分析混合型肝癌（cHCC-CC）的临床特点及超声造影（CEUS）模式。

回顾性分析从2005年1月至2015年2月在第三军医大学西南医院行CEUS检查且经手术切除病理证实为cHCC-CC的患者49例。将cHCC-CC的CEUS模式分为肝细胞癌（HCC）模式、胆管细胞癌（CC）模式及不确定模式3种。采用χ²比较cHCC-CC患者CEUS模式差异及肿瘤标志物[甲胎蛋白（AFP）和糖类抗原19-9（CA19-9）]浓度同时升高或肿瘤标志物浓度升高与CEUS表现不符的cHCC-CC患者比例与肿瘤标志物浓度同时升高的cHCC-CC患者比例差异。

49例cHCC-CC患者中，男性44例，女性5例，年龄28~74岁，平均年龄（52.3±9.8）岁。单发病灶41例（83.7%，41/49），肿瘤最大径为1.5~13.8 cm，平均直径（5.3±3.5）cm，51.0%（25/49）的病灶最大径小于5 cm。病理证实34例（69.4%，34/49）患者有肝硬化。31例（63.3%，31/49）患者AFP浓度升高，12例（24.5%，12/49）患者CA19-9浓度升高，9例（18.4%，9/49）患者AFP和CA19-9浓度同时升高。25例（51.0%，25/49）患者病灶CEUS显示为CC模式，22例（44.9%，22/49）患者病灶CEUS显示为HCC模式，两者差异无统计学意义（χ²=0.368，P=0.544）。9例AFP和CA19-9浓度同时升高的患者中，5例病灶CEUS表现为CC模式，4例病灶CEUS表现为HCC模式。12例（24.5%，12/49）患者肿瘤标志物（AFP或CA19-9）浓度升高与CEUS模式不符，其中9例为AFP浓度升高但CEUS为CC模式，3例为CA19-9浓度升高但CEUS为HCC模式。21例（42.9%，21/49）患者AFP及CA19-9浓度同时升高或肿瘤标志物（AFP或CA19-9）浓度升高与CEUS模式不符，多于AFP及CA19-9浓度同时升高的患者（18.4%，9/49），且差异有统计学意义（χ²=6.918，P=0.009）。

cHCC-CC患者临床特征与HCC患者类似。cHCC-CC的CEUS表现为HCC模式和CC模式的比例相近，血清AFP和CA19-9浓度检测与CEUS模式结合分析有助于提高cHCC-CC检出率。

To analyze the clinical characteristics and enhancement pattern on contrast-enhanced ultrasound (CEUS) of combined hepatocellular-cholangiocarcinoma (cHCC-CC).

A total of 49 patients who were pathologically confirmed as cHCC-CC by surgery and underwent CEUS examination in Southwest Hospital Affiliated to Third Military Medical University from January 2005 to February 2015 were retrospectively enrolled. There were 3 enhancement patterns on CEUS: hepatocellular carcinoma (HCC) pattern, cholangiocarcinoma (CC) pattern and indeterminate pattern. The proportions of HCC pattern and CC pattern of cHCC-CC were compared by χ² test. And the proportions of tumour maker elevation [(alpha-fetoproteins, AFP) and/or (carbohydrate antigen, CA19-9)] in accordance or discordance with enhancement patterns were compared by χ² test.

Among the 49 cHCC-CC patients, 44 were male and 5 were female. Mean age was (52.3±9.8) years old (range: 28-74 years old). Of all cases, 41 (83.7%, 41/49) patients had single nodule. Mean size of nodule was (5.3±3.5) cm (range: 1.5-13.8 cm), and the size of 51.0% (25/49) lesions were < 5 cm. Totally 34 (69.4%, 34/49) patients had pathologically diagnosed cirrhosis. AFP elevation was found in 31 (63.3%, 31/49) patients, CA19-9 elevation was found in 12 (24.5%, 12/49) patients, simultaneous elevation of both AFP and CA19-9 was found in 9 (18.4%, 9/49) patients. The percentages of CC pattern and HCC pattern were 51.0% (25/49) and 44.9% (22/49) respectively. And there was no significant difference between the two patterns (χ²=0.368, P=0.544). In 9 patients with simultaneous elevation of both AFP and CA19-9, CC pattern was observed in 5 patients and HCC pattern was noted in 4 patients. There were 12 (24.5%, 12/49) patients with tumor marker elevation (AFP or CA19-9) in discordance with enhancement patterns on CEUS. Among the 12 cases, 9 cases with AFP elevation were CC patterns on CEUS and 3 cases with CA19-9 elevation were HCC patterns on CEUS. Simultaneous elevation of tumor makers (AFP and CA19-9) or tumor mark elevation (AFP or CA19-9) in discordance with enhancement patterns on CEUS was found in 21 (42.9%, 21/49) patients, which was significantly more than simultaneous elevation of AFP and CA19-9 alone (18.4%, 9/49) (χ²=6.918, P=0.009).

Clinical characteristics of patients with cHCC-CC were similar to that of patients with HCC. The proportion of HCC pattern and CC pattern was comparable. Combination of test of tumor makers (AFP and CA19-9) and enhancement pattern on CEUS maybe helpful for the diagnosis of cHCC-CC.