Application value of digital single-operator peroral cholangioscopy on the preoperative evalua-tion of extrahepatic cholangiocarcinoma / 中华消化外科杂志

Objective:To investigate the application value of digital single-operator peroral cholangioscopy on the preoperative evaluation of extrahepatic cholangiocarcinoma.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 172 patients with extrahepatic cholangiocarcinoma who were admitted to the First Affiliated Hospital of Army Medical University from December 1, 2017 to April 1, 2022 were collected. There were 91 males and 81 females, aged 65(range, 45?68)years. Of 172 patients, 36 cases undergoing preoperative digital single-operator peroral cholangioscopy examination were allocated into the experimental group, and 136 cases not undergoing preoperative digital single-operator peroral cholangioscopy examination were allocated into the control group. Observation indicators: (1) propensity score matching and comparison of general data of patients between the two groups after matching; (2) surgical conditions. Propensity score matching was done by the 1:1 nearest neighbor matching method and caliper setting as 0.02. Measurement data with normal distribution were expressed as Mean± SD, and t test was used for comparison between groups. Measurement data with skewed distribution were expressed as M( Q1,Q3), and the Mann-Whitney U test was used for comparison between groups. Count data were expressed as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. The rank sum test was used for comparison of ordinal data. Results:(1) Propensity score matching and comparison of general data of patients between the two groups after matching. Of 172 patients, 60 cases were successfully matched, including 30 cases in the experiment group and 30 cases in the control group, respectively. Before propensity score matching, cases with or without preoperative bile drainage were 27, 9 in the experiment group, versus 62, 74 in the control group, showing a significant difference between the two groups ( χ2=9.86, P<0.05). The above indicators were 23, 7 in the experiment group, and 23, 7 in the control group after propensity score matching, showing no significant difference between the two groups ( χ2=0.00, P>0.05). The elimination of preoperative bile drainage confounding bias ensured comparability between the two groups. (2) Surgical conditions. After propensity score matching, there were 10 cases and 0 case without surgery in the two groups. Cases undergoing radical operation including R 0, R 1, R 2 resection were 16, 0, 4 in the experiment group, versus 18, 6, 6 in the control group, showing a significant difference between the two groups ( χ2=6.85, P<0.05). Conclusions:Preoperative digital single-operator peroral cholangioscopy exami-nation can improve the R 0 resection rate of extrahepatic cholangiocarcinoma.

Clinical efficacy of ex vivo liver resection and autotransplantation for liver complex space-occupying lesions / 中华消化外科杂志

