甲胎蛋白阴性的小肝占位病例的诊治经验

目的直径〈2cm的肝脏占位通常不具备典型的肝脏肿瘤影像学特点，当甲胎蛋白化验结果阴性时诊断尤其困难，通过对这部分病例诊治过程和随诊结果的回顾和分析，总结甲胎蛋白阴性的小肝占位病例的诊治经验。方法我科2003年1月-2008年12月共收治103例直径≤2cm且甲胎蛋白阴性的肝脏占位病例，根据肿瘤多发性选择数字减影血管成像（DSA）、动态增强磁共振成像（MRI）、造影超声或PET—CT进行鉴别诊断，对于疑诊的94例病例行部分肝切除术。结果这四种检查手段对肝脏恶性肿瘤的诊断准确率分别为88．2％、93．9％、88．9％和88．9％；本组手术病例手术并发症率低（6．4％）、预后良好，肝癌病例的1年生存率和3年生存率分别为98．8％和76．1％。结论DSA、动态增强MRI、造影超声和PET—CT检查对于小肝占位均有很好的诊断价值；手术方式宜采取肝脏部分切除术；小肝癌病例手术风险小、预后好，对于疑诊病例应积极进行手术治疗。     

恶性血液病肝脏浸润形成占位性病变的超声和CT表现

目的 探讨恶性血液病肝脏浸润形成占位性病变的超声及CT特点,以提高确诊率。方法 回顾性分析2012年4月至2015年5月16例恶性血液病肝脏浸润形成占位患者的超声及CT表现;其中非霍奇金淋巴瘤9例,霍奇金淋巴瘤2例,多发性骨髓瘤1例,急性髓性白血病2例,急性淋巴细胞白血病1例,慢性淋巴细胞白血病1例。结果（1）超声表现：主要为多发性小病灶,少数为单发病灶;大部分病灶形态规则,为圆形、类圆形、椭圆形,少数形态不规则;13例病灶为低回声,1例为混合回声,2例为高回声。彩色多普勒血流成像技术（CDFI）提示乏血供。（2）CT表现：平扫肝脏占位主要为多发性低密度小病灶,增强扫描无强化或仅轻度强化。（3）肝右叶病灶数量多于肝左叶。（4）非霍奇金淋巴瘤、霍奇金淋巴瘤、多发性骨髓瘤以及白血病在肝脏浸润形成占位性病变的超声及CT表现有类似的特点。结论 恶性血液病肝脏浸润形成占位有一定的影像学特征,超声与CT联合检查可作为首选的无创性影像学诊断方法。     

肝脏良性实质性局灶性病变的B型超声诊断（附21例报告）

肝脏良性实质性局灶性病变的Ｂ型超声诊断（附２１例报告）安阳市肿瘤医院功能科张靖肝脏实质性局灶性病变，有良、恶之分，区分Ｍ者具有重要的临床意义。从１９９０年至１９９４年底，注重结合肝脏全貌、病灶周围间接征象及临床，诊断２１例极似原发性小肝癌（＜Ｚｃｍ）...     

吲哚氰绿近红外光在微小肝脏占位性病变术中的应用效果

目的:探究吲哚氰绿近红外光在微小肝脏占位性病变术中的应用效果。方法:回顾性分析2015年1月至2016年1月期间我院收治的87例微小肝脏肿瘤患者的临床资料，所有患者均采用肝切除手术治疗，患者术前经CT检查，术中使用吲哚氰绿近红外光技术对肿物进行识别、界定和导航，随访患者术后复发率，分析吲哚氰绿近红外光在微小肝脏占位性病变中的应用效果。结果:87例患者共119个病灶，术前CT检查发现88个病灶，术中通过吲哚氰绿近红外光技术发现103个病灶，两种检查方法均未发现但切开肝脏后暴露发现16个病灶，吲哚氰绿近红外光检查较CT检查能发现更多病灶，差异具有统计学意义（P＜0.05）。CT检查与吲哚氰绿近红外光检查发现的肿瘤平均深度和平均最大直径差异无统计学意义（P＜0.05）。87例患者中16个病灶为全荧光型，23例环形荧光，34例高分化原发性肝癌，31例低分化原发性肝癌。87例患者随访18个月，其中11例患者术后复发，所有患者均为单个肿瘤患者，平均复发时间为（8.93±2.44）个月，复发患者肿瘤距离肝脏表面平均深度为（2.35±0.51）cm，平均大小为（1.61±0.74）cm，所有患者均未进行二次手术，采用以外科治疗的综合治疗。结论:吲哚氰绿近红外光技术对微小肝脏肿瘤的识别率高，病灶显示清晰，在术中具有重要作用。     

普通探头引导经皮肝脏穿刺46例报告

自１９９２年４月至１９９５年６月，我院对４６例肝脏占位性病变在普通探头引导下进行经皮穿刺细胞学检查，取得较好的诊断效果，现报告如下。１材料和方法１．１一般资料４６例中男３９例，女７例；年龄２７～７２岁，平均５２岁。穿刺病灶位于右叶３７例，左叶９例。直...     

