肝脏良性实性占位病变误诊分析

目的总结和分析肝脏良性实质性占位病变术前误诊问题,提高临床确诊率.方法回顾性研究我院肝胆胰外科自1998年1月至2004年6月,术前诊为肝癌接受肝切除,术后经病理证实为肝脏良性占位24例患者临床资料.所有病例术前采用统一的诊断方法和步骤,即常规检查血肿瘤标志物,影像学检查（B超、CT、MRI）,少数病例接受肝穿刺活检.结果术前误诊为恶性的24例良性占位中,肝血管瘤9例,肝局灶性结节状增生（focal nodular hyperplasia,FNH）4例,肝腺瘤2例,肝硬化结节性增生2例,肝孤立性坏死结节2例,肝寄生虫性肉芽肿3例,肝结核瘤1例,炎性假瘤1例.术前误诊的原因主要有病灶影像学表现不典型、临床及影像医生认识不足等.24例误诊患者术后发生轻微并发症2例,无需特殊处理;无1例死亡;所有患者经平均3年1个月的随访,无复发病例.结论肝脏良性实质性占位术前易误诊为肝癌.合理地选择联合检查方法和遵循诊治流程,可提高肝脏恶性占位性病变的术前确诊率,减少误诊误治,对术前不能排除恶性的肝脏占位应积极手术治疗.     

腹腔镜肝切除术11例临床报告

目的:探讨腹腔镜肝切除术的适应证和可行性。方法:回顾分析10例病灶位于肝脏边缘及左肝外叶(Ⅱ～Ⅵ段)及1例位于Ⅷ段的肝占位患者的临床资料。其中原发性肝细胞癌8例,肝海绵状血管瘤2例,胆管细胞癌1例,肝功能Child-Pugh评分A级9例,B级2例;AFP(+)7例;位于左肝外叶实质中的肿瘤,行规则性左肝外叶切除;位于肝脏边缘或右肝表面的肿瘤,行肝脏局部切除。结果:11例均成功完成腹腔镜肝切除术,无中转开腹。其中局部切除术7例,左肝外叶切除术4例,腹腔镜脾切除+胆囊切除术2例。平均手术时间105min,术中平均出血220ml,切除病灶最大直径10cm。全部肿瘤均完整切除,肿瘤包膜完整,无破裂。术后未发生胆漏和出血等并发症,恢复良好,术后平均住院8.5d。结论:位于肝脏边缘、右肝表面或左半肝(Ⅱ～Ⅵ段)的肝脏占位,行腹腔镜肝切除术是安全可行的。     

肝脏罕见肿瘤的诊断和治疗

目的 探讨肝脏罕见肿瘤的诊断和治疗方法.方法 回顾性分析我院2005年5月至2010年1月收治的25例肝脏罕见肿瘤患者的临床病理资料.结果 25例患者中肝局灶性结节性增生6例,肝血管平滑肌瘤、肝门部神经鞘瘤、肝左叶动脉瘤、肝胆管囊腺瘤、肝错构瘤、肝胆管绒毛状腺瘤、肝弥漫性大B细胞淋巴瘤各1例,肝血管平滑肌脂肪瘤2例,肝原发间质瘤2例,肝母细胞瘤5例,肝胚胎性肉瘤3例;术前行B超检查24例,CT检查22例,MRI检查6例,仅有3例(16.7%)检查和术后病理结果一致.术前诊断和术后病理符合5例(20%).25例均行手术切除治疗,包括半肝切除术7例,肝叶切除术7例,肝段切除术9例,肿瘤局部挖除2例.肝脏良性、低度恶性肿瘤及1例弥漫性大B细胞淋巴瘤术后无复发,5例恶性肿瘤随访中3例术后复发行再次手术切除,术后随访无复发;另2例死亡,平均术后生存期4个月.结论肝脏罕见肿瘤影像学诊断率低,手术切除是主要的治疗手段,对能切除的复发性肿瘤性病变应争取再次手术切除.     

