彩色多普勒漏诊、误诊局限性脂肪肝20例CT分析

目的分析CT动态增强扫描在局限性脂肪肝中的诊断价值。方法分析20例局限性脂肪肝经彩色多普勒漏、误诊原因及回顾CT动态增强扫描表现及特点。结果 CT动态增强扫描在局限性脂肪肝的诊断上具有特征性表现。结论对局限性脂肪肝在定量和鉴别诊断方面,CT动态增强扫描明显优于彩色多普勒。     

电视腹腔镜对脂肪肝的诊断价值(附63例报告)

为探讨新的脂肪肝诊断方法，在行腹腔镜胆囊切除手术时，对术前B超检查诊断为脂肪肝的63例患者的肝脏通过电视腹腔镜进行观察，并对肝脏进行图像采集，然后在脏肝表面切取小块肝组织进行病理检查，将病理结果检查与腹腔镜下诊断进行对比分析。结果显示，腹腔镜诊断脂肪肝与病理诊断脂肪肝符合率达90．48％。认为电视腹腔镜可作为诊断脂肪肝的一种新的、直观的方法。     

Differential diagnosis of liver parenchymal diseases by likelihood method using 12 laboratory data and age

Liver parenchymal diseases were statistically diagnosed by likelihood method using 12 routine liver function tests and age. 444 cases of liver diseases were classified into 8 groups by histological diagnosis. A score diagnosis table was made from the data of these cases. For the likelihood diagnosis, data of each case were adapted to the score table and the probable diagnosis was calculated. Correct diagnosis rate of the first probable diagnosis was 50% in all cases and that of the first and the second was 71%. Descending order of the correct diagnosis rate of the first diagnosis was fatty liver (76%), liver cirrhosis (67%), slight histological changes (61%), acute hepatitis (51%), alcoholic liver injury (48%), chronic aggressive hepatitis 2A (43%), chronic persistent hepatitis (40%) and chronic aggressive hepatitis 2B (26%). In conclusion, differential diagnosis of liver parenchymal diseases was made easily with the score table of 13 informations with a considerable success.     

Evaluation of liver fibrosis: a concise review

The diagnosis of liver fibrosis has traditionally relied on liver biopsy. However, recent studies have suggested that there can be up to a 33 % error in the diagnosis of cirrhosis. In this article, we review the current status of liver biopsy as a gold standard for the diagnosis of liver fibrosis and discuss the radiological and serum tests that have been proposed as potential adjuncts or alternatives to biopsies. Indirect markers of liver fibrosis which reflect alterations in liver function and or inflammation are discussed as well as more direct markers of liver fibrosis. The limitations of utilization of these markers for both cross-sectional diagnosis of fibrosis and monitoring disease progression or regression are discussed.     

4200例肝穿刺活检组织病理与临床分析

目的分析肝穿刺活检组织病理与临床诊断结果,评价各型病毒性肝炎及其他类型肝病临床与病理诊断符合率。方法采用1秒钟快速肝穿刺活检术,肝内局灶占位病变则在彩超引导下行病变处穿刺活检,肝组织常规做HE染色、Masson及网状纤维染色,根据临床病情需要加做免疫组织化学及特殊染色如刚果红、PAS、红氨酸染色等。结果病毒性肝炎临床与病理诊断分级的总体符合率约66．2％,其中以慢性肝炎轻度符合率最高,达81．3％,而急性肝炎的符合率最低,为38％;脂肪性肝炎临床与病理诊断符合率为70．6％;肝脏肿瘤及瘤样病变临床与病理诊断符合率达92．3％;遗传与代谢性疾病临床与病理诊断符合率为70．8％。结论病毒性肝炎临床与病理诊断一致性还存在一定的差异,临床资料对病理诊断有重大帮助;肝穿刺活检术是诊断脂肪肝的重要方法之一;肝穿刺术对各类原发及转移性肝脏肿瘤鉴别诊断意义最大,在罕见及疑难肝脏疾病诊断中具有辅助确诊作用。     

