肝囊腺癌的诊治(附18例报告)

目的探讨肝囊腺癌的诊治方法,提高对肝囊腺癌的认识。方法对18例在2000年1月至2004年12月在我院进行手术治疗并经病理证实为肝囊腺癌的病例进行回顾性分析,收集其临床表现、影像学及病理等资料。结果肝囊腺癌在男女发病比例为9/9,平均年龄51岁。单结节病变占94.44%(17/18),病灶平均直径约10.08cm(3-17cm),1例病灶为多发。AFP及CEA均为阴性,61.11?19.9阴性(11/18)。超声检查示病灶呈囊实性块状回声伴液化,边缘呈菜花样突起。平扫CT示:肝内低密度占位,边缘结节状突起。增强CT示:病灶结节状突起,周边强化,延迟期消失。66.67%的病灶大于10cm(12/18)。所有病例在术后均得到病理证实。其中12例位于肝左叶,3例位于肝右叶,1例位于中肝叶,1例位于尾状叶,1例肝左右叶内均有病灶。18例中6例行囊腺癌切除;2例行剖腹探察术;1例行TAE 活检;9例行肝叶切除 胆囊切除及T管引流术。其中1例行左肝叶切除 胆囊切除 胃癌根治术 淋巴结清扫。1例于术后20个月复发再次手术行胆肠吻合术,6个月后再次复发仅行PMCT,此病人死于术后胆瘘。7例患者死于复发转移。10例患者目前健在无复发和转移(平均随访时间20个月)。结论肝囊腺癌是一种少见的肿瘤,生长缓慢。该肿瘤临床特征明显。临床医师对其病理及临床特征的认识将有助于该疾病的诊治。根治性手术切除是延长患者生存期的有效方法。

Diagnosis and Treatment of Liver Cystadenocarcinoma: Reportof 18 Cases

Objective: To discuss the diagnosis and treatment of liver cystadenocarcinoma. Methods: Theclinical, imaging, and pathological data of 18 patients with liver cystadenocarcinoma between January2000 and December 2004 in our hospital were retrospectively analyzed. Results: The liver cystadeno-carcinoma was seen in males and females (m/f: 9/9); mean age was 51 years. Ultrasonography revealedcystic parenchymatous mass echoes of fluid predominance with uneven margins. Nonenhanced CT revealedintrahepatic low-density space occupying shadows with nodular protrusions on the margins in all cases. En-hancement CT revealed that part of the nodular protrusions and tissues around the lesions were enhancedand the delayed phase disappeared. 66.67% (12/18) of the lesions were more than 10 cm in diameter.The diagnosis of liver cystadenocarcinoma was confirmed by postoperative pathology in all cases. Of thesepatients, 12 lesions were in the left lobe, 3 in the right lobe, 1 in the mid lobe, 1 in the right and left lobe,and 1 in the caudate lobe. Of the 18 patients, 6 had completely resect the cystadenocarcinoma, 2 weresurgically explored, one received TAE fine needle aspiration cytology injection of chemotherapy drugs,and 9 underwent radical hepatectomy choledochostomy or T-tube drainage, in which, one patient under-went choledochostomy left hepatectomy radical gastrectomy for cancer lymphadenectomy; one patientunderwent resection of the cystadenocarcinoma, who had relapse 20 months after the initial procedure. Thepatient received repeat resect for the recurrent cystadenocarcinoma cholangio-jejunostomy. Six monthslater she had another relapse and received repeat resect (only PMCT) for the recurrent cystadenocarci-noma. The patient died from cholangiopleural fistula after third time operation (PMCT) was attemptedperioperatively. Seven patients died of metastatic disease after operation. The remaining 10 patients werealive without cancer recurrence or metastasis (mean follow-up 20 months). Conclusion: Liver cystadeno-carcinoma is rarely seen and grows slowly. It shows some typical clinical and imaging features. The cruxfor diagnosing and treating liver cystadenocarcinoma is how familiar the surgeon is with the pathology andclinical features of the condition. Prolonged survival can be achieved by radical resection of the tumor.