鱼刺致肝脏炎性假瘤误诊1例并文献复习  

Misdiagnosis of inflammatory pseudotumor of liver caused by fishbone:one case report and literature review

作　　者：庄宝鼎 木斯他巴•买买提热依木 卢逸[1] 李彦杰 苏日顺 邓美海[1] 徐见亮[1] Zhuang Baoding;Musitaba·Maimaitireyimu;Lu Yi;Li Yanjie;Su Rishun;Deng Meihai;Xu Jianliang(Department of Hepatobiliary Surgery,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;Department of General Surgery,the First People's Hospital of Kashgar,Kashgar 844000,China)

机构地区：[1]中山大学附属第三医院肝胆外科,广州510630 [2]新疆维吾尔自治区喀什地区第一人民医院普通外科,844000

出　　处：《中华肝脏外科手术学电子杂志》2021年第4期418-422,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：广东省科技创新战略专项资金(2018A030313608);广东省中医药管理局基金(20211085)。

摘　　要：目的探讨鱼刺致肝脏炎性假瘤(IPT)的诊治特点。方法回顾性分析2015年8月中山大学附属第三医院收治的1例鱼刺致肝脏IPT患者临床资料。患者男,51岁。患者签署知情同意书,符合医学伦理规定。分析并复习相关文献病例的临床病理资料,包括病史、诊治经过及预后随访等,总结此类罕见病例的诊治特点。结果患者因“反复右上腹痛3年余,加重伴胃纳差1个月”就诊。入院后实验室检查发现WBC、GGT、C-反应蛋白和红细胞沉降率等均升高。腹部超声、CT、MRI均未能排除肝内胆管细胞癌可能。超声引导经皮肝穿刺活检术诊断肝内肿物为炎性病变。经抗感染治疗后肝脏占位未见明显缩小,且临床症状仍反复。遂于2015年12月15日开腹探查,发现鱼刺从胃窦部进入肝左叶,行肝部分切除、鱼刺取出、胆囊切除、广泛粘连松解及胃壁穿孔修补术。术后病理证实肝脏肿物为肝脏IPT。出院1个月患者一般状态良好,实验室各项检测结果均恢复正常。复查腹部增强CT显示手术部位未见残留病灶。结论鱼刺等异物致肝脏IPT是一种罕见肝内占位性病变,影像学表现易误诊为肿瘤,病理活检对于IPT的诊断有重要作用,手术取出异物并修补消化道穿孔是有效的治疗手段。Objective To explore the diagnostic and treatment characteristics of inflammatory pseudotumor(IPT)of the liver caused by fishbone.Methods Clinical data of 1 patient with IPT of the liver caused by fishbone admitted to the Third Affiliated Hospital of Sun Yat-sen University in August 2015 were retrospectively analyzed.The male patient aged 51 years.The informed consent of the patient was obtained and the local ethical committee approval was received.The clinicopathological data of relevant literature were reviewed and analyzed including medical history,diagnosis and treatment,clinical prognosis and followup.The diagnostic and treatment characteristics of this rare case were summarized.Results The patient was hospitalized due to"recurrent right upper abdominal pain for more than 3 years,which was aggravated complicated with anorexia for 1 month".Laboratory examination upon admission indicated that WBC,GGT,C-reactive protein and erythrocyte sedimentation rate were increased.The possibility of intrahepatic cholangiocarcinoma could not be excluded by abdominal ultrasound,CT scan and MRI.The intrahepatic tumor was diagnosed as an inflammatory lesion by ultrasound-guided percutaneous liver biopsy.After anti-infection treatment,the liver mass was not significantly reduced,and clinical symptoms still recurred.On December 15,2015,abdominal exploration was performed on the patient and a fishbone was found invaded into the left liver lobe from the antrum.Thus partial hepatectomy was conducted,the fishbone was removed,cholecystectomy was carried out,followed by extensive adhesion management and gastric wall perforation repair.The diagnosis of IPT of the liver was confirmed by postoperative pathological examination.At 1 month after discharge,the patient was generally in good condition,and all the laboratory test results were normal.Abdominal enhanced CT scan showed no residual lesion at the surgical site.Conclusions IPT of the liver caused by foreign matter,such as fishbone,is a rare space-occupying intrahepatic lesion,which i

关 键 词：肉芽肿 浆细胞 肝 肝内胆管细胞癌 

分 类 号：R735.7[医药卫生—肿瘤]