非消化道首发症状的原发性肝癌56例临床分析

Clinical Analysis of Extra-Digestive Tract Symptoms as Early Symptoms in Patients with Primary Liver Cancer

目的探讨以消化道外症状为首发表现的原发性肝癌临床特点,以提高对原发性肝癌的诊断水平。方法回顾性分析解放军第九四医院自1996年1月-2011年10月间收治的56例以消化道外症状为首发表现的原发性肝癌患者的临床资料。结果 56例原发性肝癌首发症状分别为:肩背痛13例,腰痛9例,咳嗽、胸痛、胸闷、血痰18例,昏迷10例,头痛4例,发热2例,均存在不同程度的延误诊断。误诊为肩周炎或颈椎骨质增生13例,腰椎骨质增生或腰肌劳损9例,原发性肺癌4例,肺部感染4例,肺结核4例,胸膜炎4例,心肌炎2例,脑血管意外5例,低血糖昏迷5例,神经性头痛或偏头痛4例,发热待查2例。25例患者经皮肝脏穿刺活检或手术病理证实为PHC,其余31例患者根据影像学检查与血AFP值确定诊断。结论以消化道外症状为首发表现的原发性肝癌临床表现多样,临床医师应提高认识,避免误诊及漏诊。

Objective To discuss the clinical characteristics of PHC patients with extra-digestive tract symptoms as the early symptoms and improve diagnosis of primary hepatocellular carcinoma（PHC）. Methods A total of 56 PHC patients with extra-di-gestive tract symptoms as the early symptoms from January 1996 to October 2011 in our hospital were collected, and the clinical data were studied retrospectively. Results The early symptoms of these 56 cases were shoulder pain （ 13 cases）, waist pain （9 ca-ses）, cough, chest pain, chest tightness, blood phlegm （ 18 cases ）, coma （ 10 cases ）, headache （ 4 cases ） and fever （ 2 cases ）. There were diagnosis delays in these patients. These patients were misdiagnosed as shoulder periarthritis or cervical bone hyper-plasia （ 13 cases）, lumbar bone hyperplasia or lumbar muscle strain （ 9 cases）, primary lung cancer （ 4 cases）, lung infection （ 4 ca-ses）, tuberculosis （ 4 cases）, pleurisy （ 4 cases）, myocarditis （ 2 cases）, cerebrovascular accident （ 5 cases）, hypoglycemic coma （ 5 cases） , tension headaches or migraine （4 cases）, and fever of unknown origin （ 2 cases ） respectively. 25 patients were diagnosed as PHC by percutaneous liver biopsy or surgery, and 31 patients were diagnosed by imaging examination and serum AFP value. Conclusion The clinical manifestations of these PHC patients with extra-digestive tract symptoms as the early symptoms are va-rious, and thus the clinical physicians should improve the understanding of PHC in order to avoid misdiagnosis.