CAJ | 학술논문

目的探讨成人原发性肝肉瘤的临床特点、诊断及治疗.方法回顾性分析我院自1998年至2008年收治的4例原发性肝肉瘤患者的临床资料,总结其发病特点、检查结果、诊断、治疗及随访.结果 4例患者中男3例,女1例,年龄25～65岁,分别因腹痛、乏力、消瘦及体检发现肿块而就诊,无明显家族史,肝脏酶学检测正常或稍增高,CT表现大多见肝内较大肿块,囊实性为多,密度不均匀,边界欠清,增强后无明显强化或部分强化;分别误诊为肝囊肿、肝癌、肝腺瘤,均行肝叶切除术.术后病理学诊断分别为:恶性间叶瘤(未分化肉瘤)、癌肉瘤、平滑肌肉瘤、恶性纤维组织细胞瘤部分血管肉瘤.现存活3例(已分别为术后4、56、84个月),死亡1例(术中死亡),其中1例术后5年肝内复发.结论原发性肝肉瘤的诊断容易误诊,确诊需依赖术后病理及免疫组织化学检查.采用以手术治疗为主的综合治疗是延长患者生存期的主要手段.患者的预后与肿瘤的病理类型、分化程度、是否浸润转移及是否手术切除等密切相关.
목적 탐토성인원발성간육류적림상특점、진단급치료.방법 회고성분석아원자1998년지2008년수치적4례원발성간육류환자적림상자료,총결기발병특점、검사결과、진단、치료급수방.결과 4례환자중남3례,녀1례,년령25～65세,분별인복통、핍력、소수급체검발현종괴이취진,무명현가족사,간장매학검측정상혹초증고,CT표현대다견간내교대종괴,낭실성위다,밀도불균균,변계흠청,증강후무명현강화혹부분강화;분별오진위간낭종、간암、간선류,균행간협절제술.술후병이학진단분별위:악성간협류(미분화육류)、암육류、평활기육류、악성섬유조직세포류부분혈관육류.현존활3례(이분별위술후4、56、84개월),사망1례(술중사망),기중1례술후5년간내복발.결론 원발성간육류적진단용역오진,학진수의뢰술후병리급면역조직화학검사.채용이수술치료위주적종합치료시연장환자생존기적주요수단.환자적예후여종류적병리류형、분화정도、시부침윤전이급시부수술절제등밀절상관.
Objective To discuss the clinical features, diagnostic methods and treatment of the primary hepatic sarcomas. Methods The clinical data of 4 patients with primary hepatic sarcoma admitted to our hospital from January 1998 to December 2008 were viewed. Results There were 3 males and 1 female with age from 25 to 65 years. Abdominal pain, fatigue, weight loss and mass were among the complains. All 4 cases were misdiagnosed as liver cyst, liver cancer and liver adenoma respectively, and final diagnosis was established only by laparotomy and pathology. They were malignant mesenchymoma, carcinosarcoma, leiomyosarcoma and malignant fibrous histiocytoma respectively. Till now, 3 cases were still alive (respectively 4, 56 and 84 months after surgery), 1 case died intraoperatively. One case recurred 5 years after the operation. Conclusions Primary liver sarcoma is difficult to diagnose. Postoperative pathology and immunohistochemical examination remain the mainstay for final diagnosis. The prognosis is dependent on pathological type, differentiation, tumor invasion and metastasis.