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目的分析总结肝脏原发性癌肉瘤的临床诊治经验,以提高临床医师对本病的认识。方法回顾性分析北京协和医院2001年1月至2011年1月收治的6例肝脏癌肉瘤的临床表现、影像学及实验室检查、诊治及预后资料。本组6例患者年龄49～72岁,平均59岁;男5例,女1例;有肝炎病史者4例,无肝炎病史者2例;6例患者影像学均提示肝脏占位,2例伴胆管癌栓。术前诊断均为原发性肝癌。结果所有患者均行根治性切除手术,术后病理确诊均为肝脏原发癌肉瘤。4例合并肝炎者病理检查显示肝细胞癌肉瘤,2例不伴肝炎患者病理检查显示肝内胆管细胞癌肉瘤。6例患者有5例在术后行介入辅助治疗;随诊结果6例患者中有5例患者均在术后1年内死亡。结论肝脏原发癌肉瘤非常罕见,术前与原发性肝癌很难鉴别,诊断依靠术后病理。虽经手术切除,预后仍很差。
Objective To analyze and summarize the clinical experience of diagnosis and treatment of primary liver carcinosarcoma in order to improve clinicians’ understanding of the disease. Methods The clinical manifestations, imaging and laboratory tests, diagnosis and treatment and prognostic data of 6 cases of HCC from January 2001 to January 2011 in Peking Union Medical College Hospital were analyzed retrospectively. The group of 6 patients aged 49 to 72 years, mean 59 years; 5 males and 1 females; 4 cases of hepatitis history, no history of hepatitis 2; 6 cases of imaging showed liver space, 2 cases With cholangiocarcinoma bolt. Preoperative diagnosis of primary liver cancer. Results All patients underwent radical resection and the pathological diagnosis was all primary liver carcinosarcoma. Pathological examination of 4 patients with hepatitis showed hepatocellular carcinoma and 2 patients without hepatitis showed pathological examination of intrahepatic cholangiocarcinoma. Five of the six patients received adjuvant therapy after the procedure; five of the six patients were followed up within one year of surgery. Conclusion Primary liver carcinosarcoma is very rare. Preoperative and primary liver cancer are difficult to identify. Diagnosis depends on postoperative pathology. Although surgical resection, the prognosis is still poor.