-oriented literature published during 2015-2021,mainly focusing on highlight issues regarding diagnosis and surgical treatment of pancreatic cancer,conversion strategies for locally advanced pancreatic cancer,treatment of pancreatic cancer with oligo metastasis,adjuvant and neoadjuvant therapy,standardized processing of surgical specimens and evaluation of surgical margin status,systemic treatment for unresectable pancreatic cancer,genetic testing,as well as postoperative follow up of patients with pancreatic cancer.Forty recommendation items were finally proposed based on the above issues,and the quality of evidence and strength of recommendations were graded using the Grades of Recommendation,Assessment,Development,and Evaluation system.This guideline aims to standardize the clinical diagnosis and therapy,especially surgical treatment of pancreatic cancer in China,and further improve the prognosis of patients with pancreatic cancer.

关键词： Diagnosis Guideline Multidisciplinary team Pancreatic cancer Treatment

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The current surgical treatment of pancreatic neuroendocrine neoplasms in China: a national wide cross-sectional study

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Journal of Pancreatology 2019年第2期2卷 35-42页

作者： Wenming Wu Gang Jin Haimin li Yi Miao Chunyou Wang Tingbo liang Jinrui Ou Yongfu Zhao Chunhui Yuan yixiong li Wenhui Lou Zheng Wu Renyi Qin Huaizhi Wang Jihui Hao Xianjun Yu Heguang Huang Guang Tan Xubao liu Kesen Xu Lei Wang Yinmo Yang Chunyi Hao Weilin Wang Kejian Guo Junmin Wei Yifan Wang Chenghong Peng Xuefeng Wang Shouwang Cai Jianxin Jiang Xinmin Wu Xiao Yu Fei li Yupei Zhao 无 Department of General Surgery Peking Union Medical College HospitalPeking Union Medical CollegeChinese Academy of Medical SciencesBeijing 100730China Department of Pancreatic Surgery Shanghai Chang Hai Hospital Affiliated to The Second Military Medical UniversityShanghaiChina Department of Hepato-Biliary-Pancreatic Surgery Xijing Hospital Affiliated to the Fourth Military Medical UniversityXi’anChina Department of General Surgery Jiangsu Province HospitalThe First Affiliated Hospital to Nanjing Medical UniversityNanjingChina Department of General Surgery Union Hospital Affiliated to Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina Department of Hepato-Biliary-Pancreatic Surgery The Second Affiliated HospitalZhejiang UniversityHangzhouChina Department of General Surgery Guangdong General HospitalGuangzhouChina Department of Hepato-Biliary-Pancreatic Surgery The First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina Department of General Surgery Peking University Third HospitalBeijingChina Department of Pancreatic Surgery Xiangya Hospital Affiliated to Central South UniversityChangshaChina Department of Pancreatic Surgery Shanghai Zhongshan Hospital Affiliated to Fu Dan UniversityShanghaiChina Department of General Surgery The First Affiliated Hospital of Xi’an Jiao Tong UniversityXi’anChina Department of Pancreatic Surgery Tongji Hospital Affiliated to Tongji Medical CollegeHuazhong University of Science&TechnologyWuhanChina Institute of Hepatopancreatobiliary Surgery Chongqing General HospitalUniversity of Chinese Academy of SciencesChongqingChina Department of Pancreatic Surgery Tianjin Medical University Cancer Institute&HospitalTianjinChina Department of Pancreatic Surgery Shanghai Cancer Hospital Affiliated to Fu Dan UniversityShanghaiChina Department of General Surgery Fujian Medical University Union HospitalFuzhouChina Department of General Surgery The First Affiliated Hospital of Dalian Medical UniversityDalianChina Department

