Objective To analyze the application of bipolar radiofrequency-assisted device or monopolar radiofre-quency-assisted ablation in treatment for liver cancer by operation. Methods From June 2008 to May 2012， 56 patients with liver cancer underwent operation with bipolar radiofrequency-assisted device （Habib group， n=22） or monopolar radiofrequency-assisted ablation （mRFA group， n=34） were selected retrospectively. The operation time， postoperative morbidity， hospital stay， hospital costs， intraoperative bleeding， and therapeutic effects were compared in two groups. Results The percentage of patients with liver cirrhosis was 85.7% （48/56）， with multiple tumors was 12.5% （7/56）， underwent laparoscopic operation was 16.1% （9/56）. Patients with the tumor diameter greater than 5 cm in the Habib group were more than that in the mRFA group （P=0.000）， the laparoscopic surgery proportion had no significant difference in two groups （P=0.074）. ① The intraoperative bleeding in the Habib group was more than that in the mRFA group （P=0.000）. Two patients were adopted a hepatic portal blocking and 3 patients with intraoperative blood transfusion in the Habib group. ② The operation time in the Habib group was longer than that in the mRFA group （P=0.021）， but there was no difference of the operation time in two groups patients with tumor diameter greater than 5 cm （P=0.191）. ③ The postoperative morbidity had no obvious difference in two groups 〔18.2% （4/22） versus 11.8% （4/34）， P=0.780〕. ④ Thehospital stay and the hospital costs in the Habib group were significantly more than those in the mRFA group （P=0.001， P=0.004）.⑤The tumor residuals were found in two patients with tumor diameter greater than 5 cm. Conclusions Treatment for liver cancer by operation with bipolar radiofrequency-assisted device or monopolar radiofrequency-assisted ablation is safe and effective. The monopolar radiofrequency-assisted ablation has advantages of less intraoperative bleeding， more minimal invasion proportion， less hospital stay and hospital costs for liver cancer patients with small tumor （diameter＜3 cm）， multifocal tumors and minimal invasion conditions as compared with bipolar radiofrequency-assisted device. Operation with bipolar radiofrequency-assisted device in patients with larger tumors （diameter≥5 cm） resection might be a better choice.
ObjectiveTo discuss the indications of the nonoperative management for perforated peptic ulcer. MethodsClinical data of 145 patients with perforated peptic ulcer, aged below 70 years old, with first attack and onset timelt;12 h , admitted to our hospital between January 2002 and December 2009, were analyzed respectively. Patients who were negative for fluid of abdominopelvic cavity in ultrasound examination and leakage in watersoluble contrast examination received nonoperative management, otherwise underwent operation directly (If the patients were being on medication for the ulcer, they should also go directly to surgery). Non-operative patients were converted to operation if the symptom had not relieved during the first 12 h. When admitted , the APACHE Ⅱ score was calculated for all patients. ResultsSeventy-four and 71 patients underwent non-operative management and operation directly respectively. Sex, age, onset time, perforation site and so on were comparable between the two groups （Pgt;0.05）, while APACHE Ⅱ score over 8 was 25.7% and 76.1% respectively with significant difference (P=0000). In nonoperative group, 11 (149%) patients were converted to operation. The mortality (4.1% vs 9.8%, P=0.203), mobility (16.2% vs 25.3%, P=0.175), hospital stay 〔(11.4±2.5) d vs (11.3±1.3) d, P=0.447〕, and cost 〔(11 657.3±2 826.4) yuan vs (10 013.0±1 877.4) yuan, P=0.212〕 between two groups had also no significant difference. The mean APACHE Ⅱ score was significant different between the survivors and the dead (9.3 vs 20.2, P=0.000). APACHE Ⅱ score was positively related to mortality and morbility （r=0.98, P=0.000； r=0.52, P=0.000）. ConclusionsNon-operative management is a safe and effective way in selected patients with perforated peptic ulcer, such as APACHE Ⅱ score ≤8, negative for fluid of abdominopelvic cavity in ultrasound examination, and leakage in water-soluble contrast examination. APACHE Ⅱ score is an important factor in prognosis of these patients.