【摘要】 目的总结原发性肝癌伴胆管癌栓诊断和鉴别诊断的要点,分析常见的误诊原因。方法回顾18年内收治的392例原发性肝癌伴胆管癌栓患者的临床诊断过程,归纳该病易误诊的疾病类型,分析术前临床误诊的主要原因。按照不同时期进行分组:前期(1993至2001年)128例,后期(2002至2011年)264例,比较不同时期误诊率的差异以及误诊疾病类型的变化,总结原发性肝癌伴胆管癌栓诊断和鉴别诊断的要点。结果总体术前临床误诊率为16.6%(65/392),后期术前临床误诊率(9.8%,26/264)低于前期(30.5%,39/128)(P<0.001)。后期ERCP/MRCP的检查率(91.7%,242/264)高于前期[67.9%(87/128),P<0.001]。ERCP/MRCP的误诊率为5.5%(18/329),低于肝脏B超[26.8%(105/392),P<0.001]及肝脏CT/MRI[25.0%(98/392),P<0.001]。常易误诊的疾病包括:肝癌伴肝门部胆管压迫(4.1%,16/392),肝门部胆管腺瘤/癌(4.3%,17/392),远端胆管腺瘤/癌(包括壶腹部腺瘤/癌)(2.3%,9/392),胆管内黏液状腺瘤/癌(1.0%,4/392),转移性肝癌伴胆管癌栓(1.0%,4/392),胆管结石(3.8%,15/392)。前、后期误诊为肝癌伴肝门部胆管压迫分别为9.4%(12/128)和1.5%(4/264),误诊为胆管结石分别为7.8%(10/128)和1.9%(5/264),差异有统计学意义(P<0.01)。结论提高原发性肝癌合并胆管癌栓临床特征的认识水平,合理应用影像学检查手段,加强与相似疾病的鉴别,可有效降低误诊率。更多还原

【Abstract】 Objective To summarize the key points for diagnosis and differential diagnosis of hepatocellular carcinoma combined with bile duct tumor thrombi(HCCBDT),and analyze the common reasons for misdiagnosis.Methods A total of 392 patients with HCCBDT over a 18-year period were included in this study.The liable disease types of misdiagnoses were summarized and the main causes of preoperative misdiagnosis were analyzed.The patients were divided into two groups according to the time periods: Group A(from 1993 to 2001,128 patients) and Group B(from 2002 to 2011,264 patients).The misdiagnosis rates and types of misdiagnosed diseases were compared between the two groups.The key points of diagnosis and differential diagnosis of HCCBDT were summarized.Results The overall preoperative misdiagnosis rate was 16.6%(65/392) in our patients.The misdiagnosis rate of Group B(9.8%,26/264) was significantly lower than that of Group A(30.5%,39/128)(P<0.001).And 91.7%(242/264) patients received ERCP/MRCP examination in Group B,which was significantly higher than that in the Group A(67.9%,87/128)(P<0.001).The misdiagnosis rate of ERCP/MRCP(5.5%,18/329) was significantly lower than those of B-type ultrasound examination(26.8%,105/392)(P<0.001) and CT/MRI scan(25.0%,98/392)(P<0.001).The misdiagnosed diseases included hepatocellular carcinoma with hilar bile duct compression(4.1%,16/392),hilar bile duct adenoma/carcinoma(4.3%,17/392),distal bile duct adenoma/carcinoma(including ampullary adenoma/carcinoma)(2.3%,9/392),mucus-like bile duct adenoma/carcinoma(1.0%,4/392),metastatic liver cancer with bile duct tumor thrombi(1.0%,4/392),and bile duct stones(3.8%,15/392).The proportions of misdiagnosis as liver cancer with hilar bile duct compression in the Group A and Group B were 9.4%(12/128) and 1.5%(4/264),respectively,and those as bile duct stone were 7.8%(10/128) and 1.9%(5/264),respectively(P<0.01).Conclusion More knowledge on the HCCBDT clinical features,effective imaging examination methods,and more efforts on differential diagnosis with the similar diseases can reduce misdiagnosis of HCCBDT.更多还原