Objective:The aim of this study is to investigate the current status of the diagnosis and treatment of patients with pancreatic neuroendocrine neoplasms(pNENs)undergoing surgery in China.Methods:This is a multicenter cross-sectional study performed in China.Data from patients with pNENs undergoing surgery at 33 high-volume medical centers,where the number of pancreatectomies exceeds 20 cases per year,were collected and analyzed between March 1,2016 and February 28,2017.Results:In total,392 patients with pNENs were enrolled.The male to female ratio was 1.4.The majority of patients were aged between 40 and 70 years.65.6%of the patients had non-functional tumors.Among those with functional tumors,the percentages of insulinomas,gastrinomas,glucagonomas,and vasoactive intestinal peptide-secreting tumors were 94.8%,1.5%,2.2%,and 1.5%,respectively.Multidisciplinary team(MDT)discussion was conducted for 39.0%of the patients.Minimally invasive surgery was performed on 31.1%of the 392 patients.The incidence of grade B/C pancreatic fistula formation was 4.4%.A total of 89.0%of the surgeries achieved R0 resection,and 41.6%of the tumors were well differentiated.Lymph node metastasis was present in 8.9%of the patients.The percentages of patients with grades G1,G2,and G3 disease were 49.2%,45.7%,and 5.1%,respectively.Conclusion:This multicenter cross-sectional study systematically presents the current status of the diagnosis and treatment of patients with pNENs undergoing surgery in China.MDT consultation for pNENs has not been widely implemented in China.Although the incidence of surgical complications is relatively low,minimally invasive procedures should be further promoted.This study shows us how to improve the outcomes of these patients.

关键词： China Current status Pancreatic neuroendocrine neoplasms Pancreatic surgery

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The current surgical treatment of pancreatic cancer in China: a national wide cross-sectional study

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Journal of Pancreatology 2019年第1期2卷 16-21页

作者： Wenming Wu Gang Jin Chunyou Wang Yi Miao Huaizhi Wang Wenhui Lou Xianjun Yu Bei Sun Haimin li Renyi Qin Zheng Wu Weilin Wang Kesen Xu Lei Wang Tingbo liang Chunyi Hao Heguang Huang yixiong li Guang Tan Yongfu Zhao Jihui Hao Yifan Wang Chenghong Peng Xubao liu Jinrui Ou Chunhui Yuan Xuefeng Wang Yinmo Yang Shouwang Ca Kejian Guo Jianxin Jiang Xiao Yu Junmin Wei Fei li Xinmin Wu Yupei Zhao Pancreatic Surgery Study Group of Chinese Society of Surgery of Chinese Medical Association Medical College&Chinese Academy of Medical Sciences Beijing Department of PancreaticSurgery Shanghai Chang Hai Hospital affiliated to The Second Military MedicalUniversityShanghai Department of General Surgery Union Hospital Affiliated to TongjiMedical CollegeHuazhong University of Science&TechnologyWuhan Department ofGeneral Surgery Jiangsu Province HospitalThe First Affiliated Hospital to NanjingMedical UniversityNanjing Department of Hepato-Biliary-Pancreatic Surgery SouthwestHospitalThe First Hospital Affiliated to The Third Military Medical UniversityChongqing Department of Pancreatic Surgery Shanghai Zhongshan Hospital Affiliated to FuDan University Department of Pancreatic Surgery Shanghai Cancer Hospital Affiliated toFu Dan UniversityShanghai Department of General Surgery The First Affiliated Hospitalto Harbin Medical UniversityHarbin Department of Hepato-Biliary-Pancreatic Surgery Xijing Hospital Affiliated to the Fourth Military Medical UniversityXi’an Departmentof Pancreatic Surgery Tongji Hospital Affiliated to Tongji Medical CollegeHuazhongUniversity of Science&TechnologyWuhan Department of General Surgery The FirstAffiliated Hospital of Xi’an Jiao Tong UniversityXi’an Department of Hepato-Biliary-Pancreatic Surgery The First Affiliated HospitalZhejiang UniversityHangzhou Department of Pancreatic Surgery Qi Lu Hospital of Shandong UniversityJinan Department of Hepato-Biliary-Pancreatic Surgery The Second Affiliated HospitalZhejiangUniversityHangzhou Department of Hepato-Biliary-Pancreatic Surgery Beijing CancerHospital Affiliated to Peking UniversityBeijing Department of General Surgery FujianMedical University Union HospitalFuzhou Department of Pancreatic Surgery XiangyaHospital Affiliated to Central South UniversityChangsha Department of General Surgery The First Affiliated Hospital of Dalian Medical UniversityDalian Department ofHepato-Biliary-Pancreatic Surgery The First Affiliated Hospital of Zhengzhou UniversityZhengzhou Department of Pancreatic Surgery Tianjin Medical Un

