脓肿型肝癌诊治分析

Diagnosis and treatment of the abscess type of primary liver cancer

目的探讨脓肿型肝癌(表现为肝脓肿的原发性肝癌)诊治规律,以期早期诊断早期治疗。方法回顾分析14例脓肿型肝癌,分析临床表现、既往史、辅助检查、治疗方式及预后。结果男性12例,女性2例,平均年龄为(56.4±12.6)岁。临床表现有发热、上腹痛或上腹不适、肝区叩痛等,合并乙肝6例,AFP、CA19-9升高者各有4例;病灶位于右肝者8例,位于左肝者1例,5例患者左右肝均有病灶。病灶平均直径为(8.9±3.3)cm,边界欠清晰。CT表现方面,边缘强化者2例,内部不规则强化者7例。11例患者接受了抗感染治疗,但效果不明显。10例接受病灶切除手术治疗,4例行活检术。未行手术治疗的4例患者随访时均已死亡;接受手术治疗的患者7例复发,6例已死亡。结论脓肿型肝癌术前难以与细菌性肝脓肿鉴别。是否合并乙肝,是否有AFP、CA19-9检测指标升高对术前诊断脓肿型肝癌有帮助。脓肿型肝癌诊断时病情较晚、预后差,术前抗感染治疗不应延误手术时机,应争取早期接受手术治疗。

Objective To discussed the abscess type of primary liver cancer （presented as liver abscess） for the pur- pose of the early diagnosis and treatment. Method Patients presenting as with a pathological diagnosis of primary liver cancer （PLC） were retrospectively reviewed from January 2009 to August 2012. Results The clinical feature of the 14 patients （ 12 males and 2 females, with an average age of （56.4 ± 12. 6） years） included fever, fight-upper-quadrant ab- dominal pain or discomfort, tenderness in the right-upper-quadrant abdomen. There were 6 patients who were accompanied with hepatitis B. The number of patients with either AFP or CA19-9 was 4, respectively. Patients whose lesions located in the right hepatic lobe, left and the whole liver were eight, one and five respectively. The average diameter was （8.9 ±3.3） era, with less clear boundaries. 2 patients had edge enhancement on CT, and 7 had internal irregular enhancement. 11 patients were given anti-infection treatment, which was not effective. 10 patients （6 died when followed up） underwent lesion resection, while 4 cases （all died） underwent biopsies. Conclusion It is difficuh to differentiate the abscess type of PLC from bacterial liver abscess before surgery or biopsy. A history of hepatitis B, increased AFP or CA19-9 is helpful to identify primary liver cancer presenting as liver abscess. Preoperative anti-infective therapy should not delay surgery. It is often late to diagnose the type of PLC, with the prognosis being poor. Therefore, those patients suspected of this special type of PLC should undergo surgery as early as possible.