CAJ | 학술논문

目的总结肝脏局灶性结节状增生(FNH)的诊断与治疗经验.方法回顾性分析2010年2月至2014年8月中南大学湘雅医院收治的48例FNH患者的临床资料.患者入院分别行全面血清学检查和腹部B超、CT以及MRI检查.手术患者术后均行病理学检查.未明确诊断患者,根据占位性病变部位施行对应手术治疗,对已确诊为FNH无明显临床症状患者施行保守治疗.采用门诊或电话随访,内容包括病史回顾、临床症状及体格检查,随访时间截至2014年9月.结果 47例患者肝功能正常,TBil升高1例.患者血清肿瘤标志物AFP、CEA及CA19-9等均为阴性.患者行影像学检查发现病灶55个,其中41例患者病灶为单发,7例为多发.48例患者行B超检查均未能作出明确诊断.38例患者行CT检查示病灶呈低密度31例、等密度7例,其中病灶中央可见条状或放射状低密度影20例,3例诊断为FNH.10例患者行MRI检查,3例诊断为FNH.其结果显示:动脉期病灶均明显均匀强化;5例病灶中央可见放射状条纹,T2 WI呈高信号,增强早期不强化,延迟后信号可增强.中央瘢痕在T1 WI呈低信号,T2WI呈高信号.2例患者经皮肝穿刺活组织病理学检查证实为FNH.40例患者未能明确诊断,施行手术治疗,其中31例行开腹肝切除术,9例行腹腔镜肝切除术.术中探查患者肝脏均无肝硬化表现,发现病灶47个,其中位于左半肝16个,右半肝31个.30例患者施行肝脏肿块局部切除术、7例行右半肝切除或扩大右半肝切除术、3例行左半肝切除术;其中12例患者同时联合胆囊切除术.手术时间为78～255min,术中出血量为80～720 mL.病灶直径为(4.6±1.6)cm(1.5～11.5 cm).40例手术标本病理学检查证实为FNH.8例确诊为FNH患者予以保守治疗.48例患者均获得随访,中位随访时间为21个月(1～56个月),患者均健康生存,无复发及并发症发生,恢复良好.结论 FNH的临床表现不典型,多无明显临床症状.术前增强CT及MRI检查有助于FNH的诊断及鉴别诊断.确诊困难、有明显临床症状患者,应予手术治疗,明确诊断者可行对应保守治疗,患者预后较好. 目的總結肝髒跼竈性結節狀增生(FNH)的診斷與治療經驗.方法迴顧性分析2010年2月至2014年8月中南大學湘雅醫院收治的48例FNH患者的臨床資料.患者入院分彆行全麵血清學檢查和腹部B超、CT以及MRI檢查.手術患者術後均行病理學檢查.未明確診斷患者,根據佔位性病變部位施行對應手術治療,對已確診為FNH無明顯臨床癥狀患者施行保守治療.採用門診或電話隨訪,內容包括病史迴顧、臨床癥狀及體格檢查,隨訪時間截至2014年9月.結果 47例患者肝功能正常,TBil升高1例.患者血清腫瘤標誌物AFP、CEA及CA19-9等均為陰性.患者行影像學檢查髮現病竈55箇,其中41例患者病竈為單髮,7例為多髮.48例患者行B超檢查均未能作齣明確診斷.38例患者行CT檢查示病竈呈低密度31例、等密度7例,其中病竈中央可見條狀或放射狀低密度影20例,3例診斷為FNH.10例患者行MRI檢查,3例診斷為FNH.其結果顯示:動脈期病竈均明顯均勻彊化;5例病竈中央可見放射狀條紋,T2 WI呈高信號,增彊早期不彊化,延遲後信號可增彊.中央瘢痕在T1 WI呈低信號,T2WI呈高信號.2例患者經皮肝穿刺活組織病理學檢查證實為FNH.40例患者未能明確診斷,施行手術治療,其中31例行開腹肝切除術,9例行腹腔鏡肝切除術.術中探查患者肝髒均無肝硬化錶現,髮現病竈47箇,其中位于左半肝16箇,右半肝31箇.30例患者施行肝髒腫塊跼部切除術、7例行右半肝切除或擴大右半肝切除術、3例行左半肝切除術;其中12例患者同時聯閤膽囊切除術.手術時間為78～255min,術中齣血量為80～720 mL.病竈直徑為(4.6±1.6)cm(1.5～11.5 cm).40例手術標本病理學檢查證實為FNH.8例確診為FNH患者予以保守治療.48例患者均穫得隨訪,中位隨訪時間為21箇月(1～56箇月),患者均健康生存,無複髮及併髮癥髮生,恢複良好.結論 FNH的臨床錶現不典型,多無明顯臨床癥狀.術前增彊CT及MRI檢查有助于FNH的診斷及鑒彆診斷.確診睏難、有明顯臨床癥狀患者,應予手術治療,明確診斷者可行對應保守治療,患者預後較好.
