肝脏良性结节性病变误诊为肝癌31例分析

目的探讨肝脏良性结节性病变的诊断和治疗,总结肝脏良性结节性病变误诊的经验,提高肝脏良性结节性病变的诊断准确率。方法回顾性总结31例肝脏良性结节性病变的诊治资料并结合文献进行分析。结果术前诊断原发性肝癌而剖腹手术者627例,31例(4.9%,31/627)病理证实为肝脏良性结节性病变。其中肝局灶性增生性结节9例,肝硬化结节8例,肝再生结节5例,肝炎性结节5例,肝腺瘤样增生增节4例。结论应综合病史、临床表现、化验和影像学进行诊断,多种影像学方法联合可增加诊断的正确性,肝动脉造影对肝硬化结节和肝癌的鉴别诊断有一定意义,对HBsAg(一)和AFP阴性或定量低于200ng/mL的肝脏结节性病变,最好术前行B超引导肝穿刺活检获得病理诊断。

ANALYSIS OF 31 CASES OF HEPATIC BENIGN NODULAR LESIONS MISDIAGNOSED AS LIVER CHNCER

Objective To investigate the diagnosis and treatment of the hepatic benign nodular lesions,find out the reasons of the misdiagnosis and promote the correct rate of diagnosis of hepatic benign nodular.Method The clinical data of 31 cases with hepatic benign nodular were analyzed retrospectively,and the correlation documents were reviewed.Result Amongst the 627 cases who were performed laparotomy as HCC,31 cases(4.9%,31/627)were confirmed to hepatic benign nodular lesions by pathological diagnosed.Amongst these benign diseased,9 cases were hepatic focal nodular hyperplasia,8 cases hepatic cirrhosis nodules,5 cases hepatic regenerative nodules,5 cases hepatic inflammatory nodules,and 4 cases hepatic adenomatous hyperplastic nodules.Conclusion We should combine the case history,chinical characteristic,laboratory examination and medical imaging of patients to diagnose the hepatic nodules,associate various kinds of imaging will promote the diagnosis.TACE is a significant method in differential diagnosis between benign nodular lesions and HCC.For the patients of HBsAg and AFP negative,or AFP level lower than 200ng/mL,we recommend to get a pathologic diagnosis by ultrasound guiding liver hiopsy.