【摘要】 目的　探讨甲胎蛋白 (AFP)阴性小肝细胞癌的临床诊断与处理。方法　回顾分析 1998年 9月至 2 0 0 2年 10月收治的AFP阴性小肝细胞癌 4 2例 ,肿瘤大小为 1 2～ 4 8cm ,中位直径 3 3cm。术前经B超和CT检查 4 2例 ,MRI检查 32例 ,DSA检查 6例 ,穿刺病理 8例。诊断为原发性肝癌 2 4例 ,诊断符合率为 5 7% ,术前诊断为肝脏局灶结节增生 8例 ,炎性假瘤 4例 ,肝腺瘤 4例 ,肝硬化结节 1例 ,肝血管瘤 1例。血AFP均为阴性。病人均经手术根治性切除。结果　 4 2例中 1年生存者 38例(占 90 4 % ) ,2年生存者 31例 (占 73 8% ) ,3年生存者 2 2例 (占 5 2 3% ) ,4年生存者 18例 (占4 2 8% ) ,失去联系 4人。肿瘤复发再次手术切除肿瘤 9例。结论　依据有无肝炎和肝硬化病史以及B超、CT或MRI、DSA等影像学特点综合考虑诊断 ,局部介入等有创治疗选择应慎重 ,手术根治性切除是首选的治疗方法。更多还原

【Abstract】 Objective To explore the diagnosis and treatment of α-fetoprotein-negative small hepatocellular carcinoma (HCC). Methods The clinical data of 42 patients with α-fetoprotein-negative small HCC treated in our hospital from September 1998 to October 2002 were retrospectively analyzed. The tumor was 1.2～4.8 cm in diameter (mean=3.3 cm). Forty-two patients received B-mode ultrasonography and CT, 32 MRI, 6 DSA and 8 pathological examination through puncture. Twenty-four patients were diagnosed to suffer from primary carcinoma before the operation and the coincident rate was 57%. Meanwhile, 8 cases were diagnosed to be hepatic local nodular hyperplasia, 4 inflammatory pseudotumor, 4 hepatic adenoma, 1 cirrhotic nodule and 1 hepatic hemangioma. All patients were negative in serum AFP. The radical resection of the lesions was performed in all the 42 patients. Results The survival time was 1 year in 38 cases (90.4%), 2 years in 31 cases (73.8%), 3 years in 22 cases (52.3%) and 4 years in 18 cases (42.8%). Four cases were unable to be followed up. Nine patients received re-operation due to recurrence. Conclusions The diagnosis of the disease should be determined according to the history of hepatitis and cirrhosis and the imaging features of B-mode ultrasonography, CT, MRI or DSA. The injurious therapies such as local intervention etc. should be carefully selected. The radical resection is of the first choice for treatment of this disease.更多还原