肝移植术后迟发性门静脉血栓形成12例

目的 总结肝移植术后迟发性门静脉血栓形成的治疗方法,并分析其预后.方法 单中心3100例次尸体全肝移植中发生迟发性门静脉血栓形成12例,发生时间平均为移植术后29.8个月.12例中,2例合并严重胆道并发症(肝内胆道狭窄),2例表现为移植肝功能衰竭,1例影像学检查可见肝门部肿物致门静脉受压,均接受再次肝移植;2例表现为急性上消化道出血,分别行经胃镜下套扎、注射硬化剂治疗;余5例无任何临床表现,口服抗凝或抗血小板药物治疗.结果 12例中,除1例失访外,其他患者至随访结束时存活8例,包括2例行再次肝移植者.存活者肝功能检查结果均正常.结论 肝移植术后发生迟发性门静脉血栓形成,应根据患者的临床表现不同采用不同的治疗方法.

Abstract：

Objective To summary therapeutic method for delayed portal vein thrombosis after liver transplantation. Methods In 3100 cases undergoing cadaveric whole liver transplantation in a single center, there were 12 cases of delayed portal vein thrombosis after liver transplantation.Average occurring time was 29. 8 months after liver transplantation. Among these 12 patients, 2 cases were complicated with severe biliary complication (intrahepatic stricture) , 2 cases presented with liver failure of transplanted liver, and one case had portal vein compression by hepatic hilum tumor under the image examination, who received liver re-transplantation; two patients presented upper gastrointestinal bleeding, and they experienced endoscopic ligation and sclerotherapy respectively; the rest five patients without any clinical presentation were subjected to anticoagulation and antiplatelet therapy. Results Among 12 cases, 8 patients survived by the time of follow-up, including two patients undergoing re-transplantation; one patient lost follow-up. The liver function tests of the patients who survived were all normal. Conclusion The individualized therapeutic methods should be adopted for the patients with delayed portal vein thrombosis after liver transplantation.     

CD40在肝硬化门静脉高压症脾脏中的表达与临床意义

目的 探讨CD40在肝硬化门静脉高压症患者脾脏中的表达及临床意义.方法 采用免疫组织化学S-P法测定50例肝硬化门静脉高压症患者和15例正常脾脏中CD40的表达情况.结果 CD40在正常脾脏与巨脾组织中的表达率分别为86.7%和36.0%,存在显著性差异(P＜0.05).CD40表达与肝功能Child分级及巨脾病理分级均呈负相关(P＜0.05).结论 CD40可能为临床评估肝硬化门静脉高压症患者脾脏免疫功能状态的重要指标.

Abstract：

Objective To investigate the expression and clinical significance of CD40 in the spleen of cirrhotic portal hypertension. Methods Expression of CD40 was determined with S-P immunohistochemistry in spleen specimens from 50 cases of cirrhotic portal hypertension and 15 healthy individuals. Results The CD40 positive rates in normal spleen and cirrhotic spleen were 86.7% and 36.0%, respectively. There was a significant difference between the 2 groups (P＜0.05). There was a negative correlation between the expression of CD40 and Child grades of liver function and cirrhotic splenic types(P＜0. 05). Conclusion CD40 might reflect the changes of splenic immune function,which might be one of more exact clinical examination indexes of splenic immune function.     

肝脏局灶性结节性增生34例诊治分析

目的 探讨肝脏局灶性结节性增生的临床表现、治疗方法和预后.方法 回顾性分析我院经手术治疗的34例肝脏局灶性结节性增生患者的临床资料.结果 本组男性发病居多(67.6%),发病时男性较女性肿物直径小,患者多无临床症状(64.7%),32例为单发病灶,2例为多发病灶,肿瘤标记物CA199,AFP正常,术前MRI检查有较高的诊断准确率,为54.5%.34例患者均经手术切除,经随访17～134个月,无复发.结论 FNH如能诊断准确,可随访观察,如确诊困难、有明显临床症状、短期增长速度较快,首选手术治疗,预后良好.

