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目的：通过对肝脏实质性小占位的临床研究，探讨微小肝癌的诊断及处理原则。方法：１９８３～１９９６年２８例结节直径≤２ｃｍ的肝脏实质性小占位病变，共３４个病灶。首诊后行手术切除１４例，１９个病灶；ＴＡＥ治疗６例，７个病灶；首诊后未治、行ＡＦＰ＋Ｂ超随访８例。结果：１例ＴＡＥ后４个月，肿瘤明显增大，行手术切除；另１例２个病灶术后２个月，再次ＤＳＡ示肝弥漫结节型肝癌。未治组４例，随访１５个月～３年８个月，肿瘤增大，３例行手术切除；余４例，随访２年～９年５个月，肿瘤无增大。１８例２２个病灶获得组织学诊断。最终诊断为原发性肝癌１７例，继发性肝癌２例，肝血管瘤７例，血吸虫性肝硬化结节及肝脏炎性肉芽肿各１例。结论：微小肝癌诊断应结合病史，尤其是乙肝病史、影像学检查及ＡＦＰ等多方面因素综合分析。对伴肝硬化肝脏的微小占位，尽管Ｂ超显示强回声病灶，血管瘤诊断仍应慎重，临床中密切随访，增大者应及时治疗。微小肝癌应首选手术切除，效果尤佳。对诊断不明或部位深在，不宜手术者，经肝动脉碘油栓塞治疗具有诊断与治疗双重作用，效果优良。
OBJECTIVE: To investigate the diagnosis and treatment of micro-hepatocellular carcinoma by clinical studies on the small hepatic metastases. Methods: Twenty-eight cases of nodules with a nodule diameter of ≤2 cm were studied from 1983 to 1996. There were a total of 34 lesions. After the first diagnosis, 14 cases and 19 lesions were removed surgically; 6 cases were treated with TAE and 7 lesions were treated; after the first diagnosis, 8 cases were followed up with AFP+B ultrasound. RESULTS: In 1 case 4 years after TAE, the tumor was significantly enlarged and surgical resection was performed. In another case, 2 lesions were performed 2 months after operation. DSA showed diffuse nodular hepatocellular carcinoma of the liver. In the untreated group, 4 cases were followed up for 1-5 months and 3 years and 8 months. The tumors increased and 3 cases underwent surgical resection. In the remaining 4 cases, the follow-up period was 2 years to 9 years and 5 months. The tumors did not increase. Twenty-eight cases of 22 lesions were histologically diagnosed. The final diagnosis was primary hepatocellular carcinoma in 17 cases, secondary hepatocellular carcinoma in 2 cases, hepatic hemangioma in 7 cases, schistosomiasis cirrhosis nodule, and liver inflammatory granuloma in 1 case. Conclusion: The diagnosis of small hepatocellular carcinoma should be combined with the history, especially the history of hepatitis B, imaging and AFP. For the micro-occupying liver with cirrhosis, although B ultrasound shows strong echo lesions, the diagnosis of hemangioma should still be cautious, close follow-up in clinical, and increase should be promptly treated. Microscopic liver cancer should be the preferred surgical resection, the effect is particularly good. For patients with unclear or unexplained sites and unsuitable for surgery, hepatic arterial lipiodol embolization has a dual role in diagnosis and treatment with excellent results.