Although the name of Jobs’ pancreatic cancer resection surgery was not released, it is speculated that it should also be a pancreaticoduodenectomy, also known as the Whipple procedure. This procedure has been clinically used for nearly 100 years and is now a very mature surgical procedure and a classic procedure for treating pancreatic tumors such as pancreatic cancer. The pancreas secretes pancreatic juice, and the meat we usually eat mainly depends on pancreatic juice to help digestion, so pancreatic juice has strong tissue corrosiveness. Under physiological conditions, pancreatic juice is secreted into the intestine, and due to the barrier mechanism of intestinal mucosa, pancreatic juice is isolated in the intestinal lumen, so it will not digest its own organ tissues. However, pancreatic surgery inevitably leads to trauma to the pancreas, and pancreatic fluid can enter the abdominal cavity directly through these traumas, which is clinically known as pancreatic leakage, i.e. leakage of pancreatic fluid into the abdominal cavity. The pancreatic fluid leaking into the abdominal cavity can erode the digestive self tissue, which is a very terrible thing because it can erode the digestive self blood vessels leading to hemorrhage, and can erode the digestive self organs leading to intestinal fistula, abdominal abscess and other serious problems, and these problems are very difficult to deal with clinically, and are often the direct cause of death of the patient within a short period of time after surgery, so for many years the pancreas has been considered as a no-operation area. However, in 1935, Allen O Whipple reported 3 successful pancreaticoduodenectomies, and pancreatic resection gained widespread interest. The popularity of this procedure grew and was standardized, and it became known as the Whipple procedure in honor of the surgeon who performed 37 pancreatic resections in his lifetime. This operation is the gold standard procedure for pancreatic tumors, which requires removal of the head and neck of the pancreas, 1/2 of the stomach, 10-15 cm of the jejunum, all of the duodenum, the gallbladder and 1/2 of the common bile duct, as well as reconstruction of the continuity of the digestive system to ensure that bile, pancreatic juice, gastric juice and food can enter the digestive tract smoothly. It is recognized as the most difficult abdominal surgery. Pancreaticoduodenectomy is mainly used for tumors in the head of the pancreas. If the patient has distant metastases in the liver or outside the abdominal cavity, this procedure is not suitable because the tumor cannot be removed radically. If the tumor invades mesenteric vessels, it can be combined with vascular resection for those with smaller invasion, while those with larger invasion are also not suitable for surgical treatment. The surgical steps mainly include the following three aspects: comprehensive and step-by-step exploration: the main investigation is whether the pancreatic tumor invades the inferior vena cava, superior mesenteric artery and portal vein and other important vessels around the pancreas, which are important channels for blood supply and return flow to the digestive tract and limbs, and it is crucial to maintain the continuity of these channels. death. Intraoperative exploration of the resectability of the tumor is a key step in the surgical procedure. Without a clear understanding of whether the portal vein and superior mesenteric artery are invaded and whether the tumor can be removed, the peripancreatic organs should not be removed rashly, otherwise the patient will be in a dilemma. Pancreaticoduodenectomy Removal of gallbladder: When deciding to perform pancreaticoduodenectomy, the gallbladder can be removed first. Excision of common bile duct: The level of bile duct excision should be at the common hepatic duct, and in principle, the excision should be more than 2 cm away from the tumor in order to ensure negative tumor at the cut edge. Dissection of the stomach: The distal stomach should be dissected after dealing with the vessels in the greater and lesser curves of the stomach. Dissection of the pancreas: The neck of the pancreas is dissected by inserting a vascular clamp through the posterior part of the neck of the pancreas to protect the superior mesenteric vein behind it. Separation of adhesions between the head of the pancreas and the superior mesenteric vein and portal vein: the disconnected head of the pancreas is gently pushed away from the portal vein and the lateral wall of the superior mesenteric vein. Ligation cuts off the small venous traffic branches between the head of the pancreas and the lateral wall of this vessel. These small vessels can lead to very aggressive hemorrhage when not handled properly because they directly converge into the large vessels. Separation of the pancreatic hook: In principle, the pancreatic tissue at the hook should be completely removed to ensure a negative lateral margin tumor of the superior mesenteric artery. In addition if pancreatic tissue remains at the hook, its secreted pancreatic fluid can cause pancreatic leakage to occur. Dissection of the proximal small intestine. Thus the pancreatic tumor and its adjacent structures were completely resected. (iii) Reconstruction of the digestive tract. Pancreatic-intestinal anastomosis: the severed end of the pancreas is anastomosed with the small intestine to restore the passage of pancreatic fluid into the small intestine. Bile-intestinal anastomosis: the severed end of the bile duct is anastomosed with the small intestine to restore the passage of bile flow into the small intestine. Gastrointestinal anastomosis: the broken end of the stomach is anastomosed with the small intestine to restore the passage of food into the small intestine. (iv) Placement of abdominal drains: After the anastomosis reconstruction is completed, one irrigable drainage tube each is placed near the bile-intestinal anastomosis and pancreatic-intestinal anastomosis, respectively. The purpose of these drains is: to detect pancreatic leakage early and drain the leaking pancreatic fluid out of the body, in addition to flushing the abdominal cavity through the irrigation device on the drains to reduce the concentration of leaking pancreatic fluid, alleviate pancreatic fluid corrosion, and flush the corroded necrotic tissue out of the abdominal cavity in time to avoid bleeding and abdominal abscesses. Due to the wide resection area, many organs involved and many gastrointestinal anastomoses, pancreaticoduodenectomy is very prone to various postoperative complications, therefore, postoperative observation should be strengthened: patients undergoing pancreaticoduodenectomy, especially those who are elderly, obese or have combined cardiopulmonary diseases, need to be monitored for 24-48 hours. Due to extensive retroperitoneal dissection and large trauma, there is a large amount of plasma lymphatic fluid leakage during and after surgery, resulting in protein loss and a rapid decrease in plasma albumin concentration, which affects the patient’s smooth recovery and tissue healing, so albumin should be detected and supplemented in a timely manner after surgery. Pay attention to the postoperative observation of the abdominal drainage tube drainage fluid, if there is continuous thick bloody fluid or fresh blood outflow, accompanied by abdominal distension or rapid heart rate, should be alert to the possibility of intra-abdominal hemorrhage. Under normal circumstances, the drainage tube next to the bile-intestinal anastomosis can be removed after 1 week postoperatively, and the drainage tube next to the pancreatic-intestinal anastomosis should be removed after 2 weeks postoperatively. For patients with unexplained fever, it can be removed after 3 weeks because there is a possibility of pancreatic-enteric anastomotic fistula 3 weeks after surgery. It is advisable to start eating 8 days after surgery. About 1 week after surgery is the high incidence of anastomotic leakage, and premature eating tends to stimulate the secretion of digestive juices, especially pancreatic juices, which is not conducive to the healing of the pancreatic-enteric anastomosis.