Prediction of liver cirrhosis,using diagnostic imaging tools

Early diagnosis of liver cirrhosis is important. Ultrasoundguided liver biopsy is the gold standard for diagnosis of liver cirrhosis. However, its invasiveness and sampling bias limit the applicability of the method. Basic imaging for the diagnosis of liver cirrhosis has developed over the last few decades, enabling early detection of morphological changes of the liver by ultrasonography(US), computed tomography, and magnetic resonance imaging(MRI). They are also accurate diagnostic methods for advanced liver cirrhosis, for which early diagnosis is difficult. There are a number of ways to compensate for this difficulty, including texture analysis to more closely identify the homogeneity of hepatic parenchyma, elastography to measure the stiffness and elasticity of the liver, and perfusion studies to determine the blood flow volume, transit time, and velocity. Amongst these methods, elastography using US and MRI was found to be slightly easier, faster, and able to provide an accurate diagnosis. Early diagnosis of liver cirrhosis using MRI or US elastography is therefore a realistic alternative, but further research is still needed.     

瞬时弹性成像技术在慢性肝病肝纤维化诊断中的应用进展

肝脏纤维化程度及进展与慢性肝脏疾病的诊断与治疗密切相关。早期诊断肝纤维化程度有助于避免代偿期患者向肝硬化失代偿期发展,也有助于降低肝细胞癌的发生率。目前,临床上评估肝纤维化程度的“金标准”仍为肝脏穿刺活检,但是由于其操作的有创性,以及穿刺后可能出现的多种并发症等多种因素的影响,限制了它在临床研究中的使用。瞬时弹性成像技术无创、安全、有利于动态监测肝纤维化进展、客观评价肝脏纤维化程度,使其在国内外得到了广泛的认同,在临床上具有良好的应用前景。     

CT引导下经皮肝穿刺活检术在不明原因肝功能异常诊断中的临床应用

目的探讨CT引导下经皮肝穿刺活检术在不明原因肝功能异常诊断中的临床应用。方法回顾性分析58例不明原因肝功能异常患者行CT引导下经皮肝穿刺活检术的临床、病理资料,主要观察术后病理诊断率、GS分级诊断率、并发症。结果本组取材成功率100%,手术平均时间11.52 min,取得组织条(1.48±0.50)条,病理诊断率为84.5%(49/58),病理肝炎活动度(G)和肝纤维化程度(S)分级诊断率为72.4%(42/58)。经皮肝穿刺操作未导致肝功能指标数值(ALT、AST、ALP、GGT、TBIL)在短期内显著性增高。8例(13.8%)肝包膜下少量出血,经内科治疗后无进展。结论CT引导下经皮肝穿刺活检术对不明原因肝功能异常的病理及GS分级诊断率高,并发症可控,具有一定的临床应用价值。     

肝纤维化血清学诊断指标研究进展

肝纤维化是肝脏组织损伤后的不完全修复过程,是慢性肝病最重要的病理特征,也是肝硬化发展的必经途径和进一步恶化的重要原因。肝纤维化的诊断方法包括影像学、病理学和血清学3种。影像学诊断在肝纤维化晚期才能出现异常图像;病理学诊断是金标准,但存在肝穿刺的盲目性、肝脏病变的不均一性而导致取样误差;血清学诊断是应用最广泛的诊断方法。本文对肝纤维化的血清学诊断指标在肝纤维化诊断上的优缺点进行综述。     

肝纤维化血清学诊断研究进展

肝纤维化是由各种慢性肝病引起细胞外基质在肝脏过度沉积所致,可进展为肝硬化并导致肝功能衰竭和门静脉高压等。肝纤维化具有可逆性已成为共识。因此,准确诊断和评估肝纤维化程度对肝纤维化的防治及其预后评估具有非常重要的意义。肝纤维化诊断的金标准是肝脏活检,但由于其具有创伤性、费用昂贵而难以被患者接受。血清学检查是诊断肝纤维化较为理想的检测方法,可对肝纤维化进行早期诊断,并可进行动态观察。由多个血清学指标组成的非创伤性诊断模型,提高了肝纤维化的诊断准确性。本文就肝纤维化的血清学诊断研究进展进行综述。     

