摘要
[目的]探讨原发性肝癌早期诊断现状及影响因素。[方法]回顾性分析2014-01-2019-01期间我院首次诊断的原发性肝癌患者临床特征,收集患者人口学信息和病史信息及相关检查结果。[结果]372例原发性肝癌患者中Ⅰa期、Ⅰb期、Ⅱ期、Ⅲa期、Ⅲb期和Ⅳ期分别占5.4%、17.5%、14.8%、11.6%、34.4%和16.4%。结节最大直径≤3 cm、≤5 cm、≤10 cm和>10 cm患者,发生门静脉等大血管侵犯的比例分别为26.3%、28.2%、29.7%和29.2%,各者间比较差异无统计学意义(χ^2=0.206,P=0.977);发生肝外转移的比例分别为34.2%、40.4%、44.0%和36.1%,各者间比较差异无统计学意义(χ^2=1.008,P=0.799)。患者症状无特异性,年龄<40岁者占7.5%,无明确慢性肝病致病因素者占5.1%,有明确慢性HBV感染者占87.4%。乙肝相关性肝癌中9.1%为隐匿性乙肝,仅8.6%予以抗病毒治疗,1.2%获得病毒学应答。彩超筛查的灵敏度为87.7%,血清AFP筛查阈值越低,灵敏度越高。[结论]原发性肝癌早期诊断率低,病灶容易转移,不典型病例增加,患者规范随访诊治率低;筛查方案有待进一步细化完善。
[Objective]To explore the current status and influencing factors of early diagnosis in primary liver cancer.[Methods]Clinical features of patients with primary liver cancer who were diagnosed for the first time in our hospital from January 2014 to January 2019 were retrospectively analyzed.[Results]There were 372 patients,Ia,Ib,Ⅱ,Ⅲa,Ⅲb andⅣaccounted for 5.4%,17.5%,14.8%,11.6%,34.4%and 16.4%,respectively.In patients with maximum diameter≤3 cm,≤5 cm,≤10 cm and>10 cm,the proportion of large vascular invasion such as portal vein was 26.3%,28.2%,29.7%and 29.2%,respectively,and there was no statistical difference(χ^2=0.206,P=0.977),the proportion of extrahepatic metastases was 34.2%,40.4%,44.0%,and 36.1%,respectively,with no statistical difference(χ^2=1.008,P=0.799).The patient’s symptoms were not specific,7.5%of patients were under 40 years old,Less than 5.1%of patients had no clear pathogenic factors for chronic liver disease,and 87.4%had clear HBV infection.Among patients with hepatitis B-related primary liver cancer,9.1%were occult hepatitis B,only 8.6%were treated with antiviral therapy,and 1.2%received virological response.The sensitivity of ultrasound screening was 87.7%.The lower the threshold of serum AFP screening for primary liver cancer,the higher the sensitivity was.[Conclusion]The low early diagnosis rate of primary liver cancer has the following reasons:the lesion is easy to metastasize,the atypical cases increase,and the patient’s standardized follow-up diagnosis rate is low;the screening program is worthy of further improvement.
作者
周友乾
罗心晨
邹喜荣
李翠
欧阳帆
尹凤鸣
ZHOU You-qian;LUO Xin-chen;ZOU Xi-rong;LI Cui;OU-YANG Fan;YIN Feng-ming(Department of Infectious Diseases,922 Hospital of PLA&Xiangnan Hospital Affiliated to Hunan Normal University,421002 Hengyang,Hunan,China)
出处
《临床消化病杂志》
2019年第6期388-391,共4页
Chinese Journal of Clinical Gastroenterology
关键词
原发性肝癌
早期诊断
乙型肝炎病毒
primary liver cancer
early diagnosis
hepatitis B virus