肝扫描结合穿刺诊断肝癌四例

迄今肝扫描仍然是诊断肝脏占位性病变常用影象学方法之一,对肝脏较大的占位性病变,肝扫描优于B超,对较小病灶,肝扫描则逊于B超。我们认为肝扫描结合细针快速肝穿刺术,可提高肝脏占位性病变诊断的符合率。现列举四例报告如下: 临床资料     

肝脏小病变的螺旋CT延迟扫描

肝脏小病变是指病变直径≤3．0cm(如小肝癌)及病变直径≤1.5cm(如微小肝癌)。常见的占位病变有小肝癌及其相关结节：小血管瘤、小转移瘤及肝脏局灶性结节增生等。CT技术的改进大大增加了肝脏结节病灶的检出能力和诊断准确率，增强方法和扫描技术对肝脏小结节的检测有很大影响。本文对常见肝脏小病变的CT延迟扫描技术、延迟扫描表现和病理学基础进行综述。     

肝脏小病变的螺旋CT延迟扫描

肝脏小病变是指病变直径≤ 3 0cm(如小肝癌 )及病变直径≤ 1 5cm(如微小肝癌 )。常见的占位病变有小肝癌及其相关结节 :小血管瘤、小转移瘤及肝脏局灶性结节增生等。CT技术的改进大大增加了肝脏结节病灶的检出能力和诊断准确率 ,增强方法和扫描技术对肝脏小结节的检测有很大影响。本文对常见肝脏小病变的CT延迟扫描技术、延迟扫描表现和病理学基础进行综述。1　肝脏病变多期螺旋CT扫描的理论依据肝脏病灶的检出率取决于肝和病灶吸收值 (密度 )的最大差别[1] 。静脉注射造影剂能增加正常肝和灶性病变之间的吸收值差别。肝为双重供血 ,75 …     

倍增时间长的肺腺癌10例诊治分析

１９７９年６月￣１９９６年６月共收治倍增时间达１０￣９３．８个月的肺腺癌１０例，该组病灶生长缓慢，其中８例首诊时病灶直径１ｃｍ￣２ｃｍ，手术时病灶仍在３ｃｍ以内，而其追踪观察时间达３０￣８１个月（平均５２个月），文章对其诊断，手术指征和预后作了讨论分析。     

以左颈淋巴结转移癌首诊的78例患者临床分析

目的 探讨以左颈淋巴结转移癌首诊患者的临床特点。方法 本院从1996年1月～2003年3月收治78例以左颈淋巴结转移癌首诊的恶性肿瘤，全部病例均经病理证实，回顾性分析其临床资料。结果 78例以左颈淋巴结转移癌首诊的恶性肿瘤中原发灶来源于头颈部的46例(58．97％)、肺部10例(12．82％)、消化道10例(12．82％)，原发灶未明11例(14．20％)。临床分析发现转移灶的病理形态、解剖位置、病灶大小与原发灶有密切关系。结论 以左颈淋巴结转移癌首诊的恶性肿瘤，应强调注意其病理形态、解剖位置、病灶大小、结合病史、内镜等检查，以提高原发灶的检出率，指导临床治疗。     

Localization of small liver tumors.

Thirty-six patients with small liver tumor were diagnosed by alpha-fetoprotein (AFP); sonography, and computed tomography (CT), and underwent hepatectomy. The pathological types included 23 hepatocelluler carcinoma (HCC), 11 hepatic cavernous hemangioma, and 2 secondary liver cancer. In 22 patients, the tumor nodules were located in the right lobe and 14 cases in the left lobe. The diagnostic accuracy rate of CT was 100% for HCC and secondary liver cancer, but for hepatic cavernous hemangioma it was only 72.2%. However, the accuracy rate of sonography was as high as 81.8% for hepatic cavernous hemangioma and only 60.4% for liver malignancies. The positive rate of AFP for the HCC patients of this series was only 66.6%. The method of intraoperative detection of small liver tumor is introduced, if the tumor was invisible grossly or nonpalpable during exploratory laparotomy. In the series, 7 cases in whom the right lobe lesion was too small to be located by routine manual examination during exploratory laparotomy were detected by this method, and all small liver tumors were resected successfully.     

