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目的探讨肝囊腺癌的诊治方法,提高对肝囊腺癌的认识。方法对18例在2000年1月至2004年12月在我院进行手术治疗并经病理证实为肝囊腺癌的病例进行回顾性分析,收集其临床表现、影像学及病理等资料。结果肝囊腺癌在男女发病比例为9/9,平均年龄51岁。单结节病变占94.44%(17/18),病灶平均直径约10.08cm(3-17cm),1例病灶为多发。AFP及CEA均为阴性,61.11%CA19.9阴性(11/18)。超声检查示病灶呈囊实性块状回声伴液化,边缘呈菜花样突起。平扫CT示:肝内低密度占位,边缘结节状突起。增强CT示:病灶结节状突起,周边强化,延迟期消失。66.67%的病灶大于10cm(12/18)。所有病例在术后均得到病理证实。其中12例位于肝左叶,3例位于肝右叶,1例位于中肝叶,1例位于尾状叶,1例肝左右叶内均有病灶。18例中6例行囊腺癌切除;2例行剖腹探察术;1例行TAE+活检;9例行肝叶切除+胆囊切除及T管引流术。其中1例行左肝叶切除+胆囊切除+胃癌根治术+淋巴结清扫。1例于术后20个月复发再次手术行胆肠吻合术,6个月后再次复发仅行PMCT,此病人死于术后胆瘘。7例患者死于复发转移。10例患者目前健在无复发和转移(平均随访时间20个月)。结论肝囊腺癌是一种少见的肿瘤,生长缓慢。该肿瘤临床特征明显。临床医师对其病理及临床特征的认识将有助于该疾病的诊治。根治性手术切除是延长患者生存期的有效方法。
Objective To investigate the diagnosis and treatment of hepatocellular adenocarcinoma and to improve its understanding of hepatic cystadenocarcinoma. Methods 18 cases were treated in our hospital from January 2000 to December 2004 and were retrospectively analyzed. The clinical manifestations, imaging and pathology were collected. Results The incidence of hepatic cystadenocarcinoma in men and women was 9/9 with an average age of 51 years. Single nodules accounted for 94.44% (17/18), the average diameter of the lesion was about 10.08cm (3-17cm), and one case was multiple. AFP and CEA were negative, 61.11% CA19.9 negative (11/18). Ultrasonography showed cystic solid mass echo with liquefaction, the edge was cauliflower protuberances. CT scan showed: low-density intrahepatic space, the edge of nodular processes. Enhanced CT showed: lesions nodular processes, peripheral enhancement, the disappearance of the delay. 66.67% of the lesions were larger than 10 cm (12/18). All cases were pathologically confirmed after surgery. Of these, 12 were located in the left lobe of liver, 3 in the right lobe, 1 in the middle lobe, 1 in the caudate lobe and 1 in the left and right lobes of the liver. Of the 18 cases, 6 cases had cystadenocarcinoma resection; 2 cases had exploratory laparotomy; 1 case had TAE + biopsy; 9 cases had hepatectomy + cholecystectomy and T-tube drainage. One case of left hepatic resection + cholecystectomy + radical gastrectomy + lymph node dissection. One patient had recurrent cholesteato-jejunostomy at 20 months after operation, and only had PMCT after 6 months. The patient died of postoperative biliary fistula. Seven patients died of recurrence and metastasis. Ten patients are currently alive without recurrence and metastasis (mean follow-up of 20 months). Conclusions HEPC is a rare tumor that grows slowly. The clinical features of the tumor are obvious. Clinicians to understand the pathological and clinical features will help diagnosis and treatment of the disease. Radical surgical resection is an effective way to prolong the survival of patients.