内镜超声在诊断和治疗肝脏疾病中的价值

肝脏疾病的传统影像学诊断方法主要包括B超、CT、MRI等,内镜超声(EUS)以往较少用于肝脏疾病的诊断。近年,EUS和EUS-细针穿刺活检(FNA)在肝脏疾病的诊断中取得了较大进展,对B超、CT、MRI难以发现的微小病变有一定诊断价值,且EUS-FNA可获得较好的组织学和细胞学标本,有助于明确微小病变的性质。本文就EUS和EUS-FNA在肝脏疾病,尤其是肝癌诊断中的价值作一综述,旨在提高医师对两者临床应用的认识。     

重视肝活组织病理检查在临床肝病诊疗中的应用

目的探讨超声引导下经皮肝穿刺活组织病理检查在临床肝病诊疗中的意义。方法回顾性分析了吉林大学第一医院157例超声引导下经皮肝穿刺活组织病理检查病例,所有病例均为肝损害经常规检查方法未能明确诊断或临床诊断分期不明确。所有患者经临床生化学检查及影像学检查均未提示肝硬化。分为I组(HBV感染组)和II组(非HBV感染组)。结果 157例病例中,I组81例,其中IA组(ALT<2×ULN)43例,IB组(ALT≥2×ULN)38例。II组76例,其中自身免疫性肝病30例,药物性肝损害21例,脂肪性变11例,罕见病例8例,隐源性肝炎6例。结论超声引导下经皮肝穿刺活组织检查安全性较高,肝活组织病理检查在不明原因的肝损害或临床诊断分期不明确的肝损害诊断中有非常重要的价值,可减少临床漏诊及误诊,有利于明确肝损害的病因及程度。     

Hypertension and fatty liver: guilty by association?

Essential hypertension is associated with the metabolic syndrome, insulin resistance and the development of fatty liver. Fatty liver disease is a spectrum of liver diseases ranging from simple hepatic steatosis through steato-hepatitis to cirrhosis and hepatoma. The purpose of this review is to discuss the evidence for an association between essential hypertension and non-alcoholic fatty liver disease, and to consider the diagnosis and management of non-alcoholic fatty liver disease. We conclude that it is important to consider the diagnosis of fatty liver disease in hypertensive patients, to measure the liver function tests at diagnosis and not to ignore minor elevations of serum aminotransferases. Hypertensive patients with raised liver enzymes should be referred for further assessment, particularly if risk factors for progressive liver disease, such as obesity and diabetes, are present.     

Peritoneoscopy in the diagnosis of liver abscess. Experience with 108 cases during a 10-year period

Among 4569 cases of peritoneoscopy performed in a period of 10 years (1972-1981), 108 patients with liver abscesses were encountered. The diagnosis of hepatic abscess was made on the basis of gross liver inspection and confirmed or disproved by needle puncture biopsy, histopathologic study, or surgery. Peritoneoscopy is a valuable procedure for the diagnosis of liver abscess. Liver aspiration under direct vision during peritoneoscopy yields more dependable material for the diagnosis of liver abscess than blind liver aspiration. Moreover, during peritoneoscopy one can choose more accurately the site for the insertion of the aspirating needle.     

肝纤维化无创性诊断技术应用的新进展

肝纤维化准确分期对指导临床治疗具有重要意义,无创性诊断技术可使患者避免或减少肝活组织检查,有可能成为临床诊断肝纤维化的重要手段。笔者通过对患者的临床、血清学及影像学等肝纤维化资料的评估,介绍了提高肝纤维化及肝硬化诊断率的无创性诊断技术新进展。     

超声技术无创评估肝纤维化的临床应用进展

肝纤维化可发展为肝硬化,其中部分可进展为肝癌、肝衰竭。因此肝纤维化程度的评估对临床治疗、预后评价非常重要,而超声弹性成像是一种新的无创性评估肝纤维化程度的方法,为肝纤维化的早期诊断提供了新思路。本文就其在肝纤维化诊断中的应用进行综述。     