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Objective To investigate the clinical features,therapeutic approach and prognosis of focal nodular hyperplasia (FNH) of the liver. Methods Clinical data of 34 FNH patients confirmed by operation were analyzed retrospectively. Results Focal nodular hyperplasia of the liver was found mainly in males (67. 6% ) , Mean nodular size was significantly smaller in men than women. Most of the patients (64.7%) had no significant clinical symptoms. Tumor markers including CA19-9 and A-fetoprotein were within normal range. MRI is helpful to achieve a more accurate diagnosis of the disease, correct preoperative diagnosis rate was 54. 5%. All patients underwent liver resection with no recurrence within 17 - 134 months of follow up. Conclusions FHN of the liver is benign in entity. If a definite diagnosis can be obtained preoperatively, observation follow-up are recommended. Hepatectomy is indicated when there is a suspicion of malignancy.     

CD40在肝硬化门静脉高压症脾脏中的表达与临床意义

Objective To investigate the expression and clinical significance of CD40 in the spleen of cirrhotic portal hypertension. Methods Expression of CD40 was determined with S-P immunohistochemistry in spleen specimens from 50 cases of cirrhotic portal hypertension and 15 healthy individuals. Results The CD40 positive rates in normal spleen and cirrhotic spleen were 86.7% and 36.0%, respectively. There was a significant difference between the 2 groups (P＜0.05). There was a negative correlation between the expression of CD40 and Child grades of liver function and cirrhotic splenic types(P＜0. 05). Conclusion CD40 might reflect the changes of splenic immune function,which might be one of more exact clinical examination indexes of splenic immune function.     

肝脏局灶结节性增生的诊断与外科治疗

目的 总结肝脏局灶结节性增生的诊断和外科治疗经验.方法 回顾性分析63例经手术病理证实的肝脏局灶性结节患者临床资料.结果 本病多见于中青年,31～50岁者50例(79.4%),男女之比2.94∶1.本病起病隐匿,56例(89%)无明显临床症状,HBsAg阳性者3例(4.8%).肝功能正常者58例(92.1%),5例(7.9%)总胆红素及rGT轻度升高,但AFP、CEA、CA19-9均为阴性.肝脏局灶性结节的病灶多为单发(95.2%),肿瘤直径平均为4.5 cm.病灶位于左肝叶25例、中肝叶6例、右肝叶29例、尾状叶3例.彩色超声检查:2例(3.2%)病灶中央有粗大的血管通过,血流丰富,高流速,低阻力.61例行CT动态扫描(96.8%),增强后早期均匀明显强化,其中6例出现中央星状瘢痕.59例行MRI检查(93.7%),早期明显增强、均匀,5例出现中央星状瘢痕T2WI高信号.本组63例患者均行手术治疗,其中局部切除34例;肝段或肝叶切除术16例;半肝切除术13例.本组无手术死亡,患者无严重并发症.结论 FNH是一种肝脏良性病变,术前误诊率高达25.4%;提高对FNH的认识水平,结合临床及各种影像检查的资料,可明显提高诊断率.