Objective:To investigate the clinical efficacy of ex vivo liver resection and autotransplantation (ELRA) for liver complex space-occupying lesions.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 50 patients with liver complex space-occupying lesions who underwent ELRA in the First Hospital Affiliated to Army Medical University between June 2009 and May 2017 were collected. There were 36 males and 14 females, aged from 13 to 69 years, with a median age of 51 years. All patients underwent ELRA. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up was conducted by outpatient examination or telephone interview. Patients were followed up according to the individual follow-up plan in the first 6 months after discharge, and then once every 3 to 6 months to detect tumor recurrence and survival up to May 2019. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were represented as M (range). Count data were expressed as absolute numbers or percentages. The Kaplan-Meier method was used to calculate survival rates and draw survival curves, and Log-rank test was used for survival analysis. Results:(1) Surgical situations: all the 50 patients underwent ELRA successfully, and postoperative pathological examination showed the R 0 resection rate was 100%(50/50). The operation time of the 50 patients were (630±186)minutes, of which 9 patients with liver benign occupation had the operation time of (684±168)minutes and 41 patients with liver malignant tumor had the operation time of (618±190)minutes. The operation time of temporary reconstruction of inferior vena cava and portacaval shunt, time of anhepatic phase, volume of intraoperative blood loss of the 50 patients were (35±9)minutes, (256±71)minutes, 2 000 mL(range, 400-10 000 mL), respectively. The remnant liver mass to standard liver mass ratio of the 50 patients was 65%±16%, of which 9 patients with liver benign occupation had the remnant liver mass to standard liver mass ratio of 63%±14% and 41 patients with liver malignant tumor had the remnant liver mass to standard liver mass ratio of 65%±17%. Of the 50 patients, 35 had vascular invasion (7 cases with liver benign occupation, 28 cases with liver malignant tumor), of which 24 (6 cases with liver benign occupation, 18 cases with liver malignant tumor) underwent in vitro vascular reconstruction, 12 (5 cases with liver benign occupation, 7 cases with liver malignant tumor) had bile duct invasion and underwent choledochojejunostomy due to the inability of the common bile duct to anastomose the ends. Two cases with liver metastasis of gastric cancer, one case with liver metastasis of colon cancer and one case with liver metastasis of pancreatic cancer underwent radical gastrectomy, radical resection of colon cancer, and pancreaticoduodenectomy, respectively. (2) Postoperative situations: the duration of postoperative hospital stay of the 50 patients were 25 days (range, 11-169 days). Of the 50 patients, 12 had pleural effusion who were treated with pleural puncture drainage, 10 had bile leakage who were treated with abdominal puncture drainage, 3 had bile duct anastomotic leakage who were treated with endoscopic nasobiliary drainage or biliary stent implantation, 6 underwent reoperation among which 4 underwent exploratory laparotomy due to abdominal hemorrhage, 1 underwent portal vein reconstruction due to abdominal hemorrhage combined with portal vein thrombosis, and 1 underwent salvage liver transplantation due to liver failure. Nine of the 50 patients died within 90 days after surgery, all of whom had liver malignant tumor. Among them, 3 died of multi-organ dysfunction syndrome caused by severe infection, 3 died of acute liver failure, 2 died of abdominal hemorrhage and 1 died pulmonary embolism. (3) Follow-up: all the 50 patients were followed up for 1 to 119 months. The overall survival time, 1-, 3-, 5-year overall and tumor-free survival rates of the 50 patients after operation were 17 months (range, 1-119 months), 68.0%, 45.9%, 41.1% and 41.9%, 33.4%, 30.8%, respectively. The overall survival time, 1-, 3-, 5-year overall and tumor-free survival rates of the 9 patients who with liver benign occupation after operation were 68 months (range, 10-114 months), 88.9%, 88.9%, 88.9% and 88.9%, 88.9%, 88.9%, respectively. The overall survival time, 1-, 3-, 5-year overall and tumor-free survival rates of the 41 patients who with liver malignant tumor after operation were 15 months (range, 1-119 months), 63.4%, 36.6%, 31.0% and 31.5%, 21.0%, 18.0%, respectively. There were significant differences in the overall and tumor-free survival rates between patients who with liver benign occupation and patients who with liver malignant tumor ( χ2=7.626, 11.766, P<0.05). Conclusions:ELRA can be applied in the treatment of liver complex space-occupying lesions. The selection criteria of patients with liver malignant tumor should be more rigorous to reduce perioperative mortality.

Effect of low-dose focused ultrasound pre-irradiation versus microbubbles for enhancing high-intensity focused ultrasound ablation of VXhepatic tumor in rabbits / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare the effect of low-dose focused ultrasound pre-irradiation and microbubbles for enhancing the ablation effect of high intensity focused ultrasound (HIFU) on VXhepatic tumor in rabbits.</p><p><b>METHODS</b>Fifty-five rabbits bearing VXhepatic tumor were randomly divided into low-dose pre-irradiation + HIFU ablation group, microbubbles+HIFU ablation group, and HIFU ablation group for corresponding treatments. The pathological changes in the tumors after low-dose irradiation, time for HIFU ablation, tumor volume with coagulative necrosis, energy efficiency factor (EEF), pathological changes in the ablated tumor, and sound channel of HIFU ablation were observed.</p><p><b>RESULTS</b>Tumor cell edema, vacuolar changes in the cytoplasm and tumor interstitial vascular congestion were observed 24 h after low-dose pre-irradiation. The ablation time were significantly shorter, coagulative necrosis volume was larger, and EEF was lower in low-dose irradiation + HIFU ablation group and microbubbles+HIFU ablation group than in simple HIFU ablation group (P<0.05), but the differences between the former two groups were not significant. The effectiveness and stability of the synergistic effect of low-dose pre-irradiation were inferior to microbubbles, but the former ensured a better safety of the sound channel.</p><p><b>CONCLUSION</b>Low-dose irradiation has comparable synergistic effect in HIFU with microbubbles with such advantages as non-invasiveness, high concentration and good safety, and can be a potentially new method to enhance the efficiency of HIFU.</p>

