原发性肝肉瘤临床误诊分析

An analysis of misdiagnosed primary hepatic sarcoma

目的 加强对肝肉瘤的认识 ,提高其确诊率。方法 回顾性分析 196 6～ 1999年我院收治的 13例误诊的肝肉瘤病例 ,从临床及影像学角度 ,分析其误诊疾病、误诊时间、误治方法、术后病理诊断及随访结果。结果 CT上以囊性为主的肝肉瘤最易误诊为肝囊肿 (6 / 13)而定期复查 ;伴有发热者易误诊为肝脓肿 (2 / 13)而行抗炎治疗 ;实质性为主的肝肉瘤最易误诊为原发性肝癌 (4 / 13) ,因肿瘤巨大而行肝动脉栓塞。误诊时间 1～ 9个月 ,手术或细针穿刺活检明确病理诊断。姑息手术 2例分别存活 7个月及 12个月 ,其余经穿刺或剖腹探查 11例仅存活 1～ 3个月。结论 肝肉瘤的诊断依据临床表现及影像学检查 ,确定诊断依靠病理 ,提高对肝肉瘤的认识是降低其误诊率的关键。肝脏巨大占位病变如发展较块应想到肝肉瘤的可能性并尽早手术明确病理诊断。

Objective To deeply understand the primary hepatic sarcoma (PHS) and elevate the rate of its correct diagnosis. Methods The data of 13 patients with misdiagnosed PHS treated in our hospital from 1966 to 1999 were retrospectively analyzed. The clinical data and results of radiological examination were also used to determine diseases of misdiagnosis, time of misdiagnosis, methods of mistreatment and postoperative histodiagnosis and to analyze the follow-up results. Results PHS with cystic presentation in CT was most easily misdiagnosed as cyst of the liver (6/13) and was regularly re-examined. Those accompanied with fever were easily misdiagnosed as liver abscess (2/13) and received anti-inflammatory treatment. Parenchymal PHS was most easily misdiagnosed as primary hepatic carcinoma and the hepatic artery was embolized because of gigantic tumor mass. The time of misdiagnosis was 1-9 months. Operation or fine-needle biopsy made the diagnosis of PHS clear. The survival time in the 2 patients receiving palliative operation was 7 and 12 months, respectively, while that in the rest 11 receiving biopsy or laparotomy 1-3 moths. Conclusions The diagnosis of PHS depends on clinical manifestations and X-ray examination. Definite diagnosis relies on histodiagnosis. Improving the understanding of PHS is important for lowering the misdiagnosing rate. The possibility of PHS should be aware of and the patients should be operated on as soon as possible if their liver had a huge tumor mass that quickly enlarges. [