Abstract：

Objective To summarize the diagnosis and surgical treatment of hepatic focal nodular hyperplasia (FNH). Methods The clinical data of 63 patients with FNH proved by pathology were analyzed retrospectively. Results The disease mainly affected young to middle aged, 50 cases (79. 4% )were of 31-50 years old. Male and female ratio was 2.94: 1. Fifty-six patients (89%) were asymptomatic, 3 cases were HBsAg positive (4.8%). Liver function was basically normal (92. 1%),5 cases (7.9%) were with elevated level of total bilirubin and rGT. AFP, CEA and CA19-9 was all negative. FNH occured as a single node in 95.2% cases, ranging from 1.5 cm to 17 cm in diameter ( average 4. 5 cm). Of these patients, 25 lesions were present in the left lobe, 29 in the right lobe, 6 in the mid lobe, and 3 in the caudate lobe. A big central artery was found in 2 cases (3. 2% ) as found by color Doppler ultrasound. CT scan showed transient immediate enhancement in 96. 8% (61/63) of patients, with central scar in 6 cases. MRI demonstrated early vigorous enhancement in 93. 7% (59/63) of patients, with central scar in 5 cases. All patients underwent surgical resection; including local resection in 34 cases;segmentectomy or hepatectomy in 13 cases; hemihepatectomy in 13 cases. There was no postoperative mortality and major complications. Conclusions FNH is a kind of hepatic benign disease and characteristic of high preoperative misdiagnosis rate (25. 4% ).     

紧邻肝门及大血管的肝血管瘤手术治疗

目的 探讨紧邻肝门及重要血管的肝血管瘤的手术方式及其安全性.方法 总结自2005年6月至2010年6月解放军第一零一医院对17例患者紧邻肝门及肝内外重要血管的肝血管瘤施行肝切除手术的方法和效果.结果 本组17例患者均手术成功,无手术死亡.规则性肝叶切除术6例,其中绕肝提拉法前入路右半肝切除术2例,肝右后叶切除术2例,左半肝切除术2例;外膜剥离术8例;肝实质劈开加外包膜剥离术3例.在绕肝提拉法前入路右半肝切除术患者中,采用选择性连续右半肝血流阻断法,其他患者采用常温下间歇性入肝血流阻断法.术后并发症:胸腔积液5例,伤口感染1例,肺部感染1例.本组患者均痊愈出院.结论 根据患者肝血管瘤的不同部位、大小以及与肝门、肝内、外重要血管的关系,采用不同的手术切除方式,有助于提高手术安全性.

Abstract：

Objective To explore the surgical modality and safety of hepatectomy for hepatic hemangiomas close adjoining the hepatic portal and vital blood vessels. Methods From June 2005 to June 2010 17patients of hepatic hemangiomas underwent hepatectomy. Data were retrospectively analyzed.Results All the 17 cases were operated on successfully. Six cases were treated with anatomic liver lobectomy including right hemibepatectomy through liver hanging maneuver by anterior approach in 2 cases,under right liver blood vessel blochade and anatomic right posterior hepatectomy in 2 cases, left hemihepatectomy in 2 cases. Eight cases were treated by hemangiomas enucleation, in 3 cases hemangioma was enuleated through liver parenchyma splitting under intermittent hepatic blood inflow exclusion. There was no postoperative mortality, postoperatively pleural effussion occured in 5 cases,wound infection occured in 1 case, and pulmonary infection occured in 1 case, all the cases were cured. Conclusions Different operation styles should be applied according to the position, size of hepatic hemangiomas close adjoining the hepatic portal and the important blood vessels.     

大鼠肝脏胆管及门静脉铸型扫描图像分析

目的 建立大鼠去胆管肝叶和去门静脉肝叶自身对照模型,观察两肝叶之间胆管及门静脉是否存在交通支及其大体形态变化.方法 SD大鼠40只,分为S、BL、PL和BPL共4组,分别应用氰基丙烯酸酯对肝右叶胆管进行栓塞结扎制备去胆管肝叶;对肝方叶行门静脉结扎制备去门静脉肝叶.通过测量肝重/体重和方叶重/右叶重及对各组大鼠胆管和门静脉分别灌注硫酸钡明胶混悬液制备铸型标本,并运用Micro-CT扫描来观察两叶肝脏胆道和门静脉形态变化.结果 (1)大鼠手术后在本观察期内存活率达到100%,无黄疸表现.肝叶大体形态观察和两叶肝重量比指标显示,S、BL、PL组肝重/体重为3.5%,与BPL组比较差异有统计学意义(P<0.01).S、BL组方叶/右叶重量比为60%～70%,PL及BPL组则为20%左右,提示去胆管和去门脉肝叶之间的重量比差异有统计学意义(P<0.05或P<0.01).(2)Micro-CT铸型扫描可以直观地显示胆管和门静脉形态变化,未发现两个肝叶之间存在交通支或侧枝循环.结论 去胆管肝叶无明显萎缩.胆管及门静脉灌注造影显示两叶胆管及门静脉无明显的侧枝循环.Micro-CT扫描可以直观地显示胆管及门静脉形态变化,硫酸钡明胶灌注铸型为小动物肝脏Glissons系统形态学研究提供了一种借鉴方法.

