Objective　To introduce clinical diagnostic specificity of hepatocellular carcinoma (HCC) with serum AFP level in 21μg/L to 200μg/L. Methods　Making a literature summarizaton based on the papers review.Results and Conclusions　(1) The AFP level more than 20μg/L can be used as a diagnostic criteria of HCC when existing liver space occuping lesion (SOL). (2) The clinical diagnostic criteria using AFP level more than 20 μg/L instead of more than 200 μg/L would be helpful to avoid misdiagnosis of HCC with the AFP level in 21 μg/L to 200 μg/L. (3) The Combination of AFP level more than 20 μg/L with ultrasonography, CT scanning would have higher sensitivity and specificity than single diagnostic method.

Objective To introduce clinical diagnostic specificity of hepatocellular carcinoma (HCC) with serum AFP level in 21*!?g/L to 200*!?g/L. Methods Making a literature summarizaton based on the papers review.Results and Conclusions (1) The AFP level more than 20*!?g/L can be used as a diagnostic criteria of HCC when existing liver space occuping lesion (SOL). (2) The clinical diagnostic criteria using AFP level more than 20 ?g/L instead of more than 200 ?g/L would be helpful to avoid misdiagnosis of HCC with the AFP level in 21 ?g/L to 200 ?g/L. (3) The Combination of AFP level more than 20 ?g/L with ultrasonography, CT scanning would have higher sensitivity and specificity than single diagnostic method.

ObjectiveTo investigate the value of low positive AFP level for the diagnosis of hepatocellular carcinoma (HCC) when a space occuping lesion (SOL) was already identified in the liver.MethodsUsing randomized controlled clinical trial,a clinical epidemiological analysis was made based on the result of surgery and pathology proven hepatic SOL of 2?878 cases admitted from January 1993 to June 2001.In this series,there were 2?362 HCC cases, among which 424 HCC cases were with a low positive AFP level(between 21 and 200??g/L) which constitutes the basis of our analysis.ResultsIn HCC and non HCC groups,the sensitivity,specificity and positive predictive value were 69 9%(1?650/2?362) vs.8 9%(46/516) ( P

Objective To investigate the clinical value of intraoperative iodine-125 seed implanttation in treating pancreatic carcinoma. Methods Seventy-five patients (fourty-one men, thirty-four women;median age 54 years) with pancreatic adenocarcinoma were enrolled into the study. Thirty-one patients (group A) were accepted tumor resection,eighteen patients(group B) were implanted radioactive iodine-125 seeds into the tumors by a combination of bypass surgery, twenty-six patients(group C) were treated by bypass surgery.Results Sixty-seven patients were followed up. The median survival time was 19, 12 and 7 months in group A,B,C respectively, among which the difference was significant (P ＜ 0.05). The response rate(CR+PR) was 50 % and the effective rate of pain relieving was 80% in the group B. The 97.4 % of accordance rate of seed number was demonstrated by CT film, but the accordance rate of seed space distribution was only 56 %.Conclusion At present, the active resection of the pancreatic carcinoma, including the superior mesenteric vein and the retropancreatic fusion fascia, is essential for a curative resection. The combination of Intraoperative iodine-125 brachytherapy and bypass surgery is safe and effective for pancreatic carcinoma.The seed space distribution completed by seed computer therapeutic plan needs further study.

The clinical data were retrospectively analyzed for 21 cases of liver neoplasms undergoing laparoscopic hepatectomy from December 2007 to October 2012.Among 11 cases of borderline hepatocellular carcinoma (HCC) (1.0-9.0 cm),6 of them were of micro hepatocellular carcinoma (MHCC) with a diameter ≤2 cm.There were 10 cases of borderline hepatic benign tumor,including liver hemangioma (n =7),hepatic adenoma (n =1),liver lymphoma (n =1) and liver focal necrosis (n =1).According to Couinaud's liver segmentation method,neoplasm was located on segment Ⅲ (n =13),segment Ⅳ (n =6),segment Ⅴ (n =1) and segment Ⅵ (n =1).Laparoscopic hepatectomy was successful in all patients.There was neither conversion into open approach nor postoperative complications of bile leakage,air embolism or perioperative mortality,etc.The mean operative duration was (120 ± 30) minutes,average hemorrhagic volume (165-±79) ml and normal diet & ambulation at Day 1-2 post-operation.The average postoperative hospitalization stay was (16 ± 10)days and l-year survival rate 100％.The parameters of leucocyte,liver enzymes,albumin and bilirubin returned to normal at Week 1 post-operation.Once a reasonable surgical indication is selected,laparoscopic resection is both safe and effective for peripheral micro hepatocellular carcinoma.

The high incidence of postoperative recurrence of hepatocellular carcinoma ( HCC) is a most difficult obstacle for improving the prognosis of patients.Several adjuvant modalities have been developed to prevent recurrence in patients after surgery; nevertheless , there is no consensus regarding the standardized adjuvant therapy in terms of indications , clinical efficacy and interactions.In this article we review the currently available evidence in the medical literature on adjuvant therapy in HCC after radical resection.

