中华肝脏外科手术学电子杂志
中華肝髒外科手術學電子雜誌
중화간장외과수술학전자잡지
CHINESE JOURNAL OF HEPATIC SURGERY(ELECTRONIC EDITION)
2014年
2期
100-103
,共4页
赵东%林楠%李龑杼%李红春%陶红光%钱福永
趙東%林楠%李龑杼%李紅春%陶紅光%錢福永
조동%림남%리엄저%리홍춘%도홍광%전복영
肝肿瘤%肿瘤转移%肝脓肿%误诊
肝腫瘤%腫瘤轉移%肝膿腫%誤診
간종류%종류전이%간농종%오진
Liver neoplasms%Neoplasm metastasis%Liver abscess%Diagnostic errors
目的：探讨转移性肝癌误诊为肝脓肿的原因及其诊治和预后情况。方法回顾性分析2012年4月至2013年4月在深圳市第三人民医院普通外科收治的4例被误诊为肝脓肿的转移性肝癌患者临床资料。所有患者均签署知情同意书，符合医学伦理学规定。其中男1例，女3例；年龄44～67岁，中位年龄54岁。患者入院后检测血常规、肝功能、AFP、癌胚抗原（CEA）、糖链抗原19-9（CA19-9）等指标，行肝胆超声检查、上腹部CT、胃镜及肠镜检查。结果患者入院时平均体温为(37.8±0.8)℃，发热伴寒战2例，上腹痛或上腹不适4例。WBC升高伴ALP升高2例，CA19-9升高3例，CEA升高2例，AFP升高1例。超声检查及CT示多发病灶3例，单发病灶1例，其中囊性病灶2例；CT示边缘强化明显者3例，内部不均匀强化者2例，内部无强化者2例；肝门部或腹膜后淋巴结肿大者3例。病理学检查确诊为结肠癌肝转移2例，胃癌肝转移1例，临床诊断为胃肠道或肝外胆管癌肝转移1例。2例患者入院后接受抗感染治疗，1例行肝肿瘤穿刺活组织检查+液化坏死组织置管引流术，1例患者因肠梗阻行结肠癌切除术。4例患者均行化学药物治疗（化疗）。1例患者确诊后3个月死于多器官功能衰竭；截止至投稿日期，1例结肠癌切除术后患者仍在接受化疗，生活质量尚可，其余2例患者一般状况较差。结论部分转移性肝癌患者的临床表现不典型，易被误诊为肝脓肿。肿瘤标志物的检测对其鉴别诊断有一定帮助。该病患者宜采取以手术切除为主的综合治疗方案，但预后较差。
目的：探討轉移性肝癌誤診為肝膿腫的原因及其診治和預後情況。方法迴顧性分析2012年4月至2013年4月在深圳市第三人民醫院普通外科收治的4例被誤診為肝膿腫的轉移性肝癌患者臨床資料。所有患者均籤署知情同意書，符閤醫學倫理學規定。其中男1例，女3例；年齡44～67歲，中位年齡54歲。患者入院後檢測血常規、肝功能、AFP、癌胚抗原（CEA）、糖鏈抗原19-9（CA19-9）等指標，行肝膽超聲檢查、上腹部CT、胃鏡及腸鏡檢查。結果患者入院時平均體溫為(37.8±0.8)℃，髮熱伴寒戰2例，上腹痛或上腹不適4例。WBC升高伴ALP升高2例，CA19-9升高3例，CEA升高2例，AFP升高1例。超聲檢查及CT示多髮病竈3例，單髮病竈1例，其中囊性病竈2例；CT示邊緣彊化明顯者3例，內部不均勻彊化者2例，內部無彊化者2例；肝門部或腹膜後淋巴結腫大者3例。病理學檢查確診為結腸癌肝轉移2例，胃癌肝轉移1例，臨床診斷為胃腸道或肝外膽管癌肝轉移1例。2例患者入院後接受抗感染治療，1例行肝腫瘤穿刺活組織檢查+液化壞死組織置管引流術，1例患者因腸梗阻行結腸癌切除術。4例患者均行化學藥物治療（化療）。1例患者確診後3箇月死于多器官功能衰竭；截止至投稿日期，1例結腸癌切除術後患者仍在接受化療，生活質量尚可，其餘2例患者一般狀況較差。結論部分轉移性肝癌患者的臨床錶現不典型，易被誤診為肝膿腫。腫瘤標誌物的檢測對其鑒彆診斷有一定幫助。該病患者宜採取以手術切除為主的綜閤治療方案，但預後較差。
목적：탐토전이성간암오진위간농종적원인급기진치화예후정황。방법회고성분석2012년4월지2013년4월재심수시제삼인민의원보통외과수치적4례피오진위간농종적전이성간암환자림상자료。소유환자균첨서지정동의서，부합의학윤리학규정。기중남1례，녀3례；년령44～67세，중위년령54세。환자입원후검측혈상규、간공능、AFP、암배항원（CEA）、당련항원19-9（CA19-9）등지표，행간담초성검사、상복부CT、위경급장경검사。결과환자입원시평균체온위(37.8±0.8)℃，발열반한전2례，상복통혹상복불괄4례。WBC승고반ALP승고2례，CA19-9승고3례，CEA승고2례，AFP승고1례。초성검사급CT시다발병조3례，단발병조1례，기중낭성병조2례；CT시변연강화명현자3례，내부불균균강화자2례，내부무강화자2례；간문부혹복막후림파결종대자3례。병이학검사학진위결장암간전이2례，위암간전이1례，림상진단위위장도혹간외담관암간전이1례。2례환자입원후접수항감염치료，1례행간종류천자활조직검사+액화배사조직치관인류술，1례환자인장경조행결장암절제술。4례환자균행화학약물치료（화료）。1례환자학진후3개월사우다기관공능쇠갈；절지지투고일기，1례결장암절제술후환자잉재접수화료，생활질량상가，기여2례환자일반상황교차。결론부분전이성간암환자적림상표현불전형，역피오진위간농종。종류표지물적검측대기감별진단유일정방조。해병환자의채취이수술절제위주적종합치료방안，단예후교차。