Abstract：

Objective To establish a rat self-control model with the bile duct deprived (BDD) and the portal vein deprived (PVD) hepatic lobe and to observe whether there were communicated branches between the two lobes.Methods Forty SD rats were divided into four groups: group S with sham operation as an undisposed blank control, group BL with the right lobe bile duct embolized and ligated, group PL with the quadrate lobe portal vein ligated, and group BPL with the right lobe bile duct embolized and ligated and meanwhile the quadrate lobe portal vein ligated. The right hepatic bile ducts were embolized with cyanoacrylate and then ligated to prepare the BDD lobe. The portal vein of quadrate hepatic lobes was ligated as the PVD lobes. The observation period was 1 month after the bile duct or portal vein ligated. The values of liver weight/body weight and the quadrate lobe weight/the right lobe weight were recorded. The bile duct and portal vein casting specimens of these four groups were prepared by a perfusion with barium and gelatin solution. Three-dimensional micro-computerized tomography (Micro-CT) data sets were acquired to observe the morphological changes of bile duct and portal vein of the livers and whether there were communicated branches between the right and quadrate lobes in order to estimate the feasibility of the model.Results (1) The survival rate of rats after operation was 100%. No jaundice was observed. The ratio of liver/body weight in groups S, BL and PL was about 3.5%, significantly lower than that in group BPL (P<0.01). The ratio of quadrate/right lobe weight in groups S and BL was about 60%-70%, while that was about 20% in groups PL and BPL (P<0.05, or P<0.01); (2) Micro-CT images exhibited directly the morphological changes of the hepatic bile duct and portal vein, and no communicated branches or side circulation situation were observed between the two lobes.Conclusion No collateral branches were found between the two lobes and the model was successfully established. The barium casting liver specimen scanned by micro-CT provided a useful method for the morphological observation of rat liver Glissons system.     

医学图像三维可视化系统在精准肝切除中的应用价值

目的 探讨医学图像三维可视化系统(MI-3DVS)在精准肝切除中的指导作用.方法 2008年6月至2010年9月南方医科大学珠江医院利用自行研发的MI-3DVS在术前对45例肝癌患者肝脏的CT薄层图像数据进行三维重建.根据肝内门静脉和肝静脉走行划分肝段,确定肿瘤所在位置,测算切除的功能性肝脏体积并计算剩余肝脏体积百分比.术前评估可切除性,制订个体化的手术方案,然后进行仿真手术演练,指导临床手术.结果 45例肝癌患者根据肝内肝静脉和门静脉的走行分布分为7种类型:常见型21例,与Couinaud分段相同;未分型6例;肝右叶未分型11例;肝左叶未分型4例;肝右静脉型1例;肝中静脉双支型1例;右后下静脉型1例.39例患者行开腹肝癌切除术,平均剩余肝脏体积百分比为74%±17%,术后病理检查均为肝细胞癌;6例患者行TACE治疗.所有患者术后未发生急性肝功能衰竭、出血、胆汁漏等严重并发症.出院后随访6个月,患者无瘤或带瘤生存.结论 用MI-3DVS进行术前评估和指导临床手术,符合肝脏解剖与生理特点,对精准肝切除有重要的指导作用.

