肝良性占位性病变临床与肝穿病理诊断的分析
|
摘要
目的通过分析肝脏良性占位性病变临床与肝穿组织病理诊断,了解二者之间的差异,探讨可能存在的影响因素,以提高对肝脏良性占位性病变的认识水平,减少临床误诊率。
方法收集广西医科大学一附院2004年1月至2010年12月行B超引导下经皮肝脏穿刺活检,并经病理证实为肝脏良性占位性病变的76例住院病人(除外肝硬化结节)的临床资料,回顾分析其肝穿术前临床诊断与病理诊断。
结果本组76例病例包括肝脓肿50例(65.78%),肝血管瘤13例(17.10%),肝炎性假瘤10例(13.16%),结节型肝结核、肝腺瘤、肝淋巴管瘤各1例(各占1.32%)。男女比例为1.81∶1。①肝脓肿、肝血管瘤、肝炎性假瘤的发病年龄在19～77岁间,病程1天～2.5年;主要表现右上腹疼痛、发热、肝区叩痛或右上腹压痛,肝脓肿有临床表现者最多;②结节型肝结核见于20岁女性,有明确肺结核病史及右上腹痛;肝腺瘤、肝淋巴管瘤临床表现无特异性。13例无临床表现。肝脓肿发病前或发病时有合并症者38例:胆道结石或手术史17例,2型糖尿病8例,肝内寄生虫感染5例,肝恶性肿瘤4例,肝外感染性疾病5例。
血白细胞或中性粒细胞比值升高36例(肝脓肿35例,肝炎性假瘤1例),平均升高水平(16.24±7.35)X10~9/L,血清AFP均<200μg/L。肝穿术前影像学检查:肝内病灶单发:多发占位为2.04∶1;病变部位肝右叶∶肝二叶∶肝左叶为3.46∶1.23∶1;病灶平均直径,肝脓肿为4.89±2.33cm,肝血管瘤为4.67±4.02cm,肝炎性假瘤为2.48±1.18cm。
在肝良性占位性病变中,肝脓肿、肝血管瘤、肝炎性假瘤肝穿术前临床诊断符合率分别为73.91%、58.33%、22.22%;肝脓肿、肝血管瘤、肝炎性假瘤、肝腺瘤及肝淋巴管瘤临床误诊率分别为26.09%、41.67%、77.78%、100.00%、100.00%。其中误诊为肝恶性肿瘤19例,占临床误诊的73.08%(19/26)。
结论1.肝良性占位性病变以肝脓肿、肝血管瘤及肝炎性假瘤多见;2.肝脓肿有较明显症状、血象及影像学改变,在肝良性占位性病变中临床诊断符合率高;3.肝良性占位性病变临床上易误诊为肝恶性肿瘤;4.肝炎性假瘤临床误诊率高。
Objective To analyze the clinical and liver biopsy diagnosis of liver benign occupying lesions in order to have a good diagnosis and decrease the misdiagnosis rate.
Methods A total of 76 patients, from January 2004 to December 2010 at the first affiliated hospital of GuangXi Medical University, were diagnosed liver benign occupying lesions by B-Ultrasonic guided percutaneous liver biopsy (except nodular hyperplasia coming from liver cirrhosis), and analyzed their data of the clinical and pathological diagnosis retrospectively.
Results There were 50 cases with liver abscesses (65.78%), 13 cases with hepatic haemangiomas (17.10%), 10 cases with inflammatory pseudotumors of liver (13.16%), 1 case with focal hepatic tuberculosis, 1 case with hepatic adenoma and 1 case with lymphangioma of liver(each of the three cases accounted for 1.32% respectively ), Male to female ratio was 1.81∶1. Clinical features:①In the cases with Liver abscesses, hepatic haemangiomas and inflammatory pseudotumors, the ages from 19 to 77years and the courses from 1day to 2.5years. Right upper quadrant abdominal or liver area pain or tenderness, fever, were the most common features in the patients with liver abscesses.②Twenty-year-old female patient, with focal hepatic tuberculosis had history of pulmonary tuberculosis and right upper quadrant abdominal pain. The hepatic adenoma and the lymphangioma of liver had insignificant symptoms. Thirteen cases showed no symptoms. There were 38 cases with liver abscesses with some histories: cholelithiasis and (or) biliary tract surgery in 17cases,type 2 diabetes mellitus in 8 cases,hepatic parasitosis in 5 cases,hepatic malignant tumor in 4 cases,extra hepatic infectious disease in 5 cases。
There were 36 cases showed the raising of blood white blood cells (WBC) and (or) neutrophilic granulocytes (liver abscesses 35cases, lymphangioma of liver only 1 case ). The average count of WBC was(16.24±7.35)X109/L,and serum AFP was lower than 200μg/L. Imaging exams before liver biopsy showed: single to multiple occupying lesions ratio was 2.04∶1; the lesion locations of right hepatic lobe to left hepatic lobe and both lobes ratio was 3.64∶1.23∶1; the average diameters of the lesions were: liver abscesses 4.89±2.33cm, hepatic haemangiomas 4.67±4.02cm, inflammatory pseudotumors of liver 2.48±1.18cm.
