肝癌误诊为肝脏局灶结节性增生临床分析  

Clinical Analysis of Liver Cancer Misdiagnosed as Focal Nodular Hyperplasia of the Liver

作　　者：王伟 郄言言 付彩文 WANG Wei;QIE Yan-yan;FU Cai-wen(Department of Internal Medicine,Hospital of Wangdu,Wangdu,Hebei 072450,China;Department of Medical Imaging,Hospital of Shexian,Shexian,Hebei 056400,China)

机构地区：[1]望都县医院内科,河北望都072450 [2]涉县医院影像科,河北涉县056400

出　　处：《临床误诊误治》2020年第4期18-20,共3页Clinical Misdiagnosis & Mistherapy

基　　金：河北省卫生与计划生育委员会科研计划项目(20181763)。

摘　　要：目的分析肝癌误诊为肝脏局灶结节性增生的原因,以降低误诊率,提高临床诊疗水平。方法回顾性分析2015年5月-2018年12月于我院诊治的58例肝癌患者中术前误诊为肝脏局灶结节性增生5例的临床资料。结果本组误诊率8.62%。5例中因右上腹胀痛不适就诊2例,无明显不适于体检超声检查发现肝内肿物就诊2例,自觉肝区及右腰背部间歇性隐痛不适就诊1例,均被误诊为肝脏局灶结节性增生。5例予择期手术治疗,经术中、术后病理检查证实为肝癌,术后10~18 d均切口愈合出院,出院后均予化疗。随访半年,1例复发,再次手术治疗后死亡,余4例仍在治疗随访中。结论肝癌早期缺乏典型临床症状体征,影像和临床医生均应加强对肝癌影像学表现的认识,在对发生肝脏实质性病变者进行定性诊断时应以多项特殊检查结果作为诊断依据,以降低临床误诊率,改善患者预后。Objective To analyze the causes of misdiagnosis of liver cancer as focal nodular hyperplasia of the liver, in order to reduce the rate of misdiagnosis and improve the clinical diagnosis and treatment. Methods The clinical data of 5 patients who was misdiagnosed as focal nodular hyperplasia of the liver before operation out of 58 patients with liver cancer who were treated in our hospital from May 2015 to December 2018 was retrospectively analyzed. Results The misdiagnosis rate of this group was 8.62%. In 5 patients, 2 cases presented with right upper abdominal pain and discomfort, 2 cases were treated for hepatic masses in the physical examination, and 1 case presented with intermittent dull pain in the liver area and right back. All of them were misdiagnosed as focal nodular hyperplasia of the liver, and underwent elective surgical resection. The patients were confirmed as hepatocellular carcinoma based on intraoperative and postoperative pathological examination. All 5 patients were discharged from hospital at 10-18 days after operation when the wound healed. After discharge, they were treated with chemotherapy. During six-month follow-up, 1 patient had recurrent disease, and died after the failure of re-operation. The remaining 4 cases were being followed up. Conclusion Early primary liver cancer had no typical clinical signs and symptoms. Therefore, radiologists and clinicians should strengthen their understanding of the imaging findings of liver cancer. In the qualitative diagnosis of patients with solid lesion of liver, a number of special examination results should be used as a basis for diagnosis, to reduce clinical misdiagnosis and improve the prognosis.

关 键 词：肝肿瘤 误诊 局限性结节状增生 肝疾病 甲胎蛋白 

分 类 号：R735.7[医药卫生—肿瘤]