Computed tomographic differentiation between alcoholic and gallstone pancreatitis:Significance of distribution of infiltration or fluid collection

瞄准：评估各种各样的计算断层摄影术(CT ) 的实用性在区分尖锐胰腺炎的主要病原学的渗入或液体收集的调查结果包括分发。方法：我们考察了酒鬼的尖锐胰腺炎的 75 个相对严重的盒子(n = 43 ) 或胆汁的石头(n = 32 ) CT 上的病原学有渗入或液体收集。我们比较了胆汁的演算，和膨胀的胰腺的尺寸，分级的 CT，存在或缺席胰腺或胆汁管。我们也在每个组评估了度和渗入和液体收集的分发。结果：胰的尺寸不在醇基和石头组之间是不同的。醇基显示出比石头组分级的更高的 CT (P 【 0.05 ) 。胆汁的石头和管膨胀的存在在区分病原学是统计上重要的(P 【 0.05 ) 。醇基显示出胰腺的病理比在仅仅的石头组离开了的显著地突出的仙子腹分隔空间(P = 0.020 ) 。结论：含酒精的胰腺炎趋于形成更多的突出的仙子胰腺的变化比在相对严重的盒子中的胆石胰腺炎。这在左腹部的前面的方面上是明显的。尽管临床的历史和一些 CT 调查结果通常是病原学的一个主要决定因素，胰腺的病理可以有的仙子的这个模式在在暖昧的盒子中决定尖锐胰腺炎的病原学的一个辅助角色。

Current status of radiofrequency ablation of hepatocellular carcinoma

Loco-regional treatments for hepatocellular carcinoma(HCC) are important alternatives to curative transplantation or resection.Among them,radiofrequency ablation(RFA) is accepted as the most popular technique showing excellent local tumor control and acceptable morbidity.The current role of RFA is well documented in the evidence-based practice guidelines of European Association of Study of Liver,American Association of Study of the Liver Disease and Japanese academic societies.Several randomized controlled trials have confirmed that RFA is superior to percutaneous ethanol injections in terms of local tumor control and survival.The overall survival after RFA is comparable to after surgical resection in a selected group of patients with smaller(< 3 cm) tumors.Currently,the clinical benefits of combined RFA with transarterial chemoembolization for intermediate stage HCC are increasingly being explored.Here we review the ongoing technical advancements of RFA and future potential.

Concurrent and subsequent radiofrequency ablation combined with hepatectomy for hepatocellular carcinomas

Partial hepatectomy has long been the standard treatment modality for patients with hepatocellular carcinoma(HCC),although the majority of patients with HCCs are not candidates for curative resection.Radiofrequency ablation(RFA) has been widely used as the preferred locoregional therapy.RFA and hepatectomy can be complementary to each other for the treatment of multifocal HCCs.Combining hepatectomy with RFA permits the removal of larger tumors while simultaneously ablating any smaller residual tumors.By using this combination treatment,more patients might become candidates for curative resection.For treating recurrent tumors involving the liver after hepatectomy,RFA has been performed recently instead of transcatheter arterial chemoembolization or ethanol ablation.Many retrospective studies on the combination of RFA and hepatectomy demonstrate favorable results of effectiveness and safety.However,further investigation of prospective design will be needed to confirm these encouraging results.

Single hepatocellular carcinoma ≤ 3 cm in left lateral segment:Liver resection or radiofrequency ablation?

AIM:To evaluate the long-term results of radiofrequency ablation(RFA)compared to left lateral sectionectomy(LLS)in patients with Child-Pugh class A disease for the treatment of single and small hepatocellular carcinoma(HCC)in the left lateral segments.METHODS:We retrospectively reviewed the data of133 patients with single HCC(≤3 cm)in their left lateral segments who underwent curative LLS(n=66)or RFA(n=67)between 2006 and 2010.RESULTS:The median follow-up period was 33.5mo in the LLS group and 29 mo in the RFA group(P=0.060).Most patients had hepatitis B virus-related HCC.The hospital stay was longer in the LLS group than in the RFA group(8 d vs 2 d,P<0.001).The 1-,2-,and 3-year disease-free survival and overall survival rates were 80.0%,68.2%,and 60.0%,and 95.4%,92.3%,and 92.3%,respectively,for the LLS group;and 80.8%,59.9%,and 39.6%,and 98.2%,92.0%,and 74.4%,respectively,for the RFA group.The disease-free survival curve and overall survival curve were higher in the LLS group than in the RFA group(P=0.012 and P=0.013,respectively).Increased PIVKA-Ⅱlevels and small tumor size were associated with HCC recurrence in multivariate analysis.CONCLUSION:Liver resection is suitable for single HCC≤3 cm in the left lateral segments.

Hepatic resection vs percutaneous radiofrequency ablation of hepatocellular carcinoma abutting right diaphragm

BACKGROUND It is usually difficult to adequately conduct percutaneous ultrasound-guided radiofrequency(RF) ablation for hepatocellular carcinomas(HCCs) abutting the diaphragm. Our hypothesis was that the subphrenic location of HCC could have an effect on the long-term therapeutic outcomes after hepatic resection and RF ablation.AIM To compare the long-term therapeutic outcomes of hepatic resection and percutaneous RF ablation for HCCs abutting the diaphragm.METHODS A total of 143 Child-Pugh class A patients who had undergone hepatic resection(n = 80) or percutaneous ultrasound-guided RF ablation(n = 63) for an HCC(≤ 3 cm) abutting the right diaphragm were included. Cumulative local tumor progression(LTP), cumulative intrahepatic distant recurrence(IDR), disease-free survival(DFS), and overall survival(OS) rates were estimated. Prognostic factors for DFS and OS were analyzed. Complications were evaluated.RESULTS The cumulative IDR rate, DFS rate, and OS rate for the hepatic resection group and RF ablation group at 5 years were "35.9% vs 65.8%", "64.1% vs 18.3%", and"88.4% vs 68.7%", respectively. Hepatic resection was an independent prognostic factor for DFS(P ≤ 0.001; hazard ratio, 0.352; 95%CI: 0.205, 0.605; with RF ablation as the reference category); however, treatment modality was not an independent prognostic factor for OS. The LTP rate was 46.6% at 5 years for the RF ablation group. The major complication rate was not significantly different between the groups(P = 0.630). The rate of occurrence of peritoneal seeding was higher in the RF ablation group(1.3% vs 9.5%, P = 0.044).CONCLUSION Although OS was not significantly different between patients who had gone hepatic resection or percutaneous RF ablation for HCCs abutting the diaphragm,DFS was better in the hepatic resection group.