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目的总结少见肝占位性病变的诊治体会。方法回顾性分析2009年6月至2016年4月期间遵义医学院附属医院收治的18例少见肝占位性病变患者的临床资料。结果 18例患者中,包括肝结核4例,肝血管平滑肌脂肪瘤(HAML)3例,肝局灶性结节性增生(FNH)4例,肝腺瘤1例,肝寄生虫病6例,所有患者的影像学图像均表现为肝占位性病变。4例肝结核患者经正规抗结核治疗好转出院;2例肝肺吸虫病患者接受吡奎酮正规驱虫治疗,随访期间无异常;1例血吸虫病患者行手术治疗后治愈出院,未获得随访;3例寄生虫感染患者行手术切除病变部位,随访期间无异常;3例HAML患者行手术治疗,随访期间病情无明显异常,4例FNH患者行手术治疗,2例随访期间未见明显异常,2例未获得随访;1例肝腺瘤患者行手术治疗,随访无明显异常。出院后15例患者获访,随访时间2~6个月,中位数为3.5个月。随访期间,除4例肝结核患者因抗结核治疗引起相应并发症、经保守治疗好转外,其余患者均未见明显并发症发生。结论大多数少见肝占位性病变术前诊断较困难,熟悉掌握疾病相关特点及影像学表现,可降低误诊率,但明确诊断主要依靠病理学检查,治疗以手术为主。
Objective To summarize the diagnosis and treatment of rare hepatic mass lesions. Methods The clinical data of 18 patients with rare liver lesions admitted to Affiliated Hospital of Zunyi Medical College from June 2009 to April 2016 were retrospectively analyzed. Results Among the 18 patients, there were 4 cases of hepatic tuberculosis, 3 cases of hepatic angiomyolipoma (HAML), 4 cases of focal nodular hyperplasia (FNH), 1 case of hepatic adenoma, 6 cases of liver parasitic disease, Imaging images of all patients showed liver space-occupying lesions. 4 cases of liver tuberculosis patients were discharged after regular anti-TB treatment; 2 cases of liver paragonimiasis patients were treated with normal dewoprazole treatment, no abnormality during follow-up; 1 case of schistosomiasis patients were cured after surgery and were not followed up; Three patients with parasitic infection underwent surgical resection of the lesion, and no abnormalities were observed during the follow-up. Three patients with HAML underwent surgical treatment. No abnormalities were observed during the follow-up period. Four patients with FNH underwent surgical treatment. No significant abnormality was observed in two patients during follow-up. 2 Cases were not followed up; 1 case of liver adenoma patients underwent surgical treatment, no significant abnormalities were followed up. After discharge from the hospital, 15 patients were followed up for 2 to 6 months with a median of 3.5 months. During follow-up, except for 4 cases of patients with liver tuberculosis due to anti-TB treatment caused by the corresponding complications, conservative treatment improved, the remaining patients were no significant complications. Conclusions Most uncommon hepatic lesions are difficult to diagnose preoperatively. Familiar with the characteristics and imaging features of the disease can reduce the misdiagnosis rate. However, the definite diagnosis mainly depends on the pathological examination and the treatment is mainly based on the operation.