Objective To evaluate the effectiveness and safety of percutaneous hepatic cryoablation combined with percutaneous ethanol injection(PEI) for patients with hepatocellular carcinoma (HCC) unsuitable for surgical resection. Methods One hundred and five masses in 65 HCC patients underwent percutaneous hepatic cryoablation. The cryoablation was performed using Argon gas as a cryogen in the Cryocare System. Two freeze thaw cycles were performed, each reaching a temperature of -180 ℃ at the tip of the probe. PEI was given 1 or 2 weeks after cryoablation and then once a week for 4 6 weeks in 36 patients with tumor mass larger than 6 cm in diameter. Absolute alcohol(100%) was slowly injected into periphery zone of cancerous tissues in liver. Results During average 16 months follow up duration (ranging 5 to 21 months), 32 patients(49.2%) were alive without tumors, and 22 patients (33.8%) were alive with tumor recurrence: two had bone metastases, three lung metastases and the remaining 17 tumor recurrences in the liver, of whom only 3 developed at a cryoalbation site. Among 41 patients who had been followed up more than one year, there were 32(78%) patients who were alive with or without tumor recurrence. Eight patients (12.3%) died of tumor recurrence. Three patients(4.6%) died of noncancer related causes. Among 43 patients who had undergone CT scan, 38 ( 88.4% ) had a shrinkage of tumor mass. Among 22 patients who had received biopsies of cryoablated tumor mass, all but one biopsy showed necrotic or scar tissues. Serum AFP in 91.3% of the patients whose serum AFP had increased before cryoablation returned to normal or nearly normal levels during postoperative 3 6 months. Complications of cryoablation included liver capsular cracking in one patient, transient thrombocytopenia in 4 patients and asymptomatic right sided pleural effusions in 2 patients. Two patients developed liver abscess at the previous cryoablation sites after postoperative 2 and 4 months respectively and recovered after the treatment with antibiotics and drainage. Conclusions Percutaneous cryoablation may offer a safe and effective option for patients with HCC that cannot be surgically removed.

In an effort to overcome the inherent setbacks of private hospitals in the upcoming healthcare reform, and empower them to build people-benefit hospitals by learning the concept of scientific development, a business model is proposed. This model is designed based on analysis of their development characteristics and in combination of the business specifics, advocating a pool of the guidance force of people-benefit concept, the force of business integrity, that of differentiated competition, and that of self restraint.

Objective To discuss the clinical value of magnetic resonance diffusion-weighted imaging (MR-DWI) in distinguishing tumor remnants from tumor necrosis of pancreatic carcinoma after cryoablation treatment.Methods Conventional MRI T1WI,T2WI scan,DWI sequence and dynamic enhanced MRI scan were performed in 26 patients with pancreatic carcinoma who were received cryoablation treatment.The changes in MRI signals after cryoablation treatment were recorded.The apparent diffusion coefficient (ADC) values of the normal pancreas,preoperative tumor tissue,postoperative remnants and necrosis tissue were calculated,and the results were compared.The correlation between the ADC values and the size of the tumor was evaluated,and the differences in ADC values among the tumors that had different diameter,location and staging were statistically analyzed.Results Of the 26 patients,complete necrosis of tumor was obtained in 16.The necrotic tumor tissue displayed low-signal on T1WI,high-signal on T2WI and low-signal on DWI,with no enhancement on dynamic enhanced imaging.Active residual tumor tissue was detected in 9 patients,among them the residual tumor diameter ＞5 cm was seen in 7 patients;the residual rate was 34.6％.ADC values of the following tissue,from low to high in order,were preoperative pancreatic tumor tissue (1.022± 0.126)x10-3 mm2/s,postoperative residual tumor tissue (1.130±0.155)x10-3 mm2/s,normal pancreatic tissue (1.924±-0.124)×10-3 mm2/s and postoperative necrosis tissue (2.312-±0.214)×10-3 mm2/s.No statistically significant difference in ADC values existed between preoperative pancreatic tumor tissue and postoperative residual tumor tissue (P=0.452),while statistically significant difference in ADC values existed between normal pancreatic tissue and postoperative necrosis tissue (P＜0.001).The ADC values of pancreatic tumor tissue bore a negative correlation with the tumor size (R=-0.43,P=0.027 2),while the ADC values lacked the relationship to the tumor location as well as to the tumor staging (P=0.738 8 and P=0.089 5 respectively).Conclusion MR-DWI can effectively distinguish the residual tumor tissue from the necrotic tumor tissue of pancreatic carcinoma after cryoablation treatment,which provides reliable basis for further clinical diagnosis and treatment.

