ABSTRACT
Objective To summarize the key points for diagnosis and differential diagnosis of hepatocellular carcinoma combined with bile duct tumor thrombi(HCCBDT), and analyze the common reasons for misdiagnosis. Methods A total of 392 patients with HCCBDT over a 18-year period were included in this study. The liable disease types of misdiagnoses were summarized and the main causes of preoperative misdiagnosis were analyzed. The patients were divided into two groups according to the time periods: Group A(from 1993 to 2001, 128 patients) and Group B(from 2002 to 2011, 264 patients). The misdiagnosis rates and types of misdiagnosed diseases were compared between the two groups. The key points of diagnosis and differential diagnosis of HCCBDT were summarized. Results The overall preoperative misdiagnosis rate was 16. 6% (65/392) in our patients. The misdiagnosis rate of Group B (9. 8%, 26/264) was significantly lower than that of Group A (30. 5%, 39/ 128) (P<0. 001). And 91. 7% (242/264) patients received ERCP/MRCP examination in Group B, which was significantly higher than that in the Group A(67. 9%, 87/128) (P<0. 001). The misdiagnosis rate of ERCP/MRCP(5. 5%, 18/329) was significantly lower than those of B-type ultrasound examination (26. 8%, 105/392) (P<0. 001) and CT/MRI scan(25. 0%, 98/392) (P<0. 001). The misdiagnosed diseases included hepatocellular carcinoma with hilar bile duct compression (4. 1%, 16/392), hilar bile duct adenoma/carcinoma (4. 3%, 17/392), distal bile duct adenoma/carcinoma (including ampullary adenoma/carcinoma) (2. 3%, 9/392), mucus-like bile duct adenoma/carcinoma (1. 0%, 4/392), metastatic liver cancer with bile duct tumor thrombi (1. 0%, 4/392), and bile duct stones (3. 8%, 15/392). The proportions of misdiagnosis as liver cancer with hilar bile duct compression in the Group A and Group B were 9. 4% (12/128) and 1. 5%(4/264), respectively, and those as bile duct stone were 7. 8% (10/128) and 1. 9% (5/264), respectively (P<0. 01). Conclusion More knowledge on the HCCBDT clinical features, effective imaging examination methods, and more efforts on differential diagnosis with the similar diseases can reduce misdiagnosis of HCCBDT.
ABSTRACT
<p><b>BACKGROUND</b>The Pringle maneuver, which has been the standard for hepatic resection surgery for a long time, has the major flaw of ischemic damage in the liver. The aim of this research was to evaluate hepatic blood inflow occlusion with/without hemihepatic artery control vs. the Pringle maneuver in hepatocellular carcinoma (HCC) resection.</p><p><b>METHODS</b>Two hundred and eighty-one cases of resection of HCC with hepatic blood inflow occlusion (with/without hemihepatic artery control) and the Pringle maneuver from January 2006 to December 2008 in our hospital were analyzed and compared retrospectively; among them 107 were in group I (Pringle maneuver), 98 in group II (hepatic blood inflow occlusion), and 76 in group III (hepatic blood inflow occlusion without hemihepatic artery control). The operation time, intraoperative blood loss, postoperative liver function and complications were used as the endpoints for evaluation.</p><p><b>RESULTS</b>The operative duration and intraoperative blood loss of three groups showed no significant difference; alanine aminotransferase, total bilirubin and incidence of postoperative complications were significantly lower in groups II and III postoperation than those in group I.</p><p><b>CONCLUSION</b>Hepatic blood inflow occlusion without hemihepatic artery control is safe, convenient and feasible for resection of HCC, especially for cases involving underlying diseases such as cirrhosis.</p>