原发性肝癌的腹腔镜分型(60例报告)(英文)

原发性肝癌的发病率在亚非洲远高于欧美,同样反映于国内外腹腔镜文献中,对其腹腔镜检查的介绍皆少而简略。本文就武汉市四个医院内科自1960年12月至6月经腹腔镜检查而最后确诊为原发性肝癌者60例进行了分析。按照腹腔镜下所观察到的肝脏形态试分作6型,大块型9例,多结节型21例,单结节型5例,(氵弥)漫小结节型(或肝硬化型)16例,非结节型(或肝炎型)3例,大网膜包果型6例。与经典的病理学分型相比较,这一分型对诊断、鉴别、处理与预后似有一定价值。有癌肿的肝叶与未发现癌肿的肝叶在同时并存的病理改变有显著较大且有不一致,对于原发性肝癌以肝硬变或病毒性肝炎作为前驱病的学说提出了疑问,本组病例未能说明日本位血吸虫病为原发性肝癌的病因。认为原发性肝癌患者肝脏的结节及肝炎等改变可能为癌肿的后果而不一定为原因。腹腔镜检查对于原发性肝癌的价值在于诊断符合率高,免除许多病例不必要的剖腹;直视下肝穿刺阳性率高,对于手术可能性的决定似有相当价值,比剖腹探查经济,住院日短而较安全。

THE PERITONEOSCOPIC TYPING OF PRIMARY CARCINOMA OF THE LIVER-A REPORT OF 60 CASES

The higher incidences of primary carcinoma of the liver in Asia and Africa than in Europe and America are also reflected in the literatures of peritoneoscopy, and the reports on the peritoneoscopic apperances of it are still rather simple. A collection of 60 peritoneoscopied cases from Dec, 1960 to June 1964 from 4 hospitals in Wuhan, China has been divided into 6 types according to the peritoneocopic appearances: massive type 9 cases, multinodualr type 21 cases, mono-nodular type 5 cases, diffuse small nodular type (or cirrhotic type) 16 cases, non-nodular type (or hepatitic) 3 cases, and greater omentum enveloping type 6 cases. This typing seems to bear Signifificance of varying degrees in diagnosis, differential diagnosis, management and prognosis. Its varied correlation with the classical pathological classification was discussed. The pathological changes of the liver lobe with the tumor and that without varied, and the theory that cirrhosis or viral hepatitis as precedent of primary carcinoma of the liver is challenged. It is diseases suggeste that the cirrhotic and hepatitic changes in the liver of primary hepatoma might well be the results rather than the causes or precedent diseases of the malignancy. In selected cases when there is difficulty in clinical diagnosis, in doubted cases of primary carcinoma of the liver, or for determination of operability, peritoneoscopy is of fairly high value.