In liver benign occupying lesions, the coincidence rates in abscesses, haemangiomas and inflammatory pseudotumors of liver was 73.91%, 58.33%, 22.22% respectively; The clinical misdiagnosis rates in liver abscesses, hepatic haemangiomas, inflammatory pseudotumor of liver, hepatic adenoma and the lymphangioma of liver were 26.09%, 41.67%, 77.78%, 100.00%, 100.00% respectively. Twenty one cases were misdiagnosed as hepatic malignant tumors , account for 73.08% (19/26).
Conclusions 1. Liver abscess, hepatic haemangiomas and inflammatory pseudotumor of liver are common in liver benign occupying lesions; 2. Liver abscess has more striking findings in clinical symptoms, blood WBC and imaging, and has a higher clinical diagnosis coincidence rate in liver benign occupying lesions; 3. Liver benign occupying lesions are most often misdiagnosed as liver malignant tumors; 4. Inflammatory pseudotumor of liver has higher clinical misdiagnosis rate.
方法收集广西医科大学一附院2004年1月至2010年12月行B超引导下经皮肝脏穿刺活检,并经病理证实为肝脏良性占位性病变的76例住院病人(除外肝硬化结节)的临床资料,回顾分析其肝穿术前临床诊断与病理诊断。
结果本组76例病例包括肝脓肿50例(65.78%),肝血管瘤13例(17.10%),肝炎性假瘤10例(13.16%),结节型肝结核、肝腺瘤、肝淋巴管瘤各1例(各占1.32%)。男女比例为1.81∶1。①肝脓肿、肝血管瘤、肝炎性假瘤的发病年龄在19～77岁间,病程1天～2.5年;主要表现右上腹疼痛、发热、肝区叩痛或右上腹压痛,肝脓肿有临床表现者最多;②结节型肝结核见于20岁女性,有明确肺结核病史及右上腹痛;肝腺瘤、肝淋巴管瘤临床表现无特异性。13例无临床表现。肝脓肿发病前或发病时有合并症者38例:胆道结石或手术史17例,2型糖尿病8例,肝内寄生虫感染5例,肝恶性肿瘤4例,肝外感染性疾病5例。
血白细胞或中性粒细胞比值升高36例(肝脓肿35例,肝炎性假瘤1例),平均升高水平(16.24±7.35)X10~9/L,血清AFP均<200μg/L。肝穿术前影像学检查:肝内病灶单发:多发占位为2.04∶1;病变部位肝右叶∶肝二叶∶肝左叶为3.46∶1.23∶1;病灶平均直径,肝脓肿为4.89±2.33cm,肝血管瘤为4.67±4.02cm,肝炎性假瘤为2.48±1.18cm。
在肝良性占位性病变中,肝脓肿、肝血管瘤、肝炎性假瘤肝穿术前临床诊断符合率分别为73.91%、58.33%、22.22%;肝脓肿、肝血管瘤、肝炎性假瘤、肝腺瘤及肝淋巴管瘤临床误诊率分别为26.09%、41.67%、77.78%、100.00%、100.00%。其中误诊为肝恶性肿瘤19例,占临床误诊的73.08%(19/26)。
结论1.肝良性占位性病变以肝脓肿、肝血管瘤及肝炎性假瘤多见;2.肝脓肿有较明显症状、血象及影像学改变,在肝良性占位性病变中临床诊断符合率高;3.肝良性占位性病变临床上易误诊为肝恶性肿瘤;4.肝炎性假瘤临床误诊率高。
Objective To analyze the clinical and liver biopsy diagnosis of liver benign occupying lesions in order to have a good diagnosis and decrease the misdiagnosis rate.
