2022年 · 第60卷第04期

Primary liver cancer is the fourth common malignant tumor and the second cause of cancer death in China, which seriously threatens the life and health of our people^{［1, 2, 3］}。 Primary liver cancer mainly includes three pathological types: hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC) and combined hepatocellular-cholangiocarcinoma (cHCC-CCA). The three pathological types are quite different in pathogenesis, biological behavior, histopathology, treatment methods and prognosis, among which HCC accounts for 75% ~85% and ICC accounts for 10% ~15%^［4］。 The term "liver cancer" in this guideline refers only to HCC.

A 29-year-old male was admitted to the hospital on 25-Jul-2020 due to "upper abdominal distension with fever for 10 d". The patient experienced distension and pain in the right upper abdomen without obvious trigger 10 days ago, accompanied by low fever, and improved after physical cooling, without nausea and vomiting, diarrhea and jaundice. CT in other hospital showed liver cancer, but no treatment was performed. Since the onset of the disease, the patient's general condition is acceptable. He has a history of hepatitis B for more than 10 years and has not received antiviral therapy. Physical examination: soft abdomen, no tenderness and rebound pain in the whole abdomen, palpable hard mass under the costs of the liver, not under the costs of the spleen, Murphy sign (-), ascites sign (-), and intestinal sounds. There were no obvious abnormalities in blood routine, blood biochemistry and coagulation function, and Child-Pugh classification was A. Alpha-fetoprotein 12 452 μ g/L, abnormal prothrombin 13 516 mAU/ml, HBV-DNA: 4.31×10³U/ml. Indocyanine green 15 min retention rate 8%, left lateral lobe volume: 505 cm³。 The results of liver CT examination showed that large masses were seen in the left inner lobe and right lobe of the liver, with the largest cross section of about 157 mm ×124 mm. The arterial phase of enhanced scan showed uneven enhancement, multiple branches of blood supply arteries were seen, and the peripheral uneven enhancement was persisted in the portal vein phase and the delayed phase. The center of the lesion showed a star-shaped low density without enhancement in each phase, and the enhancement of liver parenchyma around the lesion was not uniform. The middle hepatic vein and right hepatic vein are not clear; The left and right branches of the portal vein were compressed, and no obvious filling defect was found in the cavity. The inferior vena cava of the hepatic segment is compressed and narrowed; There is no dilatation of intrahepatic and extrahepatic bile ducts, thickening and edema of gallbladder wall; The hilar lymph nodes were enlarged (Figure 1). The results of chest CT examination showed that there were micronodules in the upper lobe of the right lung, with a maximum diameter of about 2 mm. Diagnosis: hepatocellular carcinoma (stage A of Barcelona clinical liver cancer, stage IB of Chinese liver cancer staging scheme); Chronic hepatitis B.

>The patient was a 38-year-old male who was admitted to the hospital on May 1, 2012 mainly due to "anorexia for 4 months, abdominal pain and weight loss for 2 months". The patient developed anorexia, halved food intake and fatigue 4 months ago; Occasional abdominal distension, obvious after eating, is not taken seriously. 2 months ago, dull pain in the upper abdomen, accompanied by weight loss, and weight loss of about 8 kg in the past 4 months, so he went to the outpatient clinic of our hospital and was admitted to our department for further diagnosis and treatment. Past history: He was diagnosed with crescent nephritis in August 2008, and was given hormone shock therapy twice and cyclophosphamide shock therapy once; Chronic hepatitis B history for 4 years, long-term oral lamivudine antiviral therapy. Physical examination: soft abdomen, no tenderness, rebound pain; The liver is palpable 3 cm below the costs and 7 cm below the xiphoid process, with blunt edges, hard texture, nodular feeling on the surface and mild tenderness. Laboratory tests: HBV-DNA (-), HBsAg (+), HBcAb (+), HBeAb (+), alpha-fetoprotein>12 000 μ g/L, liver function Child-Pugh grade A. Chest CT findings revealed multiple metastases in both lungs (Figure 1). MRI of the liver showed a huge tumor in the left lateral lobe of the liver, approximately 11.0 cm ×9.0 cm ×11.8 cm in size, with a small amount of intratumoral bleeding (Figure 2). Preoperative diagnosis: Primary liver cancer of the left lobe of the liver with lung metastasis (stage Ⅲb), chronic hepatitis B.