Objective To evaluate laparoscopic continuous circulatory hyperthermic intraperitoneal chemotherapy (CHIPC) in the treatment of malignant ascites from peritoneal carcinomatosis.Methods From March 2006 to March 2008, 21 patients of malignant ascites secondary to peritoneal carcinomatosis received CHIPC with three courses of treatment for each patient. The first course was performed in operation room under general anesthesia, the second and third were performed in patients ward or intensive care unit (ICU), NS solution of mitomycin-C and cisplatin was delivered by continuous circulatary perfusion into peritoneal cavity at a rate of 500 ml/min for 90 min with an inflow temperature of 43 degrees C. Results Intraoperative course was uneventful in all cases, and mean operative time was (80 ± 18) min. There was no postoperative deaths and severe complications. After treatment patients KPS KPS (Karnofsky,KPS)grades rose from 10-40, with an average rise of (22.2 ± 2.4) (P ＜ 0.01). After laparoscopic CHIPC, clinical complete regression of ascites and related symptoms was achieved in 19 patients, and partial remission achieved in 2 patients. Follow-up was made to all patients until the death which occurred at post laparoscope-assisted CHIPC 1 - 9 months, with a median survival time of 6 months.Two patients who underwent partial remission suffered from port site seeding and tumor metastasis leading to death after treatment at 1 and 2 months respectively. Conclusions Laparoscopy-assisted CHIPC is effective for the treatment of malignant ascites from inoperable peritoneal carcinomatosis and improves the quality of life of these patients.

Objective To study the image segmentation, three-dimensional (3D) reconstruction and simulation operation of choledocholithotomy and T-tube drainage based on the computed tomagraphy (CT) data of patient with choledocholithiasis. Methods Patient with choledocholithiasis underwent 64-slice spiral CT imaging. The images segmentation and 3D reconstruction were performed by Medical Image Process System (MIPS) to construct the 3D model of the hepatobiliary system. The model was modified by FreeForm Modeling System. The virtual surgical instruments were developed by GHOST SDK software, and were imported to the virtual surgery. Results The data of plain, arterial phase, venous phase and portal venous phase scanning were collected, and the data stored in DICOM format were transformed to BMP format. A model of the hepatobiliary system was constructed after the data was segmented by MIPS, and then the model was exported in the STL format. The data in STL format were imported to FreeForm Modeling System for smoothing the model. Different structures were assigned different colors to make the model more vivid. The self-developed virtual surgical instruments were imported to the system, and the virtual surgery for choledocholithiasis was performed with PHANToM. Conclusions With the help of MIPS, the image segmentation and 3D reconstruction of the model are finished rapidly and effectively. After the virtual surgical instruments are developed in FreeForm Modeling System, the virtual surgery can be achieved in the 3D model with the assistance of PHANToM.

Objective To investigate the effective regimen to treat the hepatitis C virus (HCV) recurrence after orthotopic liver transplantation (OLT). Methods The clinical data of 4 cases of HCV recurrence after OLT were retrospectively analyzed. Of the 4 cases, there were 3 cases of HCV related liver cirrhosis and 1 case of HCV related liver cirrhosis in combination with hepatocellular carcinoma. The immunosuppression regimen as FK506, MMF and corticosteroids was used after OLT. As soon as HCV recurrence was confirmed by liver biopsy during 8 to 12 weeks after OLT, pegylated interferonα-2a (PEG-IFNα-2a) and ribavirin (RIB) were used for 48 weeks. PEG-IFNα-2a was started at a dose of 180 μg per week subcutaneously and RIB at a dose of 1000 mg per day orally, respective-ly. Blood routine, liver and kidney function test, HCV-RNA and transplanted liver biopsy were per-formed when necessary and biochemical response, sustained virologic response and histological re-sponse were tested in due time. Remits All of the 4 cases except for 1 achieved sustained virologic re-sponse and the liver function was as normal as before. The histological activity index was improved significantly for both inflammatory activity and fibrosis according to liver biopsy in 0, 48, 72 week srespectively. Case 4 was given corticosteroids for consecutively 3 days when acute rejection was veri-fied by liver biopsy and the condition improved. None of them stopped treatment or withdrew from them directly. Conclusion The combination of PEG-IFNα-2a and RIB was an effective regimen to treat the HCV recurrence after OLT and the side effects could be overcame easily.

