Background and purpose:Thermal ablation (radiofrequency ablation, RFA/microwave ablation, MWA) is the most commonly used minimally invasive technique for the treatment of liver cancer. Real-time shear wave elastography (SWE) is a new type of ultrasonic imaging technology, which was used in our study to monitor thermal ablation of liver cancer. This study aimed to investigate the stiffness change of liver cancer and that of surrounding liver parenchyma before and after thermal ablation, and to evaluate the application of SWE for monitoring thermal ablation for liver cancer.Methods:From Oct. 2014 to Apr. 2015, a total number of 36 patients, with 39 lesions, were treated with RFA or MWA and got complete response. SWE examination was performed before and after ablation. The SWE-mean, SWE-min, SWE-max, SWE-SD of lesions and the surrounding liver parenchyma were measured. Statistical analysis was made to compare the stiffness changes of liver cancer with those of the surrounding liver parenchyma before and after thermal ablation, and to determine whether there were differences between two different ablation modes.Results:Before and after ablation, the SWE-mean of lesions was (30.09±11.67) kPavs (52.11±17.56) kPa,SWE-min was (10.46±8.22) kPavs (20.57±11.42) kPa, SWE-max was (51.50±20.84) kPavs (88.54±27.75) kPa, SWE-SD was (10.63±4.30) kPavs (16.89±7.72) kPa; There were statistically signiifcant differences (P<0.05). Before and after ablation, the SWE-mean of surrounding liver parenchyma was (8.84±2.82) kPavs (8.91±2.78) kPa, SWE-min was (4.77±1.95) kPavs (4.69±1.90) kPa, SWE-max was (13.82±3.79) kPavs (14.34±3.97) kPa, SWE-SD was (3.24±1.32) kPavs (3.37±1.29) kPa; There were no statistically signiifcant differences (P>0.05). After ablation, the SWE-mean of RFA and MWA was (45.55±10.91) kPavs (60.59±20.99) kPa, SWE-min was (18.95±8.86) kPavs (25.93±10.93) kPa, SWE-max was (76.58±15.51) kPavs (104.01±32.59) kPa, SWE-SD was (13.82±3.52) kPavs (20.85±9.77) kPa; There were statistically signiifcant differences (P<0.05).Conclusion:SWE can quantitively analyze the stiffness of lesions. The ablation zone became stiffer after RFA or MWA, and the ablation zone of MWA was stiffer than that of RFA. Two kinds of ablation methods did not signiifcantly affect the stiffness of liver parenchyma around the lesion. SWE could potentially be used to monitor thermal ablation of liver cancer.

OBJECTIVETo conduct a systematic review of the safety and efficacy of enhanced recovery after surgery(ERAS) program in perioperative management of pancreaticoduodenectomy.

METHODSA computerized search was performed in databases including PubMed, Embase, Medline, Web of Science, Cochrane Library, CNKI, Wanfang and VIP for randomized controlled trials (RCTs) or clinical controlled trials (CCTs) describing an ERAS program in patients undergoing pancreaticoduodenectomy published between January 1966 and May 2014. After assessment of methodological quality and data extraction, meta-analysis was performed using RevMan 5.2.0 software.

RESULTSSix RCTs and 8 CCTs including 2565 patients were selected for this study, including the study group(n=1366) and the control group (n=1199). Compared with the control group, the study group had a shorter length of hospital stay(WMD=-3.67, 95% CI:-5.66--1.68, P<0.05), lower postoperative complication rate(OR=0.73, 95% CI:0.56-0.95, P<0.05) and lower mortality(OR=0.63, 95% CI:0.44-0.91, P<0.05). However, no significant differences existed in mortality, readmission rate and re-operation rate between the two groups.

CONCLUSIONSEnhanced recovery after surgery programme in perioperative management of pancreaticoduodenectomy is safe and effective. But due to the medium quality of the literature. This still need more rigorously designed RCTs to prove the safety and efficiency of ERAS programme for the patients undergoing pancreaticoduodenectomy.

Humans ; Length of Stay ; Pancreaticoduodenectomy ; Postoperative Complications