摘要
目前,大多的假性肝硬化发生于恶性肿瘤肝转移患者,可以出现水肿、腹水、消化道出血等门静脉高压相关临床表现.以"恶性肿瘤肝转移、伴或不伴肝脏轮廓呈结节样、肝节段性体积减小、尾状叶增大"等为影像学特点,而组织学为弥漫性肿瘤细胞浸润、浸润灶周围纤维化、肝窦血管形成血管栓塞、结节样增生,不伴桥接坏死、桥接纤维化、假小叶形成等典型肝硬化病理表现.肿瘤细胞浸润、肿瘤细胞和肝细胞对化疗毒性反应是假性肝硬化可能的发病机制.对已确诊恶性肿瘤的患者,假性肝硬化的存在是影响其生存期的挑战之一,出现假性肝硬化的肿瘤患者中位生存时间缩短.其发病与肿瘤类型和转移、化疗药物应用之间的关系尚不明确,不典型的临床表现、影像学特征给临床医师和患者带来巨大挑战.因此,现根据已有个案报道、观察性研究及已有的荟萃分析结果,就假性肝硬化的流行概况、病因、发病机制、诊断、治疗及预后等研究进展进行综述.
Abstract
Presently,pseudocirrhosis occurs in most patients with liver metastases from malignant tumors and can exhibit clinical manifestations related to portal hypertension,such as edema,ascites,and gastrointestinal bleeding.Imaging features include malignant tumor liver metastasis,the appearance of nodules accompanied with or without hepatic contour,segmental liver volume reduction,and caudate lobe enlargement.Histology shows the typical pathological manifestations of liver cirrhosis,such as diffuse tumor cell infiltration,fibrosis around the infiltrating lesion,hepatic sinus vascular thrombosis,nodular hyperplasia,non-accompanied bridging necrosis,bridging fibrosis,and pseudolobule formation.The possible pathogenesis of pseudocirrhosis is tumor cell infiltration and toxic reactions of tumor cells and liver cells to chemotherapy.The presence of pseudocirrhosis in patients diagnosed with malignant tumors is one of the challenges affecting their survival cycle and shortening the median survival time.The relationship between its onset,tumor type and metastasis,and the use of chemotherapy drugs is still unclear.The atypical clinical manifestations and imaging characteristics bring about great challenges for clinicians and patients.Thus,based on the existing case reports,observational studies,and meta-analysis results,this article reviews the research progress on the prevalence,etiology,pathogenesis,diagnosis,treatment,and prognosis of pseudocirrhosis.
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