Objective　To study the effect and safety of radiofrequency ablation (RFA) in the treatment of liver cancer.Methods　The clinical data of prospectively and non-randomly selected 102 liver cancer patients were analysed. Results　102 patients with a total of 216 tumors were found in this series, the size of hepatomas were 1.5 to 14*!cm in diameter (average 4.9*!cm in diameter). In 67 of primary liver hepatocellular carcinoma, the tumors' size were smaller than 5*!cm in diameter in 21 cases; 35 with secondary liver tumors. RFA were performed under the guidance of ultrasonography in 43 cases, under CT in 50, under laparoscopy in 3, and 6 were performed during open surgery. All patients received ultrasonography and CT scanning of liver one month after the ablaton. The echoes of the tumors were stronger, and the area of the echo reached was larger than pre-ablation; blood flow in the tumor obviously reduced and even disappeared in sonography; CT showed that the shadow density in the tumor was diminished. Of the 102 patients, 14 underwent 18-FDG-PET imaging 30 days after the ablation, of them, 11 showed defect of radiation in the tumor, 3 showed residual locus in the tumor. 2 of the 3 cases underwent RFA again and the residual was disappeared completely, the another subject to ethanol injection because of advanced age. All the patients were followed up for 3-18 months. Except 6 patients with late metastastic liver cancer died within 1 year after RFA, the other 96 cases remained alive now, the 1-year survival rate was 94.1%. Conclusions　RFA is a new ideal therapy for liver cancer. It is safe, effective, and good tolerance with little trauma.

Objective To investigate the clinical efficacy and safety of hyperthermic intraperitoneal perfusion chemotherapy (HIPC) in treatment of advanced colorectal cancer.Methods The Meta-analysis was applied to analyze 8 randomized controlled quantitative studies published at domestic and abroad.These patients treated by HIPC after radical operation with colorectal cancer were included for the treatment group,and those treated only by radical operation with colorectal cancer for the control group.Relative risk (RR) of outcome variable of 3-year and 5-year survival rate and safety between the two groups were compared.Results There were 8 selected literatures,including 1 501 cases,in which 765 cases for treatment group,and 736 cases for control group.RR of 5-year survival rate of the total patients was 2.39 (95% CI:1.66-3.45).RR of 3-year survival rate of the total patients was 2.13 (95% CI:1.45-3.13).The results demonstrated that HIPC could improve 5-year and 3-year survival rate,and sensitivity analysis confirmed the conclusions more reliable.The security was described in 5 literatures,the available information showed smaller potential security issue.Conclusions HIPC after radical operation of advanced colorectal cancer can increase 5-year and 3-year survival rate of patients,improve the prognosis of patients.Whether patients with increased incidence of postoperative complications related to the HIPC is no clear-cut conclusions for lack of related research.

Objective To investigate the effect of radiofrequency ablation(RFA) in the treatment of small liver cancer.Methods In recent 6 years,130 patients with primary or secondary liver cancer(≤5cm in diameter)were treated by RFA,among which 86 cases were primary,and 44 cases were secondary liver cancer.Among the 130 cases,18 received RFA plus TAEC,and 20 had RFA combined with PEI.Results Overall 1-and 3-year survival rate was 91.3% and 77.7% respectively.Complications occurred in 7 cases,including biliary fistula,intestinal fistula,and slight burn of skin.There was no death in this series.Conclusions RFA is an effective and safe therapeutic approach for small liver cancer ≤5cm in diameter.Its effect may be similar to that of surgical resection.

Objective To evaluate the use of three-dimensional reconstruction (3D) to improve the success rate in the first attempt of radiofrequency ablation (RFA) for small hepatocellular carcinoma (HCC).Methods A retrospective study was conducted on 109 patients with small HCC (with single nodule from 3 to 5 cm in diameter) treated with radiofrequency ablation between June 2010 and June 2013.A safe ablation margin was evaluated before and after radiofrequency ablation.The patients were divided into two groups: the 3D-RFA group (49 patients were evaluated by three-dimensional reconstruction before RFA treatment) and the 2D-RFA group (60 patients were not evaluated by three-dimensional reconstruction before RFA treatment).The success rate of the first attempt of radiofrequency ablation, recurrence free survival, overall survival and complications were compared between the two groups.Results The success rate of first ablation reached 95.9％ (47/49) in the 3D-RFA group which was significantly higher than the 48.3％ (29/60) in the 2D-RFA group (P ＜ 0.05).The local tumor progression rate was 8.1％ in the 3D-RFA group versus 23.3％ in the 2D-RFA group (P ＜0.05).The 1-, 2-, 3-year recurrence free survival rates were 85.4％, 63.9％, and 49.8％ respectively in the 3D-RFA group and 72.4％, 43％, and 34.4％ respectively in the 2D-RFA group (P ＜ 0.05).The 1-, 2-, 3-year overall survival rates were 91.4％,78.4％, and 60.9％ respectively in the 3D-RFA group and 83.3％, 58.7％, and 40.9％ respectively in the 2D-RFA group (P ＜0.05).Complications occurred significantly less in the 3D-RFA group (4％, 2/49) than the 2D-RFA group (13.3％, 8/60;P ＜ 0.05).Conclusion Three-dimensional reconstruction improved the success rate of the first attempt of radiofrequency ablation and the prognosis of patients, and with less complications for small hepatocellular carcinoma.

OBJECTIVETo compare the long-term outcomes of Billroth-I and Roux-en-Y reconstruction after distal gastrectomy.