Methods A total of 76 patients, from January 2004 to December 2010 at the first affiliated hospital of GuangXi Medical University, were diagnosed liver benign occupying lesions by B-Ultrasonic guided percutaneous liver biopsy (except nodular hyperplasia coming from liver cirrhosis), and analyzed their data of the clinical and pathological diagnosis retrospectively.
Results There were 50 cases with liver abscesses (65.78%), 13 cases with hepatic haemangiomas (17.10%), 10 cases with inflammatory pseudotumors of liver (13.16%), 1 case with focal hepatic tuberculosis, 1 case with hepatic adenoma and 1 case with lymphangioma of liver(each of the three cases accounted for 1.32% respectively ), Male to female ratio was 1.81∶1. Clinical features:①In the cases with Liver abscesses, hepatic haemangiomas and inflammatory pseudotumors, the ages from 19 to 77years and the courses from 1day to 2.5years. Right upper quadrant abdominal or liver area pain or tenderness, fever, were the most common features in the patients with liver abscesses.②Twenty-year-old female patient, with focal hepatic tuberculosis had history of pulmonary tuberculosis and right upper quadrant abdominal pain. The hepatic adenoma and the lymphangioma of liver had insignificant symptoms. Thirteen cases showed no symptoms. There were 38 cases with liver abscesses with some histories: cholelithiasis and (or) biliary tract surgery in 17cases,type 2 diabetes mellitus in 8 cases,hepatic parasitosis in 5 cases,hepatic malignant tumor in 4 cases,extra hepatic infectious disease in 5 cases。
There were 36 cases showed the raising of blood white blood cells (WBC) and (or) neutrophilic granulocytes (liver abscesses 35cases, lymphangioma of liver only 1 case ). The average count of WBC was(16.24±7.35)X109/L,and serum AFP was lower than 200μg/L. Imaging exams before liver biopsy showed: single to multiple occupying lesions ratio was 2.04∶1; the lesion locations of right hepatic lobe to left hepatic lobe and both lobes ratio was 3.64∶1.23∶1; the average diameters of the lesions were: liver abscesses 4.89±2.33cm, hepatic haemangiomas 4.67±4.02cm, inflammatory pseudotumors of liver 2.48±1.18cm.
In liver benign occupying lesions, the coincidence rates in abscesses, haemangiomas and inflammatory pseudotumors of liver was 73.91%, 58.33%, 22.22% respectively; The clinical misdiagnosis rates in liver abscesses, hepatic haemangiomas, inflammatory pseudotumor of liver, hepatic adenoma and the lymphangioma of liver were 26.09%, 41.67%, 77.78%, 100.00%, 100.00% respectively. Twenty one cases were misdiagnosed as hepatic malignant tumors , account for 73.08% (19/26).
Conclusions 1. Liver abscess, hepatic haemangiomas and inflammatory pseudotumor of liver are common in liver benign occupying lesions; 2. Liver abscess has more striking findings in clinical symptoms, blood WBC and imaging, and has a higher clinical diagnosis coincidence rate in liver benign occupying lesions; 3. Liver benign occupying lesions are most often misdiagnosed as liver malignant tumors; 4. Inflammatory pseudotumor of liver has higher clinical misdiagnosis rate.
引文
1.黄志强主译.Schiff’s diseases of the liver[M], 9th ed.北京:化学工业出版社,2006,4:234.
2.周平安,林礼务,薛恩生,等.超声造影引导肝脏局灶性病变穿刺活检的临床应用价值[J].中国介入影像与治疗学,2009,6(2):159-163.
3. Valerio Nobili, Donatella Comparcola, Maria Rita Sartorelli,et al. Blind And ultrasound-guided percutaneous liver biopsy in children[J]. Pediatric Radiology, 2003,33(11),772-775.
4.唐字,马洪升.24例肝结核临床研究[J].临床消化杂志,2008,20(1):49-50.
5.陈清勇,江中勇,贺林,等.肝结核30例误诊分析[J].临床误诊误治,2001,14(4):253.
6.秦权林,肖开银.易与肝肿瘤混淆的肝结核16例诊治分析[J].临床误诊误治,2009,22(3):31-32.
7.毕文俊,范竹萍.肝脓肿的临床分析[J].中华消化杂志,2008,28(2):88-90.
8. Thomsen RW, Jepsen P, et al. Diabetes mellitus and pyogenic liver abscess: risk and prognosis[J]. Clin Infect Dis,2007,44(9):1194-1201.
9.李力川,朱兴.糖尿病合并细菌性肝脓肿29例诊治体会[J].中国现代手术学杂志,2006,10:154.
