混合型肝癌临床特点及超声造影模式分析  

Analysis of clinical and contrast-enhanced ultrasound characteristics of combined hepatocellular carcinoma and cholangiocarcinoma

作　　者：孙德伟 李锐[2] 杨丹[2] 唐春霖[2] 陈朝晖[2] Sun Dewei;Li Rui;Yang Dan;Tang Chunlin;Chen Zhaohui(Department of Ultrasound,Tongliang Hospital of Traditional Chinese Medicine,Chongqing 402560,China;Department of Ultrasound,Southwest Hospital Affiliated to Third Military Medical University,Chongqing 400038,China)

机构地区：[1]重庆市铜梁区中医院超声科,402560 [2]第三军医大学西南医院超声科,400038

出　　处：《中华医学超声杂志（电子版）》2017年第6期417-422,共6页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的分析混合型肝癌(cHCC-CC)的临床特点及超声造影(CEUS)模式。方法回顾性分析从2005年1月至2015年2月在第三军医大学西南医院行CEUS检查且经手术切除病理证实为cHCC-CC的患者49例。将cHCC-CC的CEUS模式分为肝细胞癌(HCC)模式、胆管细胞癌(CC)模式及不确定模式3种。采用χ2比较cHCC-CC患者CEUS模式差异及肿瘤标志物[甲胎蛋白(AFP)和糖类抗原19-9(CA19-9)]浓度同时升高或肿瘤标志物浓度升高与CEUS表现不符的cHCC-CC患者比例与肿瘤标志物浓度同时升高的cHCC-CC患者比例差异。结果 49例cHCC-CC患者中,男性44例,女性5例,年龄28~74岁,平均年龄(52.3±9.8)岁。单发病灶41例(83.7%,41/49),肿瘤最大径为1.5~13.8 cm,平均直径(5.3±3.5)cm,51.0%(25/49)的病灶最大径小于5 cm。病理证实34例(69.4%,34/49)患者有肝硬化。31例(63.3%,31/49)患者AFP浓度升高,12例(24.5%,12/49)患者CA19-9浓度升高,9例(18.4%,9/49)患者AFP和CA19-9浓度同时升高。25例(51.0%,25/49)患者病灶CEUS显示为CC模式,22例(44.9%,22/49)患者病灶CEUS显示为HCC模式,两者差异无统计学意义(χ2=0.368,P=0.544)。9例AFP和CA19-9浓度同时升高的患者中,5例病灶CEUS表现为CC模式,4例病灶CEUS表现为HCC模式。12例(24.5%,12/49)患者肿瘤标志物(AFP或CA19-9)浓度升高与CEUS模式不符,其中9例为AFP浓度升高但CEUS为CC模式,3例为CA19-9浓度升高但CEUS为HCC模式。21例(42.9%,21/49)患者AFP及CA19-9浓度同时升高或肿瘤标志物(AFP或CA19-9)浓度升高与CEUS模式不符,多于AFP及CA19-9浓度同时升高的患者(18.4%,9/49),且差异有统计学意义(χ2=6.918,P=0.009)。结论 cHCC-CC患者临床特征与HCC患者类似。cHCC-CC的CEUS表现为HCC模式和CC模式的比例相近,血清AFP和CA19-9浓度检测与CEUS模式结合分析有助于提高cHCC-CC检出率。Objective To analyze the clinical characteristics and enhancement pattern on contrast-enhanced ultrasound（CEUS） of combined hepatocellular-cholangiocarcinoma（cHCC-CC）. Methods A total of 49 patients who were pathologically confirmed as cHCC-CC by surgery and underwent CEUS examination in Southwest Hospital Affiliated to Third Military Medical University from January 2005 to February 2015 were retrospectively enrolled. There were 3 enhancement patterns on CEUS： hepatocellular carcinoma（HCC） pattern, cholangiocarcinoma（CC） pattern and indeterminate pattern. The proportions of HCC pattern and CC pattern of cHCC-CC were compared by χ^2 test. And the proportions of tumour maker elevation [（alpha-fetoproteins, AFP） and/or（carbohydrate antigen, CA19-9）] in accordance or discordance with enhancement patterns were compared by χ^2 test. Results Among the 49 cHCC-CC patients, 44 were male and 5 were female. Mean age was（52.3±9.8） years old（range： 28-74 years old）. Of all cases, 41（83.7%, 41/49） patients had single nodule. Mean size of nodule was（5.3±3.5） cm（range： 1.5-13.8 cm）, and the size of 51.0%（25/49） lesions were 5 cm. Totally 34（69.4%, 34/49） patients had pathologically diagnosed cirrhosis. AFP elevation was found in 31（63.3%, 31/49） patients, CA19-9 elevation was found in 12（24.5%, 12/49） patients, simultaneous elevation of both AFP and CA19-9 was found in 9（18.4%, 9/49） patients. The percentages of CC pattern and HCC pattern were 51.0%（25/49） and 44.9%（22/49） respectively. And there was no significant difference between the two patterns（χ^2=0.368, P=0.544）. In 9 patients with simultaneous elevation of both AFP and CA19-9, CC pattern was observed in 5 patients and HCC pattern was noted in 4 patients. There were 12（24.5%, 12/49） patients with tumor marker elevation（AFP or CA19-9） in discordance with enhancement patterns on CEUS. Among the 12 cases, 9 cases with AFP elevation were CC patterns on CEUS and 3 cases with CA19-9

关 键 词：肝肿瘤 超声检查 造影剂 甲胎蛋白 糖类抗原19-9 

分 类 号：R445.1[医药卫生—影像医学与核医学] R735.7[医药卫生—诊断学]