The patient, a 58-year-old Tibetan female, came to the hospital for "abdominal discomfort with skin and sclera yellowing for more than 1 month". Laboratory examination showed that total bilirubin fluctuated from 36.6 to 98.2 μ mol/L. Enhanced CT showed widening of intrahepatic and extrahepatic bile ducts, duodenal papilla occupying a space diameter of 1.9 cm ×2.7 cm, secondary bile duct and pancreatic duct obstruction, no signs of lymph node or other sites metastasis, and no clear vascular invasion. Duodenoscopy showed duodenal papillary tumor with hemorrhagic manifestations, and biopsy pathology showed ampullary tumor conforming to neuroendocrine tumor grade G1. The diagnosis was a neuroendocrine tumor of the duodenal ampulla (grade G1, T3N0M0, stage II), obstructive jaundice. A digital three-dimensional model (including pancreas, pancreatic duct, duodenum, biliary system, lesion, hepatic artery system, portal vein, superior mesenteric artery and vein, etc.) was constructed and imported from patients' enhanced CT data IQQA QMR system (intelligent/interactive qualitative and quantitative analysis, quantitative mixed reality, EDDA Technology) Pylorus-preserving pancreaticoduodenectomy under mixed reality (MR) assisted navigation is proposed. Preoperative three-dimensional reconstruction showed the relationship between bile duct, pancreatic duct, duodenum and tumor location, and suggested the presence of pancreaticobiliary maljunction (PBM) (Figure 1). Intraoperatively, the patient was taken in the recumbent position, and the right hypochondrial region was incised with reverse L. The abdominal cavity was not metastasized by exploration. The gallbladder was removed and the common hepatic duct was transected above the confluence of the cystic duct. Regional lymph nodes were dissected. The gastrocolic trunk was exposed by Kocher's method, the right gastroomental vein was dissected, and the duodenocolic ligament was severed. Make a "tunnel" separation between the posterior pancreas and the superior mesenteric vein. The jejunum and the neck of the pancreas were dissected, and the duodenum was dissected on the right side of the pylorus to preserve the pylorus. Separation of the pancreatic uncinate process from bottom to top along the superior mesenteric vein. After removing the specimens, the Kakita method was used to complete pancreaticointestinal anastomosis, and the bile-intestinal anastomosis and gastrointestinal anastomosis were The pancreaticojejunostomy was wrapped and the surrounding vessels covered using the omental liner technique (Figure 2). Intraoperative hemorrhage was 100 ml and the operation time was 6.5 h. The patient recovered smoothly without complications, and was in good condition after 1 year follow-up.