METHODSClinical data of 151 patients with gastric cancer undergoing distal gastrectomy in the Affiliated Oncologic Hospital of Guangzhou Medical University between June 2000 and June 2010 were analyzed retrospectively. Reconstruction was performed with Billroth-I in 87 patients (B-I group) and Roux-en-Y in 64 (R-Y group). All the patients were followed up for at least 3 years. Three years after operation, clinical symptoms, endoscopic findings, nutritional status, gallstone formation, and late gastrointestinal complications were compared between the two groups.

RESULTSThree years after operation, gastroesophageal reflux symptoms were found in 10 patients (11.5%) in B-I group and in 3 (4.7%) in R-Y group, and dumping syndrome was diagnosed in 8 patients (9.2%) in B-I group and in 3 (4.7%) in R-Y group, but the differences between the two groups were not statistically significant (both P>0.05). Endoscopic examination showed that the amount of residue in the gastric stump, remnant gastritis-reflux esophagitis, and bile reflux in R-Y group were better as compared to B-I group (all P<0.05). Body weight, serum albumin level, and total cholesterol level were similar in the two groups (all P>0.05). The incidences of gallstone formation and late gastrointestinal complications did not differ between B-I group and R-Y group (13.2% vs. 15.8%, and 8.0% vs. 4.7% respectively, both P>0.05).

CONCLUSIONAs compared with Billroth-I, Roux-en-Y is associated with better long-term outcomes in terms of less remnant gastritis-reflux esophagitis and less bile reflux into the gastric remnant.

Aged ; Anastomosis, Roux-en-Y ; Female ; Follow-Up Studies ; Gastrectomy ; Gastroenterostomy ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Stomach Neoplasms ; surgery ; Treatment Outcome

Objective To compare the long-term outcomes of Billroth-Ⅰ and Roux-en-Y reconstruction after distal gastrectomy. Methods Clinical data of 151 patients with gastric cancer undergoing distal gastrectomy in the Affiliated Oncologic Hospital of Guangzhou Medical University between June 2000 and June 2010 were analyzed retrospectively . Reconstruction was performed with Billroth-Ⅰ in 87 patients (B-Ⅰgroup) and Roux-en-Y in 64 (R-Y group). All the patients were followed up for at least 3 years. Three years after operation, clinical symptoms, endoscopic findings, nutritional status , gallstone formation , and late gastrointestinal complications were compared between the two groups. Results Three years after operation, gastroesophageal reflux symptoms were found in 10 patients (11.5%) in B-Ⅰ group and in 3 (4.7%) in R-Y group , and dumping syndrome was diagnosed in 8 patients (9.2%) in B-Ⅰ group and in 3 (4.7%) in R-Y group, but the differences between the two groups were not statistically significant(both P>0.05). Endoscopic examination showed that the amount of residue in the gastric stump, remnant gastritis-reflux esophagitis, and bile reflux in R-Y group were better as compared to B-Ⅰ group(all P<0.05). Body weight, serum albumin level, and total cholesterol level were similar in the two groups (all P>0.05). The incidences of gallstone formation and late gastrointestinal complications did not differ between B-Ⅰgroup and R-Y group (13.2% vs. 15.8%, and 8.0% vs. 4.7% respectively, both P>0.05). Conclusion As compared with Billroth-Ⅰ, Roux-en-Y is associated with better long-term outcomes in terms of less remnant gastritis-reflux esophagitis and less bile reflux into the gastric remnant.

Objective To compare the long-term outcomes of Billroth-Ⅰ and Roux-en-Y reconstruction after distal gastrectomy. Methods Clinical data of 151 patients with gastric cancer undergoing distal gastrectomy in the Affiliated Oncologic Hospital of Guangzhou Medical University between June 2000 and June 2010 were analyzed retrospectively . Reconstruction was performed with Billroth-Ⅰ in 87 patients (B-Ⅰgroup) and Roux-en-Y in 64 (R-Y group). All the patients were followed up for at least 3 years. Three years after operation, clinical symptoms, endoscopic findings, nutritional status , gallstone formation , and late gastrointestinal complications were compared between the two groups. Results Three years after operation, gastroesophageal reflux symptoms were found in 10 patients (11.5%) in B-Ⅰ group and in 3 (4.7%) in R-Y group , and dumping syndrome was diagnosed in 8 patients (9.2%) in B-Ⅰ group and in 3 (4.7%) in R-Y group, but the differences between the two groups were not statistically significant(both P>0.05). Endoscopic examination showed that the amount of residue in the gastric stump, remnant gastritis-reflux esophagitis, and bile reflux in R-Y group were better as compared to B-Ⅰ group(all P<0.05). Body weight, serum albumin level, and total cholesterol level were similar in the two groups (all P>0.05). The incidences of gallstone formation and late gastrointestinal complications did not differ between B-Ⅰgroup and R-Y group (13.2% vs. 15.8%, and 8.0% vs. 4.7% respectively, both P>0.05). Conclusion As compared with Billroth-Ⅰ, Roux-en-Y is associated with better long-term outcomes in terms of less remnant gastritis-reflux esophagitis and less bile reflux into the gastric remnant.