Objective To understand the clinical features of peripheral cholangiocarcinoma (PC) developed against the background of hepatolithiasis. Methods Between 1995 and 2002, a total of 11 PC patients with definite history of hepatolithiasis were treated surgically in our hospital. The diagnosis, treatment and prognosis of this clinical entity were retrospectively analyzed. Results Peripheral cholangiocarcinoma occurred in 5 1% of patients with hepatolithiasis in this group and the tumor was located in the left lobe in 7 (64 7%) cases. All patients underwent laparotomy, with diagnosis established preoperatively in 3 (27 2%) cases and intraoperative diagnosis was missed in 2 (18 1%) cases. Radical resections were performed in only 3 (27 2%) cases. The overall operative morbidity and mortality were 72 7% and 9 1% respectively . Infection was the main postoperative complication. The postoperative 1 and 2 year survival rate was 33 3% and 11 1% respectively. Conclusions Cholangiocarcinoma may develope in patients with a history of hepatolithiasis. The prognosis of PC is still poor because of the difficulty to achieve early diagnosis and radical resection.

Objective　To investigate the operation treatment of gallbladder carcinoma(GBC). Methods The clinical data of 132 patients with GBC from 1980 to 1999 were analysed. Results　The mean age was 55 years and the occurrence sex ratio in female/male was 1.5∶1. Gallstone was found in 80% of the patients, and 87.1% of the GBC were adenocarcinoma. Before December 1990(forward group), simple cholecystectomy were performed on 11 cases, radical cholecystectomy on 9 cases, extended radical cholecystectomy on 5 cases, palliative extra- or intra- drainge on 15 cases, surgical biopsy on 30% cases. Hospital death occurred in 4 cases, the postoperative complications occurred in 20 cases including biliary fistula in 4 cases, pancreatic fistula in 2 cases. Since January 1991(latter group), radical simple cholecystectomy were performed on 2 cases, radical cholecystectomy on 16 cases, extended radical cholecystectomy on 24 cases; palliative extra- or intra- drainge in 9 cases, surgical biopsy on 8 cases. Hospital death occurred in 1 cases; postoperative complications in 12 cases, including biliary fistula in 1 cases, pancreatic fistula in 1 cases. Radical resection rate was 35.7% in forword group, 72.6% in latter group. Conclusions　Surgical tech-nique progress and application with Peng's Multifunctional Operative Dissector can improve the resection rate of GBC. Extended redical resection is an effective and active method to treat middle or late stage GBC.

Objective To evaluate the treatment modalities for local recurrent periampullary carcinoma. Methods From January 1997 to May 2007, 23 patients with local recurrent periampullary carcinoma underwent different therapy. The recurrent tumor was resected through laparotomy in 3 cases and the unresectable tumors were treated with radiofrequency ablation(RFA) in 5 patients. In 10 patients and 5 patients respectively high intensity focused ultrasound ( HIFU ) and regional chemotherapy ( RC ) were performed. Results The resection rate for local recurrent periampullary carcinoma was 13% in this group, 2 patients have survived for 10 months and 13 months respectively after reoperation while one patient achieved tumor-free survival for six months so far. The symptoms were alleviated to some extent in 20 patients treated with RFA, HIFU or RC. Conclusions Resection of local recurrent periampullary carcinoma may benefit a longer survival time, and the improvement of the quality of life. RFA, HIFU and RC are the alternative modalities for patients with unresectable tumors.