The new technology of enhanced radiofrequency ablation is safe and effective for treating giant hepatic hemangioma / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To determine the safety and efficacy of the enhanced radiofrequency ablation (RFA) new technology for treatment of giant hepatic hemangiomas.</p><p><b>METHODS</b>From August 2010 to September 2011, 30 patients with giant hepatic hemangiomas (average diameter: 7.7+/-1.9 cm, range: 5.0 to 12.8 cm) were treated with enhanced RFA. The original lesion diameter, enhanced radiofrequency duration, and cases of RFA-induced burning were recorded. Cases requiring a second RFA treatment were also recorded. Correlation analysis was carried out to determine the association of enhanced RFA with adverse events and change in lesion diameter.</p><p><b>RESULTS</b>The rate of completely destroyed lesions by enhanced RFA was 70.96%, and the total rate of reduced lesions was 87.1%. No severe adverse events occurred. The duration of enhanced radiofrequency correlated positively with the original lesion diameter (r=0.687, P less than 0.01). The enhanced RFA treatment significantly reduced the average lesion diameter (follow-up: 6.2+/-1.8 cm; t=6.417, P less than 0.01).</p><p><b>CONCLUSION</b>The new minimally-invasive technology of enhanced radiofrequency ablation is effective and safe for treating giant hepatic hemangiomas and produces an obvious, short-term curative effect.</p>

Potential value of event-related potentials and electroencephalogram in the early diagnosis of dementia / 中国综合临床

Objective To identify the potential value of event-related potentials ( ERPs ) and electroencephalogram(EEG) in early diagnosis of dementia.Methods From June 2008 to July 2011,113 patients with dementia were recruited fom First Affiliated Hospital of Anhui College of Traditional Chinese Medicine.Meanwhile,100 healthy individuals conducting physical examination at this hospital were collected as the control group.P300 and EEG were measured in patients and healthy controls.Results ( 1 ) Compared with healthy controls,patients with early diagnosis of dementia had significantly longer latency(402.5 ± 37.4)ms vs.( 320.4 ± 23.5 ) ms ;t =19.40 ; P =0.02 ) and lower amplitude of P300 ( 3.76 ± 1.76 ) μV vs.( 5.32 ± 1.38 )μV;t=7.24;P=0.01 ).(2)Significant higher proportionof abnormal EEG cases was found in individuals with dementia (68/113,60.2％ ) than that of participants in the healthy control group(34/100,34.0％ ) ( x2 =13.54,P ＜0.01 ).Specifically,patients with early diagnosis of dementia had significantly higher prevalence of moderate (26.5 ％ [ 18/68 ] vs.5.9 ％ [ 2/34 ] ; x2 =4.85,P =0.02 ) and severe ( 8.8 ％ [ 6/68 ] vs.2.9 ％ [ 1/34 ] ; x2 =1.22,P =0.02 ) abnormal EEG than healthy controls,while there were no significant difference of the proportions of mild or borderline abnormal EEG between the two groups ( P ＞ 0.05 ).Conclusion P300 is an extraordinary objective indicator for early diagnosis of dementia.EEG can provide evidence of impaired brain function for individuals with dementia.

