乙型病毒性肝炎肝硬化并肝脏畸胎瘤误诊为肝癌原因分析

目的提高乙型病毒性肝炎（乙肝）肝硬化并肝脏畸胎瘤诊断水平，减少误、漏诊。方法回顾分析1例乙肝肝硬化并肝脏畸胎瘤误诊为肝癌临床资料。结果患者以右上腹痛伴尿黄入院，经血清肝纤维化指标、肝炎病毒血清标志物检查诊断乙肝肝硬化，根据B超及CT检查显示肝右叶占位及甲胎蛋白（AFP）1320．00μg／L，诊断原发性肝癌。患者拒绝手术，经保肝、降酶及抗病毒治疗，肝功能及AFP改善，3个月后恢复正常。随访20个月，肝脏占位病变无变化，行手术治疗，经病理检查确诊肝脏畸胎瘤。结论乙肝肝硬化并肝脏占位伴AFP增高者，易误诊，条件许可情况下，应尽早手术确诊。

Cause Analysis of Viral Hepatitis Type B Cirrhosis Combined with Hepatic Teratoma Misdiagnosed as Hepatocellular Carcinoma

Objective To improve the diagnosis of viral hepatitis B cirrhosis combined with hepatic teratoma in order to reduce misdiagnosis and missed diagnosis rate.Methods Retrospective analysis of clinical data of one case with viral hepatitis B cirrhosis combined with hepatic teratoma misdiagnosed as hepatocellular carcinoma was made.Results The patient was admitted for right hypochondrial region combined with xanthic urine and was diagnosed as having viral hepatitis B cirrhosis by serum liver fibrosis markers,hepatitis virus serum markers examinations.Ultrasound and CT examinations showed the placeholder on the right liver lobe and alpha fetoprotein(AFP) 1320.00 μg/L.The patient was diagnosed as having primary liver cancer and refused to receive surgical treatment.The hepatic function and AFP improved after liver protection,reduce enzymes and anti viral therapy and returned to normal three months later.After a follow-up of 20 months,liver placeholder did not change significantly and was confirmed as liver teratoma by pathology after operation.Conclusion Patients with liver cirrhosis combined with liver placeholder and increased AFP levels may be easily misdiagnosed.The patients should be given surgical treatment as soon as possible if the condition permits.