原发性肝癌初诊误诊肝炎肝硬变18例临床分析

CLINICAL ANALYSIS OF 18 CASES OF PRIMARY HEPATIC CARCINOMA INITIALLY MISDIAGNOSED AS HEPATITIS CIRRHOSIS

１９８５～１９９５年间初诊误诊肝炎肝硬变（ＨＬＣ）的原发性肝癌１８例，与配对抽取同期住院，性别、年龄相同的肝炎肝硬变１８例，将其临床表现、病毒性肝炎血清标志、生化及ＡＦＰ检测，以及Ｂ超、ＣＴ扫描影像学检查等进行对比分析，有以下鉴别注意点：１）肝脾肿大质地硬或呈结节状，持续性右上腹痛（Ｐ＜００１）。２）排除其它原因的持续低热或血性腹水（Ｐ＜００５）。３）黄疸升高与ＡＬＴ不平行，消化道症状轻（Ｐ＜００５），ＰＴＡ＜８０％。４）肝脏不大，进行性消瘦，右上腹持续隐痛，ＡＦＰ≥４００ｎｇ／ｍｌ。５）肝炎肝硬变患者ＡＫＰ、γ—ＧＴ持续增高，ＡＦＰ持续高于正常值。６）警惕ＡＦＰ阴性肝癌，早做γ—ＧＴ—Ⅱ协诊。７）警惕Ｂ超或ＣＴ扫描误诊、漏诊肝癌，强调影像学定位诊断协同ＡＦＰ、γ—ＧＴ—Ⅱ定性诊断更能减少误诊提高ＰＨＣ诊断水平。

18 cases of primary hepatic carcinoma were initially, misdignosed as hepatitis cirrhosis from 1985 to 1995. When contrasting with 18 hepatitis cirrhosis patients, hospitalized at same period and with same age and sex, we suggested that more attention should be paid to the following points. 1. Hepatosplenomegaly with sclerotic nature nodular surface and sustained right epigastralgia (P<001). 2. Continued low fever without other visible causes(P<005) or bloody ascites(P<005). 3. The degrees of jaundice and ALT were not parallell, only with slight gastrointestinal symptom(P<005). 4. Without hepatomegaly, but with progressive emaciation and sustained right epigastralgia, AFP≥400ng/ml. 5. AKP,γ—GT increased continually and AFP was higher than nomal in hepatitis cirrhosis patients. 6. Attention should be paid to the hepatocarcinoma patients with negative AFP, γ—GT—Ⅱ exam should be taken as early as possible. 7. The possibility of misdignosis and missed diagnosis of hepatocarcinoma by B—ultrasonic exam or CT must keep in mind. The effective coordination between the locating diagnosis of image and qualitative diagnosis of AFP,γ—GT—Ⅱ could hopefully raise the diagnosis level of primary hepatic carcinoma.