Abstract：

Objective To investigate the guiding significance of medical image three-dimensional visualization system (MI-3DVS) in precise hepatectomy. Methods The clinical data of 45 patients with hepatic neoplasms who were admitted to the Zhujiang Hospital from June 2008 to September 2010 were prospectively analyzed. The preoperative image data of the liver were three-dimensionally reconstructed by MI-3DVS. According to the distribution of the intrahepatic portal veins and hepatic veins, the liver was divided into different sections,and then tumors can be located within these hepatic segments. The volume percentage of residual liver and volume of liver resected were detected. Evaluation of surgical resectability and surgery simulation were done before operation. Results According to the distribution of the intrahepatic portal veins and hepatic veins, all patients were divided into seven types: 21 patients were with normal type which was the same as Couinaud type, six with nondivided type, 11 with non-divided right liver type, four with non-divided left liver type, one with right hepatic vein type, one with double middle hepatic vein type and one with right posterior vein type. Thirty-nine patients received open hepatectomy, and the volume percentage of the residual liver was 74% ± 17%. Postoperative pathological examination confirmed that all the 39 patients were with hepatocellular carcinoma. Six patients received transcatheter arterial chemoembolization. No severe complications such as acute hepatic failure, bleeding, bile leakage were detected. All patients were followed up for six months, and they survived with or without tumor. Conclusion MI-3DVS has guiding significance in preoperative assessment and perioperative guidance for precise hepatectomy.     

选择性断流术后门静脉压力梯度变化与上消化道再出血的关系

目的 分析选择性断流术后门静脉压力梯度(portal pressure gradient,PPG)的改变与门静脉高压症患者术后并发症及远期疗效的关系,探讨PPG在评价患者再出血中的作用.方法 收集135例行选择性断流术门静脉高压症患者的临床资料,测量切脾前与断流术后PPG的变化,并与其术后并发症及远期疗效作统计学分析.结果 本组135例门静脉高压症患者均接受断流手术治疗,术后死亡2例(1.5%).依据断流术后PPG＜12 mm Hg、PPG 12 mm Hg但与切脾前比较至少下降20%、PPG≥12 mm Hg但与切脾前比较下降＜20%将患者分为3组,分别为62例、41例和32例.3组术后并发症发生率之间相比差异无统计学意义(P＞0.05).3组1、2、3年累计未出血率分别为100%:100%:95%、100%:97%:90%、100%:93%:87%,3组之间相比差异均有统计学意义(x2=6.859,P=0.032).COX风险回归亦显示PPG是影响门静脉高压症患者术后上消化道出血复发的独立因素(P=0.002).3组1、2、3年累计生存率分别为100%:100%:94%、98%:95%:92%、97%:93%:88%,3组之间相比差异均无统计学意义(x2=2.917,P=0.233).结论 选择性断流术后PPG变化是门静脉高压症患者上消化道出血复发的一项预测指标,但不是生存率的一项预后指标.

Abstract：

Objective To investigate the relationship between the changes of portal pressure gradient after selective devascularization with postoperative complications and recurrent bleeding of gastroesophageal varix in patients of portal hypertension. Methods The clinical data of 135 cases of portal hypertension undergoing selective devascularization was collected. Portal pressure gradient was measured before splenectomy and after selective devascularization, and was analyzed against postoperative complications and recurrent bleeding. Results In this study, 135 patients of portal hypertension underwent selective devascularization, two cases died during perioperative period ( 1.5% ). Postoperatively patients were divided into three groups based on PPG ＜ 12 mm Hg after selective devascularization (62 cases), HVPG ≥ 12 mm Hg but a more than 20% of decrease off the pre-splenectomy baseline (41 cases) and HVPG ≥12 mm Hg with less than 20% of decrease from the baseline (32 cases). The postoperative complications between the three groups were of no significant difference ( P ＞ 0. 05 ). The 1,2,3 year cumulative rate of no variceal rebleeding of the three groups were 100% vs. 100% vs. 95%; 100%vs. 97% vs. 90%; and 100% vs. 93% vs. 87% (x2 =6. 859, P = 0. 032). COX regression analysis indicated portal vein pressure gradient was an independent prognostic factor of variceal bleeding recurrence (P=0.002). 1,2,3 year cumulative survival rates of the three groups were 100% vs. 100% vs. 94%; 98% vs. 95% vs. 92%; 97% vs. 93% vs. 88%, there were no significant difference among the three groups ( x2 = 2. 917, P = 0. 233 ). Conclusions The decrease in the PPG after selective devascularization is a predictor for the risk of rebleeding but not for survival after selective devascularization.     