Objective To assess the efficacy of postoperative adjuvant interferon (IFN) therapy on patients with hepatitis B virus (HBV) related hepatocellular carcinoma (HCC).Methods An electronic search for articles published from January 2000 to January 2013 was conducted to identify English language comparative studies evaluating IFN therapy on recurrence and survival after surgical treatment of HCC.Results A total of five trials consisting of 694 patients were included in the Meta-analysis.The estimated odds ratios (OR) for the 1-,2-,3-,and 5-year overall survival rates of HBV-related HCC were 3.37 (95％CI:1.18-6.27,P=0.000),2.36 (95％ CI:1.45-3.83,P=0.001),1.81 (95％ CI:1.21-2.72,P=0.004),and 1.93 (95％ CI:1.35-2.75,P=0.000),respectively.The OR for the 1-,2-,3-,and 5-year recurrence rates were 0.63 (95％ CI:0.44-0.91,P=0.014),0.84 (95％ CI:0.60-1.18,P=0.322),0.88 (95％ CI:0.63-1.22,P=0.431),and 0.78 (95％ CI:0.56-1.07,P=0.120),respectively.Conclusion This Meta-analysis shows that IFN therapy had a significant clinical effect in improving overall survival rates but not in decreasing recurrence rates of HBV infected HCC patients postoperatively.

ObjectiveTo investigate the optimal cut-off value of alpha-fetoprotein (AFP) in the diagnosis and early screening of hepatocellular carcinoma (HCC). MethodsThe clinical data of 2212 HCC patients who were diagnosed and hospitalized in our hospital and 1998 non-HCC patients were collected, and the AFP level was summarized. The AFP level was divided into 10 ranges of 10-20 μg/L, 21-65 μg/L, 66-110 μg/L, 111-155 μg/L, 156-200 μg/L, 201-250 μg/L, 251-300 μg/L, 301-350 μg/L, 351-400 μg/L, and ＞400 μg/L, and a comparative analysis was performed for the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of each cut-off value of AFP, ultrasound, and their combination in the diagnosis of HCC. The receiver operating characteristic (ROC) curve was plotted to determine the optimal cut-off value. ResultsThe cut-off valve of AFP of 200-250 μg/L had the largest sum of sensitivity and specificity (1.370 1) and the largest area under the ROC curve (0.896 4). AFP ＞20 μg/L combined with ultrasound had the highest sensitivity (95.35%) in the diagnosis of HCC, with a diagnostic odds ratio of 26.13. ConclusionThe optimal cut-off value of AFP in the diagnosis of HCC is 200 μg/L. When AFP combined with ultrasound is used for the screening of people at a high risk of HCC, AFP＞20 μg/L is recommended as a positive index, and its combination with differential diagnosis and close follow-up and examinations can reduce the false negative rate of screening.

Objective To compare the long-term efficacy between laparoscopic liver resection and open liver resection to treat small hepatocellular carcinoma.Methods The clinical data of 52 patients with small hepatocellular carcinoma treated from August 2011 to November 2012 were reviewed.Twenty patients underwent laparoscopic liver resection (the laparoscopic group),while the remaining 32 patients underwent open liver resection (the laparotomy group).The preoperative,postoperative and overall survival data between the two groups were compared.Results The data between the two groups before surgery were comparable (all P ＞ 0.05).The differences in tumor size and pathologic type between the two groups did not reach statistical significance (t =1.087,x2 =0.738,all P ＞ 0.05).However,the length of hospital stay in the laparoscopic group was significantly shorter than in the laparotomy group (t =3.363,P ＜ 0.05).Post-procedural complications occurred in no patients in the laparoscopic group,but in 8 patients in the laparotomy group (x2 =5.909,P ＜ 0.05).The cumulative survival rates in the two groups were not statistically signifi cant (P ＞ 0.05),but the recurrence-free survival of the laparoscopic group was significantly longer than the laparotomy group (P ＜ 0.05).The postoperative 1-year disease-free survival was not significantly different (P ＞ 0.05),though the 3-and 5-year recurrence-free survival rates were significantly different (all P ＜ 0.05).Conclusion The long-term overall survival rate of laparoscopic treatment for small liver cancer was similar to open operation,but the recurrence free survival rate was greatly improved.

Objective To summarize the experience in application of amputation of secondary structures of splenic pedicle and self-made spleen-removing bag in laparoscopic splenectomy the using 3-hole method. Methods The clinical data of 11 patients receiving the procedure from June 2007 to April 2009 in our hospital were retrospectively analyzed. Results Advantages of the procedure were less bleeding, small wound, quick recovery and no occurrence of postoperative complications. Six cases had slight postoperative pain. All 11 patients were cured. Conclusion The technique of amputation of secondary structures of splenic pedicle is safe and feasible in laparoscopic splenectomy using the 3-hole method.