肝硬化的诊断和评估

肝硬化是各种慢性肝病的终末阶段,如何早期诊断肝硬化及对肝硬化进行分期并进行有效病情评估,在临床工作中尤为重要。介绍了肝脏穿刺病理学检查、血清学检查及影像学检查在肝硬化的临床诊断中的应用,以及肝脏储备功能评估、并发症评估和预后评估的研究进展。指出随着分子生物学及影像学诊断技术的发展,必将大力提高无创诊断的准确性和特异性,并深入完善疾病的评估体系。     

非酒精性脂肪性肝病肝纤维化的诊断和治疗进展

非酒精性脂肪性肝病(NAFLD)正成为全球最常见的慢性肝病。从其疾病谱来看,非酒精性脂肪性肝炎(NASH)是疾病进展形式,可进展为肝纤维化,从而导致NAFLD相关肝硬化和肝癌。NASH肝纤维化与疾病预后密切相关,临床亟需有效措施诊断及干预疾病进展。重点介绍了目前非酒精性脂肪性肝纤维化的诊断和治疗进展。     

An assessment of the role of liver biopsies in asymptomatic patients with chronic liver test abnormalities

OBJECTIVE: The role of liver biopsy in the management of patients with nonspecific chronic liver enzyme abnormalities is not well established. The aim of this study is to determine whether liver histology changes the clinical impression formed before liver biopsy and the preliminary management plan. METHODS: Consenting asymptomatic adult patients with persistent (> or = 6 months) liver test abnormalities were enrolled. Patients with a strong suspicion for a specific liver disease were excluded. A presumptive diagnosis and a preliminary management plan were documented before a liver biopsy. After the liver biopsy, the patients were reassessed to determine the effect of the biopsy on the diagnosis and management plan. RESULTS: A total of 36 patients were enrolled: 15 men and 21 women, with a median age of 51 yr. The prebiopsy diagnoses were nonalcoholic steatohepatitis (24), autoimmune hepatitis (3), primary biliary cirrhosis (2), primary sclerosing cholangitis (2), and miscellaneous (5 patients). The liver biopsy changed the diagnosis in 14% of cases. Lifestyle recommendations were not significantly altered by the biopsy. The liver biopsy affected the frequency of liver test monitoring in 13 patients (36%). Treatment recommendations were affected in 12 cases, 10 of whom were offered investigational therapy. CONCLUSIONS: Although a liver biopsy may help to definitively establish the final diagnosis in patients, the results alter the presumptive prebiopsy diagnosis infrequently, and no proven therapy exists for the vast majority of these patients. Therefore, the risks and benefits of a liver biopsy should be carefully weighed, especially in settings in which investigational therapies are unavailable.     

螺旋CT三期增强扫描在肝脏肿瘤鉴别诊断中的价值

目的:评价螺旋CT三期扫描在肝脏肿瘤鉴别诊断中的价值,重点探讨动脉期、门静脉期及延迟期扫描的意义,以进一步提高CT诊断的正确性.方法:100例肝脏肿瘤[38例肝血管瘤,28例原发性肝癌,23例肝转移瘤,4例肝脏局灶性结节性增生(FNH),5例肝脓肿,2例肝母细胞瘤]行螺旋CT三期增强扫描.一次屏气完成全肝扫描,观察肿瘤三期强化的方式和特征.结果:38例肝血管瘤准确定性36例,2例诊断不典型血管瘤可能;28例肝癌误诊4例;23例肝转移瘤中多发性转移瘤无1例误诊,1例单发转移瘤误诊;4例FNH中有1例误诊为纤维板障型肝癌;肝脓肿及肝母细胞瘤均诊断明确.结论:螺旋CT三期扫描在肝脏肿瘤鉴别诊断中具有重要价值,是肝脏肿瘤鉴别诊断的最佳方法,应作为肝脏肿瘤的常规扫描方法.