完全腹腔镜下肝部分切除治疗体会

目的探讨腹腔镜肝部分切除术的适应证、可行性及手术操作技术。方法回顾分析2009年7月至2009年12月在我院行腹腔镜部分肝切除9例患者的临床资料。其中原发性肝细胞肝癌5例,直肠癌肝转移瘤1例,肝海绵状血管瘤1例,肝内胆管结石2例,肝功能Child-Pugh评分均在B级以上。位于左半肝实质中的肿瘤及左半肝肝内胆管结石,行规则性左半肝切除;位于肝脏边缘或右肝表面的肿瘤,行肝脏局部切除。结果 8例成功完成腹腔镜肝切除术,其中局部切除术1例,左肝外叶切除术5例,左半肝切除术2例。1例因术中出血较多(800ml)而中转开腹手术。平均手术时间(173±52)min,术中平均出血(402±91)ml,切除病灶最大直径8cm。全部患者肿瘤均完整切除,肿瘤包膜完整。术后未发生明显胆漏和出血等并发症,患者恢复良好,术后平均住院(8.3±3.2)d。结论位于肝脏边缘、右肝表面或左半肝的肝脏占位或肝内胆管结石,在充分掌握适应证及相应的手术操作技巧的基础上,行腹腔镜肝切除术是安全可行的。     

多中心性肝癌选择性肝部分切除术后右门静脉主干血栓形成1例报道

患者，男，62岁，因“体检发现肝左内叶及右后叶占位10d”入院，有慢性乙型肝炎病史，AFP：79．5μg／L，B超及CT提示肝左内叶及右后叶占位，疑原发性多发性肝癌。术中发现：肝呈小结节样改变，右后叶可触及肿瘤，左内叶未触及明确肿瘤，结合术中B超定位，右后叶及左内叶分别有直径约3cm及2．5cm的占位。术中右肝动脉及门静脉暂时性阻断10min左右，行左内叶及右后叶第7段跳跃式肝部分切除，术后病理诊断：     

腹腔镜肝切除术15例报告

目的:探讨腹腔镜肝切除术的适应证及可行性。方法:回顾分析2010年12月至2013年12月为15例肝占位性病变患者行完全腹腔镜肝切除术的临床资料。结果:13例成功完成腹腔镜肝切除术,2例中转开腹。原发性肝癌5例,肝海绵状血管瘤5例,肝内胆管结石2例,肝囊肿2例,肝血管平滑肌脂肪瘤1例。其中行局部切除术8例,左肝外叶切除术5例,肝囊肿切除2例;合并腹腔镜胆囊切除术2例。手术时间平均(153±53)min,术中出血量平均(412±93)ml,切除病灶最大直径12 cm。肿瘤均完整切除,包膜完整,无破裂。1例术后发生胆漏,保守治疗后痊愈;2例术后出血,经对症治疗后痊愈,无死亡病例,术后平均住院(10±3)d。结论:位于肝脏边缘、右肝表面或肝左外叶(Ⅱ~Ⅵ段)的肝脏占位性病变,行腹腔镜肝切除术是安全、可行的。     

少见类型的原发性肝脏良性肿瘤

本文报告１３例少见类型的原发性肝脏良性肿瘤，其中肝腺癌８例，行炎性假瘤３例，肝局生结节增生２例，少见类型的原发怀良性肝肿瘤术前确诊困难，本组９例误诊，其中６例误诊为原发性肝癌。各种影像学有助于肿瘤定位，但缺乏诊断特异性，最后确诊依赖于术后病理学检查，治疗方式为肿瘤所在的部位的肝段或局部切除术。     

肝脏占位性病变的术前诊断方法评估

目的 探讨不同肝脏占位性病变的影像学特点和病理诊断结果,以提高肝脏占位性病变术前确诊率的方法.方法 回顾性分析40例患者的临床资料和诊治情况,总结患者术前不同影像学检查中肝脏占位性病变的特征表现,通过对比术后肝脏占位件病变的病理诊断结果,比较B超、动态增强CT和动态增强MRI的术前确诊率. 结果 40例患者均通过手术切除肝脏占位性病变,切除标本中经病理诊断原发肝细胞肝癌22例、肝脏巨大再生结节7例、局灶性结节样增生、胆管细胞肝癌、肝血管瘤和肝硬化结节各2例、肝腺瘤、肝紫癜症和肝内异物反应结节各1例.肝脏B超的确诊率普遍较低,只有20%;增强CT在原发性肝癌和肝脏巨大再生结节的鉴别诊断中准确率较低,分别只有45.8%和0,全部病例的确诊率为42.5%;MRI在各种不典型病变的术前鉴别诊断中确诊率高达92.5%.结论 某些肝脏占位性病变的术前诊断较为困难,应加强对这些病变的认识和鉴别诊断,动态增强MRI对各种肝脏占位性病变的诊断率高.     