结直肠癌肝转移与门静脉血K-ras基因突变的关系

目的 检测结直肠癌患者门静脉血液、原发癌组织及肝转移灶中K-ras基因突变,探讨K-ras突变与结直肠癌肝转移的关系.方法 采用实时荧光定量聚合酶链反应(PCR)技术和基因测序技术检测48例结直肠癌患者门静脉血液、原发肿瘤组织、相应的癌旁肠黏膜以及8例肝转移灶组织中K-ras基因突变.结果 48例结直肠癌组织中17例(35.4%)发现K-ras基因突变,48例癌旁黏膜中4例(8.3%)发现K-ras基因突变,明显低于癌组织的基因突变率(P＜0.05).48例结直肠癌患者中16例(33.3%)门静脉血中发现K-ras基因突变,与癌组织的基因突变率差异无统计学意义(P＞0.05).有肝转移患者门静脉血中K-ras基因突变率(7/10,70.0%)明显高于无肝转移者(9/38,23.7%,P＜0.05).16例门静脉血存在K-ras基因突变者,其相应的肿瘤组织中均发现K-ras突变.而结直肠癌组织中无K-ras基因突变者,患者门静脉血及癌旁黏膜无基因突变.8例同时性肝转移患者中5例门静脉血发现K-ras基因突变,且其相应的肝转移灶组织也发现相同的K-ras突变.2例异时性肝转移患者门静脉血检测到K-ras基因突变,手术时无肝转移,但分别于术后第6个月和第9个月经CT检查证实有肝转移.原发肿瘤组织K-ras基因突变类型与门静脉血、肝脏转移灶的K-ras基因突变一致,即K-ras基因12密码子GGT突变为GAT或GTT.结论 结直肠原发癌组织和患者门静脉血有K-ras基因的突变,预示着肿瘤可能有肝脏转移.

Abstract：

Objective To detect mutations of K-ras oncogene in portal vein blood of patients with colorectal cancer, and to find out the relationship between mutated K-ras oncogene and liver metastases in colorectal cancer. Methods Forty-eight patients with colorectal cancer were screened for the mutations of K-ras oncogene in tissue samples from their tumors, portal vein blood, proximally adjacent mucosa and 8metastatic liver biopsies by real-time fluorescence quantitative polymerase chain reaction (PCR) and DNA sequencing. The results were analyzed with their clinical data. Results Sixteen of the 48 patients with colorectal cancer had K-ras point mutations at codon 12 in their portal vein blood, and 17 of 48 patients had K-ras mutations in their primary tumors, but only 4 of 48 patients had K-ras mutations in proximally adjacent mucosa. There was no significant difference in rate of K-ras mutation between tumor tissues and portal vein blood (P ＞ 0. 05 ), but significant difference was found between the tumor tissue and the proximally adjacent mucosa ( P ＜0. 05 ). The rate of K-ras mutations in portal vein blood of colorectal cancer with liver metastases (70. 0% ) was higher than that of without liver metastases (23.7%). Sixteen cases of mutated K-ras in portal vein blood showed mutations in tumor tissues. Patients without mutated K-ras in tumor tissue had no mutations in their portal vein blood and proximally adjacent mucosa. In 5 of 8 patients with simultaneous liver metastasis, mutated K-ras oncogenes were detected in portal vein blood, and the type of K-ras mutation detected in the tumor tissue was accord with that in metastatic liver biopsies. Two patients with mutated K-ras detected in their portal vein blood had no liver metastases during perioperation, but liver metastases were diagnosed by CT at the postoperative month 6 and 9 respectively. The main types of K-ras mutations at codon 12 included GGT to GAT and GGT to GTT. No one had point mutation at codon 13. Conclusion Mutated K-ras detected in both cancer tissue and portal vein blood may indicate livermetastases from colorectal cancer.     

