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原发性肝癌的发病率在亚非洲远高于欧美,同样反映于国内外腹腔镜文献中,对其腹腔镜检查的介绍皆少而简略。本文就武汉市四个医院内科自1960年12月至6月经腹腔镜检查而最后确诊为原发性肝癌者60例进行了分析。按照腹腔镜下所观察到的肝脏形态试分作6型,大块型9例,多结节型21例,单结节型5例,(氵弥)漫小结节型(或肝硬化型)16例,非结节型(或肝炎型)3例,大网膜包果型6例。与经典的病理学分型相比较,这一分型对诊断、鉴别、处理与预后似有一定价值。有癌肿的肝叶与未发现癌肿的肝叶在同时并存的病理改变有显著较大且有不一致,对于原发性肝癌以肝硬变或病毒性肝炎作为前驱病的学说提出了疑问,本组病例未能说明日本位血吸虫病为原发性肝癌的病因。认为原发性肝癌患者肝脏的结节及肝炎等改变可能为癌肿的后果而不一定为原因。腹腔镜检查对于原发性肝癌的价值在于诊断符合率高,免除许多病例不必要的剖腹;直视下肝穿刺阳性率高,对于手术可能性的决定似有相当价值,比剖腹探查经济,住院日短而较安全。
The incidence of primary liver cancer is much higher in sub-Africa than in Europe and the United States. It is also reflected in laparoscopic literature both at home and abroad. The introduction of laparoscopic examination is rare and brief. This article analyzed 60 patients who were diagnosed as primary liver cancer by laparoscopy from December to June in 1960 in four hospitals in Wuhan. In accordance with the liver morphology observed under laparoscopic examination was divided into 6 types, 9 cases of massive type, 21 cases of multinodular type, 5 cases of single nodular type, (Mi Mi) diffuse nodules (or cirrhosis type) In 16 cases, 3 were non-nodular (or hepatitis) and 6 were omental. Compared with the classic pathological classification, this classification seems to have some value for diagnosis, identification, treatment and prognosis. There are significant and inconsistent pathological changes in the simultaneous coexistence of the cancerous liver lobe and the undetected cancerous lobe, and questions have been raised about the hepatocirrhosis or viral hepatitis as precursors for primary liver cancer. This group of cases failed to show that schistosomiasis in Japan is the cause of primary liver cancer. It is considered that liver nodules and hepatitis changes in patients with primary liver cancer may be the consequence of cancer but not necessarily the cause. The value of laparoscopy for primary hepatocellular carcinoma lies in the high diagnostic coincidence rate, eliminating many cases of unnecessary laparotomy; the positive rate of hepatic puncture under direct vision seems to be of considerable value for the decision of surgical possibility, compared with laparotomy economy, hospitalization The day is shorter and safer.