肝脏局灶性结节性增生的诊断与治疗(附6例报告)

报告经手术及病理证实的肝脏局灶性结节性增生6例,影像学检查均提示肝实性占位病变。但术前诊断困难,全组均误诊为原发性肝癌。讨论了B超、CT、MRI、血管造影以及同位素检查对该病诊断的价值,认为需要结合临床及多种影像学检查,才能作出较恰当的诊断。若不能与肝脏恶性肿瘤鉴别,宜早期手术切除病灶,以明确诊断。     

肝内胆管结石的外科诊断与治疗

目的 总结肝胆管结石诊治的临床经验。方法 回顾性分析78例肝胆管结石的定位诊断、术式选择和治疗结果。结果 术前检查与术中所见符合率B超为80．8％，CT为87．5％，B超联合CT为93．8％；局限于左肝管或右肝管结石行相应肝段／叶切除治愈率96．4％；双侧肝胆管结石行-侧肝段／叶切除 高位肝胆管切开取石 术后胆道镜取石治愈率达72．7％。结论 ①B超联合CT在肝胆管结石的术前定位诊断中优于单-B超或CT检查。②以切除含病灶的肝段／叶为基本的方案是治疗肝胆管结石的有效手段。③肝段／叶切除 术后胆道镜取石能提高双侧肝胆管结石的治愈率。     

Polypoid lesions of the gallbladder

26 cases of polypoid lesions of the gallbladder are reported. 19 were benign lesions, among them, there were 12 (63%) cholesterol polyp, 4 adenoma, 1 inflammatory polyp, and 2 others. 95% of benign lesions were less than 1 cm in diameter, 63% of which were less than 0.5 cm in diameter, 15 cases were multiple lesions; all cases were not associated with gallstones. 7 cases were carcinoma of the gallbladder, of which, 5 were more than 1 cm in diameter, 2 were less than 1 cm which were carcinoma in situs; 3 were associated with gallstones. The accuracy of preoperative diagnosis of polypoid lesions of the gallbladder made by B-mode ultrasonography, cholecystography, CT, endoscopic ultrasonography were 84%, 53%, 80% and 75% respectively. It is concluded that preoperative diagnosis of polypoid lesions on the gallbladder mainly depends on the B-mode ultrasonography; the lesions less than 0.5 cm in diameter should not be treated by operation for the time being; the lesions between 0.5-1 cm should be followed up by B-mode ultrasonography; the operation may be considered if stones present; the lesions more than 1 cm should be resected since malignancy could not be excluded.     

术中超声在肝脏肿瘤手术中的应用价值

目的 探讨术中超声在肝脏肿瘤手术中的应用价值.方法 对45例肝脏肿瘤患者行术中超声检查(Logiq 500型超声仪,5～7.5 MHz线阵式术中专用探头),并与术前超声(PHILIPSHDI 5000型超声仪,3.5～5 MHz凸阵式探头)和增强CT检查对比分析,比较三者在病灶检出率方面的差异.结果 术中超声对直径≥1 cm病灶的检出率为100%,高于术前超声(89.80%)和CT(97.96%)的检出率,但差异无统计学意义(术前超声xc2=3.372,P>0.05,CT Fisher确切概率为P=1.00);术中超声对直径<1 cm病灶的检出率为90.70%,明显高于术前超声的检出率(62.79%)和CT检出率(74.42%)(术前超声x2=9.382,CT x2=3.957,均P<0.05);术中超声对病灶的总体检出率为95.65%,明显高于术前超声的检出率(77.17%)和CT检出率(86.96%)(术前超声x2=13.378,CT x2=4.381,均P<0.05),所有新发现的病灶都在术中超声的引导下行手术切除或无水乙醇瘤内注射.结论 与术前影像学检查相比,术中超声可以提高隐匿部位和微小病灶的检出率,有助于指导外科操作和手术治疗.     

