原发性肝癌累及肝门部胆管误诊病例分析

A MISDIAGNOSED CASES ANALYSIS FOR PRIMARY HEPATOCELLULAR CARCINOMA WITH EXTRAHEPATIC BILE DUCT TUMOR THROMBUS

目的 分析原发性肝癌合并胆管癌栓易误诊为肝门部胆管癌的原因 ,阐明该病征的解剖和病理特征。方法 从术前、术中两方面分析 1 8例误诊的病人 ,了解该病症的特点和这两种疾病的鉴别诊断。结果 原发性肝癌的发生学背景的调查、影像学资料分析以及术中探查包括肝原发灶、胆管占位病变的特征、肿瘤的侵袭发展方式等 ,为疾病的诊断提供了重要的依据。肝肿瘤邻近肝门、肝硬化程度轻、肿瘤恶性程度高等是此类病征的特点。

Objective To analyze the reasons of primary hepatocellular carcinoma with extrahepatic bile duct tumor thrombus misdiagnosed by hilar cholangiocarcinoma and elucidate the anatomical and pathological characteristics of the syndrome. Methods 18 misdiagnosed patients were retrospectively investigated preoperatively and intraoperatively to reveal the reasons of the feature for further differentiation.Results Preoperative etiopathogical background of primary hepatocellular carcinoma,such as HBV infection?presence of cirrhosis? AFP elevation,and operative explorations including identification of primary leision?mass in the bile ducts and progress approach of tumor would provide valuable information for differentiation.Meanwhile the symptom was characterized by mild cirrhosis?high malignance and intrahepatic leision close to hilum.Conclusion Comprehensive clinical materials collection, good knowledge in the syndrome would maximumly decrease the incidence of misdiagnosis..