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原发性肝癌以腹泻为首发症状临床较少见,容易误诊。本院自1988年以来共遇12例临床误诊,为提高认识,特分析如下。 1 临床资料 本组共12例,男7例,女5例,年龄45～75岁。均以腹泻起病,水样便8例,粘液糊样4例,经大便常规镜检仅有少量白细胞,3例作钡剂灌肠造影无异常,1例做纤维结肠镜检查无异常。12例均查肝功能,7例正常,5例sGPT升高,8例HBsAg64～256(+)。原有慢性肝病史7例。 误诊情况:12例均不同程度误诊,误诊最长者达4个月,最短者1个月。误诊期间曾用抗生素、输液、维生素、止泻药等治疗,有7例腹泻症状一度好转,但停药后又加重,5例效果不显,其中有2例出现腹水征,1例出现上消化道大出血,经手术发现原发性肝癌。12例中除1例经手术证实肝癌外,余11例均经B超检查发现肝癌,肿块为4.5～12cm大小不等,9例做AFP放免测定均>400mg/ml。
The primary liver cancer with diarrhea as the first symptom is rare in clinic and is easily misdiagnosed. The hospital has encountered 12 cases of clinical misdiagnosis since 1988. To increase awareness, special analysis is as follows. 1 clinical data in this group a total of 12 cases, 7 males and 5 females, aged 45 to 75 years old. All patients had diarrhea, 8 cases of watery stools and 4 cases of mucoid paste. Only a few white blood cells were detected by routine microscopic examination. No abnormality was found in 3 cases of barium enema, and no abnormality was found in 1 case of colonoscopy. Liver function was examined in 12 cases, 7 cases were normal, 5 cases had elevated sGPT, and 8 cases had HBsAg 64-256(+). The original history of chronic liver disease in 7 cases. Misdiagnosis: 12 cases were misdiagnosed to different degrees, the longest misdiagnosis was 4 months, the shortest was 1 month. During the misdiagnosis period, antibiotics, infusions, vitamins, and antidiarrheal medicines were used for treatment. Seven cases of diarrhea were once improved, but they were aggravated after discontinuation. Five cases had no significant effect. Among them, 2 cases developed ascites, and 1 case developed upper gastrointestinal tract. Hemorrhage, primary liver cancer was found by surgery. Of the 12 cases, except 1 case with hepatocellular carcinoma confirmed by surgery, 11 cases were found to have hepatocellular carcinoma by B-ultrasound. The size of the tumor ranged from 4.5 cm to 12 cm, and 9 cases of AFP radioimmunoassay all exceeded 400 mg/ml.