10.白熙.肝脓肿117例临床分析[J].中国医刊,2009,44(11):45-46.
11.白浪,徐珊玲,王晓辉,等.II型糖尿病合并肝脓肿32例临床分析[J].寄虫病与感染性疾病,2005,3(3):116-117.
12. Chan KS, Yu WL, et al. Pyogenic liver abscess caused by Klebsiella pneumoniae:analysis of the clinical characteristics and outcomes of 84 patients[J]. Chin Med J(Engl),2007,120(2):136-139.
13. Yang CC, Chen CY, et al. Pyogenic liver abscess in Taiwan: emphasis Ongas-forming liver abscess in diabetics [J]. Am J Gastroenterol, 1993, 88(11):1911-1915.
14.刘真真,熊亚莉,卢家桀,等.267例细菌性肝脓肿患者的临床表现及病原学分析[J].临床内科杂志,2006,3:464-466.
15.赵宗珉,赵金满,万建华,等.肺炎克雷伯杆菌肝脓肿与非肺炎克雷伯杆菌肝脓肿的临床比较[J].世界华人消化杂志,2006,14(16):1582-1586.
16.朱文静,周振芳,王秀云,等.超声在肝脓肿诊断及治疗中的应用价值[J].中华医学超声杂志,2001,7(11):1925-1929.
17.梁扩寰,李绍白,等.肝脏病学[M].北京:人民卫生出版社,2003:1168-1169.
18. Glinkova V, Shevah O, Boaz M, et a1. Hepatic haemangiomas: possible association with female sex hormones[J]. Gut, 2004,53(9):1352-1355.
19.张晶,董宝纬,梁萍,等.肝实性占位超声回声特征的病理基础[J].中华超声影像学杂志,2000,9:206-208.
20.张铎,孟恒,韩向君,等.肝血管瘤影像学对比研究[J].中国医学影像技术,2001,17(8):757-759.
21.殷信道,王丽萍,李克,等.动态及延时增强磁共振成像对肝血管瘤诊断的评价[J].中国医学计算机成像杂志,2006,12(6):392-395.
22. Horiuchi R, UchidaT, Kojima T, et al. Inflammatory Pseudtumor of the liver[J]. Clinicopathologic study and review of the literature Cancer, 1990,65:1583-1590.
23.王巍,刘志兰,刘鹏非,等.MRI动态增强扫描在肝脏炎性假瘤诊断中的应用[J].哈尔滨医科大学学报,2007,41(5):465-467.
24.程伟中,严福华,周康荣,等.肝脏炎性假瘤:13例MRI征象[J].临床放射学杂志,2003,22(1):30-32.
25. Sol Z, Ramon C. Hepatobiliary tuberculosis[J]. Digestive Diseases and Sciences,1983,3:193.
26.秦权林,肖开银.易与肝肿瘤混淆的肝结核16例诊治分析[J].临床误诊误治,2009,22(3):31-32.
27. Saluja S, Ray S, Pal S, et a1. Hepatobiliary and pancreatic tuberculosis: a two decades experience[J]. BMC Surg,2007,7:10.
28. Sheen Chen S M, Chen M C, Hu T H, et a1. Computed Tomography And Angiography in hepatic tuberculosis mimicking liver tumor[J]. Int J TubercLung Dis,2001,5(9):876-878.
29. Huang WT, Wang CC, Chen WJ, et al. The nodular form of hepatic tuberculosis: a review with five additional new cases[J]. J clin Pathol,2003,56: 835-839.
30. Wittekind C. Prognostic factors in liver tumors[J]. Verh Dtsch Ges Pathol,1995,79:109-115.
31. Burri E, Steuerwald M, Cathomas G, et a1. Hepatocenular carcinoma in a liver cell adenoma within a non-cirrhotic liver[J]. Ear J Gastroenterol Hepatol,2006,18(4):437-441.
32.许东奎,汪毅,赵平,等.肝腺瘤的诊断和治疗[J].中华肝胆外科杂志,2008,14(6):388-390.
33. Paulo H, Vincenzo P, Marcel Ac. Hepatic adenoma and focal nodular hyperplasia: differential diagnosis and treatment[J]. World J Surg, 2000,24:372- 376.
34. Zucman-Rossi J, Jeannot E, Nhieu JT. Genotypephenotype correlation in heaptocellular adenoma: new classification and relationship with HCC[J]. Hepatology,2006,43:515-524.
