%0 Journal Article
%T 原发性肝癌合并胆囊癌病例报道<br>A case report of primary hepatocellular carcinoma with gallbladder cancer
%A 覃
%A 丹
%A 万
%A 永
%A 张晓刚
%A 梁
%A 华
%A 刘
%A 昌
%J 西安交通大学学报(医学版)
%D 2015
%R 10.7652/jdyxb201502027
%X 摘要：目的 报道1例罕见双原发恶性肿瘤(原发性肝癌合并胆囊癌)病例以指导临床。方法与结果 报道1例原发性肝癌合并胆囊癌病例，54岁男性患者以“右上腹间断性疼痛4d”之主诉入院。于当地县医院行上腹部CT示：胆囊结石、胆囊癌肝浸润后，到西安交通大学第一附属医院就诊。实验室检查示：HBsAg(+)，HBcAb(+)，甲胎蛋白(AFP)>60500ng/mL，癌胚抗原(CEA)5.25ng/mL。CT检查提示：肝门部稍强回声光团，肝癌待定，胆囊癌待定，胆囊结石，胆囊炎；肝动脉、门静脉血管CT成像(CTA+CTV)检查示肝左内侧叶巨大恶性肿块影，胆囊壁不均匀增厚，疑肝脏病变侵犯胆囊或/及胆囊病变侵犯肝脏。术前初步考虑为原发性肝癌伴胆囊浸润，行肝脏Ⅳb、Ⅴ段切除+胆囊切除+T管引流术。术后病理示：肝脏巨块型肝细胞癌Ⅲ级、胆囊隆起型中-低分化腺癌。术后1个月，患者复查CT示肝内播散，预后差。结论 双原发癌中的“两者不相连续”这一标准并非适合于所有的双原发癌，并为以后诊治类似疾病提供了有益经验；及时准确地鉴别“转移”或“原发”，是临床医师给予患者有效治疗的关键。<br>ABSTRACT: Objective To a rare case of double primary cancer (hepatocellular carcinoma with gallbladder) to guide clinical application. Methods and Results We reported one case of primary hepatocellular carcinoma and gallbladder. A male patient, 54 years old, had main complaints of intermittent right upper quadrant pain for 4 days. The abdominal CT of the local county hospital showed gallstones, gallbladder with liver infiltration. And then he went to the First Affiliated Hospital of Xi？？an Jiaotong University for further treatment. Laboratory examination revealed: HBsAg(+), HBcAb(+), alpha-fetoprotein (AFP)>60500ng/mL, carcinoembryonic antigen (CEA) 5.25ng/mL. Abdominal CT showed hilar slightly stronger light echo groups: liver cancer or gallbladder cancer? Hepatic artery and portal vein CT imaging (CTA+CTV) examination showed the malignant tumor shadow in the inside of the left hepatic lobe huge, uneven thickening of the gallbladder wall, suspected liver disease with gallbladder infringement or gallbladder disease with liver infringement. With the preoperative preliminary consideration of primary liver cancer with infiltration of the gallbladder, we chose the operation as the resection of segment Ⅳb and Ⅴof the liver, cholecystectomy and T tube drainage. Pathological examination postoperative showed the bulky liver carcinoma grade Ⅲ and the poorly differentiated adenocarcinoma of gallbladder. A month later, abdominal CT showed the tumor spread intrahepatic, prompting the poor prognosis. Conclusion The two which are not continuous, which is the standard of double primary cancer, are not suitable for all double primary cancers. This case provides useful experience for future similar diagnosis and treatment of disease, and also helps us with timely and accurate identification of metastatic or rimary？？, which is the key point for clinicians to give patients an effective treatment
%K 双原发癌
%K 原发性肝癌
%K 胆囊癌&lt
%K br&gt
%K multiple primary cancers
%K primary hepatocellular carcinoma
%K gall bladder cancer
%U http://yxxb.xjtu.edu.cn//oa/darticle.aspx?type=view&id=201502027