以高热为主要临床表现的肝恶性肿瘤的诊疗思考  

Thinking On the Diagnosis and Treatment of Hepatic Malignant Tumor with High Fever as the Main Clinical Manifestation

作　　者：杜鲲 李骏 邓绍雄 靳雪广 罗军 熊臣 尹君 DU Kun;LI Jun;DENG Shao-xiong;JIN Xue-guang;LUO Jun;XIONG Chen;YIN Jun(Department of Interventional Radiology,Xinyang Central Hospital,Xinyang 464000,Henan Province,China)

机构地区：[1]河南省信阳市中心医院介入放射科,河南信阳464000

出　　处：《罕少疾病杂志》2022年第11期4-6,共3页Journal of Rare and Uncommon Diseases

摘　　要：目的总结以高热为首发临床表现的肝恶性肿瘤的病例及影像学特点,以提高诊断准确率。方法回顾性分析了我科近7年收治以高热为主要临床表现,误诊为肝脓肿的肝恶性肿瘤11例患者的临床资料,影像表现及预后情况。结果11例患者抗炎治疗2~6周无效后均给以穿刺活检,病理结果回示胆管细胞癌4例,肝细胞癌3例,肝转移瘤2例,肝淋巴瘤1例,肝鳞状细胞癌1例,其中内科抗肿瘤治疗4例,外科切除2例,行TACE术2例,自动放弃治疗2例,射频消融治疗1例,生存期3~27月。结论以高热为主要临床表现的肝恶性肿瘤患者预后差,肿瘤病理类型复杂,影像表现不典型,易误诊为肝脓肿,对严格抗炎治疗2周无效者应及时行肝穿刺活检,必要时可手术探查,以利于明确诊断,早期治疗。Objective To summarize the cases and imaging characteristics of hepatic malignant tumor with high fever as the first clinical manifestation,so as to improve the diagnostic accuracy.Methods Retrospectively analyze the clinical data,imaging manifestations and prognosis of 11 patients with hepatic malignant tumors misdiagnosed as hepatic abscesses and with high fever as the main clinical manifestation in our department in the past 7 years.Results 11 patients underwent needle biopsies after 2~6 weeks of failure to respond to anti-inflammatory therapy.Pathological results showed 4 cases of cholangiocarcinoma,3 cases of hepatocellular carcinoma,2 cases of liver metastasis,1 case of lymphoma,1 case of liver squamous cell carcinoma.Among them,4 cases were treated with medical antitumor therapy,2 with surgical resection,2 with TACE,2 with automatic abandoment treatment,and 1 with radiofrequency ablation.The survival period was 3~27 months.Conclusion Patients with liver malignant tumors with high fever as the main clinical manifestations have a poor prognosis,the pathological types of tumor are complex,the imaging findings are not typical,it is easy to be misdiagnosed as liver abscess.Liver biopsy should be performed in time for those who failed to strict anti-inflammatory treatment for 2 weeks,and surgical exploration can be performed if necessary,so as to facilitate the diagnosis and early treatment.

关 键 词：脓肿型肝癌 肝恶性肿瘤 肝脓肿 鉴别诊断 

分 类 号：R735.7[医药卫生—肿瘤]