35. Ichikawa T, Federle MP, et al. Hegatocellular ademoma: Multiphasic CT And histopathologic findings in 25 patients[J]. Arch Surg,2001,136(9): 1033-1038.
36.丁可,黄仲奎,龙莉玲,等.肝腺瘤的影像诊断[J].实用放射学杂志,2007,12,23(12):1636-1639.
37. Barri E, Steuerwald M, Cathomas G, et a1. Hepatocellular carcinomain aliver-cell adenoma within a non-cirrhotic liver[J]. Ear J Gastroenterol Hepatol,2006,18(4):437-441.
38.李兴华,周平,王利华,等.超声造影对肝局灶性结节增生与肝腺瘤的鉴别诊断[J].中国超声医学杂志,2010,26,(9):847-849.
39. McQuown DS, Fishbein MC, et al. Abdominal cystic lymphangiomatosis: report of a case involving the liver and spleen and illustration of two cases with origin in the greater omentum and root of the mesentery[J]. J Clin Ultra-sound,1975,3(4):291-296.
40. Van Steenbergen W, Joosten E, Marchal G,et al. Hepatic lymphangiomatosis. Report of a case and review of the literature[J]. Gastroenterology,1985,88 (6):1968-1972.
41. Asch MJ, Cohen AH. et al. Hepatic and splenic lymphangiomatosis with skeletal involvement: report of a case and review of the literature[J]. Surgery,1974,76(2):334-339.
42. Rumpf P, Mannfeld U. Cystic lympangioma of the liver in childhood [J]. Zentralbl Chir,1972,97(30):1060-1063.
43.卢春燕,闵鹏秋,冯黎,等.肝脏淋巴管瘤一例[J].中华放射学志,2004,38(2): 221-222.
44.张海兰,王练英.小婴儿肝巨大多囊性淋巴管瘤一例[J].中华小儿外科杂志,2002,23(6):542.
45. Charles Miller, Vincenzo Mazzaferro. Orthotopic liver transplantation for massive hepatic lymphangiomatosis[J]. Surgery,1988,103(4):490-495.
1.黄志强主译.Schiff’s diseases of the liver[M],9th ed.北京:化学工业出版社,2006,4:225.
2.袁农,李子俊,刘军,等.肝活检病理与临床[M].北京:人民卫生出版社,2008,7:3.
3.袁农,李子俊,刘军,等.肝活检病理与临床[M].北京:人民卫生出版社,2008,7:1.
4. Menghini G. One-second needle biopsy of the liver [J]. Gastro- Enterology,1958,35:190-199.
5. Reddy KR, Schiff ER. Complications of liver biopsy[J]. Gastrointestinal emergencies,1997:959-968.
6.周平安,林礼务,薛恩生,等.超声造影引导肝脏局灶性病变穿刺活检的临床应用价值[J].中国介入影像与治疗学,2009,6(2):159-163.
7. Langen HJ, Stutzer H, Kugel H, et al. Precision of MRI-guided needle placement-experimental results[J]. Rofo Fort Geb Rontf Neuen Bild Verf,2000,172:922-926.
8.张雪哲,洪闻,陆立,等.MRI导引介入技术临床应用的探讨[J].中华放射学杂志,1998,32:600-603.
9.张雪哲,卢延,王武,等.磁共振成像导引肝穿刺活检[J].中华医学杂志,2001,81(16):968-970.
10. Adam G, Neuerburg J , Bucker A , et a1. Interventional magnetic resonance. Initial clinical experience with a 1.5-tesla magnetic resonance system combined with c-arm fluoroscopy[J]. Invest Radiol,1997,32(4):191-197.
11.贺能树主编.介入性磁共振成像[M].北京:人民卫生出版社,2001,17-21.
12. Hederstr?m E, Forsberg L, Florén CH, et al. Liver biopsy complicationsmonitored by ultrasound[J]. J Hepatology, 1989,8(1):94-98.
13. Minuk GY, Sutherland LR, Wiseman D, et al. Prospective study of the incidence of ultrasound-detected intrahepatic and subcapsular hematomas in patients randomized to 6 or 24 hours of bed rest after percutaneous liver biopsy[J]. Gastroenterology 1987,92:290-293.
14.钱林学,王宝恩. 3种不同肝活组织检查方法的并发症分析[J].中华肝脏病杂志,2007,15(1):47-49.
15.黄志强主译, Schiff’s diseases of the liver[M], 9th ed.北京:化学工业出版社,2006,4:234.
