Objective:To study the treatment outcome of percutaneous image-guided radiofrequency ablation(RFA)for larger hepatocellular carcinomas(with the maximal diameter longer than 4 cm)and to summarize our experience.Methods:From December,1999 to March,2007,441 patients with larger hepatocellular carcinomas,who had missed the best time for surgery, received RFA treatment in our department.The maximal diameter of the tumor was 4-8.2 cm,with a mean of(4.6?0.63)cm. The patients were followed up and the necrosis of the tumor,complication,local recurrence and survival of patients were observed.Results:The complete necrosis rate of tumors was 72.9%.The rate of RFA-associated complication was 20.9% and the rate of severe complication was 9.5%.Seven patients died of RFA.Valid follow-up data of 359 patients were obtained, including 379 tumors with diameter longer than 4 cm.A total of 302 tumors were completely necrotic and 130 of them had recurrence,with a recurrence rate of 43.0%.For patients with a tumor diameter of 4-5 cm,the 1-year,3-year,and 5-year survival rates were 78.2%,48.1%s,and 17.6%,respectively,with a median survival period of 27 months;for patients with a tumor diameter of 5-6 cm,the rates were 66.3%,36.4% and 9.7%,respectively,with a median survival period of 18 months;for patients with a tumor diameter longer than 6 cm,the rates were 53.6%,28.1%,and 0,respectively,with a median survival period of 11 months.Conclusion:RFA is an effective treatment for patients with larger HCC who are not suitable for surgery,but the patients should be selected according to the indications.

Objective:To study the risk factors and treatment of lymphatic fistulas after the radical operation of gastric cancer.Methods:Observed the clinical data of 631 cases after the radical operation of gastric cancer that had been received in our hospital from February 1998 to February 2008.Multiple factor analysis with logistic regression was performed for the risk factors.Results:The level of post-operative serum albumin on the first day and Ultrasonically activated shears are protective facrors against lymphatic fistulas(P

Nuclear reconstitution around Lambda DNA in a cell-free system from Xenopus eggs involves distinct steps at ultrastructural level. First, Lambda DNA polymers were induced to form chromatin-like structures with the proteins in egg extracts. Then, along with membrane vesicles and nuclear pore components attached to them to assemble double nuclear membranes, these chromatin-like structures underwent variations from condensation to decondensation, simultaneously. It is different from the nuclear reconstitution induced by chromatin in that, while membrane vesicles were attaching to the chromatin-like structures to fuse each other, the assembly of nuclear pore complexes occurred practically.

Objective: To analyze the risk factors, prevention and treatment of needle-tract bleeding after percutaneous image-guided radiofrequency ablation (PRFA) for hepatocellular carcinomas (HCC). Methods: A total of 1 567 RFA sessions were performed on 1 203 patients with 3 067 focuses of hepatocellular carcinoma between December 1999 and January of 2008. The clinical data of patients suffering from needle-tract bleeding were analyzed for risk factors, prevention, and treatment. Results: Seventeen (1.08%,17/1 567) patients developed needle-tract bleeding. Univariate analysis showed that the incidence of needle-tract bleeding was significantly correlated with the lower platelet count,prolongation of prothrombin time,the degree of liver cirrhosis,subcapsular HCCs and pattern of RF needle electrode (P=0.039; P=0.023; P=0.012; P=0.032 and P=0.016, respectively). Logistic regression model found that only lower platelet count,prolongation of prothrombin time,degree of liver cirrhosis and subcapsular HCCs were the independent risk factors for needle-tract bleeding after PRFA in patients with hepatocellular carcinoma (OR=4.032,P=0.040;OR=5.611,P=0.009;OR=3.871,P=0.046 and OR=5.216,P=0.026, respectively). Of the 17 patients 5 received only medicine therapy in the internal department,4 received surgery and 10 received transcatheter embolization. Thirteen patients survived and 4 died. Conclusion: It is indicated that prolongation of prothrombin time,lower platelet count, sub-capsular HCCs and pattern of RF needle electrode can influence the needle-tract bleeding after PRFA in hepatocellular carcinoma patients. The most effective methods to control the bleeding are transcatheter embolization and DSA or surgery for HCC patients after PRFA.

Objective: To investigate the factors affecting the intrahepatic infection after percutaneous radiofrequency ablation (PRFA) for liver cancers. Methods: The clinical data of 1 567 patients with intrahepatic infection after PRFA for liver cancers (from Dec. 1999 to Oct. 2007) were retrospectively summarized. Logistic regression method was used to analyze the possible affecting factors. Results: Twenty-eight person-times of intrahepatic infection occurred in 1 635 patients who received a total of 2 035 times of PRFA, with the infecting rate being 1.38%. The intrahepatic infection-related mortality was 0.13% (2/1 567). Univariate analysis indicated that the intrahepatic infection was significantly correlated with metastatic liver cancer, pattern of past abdominal operation, tumor location, tumor size and tumor numbers (P<0.05). Multivariate analysis showed that the types of liver cancer, tumor number, tumor location and pattern of past abdominal operation were independent risk factors for intrahepatic infection after PRFA for liver cancers(r=3.647, P=0.004; r=1.155, P=0.042; r=1.701, P=0.019; r=2.213, P=0.010, respectively). Conclusion: Our findings suggested that patients with metastatic liver cancer(especially for the patients who have received gastroenterostomy or cholangioenterostomy), multi-liver cancer, and cancers locating near the cavity organs are liable to intrahepatic infection after PRFA.

