Pancreatic cancer is a highly malignant digestive system tumor, accounting for 1%-2% of malignant tumors, and it is a digestive system tumor that has been gradually increasing in recent years, with high malignancy, rapid development, difficult early diagnosis, low surgical resection rate, and poor prognosis. Among them, the malignant tumor occurring in the head of pancreas is called pancreatic head cancer, which accounts for about 2/3-3/4 of pancreatic cancers.The regional distribution of pancreatic cancer incidence and mortality rate in China has significant differences, among which the mortality rate of pancreatic cancer in Shanghai city is the highest, followed by Northeast China and North China, which is significantly higher than that in other regions. The mortality rate of pancreatic cancer in urban areas is more than two times higher than that in rural areas. In recent years, the incidence rate of pancreatic cancer has been increasing year by year. According to the results of epidemiological statistics in urban Shanghai, the incidence rate of pancreatic cancer in 1963 was 1,16/100,000, ranking the 20th in the incidence rate of malignant tumors; in 1977, it was 3,80/100,000, ranking the 12th in the incidence rate of malignant tumors; and in 1982, it was 6,92/100,000, which was six times of that of 1963, ranking the 8th in the incidence rate of malignant tumors for males and the 12th for females; In 2008, the incidence rate of pancreatic cancer in the urban area of Shanghai had risen to 7,26/100,000 for men and 4,95/100,000 for women, ranking the 8th and 9th in the incidence rate of malignant tumors for both men and women, respectively. In recent years, the mortality rate of pancreatic cancer has risen to the 5th place of malignant tumors, becoming one of the 10 malignant tumors with the highest mortality rate in China. The number of young pancreatic cancer patients has also increased significantly compared with 10 years ago. Clinical manifestations: The most common clinical manifestations of pancreatic head cancer are abdominal pain, jaundice and emaciation. Epigastric pain and discomfort: it is the common first symptom. In the early stage, due to the obstruction of pancreatic duct, the pressure in the duct lumen increases, and epigastric discomfort, or vague pain, dull pain or distension occurs. A small number of patients (about 15%) may have no pain. The diagnosis is usually delayed due to neglect of early symptoms. In middle and late stage, when the tumor invades the nerve plexus, there will be persistent severe abdominal pain radiating to the lower back, which makes patients unable to lie down and often sit in curled position overnight, thus affecting their sleep and diet; 2. Jaundice: it is the most important clinical manifestation of pancreatic head cancer, and it is aggravated progressively. The closer the cancer is to the common bile duct, the earlier jaundice appears. The more complete the bile duct obstruction is, the deeper the jaundice is. Most of the patients are in middle or late stage when jaundice appears. Accompanied by itching of skin, there may be bleeding tendency in a long time. The urine is deep yellow, and the stool is clay-colored. Physical examination shows yellow staining of sclera and skin, large liver, and most patients can touch the enlarged gallbladder; 3. Gastrointestinal symptoms: such as loss of appetite, abdominal distension, dyspepsia, diarrhea or constipation. Some patients may have nausea and vomiting. Some patients may have nausea and vomiting. In advanced stage, when the cancer invades the duodenum, there may be upper gastrointestinal obstruction or gastrointestinal bleeding; 4. Wasting and fatigue: patients may have wasting, fatigue and weight loss in the early stage of the disease, which are related to diet reduction, indigestion, lack of sleep and cancer consumption; 5. Other: some patients may show mild diabetes mellitus in the early stage of the disease, with elevated glucose and positive glucose in the urine. Pancreatic head cancer causes biliary tract obstruction without biliary tract infection, but a few patients can be combined with biliary tract infection, and chills and high fever can be easily confused with cholelithiasis. In the advanced stage, patients may find an epigastric mass, which is hard and fixed, and may have ascites. Diagnosis: (1) Laboratory tests: (1) serum biochemistry: there may be a transient elevation of blood and urine amylase, fasting or postprandial glucose elevation, glucose tolerance test has an abnormal curve. In case of biliary obstruction, serum total bilirubin and direct bilirubin are elevated, alkaline phosphatase and aminotransferase can be mildly elevated, and urine bilirubin is positive; (2) Immunological examination: most of the serological markers for pancreatic cancer can be elevated, including CA19-9, CEA, pancreatic embryo antigen (POA), pancreatic cancer-specific antigen (PaA) and pancreatic cancer-associated antigen (PCAA). However, no specific marker for pancreatic cancer has been found yet, and CA19-9 is most commonly used as an aid in the diagnosis of pancreatic cancer and in postoperative follow-up. 2. Imaging examination: Imaging diagnostic technique