X-ray endovascular embolization of the hepatic artery in the palliative treatment of hepatocellular cancer

X-ray endovascular embolization of hepatic artery (HAE) was carried out in 10 cases of liver cell carcinoma (hepatic cirrhosis included). Immediate beneficial effect was recorded in 8 cases. Remission for 12 months and more was registered in three cirrhosis-free patients; mean survival in five patients was 15 months. In cases of cancer aggravated with cirrhosis, HAE effectiveness proved much lower and survival dropped to average 5.5 months.     

肝动脉门静脉双重栓塞术治疗肝癌对肝脏储备功能的影响

１０例原发性肝癌患者经腹脉动脉门静脉双重插管，同时化疗栓塞，并观察了术前术后肝脏储备功能指标的变化。１０例患者的肝实质栓塞率在８．３６％～４７．８％。其中４例接近或超过４０％，血浆中ｃＡＭＰ基础浓度，术前术后相比无显著变化，Ｐ＞０．０５，经胰高血糖素负荷后，ｃＡＭＰ浓度从术前的２７８．３１降至术后的１４２．３８ｐｍｏｌ／ｍｌ，Ｐ＜０．０５，４例术后ｃＡＭＰ明显低下（小于９０ｐｍｏｌ／ｍｌ）；患者术前肝动脉门静脉血流灌注指数与肝硬化时改变相似，８例中２例肝动脉门静脉血流均增加，３例肝动脉血流增加，门静脉减少，另外３例则相反；３例栓塞率较高。负荷后ｃＡＭＰ低下者出现了一过性黄疸和腹水。结果表明：①双重栓塞可损害一部分肝实质，对肝脏储备功能产生一定影响，但尚在代偿范围之内；②双栓范围较大，ｃＡＭＰ低下时注意保护功能；③双栓后肝血流的变化复杂，应进一步研究必手术操作简便，方法可靠安全。     

肝原发性肿瘤及占位性病变CT延迟增强扫描的意义

本文通过前瞻性研究,对42例原发性肝肿瘤及肝病变患者进行了肝CT平扫、常规增强及肝延迟增强扫描(简称DICT)。其中肝癌32例,共有癌瘤、癌灶58个;肝血管瘤6例,共有血管瘤7个;局灶性结节状增生(简称FNH)1例;另有孤立性肝硬变大结节3个。全部病例均经手术、病理证实。结果表明:1、肝DICT对于5.0cm以下的小肿瘤检出灵敏度高于平扫和常规增强CT扫描。本组病例,DICT灵敏度为79.1％,平扫和常规增强CT扫描联合使用灵敏度为48.8％,差异有显著性(P<0.01)。2、DICT假阳性率低于平扫和常规增强,DICT为5.0％,平扫为25％,常规增强为9.1％,DICT与CT平扫假阳性率差异有显著性(P<0.05)但DICT与常规增强无显著性差异(P>0.05)。3、DICT对具有肝组织功能的病变如FNH、肝硬变结节有一定的鉴别诊断价值。     

Highly enhanced hepatic masses seen on CT during arterial portography: early hepatocellular carcinoma and adenomatous hyperplasia

BACKGROUND: To describe computed tomographic (CT) features of highly enhanced hepatic masses as seen on CT during arterial portography (CTAP) and to survey the varieties of hepatic lesions associated with such findings. METHODS: CTAP files for 400 patients were reviewed, on the basis of which six patients with highly enhanced hepatic masses were selected. These six patients also subsequently underwent CT during hepatic arteriography (CTHA) on the same day. All the patients had chronic liver damage, which was cirrhotic in five cases. Five had a current diagnosis and one had a history of hepatocellular carcinoma (HCC). RESULTS: Solitary highly enhanced masses were observed on CTAP in three patients, three masses were seen in one patient and multiple (10-12) masses in the other two patients. All the CTAP-enhanced masses except one were round in shape and homogeneous in attenuation. The size of the mass ranged from 6 to 25 mm in diameter. In all except two nodules in one patient, the masses were hypoattenuated on CTHA. On histopathological examination of five nodules in three patients, the nodular lesions were consistent with so-called early HCC (well-differentiated HCC of Edmondson I) in four nodules and adenomatous hyperplasia in the other nodule. CONCLUSIONS: Highly enhanced hepatic masses relative to the surrounding liver parenchyma have been sporadically noted on CTAP, especially in patients with liver cirrhosis. When present, such nodules are typically hypoattenuated on CTHA and histological features are consistent with early HCC and adenomatous hyperplasia.     

