原发性肝肉瘤的诊断与治疗

DIAGNOSIS AND SURGICAL TREATMENT FOR PRIMARY HEPATIC SARCOMA

目的探讨原发性肝肉瘤的临床特点及其诊治。方法回顾性分析7例原发性肝肉瘤的临床资料。结果7例均因腹痛就诊而发现肝脏肿瘤。完整切除6例,姑息性切除1例。术前肝动脉栓塞1例,术后化疗1例;因肿瘤复发经历4次肿瘤切除手术1例。存活3例,生存时间最长已达9年;死亡3例,分别于术后2月,2月,22月死亡;失访1例。病理诊断恶性间叶瘤(未分化肉瘤)3例,恶性纤维组织细胞瘤,血管肉瘤,平滑肌肉瘤,脂肪肉瘤各1例。4例行免疫组织化学或组织化学检测确诊。结论原发性肝肉瘤术前诊断非常困难,确诊尚需依赖术后病理或穿刺细胞学检查甚至免疫组织化学检查。采用以手术治疗为主的综合治疗,是延长患者生存期的主要手段。

Objective To discuss the clinical characteristic of primary hepatic sarcoma and to investigate its preoperative diagnosis and surgical treatment. Method The clinical data of seven patients with the primary sarcoma of the liver were retrospectively analyzed. Results Six cases underwent surgical resection completely, and one underwent partial resection. One underwent hepatic arterioembolization（TAE）before operation, one did adjuvant chemotherapy after operation, and one did four time operations because of the recurrences of tumor. After the operation,three patients have survived more than 30 months. The longest survival time was nine years, and the postoperative survival time of three patients was 2, 2, and 22 mouths respectively, and one patient hasn＇t been followed up successfully. The pathologic diagnosis of seven cases of primary hepatic sarcoma was malignant mesenchymoma （undifferentiated sarcoma） in three cases, malignant fibrous histiocytoma, angiosarcoma, leiomyosarcoma, liposarcoma, one case each. Four cases were diagnosed with immunohistochemical and histochemical studies. Conclusion The preoperative diagnosis of primary sarcoma of the liver is very difficult and depends on liver biopsy or pathology, even further immunohistochemical studies. To prolong the patients＇survival, surgical resection is most effective therapy, but better adjuvant therapy is necessary.