Liver transplantation for severe intrahepatic noncirrhotic portal hypertension.

Intrahepatic noncirrhotic portal hypertension can be idiopathic or associated with known toxic, developmental, vascular, or biliary tract diseases. Most patients are successfully managed medically or with shunting procedures. The goal of this study was to explore the reasons some patients require orthotopic liver transplantation (OLT). The clinical features, gross and microscopic liver explant pathology, and posttransplantation course in 16 patients who underwent OLT for intrahepatic noncirrhotic portal hypertension were studied. There were 11 men and 5 women with a mean age of 47 years. Clinical manifestations included gastrointestinal varices (n = 12), ascites (n = 8), encephalopathy (n = 3), and hepatopulmonary syndrome (n = 3). Cirrhosis was misdiagnosed clinically, radiographically and/or histologically in 13 patients (81%). Grossly, liver explants weighed a mean of 1,100 g, and 12 had a nodular appearance. Histologically, all 16 livers had portal tract vascular abnormalities, 15 had nodular regenerative hyperplasia (NRH), and 9 had incomplete septal cirrhosis. After OLT, mild NRH features were noted in 2 patients, and 1 of these patients developed evidence of portal hypertension. This study demonstrates that a subset of patients with intrahepatic noncirrhotic portal hypertension have severe symptoms requiring OLT. Accurate pre-OLT diagnosis is frequently difficult at advanced stages of the disease; 81% of our patients carried a diagnosis of cirrhosis. Morphologically, the explanted livers showed evidence of vascular abnormalities, NRH, and increased fibrosis, but not cirrhosis. Importantly, however, a diagnosis of cirrhosis is not required in this group of patients to qualify them for OLT, and these patients have good long-term graft function after OLT.     

Partial nodular transformation in a cirrhotic liver

We present a case of partial nodular transformation (PNT) of the liver in a 57-year-old man with a history of heavy drinking. On computed tomography, a low-density mass, measuring 3 cm in diameter, and associated with portal flow defect was visualized. Based on this finding and on the findings of other imaging studies, hepatic resection was performed because of suspected hepatocellular carcinoma. Pathology examination of the excised specimen showed small portal tracts in the lesion. The findings for the rest of the liver were suggestive of mild liver cirrhosis. While PNT is similar to nodular regenerative hyperplasia (NRH), in NRH there is diffuse nodular transformation of the whole liver, whereas in PNT only the area adjacent to the porta hepatis is affected. The portal flow defect in PNT may be the result of attenuation of the portal tracts in the lesion. This case is of interest because there was only one PNT lesion, rather than multiple lesions, and because it occurred in a cirrhotic liver, thus giving rise to the suspicion of hepatocellular carcinoma. PNT is a benign disorder, thus it is essential to establish a definitive diagnosis by imaging and ultrasound-guided histological biopsy to prevent unnecessary hepatic resection.     

