2019年 · 第57卷第04期

A 55-year-old male was hospitalized in our hospital on May 1, 2017 mainly due to "abdominal pain caused by impact of heavy objects for 6 h". The patient was injured by a heavy object 6 hours ago, and immediately felt severe pain in the left lower abdomen, which was persistent dull pain, accompanied by dizziness and palpitation, and no other discomfort. After relevant examinations in another hospital, it was recommended to be transferred to our hospital for further treatment. He is usually in good health and denies special medical history. Physical examination: abdominal muscle tension, obvious tenderness in the right lower abdomen, rebound pain, no obvious rebound pain in the rest of the abdomen, no palpation under the costal margin of the liver and spleen, negative mobile voiced sound, and no intestinal sound. CT of head + chest + abdomen: (1) bilateral hydropneumothorax, exudation of both lower lungs, and multiple rib fractures on both sides; Extensive subcutaneous gas accumulation in the right neck and both sides of the chest and back; (2) Consider perforation of cavity organs, contusion and laceration of right kidney, extensive swelling and gas accumulation of right lumbar muscles; Peritoneal effusion, multiple lumbar adnexal fractures; (3) There were no obvious traumatic changes in intracranial brain parenchyma, atlantoaxial joint and pelvis. Exploratory laparotomy + partial ileocecal colectomy + right nephrectomy + vascular crisis exploration were performed in the emergency department. Intraoperative diagnosis: closed abdominal injury, ascending colon rupture, liver contusion, right kidney rupture, acute diffuse peritonitis, retroperitoneal hematoma, bilateral hemopneumothorax, multiple rib fractures, hemorrhagic shock. After operation, he was admitted to the general surgery department and was given anti-infection, fluid rehydration, nutritional support and other treatments.

A 72-year-old male was admitted to the hospital on 14-May-2018 due to "found liver parenchymal mass occupation for 4 d". Four days before admission, the patient underwent abdominal ultrasound at the local hospital, and the results showed that the liver was substantially occupied; The results of plain CT scan and enhanced examination of the upper abdomen showed that the anterior and inferior segment of the right lobe of the liver was a patchy slightly low-density shadow focus, which was single and about 3.0 cm ×4.0 cm in size, which considered the possibility of liver cancer. Physical examination in our hospital: no liver palm and spider nevus, no abnormalities in the abdomen. MRI results of liver, biliary tract and spleen showed an irregular lobulated mass in the 5th and 8th segments of liver, showing low T1WI and high T2WI signal, and high signal shadow of magnetic resonance diffusion weighted imaging, with a size of about 41 mm ×40 mm ×30 mm; The enhanced scan showed that the arterial phase showed obvious uneven enhancement at the edge, high and low mixed signal shadows in the center, and the enhancement curve showed a plateau shape. At 1 h, there were patchy high signal shadows in the central area of the hepatobiliary phase, and low signal shadows at the edge. There were no filling defects in the portal vein and hepatic vein, and no abnormal enlarged lymph nodes in the hilar area and retroperitoneal area (Figure 1）。 Laboratory results: carcino-embryonic antigen (CEA) 2.67 μ g/L, alpha-fetoprotein (AFP) 3.62 μ g/L, ferritin 169.80 μ g/L, CA19-9 6.81 U/ml. There were no abnormalities in five items of hepatitis B, hepatitis C antibody and liver function. Previous history of hypertension for 20 years, up to 170/110 mmHg (1 mmHg =0.133 kPa), intermittent oral nifedipine tablets 10 mg, once/d, weekday blood pressure controlled at 130-140/80-90 mmHg. He denied a history of hepatitis, no history of alcoholism, and no special remainder.

intrahepatic cholangiocarcinoma (ICC) refers to a malignant tumor of secondary and higher bile duct epithelial origin in the liver^[1], also known as intrahepatic cholangiocarcinoma. ICC accounts for 5% ~15% of primary liver malignancies^[2], second only to primary hepatocellular carcinoma. SEER data from 1973 to 2012 show that the incidence of ICC is increasing at an annual rate of change of 2.3%^[3]。 The increase in the incidence of ICC may be related to the improvement of diagnostic techniques such as imaging, molecular biology and pathology, but at the same time, the absolute number of diseases has also increased. ICC has highly malignant biological behavior, early extrahepatic metastasis, even after surgical resection, often early postoperative recurrence, the overall prognosis of patients is extremely poor, the 5-year survival rate is only 25% ~35%^[2,4,5]。 Because ICC is located in the liver, domestic textbooks usually describe it in primary liver cancer, but as early as 2000, the third edition of Hepatobiliary and Pancreatic Surgery edited by Blumgart has incorporated ICC into the biliary tumor system. In 2010, the AJCC version 7 TNM staging system first proposed to incorporate ICC into biliary malignancies and stage them independently. In the same year, the second edition of biliary surgery edited by Shi Weijin in China listed ICC as biliary malignant tumor.

A 51-year-old male was admitted to the hospital "more than half a month after discovering liver space-occupying lesions", and there was no special discomfort during the course of the disease; Hepatitis B history for 10 years, no standardized treatment; Hepatitis B virus DNA quantification<500 U/ml, alpha-fetoprotein 701.82 μ g/L. The 15 min retention rate of indocyanine green before operation was 6.8%, and the liver function was Child-Pugh A. Enhanced CT scan of the liver showed solid mass occupation in segments 4b and 5 of the right anterior lobe of the liver, considering liver cancer (Figure 1）； Contrast-enhanced ultrasound showed multiple mixed echo masses in the liver, which was considered as a possible malignant tumor. Preoperative diagnosis: liver occupying space (malignancy may be large). The patient was generally in good condition and proposed to undergo laparoscopic partial hepatectomy.