Objective To explore the application value of the lower leg perforator flaps in repairing soft tissue defect on ankle.Methods From January 2007 to December 2012,62 cases of soft tissue defect on ankles have been repaired.The defects were combined with tendon and/or bone exposure for all the cases,among them 7 cases were exposure or sinus tract after achilles tendon rupture surgery,8 cases with ankle or intertarsal joint defect and exposure,24 cases with distal tibia fracture,or medial malleolus fracture,or lateral malleolus fracture,or calcaneus fracture,11 cases with different level of infection.Fifteen cases were primarily repair,and 47 cases were secondly repair or extended phase.The cases were repaired by applying different types retrograde transferred perforator pedicle flaps of lower legs,with 10 cases of posterior tibial artery perforator flaps on the medial malleolus,12 cases of front top flaps of com peroneal artery on external ankle,40 cases of back top flaps of peroneal artery on external ankle.The sizes of the flap ranged from 4.0 cm ×5.5 cm to 9.0 cm × 15.0 cm.Ten cases were applied direct suturing in donor site,and other cases were applied skin grafts to repair the defect.Results Flaps in 56 cases completely survived.Partial necrosis appeared in 3 cases of front top flaps of peroneal artery on external ankle,one perforator flap of posterior tibial artery on the medial malleolus and 2 cases of back top flaps of peroneal artery on external ankle.All these cases recovered after careful dressing changes.Sixty two cases were followed up for 3-12 months.Texture of flaps was soft with good elasticity.All of the donor skin grafts in patients survived.Conclusion Perforator flaps have the advantage of easy operation,little damage to the main blood vessels,high reliability in flap survival,less destroy to donor site.It is important that individualized flap is selected given different position of defect.

ObjectiveTo evaluate the diagnostic value of ultrasound or CT guided percutaneous Trucut needle biopsy on the diagnosis of pancreatic tumors.Methods One hundred and twenty-four patients clinically diagnosed as pancreatic cancer without pathological diagnosis underwent percutaneous pancreatic biopsy by using Trucut needle under ultrasound or CT guidance.ResultsOne hundred and nine procedures of ultrasound-guided biopsy and 15 procedures of CT-guided biopsy were performed,and one patient received 2.3times of punctures.Tissue samples were obtained in all 124 patients,the diagnostic accuracy was 95.2％,among them 115 were adenocarcinoma,5 were cystadenoma,2 were metastasis cancer,1 was cancer of unknown origin and 1 was normal.The sensitivity,specificity,and accuracy were 99.2％ 100％,and 99.2％,respectively.Transient serum amylase increase was observed in 3 patients; 5 patients' abdominal pain aggravated,but all recovered with conservative management.One patient was found to have tumor seeding on the spot of insertion after 34 days.No other major complications occurred.ConclusionsUltrasound or CTguided percutaneous pancreatic 16 ～ 18G Trucut needle biopsy is a safe and simple procedure with excellent diagnostic value for pancreatic cancer.

