【摘要】 目的探讨外生型肝癌(EGHC)诊治方法和误诊原因、防范措施。方法对2016年11月—2017年12月收治的曾误诊为肾上腺嗜铬细胞瘤的EGHC 2例的临床资料进行回顾性分析,并复习相关文献。结果本组2例分别因在当地医院行超声检查显示肝肾间隙占位性病变2周和阵发性高血压病3年入院。腹部影像学检查皆显示肝肾之间占位性病变,均考虑为右侧肾上腺嗜铬细胞瘤,并行手术治疗,术后病理检查示肝细胞癌,确诊EGHC。1例术后给予放化疗和靶向药物治疗,术后40个月存活良好;1例术后拒绝任何辅助治疗,6个月后死亡。结论 EGHC误诊率较高。临床遇及肾上腺区占位患者时,应按常规行定性、定位诊断,在临床表现及检查结果不符合肾上腺相关疾病时,特别是患者有肝炎、肝硬化和肝癌等病史时应考虑到EGHC,可行肝脏进一步检查,以减少或避免误诊误治。更多还原

【Abstract】 Objective To investigate diagnosis and treatment, misdiagnosed causes and preventive measures of extrahepatic growing hepatocellular carcinoma(EGHC). Methods Clinical data of two EGHC patients misdiagnosed as having adrenal pheochromocytoma during November 2016 and December 2017 was retrospectively analyzed, and a literature review of related articles was conducted. Results One patient was admitted for space-occupying lesion in hepatorenal interspace in local hospital for 2 weeks, and the other one was admitted for paroxysmal hypertension for 3 years. Abdominal imaging examination showed space-occupying lesions between the liver and kidney in both patients, and both were diagnosed as having right adrenal pheochromocytoma, and then surgical treatment was given. Postoperative pathological examination showed hepatocellular carcinoma, was and EGHC was confirmed. One patient was treated with chemoradiation and targeted drugs, and the patient survived well in 40 months after operation, while the other one refused any adjuvant therapy after operation and died in 6 months later. Conclusion Misdiagnosis rate of EGHC is relatively high. For patients with space-occupying lesion in adrenal glands, conventional qualitative and localized diagnosis should be performed. When clinical manifestations and examination results do not accord with adrenal gland-related diseases, especially when the patients have histories of hepatitis, liver cirrhosis and liver cancer, the possibility of EGHC should be considered, and further liver examination should be carried out to reduce or avoid misdiagnosis and mistreatment.更多还原