CAJ | 학술논문

目的探讨肝脏孤立性坏死结节的临床表现、治疗方法和预后.方法回顾性分析经手术治疗的10例肝脏孤立性坏死结节患者的临床资料.结果该病好发于男性(7/10),中位年龄47岁.患者多无临床症状(8/10)；多不合并肝炎病毒感染,肿瘤标记物CA199,AFP,CEA等正常.本组9例患者为单发病灶,l例为2个病灶,其中7个病灶位于肝左叶,4个病灶位于肝右叶.结节大小为(2.9±1.1) cm.MRI检查T1WI扫描肿瘤呈低信号或中信号,T2WI扫描肿瘤呈低或稍高信号,增强扫描无强化或有周边强化,MRI有较高的诊断准确率,达66.7％ (4/6).术前穿刺活检较难定性.术后病理检查提示病灶结节中心由坏死的肝细胞组成,周边为增生的纤维细胞、炎性细胞及多核巨细胞,5例患者存在肝组织脂肪变性.10例患者病灶均经手术切除,经随访6～67个月,无复发.结论该病病因尚未达成共识,由于临床少见,临床医师认识不足,容易误诊,如能诊断准确,可随访观察,本病预后良好.
목적 탐토간장고립성배사결절적림상표현、치료방법화예후.방법 회고성분석경수술치료적10례간장고립성배사결절환자적림상자료.결과 해병호발우남성(7/10),중위년령47세.환자다무림상증상(8/10)；다불합병간염병독감염,종류표기물CA199,AFP,CEA등정상.본조9례환자위단발병조,l례위2개병조,기중7개병조위우간좌협,4개병조위우간우협.결절대소위(2.9±1.1) cm.MRI검사T1WI소묘종류정저신호혹중신호,T2WI소묘종류정저혹초고신호,증강소묘무강화혹유주변강화,MRI유교고적진단준학솔,체66.7％ (4/6).술전천자활검교난정성.술후병리검사제시병조결절중심유배사적간세포조성,주변위증생적섬유세포、염성세포급다핵거세포,5례환자존재간조직지방변성.10례환자병조균경수술절제,경수방6～67개월,무복발.결론 해병병인상미체성공식,유우림상소견,림상의사인식불족,용역오진,여능진단준학,가수방관찰,본병예후량호.
Objective To investigate the clinical features,therapeutic approach and prognosis of solitary necrotic nodule of the liver (SNN).Methods Clinical data of 10 SNN patients confirmed by operative pathology were analyzed retrospectively.Results Solitary necrotic nodule of the liver was found mainly in males (70.0％,7/10),with a median age of 47 years,most of the patients (80.0％,8/10) have no significant clinical symptoms,no underlying hepatitis.Tumor markers including CA19-9,a-fetoprotein and CEA were within normal range.Nine patients had solitary nodule and 1 patient had multiple nodules.Seven lesions located in left lobe and 4 lesions in right lobe.The diameter of the nodules was 2.9 cm ± 1.1 cm.The lesions were low or iso-intense in T1-weighted MR image,low or slight high intense in T2-weighted MR image.Contrast-enhanced MR imaging showed that internal part of lesions had no enhancement,while the capsule of the lesions demonstrated enhancement.MRI image had high diagnostic accuracy rate of 66.7％.A preoperative liver biopsy was difficult to achieve a definite diagnosis.On microscopic examination,all nodules had a central necrotic core,surrounded by fibrotic cells,inflammatory cells and multinucleated giant cells.Furthermore,among them 5 patients have fatty degeneration of the liver.All patients underwent liver resection with no recurrence within 6 - 67 months of follow up.Conclusions The etiology of solitary necrotic nodule is unclear.Misdiagnosis was common due to the low incidence and insufficient recognition among physicians,if a definite diagnosis can be obtained,clinical observation is recommended,and the prognosis is good.