Objective To evaluate the efficacy of transarterial chemoembolization (TACE) and percutaneous cryosurgery sequential therapy for unresectable hepatocellular carcinoma (HCC).Methods Four hundred and twenty patients with unresectable HCC were divided into sequential TACE-cryosurgery sequential (sequential) group (n=290) and cryosurgery alone (cryoalone) group (n = 130). TACE was performed with the routine operation; the percutaneous cryosurgery was conducted 2 to 4 weeks after TACE. The patients were followed up at the first month and once every 2 to 3 month later. Liver ultrasound or both computer tomography and alpha fetal protein were examined during follow-up. Results During a mean follow-up of (42±17) months (range from 24 to 70 months), the local recurrence rate of ablated lesion was 17% for all the patients, 11% and 24% for patients in sequential group and cryoalone groups respectively (P=0. 001). The overall 1-, 2-, 3-, 4-and 5-year survival rate was 72%, 57%, 47%, 39% and 31%, respectively. The 1- and 2-year survival rates (71% and 61 % ) in sequential group were similar to those (73 % and 54 % ) in cryo-alone group (P=0.69 and 0. 147), while the 4- and 5-year survival rates were higher in sequential group (49 % and 39 % ) than those (29 % and 23 % ) in cryo-alone group (P= 0.001). Eighteen patients with large HCC (＞5 cm in diameter) in sequential group survived for more than 5 years while no one in cryo-alone group. Complication rate was 24% in all patients, 21% and 26% for the sequential and cryo-alone groups respectively (P=0. 06). The incidence of hepatic bleeding was higher in cryo-alone group than in sequential group (P=0. 02). Liver crack occurred in two patients of the cryoalone group. Conclusions Pre-cryosurgical TACE increased the cryoablation efficacy and decrease its complications, especially hepatic bleeding. TACE and cryosurgery sequential therapy may be a better treatment for unresectable HCC, especially for large HCC.

Objective To observe the blood biochemical and histological changes before and after pancreas freezing, to provide evidence for cryosurgery for pancreatic cancer. Methods Fifteen healthy pigs were divided into deep frozen group (n = 5), shallow frozen group (n = 5), non-frozen group (n = 3) and normal group (n = 2). After anesthesia and Iaparotomy, a probe of the Argon-Helium Surgical System was inserted into the pancreas, 100% and 10% argon output power were used in deep and shallow frozen group, respectively;and the temperature were - 130 ～ - 140℃ and - 110 ～ - 120℃, respectively;which results in an ice-ball with 15 ～ 20 mm in diameter. Then helium gas was inputted to increase the temperature to 10 ～ 20℃ for three minutes;then the whole process was repeated. A probe was inserted into the pancreas in the non-frozen group only and only laparotomy was performed in non-grozen group normal group and normal group. Serum amylase, IL-6, CRP levels before and after the experiment was determined;the pigs were sacrificed at day 7 and the pancreas was harvested for light microscope and electron microscope examination. Results The frozen pancreatic tissue became pitchy necrosis zone, and it could be distinguished from non-frozen tissue;there were obvious tissue necrosis in the center and para-center of frozen area, and the ultra-structure were destroyed and disappeared, mitochondria degranulation and rough endoplasmic reticulum degrannlation were observed. Serum amylase was elevated in 13 (86.7%) pigs and most returned to normal at 6th day. Serum IL-6 was slightly elevated in 5 (33.3%) pigs. There was no significant difference among all the groups in term of serum CRP. All the pigs were alive until the time of sacrifice. Conclusions Cryosurgery has affirmative fatal ablative effects on pancreatic tissue, and it is safe with no serious complications.

