2017年 · 第32卷第11期

delayed gastric emptying (DGE) is one of the most common complications after pancreaticoduodenectomy (PD), with an incidence of about 6% to 57%^[1]。 Although DGE is not a fatal complication, it seriously affects the quality of life of patients and increases the length of hospital stay and the risk of other complications. In recent years, there is still controversy about the incidence of DEG after pylorus-preserving pancreaticoduodenectomy (PPPD) and standard pancreaticoduodenectomy (SPD). In this paper, the clinical data of 203 patients with PD were retrospectively analyzed to explore the effects of these two surgical methods on DGE, which are reported below.

abdominal aortic aneurysm (AAA) is commonly defined as a permanent dilatation of the diameter of the abdominal aorta that exceeds at least 50% of the normal expected diameter, or a diameter of the infrarenal abdominal aorta ≥30 mm^[1]。 AAA with a diameter ≥55 mm are generally considered to have a higher risk of annual rupture rate and tumor diameter growth rate^[2]。 However, related studies have found that the diameter<The annual rupture rate of AAA at 55 mm was 1.0% or related to outflow tract stenosis (OTS)^[3]。 We established OTS-AAA model by elastase outer membrane incubation to explore the characteristics of the model, the high risk factors of AAA rupture and the influence of OTS on the pathological changes of AAA.

The patient, a 72-year-old female, visited the outpatient clinic of our hospital mainly for "abdominal distension and pain for 3 weeks". She was admitted to our hospital on February 4, 2017 after abdominal B-ultrasound: multiple solid liver occupying space. Physical examination on admission: clear consciousness, good spirit, normal head and facial features, not swollen superficial lymph nodes, and no abnormalities in cardiopulmonary auscultation; Soft abdomen, tenderness in the right upper abdomen, no rebound pain, 4 fingers under the costs of the liver margin, palpable 10.0 cm ×8.0 cm hard mass, fixed, no tenderness, unclear boundary, negative abdominal mobile voicing, and no edema in both lower limbs. There were no abnormalities in the anal diagnosis. Neurological examination showed no abnormalities. After admission, abdominal CT and enhanced CT were examined: tumor at the lower pole of the right lobe of the liver, about 13.5 cm ×8.5 cm ×11.0 cm in size, considered malignant (cholangiocarcinoma?); Multiple nodules in the right lobe and left lateral lobe of the liver are considered malignant. Alpha-fetoprotein (AFP) was normal. Ultrasound-guided percutaneous puncture biopsy of right liver mass was performed. Pathological examination revealed malignant melanoma (combined with clinical exclusion of metastasis); Immunohistochemistry: HMB45 positive, Melan-A positive, CK negative, Ki67 positive cells>60%. PET-CT was performed: (1) mixed density mass in the right lobe of the liver, abnormally increased metabolism, multiple nodules in the remaining liver, abnormally increased metabolism, the above considered malignant; (2) Multiple swollen lymph nodes in the intraperitoneal portal space, abnormally increased metabolism, consider metastasis. The medical history was followed up in detail to deny the surgical history of "black mole" in the eyes and skin, and no abnormalities were found on the body surface again. The diagnosis was: primary melanoma of the liver. Hepatic artery interventional embolization was performed on 18 Feb 2017 and interferon (1 800 U iH q.o.d) was given. After 2 months of follow-up, the patient's abdominal distension and pain improved. Reexamination of B-ultrasound showed that there were multiple liver tumors, with a maximum of 10.0 cm ×7.0 cm.

A 71-year-old male complained of repeated melena for more than half a year and fatigue for 3 weeks. Previous history of type 2 diabetes for 7 years and alcoholic cirrhosis for 6 years. Physical examination at admission: general condition is poor, anemic appearance, pale conjunctiva, and no yellowing staining of skin and sclera. The superficial lymph nodes of the whole body were not palpable and significantly enlarged. The upper abdomen is full, the abdominal wall veins are not varicose, and there are no gastrointestinal patterns and peristaltic waves. The abdominal wall is soft, without obvious mass, and the liver and spleen are not subcostal. Laboratory Tests: Blood AFP 117.03 ng/ml, CEA 3.3 ng/ml, CA19-9 12.6 ng/ml; Gastroscopy and mucosal tissue biopsy showed moderately differentiated adenocarcinoma at the protuberance of the pyloric duct area. Preoperative (August 16, 2015) abdominal plain CT scan showed: "Gastric malignant tumor, splenomegaly and gallbladder stones, no obvious lymph node metastasis in the abdominal cavity and retroperitoneum (FIG. 1A), underwent radical distal subtotal gastrectomy and Bi II anastomosis (D2+) under general anesthesia + continuous epidural anesthesia on August 20, 2015. During the operation, the tumor was located on the small curved side of the gastric antrum, 7.5 cm ×3.5 cm in size, Borrmann type 2, and no metastatic nodules were found in the liver and peritoneum. He recovered smoothly and was discharged from the hospital. Postoperative histopathological examination showed that gastric pyloric protuberance type moderate to poorly differentiated adenocarcinoma, invasion of 3/4 muscle layer, no cancer invasion at upper margin, lymph node metastasis rate (0/27), but one cancerous nodule (N1a) in omentum.

