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目的总结肝脏局灶性结节增生的临床特点、影像学表现、临床诊治方法及预后。方法回顾性分析中南大学湘雅医院2014年7月至2016年7月期间31例行肝脏占位病灶切除术并最终确诊为肝脏局灶性结节增生患者的临床资料。结果 31例肝脏局灶性结节增生患者中男12例,女19例,男女比例为1∶1.58;年龄15~67岁,(39.7±11.5)岁。体检发现占位者21例,有症状表现者10例。实验室检查:仅2例有长期饮酒史的患者AST轻度异常,有6例HBs Ag阳性,1例CA19-9略升高(40.54 k U/L)。影像学考虑肝脏局灶性结节增生13例,MRI的诊断率高于彩超(P<0.05)及CT(P<0.05)。病灶直径为2~11 cm,(4.6±2.1)cm。所有病灶均行手术切除,其中腹腔镜下肝切除13例,开腹手术18例。与开腹手术比较,腹腔镜下肝切除者的术中出血量更少(P<0.05)、肠道排气时间和住院时间更短(P<0.05)。有29例患者获得随访,随访时间为3~24个月,无死亡患者,患者生活质量良好,无复发转移。结论肝脏局灶性结节增生为肝脏良性病变,预后较好;常无临床症状,实验室检测无特征性表现,多种影像学及病理学联合诊断可提高诊断率;对于不能排除肝细胞癌等恶性肿瘤及其他肝脏占位性病变时应行手术切除,且腹腔镜手术较开腹手术有出血少、恢复快的优势。
Objective To summarize the clinical features, imaging findings, clinical diagnosis and treatment, and prognosis of hepatic focal nodular hyperplasia. Methods The clinical data of 31 patients with hepatic lesions resected from Xiangya Hospital of Central South University from July 2014 to July 2016 were retrospectively analyzed and finally diagnosed as focal nodular hyperplasia of liver. Results There were 12 males and 19 females with focal nodular hyperplasia in 31 cases. The ratio of male to female was 1: 1.58. The age ranged from 15 to 67 years (39.7 ± 11.5) years. Physical examination found that the placeholder in 21 cases, 10 cases of symptoms. Laboratory tests: Only 2 patients with long history of alcohol consumption had mild abnormalities of AST, 6 were positive for HBs Ag and 1 was slightly elevated for CA19-9 (40.54 kU / L). Thirteen cases of hepatic focal nodular hyperplasia were considered in imaging. The diagnostic rate of MRI was higher than that of ultrasonography (P <0.05) and CT (P <0.05). Lesions diameter of 2 ~ 11 cm, (4.6 ± 2.1) cm. All lesions were surgically removed, including laparoscopic hepatectomy in 13 cases, 18 cases of laparotomy. Compared with laparotomy, laparoscopic hepatectomy had less intraoperative blood loss (P <0.05) and shorter bowel exhaust and hospital stay (P <0.05). Twenty-nine patients were followed up for 3-24 months without any death. The patients had good quality of life and no recurrence and metastasis. Conclusions Focal nodular hyperplasia of the liver is a benign liver lesion, with a good prognosis. Often, no clinical symptoms are found, laboratory tests have no characteristic manifestations, and multiple imaging and pathological diagnosis can improve the diagnosis rate. For patients who can not rule out hepatocellular carcinoma Other malignant tumors and other liver lesions should be performed when the surgical resection, and laparoscopic surgery less bleeding than laparotomy, the advantages of rapid recovery.