Objective: The aim of this study is to investigate the current status of pancreatic cancer patients undoing surgical treatment in China and to find ways to improve the survival of these patients in the future. Methods: This study is a national, multicenter, cross-sectional study in China. Information regarding pancreatic cancer patients undergoing surgical treatment from 34 high-volume tertiary IIIA level hospitals was collected and analyzed from the March 1, 2016 to the February 28, 2017. Results: In total, 2200 pancreatic cancer patients were enrolled from 34 tertiary IIIA level hospitals in 16 provinces across China. The male-to-female ratio was 1.5. More than 80% of the patients were between 50 and 70 years old. The top 4 symptoms were epigastric discomfort, abdominal pain, jaundice, and weight loss. Carbohydrate antigen 19-9 and carcinoembryonic antigen were elevated in 70.9% and 27.1% of patients, respectively. A multidisciplinary team (MDT) discussion was carried out for 35.0% of patients before surgery. The proportion of minimally invasive pancreatic surgeries was approximately 20%. A total of 83.4% of the operations achieved R0 resection, and the incidence of grade 3/4 postoperative complications was 7.7%. Only 13.4% of the patients received postoperative adjuvant chemotherapy. The percentage of pathological stage I tumors was only 24.5%. Conclusion: The majority of pancreatic cancer patients undergoing surgical resection in China are in an advanced stage. The MDT consultations for pancreatic cancer have not been widely carried out. R0 resection has been achieved in most cases, with relatively low incidence of serious complications, but minimally invasive pancreatic surgery should be further promoted. The application of postoperative chemotherapy remains low. This national, multicentre, cross-sectional study comprehensively presents the current status of pancreatic cancer patients undergoing surgical treatment and shows the road to improve survival of these patients in the future.

关键词： China Current status Pancreatic cancer Pancreatic surgery Treatment

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局部进展期胰腺癌新辅助治疗的现状与进展

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中国普通外科杂志 2023年第3期32卷 317-326页

作者：柯牧京纪连栋李宜雄中南大学湘雅医院超声影像科湖南长沙410008 中南大学湘雅医院普通外科湖南长沙410008

胰腺癌恶性程度高,其总体5年生存率仅约11%。虽然根治性手术切除可能治愈胰腺癌,但仅约15%胰腺癌在首次确诊时为可切除性疾病。新辅助治疗使得有些原本不可切除的局部进展期胰腺癌(LAPC)获得了R0切除的机会。LAPC新辅助治疗是基于目前... 详细信息