The patient was 27 years old, unmarried, with 1 pregnancy and 0 delivery. He was admitted to the hospital for "56 d of menopause, 15 d of vaginal bleeding and 12 h of abdominal pain". Medical history: ① The patient's last menstruation was on December 22, 2014. In the past half month, he had irregular vaginal bleeding, which was less than menstrual flow. On February 8, 2015, the B-ultrasound examination in our hospital showed that there was no embryo sac in the uterine cavity, no mass in the attachment, no effusion in the pelvic cavity, and blood HCG: 119 027 mIU/ml. At that time, the outpatient physician recommended that the patient be hospitalized for detailed examination, but the patient refused. The patient suddenly suffered from persistent total abdominal pain half a day before admission, and went to the local maternal and child health hospital for B-ultrasound examination, which showed a mixed mass of 7.7 cm ×5.0 cm ×4.6 cm in the pelvic cavity, and a mixed mass of 6.6 cm ×5.2 cm between the spleen and the left kidney. A fetus with a brachiocephalic diameter of 2.7 cm was seen. Then he was quickly transferred to our hospital. ② Admission physical examination: T 37.0 ℃, P 94 times/min, R 18 times/min, BP 85/26 mmHg, clear consciousness, pale complexion, abdominal bulge, total abdominal tenderness with rebound pain, mainly left upper abdominal tenderness, mobile voicing (+). ③ Auxiliary examination: B-ultrasound in our hospital on December 16, 2015: moderate volume of pelvic effusion, gestational sac-like echo between spleen and left kidney 4.2 cm ×5.4 cm, embryo inside, and parietal-gluteal diameter 3.2 cm. The initial diagnosis of admission was: ectopic pregnancy (abdominal pregnancy?), hemorrhagic shock. On 16 February 2015, under emergency general anesthesia, a gynecologist performed a median incision laparotomy of the lower abdomen: 2 500 ml of abdominal free blood, about 500 g of blood clot, normal uterus, and no abnormalities in bilateral fallopian tubes and ovaries. Immediately consult a hepatobiliary surgeon, extend the incision upward, and explore the spleen 10.0 cm ×5.0 cm, and its upper diaphragmatic surface can reach a 5.0 cm ×3.0 cm ectopic pregnancy placental implant surface with a shaped fetus, about 3.0 cm ×4.0 cm (Figure 1), the implant surface has been partially stripped from the spleen, with active bleeding of the stripped surface. The spleen was removed by surgery. Postoperative pathology showed that the spleen coincided with ectopic pregnancy. He was discharged 12 days after surgery and has recovered well since the outpatient follow-up.