목적 총결간장국조성결절상증생(FNH)적진단여치료경험.방법 회고성분석2010년2월지2014년8월중남대학상아의원수치적48례FNH환자적림상자료.환자입원분별행전면혈청학검사화복부B초、CT이급MRI검사.수술환자술후균행병이학검사.미명학진단환자,근거점위성병변부위시행대응수술치료,대이학진위FNH무명현림상증상환자시행보수치료.채용문진혹전화수방,내용포괄병사회고、림상증상급체격검사,수방시간절지2014년9월.결과 47례환자간공능정상,TBil승고1례.환자혈청종류표지물AFP、CEA급CA19-9등균위음성.환자행영상학검사발현병조55개,기중41례환자병조위단발,7례위다발.48례환자행B초검사균미능작출명학진단.38례환자행CT검사시병조정저밀도31례、등밀도7례,기중병조중앙가견조상혹방사상저밀도영20례,3례진단위FNH.10례환자행MRI검사,3례진단위FNH.기결과현시:동맥기병조균명현균균강화;5례병조중앙가견방사상조문,T2 WI정고신호,증강조기불강화,연지후신호가증강.중앙반흔재T1 WI정저신호,T2WI정고신호.2례환자경피간천자활조직병이학검사증실위FNH.40례환자미능명학진단,시행수술치료,기중31례행개복간절제술,9례행복강경간절제술.술중탐사환자간장균무간경화표현,발현병조47개,기중위우좌반간16개,우반간31개.30례환자시행간장종괴국부절제술、7례행우반간절제혹확대우반간절제술、3례행좌반간절제술;기중12례환자동시연합담낭절제술.수술시간위78～255min,술중출혈량위80～720 mL.병조직경위(4.6±1.6)cm(1.5～11.5 cm).40례수술표본병이학검사증실위FNH.8례학진위FNH환자여이보수치료.48례환자균획득수방,중위수방시간위21개월(1～56개월),환자균건강생존,무복발급병발증발생,회복량호.결론 FNH적림상표현불전형,다무명현림상증상.술전증강CT급MRI검사유조우FNH적진단급감별진단.학진곤난、유명현림상증상환자,응여수술치료,명학진단자가행대응보수치료,환자예후교호.
Objective To summarize the diagnosis and treatment experiences of focal nodular hyperplasia (FNH).Methods The clinical data of 48 patients with FNH who were admitted to the Xiangya Hospital from February 2010 to August 2014 were retrospectively analyzed.All the patients received complete serologic tests,abdomen B ultrasound,computed tomography (CT) and magnetic resonance imaging (MRI) examinations.The pathological examinations were done on the patients undergoing surgical treatment.The surgical treatment was done on the unconfirmed FNH patients according to location of space-occupying lesions.The conservative treatment was done on the confirmed FNH patients without clinical symptoms.All the patients were followed up via outpatient examination and telephone interview up to September 2014,and the follow-up included the history review,clinical symptoms and medical examinations.Results Forty-seven patients had normal liver function and 1 had high level of total bilirubin (TBil).The serum tumor markers including AFP,CEA and CA19-9 in all the patients were negative.Fifty-five foci were detected by imaging examination,41 foci were single mass and 7 foci were multifocality.Forty-eight patients were definitively unconfirmed with FNH by B ultrasound.The results of CT examinations in 38 patients showed as follows:low density was in 31 patients and isodensity in 7 patients,including striped and radiated low density showing in the center of tumor in 20 patients and 3 patients with the confirmed FNH.The results of MRI examinations in 10 patients showed as follows:3 patients were confirmed as with FNH; all the 10 patients showed rather homogeneous enhancement in arterial phase; 5 patients were accompanied with radiated foci in the center of tumor,and showed high signal on T2WI,no enhancement in early arterial phase and enhancement in delayed arterial phase.The central scar showed low signal on T1WI and high signal on T2WI.Two patients were confirmed as with FNH by percutaneous trans-hepatic histopathological examinations.Forty patients without the confirmed FNH underwent surgical treatment,including 31 undergoing open hepatectomy and 9 undergoing laparoscopic hepatectomy.No patients had cirrhosis of liver.During operation,47 foci were detected,16 of which located at the left lobe of liver and 31 of which located at the right lobe of liver.Local tumor resection of liver was carried out on 30 patients,right hemihepatectomy or extended right hepatectomy on 7 patients,left hemihepatectomy on 3 patients and combined treatment of cholecystectomy on 12 patients.The operation time,volume of blood loss and diameter of foci were (78-255) minutes,(80-720) mL and (4.6 ± 1.6) cm (range,1.5-11.5 cm).Forty patients were confirmed as with FNH by pathological examination,and 8 patients were cured by conservative treatment.All the 48 patients were followed up for 21 months (range,1-56 months) and survived well without recurrence and complications.Conclusions The clinical symptoms of FNH are atypical and unobvious.The preoperative enhanced CT and MRI examinations can help improve the diagnosis and differential diagnosis of FNH.The surgical treatment could be performed on the patients with significant clinical symptoms and without definitive diagnosis,and the patients with definitive diagnosis should be treated by conservative treatment with the good prognosis.