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Objective:To investigate the application value of machine learning algorithms for gauze detection in laparoscopic pancreatic surgery.Methods:The retrospective and descriptive study was conducted. The 80 intact laparoscopic pancreatic surgery videos from Peking Union Medical College Hospital of Chinese Academy of Medical Sciences with timing of July 2017 to July 2020 were collected. The training set was used to train the neural network, and the test set was used to test the ability of neural network for gauze detection under different difficulties. Under the supervision of two superior doctors, videos that containing gauze were selected and classified according to recognition difficulty into three difficulty level including easy, normal and hard difficulty, and further divided based on random number method into training set with 61 videos and test set with 19 videos in a ratio of 3:1 roughly. The minimum enclosing rectangle of the gauze were marked frame by frame. All images were input to the neural network model for training after normalization and preprocessing. For every image, the output of neural network is the predicted minimum enclosing rectangle of gauze. The intersection over union >0.5 was identified as positive result. Observation indicators: (1) video annotation and classification; (2) test outcomes of neural network for test set.Count data were represented as absolute numbers or percentages.Results:(1) Video annotation and classification: a total of 26 893 frames of images form 80 videos were annotated, with 61 videos including 22 564 frames of images as the training set and 19 videos including 4 329 frames of images as the test set. Of the training set, 19 videos including 5 791 frames of images were classifed as easy difficulty, 38 videos including 15 771 frames of images were classifed as normal difficulty, 4 videos including 1 002 frames of images were classifed as hard difficulty, respectively. Of the test set, 4 videos including 1 684 frames of images were classifed as easy difficulty, 6 videos including 1 016 frames of images were classifed as normal difficulty, 9 videos including 1 629 frames of images were classifed as hard difficulty, respectively. (2) Test outcomes of neural network for test set: the overall sensitivity and accuracy of gauze detection by neural network in the test set were 78.471%(3 397/4 329) and 69.811%(3 397/4 866), respectively. The sensitivity and accuracy of gauze detection by neural network were 94.478%(1 591/1 684) and 83.168%(1 591/1 913) in easy difficulty test set. The sensitivity and accuracy of gauze detection by neural network were 80.413%(817/1 016) and 70.859%(817/1 153) in normal difficulty test set, 60.712%(989/1 629) and 54.944%(989/1 800)in hard difficulty test set. The frame rate reached more than or equally to 15 fps. The overall false negative rate and false positive rate of gauze detection by neural network in the test set were 21.529%(932/4 329) and 30.189%(1 469/4 866), respectively. The false negative was mainly due to the existence of blurred images, too small gauze exposure or blood immersion of gauze. The false positive was caused by the reflection of connective tissue or body fluids.Conclusion:The machine learning algorithms for gauze detection in laparoscopic pancreatic surgery is feasible, which could help medical staff identify gauze.
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Pancreatic tuberculosis is very rare, though dissemination to the gastrointestinal tract and mesenteric lymph nodes is common. We describe a case of pancreatic tuberculosis presenting as a cystic mass in the pancreatic head, with biliary obstruction, in a patient with miliary pulmonary tuberculosis. Surgery for the curative treatment of jaundice was performed, and the histopathologic findings indicated that a pancreatic abscess with caseous necrosis was present, consistent with tuberculosis.
Subject(s)
Humans , Abscess , Gastrointestinal Tract , Head , Jaundice , Jaundice, Obstructive , Lymph Nodes , Necrosis , Pancreas , Tuberculosis , Tuberculosis, PulmonaryABSTRACT
Objective To explore the effect of non-operative management in the treatment of external pancreatic fistula(EPF). Methods 18 cases of EPF underwent non-operative treatment were analyzed retrospectively . The causes of EPF, the criteria of case selection were summarized respectively. the non- operative treatments methods and the change of drainage volume after the treatment were analyzed.Results After the non-operative treatment,the drainage volume reduced gradually,and all the 18 cases were curred in 1 to 8 (averaged 5.5) months.No recurrence happened after the drainage withdrawn.There were no other severe complications except 4 pancreatic pseudocysts formation. Conclusions Non-operative treatment plays an important role in the treatment of EPF.It could reduce patients' sufferings.The choice of the method should be according to patients' condition.
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Inflammatory pseudotumors are tumor-like benign lesions of uncertain pathogenesis and have most commonly been reported in the lungs. In the pancreas they are rare. We describe a case of inflammatory pseudotumor of the pancreas which was seen to be isoattenuating at non-contrast CT, and as a well-defined nodule with homogeneous enhancement in the pancreatic tail at contrast-enhanced CT. After a preoperative diagnosis of islet cell tumor, partial pancreatectomy of the pancreatic tail, with splenectomy, was performed. The gross specimen was a yellowish-white, solid mass and the lesion was histopathologically confirmed as inflammatory pseudotumor with an extensive area of sparse cellular fibrosis and collagen deposition.