A 33-year-old female was admitted with "upper abdominal discomfort for 12 d and fever for 7 d". Past physical health with a history of appendix surgery for ten years. He usually had irregular menstruation, no obvious history of dysmenorrhea, had a son, delivered naturally, and had no history of miscarriage. Physical examination: There was no tenderness, rebound pain in the abdomen, no muscle tension, negative Murphy sign, no mass in the whole abdomen, and no obvious percussion pain in the liver and kidney areas. Laboratory tests: ALT 41 U/L, GGT 74 U/L, CRP 36 mg/L, CA 19-9 39.52 KU/L, other laboratory tests showed no significant abnormalities. Imaging examination: CT showed a cystic low-density shadow in the left lobe of the liver, about 8.8 cm ×6.5 cm in size, with a clear boundary, no obvious enhancement after enhancement, and a patchy enhancement shadow around the arterial phase lesion (Figure 1,Figure 2,Figure 3)。 Cystic lesions in the left inner lobe of the liver were considered; The posterior wall of the uterus seems to see low-enhancement nodules, and the possibility of fibroids in the posterior wall of the uterus is considered. B-ultrasound showed a liquid-based mixed acoustic mass at the junction of the left and right lobes of the liver, with a size of about 9.3 cm ×8.0 cm. Color Doppler showed that blood flow signal bypassed around the mass. Clinical diagnosis: hepatic cystic mass occupation. Laparoscopic partial hepatectomy was performed under general anesthesia on 14 Oct 2016. Intraoperative exploration showed: a cystic mass about 9.0 cm ×6.0 cm in the left inner lobe of the liver, with clear boundaries and envelope formation. The cystic fluid was turbid and coffee-colored, without bile-like fluid and mucus. The inner wall of the cyst was mostly smooth, and some had papillary protrusions of 0.5~1 cm in size, without obvious satellite foci around it. The surgery went smoothly and the patient recovered well after surgery. Postoperative pathology revealed hepatic endometriosis cyst (Figure 4，Figure 5)。

A 51-year-old male patient. He was admitted to the hospital because of "distension and pain in the upper abdomen for one week". There was no fever, anorexia, and no wasting. Physical examination: the superficial lymph nodes of the whole body were not palpable and enlarged, the breathing sounds of both lungs were clear, no dry and wet rales were heard, the abdomen was flat, the right upper abdomen was mild tender, no rebound pain, no palpable mass, the liver and spleen were not reached under the costs, the liver area was mild percussion pain, the mobile voiced sound was negative, and the intestinal sound was normal. Imaging examination: Chest radiograph showed no abnormalities. B-ultrasound showed that two hypoechoic nodules were found in the right lobe of the liver, with the size of 1.3 cm ×1.6 cm and 1.6 cm ×1.1 cm respectively. CT of the upper abdomen showed that multiple low-density shadows could be seen in the liver, some of which were unclear, and the larger one was located in the S7 segment, with a size of about 3.5 cm ×3.6 cm. The lesions on enhanced scan seemed to be mildly enhanced (Figure 1)。 MRI showed that circular and slightly longer T2 abnormal signal shadow changes were seen in the right lobe of the liver, DWI showed slightly higher signal, cirrhosis changed, and splenomegaly (Figure 2)。 Laboratory test: Blood routine WBC 4.02×10⁹/L, N% 48.9%; The tumor markers were AFP 24.54 μ g/L (normal value 0-8.78 μ g/L), CA19-9 18.43 μ/ml (normal value 0-37.00 μ/ml), hepatitis B surface antigen positive, HBV gene quantification 4.79×10⁴Iu/ml (normal<5×10²Iu/ml). Admission diagnosis: liver mass occupation, primary liver cancer? Hepatitis B cirrhosis; Hepatitis B active phase; Splenomegaly. B-ultrasound-guided resection of liver tumors under general anesthesia. Intraoperative B-ultrasound exploration revealed a mass of about 3 cm ×3 cm in the right lobe of the liver, and a satellite nodule next to the mass was about 0.5 cm in diameter. The postoperative pathology showed that a large number of structurally nonnecrotic tissue and a large number of chronic inflammatory cell infiltration in the interstitium were seen under the microscope, which was considered as liver tuberculosis (Figure 3)； Immunohistochemical tumor cells showed: CD163 (histiocyte 2+), CD68 (cell +), Ki67 (1% +), CD38 (plasma cell +), Hepatocyte (Hepatocyte +).

