ABSTRACT
Gallbladder cancer (GBC) is the most common cancer of the biliary tract,constituting 80％-95％ of malignant biliary tract tumors.Surgical resection is currently regarded as the sole curative treatment for GBC.Hepatopancreatoduodenectomy (HPD) has been adopted to remove the advanced gallbladder tumor together with the infiltrated parts within the liver,lower biliary tract and the peripancreatic region of GBC patients.However,patients who underwent HPD were reported to have a distinctly higher postoperative morbidity (71.4％,ranging from 30.8％ to 100％) and mortality (13.2％,ranging from 2.4％ to 46.9％) than those given pancreatoduodenectomy (PD) alone.We present two patients with advanced GBC who underwent a modified surgical approach ofHPD:PD with microwave ablation (MWA) of adjacent liver tissues and the technique of intraductal cooling of major bile ducts.No serious complications like bile leakage,pancreatic fistula,hemorrhage and organ dysfunction,etc.occurred in the two patients.They had a rapid recovery with postoperative hospital stay being 14 days.Application of this approach effectively eliminated tumor-infiltrated adjacent tissues,and maximally reduced the postoperative morbidity and mortality.This modified surgical method is secure and efficacious for the treatment of locally advanced GBC.
ABSTRACT
Objective To explore the efficacy of intraductal chilled saline perfusion (ICSP) to reduce the thermal bile duct injury during the treatment of radiofrequency ablation (RFA) associating with occlusion of hepatic blood supply in rabbits.Methods 16 healthy New Zealand white rabbits were divided into 2 groups.Rabbits of the ICSP group were placed tubes in the common bile duct after laparotomy,and ICSP was performed during the RFA procedure accompanied with hepatic blood occlusion.While for rabbits of the non-ICSP group,hepatic blood occlusion and RFA were performed without ICSP.RFA electrodes were placed about 5 mm away from the hilus hepatis approximately.Contrast-enhanced ultrasonography (CEUS) was administrated to evaluate the sizes of the ablative zones after the procedure.On post-procedure 6 week,ultrasonography was prerformed to evaluate the changes of the biliary structure,and liver specimens of rabbits wcrc obtained for histopathologic observation of main bile ducts.Results Post-procedure CEUS examination showed that there was no significant difference in the size of the ablative zone between the groups (P ＞0.05).On post-procedure 6 week,rabbits of the ICSP group appeared with biliary dilatation more frequently by ultrasonography (P ＜0.05),and a higher degree of the injury of main bile duct by histopathologic observation (P ＜0.05).Conclusions In treatment of RFA accompanied with hepatic blood occlusion,RFA-induced bile duct injury may be decreased significantly with ICSP.