The influence of non-ablating ultrasound pre-exposure on the efficacy of high intensity focused ultrasound in ablating VX2 liver tumors / 中华物理医学与康复杂志

Objective To assess the influence of pre-exposure to non-ablating ultrasound on the effect of high intensity focused ultrasound(HIFU)ablation.Methods Forty rabbits with transplanted VX2 tumors on their livers were divided into three pre-exposure groups(60 W,80 W and 100 W)and a control group(O W),with 10 rabbits in each group.Each group was pre-exposed to lower intensity focused ultrasound at the corresponding power.From each group,5 rabbits were randomly selected to be exposed to HIFU on the next day.Each group received 14scans.The rabbits were sacrificed 24 h later to take tissue samples for tfipheny tetrazolium chloride(TTC)staining to measure the amount of coagulative necrosis.Hematoxylin and eosin(HE)staining and succinate dehydrogenase (SDH)were also measured to observe the structure and activation of pre-exposed tumors.Results After HIFU exposure,the ablated volumes increased with pre-exposure acoustic intensity,and all volumes were larger than those in the control group.The ablating efficiency in the 100 W group was the highest.The pre-exposure did not itself ablate tumor tissue,but in the 80 W and 100 W groups the structure and activation of the tissues changed.Those in the 60 W group were not obviously altered.Conclusion Prior exposure to non-ablating ultrasound can highly enhance the efficacy of HIFU ablation.

Pathological regression of rabbit liver after low-dose irradiation with high intensity focused ultrasound / 中国医学影像技术

Objective To observe the pathological regression of rabbit liver after the low-dose irradiation with high intensity focused ultrasound (HIFU), and to explore the role and mechanism of the irradiation in changing acoustic environment of rabbit liver. Methods Pathological study was performed in 10 New Zealand white rabbits, the livers were observed under light and electron microscope. The observation was done immediately after low-dose HIFU irradiation and in 2, 3, 5, 7 days after the low-dose irradiation with HIFU. Results Light microscope changes: Edema existed in hepatocytes after irradiation instantly, congestion and aggravated edema were found at 2-3 days, then the injured cells recovered gradually. Electron microscope changes: Detached endothelial cells of hepatic sinusoid and swelling organelles were observed after irradiation, while 2 or 3 days later, erythrocyte aggregation was found in hepatic sinusoid and cavitation was found in cytoplasm. Thereafter, organelles swelling reduced till resumed to normal. Conclusion Low-dose HIFU irradiation can make corresponding changes to the acoustic environment of rabbit liver.

Comparison of Two Ways of Twice Irradiation on Rabbit Liver Tumor Using High Intensity Focused Ultrasound / 中国医科大学学报

Objective To compare the two ways of twice irradiation on the rabbit liver VX2 tumor using high intensity focused ultrasound (HIFU).Methods Totally 45 tumor-bearing rabbits were randomly divided into 3 groups:group A(one-time irradiation group) received a one-time ablation;group B and C(twice irradiation group) firstly received a low-dose irradiation(without ablation),then group B received ablation on the next day while group C received it 2 days later.Results Compared with one-time irradiation group,the total treatment time of twice irradiation group was not significantly different,but the time of each irradiation,the incidence of skin erythema and the energy efficiency factor(EEF)were less,and that of group B were the least.After ablation,the typical coagulation necrosis in tumor tissues occurred,and the recurrence and metastasis were effectively controlled in all the three groups.Conclusion The total treatment time and efficacy of twice irradiation were same as one-time ablation,but the time and dose of each irradiation significantly decreased,the damage efficiency was enhanced and the complications were reduced.The way of continuous two-days twice irradiation was the most effective,which would be a safe and effective method of HIFU treatment.

Endoscopic sphincterotomy for choledocholithtasis / 中华普通外科杂志

Objective To evaluate endoscopic sphincterotomy(EST)for the management of choledocholithiasis. Methods Between July 1987 and March 2007,991 cases of choledocholithiasis treated with EST were reviewed,and 710 cases were followed-up. Results All cases were treated with EST.The common bile duct stones were removed in 909 cases(91.7%,909/991).The rate of complications after EST was 6.0%(59/991)including pancreatitls in 29 cases(2.9%),hemorrhage in 18 cases(1.8%),cholangitis in 11 cases(1.1%),and duodenal perforation in 1 case(0.1%).There was no mortality in this group.Follow-up found reflux cholangitis in 51 cases(7.2%)and recurrent choledocholithiasis in 42 cases(5.9%). Conclusion Therapeutic endoscopy for choledocholithiasis is safe and effective.