【作者】 何蕾丽；

【导师】 唐国都；

【作者基本信息】 广西医科大学 ， 消化内科， 2011， 硕士

【摘要】 目的通过分析肝脏良性占位性病变临床与肝穿组织病理诊断,了解二者之间的差异,探讨可能存在的影响因素,以提高对肝脏良性占位性病变的认识水平,减少临床误诊率。方法收集广西医科大学一附院2004年1月至2010年12月行B超引导下经皮肝脏穿刺活检,并经病理证实为肝脏良性占位性病变的76例住院病人(除外肝硬化结节)的临床资料,回顾分析其肝穿术前临床诊断与病理诊断。结果本组76例病例包括肝脓肿50例(65.78%),肝血管瘤13例(17.10%),肝炎性假瘤10例(13.16%),结节型肝结核、肝腺瘤、肝淋巴管瘤各1例(各占1.32%)。男女比例为1.81∶1。①肝脓肿、肝血管瘤、肝炎性假瘤的发病年龄在19～77岁间,病程1天～2.5年;主要表现右上腹疼痛、发热、肝区叩痛或右上腹压痛,肝脓肿有临床表现者最多;②结节型肝结核见于20岁女性,有明确肺结核病史及右上腹痛;肝腺瘤、肝淋巴管瘤临床表现无特异性。13例无临床表现。肝脓肿发病前或发病时有合并症者38例:胆道结石或手术史17例,2型糖尿病8例,肝内寄生虫感染5例,肝恶性肿瘤4例,肝外感染性疾病5例。血白细胞或中性粒细胞比值升高36例(肝脓肿35例,肝炎性假瘤1例),平均升高水平(16.24±7.35)X10~9/L,血清AFP均<200μg/L。肝穿术前影像学检查:肝内病灶单发:多发占位为2.04∶1;病变部位肝右叶∶肝二叶∶肝左叶为3.46∶1.23∶1;病灶平均直径,肝脓肿为4.89±2.33cm,肝血管瘤为4.67±4.02cm,肝炎性假瘤为2.48±1.18cm。在肝良性占位性病变中,肝脓肿、肝血管瘤、肝炎性假瘤肝穿术前临床诊断符合率分别为73.91%、58.33%、22.22%;肝脓肿、肝血管瘤、肝炎性假瘤、肝腺瘤及肝淋巴管瘤临床误诊率分别为26.09%、41.67%、77.78%、100.00%、100.00%。其中误诊为肝恶性肿瘤19例,占临床误诊的73.08%(19/26)。结论1.肝良性占位性病变以肝脓肿、肝血管瘤及肝炎性假瘤多见;2.肝脓肿有较明显症状、血象及影像学改变,在肝良性占位性病变中临床诊断符合率高;3.肝良性占位性病变临床上易误诊为肝恶性肿瘤;4.肝炎性假瘤临床误诊率高。更多还原

【Abstract】 Objective To analyze the clinical and liver biopsy diagnosis of liver benign occupying lesions in order to have a good diagnosis and decrease the misdiagnosis rate.Methods A total of 76 patients, from January 2004 to December 2010 at the first affiliated hospital of GuangXi Medical University, were diagnosed liver benign occupying lesions by B-Ultrasonic guided percutaneous liver biopsy (except nodular hyperplasia coming from liver cirrhosis), and analyzed their data of the clinical and pathological diagnosis retrospectively.Results There were 50 cases with liver abscesses (65.78%), 13 cases with hepatic haemangiomas (17.10%), 10 cases with inflammatory pseudotumors of liver (13.16%), 1 case with focal hepatic tuberculosis, 1 case with hepatic adenoma and 1 case with lymphangioma of liver(each of the three cases accounted for 1.32% respectively ), Male to female ratio was 1.81∶1. Clinical features:①In the cases with Liver abscesses, hepatic haemangiomas and inflammatory pseudotumors, the ages from 19 to 77years and the courses from 1day to 2.5years. Right upper quadrant abdominal or liver area pain or tenderness, fever, were the most common features in the patients with liver abscesses.②Twenty-year-old female patient, with focal hepatic tuberculosis had history of pulmonary tuberculosis and right upper quadrant abdominal pain. The hepatic adenoma and the lymphangioma of liver had insignificant symptoms. Thirteen cases showed no symptoms. There were 38 cases with liver abscesses with some histories: cholelithiasis and (or) biliary tract surgery in 17cases,type 2 diabetes mellitus in 8 cases,hepatic parasitosis in 5 cases,hepatic malignant tumor in 4 cases,extra hepatic infectious disease in 5 cases。There were 36 cases showed the raising of blood white blood cells (WBC) and (or) neutrophilic granulocytes (liver abscesses 35cases, lymphangioma of liver only 1 case ). The average count of WBC was(16.24±7.35)X109/L,and serum AFP was lower than 200μg/L. Imaging exams before liver biopsy showed: single to multiple occupying lesions ratio was 2.04∶1; the lesion locations of right hepatic lobe to left hepatic lobe and both lobes ratio was 3.64∶1.23∶1; the average diameters of the lesions were: liver abscesses 4.89±2.33cm, hepatic haemangiomas 4.67±4.02cm, inflammatory pseudotumors of liver 2.48±1.18cm.In liver benign occupying lesions, the coincidence rates in abscesses, haemangiomas and inflammatory pseudotumors of liver was 73.91%, 58.33%, 22.22% respectively; The clinical misdiagnosis rates in liver abscesses, hepatic haemangiomas, inflammatory pseudotumor of liver, hepatic adenoma and the lymphangioma of liver were 26.09%, 41.67%, 77.78%, 100.00%, 100.00% respectively. Twenty one cases were misdiagnosed as hepatic malignant tumors , account for 73.08% (19/26).Conclusions 1. Liver abscess, hepatic haemangiomas and inflammatory pseudotumor of liver are common in liver benign occupying lesions; 2. Liver abscess has more striking findings in clinical symptoms, blood WBC and imaging, and has a higher clinical diagnosis coincidence rate in liver benign occupying lesions; 3. Liver benign occupying lesions are most often misdiagnosed as liver malignant tumors; 4. Inflammatory pseudotumor of liver has higher clinical misdiagnosis rate.更多还原