is an important means for the localization and qualitative diagnosis of pancreatic head cancer. (1) Ultrasound: it can show dilatation of intrahepatic and extrahepatic bile ducts, gallbladder distension, dilatation of pancreatic ducts (normal diameter of 3 mm), pancreatic head occupying lesions, and at the same time, it can observe whether there are liver metastasis and lymph node metastasis; (2) Endoscopic ultrasound: it is better than ordinary ultrasound; (3) Barium gastrointestinal contrast: it can show enlargement of the duodenal curvature and the anti-3 sign in the case of pancreatic head cancer with a large mass. (4) CT: dynamic thin-layer enhancement scanning of pancreatic area can get better effect than ultrasound, and it is not affected by intestinal gas, which is also of great significance in determining the resectability of the tumor; (5) ERCP: it can show the image of bile ducts and pancreatic ducts near the jugular side of the abdomen, or the image of bile ducts and pancreatic ducts dilatation in the distance of the tumor. This examination may cause acute pancreatitis or biliary tract infection, and should be alerted. It can also be performed in the bile ducts at the same time of ERCP with internal support tubes to reduce gangrene before operation; (6) Percutaneous Transhepatic Tunnelling Cholangiography (PTC): it can show the dilatation of intra-hepatic and extra-hepatic bile ducts above the obstruction, which is of great value in determining the site of the obstruction and the degree of bile duct dilatation. At the same time of PTC, the built-in bile duct drainage (PTCD) can reduce xanthomas and prevent bile leakage; (7) MRI or magnetic resonance cholangiopancreatography (MRCP): simple MRI diagnosis is not better than enhanced CT, MRCP can show the site of pancreatic and bile duct obstruction, the degree of dilatation, and it has important diagnostic value, it is noninvasive, multiangle imaging, accurate localization, and no complications; (8) selective arteriography: can display the dilatation of intrahepatic and extrahepatic bile ducts above the obstruction, it is valuable in determining the site of obstruction and the degree of bile duct dilatation. (8) Selective arteriography: it has little diagnostic value for pancreatic head cancer, but it is of some significance in showing the relationship between the tumor and the adjacent blood vessels in order to estimate the feasibility of radical surgery; (9) percutaneous fine-needle aspiration cytology: the positive rate of cytology can be up to 80% under the guidance of ultrasound or CT. It can also be used for genetic testing, such as detecting whether there is a mutation in the twelfth codon of the C-Ki-ras gene, and its positive rate is about 90%. Treatment: Surgical resection is an effective treatment for pancreatic head cancer. Pancreatic head cancer without distant metastasis should strive for surgical resection in order to prolong the survival time and improve the quality of life. Commonly used surgical methods: 1. Pancreatic head and duodenectomy: the scope of resection includes pancreatic head (including hooked process), distal stomach, duodenum, upper jejunum, gallbladder and common bile duct, and related lymph nodes need to be removed at the same time. After resection, the pancreas, bile and stomach are reconstructed with the jejunum. There are various types of reconstruction; 2. Pancreaticoduodenectomy with pylorus preservation (PPPD): this procedure has been more frequently used abroad in recent years, applicable to those who have no metastasis of lymph nodes above and below the pylorus, and those whose duodenal margins are free of residual cancer cells; 3. Palliative surgery: it is applicable to those patients who are of advanced age, with liver metastasis, with tumors that can not be resected, or those who can not tolerate larger surgeries because of obvious combined cardiorespiratory dysfunctions. Including: lifting biliary obstruction by biliary-intestinal anastomosis; lifting or preventing duodenal obstruction by gastrojejunal anastomosis; in order to alleviate the pain, chemical visceral neurectomy with injection of anhydrous ethanol around the visceral nerve ganglion or abdominal nerve ganglionectomy can be carried out during the operation. Postoperative adjuvant treatment: systemic chemotherapy is used for adjuvant treatment and locally advanced unresectable as well as distant metastatic pancreatic cancer cases; the purpose of chemotherapy should be communicated with the patients before the treatment, and the patients who are undergoing chemotherapy need to be closely followed up. It is also advocated that radiotherapy should be the basic comprehensive treatment. Pancreatic head cancer is difficult to operate due to its special site of development, wide range of metastasis and involvement of many important organs and blood vessels. Therefore, there are strict requirements for surgical techniques, patient tolerance, postoperative care, etc. Although the surgical mortality rate continues to decrease, the overall postoperative complications are still high. Especially in elderly patients, the complication rate and death rate are the highest in abdominal surgery.