Subject(s)
Adenoma, Islet Cell , Collagen , Diagnosis , Fibrosis , Granuloma, Plasma Cell , Lung , Pancreas , Pancreatectomy , Splenectomy , Tomography, X-Ray ComputedABSTRACT
Objective To explore the clinical characteristics,diagnosis and treatment of pancreatic reginal(portal) hypertension(PSPH).Methods The clinical data of 11 cases of PSPH were analysed and(summarized).Results All of the patients in this group underwent surgical operation.Postoperative(complications) occurred in 4 patients,all of whom recovered with conservative treatment.There was no(operative) mortality.Seven cases were followed up after operation;one patient died from cancer of the pancreas three years after operation;in other six cases,no massive digestive tract re-bleeding occurred,and symptoms of hypersplenism disappeared completely.Conclusions PSPH is a special type of portal hypertension,surgical treatment can get excellent results.
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Objective To evaluate the CT findings of pancreatic carcinoid tumors.Methods The CT imaging data of five patients with pancreatic carcinoid tumors confirmed by pathology were retrospectively analyzed.Results The tumors ranged in maximum diameter from 2.0 to 11.0 cm with a mean of 6.4 cm. On unenhanced CT,the tumors were slightly hypodense relative to the pancreatic parenchyma,homogenous in 2 cases,and heterogenous in 3 cases.One tumor showed calcification.After contrast material injection, the solid component of the tumor showed marked heterogenous enhancement on the arterial phase scanning in 3 cases,and mild heterogenous enhancement in 2 cases.The degree of tumor enhancement was less intense than the surrounding pancreatic parenchyma due to necrosis of various degree,which led to the cystic appearance of the tumor in 1 ease.On the portal phase scanning,all tumors showed marked enhancement similar to that of the pancreatic parenchyma.On the delayed phase scanning,the degree of enhancement was more intense than the surrounding pancreatic parenchyma in 1 case.Liver metastases with retroperitoneal lymphadenopathy and peripancreatic vessels invasion were seen in 1 case.No dilatation of the biliary tract or pancreatic duct was present.Conclusion The CT features of pancreatic carcinoid tumors included infrequent dilatation of the biliary tract or pancreatic duct and unusual vascular involvement,calcification within the mass,marked enhancement similar to that of the surrounding pancreatic parenchyma during the portal phase scanning and more intense during the delayed phase scanning.
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PURPOSE: To compare the images of arterial phase (AP) and portal venous phase (PVP) in the evaluation of conspicuousness of lesion and peripancreatic arterial and venous opacification in pancreatic diseases. MATERIALS AND METHODS: Dual-phase spiral CT was performed in 37 patients with pancreatic adenocarcinoma and 21 patients with pancreatitis. CT scans were performed with 5mm collimation at 1 : 1 pitch table feed. Images of AP and PVP were obtained at 30 and 65 seconds after administration of contrast material, was initiated. Using a gradingsystem, images were analalysed for conspicuousness of lesion and vascular opacification(grade 1=good, grade2=fair, grade 3=poor). RESULTS: In pancreatic adenocarcinoma, 35 and 36 of 37 cases showed low attenuation on APand PVP, respectively. With regard to conspicuousness of tumour, PVP(mean grade : 1.24) was superior AP(mean grade: 1.43), but not significantly(p=0.0745). In arterial opacification, AP(mean grade : 1.03) was significantly superior to PVP(mean grade : 1.30, ; p=0.0051). In venous opacification, PVP(mean grade : 1.19) was significautlyto AP(mean grade : 2.41 ; p<0.0001). In pancreatitis, 14 and 15 of 21 cases showed localized hypo-attenuating lesion indicating necrosis or fluid collection, on AP and PVP, respectively. With regard to conspicuousness oflesion, PVP(mean grade : 1.61) was superior to AP(mean grade : 1.81), but not significantly(p=0.1088). In arterial opacification, AP(mean grade : 1.05) was significantly superior to PVP(mean grade: 1.38 ; p=0.0180). In venous opacification, PVP(mean grade : 1.10) was significantly superior to AP(mean grade : 2.33 ; p=0.0005). CONCLUSION: For the diagnosis and staging of pancreatic disease, dual-phase spiral CT in arterial and portal venous phase maybe recommendable. The portal venous phase of spiral CT seems, however, to be superior to the arterial phase because the lesion is more conspicuous and there is venous opacification.