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对17年来作过腹腔镜检的原发性肝癌173例进行了分析。 143例作了指引式肝活检:106例证实为肝细胞癌,11例为胆管细胞癌,诊断率为81.8％;26例肝活检未能证实,但腹腔镜检予以证实。 30例未作肝活检:腹腔镜检证实者25例;5例腹腔镜检未确诊,经开腹探查确诊。男:女为4.2:1。年龄为15—77岁,高峰在40—50岁。腹腔镜下的主要表现:肝呈肿块突起及颜色的改变;53.1％的病例伴发肝硬化。脾肿大者占30.3％,此中只有一半的病例临床上触及脾脏。主要症状有上腹痛(47.9％)、乏力(43.3％)、上腹肿块(31.2％)、发热(30.6％)、食欲不振(29.2％)、上腹胀(26％)、呕、便血(4％)等。主要体征有肝大(98.2％)、消瘦(30％)、脾大(19.7％)、黄疸(16.7％)、腹水(4％)、蜘蛛痣(4％)等。82％病例自首发症至就诊时的病程为6个月以内,仅18％在6个月以上。 76.1％病例的血红蛋白在10克以上,贫血现象不突出。肝功能检查主要有麝香草酚浊度试验、血清白蛋白、球蛋白、胆红素、谷丙转氨酶测定等,正常者28.3％,不正常者71.7％。对原发性肝细胞癌的超微结构进行了初步观察。
For 173 patients with primary liver cancer who underwent laparoscopy over the past 17 years, the analysis was performed. In 143 cases, guided liver biopsy was performed: 106 demonstrated hepatocellular carcinoma, and 11 cases had cholangiocellular carcinoma. The diagnostic rate was 81.8%; 26 cases were not confirmed by liver biopsy, but laparoscopy confirmed it. In 30 cases, no liver biopsy was performed: laparoscopy confirmed 25 cases; 5 cases were not diagnosed by laparoscopy and confirmed by laparotomy. Male: Female is 4.2:1. The age is 15-77 years old and the peak is 40-50 years old. The main manifestations of laparoscopy: hepatic mass changes in the protrusions; 53.1% of cases associated with cirrhosis. Splenomegaly accounted for 30.3%, of which only half of the cases clinically touched the spleen. The main symptoms were upper abdominal pain (47.9%), fatigue (43.3%), upper abdominal mass (31.2%), fever (30.6%), loss of appetite (29.2%), abdominal distention (26%), vomiting, and blood in the stool (4%) )Wait. The main signs were hepatomegaly (98.2%), emaciation (30%), splenomegaly (19.7%), jaundice (16.7%), ascites (4%), and spider mite (4%). The course of disease in the 82% of patients from the first episode to the visit was within 6 months, and only 18% was over 6 months. In 76.1% of cases, hemoglobin was more than 10 grams, and anemia was not prominent. Liver function tests mainly include thymol turbidity test, serum albumin, globulin, bilirubin, alanine aminotransferase, etc., 28.3% of normal persons, and 71.7% of abnormal subjects. The ultrastructure of primary hepatocellular carcinoma was initially observed.