以化脓性肝脓肿为初始表现的原发性肝癌的临床特点及诊治体会

Characteristics, Diagnosis and Treatment for Primary Liver Cancer with Pyogenic Liver Abscess as the Initial Manifestation

目的:探讨以化脓性肝脓肿(PLA)为初始表现的原发性肝癌(PLC)的临床特点,总结诊治体会。方法:回顾性分析哈尔滨医科大学附属第一医院肝脏外科2007年6月至2012年6月收治的10例以PLA为初始表现的PLC患者以及269例同期收入院的PLA患者的临床资料。结果:以PLA为初始表现的PLC患者可表现为发热、寒战、右上腹痛、恶心、呕吐、腹泻、体重减轻以及黄疸等。实验室检查显示以PLA为初始表现的PLC患者甲胎蛋白(AFP)和糖类抗原19-9(CA19-9)升高的比例显著高于PLA患者,但其他实验室检查的差异无统计学意义。患者除静脉抗生素治疗外均接受了有创治疗,生存时间最长为13个月,最短仅为2个月。结论:对于AFP及CA199升高的PLA患者要警惕伴发PLC的可能。肝脏增强CT检查对AFP及CA199正常的此类患者有较大的诊断价值。早期准确诊断,把握手术时机是提高此类患者预后的根本。

Objective： To investigate the characteristics, diagnosis and treatment for primary liver cancer （PLC） with pyogenic liver abscess （PLA） as the initial manifestation. Methods： The clinical data of 10 patients whose initial diagnosed as PLA but finally confirmed as PLC and 269 patients diagnosed as PLA, were analyzed retrospectively, from June 2007 to June 2012 in department of hepatic surgery, The 1st affiliated hospital of Harbin Medical University. Results： The presenting symptoms of the 10 patients were included fever, chills, right-upper-quadrant abdominal pain, nausea, vomiting, weight loss, diarrhea, and jaundice. Lab results showed that alpha-fetoprotein （AFP） and carbohydrate antigen 19-9 （CA 19-9） elevated rates in the 10 patients were significantly higher than that in patients with PLA. All the 10 patients underwent invasive treatment in addition to antibiotics. The longest survival time is 13 months and the shortest one is 2 months. Conclusion： Elevated AFP and CA19-9 could suggest PLC in patients with PLA. To patients with normal AFP and CA19-9, enhanced CT was greatly helpful to make the diagnosis. Early and accurate diagnosis and timely surgical treatment are fundamental measures to improve the prognosis.