16.腾光菊,聂青和.经皮肝脏活体穿刺活检技巧及研究进展[J].世界华人消化杂志,2003,11(6):775-776.
17. Lachaux A, Le Gall C, Chambon M, et al. Complications of percutaneous liver biopsy in infants and children[J]. European Journal Of Pediatrics,1995,154(8):621-623.
18. Valerio Nobili, Donatella Comparcola, Maria RitaSartorelli, et al. Blind and ultrasound-guided percutaneous liver biopsy in children. Pediatric Radiology[J],2003,33(11):772-775.
19. Whitington PF. Safety of Percutaneous Liver Biopsy in Infants Less than Three Months Old [J]. Journal of Pediatric Gastroenterology and Nutrition,2005,41(5):639-643.
20. Wood B, Pearson N, Crisp M, et al. Pseudoaneurysm formation after ultrasound-guided liver biopsy in an obese child[J]. Southern Medical Journal, 2009,102(4):432-434.
21. Cohen MB, A-Kader HH, Lambers D, et al. Complications of percutaneous liver biopsy in children[J].Gastroenterology,1992,102(2):629-32.
22. Sebagh M, Samuel D, Place of the liver biopsy in liver transplantation[J].Hepatol,2004,41:897-901.
23.高斌,贺克武,张秀珊,等.CT导引下移植肝脏穿刺活检方法及病理改变[J].介入放射学杂志,2007,16(12):855-857.
24. Malnick S. Routine ultrasound-guided liver biopsy: a time whose idea has come? [J]. Journal of clinical gastroenterology, 2005,39(10):900-903.
2.周平安,林礼务,薛恩生,等.超声造影引导肝脏局灶性病变穿刺活检的临床应用价值[J].中国介入影像与治疗学,2009,6(2):159-163.
3. Valerio Nobili, Donatella Comparcola, Maria Rita Sartorelli,et al. Blind And ultrasound-guided percutaneous liver biopsy in children[J]. Pediatric Radiology, 2003,33(11),772-775.
4.唐字,马洪升.24例肝结核临床研究[J].临床消化杂志,2008,20(1):49-50.
5.陈清勇,江中勇,贺林,等.肝结核30例误诊分析[J].临床误诊误治,2001,14(4):253.
6.秦权林,肖开银.易与肝肿瘤混淆的肝结核16例诊治分析[J].临床误诊误治,2009,22(3):31-32.
7.毕文俊,范竹萍.肝脓肿的临床分析[J].中华消化杂志,2008,28(2):88-90.
8. Thomsen RW, Jepsen P, et al. Diabetes mellitus and pyogenic liver abscess: risk and prognosis[J]. Clin Infect Dis,2007,44(9):1194-1201.
9.李力川,朱兴.糖尿病合并细菌性肝脓肿29例诊治体会[J].中国现代手术学杂志,2006,10:154.
10.白熙.肝脓肿117例临床分析[J].中国医刊,2009,44(11):45-46.
11.白浪,徐珊玲,王晓辉,等.II型糖尿病合并肝脓肿32例临床分析[J].寄虫病与感染性疾病,2005,3(3):116-117.
12. Chan KS, Yu WL, et al. Pyogenic liver abscess caused by Klebsiella pneumoniae:analysis of the clinical characteristics and outcomes of 84 patients[J]. Chin Med J(Engl),2007,120(2):136-139.
13. Yang CC, Chen CY, et al. Pyogenic liver abscess in Taiwan: emphasis Ongas-forming liver abscess in diabetics [J]. Am J Gastroenterol, 1993, 88(11):1911-1915.
14.刘真真,熊亚莉,卢家桀,等.267例细菌性肝脓肿患者的临床表现及病原学分析[J].临床内科杂志,2006,3:464-466.
15.赵宗珉,赵金满,万建华,等.肺炎克雷伯杆菌肝脓肿与非肺炎克雷伯杆菌肝脓肿的临床比较[J].世界华人消化杂志,2006,14(16):1582-1586.
16.朱文静,周振芳,王秀云,等.超声在肝脓肿诊断及治疗中的应用价值[J].中华医学超声杂志,2001,7(11):1925-1929.
17.梁扩寰,李绍白,等.肝脏病学[M].北京:人民卫生出版社,2003:1168-1169.
18. Glinkova V, Shevah O, Boaz M, et a1. Hepatic haemangiomas: possible association with female sex hormones[J]. Gut, 2004,53(9):1352-1355.
