The Influence And Significance Of Hand-assisted Laparoscopic Hepatectomy(HALH) On Intercellular Adhesion Molecule-1(ICAM-1) Expression In The Serum Of Patients With Liver Cancer

Objective: To detect ICAM-1 expression in tissue and peripheral blood in patients underwent hand-assisted laparoscopic hepatectomy (HALH) and open hepatectomy(OH) of liver cancer,compare the changes of sICAM-1 in the patients with liver cancer preoperation and postoperation,hand-assisted laparoscopy and laparotomy, and to investigate the influence and clinical significance of hand-assisted laparoscopic hepatectomy of liver cancer.Methods: According to our protocol,40 patients with primarily liver cancer were selected from July 2006 to December 2007,and were randomly divided into HALH group and OH group , there were 20 cases in each group respectively. The age,weight,liver function degrade, tumor size,tumor position were no statistically signifycant(P>0.05) between the two groups. All operations were performed by the same group surgeons in endotracheal tube general anesthesia. Carbon dioxide has been inflating medium of the abdominal cavity in HALH group, the abdominal pressure is between 12 and 14mmHg.ICAM-1 were detected in tissu samples of liver cancer by immunohistochemical (IHC)SP method. Collect the peripheral blood of patients with liver cancer at preoperation and postoperation,the 1st, 4th and 7th day after operation in two groups. the levels of serum sICAM-1 were tested in two groups by using double antibody sandwich enzyme-linked immnunoadsordent assay(ELISA),and investigate and compare the changes of sICAM-1 in the patienwith liver cancer in preoperation and postoperation,HALH and OH.10 normal heaptic tissues and 10 health adult's peripheral blood were chosed to be healthy control group. Results:(1)The operation time,scope of exairesis,distance between cutting edge and tumor and pathology diagnosis were no statistically significant(P>0.05) between the two groups,there were a statistically significant difference of length of incision and the intraoperative hemorrhage between the two groups(P<0.05), the mean of data of HALH group was significantly less than that of OH group in such markers as length of incision and the intraoperative hemorrhage.(2)The ICAM-1 expression of 10 normal hepatic tissues was negative in healthy control group.The positive rate of ICAM-1 was 75.00%(15/20) in tumor and 40.00%(8/20) in tissues near tumor in HALH group,there were a statistically significant difference(P<0.05). The positive rate of ICAM-1 was 70.00%(14/20) in tumor and 35.00%(7/20) in tissues near tumor in OH group,there were a statistically significant difference(P<0.05).There were a statistically significant difference of the positive rate of ICAM-1 between tumor and normal hepatic tissues(P<0.01).There were a statistically significant difference of the positive rate of ICAM-1 in the same tissue between HALH group and OH group(P>0.05).(3)Liver cancer showed significantly higher serum levels of sICAM-1 compared with those in healthy controls (P<0.01). Compared with the preoperative level,the concentration of sICAM-1 in the HALH group was significantly increased at the 1st day after operation(P<0.05),decreased at the 4th day(P>0.05),and decreased significantly at the 7th day(P<0.05). Compared with the preoperative level , the concentration of sICAM-1 in the OH group was significantly increased at the 1st day after operation(P<0.01),decreased at the 4th day(P>0.05),and decreased significantly at the 7th day(P<0.05). Compared with OH group,there were no significant statistically difference of the concentration of sICAM-1 was found in HALH group at preoperation,the 4th and 7th day after operation (P>0.05). however,there were a statistically significant difference at the 1st day after operation.Conclusions:(1) The positive expression of ICAM-1 was 72.50% (29/40) in liver cancer tissues,47.50%(19/40) in tissues near tumor and negative in healthy controls, the expression of sICAM-1 was significantly higher in the patients of HALH group and OH group than in the healthy control group.(2) ICAM-1 was concerned with the diagnosis,metachoresis and prognosis of liver cancer;Compared with OH group, hand-assisted laparoscopic hepatectomy of liver cancer does not increase the expression of sICAM-1,does not increase the metastatic potential of liver cancer in postoperative convalescence stage.