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目的直径<2cm的肝脏占位通常不具备典型的肝脏肿瘤影像学特点,当甲胎蛋白化验结果阴性时诊断尤其困难,通过对这部分病例诊治过程和随诊结果的回顾和分析,总结甲胎蛋白阴性的小肝占位病例的诊治经验。方法我科2003年1月～2008年12月共收治103例直径≤2cm且甲胎蛋白阴性的肝脏占位病例,根据肿瘤多发性选择数字减影血管成像(DSA)、动态增强磁共振成像(MRI)、造影超声或PET-CT进行鉴别诊断,对于疑诊的94例病例行部分肝切除术。结果这四种检查手段对肝脏恶性肿瘤的诊断准确率分别为88.2%、93.9%、88.9%和88.9%;本组手术病例手术并发症率低(6.4%)、预后良好,肝癌病例的1年生存率和3年生存率分别为98.8%和76.1%。结论 DSA、动态增强MRI、造影超声和PET-CT检查对于小肝占位均有很好的诊断价值;手术方式宜采取肝脏部分切除术;小肝癌病例手术风险小、预后好,对于疑诊病例应积极进行手术治疗。
The purpose of the liver diameter <2cm of the liver mass imaging usually do not have the typical features of the liver imaging, when the negative test results of alpha-fetoprotein is particularly difficult to diagnose this part of the case by the diagnosis and treatment of follow-up and follow-up review and analysis summary of the Protein-negative small liver cases of diagnosis and treatment experience. Methods A total of 103 liver biopsies of ≤2 cm in diameter and with alpha-fetoprotein were treated in our department from January 2003 to December 2008. According to multiple choice digital subtraction angiography (DSA), dynamic contrast-enhanced magnetic resonance imaging MRI), contrast-enhanced ultrasound or PET-CT for the differential diagnosis of 94 cases of suspected partial hepatectomy. Results The diagnostic accuracy of these four examinations was 88.2%, 93.9%, 88.9% and 88.9% respectively for the malignant tumors of the liver. The surgical complications in this group were low (6.4%), the prognosis was good, and the incidence of liver cancer was 1 year Survival and 3-year survival rates were 98.8% and 76.1%, respectively. Conclusions DSA, dynamic contrast-enhanced MRI, contrast-enhanced ultrasound and PET-CT have a good diagnostic value for small liver space occupying; partial hepatectomy should be taken in surgical approach; small hepatocellular carcinoma has small operation risk and good prognosis. For suspected cases Surgical treatment should be actively carried out.