Objective To investigate the causes, diagnosis, treatment and prognosis of misdiagnosing metastatic liver cancer as liver abscess. Methods Clinical data of 4 patients with metastatic liver cancer misdiagnosed as liver abscess in Department of General Surgery, the Third Hospital of Shenzhen from April 2012 to April 2013 were retrospectively analyzed. The informed consents of all patients were obtained and the ethics committee approval was received. There were 1 male and 3 females with age ranging from 44 to 67 years old and a median age of 54 years old. All the patients received tests such as blood routine, liver function, alpha fetoprotein (AFP), carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9) and so on, and examinations of hepatobiliary ultrasonography, computed tomography (CT) scan of the upper abdomen, gastroscope and colonoscope after admission to hospital. Results The mean temperature of patients was (37.8±0.8)℃when admitted in hospital. Two cases got fever and shivering, and 4 cases suffered upper abdominal pain or discomfort. There were 2 cases with increasing white blood cell (WBC) and increasing alkaline phosphatase (ALP), 3 cases with increasing CA19-9, 2 cases with increasing CEA and 1 case with increasing AFP. By ultrasound examination and CT , multiple lesions were observed in 3 cases and single lesion in 1 case, including 2 cases of cystic lesions. Obvious edge enhancement was found in 3 cases by CT scan, heterogeneous internal enhancement in 2 cases, no internal enhancement in 2 cases, and 3 cases were found with lymphadenectasis in the porta hepatis or retroperitoneum. By pathological examination, 2 cases were diagnosed with liver metastasis of colon cancer, 1 case with liver metastasis of gastric cancer. And 1 case was clinically diagnosed with liver metastasis of gastrointestinal tract or extrahepatic bile duct cancer. Two cases received anti-infection treatment after admission to hospital. One case received liver tumor biopsy+catheter drainage of liqueifed necrotic tissues, and 1 case received colon cancer resection for intestinal obstruction. All the 4 patients received chemotherapy. One case died of multiple organ failure 3 months after being diagnosed and 1 case who had undergone colon cancer resection still received chemotherapy and lived well till the date of paper submission. The other 2 cases were in poor condition. Conclusions Some patients with metastatic liver cancer are usually misdiagnosed as liver abscess because of the untypical clinical features. The tumor marker detection is helpful for the differential diagnosis. Comprehensive treatments with the main of surgical resection should be employed in the patients but the prognosis is poor.