A 69-year-old male was admitted for "abdominal pain with yellowing skin staining for 4 d". Admission physical examination: body temperature: 36.7 ℃, blood pressure: 138/77 mmHg, skin sclera yellowing, superficial lymph nodes not swollen, soft abdomen, right upper abdomen tenderness, no rebound pain, positive Murphy sign, normal intestinal sounds. Laboratory tests: ALT: 128 U/L, AST; 137 U/L, TBIL; 72 μ umol/L, DBIL: 52 μ mol/L, CA199: 213 U/ml, White blood cells are normal. Ultrasound examination: "Intrahepatic bile duct dilatation with uneven echo of hepatic hilar structure, gallbladder separation with gallbladder wall thickening" (Figure 1)； CT examination: "Two cystic density shadows in the gallbladder area, local thickening of the gallbladder wall, dilatation of the intrahepatic bile duct, local stenosis of the common hepatic duct, and enlarged lymph nodes in the hilar area" (Figure 2，Figure 3)； MRCP suggested: "Gallbladder internal septum, intrahepatic bile duct dilation, local stenosis of the upper common hepatic duct" (Figure 4)。 Admission diagnosis: "hilar bile duct tumor, obstructive jaundice, double gallbladder malformation". Surgical treatment was performed after perfect preoperative preparation. Intraoperative findings: gallbladder swelling, hard texture of gallbladder ampulla, cystic duct and confluence, and several small nodules scattered in the left and right livers (intraoperative pathological examination: adenocarcinoma). Intraoperative informed the patient's family, and after discussion, it was decided to perform "cholecystectomy plus external bile duct drainage"; Excision of the gallbladder revealed two independent cystic ducts joining into the common bile duct side by side, 0.5 cm apart (Figure 5), both intrahepatic and extrahepatic bile ducts can be revealed by angiography, and the gallbladder specimen can see two openings. After cutting, the gallbladder has two independent cavities, completely separated by a septum in the middle (Figure 6)； The ampulla and cystic duct of the two gallbladders are hard and thickened, and the texture of the two cystic ducts flowing into the common bile duct is hard; Incision of the common bile duct showed local stenosis of the common hepatic duct at the entrance of the cystic duct, which was about 1.5 cm long. Postoperative pathological examination results: "Both gallbladders were well-differentiated adenocarcinomas, infiltrated into the subserous membrane, and metastasis was considered intrahepatic".

A 75-year-old female was admitted to the hospital on 5 November 2014 due to progressive systemic yellowing with deepening urine color for 2 weeks. Physical examination: Skin and sclera were yellow stained, abdomen was flat and soft, no tenderness and rebound pain, no obvious mass was palpable, and no moving voiced sound. Laboratory tests after admission showed hepatic function ALT 147.0 U/L, AST 170.0 U/L, AKP 660.0 U/L, γ-GT 1 333.0 U/L, TBil 456.4 μ mol/L and DBil 317.9 μ mol/L, and normal plasma albumin. Blood tumor markers: CEA 7.85 μ g/L, CA199 239.2 μ/ml, CA50 154.55 μ/ml, and other indexes within the normal range. Blood routine, renal function and prothrombin time were all within the normal range. Upper abdominal CT enhanced venous examination showed visceral inversion, intrahepatic and extrahepatic bile duct dilatation, abnormal enhancement of distal common bile duct and adjacent uncinate process, and possible periampullary malignant tumor (Figure 1)。 The patient underwent pancreaticoduodenectomy under general anesthesia on 10 Dec 2014. Intraoperative exploration of the abdominal cavity showed total visceral inversion (Figure 2), dilatation of the common bile duct, 2.5 cm in diameter, open the common bile duct for exploration, distal stenosis of the common bile duct; The duodenal papilla was stiff, and the head of the pancreas was not palpable. Carcinoma of the distal common bile duct was considered. Pancreaticoduodenectomy was performed, and the digestive tract was reconstructed by Child method. When the specimen was removed, the residual pancreatic body and tail were located on the right side, while the bile duct was located on the left side (Figure 3)。 Postoperative pathology showed that adenocarcinoma of distal common bile duct grade Ⅱ ~ Ⅲ (3cm ×2cm ×1.5cm) invaded the whole thickness of bile duct wall, involved nerve bundles, duodenal submucosa and pancreatic tissue, and all resection margins and lymph nodes were negative. Immunohistochemistry: CK7 (+), CK19 (+), CK20 (+), p53 (-), Ki67 positive rate 80%, EGFR (+), muc-1 (+), muc-2 (+) in tumor cells. TNM Stage: T4N0M0. The intestinal function recovered on the 6th postoperative day, and liquid was fed on the 7th day. Two drainage tubes were removed at 14 and 21 days postoperatively, respectively, and they were discharged. The patient was treated with oral Tigeo chemotherapy for 6 courses from January to October 2015 one month after surgery. The patient was re-examined in September 2015, and there were no signs of recurrence. The patient was re-examined in January 2016, and CT showed multiple intrahepatic metastases. From January to July 2016, the chemotherapy regimen of gemcitabine combined with Tegio was used for 4 courses. After reexamination in July 2016, CT showed that multiple intrahepatic metastases were larger than the previous film, and there were no signs of recurrence so far.

