Patient: Pancreatic stone was found in March this year during medical checkup, symptoms: weight loss, diabetes (now on insulin treatment), no abdominal pain, no steatorrhea, no jaundice and other symptoms. I had ERCP surgery at a local hospital, but the stone was too big to be removed, so I had a stent put in, and the CT results were the same as those in March when I was re-examined in June. Do I have to undergo open surgery in this case? Is surgery risky? What is the chance of cancer without surgery? 2.If surgery is done, can the stone be removed in one operation and if not, do I need to have several operations to remove the stone? 3.If surgery is done, what are the chances of having abdominal pain from time to time after surgery (I am afraid that abdominal pain will affect my work from time to time)? 4.If surgery is done, can it be cured after surgery? Will the chance of becoming cancerous decrease after surgery? What is the probability of becoming cancerous? 5.If surgery is done, what is the chance of diabetes getting better after surgery? General surgery Xie Min: Let me see the relevant CT film before answering, okay? Patient: Hello, Dr. Xie! Do you mean the CT description? The CT image description is as follows: pancreatic duct widening, multiple dense shadows in the pancreatic duct, the largest one is about 2.5×1.0 cm in size, the peripancreatic fat gap is basically clear and slightly underdeveloped, the pancreatic parenchyma is slightly uniformly strengthened after enhancement, a dense shadow of about 0.6×0.3 cm is seen at the lower end of the common bile duct, a nodule of about 2.2×1.8 cm is seen in the hilar region, and a nodule of about 2.2×1.8 cm is seen in the hilar region. A nodule of about 2.2×1.8 cm was seen in the hilar region. The morphology of the liver was normal in size. The lobe of the liver was moderately proportioned with well-defined margins. There was no abnormal dense shadow in the liver parenchyma, no abnormal foci of enhancement in the liver on the post-enhanced duplex scan, normal visualization of the portal trunk and its branches, and no dilatation of the bile ducts inside and outside the liver. No abnormalities were seen in the bile and spleen, and no enlarged lymph nodes were seen in the retroperitoneum. Opinion: chronic pancreatitis, multiple stones in the main pancreatic duct with obstructive dilation of the pancreatic duct, possible small stones in the lower part of the common bile duct, and enlarged lymph nodes in the hilar. If I need specific films, how do I pass them to you? Min Xie, General Surgery: Sorry, the report from the imaging department is only the opinion of the imaging doctor. If you want to ask my opinion, please upload the relevant images for me to judge. It is a film, not a report. Patient: Please ask: 1. Do I have to undergo open surgery in this case? Is surgery risky? What is the chance of cancer without surgery? 2.If surgery is done, can the stone be removed in one operation and if not, do I need to have several operations to remove the stone? 3.If surgery is done, what are the chances of having abdominal pain from time to time after surgery (I am afraid that abdominal pain will affect my work from time to time)? 4.If surgery is done, can it be cured after surgery? Will the chance of becoming cancerous decrease after surgery? What is the probability of becoming cancerous? 5.If surgery is done, what are the chances of diabetes getting better after surgery? General Surgery Xie Min: Diagnosis: pancreatic stone with pancreatic insufficiency, if serum CA199 and pancreatic fluid CA199 are negative, malignancy can be excluded. Personal opinion: 1. ERCP can not take out this kind of stone, the internal stent tube is easy to cause infection in the pancreatic duct; 2. Surgical option one is pancreatic duct incision to remove the stone + pancreatic duct – jejunum lateral anastomosis, the surgery is less invasive, can achieve the purpose of pancreatic duct decompression and biopsy, but the stone of the head and tail of the pancreas may not be taken out, forced removal will cause intraoperative haemorrhage, postoperative malignant tissue occurring more; 3. The second surgical option is pancreaticoduodenectomy or total pancreatectomy, which is very traumatic and can remove the head of the pancreas or the whole pancreas and the stones in it, with a high rate of abdominal pain relief and relatively little or no postoperative malignant tissue. Regardless of the type of surgery, postoperative endocrine replacement therapy of the pancreas is required.