Laparoscopic radiofrequency ablation of hepatic cavernous hemangioma. A preliminary experience with 27 patients.

BACKGROUND: Radiofrequency ablation (RFA), currently used extensively for liver tumors, also has been applied successfully to hepatic cavernous hemangioma (HCH) percutaneously. The aim of this study was to assess the feasibility, safety, and efficacy of laparoscopic RFA for patients with HCHs. METHODS: Between March 2001 and March 2004, 27 patients with symptomatic and rapid-growth lesions were treated by laparoscopic RFA using the RF-2000 generator system. The treatment-related complications were observed. All the patients were followed up with helical computed tomography scans and ultrasonography at regular intervals to assess the therapeutic efficacy of laparoscopic RFA. RESULTS: This study assessed 9 men and 18 women with a mean age of 41.6 +/- 8.3 years. Three additional intrahepatic lesions missed preoperatively were found in three patients on intraoperative ultrasound. A total of 27 patients with 50 liver lesions were treated successfully with laparoscopic RFA. The mean maximum tumor diameter was 5.5 +/- 2.0 cm. The mean length of time for RFA per lesion was 20.7 +/- 11.9 min, and the mean blood loss was 134.4 +/- 88.9 ml. Laparoscopic cholecystectomy was performed simultaneously for gallstones in 13 patients and for abutting of gallbladder from hemangioma in 2 patients. In addition, 3 patients also had a laparoscopic deroofing of simple hepatic cysts. Although postoperative low-grade fever and transient elevation of serum transaminase levels were observed in 13 patients, there were no complications related to laparoscopic RFA. During a median follow-up period of 21 months (range, 12-42 months), complete lesion necrosis was achieved for all the patients. CONCLUSIONS: Laparoscopic RFA therapy is a safe, feasible, and effective treatment option for patients with symptomatic and rapid-growth HCHs located on the surface of the liver or adjacent to the gallbladder. Intraoperative ultrasonography is a useful adjunct for detecting additional liver lesions and offering more accurate targeting for RFA.

[Experience in the surgical treatment of hepatic hydatidosis].

Of 1290 cases of hydatidosis hospitalized, 907 (70.3%) cases of hepatic hydatid cyst (HHC) were treated surgically (1954-1990). Of the 907 cases, 484 (53.3%) were males and 423 (46.7%) females. Hepatic hydatid cysts were single in 54%, multiple in 21.2% and complicated with hydatid cysts of other organs in 24.8%. 67.5% of the cysts were in the right lobe of the liver, 15.6% in the left lobe, 16.9% in both lobes. 79.0% were situated in the right lower part of the liver, 21.0% on the dome of the liver. Rupture of the cysts into biliary system, peritoneal cavity, the thorax (pulmonary-bronchial tree) and the pericardial sac were 35 (30%), 50 (42.6%), 31 (26.5%) and 1 case (0.9%) respectively. There were 5 deaths. Our experiences include: (1) routine intravenous drip of corticosteroids to alleviate the possible occurrence of allergic reaction during the operation and postoperative hyperpyrexia. (2) mebendazole or albendazole (ABZ) 20 mg/kg/d for one week before operation and 1-2 courses (1 course = 30 days) after operation to destroy the protoscoleces left in the body during operation. (3) antibiotics administration in complicated cases. (4) closure of intrahepatic biliary fistula.

[Protoscolicidal effect of some chemical agents and drugs against Echinococcus granulosus].

The present paper reports the protoscolicidal action of hydrastine, ether-acetic acid-ethanol admixture, H2O2, pyquiton and albendazole through in vitro or in vivo exposure, for 15 minutes and transplantation studies. The mortality of protoscolices in vitro and in vivo were 70.2% and 68.9% for 0.3% hydrastine, 56.8% and 56.2% for 10% ether-acetic acid-ethanol admixture, 6.0% and 8.8% for 0.3% H2O2; 6.1% for 0.004% pyquiton in vitro and 5.0% were 10% and 25% for 0.3% hydrastine, 30% and for 0.004% albendazole in vitro. The survival rates after transplantation of protoscolices 37.5% for 10% ether-acetic acid-ethanol admixture, 100% and 95% for 0.3% H2O2 respectively. Disruption of external plasma membrane, hook detachment, sucker deformity of protoscolices exposed to hydrastine were demonstrated by scanning electron microscopy. It is suggested that hydrastine exerts a profound intracellular effect on the protoscolex of E. granulosus of sheep and man, and might be a promising protoscolicide as adjuvant to hydatid surgery.

[Effect of d-hydrastine on the ultrastructure of experimental Echinococcus granulosus cyst in mice].

The ultrastructural changes in the germinal membranes of Echinococcus granulosus cysts treated with d-hydrastine (3.75 mg/(kg.d), ig) for 20 d were studied. Cysts from d-hydrastine treated mice were shown by transmission electron microscope to have dissolution of the microtriches, disturbance of organelles in their arrangement, dilatation and disruption of microtubules, increase in size and number of lysosomes, a decrease in number of Golgi complexes and lessening in density and swelling of mitochondria. Under scanning electron microscope, many pits arising from the outer and inner surfaces of the germinal membrane were observed. It seems that d-hydrastine has a profound intracellular effect on experimental Echinococcus granulosus cysts in mice, and that it may be a promising drug for treating hydatidosis.