48例疑难肝病临床与病理分析  

The clinicopathological analysis of 48 patients with difficultly diagnosed liver diseases

作　　者：朱洪芳[1] 吴广利[1] 刘成霞[1] 牛琼[1] 马锋振[1] 史宁[1] 李锟[1] 王伟[1] 

机构地区：[1]山东滨州医学院附属医院消化内科,256603

出　　处：《肝脏》2014年第4期241-245,共5页Chinese Hepatology

摘　　要：目的评价肝活组织穿刺检查对疑难肝病的诊断价值。方法对48例临床不能确诊的疑难肝病患者行肝活组织穿刺检查,分析其临床与病理组织学特点。结果 48例疑难肝病患者中,肝脏占位性病变24例(其中肝细胞癌7例,转移性肝癌7例,胆管细胞癌2例,肝脓肿3例,慢性肝炎重度1例,肝结核1例,肝海绵状血管瘤1例,未能确诊2例;慢性肝炎与肝硬化鉴别困难者12例(慢性肝炎轻度3例,慢性肝炎中度4例,慢性肝炎重度1例,早期肝纤维化1例,肝硬化3例);隐源性肝炎5例(急性淤胆型肝炎1例,慢性肝炎中度4例);隐源性肝硬化3例(结节性肝硬化1例,特发性门静脉高压2例);慢性肝炎中度伴结节性肝硬化1例;急性淤胆型肝炎1例;自身免疫性肝病1例(原发性胆汁性肝硬化);肝脏寄生虫病1例。病理组织学确诊46例。结论疑难肝病中以肝脏占位性病变多见,其中以原发性肝癌与转移性肝癌最常见。对疑难肝病行肝活组织穿刺检查可明显提高诊断率。Objective To evaluate the clinical and histological features in patients with difficultly diagnosed liver diseases. Methods Forty-eight patients with difficultly diagnosed liver diseases were collected from January 2010 to September 2013. Liver biopsy was performed to analyze their clinical and histological features.Results Forty-eight cases with difficultly diagnosed liver disease were enrolled. All were punctured successfully drawn,success rate is 100% . No pain,bleeding,hematoma or other serious complications occurred. The primary diagnoses involved 24 patients with space occupying lesions （hepatocellular carcinoma [29.17% （7/24）],metastatic liver cancer [29.17% （7/24）],cholangiocellular carcinoma [8. 33% （2/24 ）],liver abscess [12. 50% （3/24 ）],severe chronic hepatitis [4. 17% （1/24 ）],hepatic tuberculosis [4.17% （1/24）],cavernous hemangioma [4.17% （1/24）]which were confirmed by histopathology）;Twelve patients with difficulty to differentiate chronic hepatitis from liver cirrhosis （mild chronic hepatitis [25% （3/12）],moderate chronic hepatitis [33.3% （4/12）],severe chronic hepatitis [8.3% （1/12）],early liver fibrosis [8.3% （1/12）],cirrhosis [25% （3/12）]which were confirmed by histopathology）;Five cases with cryptogenic hepatitis （one was acute cholestatic hepatitis,others were moderate chronic hepatitis）;Three cases with cryptogenic cirrhosis （histopathology showed one was nodular cirrhosis,others were idiopathic portal hypertension）;One patient showed significantly elevated AFP ,with a high degree of suspicion of HCC （histopathology showed moderate chronic hepatitis with nodular cirrhosis）;One patient with chronic hepatitis B who responded poorly to conventional methods （histopathology showed acute cholestatic hepatitis）;One patient with autoimmune liver disease （pathological diagnosis was primary biliary cirrhosis ）. There was also one patient diagnosed with liver parasites. Forty-six cases were confirmed by histopathology,with a 95

关 键 词：经皮肝穿刺活检 疑难肝脏疾病 临床特征 组织病理学 

分 类 号：R575[医药卫生—消化系统]