胰腺癌恶性程度高,其总体5年生存率仅约11%。虽然根治性手术切除可能治愈胰腺癌,但仅约15%胰腺癌在首次确诊时为可切除性疾病。新辅助治疗使得有些原本不可切除的局部进展期胰腺癌(LAPC)获得了R0切除的机会。LAPC新辅助治疗是基于目前治疗现状的一种新的治疗模式,逐渐为临床外科医生接受。新辅助治疗方案的出现,使得20%~61%的LAPC经新辅助治疗后转化为可切除病例。奥沙利铂、伊立替康、氟尿嘧啶和亚叶酸钙(FOLFIRINOX)及吉西他滨联合白蛋白紫杉醇(AG)明显提高了LAPC的手术切除率,是LAPC首选一线新辅助治疗方案。各医疗中心关于LAPC新辅助治疗的方案选择、周期、评估指标、手术时机等方面仍存在较大差异。部分术前全身化疗不足以使肿瘤降期达到手术指征的LAPC患者,可将联合化放疗作为初始治疗。对于不能耐受系统性化疗的LAPC患者,可采用立体定向放射治疗(SBRT)控制局部肿瘤进展。胰腺癌的治疗靶点包括KRAS、EGFR、PARP及NTRK等。NCCN指南建议对所有LAPC患者进行基因检测,指导最佳药物治疗方案及参与新药的临床研究。胰腺癌免疫治疗主要包括免疫检查点抑制剂、过继性T细胞治疗及肿瘤疫苗。帕博利珠单抗是唯一获得美国食品药品管理局批准用于微卫星高度不稳定或错配修复缺陷的实体瘤(包括胰腺癌)的二线治疗方案。目前过继性T细胞治疗仅限于转移性胰腺癌。肿瘤疫苗GVAX现处于临床试验阶段。免疫治疗与某些靶向药物(如抗血管生成因子及酪氨酸激酶抑制剂)之间存在协同作用。未来的免疫治疗应旨在联合多种新型免疫治疗策略,以及联合细胞毒性药物和/或局部消融治疗,针对肿瘤诱导的免疫逃逸机制产生作用。关于联合治疗,药物选择、给药顺序及剂量将是主要挑战。选择特定的LAPC患者行新辅助治疗后实施手术是值得积极推荐的方法。通过影像学评估新辅助治疗后肿瘤的可切除性是困难的,CT无法准确区分肿瘤组织与纤维组织。18F-FDG PET判断胰腺癌R0可切除性较CT更加准确,但未来仍然需要高质量的证据进一步证实。其他对于新辅助治疗效果的评估包括肿瘤标志物血清学水平下降以及临床症状的改善。液体活检技术(包括循环肿瘤细胞、循环肿瘤DNA及外泌体检测等)在确定微转移灶及新辅助治疗疗效评估方面显现出潜在的应用前景。新辅助治疗后接受手术切除的LAPC患者长期生存率有所提高。创新技术动脉外膜鞘剥离及自体小肠移植有助于新辅助治疗后的手术切除。笔者就LAPC新辅助治疗的现状和进展等方面进行回顾和讨论。

关键词：胰腺肿瘤肿瘤辅助疗法综述

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一种添加部分自适应噪声的集成经验模态分解方法

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南京理工大学学报 2024年第2期48卷 227-234页

作者：李昊陈强徐一雄上海工程技术大学电子电气工程学院上海201600 上海航天控制技术研究所上海201109

为了解决集成经验模态分解(EEMD)及其改进形式中普遍存在的噪声量和计算量需求大的问题,统计分析了白噪声内涵模态函数(IMF)的极值点和能量变化规律,总结出白噪声IMF极值点数随长度和阶数变化的经验公式。发现白噪声的高阶IMF不能有效... 详细信息

为了解决集成经验模态分解(EEMD)及其改进形式中普遍存在的噪声量和计算量需求大的问题,统计分析了白噪声内涵模态函数(IMF)的极值点和能量变化规律,总结出白噪声IMF极值点数随长度和阶数变化的经验公式。发现白噪声的高阶IMF不能有效调整信号的极值点分布,提出添加部分自适应噪声的集成经验模态分解(EEMDPAN)。相比于自适应噪声完全集成经验模态分解(CEEMDAN),EEMDPAN有2点改进:不使用全部独立的自适应噪声,而使用成对相加为0的互补自适应噪声;不添加全部阶的自适应噪声,而是在中间的某一阶停止,而后使用经典EMD方法。对2个人工信号进行分解,实验证明,EEMDPAN很好地继承了EEMD抑制模态混叠的能力,相比于CEEMDAN,计算量降低至1/3,并且分解结果的低阶成分信号附加噪声更小,高阶成分信号可信度更高。

关键词：自适应噪声集成经验模态分解白噪声内涵模态函数互补噪声附加噪声信号可信度

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