Power Doppler ultrasonographic diagnosis of small hepatocellular carcinomas

BACKGROUND/AIMS: Power Doppler ultrasonography can evaluate the hemodynamics of intrahepatic tumors. The ability of power Doppler ultrasonography to detect small hepatocellular carcinomas and estimate the differentiation of the tumor by the patterns of intranodular waves was assessed. METHODS: We used conventional B-mode ultrasonography, power Doppler ultrasonography, and dynamic computed tomography to examine 71 hepatocellular carcinomas (相似文献   

Intraoperative ultrasonographic detection of occult liver metastases in colorectal cancer

Summary The efficacy of intraoperative ultrasonographic detection of colorectal cancer liver metastases was evaluated in 85 patients undergoing operation for primary colorectal tumors or liver secondaries. The results of intraoperative ultrasonography were compared with those of preoperative ultrasonography and computed tomography, as well as the intraoperative appearances of the liver. Additional information about the number of metastases was obtained in 12 cases (14.1%); 17 (24.3%) out of 70 metastases could only be detected by intraoperative ultrasonography. In 4 cases (4.7%) these lesions were solitary. As a result, the operative procedure of choice was changed in 15.3% of the patients. We conclude that intraoperative ultrasonography has a significantly higher ability to detect colorectal cancer liver metastases than preoperative methods or intraoperative inspection and palpation. Intraoperative ultrasonography should be performed in patients without preoperative evidence of liver metastases and in all patients with planned resection of metastases.     

甲状旁腺病变的超声诊断及多种影像学对比分析

评价超声在甲状旁腺疾病诊断中的价值及多种影像学检查技术在甲状旁腺疾病诊断中的对比分析。方法回顾性分析于我院行甲状旁腺手术切除患者94例,共104个病灶。观察病变的声像图特征,对比分析多种影像学检查结果。结果不同甲状旁腺病变的超声声像图特征具有差异性,超声诊断甲状旁腺病变的敏感度为82.69%(86/104),对于直径1cm的病变,超声诊断的敏感度明显高于其他检查单独使用,而对于合并甲状腺结节的病变超声的敏感度低于核素显像及超声联合核素检查(P均0.05)。结论超声可作为甲状旁腺病变诊断的首选检查方法,联合运用各种影像学检查,可更好地进行病变的术前定位及诊断。     

周围型肝内胆管细胞癌的诊断和治疗

目的 探讨周围型肝内胆管细胞癌(PICC)的诊断及外科治疗，提高其诊治水平。方法 总结分析1991～2000年间我科收治的46例PICC病人诊断、治疗及预后的资料。结果 (1)本病早期无特异性临床表现，部分病例可并存乙型肝炎(20％)、肝硬化(45％)，部分伴有肝内胆管结石(20％)，血清AFP升高(30％)；(2)影像学检查：B超、CT、MRI的诊断率分别为90．0％、95．4％及100．0％；(3)手术切除率为64．0％．全组病例的1、3、5年生存率分别为60．0％、33．0％及26．0％；(4)生存5年以上的12例病人中，直径≤3cm的小肝癌9例，包膜完整的肿块型直径位于3～5cm肝癌3例，术后均辅助性放射治疗和选择性肝动脉灌注化疗。结论影像学检查能在早、中期提供临床线索，但缺乏特异性血清肿瘤标志物，治愈性切除术加辅助治疗可获得良好生存率。     

Accuracy of Preoperative Imaging of Hepatic Tumors With Helical Computed Tomography

Background The accuracy of preoperative computed tomography (CT) scans in the era of modern imaging techniques with helical, high-resolution CT has not been adequately assessed. We reviewed the data from our departmental prospective database with the hypothesis that intraoperative ultrasonography (IOUS) still detects more hepatic tumors than are evident on preoperative helical CT scans. Methods All patients who underwent surgical resection and/or radiofrequency ablation of primary or metastatic hepatic tumors between January 2001 and July 2002 were included in the review. All patients had preoperative helical CT imaging followed by hepatic IOUS. The number of malignant lesions and evidence of local disease identified by the preoperative CT scan versus IOUS and surgical exploration were compared. Results In this time period, 250 patients underwent surgical resection and/or radiofrequency ablation of hepatic tumors. In 67 (27%) of these patients, IOUS identified more hepatic tumors than were seen on preoperative helical CT scan. In eight patients (3%), CT underestimated local extension of the disease into the diaphragm. The incidence of inaccurate preoperative prediction of the extent of disease increased significantly with a greater number of hepatic tumors. Conclusions IOUS identified additional hepatic tumors in 27% of patients who underwent hepatic resection after state-of-the-art preoperative CT imaging. This study provides evidence that IOUS remains an essential part of the complete assessment of hepatic malignancies in patients who receive surgical treatment.     

