超声体检对无症状肝癌和小肝癌的临床诊断价值以及肝癌病人的预后

Clinical Value of Ultrasonography Diagnosing Asymptomatic and Small Hepatocellular Carcinoma

[目的]评价超声体检在早期发现无症状肝癌和小肝癌（≤3．0cm）的临床诊断价值。[方法]对14万人次的超声体检及门诊常规检查病人，检出可疑肝癌79例经手术病理证实的77例肝癌患者进行回顾分析。[结果]检出79例可疑肝癌患者，经手术病理证实的77例。根据患者有无症状，分A、B组，A组为无症状肝癌51例，在健康体检或因其他疾患就诊时经超声检查首先发现疑似肝癌的计为无症状组；B组为症状性肝癌组26例，有剑突下或右上腹疼痛不适的计为症状组。无症状性肝癌明显多于症状性肝癌，分别为66．23％和33．76％，77例患者术后随访12～60个月，A、B组瘤体大小3．1～5．0cm，术后1、3、5年无瘤生存率分别为91．30％、82．60％、65．21％和90．90％、36．36％、18．18％；瘤体〉5．1cm．术后1、3、5年无瘤生存率分别为87．50％、75．00％、37．50％和80．00％、13．33％、6．66％，术后3、5年无瘤生存率A组明显高于B组。小肝癌组术后预后较好，3年和5年无瘤生存率（100．00％、94．73％）均明显高于3．1～5．0cm及〉5．1cm者。[结论]超声体检是筛查早期无症状性肝癌和小肝癌的有效方法，无症状性患者的远期无瘤生存率显著高于有症状性患者。

[Objective]To study the diagnostic value of ultrasonography（US） in earlier detection of asymotpmatic Hepatocellular carcinoma（HCC） and small HCC（≤3cm）. [Methods]140 000 patients of railroad detected by Ultrasonography during January 1995 to December 2006 ,77 patients with HCC confirmed by operation and pathology were analyzed retrospectively. [Results]According to the clinical symptoms they were divided into two groups： 51 patients detected first by US in mass screening were asymptomatic （group A）,and 26 patients detected first by US in our clinic were symptomatic （group B）. In 77 cases （66.23%）of patients （51/77） in group A vs 33.76% of patients （26/77） in group B,A group was higher. The patients were followed up for 12 to 60 months. The 1,3 and 5 year cancer free survival rates of the asymptomatic and symptomatic groups with 3.1-5.0cm in diameter were 91.30%, 82.60%, 65.21% and 90.90%, 36.36%,18. 18% respectively and with 5cm in diameter were 87.50%,75. 00%,37.50% and 80. 00% ,13.33%,6.66%, respectively. A group was higher than group B in 3 and 5 year cancer free survival rates. The small HCC prognosis was extremely good after operation, higher than HCC（〉 3.1-5.0cm, 5.1-cm） in 3 and 5 year cancer free survival rates （100.00 %, 94.73 % ）. [Cunclusiun]Ultrosound can be applied as a very useful screening tool in earlier detection of asymotomatic and small HCCS. The long tem cancer free survival rates of asymptomatic patients are significantly higher than those of symptomcitic survival rates of asymptomatic patients are significantly higher than those of symptomcitic patients.