Roget L, Coppéré H, Richard P, Barthélém C, Veyret C, Audigier J C
Service de Gastroentérologie et d'Hépatologie, CHRU de Saint-Etienne, Hôpital Nord, Saint-Priest-en-Jarez, Cedex.
Gastroenterol Clin Biol. 1988 Nov;12(11):827-32.
This study was carried out in order to assess the accuracy of ultrasound in a) screening for hepatocellular carcinoma in patients hospitalized for cirrhosis and b) determining the possibility of hepatic resection. From January 1983 to January 1987, 492 patients with cirrhosis were investigated for hepatocellular carcinoma using clinical examination, serum alphafetoprotein measurement and ultrasound study. Four hundred and thirty-seven patients had alcohol-related cirrhosis (88.8 p. 100); ascites was found in 280 cases (56.9 p.100). Ultrasonography-guided aspiration cytology was performed whenever a tumor was found. Four hundred and nineteen patients underwent ultrasonography and alpha-fetoprotein chemistry. The diagnosis of hepatocellular carcinoma was confirmed in 66 of 419 patients (15.8 p. 100). Sixty of the 88 patients diagnosed as having tumor on ultrasound were found to have hepatocellular carcinoma. In 6 out of 66 patients (9.1 p. 100), the tumor was not identified by ultrasonography but the level of alphafetoprotein was high (greater than 1,000 ng/ml). Sixteen cancers (24.2 p. 100) were diagnosed by ultrasonography only. All patients were men with alcohol-related cirrhosis, their ages ranging from 52 to 82 years. The results of ultrasound investigation were: 8 solitary tumors, 5 multicentric tumors, 3 diffuse tumors. Only 2 of the 16 tumors were resectable. We conclude that ultrasound is an accurate procedure in the diagnosis of hepatocellular carcinoma associated with cirrhosis. However, in hospitalized patients, the value of screening for hepatocarcinoma is small because liver resection is often impossible due to the wide spread tumor involvement or advanced liver cirrhosis at the time of diagnosis. On the other hand, screening should be performed in patients with compensated cirrhosis.
a）对因肝硬化住院患者进行肝细胞癌筛查；b）确定肝切除的可能性。1983年1月至1987年1月，对492例肝硬化患者进行了肝细胞癌调查，采用了临床检查、血清甲胎蛋白测定和超声检查。437例患者为酒精性肝硬化（占88.8%）；280例有腹水（占56.9%）。一旦发现肿瘤，即进行超声引导下细针穿刺细胞学检查。419例患者接受了超声检查和甲胎蛋白化学检测。419例患者中有66例确诊为肝细胞癌（占15.8%）。超声诊断为肿瘤的88例患者中，60例被发现患有肝细胞癌。66例患者中有6例（占9.1%）超声未发现肿瘤，但甲胎蛋白水平较高（大于1000 ng/ml）。仅通过超声诊断出16例癌症（占24.2%）。所有患者均为酒精性肝硬化男性，年龄在52至82岁之间。超声检查结果为：8例孤立性肿瘤，5例多中心性肿瘤，3例弥漫性肿瘤。16例肿瘤中只有2例可切除。我们得出结论，超声是诊断与肝硬化相关的肝细胞癌的准确方法。然而，对于住院患者，肝癌筛查的价值不大，因为在诊断时由于肿瘤广泛累及或肝硬化晚期，往往无法进行肝切除。另一方面，对于代偿期肝硬化患者应进行筛查。
