【摘要】 目的 总结肝细胞癌(HCC)以四肢骨转移为首发症状患者的临床特征，探讨其诊治经验。方法 2022年8月—2023年8月河北医科大学第三医院诊治2例以四肢骨转移为首发症状的HCC患者。例1以右下肢疼痛为首发症状，例2以右臀部、右大腿内侧间断疼痛为首发症状。2例经超声、MRI、CT、全身骨显像、活检或手术组织病理等检查诊断为HCC骨转移。例1行肝脏及骶骨动脉灌注化疗栓塞(TACE)治疗。例2行右髂骨病灶局部放射治疗后应用信迪利单抗+贝伐珠单抗靶向联合免疫治疗。结果 例1患者TACE术后症状减轻，后因病情进展死亡。例2患者局部放射治疗后症状减轻，规律行靶向联合免疫治疗出院后8个月肝脏肿瘤进展给予仑伐替尼联合肝内病灶姑息放疗，末次随访时病情稳定。结论 HCC首发症状为四肢骨转移临床少见，发现骨病灶后应尽早行影像学及组织病理检查明确原发病灶，及时行TACE、放射治疗、靶向及免疫治疗可延长患者生存期。更多还原

【Abstract】 Objective To summarize the clinical characteristics of hepatocellular carcinoma(HCC) patients with initial symptom of bone metastasis of extremities, and to explore the diagnosis and treatment experiences. Methods Two HCC patients with initial symptom of bone metastasis of extremities were treated in the Third Hospital of Hebei Medical University from August 2022 to August 2023. The initial symptom was right lower limb pain in patient 1, and intermittent right buttock and right inner thigh pain in patient 2. Both two patients were diagnosed with HCC bone metastasis by ultrasound, MRI, CT, whole-body bone scanning, biopsy, or surgical pathological examination. Patient 1 underwent transcatheter arterial chemoembolization(TACE) of liver and sacral artery, and patient 2 underwent local radiotherapy of right iliac bone lesion, followed by targeted therapy + immunotherapy with sintilimab + bevacizumab. Results Patient 1 experienced an alleviation in symptoms after TACE, and died of disease progression afterwards. Patient 2showed a relief of symptom after local radiotherapy,followed by regular targeted therapy + immunotherapy.Liver tumor progression occurred 8months after discharge,and lenvatinib combined with intrahepatic palliative radiotherapy was given.The latest follow-up showed a stable condition.Conclusions HCC rarely presents an initial symptom of bone metastasis of extremities.Once bone lesions are detected,an early imaging and pathological examinations should be conducted to identify the primary lesion,and timely TACE,radiotherapy,targeted therapy and immunotherapy can prolong the survival of patients.更多还原