19.张晶,董宝纬,梁萍,等.肝实性占位超声回声特征的病理基础[J].中华超声影像学杂志,2000,9:206-208.
20.张铎,孟恒,韩向君,等.肝血管瘤影像学对比研究[J].中国医学影像技术,2001,17(8):757-759.
21.殷信道,王丽萍,李克,等.动态及延时增强磁共振成像对肝血管瘤诊断的评价[J].中国医学计算机成像杂志,2006,12(6):392-395.
22. Horiuchi R, UchidaT, Kojima T, et al. Inflammatory Pseudtumor of the liver[J]. Clinicopathologic study and review of the literature Cancer, 1990,65:1583-1590.
23.王巍,刘志兰,刘鹏非,等.MRI动态增强扫描在肝脏炎性假瘤诊断中的应用[J].哈尔滨医科大学学报,2007,41(5):465-467.
24.程伟中,严福华,周康荣,等.肝脏炎性假瘤:13例MRI征象[J].临床放射学杂志,2003,22(1):30-32.
25. Sol Z, Ramon C. Hepatobiliary tuberculosis[J]. Digestive Diseases and Sciences,1983,3:193.
26.秦权林,肖开银.易与肝肿瘤混淆的肝结核16例诊治分析[J].临床误诊误治,2009,22(3):31-32.
27. Saluja S, Ray S, Pal S, et a1. Hepatobiliary and pancreatic tuberculosis: a two decades experience[J]. BMC Surg,2007,7:10.
28. Sheen Chen S M, Chen M C, Hu T H, et a1. Computed Tomography And Angiography in hepatic tuberculosis mimicking liver tumor[J]. Int J TubercLung Dis,2001,5(9):876-878.
29. Huang WT, Wang CC, Chen WJ, et al. The nodular form of hepatic tuberculosis: a review with five additional new cases[J]. J clin Pathol,2003,56: 835-839.
30. Wittekind C. Prognostic factors in liver tumors[J]. Verh Dtsch Ges Pathol,1995,79:109-115.
31. Burri E, Steuerwald M, Cathomas G, et a1. Hepatocenular carcinoma in a liver cell adenoma within a non-cirrhotic liver[J]. Ear J Gastroenterol Hepatol,2006,18(4):437-441.
32.许东奎,汪毅,赵平,等.肝腺瘤的诊断和治疗[J].中华肝胆外科杂志,2008,14(6):388-390.
33. Paulo H, Vincenzo P, Marcel Ac. Hepatic adenoma and focal nodular hyperplasia: differential diagnosis and treatment[J]. World J Surg, 2000,24:372- 376.
34. Zucman-Rossi J, Jeannot E, Nhieu JT. Genotypephenotype correlation in heaptocellular adenoma: new classification and relationship with HCC[J]. Hepatology,2006,43:515-524.
35. Ichikawa T, Federle MP, et al. Hegatocellular ademoma: Multiphasic CT And histopathologic findings in 25 patients[J]. Arch Surg,2001,136(9): 1033-1038.
36.丁可,黄仲奎,龙莉玲,等.肝腺瘤的影像诊断[J].实用放射学杂志,2007,12,23(12):1636-1639.
37. Barri E, Steuerwald M, Cathomas G, et a1. Hepatocellular carcinomain aliver-cell adenoma within a non-cirrhotic liver[J]. Ear J Gastroenterol Hepatol,2006,18(4):437-441.
38.李兴华,周平,王利华,等.超声造影对肝局灶性结节增生与肝腺瘤的鉴别诊断[J].中国超声医学杂志,2010,26,(9):847-849.
39. McQuown DS, Fishbein MC, et al. Abdominal cystic lymphangiomatosis: report of a case involving the liver and spleen and illustration of two cases with origin in the greater omentum and root of the mesentery[J]. J Clin Ultra-sound,1975,3(4):291-296.
40. Van Steenbergen W, Joosten E, Marchal G,et al. Hepatic lymphangiomatosis. Report of a case and review of the literature[J]. Gastroenterology,1985,88 (6):1968-1972.
41. Asch MJ, Cohen AH. et al. Hepatic and splenic lymphangiomatosis with skeletal involvement: report of a case and review of the literature[J]. Surgery,1974,76(2):334-339.
42. Rumpf P, Mannfeld U. Cystic lympangioma of the liver in childhood [J]. Zentralbl Chir,1972,97(30):1060-1063.
43.卢春燕,闵鹏秋,冯黎,等.肝脏淋巴管瘤一例[J].中华放射学志,2004,38(2): 221-222.
