14例病理诊断明确的隐源性肝癌临床资料分析

Clinical Data of Cryptogenic Liver Cancer Confirmed by Pathological Diagnosis:An Analysis of 14 Cases

目的初步探讨天津中医药大学第一附属医院收治的病理学诊断明确的隐源性肝癌临床特征。方法回顾性分析2015年12月至2019年8月间收治,具有明确病理学诊断的14例隐源性肝癌患者一般情况、血清学指标及肿瘤病理类型、发病部位、转移情况、中医证型及其首发症状。结果14例患者男女比例约为3.7∶1;平均年龄63.9±6.2岁,其中合并血脂异常/脂肪肝2例,合并高血压5例,合并高血糖状态8例,合并高血压、肥胖者1例,完全符合代谢综合征诊断2例,伴有肝硬化3例;AFP≥400 ng/ml 3例,<400 ng/mL 11例;CEA≥5ng/mL 4例,<5 ng/ml 10例;其血清HBV-DNA检测均为阴性,其中3例乙肝表面抗体HBsAb(+);14例中符合脾虚证者8例、非脾虚证6例;体检时发现的1例,13例患者首发症状分别有不同程度的乏力、腹胀痛或胁痛,1例乏力伴发黄疸;病理分型6例为胆管细胞癌,7例为肝细胞癌,1例混合型。结论目前有限的病例研究提示隐源性肝癌患者年龄偏大,多缺乏肝硬化背景,胆管细胞癌所占比例相对为大,其发生与代谢因素密切相关,临床上中医脾虚证多见。

Objective To investigate the clinical characteristics of patients with cryptogenic liver cancer confirmed by pathological diagnosis in the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine.Methods A retrospective analysis was carried out in 14 cases of cryptogenic liver cancer confirmed by pathological diagnosis and admitted from December,2015 to August,2019.The general demographic data and serological indexes of the patients,types of tumor pathology,onset location,and metastasis of the cancer,TCM syndrome types and the initial symptoms of cryptogenic liver cancer patients were analyzed retrospectively.Results Of the 14 patients,the ratio of men to women is about 3.7∶1.The average age of the 14 cases was 63.9±6.2 years old.Two cases of the 14 patients were complicated with dyslipidemia/fatty liver,5 cases with hypertension,8 cases with hyperglycemia,one case with obesity.Of the 14 patients,2 cases met the diagnostic criteria of metabolic syndrome and 3 cases were accompanied by liver cirrhosis.There were 3 cases of AFP≥400 ng/mL,11 cases of AFP<400 ng/mL,4 cases of CEA≥5 ng/mL,and 10 cases of AFP<5 ng/ml.All of the 14 cases had serum HBV-DNA test being negative,but 3 cases had HBsAb(+).Of the 14 patients,8 cases were differentiated as spleen deficiency syndrome,and 6 cases were differentiated as non-spleen deficiency syndrome.Of the 14 cases,one asymptomatic case was found in the physical examination,and the other 13 cases had various degrees of weakness,abdominal distention or hypochondriac pain,and 1 case was also complicated with jaundice.In respect of the pathological classification,6 cases were classified as intrahepatic cholangiocarcinoma,7 cases as hepatocellular carcinoma and one case as the mixed type of carcinoma.Conclusion The results of small-sample case study suggested that the patients with cryptogenic liver cancer are the elderly,and most of them have no history of liver cirrhosis.The cholangiocarcinoma accounts for a large proportion,which is closely related to the metabolic factors.Spleen deficiency syndrome is the common syndrome type in patients with cryptogenic liver cancer.