Objective: To study the treatment outcome of percutaneous image-guided radiofrequency ablation (RFA) for larger hepatocellular carcinomas (with the maximal diameter longer than 4 cm) and to summarize our experience. Methods: From December, 1999 to March, 2007, 441 patients with larger hepatocellular carcinomas, who had missed the best time for surgery, received RFA treatment in our department. The maximal diameter of the tumor was 4-8. 2 cm, with a mean of (4.6 ± 0.63) cm. The patients were followed up and the necrosis of the tumor, complication, local recurrence and survival of patients were observed. Results: The complete necrosis rate of tumors was 72.9%. The rate of RFA-associated complication was 20.9% and the rate of severe complication was 9.5%. Seven patients died of RFA. Valid follow-up data of 359 patients were obtained, including 379 tumors with diameter longer than 4 cm. A total of 302 tumors were completely necrotic and 130 of them had recurrence, with a recurrence rate of 43.0%. For patients with a tumor diameter of 4-5 cm, the 1-year, 3-year, and 5-year survival rates were 78.2%, 48.1%s, and 17.6%, respectively, with a median survival period of 27 months; for patients with a tumor diameter of 5-6 cm, the rates were 66.3%, 36.4% and 9.7%, respectively, with a median survival period of 18 months; for patients with a tumor diameter longer than 6 cm, the rates were 53.6%, 28.1%, and 0, respectively, with a median survival period of 11 months. Conclusion: RFA is an effective treatment for patients with larger HCC who are not suitable for surgery, but the patients should be selected according to the indications.

Objective To explore the surgical diagnosis of pediatric empyema, treatment and surgical operation opportunity. Methods From July 2003 to March 2009, 55 cases were treated , and plcural effusion was punctured in 2 cases. Closed drainage of thoracic cavitythe was done under local anesthesia in rest cases. 21 case fully recovered and 32 cases were taken pleural decortication. One case was taken pleural decortication and thoracoplasty. Results There was no operative mortality. After follow - up of 3 to 24 months, there was no recurrence , no complications such as thoracic deformity. Conclusion Pediatric empyema need timely diagnosis and active conservative treatment. Once fluidify absorbed slowly and there was persistent tendency, operation need to be done as soon as possible. After pleural decortication, we can get satisfied therapeutic effect.

Objective To evaluate the therapeutic effectiveness of echo-guided percutaneous radiofrequency ablation(RFA) by using a LeVeen needle electrode combination in the treatment of large liver tumor,and to discuss the relationship between the amount as well as the distribution pattern of the electrodes and the therapeutic effectiveness.Methods During the period of Feb.2006-Dec.2008,echo-guided RFA was performed in 113 patients with large and unresectable liver tumor,with a total of 118 lesions.According to the size of the tumor,the patients were divided into four groups.The tumor’s diameter of Group A(n = 64) was 4.0-5.0 cm,Group B(n = 28) was 5.1-6.0 cm,Group C(n = 11) was 6.1-7.0 cm and Group D(n = 10) was 7.1-9.3 cm.Based on the tumor’s diameter,the amount of the electrodes to be used and the sites to be ablated were determined.After the procedure,the follow-up checks with MRI or CT scanning were carried out to observe the necrotic extent and the local recurrence.Results Two months after the treatment,the complete necrosis rate of the tumor in Group A,B,C and D was 88.4%,78.6%,63.6% and 40.0%,respectively,with an overall necrosis rate of 79.7% in total 118 lesions.During a follow-up period of 3-36 months,the local recurrence rate in Group A,B,C and D was 5.5%,10.0%,28.6% and 50.0%,respectively.Severe complications,including intrahepatic infection(n = 2),puncture passage bleeding(n = 1),symptomatic pleural effusion(n = 4) and biloma(n = 2),occurred in 9 cases.No death related to RFA treatment occurred.Conclusion Echo-guided percutaneous radiofrequency ablation by means of multi-sites superimposition method with a LeVeen needle electrode combination is an safe and effective therapy for the hepatic tumors with the diameter over 4 cm.

Objective To investigate the feasibility,safety and effectiveness of percutaneous biliary stenting combined with brachytherapy in treating unresectable Klatskin's tumor,and to discuss the effect of this combination treatment on jaundice recurrence and survival.Methods The clinical data of 21 patients with unresectable Klatskin's tumor (combination group),who were admitted to Department of Interventional Oncology,Shanghai Renji Hospital during the period from February 2014 to December 2015 to receive percutaneous biliary stenting combined with brachytherapy,were retrospectively analyzed;and other 28 patients,who were admitted to hospital to receive pure biliary drainage or bare metal stent implantation during the same period,were collected and used as the control group.The success rate of operation,the effect of reducing jaundice and postoperative complication rate were calculated,and the differences in survival time and jaundice recurrence time were compared between the two groups.Results A total of 32 bare metal stent sand 580 125I seeds were implanted in the 21 patients of the combination group,the success rate of operation was 100％,and the effective rate of treatment was 85.7％.The early postoperative complication rate was 9.5％,and no procedure-related death occurred.The median jaundice recurrence time in the combination group was 344 days,while it was 193 days in the control group (P=0.035).The median survival time in the combination group was 387 days,which was strikingly longer than 256 days in the control group (P=0.022).Conclusion For the treatment of unresectable Klatskin's tumor,percutaneous biliary stentingcombined with brachytherapy,used as a palliative therapeutic regimen,is safe,effective and feasible,it can delay the recurrence of jaundice and prolong the survival time.(J Intervent Radiol,2017,26:243-248)