ObjectiveTo study the clinical value of changes of serumα-fetoprotein(AFP) and soluble cell adhesion molecule-1(sICAM-1) levels before and after surgical treatment of primary hepatocellular carcinoma(PHC) as predictors of patient survival. MethodsThe clinical data and followed-up results of 86 patients with hepatocellular carcinoma received hepatectomy or radiofrequency ablation(RFA) in Xijing Hospital and the 451st Hospital of PLA were retrospectivly analyzed. The changes of peripheral blood AFP and sICAM-1 levels in patients before and in 1 month after treatment were observed and all patients were divided into different groups according to the changes in both two markers. Then survival rates of each group were analyzed. ResultsThe patients with AFP < 20μg/L or sICAM-1 < 1 000 U/L before treatment had lower tumor recurrence rate and higher survival rate than patients with elevated serum levels of the both markers(AFP:P=0.018, P < 0.001;sICAM-1:P=0.027, P < 0.001). The larger tumor, late TNM stage, and higher rate of recurrence were associated with elevated serum levels of the both markers(AFP:P=0.016, P=0.026 and P=0.025;sICAM-1:P < 0.001, P=0.024 and P=0.032). The better survival situation was closely related with these cases treated with hepatectomy and their levels of both markers were lower than the above cutoff values both before and after treatment, or leves of both markers above the cut-off values returned to within the normal range after treatment (AFP:P=0.006, P=0.001;sICAM-1:P=0.001, P=0.002). The patients who had simultaneous increase of AFP and sICAM-1 after operation showed the worst tumor-free and overall survivals(P=0.007, P < 0.001). ConclusionTo test the changes of serum AFP and sICAM-1 levels in early stage after treatment for patients who received radical resection of hepatocellular carcinoma has good clinical value for monitoring of tumor recurrence and predict prognosis.
目的探讨腹腔镜在腹部外伤诊断与治疗中的应用价值。方法 对36例腹部外伤患者行腹腔镜探查术，首先明确诊断，根据不同的损伤脏器和类型，进行腹腔镜下处理，处理困难或无效时及时中转开腹。结果本组病例术中均明确诊断。10例开放性腹部外伤中，胃破裂伤2例，肝裂伤2例，脾破裂1例，小肠破裂伤2例，大网膜损伤1例，肠系膜血管破裂1例，单纯腹壁裂伤1例。26例闭合性腹部外伤中，胃破裂2例，肝破裂7例，脾破裂12例，小肠破裂2例，肠系膜血管破裂1例，单纯腹膜后血肿2例。于腹腔镜下行缝合、修补、电凝、明胶海绵止血等治疗20例（55.6%），10例（27.8%）未做特殊处理，6例（16.6%）中转开腹。本组病例术中出血量为55~1 800 ml（平均520 ml），手术时间为60~186 min（平均128 min）。 所有病例均放置腹腔引流2~5 d（平均3 d），住院时间3~16 d（平均9 d）。全组均无气腹相关并发症和死亡病例。结论腹腔镜诊治腹部外伤具有创伤小、诊断率高、恢复快等优点，大部分病例还可在腹腔镜下达到诊治一体化的目的。