肝内钙化灶的临床分析
作者:周飞国，严以群，黄 亮，刘才峰，张向化，晏建军
【摘要】 目的 分析肝内钙化灶的临床和影像特征。方法 对我科近6年来在住院病人中发现的17例肝内钙化灶临床资料进行回顾性分析。结果 钙化灶单发6例，多发11例；位于肝右叶13例，左叶2例，左右叶均有2例；肝包膜下3例，肝实质内14例；直径5～40mm不等。B超表现为肝内强回声后方伴声影；CT表现为肝内极高密度影，CT值约100～200HU，明显高于肝组织及肝内胆管结石密度；ERCP、MRCP未见钙化灶所在区域肝内胆管扩张及充盈缺损。其中1例行肝右叶病灶局部切除，见钙化灶多发，呈乳白色，界限清楚，无包膜，质地较硬。结论 肝内钙化灶是肝脏某些病变稳定或愈合后的一种病理改变，临床上易与肝内胆管结石混淆，典型的.根据B超、CT表现可明确诊断。钙化灶形成后即稳定存在，对身体无明显不利影响，一般不需外科治疗。
【关键词】 钙化；肝脏；诊断
Clinical analysis of intrahepatic calcification
【Abstract】 Objective To analyse the clinical characteristics of intrahepatic calcification.Methods The clinical data of seventeen patients with intrahepatic calcification were retrospectively analysed.Results For majority cases，lesions were multiple and located in the right lobe of liver，within the liver parenchyma.The size was from 5 to 4mm in diameter.High echo with acoustic shadow was the main ultrasound feature.The CT finding was of very high density lesions，which was obviously higher than that of liver parenchyma and calculus of intrahepatic duct.Cholangiectasis and filling defect were not displayed in ERCP or MRCP.Local hepatic resection was performed in one case，in which multiple，white and hard lesions without capsule were found.Conclusion Intrahepatic calcification might be a sort of pathological change in the healing process of some liver diseases.Typical cases can be correctly diagnosed by ultrasound and CT scan.Lesions are stable and not harmful to health.Surgical treatment is then not required.
【Key words】 calcification；liver；diagnosis
随着B超、CT的广泛应用，肝内钙化灶的检出日渐增多，其影像学表现同肝内胆管结石相似，容易与之发生混淆。临床上肝内钙化灶常被误诊为肝内胆管结石，因二者处理及预后截然不同，因此正确作出诊断与鉴别诊断有着重要临床意义［1］。临床医师对肝胆管结石病的认识已经较为深入，然而，关于肝内钙化灶的成因、临床表现、诊断与处理目前未见详细的文献报告。我科近6年来在住院病人中共发现肝内钙化灶17例，现将其临床和影像特征简要总结如下。
1 临床资料
1.1 一般资料 本组17例，其中男9例，女8例；年龄12～64岁，平均47岁。病史中有明确乙肝史2例，肝血吸虫病史1例，肠道蛔虫病史1例。因右上腹隐痛不适就诊4例，健康体检发现4例，余9例均因肝胆结石病就诊时发现，其中胆囊结石4例，胆总管结石2例，肝内胆管结石3例。钙化灶单发6例，多发11例；位于肝右叶13例，左叶2例，左右叶均有2例；肝包膜下3例，肝实质内14例；直径5～40mm不等。
1.2 B超表现 所有病例入院后均行B超检查，检出15例。表现为肝内强光点、强光团或强光带，大部分后方伴明显声影；多发的一般呈散在分布，有的相互靠近呈条索状或串珠状排列；实质内病灶多位于肝内管道附近，但局部胆管不扩张。诊断肝内钙化灶4例，肝内胆管结石10例，肝血管瘤1例。