术中B超动态引导切除乳腺微小肿物临床应用体会

【摘要】〓目的〓探讨乳腺微小肿物在B超动态引导下切除的临床应用体会。方法〓对100例临床检查不能触及的乳腺微小肿物女性患者按手术方式不同分成2组,术中B超引导组56例,对照组44例,术中B超引导组在术中B超动态引导下切除肿物,对照组实行术前体表定位,按定位切除肿物。结果〓术中B超引导组56例患者肿物皆被准确切除,平均手术时间18 min,对照组42例患者肿物被准确切除,2例漏切,平均手术时间27 min。结论〓B超术中动态引导切除乳腺微小肿物,准确、快速、美观、经济,可用于乳腺微小肿块早期诊断和治疗。     

局麻下CT引导肝癌微波消融术中肿瘤位置与疼痛的关系

目的:探讨肝癌病灶距肝包膜或肝段以上门静脉分支远近与局麻下CT引导行微波消融(MWA)术中疼痛的关系。方法:选取先成功实施肝动脉栓塞化疗后行MWA治疗的78例肝癌患者,根据原发病灶位置分为近端组(病灶距离肝包膜或肝段以上门静脉分支距离≤5 cm,32例,37个病灶)和远端组(病灶距离肝包膜或肝段以上门静脉分支距离5 cm,46例,54个病灶),比较两组治疗效果及术中疼痛程度等指标的差异。结果:近端组的病灶完全消融率与远端组差异无统计学意义(75.86%vs.81.48%,P0.05);两组术后AFP水平均较术前明显降低(均P0.05),但无组间差异(P0.05)。按肿瘤大小(≤2 cm和2 cm)分层比较,近端组与远端组的术前VAS评分、可耐受的最大治疗功率、消融时间比较差异均无统计学意义(均P0.05),但近端组术中VAS评分、VAS相对值、哌替啶用量均明显的高于远端组(均P0.05);近端组和远端组病灶2 cm的患者的术中VAS评分、消融时间、哌替啶用量均明显高于本组病灶≤2 cm的患者(均P0.05)。近端组总并发症发生率明显高于远端组(15.63%vs.2.17%,P0.05)。结论:肝癌病灶距离肝包膜或肝段以上门静脉分支的位置≤5 cm会增加患者MWA治疗过程中的疼痛感受,尤其是病灶直径2 cm的患者增加会更加明显。     

Prospective comparison of preoperative imaging and intraoperative ultrasonography in the detection of liver tumors

A prospective evaluation of the accuracy of preoperative computed tomography (CT), ultrasonography (US), and angiography was performed in 54 patients undergoing resection of hepatic neoplasms. The results were compared with surgical findings and intraoperative ultrasonography (IOUS). A total of 167 lesions was seen by means of IOUS, of which preoperative US enabled detection of 127 (76%). In 48 patients CT allowed detection of 91 of 150 lesions (61%), and in 35 patients angiography showed 56 of 107 lesions (52%). When the detection rate is analyzed according to hepatic segment, the greater overall accuracy of preoperative US may be attributed to a markedly better detection rate in lateral segment of the left lobe of the liver. Lesion size also represented a factor, with preoperative US allowing detection of a greater number of small (less than 2 cm) lesions compared with CT. In patients studied with both CT and US, the combined lesion-detection rate increased to 81% in the right lobe and 76% in the left lobe. Because of this we recommend that preoperative assessment include both CT and US evaluation of the liver. IOUS showed 25% to 35% additional lesions compared with preoperative US and CT. More importantly, 40% of the lesions demonstrated by IOUS were neither visible nor palpable at surgery. We recommend that IOUS be considered in all patients in whom resection of hepatic neoplasm is planned.