Experience of diagnosis and treatment of carcinoma arising from congenital biliary duct cyst / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the experience in diagnosis, prevention and treatment of carcinoma arising from congenital biliary duct cyst.</p><p><b>METHODS</b>The clinical and pathological data of 185 patients with congenital biliary duct cyst admitted to Chinese PLA General Hospital were analyzed retrospectively.</p><p><b>RESULTS</b>Among 185 patients, twenty-seven cases had carcinomas arising from congenital biliary duct cyst, and the frequency of malignant transformation was 14.6%, which closely related to the age (P < 0.001). The incidences of malignancy for different age groups were: 0 for 0-9 age group, 5.1% for 0-19, 9.1% for 20-29, 16.2% for 30-39, 26.7% for 40-49, 33.3% for 50-59, and 50% for over 60, respectively. Six patients had the history of cyst-enterostomy. Abdominal pain, fever, jaundice and weight loss were the main clinical manifestations. Abdominal ultrasonography, CT, MRI or magnetic resonance cholangiopancreatography, MRCP and endoscopic retrograde choledochopancreatography (ERCP) were the main diagnostic methods. For twenty patients (74.1%), a definite diagnosis was made preoperatively, but it's hard to make an early diagnosis. Nine patients (33.3%) underwent curative resection.</p><p><b>CONCLUSIONS</b>Congenital biliary duct cyst is a premalignant lesion, and the incidence of carcinogenesis increases remarkably with age. The most effective method for prevention of carcinogenesis in choledochal cyst is complete excision of choledochal cyst during childhood, and the prognosis is poor for patients with biliary malignancy.</p>

Clinical research on radiofrequency ablation for hypersplenism / 中华外科杂志

<p><b>OBJECTIVE</b>To study the security and curative effect of radiofrequency ablation (RFA) for hypersplenism due to portal hypertension in the near future.</p><p><b>METHODS</b>12 patients of the disease were treated with RFA. The blood count showed that WBC is (2.0 +/- 0.7) x 10(9)/L, PLT (25 +/- 10) x 10(9)/L, RBC (3.08 +/- 0.56) x 10(9)/L. In manners of systemic anaesthesia, through skin or in the operation or under the celioscopes the RFA needles are inserted the upper and middle parts of spleen in the instructing of US. Average time of RFA is (36.4 +/- 5.4) s.</p><p><b>RESULTS</b>After the RFA, 1 case develop hematoma under the envelope of liver, and 1 case developed skin burn; 6 patients appeared middle or little fluid in the left thorax, 2 of them were drawn through puncture. The volume of spleen and damaged part of spleen from RFA were determined by enhanced CT in the days of 10 after RFA, the percentage of damaged part of spleen from RFA is 49.1% (23.3% - 88.9%). In the days of 14 after RFA, RBC is (5.5 +/- 0.9) x 10(9)/L, PLT is (124 +/- 21.36) x 10(9)/L; In the days of 33 after RFA, RBC is (5.4 +/- 1.1) x 10(9)/L, PLT is (205 +/- 34) x 10(9)/L. The levels of WBC and PLT in the blood after RFA are significantly higher than those of levels of WBC and PLT before RFA (P < 0.01).</p><p><b>CONCLUSIONS</b>Radiofrequency ablation for Hypersplenism due to portal hypertension of hepatitis hepatocirrhosis is safety and credibility and has excellent curative effect in the near future.</p>

The feasibility and safety of radiofrequency ablation for secondary splenomegaly and hypersplenism in dogs / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the feasibility and safety of radiofrequency ablation (RFA) in spleen to treat secondary splenomegaly and hypersplenism in dogs.</p><p><b>METHODS</b>Fourteen healthy mongrel dogs were randomly divided into two groups: group A (n = 4) and group B (n = 10) Both groups underwent ligation of the splenic vein and its collateral branches to induce congestive splenomegaly. At the end of the 3rd week, radiofrequency thermal ablation of the spleen was performed in the group B via laparotomy. After splenic RFA, the procedure-related complications were observed, CT scan was performed and the spleens were obtained according to schedule. The radiofrequency (RF) thermal lesions and its histo- pathological changes of the spleen were examined regularly.</p><p><b>RESULTS</b>There were no morbidity and mortality in the experimental dogs. CT findings revealed that splenomegaly could sustained over 2 months after ligation of the splenic vein. The segmental RF lesions included hyperintense zone of coagulative necrosis and more extensively peripheral hypo-intense infarcted zone. The latter was called as "bystander effect". The infarcted zone would be absorbed and subsequently disappeared between 4 and 6 weeks after RFA, and the size of the remnant spleen shrunk, but the lesion of coagulative necrosis hardly altered. The fundamental histopathological changes of splenic lesions caused by RF thermal energy included local coagulative necrosis and the peripheral thrombotic infarction zone. Subsequently, tissue absorption and fibrosis occurred in the zone of thrombotic infarction. Simultaneously occluded vessels, fibrin deposition, and disappearance of normal splenic sinuses resulted in the condensed structure of the viable remnant spleen, which were the pathological basis responsible for the shrunk spleen.</p><p><b>CONCLUSIONS</b>It is feasible and safe to perform RFA in the spleen to treat experimental splenomegaly and hypersplenism. The RFA technique could be safely performed clinically via laparotomy or laparoscopic procedure to strictly isolate the spleen from the surrounding organs.</p>