原发性胆管细胞性肝癌27例误诊误治原因探讨

目的 探讨原发性胆管细胞性肝癌的误诊误治情况及其原因，以及避免误诊误治的方法。方法 对我院经病理学检查证实40例原发性胆管细胞性肝癌的诊断和治疗情况进行调查和统计分析，了解误诊误治情况及易误诊的疾病。结果 首次就诊的误诊率为68％，所误诊的疾病依次为胆石症伴肝内炎症包块，肝脓疡、肝囊肿、肝腺瘤。施行误治的有：胆管探查取石术、肝脓疡切开引流术或B型超声引导下穿刺抽吸引流术，肝囊肿开窗引流术、肝囊肿切除术。结论 原发性胆管细胞性肝癌误诊率高，且常被误诊。避免误诊的方法有：（1）注意寻找本病的特征性表现；（2）提倡所有肝内占位术前、术中活体组织学检查是避免误漏诊的重要方法。

Misdiagnosis and incorrect treatment of hepat ic cholangiocarcinoma

Objectives In this retrospective study we investigated the causes of misdiagnosis and incorrect treatment of hepatic cholangiocarcinoma and ways helpful in the improvement of correct diagnosis.Methods There were altogether pathollgy proved 40 cases of hepatic cholangiocarcinoma. The preoperative diagnostic procedures and surgical measurcs adopted were reviewed. Results The primary misdiagnosis rate was 68%. Patients were misdiagnosed as cholelithiasis complicated by intrahepatic inflammatory mass, hepatic abscess, hepatic hydrocyst, and hepatic adenoma;The surgical procedure performed were: choledocholithotomy, hepatophyma incision drainage or liver puncture drainage on B mode ultrasound localization, and hepatic cyst fenestration. Conclusions The hepatic cholangiocarcinoma can mimic many other benign diseases leading to misdiagnosis and improper surgery. Hence clinical features,history and laboratory evidence characteristic of the cancer must be sought preoperatively and intraoperative biopsy should be taken before definite surgical procedure. [