48例疑难肝病临床与病理分析

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。

The clinicopathoiogical analysis of 48 patients with difficultly diagnosed liver diseases

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. 83% histopathological diagnostic rate.Conclusions Liver histopathology can significantly improve the diagnostic rate of difficultly diagnosed liver diseases. Among the difficultly diagnosed liver diseases,liver lesions are the most common,and most of them diagnosed as hepatocellular carcinoma and metastatic liver cancer in the end. Liver biopsy with the guide of ultrasound is safe,and no major complications occurred.