A 52-year-old female was admitted to the emergency department with the complaint of "metastatic right lower abdominal pain for 10 d". He had "partial small intestine resection" due to "intestinal obstruction" 27 years ago and had blood transfusion during his hospitalization. Physical examination: P 108 times/min, BP 90/60 mmHg, tenderness under xiphoid process and right lower abdomen with rebound pain. Laboratory test: Hb 84 g/L, hepatitis C antibody positive. Ultrasonography showed that there was no enlarged appendix in the right lower abdomen, and 45 ml of peritoneal fluid was found. Diagnostic abdominal puncture was performed, and red non-coagulant blood was extracted from McDonald's point. Preoperative diagnosis: abdominal hemorrhage. Exploratory laparotomy in emergency surgery. Take the middle incision of the right lower abdomen and enter the abdomen, and see abdominal intestinal adhesion. After releasing the intestinal tube, a large amount of blood accumulation in the pelvic cavity, subhepatic cavity and splenic fossa can be seen, but there is no clot. After aspiration of the accumulated blood, the small intestine was not strangled, the liver and spleen were not ruptured and bled, and the incision was extended upward, showing cirrhosis and esophageal and gastric varices. The omental sac was opened, and a large number of blood clots and accumulated blood were found in the omental sac. After the accumulated blood was cleared, active hemorrhage of the posterior gastric vein was found. The blood vessels were ligated and splenectomy plus pericardial vascular dissection was performed. Intraoperative hemorrhage and accumulation of blood were about 5 000 ml, 10 U of suspended red blood cells and 600 ml of frozen plasma were transfused. Postoperatively, Hb was reexamined at 102 g/L, and 4U of suspended red blood cells and 600 ml of frozen plasma were transfused again. The patient recovered well after surgery. Postoperative pathological report: congestive splenomegaly. After 1 year follow-up, the patient's liver function was normal and there was no rebleeding.

A 63-year-old male was admitted to the hospital for "repeated hematemesis and melena for 8 days". There was no previous surgical history. Physical examination: conscious, acute disease, anemic appearance, flat and soft abdomen, no tenderness, unpalpable liver and spleen under the costs, unpalpable mass, negative mobile voicing. Auxiliary examination: hemoglobin 62 g/L, platelet count 70×10⁹/L. Gastroscopy showed a large amount of blood in the stomach, and no bleeding lesions were found. Abdominal CT examination showed a slightly lower density mass shadow on the small curved side of the stomach; The boundary between adjacent stomach wall and pancreas is unclear, and neoplastic lesions cannot be excluded; A slightly higher density shadow was seen in the gastric cavity; A small amount of pelvic effusion, accumulated blood to be eliminated (Figure 1)。 Abdominal color ultrasound examination showed: cystic-solid mass in the tail area of the pancreas, which was closely related to the splenic artery (Figure 2)。 The diagnosis was: acute massive gastrointestinal hemorrhage. On the third day after admission, the patient suffered from sudden hemorrhagic shock, and an emergency angiography was performed. Intraoperative observations: contrast medium spillover in the middle segment of the splenic artery, pseudoaneurysm formation, and poor vascular perfusion at the distal end (Figure 3)。 Embolization of the splenic artery was performed to stop the hemorrhage, and the embolization was good again. About 5 hours after the operation, the patient's condition deteriorated again, considering that there was still active bleeding, "exploratory laparotomy" was performed in the emergency department. Intraoperative findings: About 500 ml of pale yellow clear ascites in the abdominal cavity, no signs of bleeding, 3 cm ×4 cm ×4 cm splenic aneurysm can be seen 3 cm from the celiac trunk, densely adhered to the posterior wall of the stomach near the fundus of the stomach, protruding into the gastric cavity, and arterial pulsation can be palpable. The splenic artery was separated and ligated, and the gastric cavity was opened to remove about 1 500 ml of clotting. The splenic artery aneurysm invaded the fundus of the stomach and saw active bleeding, with obvious blood accumulation in the intestinal cavity. Splenic aneurysm resection + splenectomy + proximal gastrectomy + jejunal nutrition tube placement were performed. The operation was successful, and the postoperative pathological report showed that it was consistent with splenic artery pseudoaneurysm; Mild chronic inflammation of the gastric mucosa. The patient recovered well after surgery and was discharged smoothly.