新生儿肝脏血管瘤的临床诊治分析

目的总结新生儿肝脏血管瘤的临床特点,指导临床诊断和治疗。方法回顾性分析16例新生儿肝血管瘤的临床资料,并结合文献加以讨论。结果 16例新生儿肝脏血管瘤患儿中,7例手术完整切除,近期1例出现胆瘘,1例出现呼吸衰竭,远期并发症随访期间尚未发现,手术效果良好,术后随访3～36个月,复查肿瘤均未复发,肝功能及AFP恢复正常;9例未行手术进行临床动态观察,随访3～36个月,复查肿瘤逐渐增大。所有患儿生长发育同正常儿。结论新生儿肝脏血管瘤应根据患者病情选择个体化治疗方案,如术前能明确诊断,肿瘤较小、且无症状者可密切随访;如瘤体巨大、凝血功能异常、肝功能异常者,应早期手术治疗。     

The usefulness of digital subtraction imaging with Levovist in the diagnosis of focal hepatic tumors

This study was designed to evaluate digital subtraction imaging (DSI) with Levovist in the diagnosis of hepatocellular carcinoma (HCC), metastatic hepatocellular carcinoma, and hepatic hemangioma. The subjects in this study were 70 patients with 76 nodules of hepatic tumors (48 nodules in 46 cases of hepatocellular carcinoma, 20 nodules in 16 cases of metastatic hepatocellular carcinoma, and 8 nodules in 8 cases of hepatic hemangioma). Contrast enhancement of tumors acquired in the early, portal, and late phases with DSI were compared to classify the tumors. DSI of HCC showed contrast enhancement of 40 nodules (82.2%). High contrast enhancement in the early phase, which was maintained in the portal phase, changed to images with no contrast enhancement with partial persistence of contrast enhancement in the late phase. DSI of metastatic hepatic carcinomas demonstrated contrast enhancement of tumor of 18 nodules (90%) to a high degree in the early and portal phases, which changed to images with no contrast enhancement in the late phases. DSI of hepatic hemangioma maintained high contrast enhancement on tumor margins of 5 nodules (62.5%) and on the entire tumor of 3 nodules (37.5%) in the early, portal, and late phases. DSI of hepatic tumors (hepatocellular carcinoma, metastatic hepatocellular carcinoma, and hepatic hemangioma) provided characteristic findings of contrast enhancement in the early, portal, and late phases, and contribute to differential diagnosis.     

肝超声造影监测和早期诊断微小肝癌的应用价值

背景与目的：我国肝癌发病率高,原发性肝癌常在肝硬化的基础上发生,早期诊断较为困难。本研究应用实时超声造影对肝癌高危患者进行定期跟踪监测,探讨其早期发现和诊断微小肝癌的临床应用价值。方法：2011年2月-2013年11月针对320例肝癌高危患者进行定期的肝常规超声检查和追踪定位的肝超声造影检查,根据肝内病灶在超声造影不同时相的增强表现特点鉴别诊断其良恶性。结果：320例肝癌高危患者定期随访中,经肝超声造影发现和诊断微小肝细胞癌20例,并经手术病理证实,包括直径≤1.0 cm肝癌7例、1.1~2.0 cm肝癌13例。其中6例(30.0%)呈不典型的“快进同出”型表现;病灶小,灰阶超声上呈等回声是超声造影表现不典型的主要因素。结论：常规超声和超声造影对肝癌高危患者的定期跟踪监测,可早期发现微小肝癌,使患者得到及时治疗。     

选择性肝动脉栓塞治疗肝海绵状血管瘤

目的 研究使用平阳霉素碘油乳剂经导管超选择插入肝动脉栓塞治疗肝海绵状血管瘤的方法和效果。方法 对32例肝海绵状血管瘤进行平阳霉素碘油乳剂经肝动脉栓塞治疗，将导管超选择插入肝血管瘤的供血动脉，以平阳霉素碘油乳剂栓塞。男14例,女18例，年龄28～62岁,平均44岁，术前均经US、CT、DSA检查确诊。结果 所有病例均成功实施了栓塞治疗;32 例中有30例分别于术后1 ～24个月进行CT或B超随访;瘤体缩小〉50%者25例,〉 30%者5例，其中B超随访肿瘤完全消失1例;1例患者肿瘤缩小不明显.30例临床有症状患者中,临床症状消失28例，明显减轻1例，总有效率96.7 %（29/30）。术中及术后无严重并发症。结论 平阳霉素碘油乳剂经肝动栓塞是治疗肝海绵状血管瘤的安全、有效的首选方法。