Objective To explore the safety and short?term efficacy of irreversible electroporation (IRE)ablation which is a novel ablation technology in unresectable hepatic neoplasms. Methods Patients with pathologically diagnosed as liver cancer or liver metastases were prospectively enrolled. The patients were not suitable for surgery with PS score ≤ 2. Exclusion criteria included who was not tolerate general anesthesia, severe liver and kidney dysfunction, and with cardiac pacemaker. A total of 16 patients were included in this study. There was 12 males and 4 females, aged 40 to 86 years with mean age (60 ± 10)y. Ultrasound and CT guided percutaneous IRE ablation was performed. Perioperative hemodynamic changes were reviewed. Liver and kindey function before and 7 d after ablation was compare by t test. The adverse reactions within 30 d after ablation treatment were recorded. CT and MR scans within 1 month were performed and the 30 d curative effect was evaluated by the modified RECIST criteria. Results All patients received IRE treatment successfully, and some patients experienced adverse reactions within 30 days after ablation, including abdominal pain in 7 cases, peritoneal effusion in 5 cases, hydrothorax in 4 cases, fever in 3 cases, cough, nausea and vomiting in 2 cases, biliary tract infection and thrombocytopenia in 1 case. After symptomatic treatment, these symptoms were improved. Severe complications, such as massive haemorrhage and bile leakage didn't occur. At 30 days after ablation, the curative effects were evaluated. Complete response (CR) was achieved in 1 patient , partial response (PR) was achieved in 12 patients, stable disease (SD) was in 2 patients , and progressive disease(PD) was 1 patients . The tumor relief rate (complete response+partial response) was 81.3%. Conclusions IRE ablation in the treatment of unresectable hepatic malignant tumor could have many advantages, including high safety, mild adverse reactions, and short?term efficacy. However, its long?term effect still need further observation.

Objective To observe the adverse reaction, tumor response and short term outcomes of percutaneous cryoablation for locally advanced pancreatic cancer, and investigate its feasibility. Methods Fifty-nine consecutive patients with locally advanced, unresectable pancreatic cancer underwent percutaneous cryoablation at our hospital from Sept. 2008 to Sept. 2009, were prospectively studied. Percutaneous cryoablation was performed with an argon/helium-based cryosurgical system under the guidance of ultrasound.Freezing probe was inserted into the center of pancreatic mass and two cycles of freezing were performed with each cycle for 5 min and temperature at-160℃, then the temperature was returned to normal for 10 min.Serum amylase was detected before operation and 1 to 7 days postoperatively. CT or PET-CT scanning was performed for evaluation of tumor response every 4 to 6 weeks after cryoablation. Survival was assessed by Kaplan-Meier method. Results 59 patients had a total of 76 biopsy-proven tumors, which were located at the pancreas head (n = 56), body (n = 7), and tail (n = 13). The median size of tumor was 4.5 cm (range 3 ～6 cm). Nineteen patients had liver metastases. Postoperative abdominal pain occurred in 45 cases (76.3%),fever occurred in 29 cases (49.2%) and elevation of serum amylase occurred in 34 cases (57.6%). Severe complications including intra-abdominal bleeding, pancreatic leaks, ileus, and metastasis by probe tract occurred in 5 cases (8.5%). There was no death associated with cryoablation. The median hospital stay was 21 days. 2 patients (3.4%) achieved complete response, 23 patients (39.0%) achieved partial response,30patients (50.8%) had stable disease, 4 patients(6.8%) had progressive disease. The median survival was 8.4 months. The overall survival at 3, 6 and 12 months was 89.7%, 61.1% and 34.5%, respectively.Conclusions Ultrasound-guided percutaneous cryoablation appears to be a safe and feasible, minimally invasive technique for locally advanced pancreatic cancer.

Objective This study compares a dual-freeze protocol with a triple freeze protocol for hepatic cryoablation in the Tibetan pig model.Method Cryoablation with a dual-(10-5-10-5 min)and triple-freeze (5-5-5-5-10-5 min) protocol for the normal livers of 9 Tibet pigs was performed under exposed operation.Temperature changes of cryoprobes and diameter changes of iceballs were measured during the ablation,and seven days later the pathological changes of cryozones were reviewed and the surface and depth cryolesions were measured.Results Compared with cryoablation with two freeze-thaw cycles,there was a greater iceball diameter for cryoablation by three freeze-thaw cycles.Also,seven days after cryosurgery,there were similar surface and deep cryolesions in dual-and triple-freeze protocols.Pathologically,the triple freezing protocol was associated with a longer zone of complete necrosis.Conclusions With the same freezing time (20 min),the triple-freeze protocol may become a more powerful liver-ablation method in cryosurgical application.