摘要
目的探讨肝脏局灶性结节性增生的诊治经验。方法回顾性分析31例FNH患者的临床表现、影像学检查、诊断及治疗方法等临床资料。结果全组31例中25例(80.6%)为40岁以下青壮年,23例(74.2%,23/31)无明显症状,HbsAg阳性1例,肝功能,AFP,CA19-9等肿瘤标记物均在正常范围内。单发肿瘤27例,4例为2个病灶。病灶多位于Ⅳ,Ⅴ,Ⅷ肝段。病灶大小0.5～15.0 cm。FNH术前诊断符合率分别为:彩超3.2%(1//31),CT 32.1%(9/28),MRI 20.0%(2/10),肝动脉造影0(0/3)。术前诊断正确3例(9.7%),误诊为肝癌13例(41.9%),肝腺瘤4例(12.9%),肝血管瘤2例(6.5%),诊断不明9例(29.0%)。手术切除29例,2例经皮穿刺活检及影像学检查等确诊后予保守治疗。随访时间8个月至6.5年,29例术后均无复发。未手术2例,随访时间18～53个月,均健在,肿块大小无明显变化。结论 FNH患者往往无临床症状,对影像学检查结果进行综合分析,是提高FNH正确诊断率的有效方法。怀疑FNH者,可经皮穿刺活检协助诊断,对于诊断明确、无症状的FNH,可定期观察,无需治疗。[中国普通外科杂志,2011,20(1):71-74]
Objective To explore the experience on the diagnosis and treatment of hepatic focal nodular hyperplasia（FNH）.Methods Clinical data of 31 FNH patients,including the clinical manifestations,laboratory tests,imaging,diagnosis and treatment,were studied retrospectively.Results Twenty-five cases（80.6%） were young adults（less than 40 years old）.Most of the patients（74.2%,23/31） had no obvious symptoms,and HBsAg positive was only in one case.All the patients had normal liver functions,while AFP、CA19-9 and other tumor markers were within normal range.Twenty-seven patients had a single solitary focus and 4 had two lesions.Most of the lesions were located in hepatic segments Ⅳ,Ⅴ and Ⅷ.Lesion sizes ranged between 0.5 cm and 15.0 cm.The rate of diagnosis in this group was 3.2% by color Doppler ultrasound,32.1%（9/28） by CT,20%（2/10） by MRI,and 0%（0/3） by hepatic artery angiography.Correct preoperative diagnosis was made in only 3 cases（9.7%）.Thirteen cases（41.9%） were misdiagnosed as liver cancer,4 misdiagnosed as hepatic adenoma,2 misdiagnosed as hepatic hemangioma and 9 cases had indefinite diagnosis.Twenty-nine cases underwent hepatic resection,and 2 cases were treated conservatively after the diagnosis was confirmed by the comprehensive utilization of biopsy and imaging examinations.Follow-up time was 8 months to 6.5 years,and all the operated patients suffered no relapse.Two patients,who were treated conservatively,were followed up for 18 months to 53 months,and they were all alive,without significant changes in lesion sizes.Conclusions Most cases of FNH have no clinical symptoms,and an effective method to improve the diagnostic accuracy of FNH is by the comprehensive analysis of the imaging examinations.The patients suspected of FNH may undergo percutaneous biopsy and those symptomless patients who have a definite diagnosis of FNH,may be treated by regular and close observation.
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2011年第1期71-74,共4页
China Journal of General Surgery
