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Objective To evaluate ultrasound assisted virtual MRI guided radiofrequency ablation (RFA) in the treatment of hepatocellular carcinoma (HCC) adjacent to gastrointestinal tract with artificial ascites.Methods A total of 33 HCC lesions in 32 patients adjacent to gastrointestinal tract in our hospital were collected.After the establishment of artificial ascites,they were treated with radiofrequency ablation guided by ultrasound-guiding fusion and virtual MRI navigation.The curative effect and complication rate were compared with the control group (non-hollow GI tract abutting HCC lesions).Results All 33 lesions were completely ablated without residual.After 1 month and 3 months follow-up,the reexamination of contrast-enhanced ultrasound and MRI showed no activity and no new lesions.All cases had no serious complications such as gastrointestinal injury.There were no statistically significant differences in tumor complete inactivation rate,complication rate and recurrence rate between the two groups.Conclusion Ultrasound-guiding fusion and virtual MRI guided radiofrequency ablation with artificial ascites is safe and effective in the treatment of liver cancer adjacent to gastrointestinal tract.
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Objective To evaluate the use of intercostal trocars (ICS) and transthoracic trocars in laparoscopic resection of liver segments 7 and 8.Method From November 2015 to June 2017,20 patients who underwent laparoscopic S7 or 8 segmentectomy for liver tumors in the Department of Hepatobiliary Surgery,the First Affiliated Hospital,Guangxi Medical University were analyzed retrospectively.Results Ports were inserted at the 8th or 9th ICS,respectively,in addition to the conventional abdominal ports.The mean operation time was 225.0 min (110.0 ～ 486.0 min).Anatomical resection was completed in 1 patient,and non-anatomical resection in 19 patients.The conversion rate was 0％.Pringle's maneuver was used in 9 patients.The mean blood loss was 85.0 (25.0 ～410.0) ml,and the mean length of hospital stay was 7.0 (5.0 ～ 12.0) days.The complication rate was 10.0％.Pathologic findings revealed that 17,2,1 patient(s) had HCC,hemangioma,and inflammatory nodule,respectively.The mean tumor size and tumor free margin were 33.8 (15.0 ～ 74.0) mm;and 15.0 (1.0 ～ 30.0) mm,respectively.There was no HCC recurrence on follow-up,expect for one patient who developed tumor recurrence at 20 months after laparoscopic liver resection.Conclusions In selected patients,laparoscopic liver resection using intercostal trocars was useful and safe for tumors located in liver segments 7 and 8.The long-term oncologic outcomes need to be further evaluated.
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Objective To detect the existence of vasculogenic mimicry in hepatocellular carcinoma (HCC). Methods In this study 42 patients with a total of 47 HCC nodules underwent radical resection.Histological and immunohistochemical double staining of CD31 and PAS were applied to observe the existence of vasculogenic mimicry ( VM ). Reverse tanscription PCR (RT-PCR) were applied to study the expression of VE-cadherin, EPHA2 and MMP-2 genes. Results VM was found in 16 of the 42 (38. 1% )HCC cases. The typical forms of VM in the microscope are vessel-like structure formed by tumor cells,without endothelial cells and the PAS-positive looping pattern. The existence of VM in HCC correlates to a higher Edmondson grade, higher capacity of intrahepatic disseminating and poorer tumor-free survival time (P＜ 0. 05). Comparing the difference of VE-cadherin gene, EPHA2 gene and MMP-2 gene expression between VM positive nodes and in VM negative nodes by RT-PCR method demonstrated that VE-cadherin gene, EPHA2 gene and MMP-2 gene have a more intense expression in VM positive nodes than in VM negative nodes ( P ＜ 0. 05 ). Conclusion VM exists in human hepatocellular carcinoma. VM occurred more frequently in higher malignant HCC and predicts a higher rate of tumor recurrence and poorer prognosis.
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Objective To evaluate the clinical significance of a modified T-staging system for hilar cholangiocarcinoma(HCC).Methods From 1999 through 2007,98 HCC patients were stratified by the Tstaging system.Statistical differences were evaluated for resectability,radical resectability,concomitant partial hepatectomy,partial portal vein resection,histological differentiation,lymph node characteristic and survival rate.Results There were 43 HCC patients graded at T1,37 at T2 and 18 at T3 respectively.The resectability rates were 65%,40% and 11%,and radical resection was achieved in 46%,21% and 0% respectively.Resectabilities decreased with increasing T stage(χ~2=15,P<0.01;χ~2=14,P<0.01,separately).In patients with T1 and T2 tumors who underwent resection,the concomitant partial hepatectomy accounted for 60% and 73%(χ~2=0.6,P>0.05),partial portal vein resection for 3% and 33%(χ~2=4,P<0.05),poor differentiated types for 71% and 40%(χ~2=4,P<0.05),and lymph node metastasis for 50% and 40%(χ~2=0.4,P>0.05),respectively.The 1-,3-and 5-year survival rates in patients with T1 lesions were 58%,30%and 18%,in 12 patients it was 43%,11%and 0.The 1-and 2-year survival rate in T3 patients was 12%and 0.Patients witll T1 or T2 stage tumors had a significantly longer survival than those with T3(P<0.05)(Log rank χ~2=14,Breslow χ~2=12,P<0.01;Log rank χ~2=6,Breslow χ~2=4,P<0.05,individually),and the difference in survival between T1 and T2 was not significant(Log rank χ~2=2,Breslow χ~2=1,P>0.05).Conclusions The T-staging system is appropriate for preoperative evaluation in HCC patients.However,its correlation with tumor histological differentiation and lymphatic characteristics needs to be elucidated.
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Objective To summarize our experience in the diagnosis and treatment of malignant peritoneal mesothelioma(MPM). Methods Clinical data of 10 patients admitted with MPM were analyzed retrospectively. Results The main symptoms of MPM were intraabdominal mass and abdominal pain in these patients; Seven patients were of localized type, 3 cases were of diffused type; Preoperatively 7 cases were misdiagnosed as other intraperitoneal tumor, 9 patients underwent laparotomy and tumor resection for a total 16 times, including once in 4 cases, two times in 3 cases, and three times in 2 cases. Seven patients received curative resection in initial operation. Five patients died within one year, 6 cases within two years, Tumors recurred postoperatively in 4 cases. 1 case is still survival 9 years after. Conclusion Being comparatively rare, MPM is often misdiagnosed, the prognosis is very poor, curative resection sometimes provides a long survival for localized type of MPM, when combined with perioperative comprehensive therapy.