Objective To evaluate the feasibility,safety,and efficacy of laparoscopic radiofrequency ablation(RFA) for the treatment of hepatic cavernous hemangioma(HCH) in patients with liver cirrhosis.Methods A total of 15 patients with HCH and liver cirrhosis received laparoscopic RFA under general anesthesia between March 2001 and August 2005.There were 6 men and 9 women,with a mean age of 46.2?7.0 years.All the patients had complained of obvious symptoms of abdominal discomfort,pain,or fullness. The etiologic factor of liver cirrhosis was hepatitis B in 13 patients and hepatitis C in 2 patients.The Child classification revealed grade A in 10 patients and grade B in 5 patients.A total of 20 liver lesions located on the surface of the liver or adjacent to the gallbladder,with a mean diameter of 7.2?1.4 cm,were identified preoperatively in the 15 patients by ultrasonography,helical CT scans,or MRI.The platelet count was(31.2?10.4)?10~9/L.Co-morbidities included chronic calculous cholecystitis in 3 patients and diabetes mellitus in 2 patients.Laparoscopic ultrasonography and liver biopsy were routinely performed during the operation.Results Laparoscopic RFA was successfully performed in all the 15 patients and laparoscopic cholecystectomy was conducted simultaneously in 3 patients.The ablation time per lesion was 68.8?34.0 min,and the total operative time was 120.0?28.0 min.No severe complications,such as intraperitoneal hemorrhage,gastrointestinal injury,diaphragmatic injury,bile leakage,and liver function failure,developed during and after the operation.Complete tumor necrosis was achieved in all the 20 lesions(100%,20/20) on contrast-enhanced helical CT scans 1 month after the treatment.During a follow-up period of 5~31 months,symptoms completely disappeared in 13 patients and significantly subsided in 2 patients.Conclusions Laparoscopic radiofrequency ablation is a feasible,safe,and effective treatment for hepatic cavernous hemangioma complicating liver cirrhosis.

Objective To investigate the feasibility and efficacy of surgical resection combined with radiofrequency ablation (RFA) for multifocal hepatocellular carcinomas (HCC) in patients with cirrhosis. Methods A total of 18 patients with multifocal HCCs and liver cirrhosis was treated between August 2003 and January 2006. Forty-six hepatic lesions were identified preoperatively by ultrasonography, helical CT, or MRI. Ten patients were found as having 2 lesions, 6 patients having 3 lesions, and 2 patients, 4 lesions. Under general anesthesia, segmental hepatectomy for major lesions (with a 2cm resection margin) and RFA therapy for minor lesions were performed. Results The combination therapy was performed successfully in all the 18 patients. A cholecystectomy was performed simultaneously for gallstones in 2 patients, and a splenectomy with para-esophagogastric devascularization was performed for portal hypertension in 1 patient. The surgical resection time was 37.4?8.8 min, the RFA time per lesion was 25.6 ? 8.9 min, the total RFA time was 39.8 ?14.7 min, the total operative time was 152.4?30.8 min, and the intraoperative blood loss was 465.6 ? 171.0 ml. No severe complications, such as intraabdominal hemorrhage, gastrointestinal tract injury, diaphragmatic injury, and liver function failure, developed after operations. No residual tumor was found on the margin of surgical resection and a complete lesion necrosis was achieved in the RFA regions on contrast-enhanced helical CT scanning 1 month after the procedure. During a follow-up period for 6~31 months (mean, 15.5 months), 5 patients were diagnosed as having new malignant nodules and were given a percutaneous RFA therapy. Out of the 5 patients, one died from tumor recurrence and lung metastases, and two patients died from liver failure at 7 and 16 months after treatment, respectively. Conclusions Surgical resection combined with RFA therapy is a feasible, safe, and effective treatment for proper patients with multifocal HCCs and liver cirrhosis, preserving impaired liver functions to the greatest advantages.

The core of hospital management is to strengthen and upgrade medical quality and secure satisfactory medical service through the mobilization of manpower,fund and materiel.The Lanzhou Aumy Hospital has gradually perfected the medical quality control system of a general hospital in combi- nation with the hospital's management system and in consideration of the development of modern hospi- tal administration in recent years.The operational law of the system is also studied and formulated.

Objective To investigate the effect of dexmedetomidine on cognitive dysfunction after offpump coronary artery bypass grafting in patients.Methods Fifty-eight ASA physical status Ⅱt or Ⅲ patients,aged 51-63 yr,weighing 52-83 kg,undergoing off-pump coronary artery bypass grafting,were randomly divided into 2 groups (n =29 each):control group (group C) and dexmedetomidine group (group D).Anesthesia was induced with midazolam,etomidate,sufentanil and pipecuronium.The patients were thracheal intubated and mechanically ventilated.Anesthesia was maintained with propofol,sufentanil,isoflurane and pipecuronium.A loading dose of dexmedetomidine 1 μg/kg was infused over 15 min after tracheal intubation,followed by dexmedetomidine infusion at 0.5 μg· kg-1 · h-1 until the end of operation in group D,while the equal volume of normal saline was infused in group C.Cognitive function was assessed by Mini-Mental State Examination (MMSE) at 24 h before operation and 24,48 and 72 h after operation.The development of postoperative cognitive dysfunction was recorded within 72 h after operation.The consumption of sufentanil and extubation time after extubation was recorded.Results Compared with group C,MMSE scores at 24 and 48 h after operation were significantly increased and the incidence of postoperative cognitive dysfunction within 72 h after operation was decreased (P ＜ 0.05),and no significant change was found in the consumption of sufentanil and extubation time in group C (P ＞ 0.05).Conclusion Dexmedetomidine can decrease the development of postoperative cognitive dysfunction after off-pump coronary artery bypass grafting in patients.