摘要：早期肝癌可無癥狀體征，一旦出現典型的臨床表現時，已屬于中晚期肝癌。肝腫大、上腹腫塊為中晚期肝癌的特征性體征，晚期肝癌或有肝硬變背景者可同時有黃疸、腹水、脾腫大、下肢浮腫及肝掌、蜘蛛痣、腹壁靜脈曲張等。1．肝腫大位于肝右葉上段肝癌表現為肝上界上移，膈肌上抬、固定、運動受限；右葉下段肝癌常可在右肋弓下觸及腫塊；左葉肝癌常表現為劍突下腫塊，或有上腹部隆起。

　　臨床表現

　　（一）癥狀

　　早(zao)期肝癌可無癥狀(zhuang)體征，一旦出現典型的(de)臨床表現時，已屬于中晚期肝癌。肝癌的(de)常(chang)見癥狀(zhuang)有：肝區疼痛、納(na)差、消瘦(shou)、乏力以(yi)及不明原因的(de)發(fa)熱、腹脹、、黃疸等。

　　1．肝(gan)(gan)(gan)(gan)(gan)區疼(teng)(teng)痛(tong)(tong)(tong) 常由腫(zhong)瘤(liu)生長迅速使肝(gan)(gan)(gan)(gan)(gan)包(bao)(bao)膜(mo)張(zhang)力(li)增大，或(huo)腫(zhong)瘤(liu)累及肝(gan)(gan)(gan)(gan)(gan)包(bao)(bao)膜(mo)所致。常為中(zhong)晚期(qi)肝(gan)(gan)(gan)(gan)(gan)癌的首(shou)發癥狀。疼(teng)(teng)痛(tong)(tong)(tong)多位(wei)于(yu)右(you)(you)肋脅部或(huo)劍突下，初(chu)起多呈間(jian)歇(xie)性或(huo)持續性鈍痛(tong)(tong)(tong)或(huo)刺痛(tong)(tong)(tong)。疼(teng)(teng)痛(tong)(tong)(tong)可(ke)時(shi)(shi)輕(qing)時(shi)(shi)重(zhong)或(huo)一段時(shi)(shi)間(jian)內自行(xing)緩(huan)解，甚或(huo)消失。疼(teng)(teng)痛(tong)(tong)(tong)多以夜間(jian)明(ming)顯，有時(shi)(shi)需用鎮痛(tong)(tong)(tong)劑(ji)。若(ruo)腫(zhong)瘤(liu)位(wei)于(yu)肝(gan)(gan)(gan)(gan)(gan)右(you)(you)葉膈頂部則(ze)疼(teng)(teng)痛(tong)(tong)(tong)常可(ke)放射(she)至(zhi)右(you)(you)肩或(huo)右(you)(you)背部；若(ruo)腫(zhong)瘤(liu)位(wei)于(yu)肝(gan)(gan)(gan)(gan)(gan)左葉則(ze)較早(zao)出現中(zhong)上腹脹痛(tong)(tong)(tong)；當腫(zhong)瘤(liu)位(wei)于(yu)肝(gan)(gan)(gan)(gan)(gan)右(you)(you)葉實質深部時(shi)(shi)，一般很少出現疼(teng)(teng)痛(tong)(tong)(tong)。肝(gan)(gan)(gan)(gan)(gan)區疼(teng)(teng)痛(tong)(tong)(tong)突然加劇，伴觸(chu)痛(tong)(tong)(tong)或(huo)肌(ji)衛征陽性者，應想到是肝(gan)(gan)(gan)(gan)(gan)破裂或(huo)腫(zhong)瘤(liu)出血至(zhi)肝(gan)(gan)(gan)(gan)(gan)包(bao)(bao)膜(mo)下。

　　2．消(xiao)化道(dao)(dao)癥(zheng)狀(zhuang) 常(chang)表現(xian)為胃(wei)納減退、飯后上(shang)腹飽脹、甚或惡心、嘔(ou)吐或腹瀉(xie)。消(xiao)化道(dao)(dao)癥(zheng)狀(zhuang)常(chang)由肝(gan)臟病理性改變，致門靜脈系(xi)統(tong)升高，消(xiao)化道(dao)(dao)功(gong)能失(shi)調；或增大的腫瘤壓迫或累(lei)及(ji)胃(wei)所致。

　　3．消瘦與乏力 常出現(xian)于肝癌的中(zhong)晚期(qi)。可(ke)能(neng)是腫瘤(liu)代謝(xie)產(chan)物引起機體生化(hua)代謝(xie)改變，加之(zhi)進食(shi)減(jian)少所致。嚴重(zhong)時出現(xian)惡病質。

　　4．發熱(re)(re) 肝癌(ai)所致發熱(re)(re)一(yi)般(ban)在37．5℃一(yi)38℃左(zuo)右，偶可(ke)達3g℃以上，呈不規則熱(re)(re)型，多不伴(ban)寒(han)戰，午(wu)后發熱(re)(re)較常(chang)見，有時(shi)也(ye)可(ke)見弛(chi)張型高熱(re)(re)。發熱(re)(re)可(ke)因(yin)腫瘤壞(huai)死或(huo)其(qi)代謝(xie)產物引起。

　　5．其他癥狀 有肝炎、肝(gan)硬變背(bei)景(jing)或腫(zhong)(zhong)瘤(liu)浸潤性(xing)生長較大致肝(gan)臟功(gong)能失代償者可(ke)有出(chu)血(xue)(xue)傾向(xiang)，如牙齦、鼻出(chu)血(xue)(xue)及皮下淤斑等(deng)；也可(ke)出(chu)現(xian)低蛋白(bai)血(xue)(xue)癥，致水(shui)腫(zhong)(zhong)、腹水(shui)、腹脹(zhang)等(deng)。腫(zhong)(zhong)瘤(liu)轉移至(zhi)肺可(ke)引起。腫(zhong)(zhong)瘤(liu)侵及并阻塞肝(gan)靜(jing)(jing)脈(mo)或下腔靜(jing)(jing)脈(mo)時可(ke)出(chu)現(xian)呈進行性(xing)加重的(de)下肢水(shui)腫(zhong)(zhong)，甚至(zhi)出(chu)現(xian)腹水(shui)等(deng)布(bu)-查綜合征的(de)表現(xian)。

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