A 30-year-old male suffered from "left upper abdominal pain 10^＋The patient had sudden left upper abdominal pain without obvious trigger more than 10 days ago, showing persistent distension and pain, gradually aggravating, no nausea, vomiting, acid reflux, belching, jaundice, fever, chills, palpitation, chest pain, dyspnea, and defecation as usual. The history of trauma and hepatitis was denied, and the rest of the past history was not special. Physical examination at admission: vital signs were stable, the whole abdomen was soft, left upper abdomen tenderness, no rebound pain and muscle tension, the spleen was palpable and swollen 2 cm below the umbilicus, the surface was smooth, the texture was tough, with palpable pain, the liver was not palpable under the costs, and the mobile voicing was negative. CT examination on admission showed: giant spleen with rupture and hemorrhage (Figure 1，Figure 2), B-ultrasound examination revealed: giant spleen with rupture and bleeding (Figure 3), routine blood test showed: white blood cells 17.71×10⁹/L, red blood cells 3.15×10¹²/L, hemoglobin 95.0 g/L, platelets 257.0×10⁹/L, neutrophil percentage 70.5%; Biochemical examination showed that alanine aminotransferase 35 U/L, aspartate aminotransferase 40 U/L, total bilirubin 36.4 μ mol/L, direct bilirubin 11.6 μ mol/L, indirect bilirubin 24.80 μ mol/L; A series of hepatitis examinations showed that hepatitis B surface antigen (quantitative)>250.00 IU/ml, hepatitis B e antibody (quantitative) 0.85 S/CO, hepatitis B core antibody (quantitative) 10.82 S/CO, hepatitis B pre-S1 antigen positive (+). The diagnosis considered at admission was: (1) giant spleen rupture and hemorrhage; (2) Hepatitis B virus carriers. Laparoscopic exploration and splenectomy were performed after actively improving the preoperative preparation. Intraoperative exploration showed that the spleen was enlarged, the surface was smooth, no nodules or masses were found, the size was about 30 cm ×20 cm, and a hematoma with a diameter of about 15 cm was seen at the upper pole behind the spleen pedicle. Laparoscopic splenectomy was decided. The operation was smooth, the operation time was about 160 minutes, and the bleeding was about 500 ml. The patient recovered well after operation, without complications such as bleeding and pancreatic leakage. Postoperative pathological findings suggested splenic Niemann-Pick disease with rupture and hemorrhage (Figure 4，Figure 5)。

biliary tract cancer (BTC) is a malignant tumor originating from the biliary epithelium. According to the anatomical location, it can be divided into gallbladder cancer, intrahepatic cholangiocarcinoma and extrahepatic cholangiocarcinoma. In China, the incidence of gallbladder cancer is 52.5 per 100,000^[1], much higher than countries such as Europe and America. The incidence of cholangiocarcinoma accounts for 3% of gastrointestinal tumors, and it is increasing year by year, and its 5-year survival rate is less than 10%^[2]。 Complete surgical resection is the gold standard for the treatment of biliary system tumors, but the vast majority of patients are mostly in the progressive stage of tumor when they see the doctor, and less than 10% of patients can undergo surgical treatment. Even after R0 resection, the prognosis of patients is still not ideal. The 5-year survival rate of gallbladder carcinoma is only 5% ~10%, and the 5-year survival rate of cholangiocarcinoma is 10% ~40%^[3]。 Therefore, non-surgical treatment (including chemotherapy, radiotherapy, targeted therapy, etc.) becomes an important adjuvant treatment option for advanced or inoperable patients. We will review the research on non-surgical treatment of biliary tumors reported in recent years at home and abroad.

Intraperitoneal adhesions can be divided into two types: primary and secondary. Secondary adhesions originate from intraperitoneal inflammation, peritoneal inflammatory response caused by radiation and surgical injury^[1]。 Postoperative adhesion refers to the abnormal fibrous connection formed during the repair of organ and tissue trauma caused by surgery, and is the most common complication after abdominal and pelvic surgery. Depending on the site of postoperative adhesion and the organs and tissues involved, the adhesion can remain "static" without any clinical symptoms, or cause serious complications. In severe cases, it can lead to acute intestinal obstruction, intestinal strangulation and even endanger the patient's life. Therefore, it is of great clinical significance to formulate an expert consensus on the prevention of postoperative abdominal adhesions in accordance with the actual situation in China.