临床误诊误治2025，Vol.38Issue(10)：20-26,7.DOI:10.3969/j.issn.1002-3429.2025.10.004
早期肝癌误诊原因及防范措施分析
Analysis of Causes of Misdiagnosis and Preventive Measures of Early Liver Cancer
摘要
Abstract
Objective To analyze the causes of clinical misdiagnosis of early liver cancer and to correct the methods of misdiagnosis,so as to improve the level of diagnosis and treatment by clinicians.Methods The clinical data of 2 patients with early liver cancer misdiagnosed as liver abscess and chronic colitis respectively admitted to our hospital from June 2020 to June 2023 were retrospectively analyzed.Results One patient presented with right upper abdominal pain accompanied by chills and high fever for 7 d.Liver abscess was diagnosed by hepatitis B virus antigen detection,liver function test and other laboratory indicators combined with abdominal color ultrasound.After 2 d of anti-infective treatment,symptoms were mildly relieved.Incision and drainage of liver abscess was performed on the 3rd day of admission,intraoperative exploration and rap-id pathological examination were performed to diagnose early liver cancer,and radical liver lobectomy was performed during the operation.The diagnosis was further confirmed by pathological and immunohistochemical examination after operation,and the misdiagnosis lasted 12 d.At 12 months after follow-up,liver function of the patient was normal without recurrence or me-tastasis.One patient presented with recurrent constipation and diarrhea occurred alternately for more than 1 year,and diarrhea accompanied with abdominal pain for 7 d.According to the clinical symptoms and results of fibrocolonoscopy,the patient was diagnosed with chronic colitis.After 3 d of symptomatic treatment,the condition did not improve and the abdominal pain wors-ened.Further liver function and hepatitis B virus antigen test,abdominal CT plain scan,abdominal magnetic resonance ima-ging plain scan and dynamic enhanced scan were performed to diagnose primary liver cancer.Open exploration was performed,and partial hepatectomy was performed according to the exploration results.The postoperative pathological report was medium-low differentiated hepatocellular carcinoma of the liver.The misdiagnosis lasted 14 d.At 6 months after follow-up,the Alpha-fetoprotein was 5 μg/L and liver function of the patient was normal without recurrence or metastasis.Conclusion The main causes of early misdiagnosis of liver cancer are atypical clinical symptoms,careless physical examination and insufficient un-derstanding of the disease.Careful physical examination,supplemented by ultrasound,CT and other imaging examinations and relevant medical technical examinations,and pathology examination when necessary,can help reduce the early misdiagnosis rate of this disease.关键词
早期肝癌/误诊/肝脓肿/慢性结肠炎/乙型肝炎/甲胎蛋白/肝脏病理检查/鉴别诊断Key words
Early liver cancer/Misdiagnosis/Liver abscess/Chronic colitis/Viral hepatitis B/Alpha-fetoprotein/Diagnostic liver pathology/Differential diagnosis分类
临床医学引用本文复制引用
朱娅,王颖,齐红..早期肝癌误诊原因及防范措施分析[J].临床误诊误治,2025,38(10):20-26,7.基金项目
保定市科学技术研究与发展指导计划项目(17ZF045) （17ZF045）
