Kew M C, Dos Santos H A, Sherlock S
Br Med J. 1971 Nov 13;4(5784):408-11. doi: 10.1136/bmj.4.5784.408.
The diagnosis of primary cancer of the liver was reviewed in 75 patients. A definitive diagnosis was made during life in 63% and in a further 20% this condition was suspected though histological confirmation was obtained only at necropsy. The most common presenting complaints were abdominal pain and weight loss and the most frequent findings hepatomegaly and ascites. Less than one-half of the patients were jaundiced and when present it was usually mild. An arterial bruit was heard over the liver in 25% of the patients. A sudden and unexplained deterioration in a patient known to have cirrhosis or haemochromatosis should raise the possibility of a primary hepatic tumour; this occurred in 24% of our patients.Alpha-fetoprotein was found in the serum of 11 out of 18 cases. The presence of a mass in the liver was frequently confirmed by liver scan, portal venography, or hepatic arteriography, but these showed no features diagnostic of a primary tumour. Liver scan also proved useful in localizing the lesion for biopsy purposes. Definitive diagnosis is dependent on the histological demonstration of the features of the tumour. This can frequently be achieved by percutaneous needle biopsy, which was positive in 38 out of 57 patients. Wedge biopsies were positive in a further nine patients.
对75例原发性肝癌患者的诊断情况进行了回顾。63%的患者在生前得到了明确诊断，另有20%的患者虽在生前怀疑患有此病，但仅在尸检时获得了组织学证实。最常见的主诉是腹痛和体重减轻，最常见的体征是肝肿大和腹水。不到一半的患者出现黄疸，且黄疸通常较轻。25%的患者肝脏可闻及动脉杂音。已知患有肝硬化或血色素沉着症的患者突然出现无法解释的病情恶化，应考虑原发性肝肿瘤的可能性；我们的患者中有24%出现了这种情况。18例患者中有11例血清中发现甲胎蛋白。肝脏扫描、门静脉造影或肝动脉造影经常可证实肝脏存在肿块，但这些检查均未显示出原发性肿瘤的诊断特征。肝脏扫描在为活检定位病变方面也很有用。明确诊断取决于肿瘤特征的组织学证实。这通常可通过经皮针吸活检来实现，57例患者中有38例活检结果为阳性。另外9例患者楔形活检结果为阳性。