44.张海兰,王练英.小婴儿肝巨大多囊性淋巴管瘤一例[J].中华小儿外科杂志,2002,23(6):542.
45. Charles Miller, Vincenzo Mazzaferro. Orthotopic liver transplantation for massive hepatic lymphangiomatosis[J]. Surgery,1988,103(4):490-495.
1.黄志强主译.Schiff’s diseases of the liver[M],9th ed.北京:化学工业出版社,2006,4:225.
2.袁农,李子俊,刘军,等.肝活检病理与临床[M].北京:人民卫生出版社,2008,7:3.
3.袁农,李子俊,刘军,等.肝活检病理与临床[M].北京:人民卫生出版社,2008,7:1.
4. Menghini G. One-second needle biopsy of the liver [J]. Gastro- Enterology,1958,35:190-199.
5. Reddy KR, Schiff ER. Complications of liver biopsy[J]. Gastrointestinal emergencies,1997:959-968.
6.周平安,林礼务,薛恩生,等.超声造影引导肝脏局灶性病变穿刺活检的临床应用价值[J].中国介入影像与治疗学,2009,6(2):159-163.
7. Langen HJ, Stutzer H, Kugel H, et al. Precision of MRI-guided needle placement-experimental results[J]. Rofo Fort Geb Rontf Neuen Bild Verf,2000,172:922-926.
8.张雪哲,洪闻,陆立,等.MRI导引介入技术临床应用的探讨[J].中华放射学杂志,1998,32:600-603.
9.张雪哲,卢延,王武,等.磁共振成像导引肝穿刺活检[J].中华医学杂志,2001,81(16):968-970.
10. Adam G, Neuerburg J , Bucker A , et a1. Interventional magnetic resonance. Initial clinical experience with a 1.5-tesla magnetic resonance system combined with c-arm fluoroscopy[J]. Invest Radiol,1997,32(4):191-197.
11.贺能树主编.介入性磁共振成像[M].北京:人民卫生出版社,2001,17-21.
12. Hederstr?m E, Forsberg L, Florén CH, et al. Liver biopsy complicationsmonitored by ultrasound[J]. J Hepatology, 1989,8(1):94-98.
13. Minuk GY, Sutherland LR, Wiseman D, et al. Prospective study of the incidence of ultrasound-detected intrahepatic and subcapsular hematomas in patients randomized to 6 or 24 hours of bed rest after percutaneous liver biopsy[J]. Gastroenterology 1987,92:290-293.
14.钱林学,王宝恩. 3种不同肝活组织检查方法的并发症分析[J].中华肝脏病杂志,2007,15(1):47-49.
15.黄志强主译, Schiff’s diseases of the liver[M], 9th ed.北京:化学工业出版社,2006,4:234.
16.腾光菊,聂青和.经皮肝脏活体穿刺活检技巧及研究进展[J].世界华人消化杂志,2003,11(6):775-776.
17. Lachaux A, Le Gall C, Chambon M, et al. Complications of percutaneous liver biopsy in infants and children[J]. European Journal Of Pediatrics,1995,154(8):621-623.
18. Valerio Nobili, Donatella Comparcola, Maria RitaSartorelli, et al. Blind and ultrasound-guided percutaneous liver biopsy in children. Pediatric Radiology[J],2003,33(11):772-775.
19. Whitington PF. Safety of Percutaneous Liver Biopsy in Infants Less than Three Months Old [J]. Journal of Pediatric Gastroenterology and Nutrition,2005,41(5):639-643.
20. Wood B, Pearson N, Crisp M, et al. Pseudoaneurysm formation after ultrasound-guided liver biopsy in an obese child[J]. Southern Medical Journal, 2009,102(4):432-434.
21. Cohen MB, A-Kader HH, Lambers D, et al. Complications of percutaneous liver biopsy in children[J].Gastroenterology,1992,102(2):629-32.
22. Sebagh M, Samuel D, Place of the liver biopsy in liver transplantation[J].Hepatol,2004,41:897-901.
23.高斌,贺克武,张秀珊,等.CT导引下移植肝脏穿刺活检方法及病理改变[J].介入放射学杂志,2007,16(12):855-857.
24. Malnick S. Routine ultrasound-guided liver biopsy: a time whose idea has come? [J]. Journal of clinical gastroenterology, 2005,39(10):900-903.