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目的 加强对肝肉瘤的认识 ,提高其确诊率。方法 回顾性分析 196 6～ 1999年我院收治的 13例误诊的肝肉瘤病例 ,从临床及影像学角度 ,分析其误诊疾病、误诊时间、误治方法、术后病理诊断及随访结果。结果 CT上以囊性为主的肝肉瘤最易误诊为肝囊肿 (6 / 13)而定期复查 ;伴有发热者易误诊为肝脓肿 (2 / 13)而行抗炎治疗 ;实质性为主的肝肉瘤最易误诊为原发性肝癌 (4 / 13) ,因肿瘤巨大而行肝动脉栓塞。误诊时间 1～ 9个月 ,手术或细针穿刺活检明确病理诊断。姑息手术 2例分别存活 7个月及 12个月 ,其余经穿刺或剖腹探查 11例仅存活 1～ 3个月。结论 肝肉瘤的诊断依据临床表现及影像学检查 ,确定诊断依靠病理 ,提高对肝肉瘤的认识是降低其误诊率的关键。肝脏巨大占位病变如发展较块应想到肝肉瘤的可能性并尽早手术明确病理诊断。
Objective To strengthen the understanding of hepatic sarcoma and improve its diagnosis rate. Methods A retrospective analysis of 13 cases of misdiagnosed hepatic sarcoma treated in our hospital from 1996 to 1999 was done. The misdiagnosis time, misdiagnosis time, misdiagnosis method, postoperative pathological diagnosis and follow-up results were analyzed from clinical and imaging aspects. Results Most cystic sarcoma on CT was most often misdiagnosed as hepatic cyst (6/13). The patients with fever were easily misdiagnosed as hepatic abscess (2/13) and treated with anti-inflammatory therapy Hepatic sarcoma is most easily misdiagnosed as primary liver cancer (4/13), due to the huge tumor and hepatic artery embolization. Misdiagnosis time 1 to 9 months, surgery or fine needle biopsy clear pathological diagnosis. Two cases of palliative surgery survived for 7 months and 12 months, respectively, and the remaining 11 cases survived for 1 ~ 3 months after puncture or laparotomy. Conclusions The diagnosis of hepatic sarcoma is based on clinical manifestations and imaging findings. It is crucial to determine the diagnosis of hepatic sarcoma by reducing the rate of misdiagnosis. Large liver lesions such as the development of more block should think of the possibility of hepatic sarcoma and surgery clear pathological diagnosis as soon as possible.