肝脏局灶性结节性增生的诊疗分析

目的 分析探讨肝脏局灶性结节性增生的临床特点、发病机制、诊断和治疗方法。方法 回顾研究我科自1996年6月至2000年8月所收治8例肝脏局灶性结节性增生病例，分析病史、实验室检查、影像学检查及治疗效果。结果 本组8例病人均无自觉症状，肝功能、AFP正常，均行肝部分切除手术，病理诊断证实为肝脏局灶性结节性增生，术后转归良好。结论 肝脏局灶性结节性增生发病机制尚不清楚，联合应用多种影像学检查有助于明确诊断；对诊断不明确病例仍应手术探查。     

自身免疫性疾病相关的非肝硬化性门静脉高压症

目的 探讨自身免疫性疾病相关的非肝硬化性门静脉主症患者的临床、病理特点。方法 分析６例自免疫性疾病丁关的非肝硬化性门静脉高压症患者的资料。患者均为女性,无肝炎病史,其中５例发生上消化道出血,１例行硬化治疗,３例行手术治疗。４例患者获得了病理诊断。结果 ６例患者均维持稳定的肝功能,短期内随诊未再发生上消化道出血。病理检查邮到肝脏纤维间隔形成,主要表现为肝结节性再生性增生。结论自免疫性疾病相关的非肝硬     

肝脏局灶性结节增生的诊治

目的 总结对肝脏局灶性结节增生（focal nodular hyperplasis,FNH）的临床诊治经验,提高对FNH的认识。方法 回顾性分析我院外科2010年10月至2017年1月收治的22例FNH病人,术后病理均证实为FNH。结果 22例FNH病人中,男12例,女10例,男女比1.2∶1.0,平均年龄（32.50±8.38）（18~50）岁。3例病人因上腹痛至医院检查发现,1例因体检发现CA-724升高就诊,其余病人均无临床症状。术前影像学检查诊断为FNH者17例。所有病人均接受手术治疗,平均手术时间（142.72±54.81）（50~300） min,术中平均出血量（397.27±466.95）（50~1 700） mL,平均住院天数（7.90±2.86）（4~15） d,所有病人均无严重并发症,无围术期死亡病人,术后随访11~75个月均未见复发。结论 FNH是较少见的肝脏良性增生性病变,多无明显临床症状,中央瘢痕为其特征性表现,联合多种影像学检查对本病的诊断具有较大价值。对于有明显临床症状,与肝癌及肝腺瘤难以鉴别,合并肝炎肝硬化的病人应积极手术,其预后较好。     

Liver transplantation in precirrhotic biliary tract disease: Portal hypertension is frequently associated with nodular regenerative hyperplasia and obliterative portal venopathy

Chronic biliary tract disease is the third most common indication for orthotopic liver transplantation (OLT) in the United States. Most patients undergoing OLT for chronic biliary tract disease have end-stage liver disease associated with cirrhosis, but a minority are transplanted in the precirrhotic stage for indications that can include poor quality of life (eg, intractable pruritis or fatigue), recurrent ascending cholangitis, or cholangiocarcinoma. A smaller subset of these patients suffer from severe noncirrhotic portal hypertension that can be associated with histologic features of nodular regenerative hyperplasia (NRH) and/or obliterative portal venopathy. We reviewed 306 liver explants performed for chronic biliary tract disease at 2 institutions during 1995 to 2003 to identify patients who were transplanted in the precirrhotic stage. The following clinical data were recorded: age, sex, type of biliary tract disease, radiology, clinical symptoms, signs of portal hypertension, pretransplant shunting procedures, time between diagnosis and OLT, and primary indication for OLT. Histopathologic data included: explant weight, gross appearance, fibrosis stage (1 to 4), cholangitis, bile duct dysplasia, malignancy, portal vein thrombi, presence of NRH, and presence of obliterative portal venopathy. Twenty-six of 306 (8.5%) patients underwent OLT in the precirrhotic stage (12 females: 14 males, mean age of 46 y, age range 12 to 68 y). At explant, fibrosis stage ranged from 1 to 2 (portal and periportal fibrosis) to 3 (multiple bridging fibrosis). Underlying biliary tract disease included primary sclerosing cholangitis (18 cases), primary biliary cirrhosis (5 cases), autoimmune cholangitis (2 cases), and secondary sclerosing cholangitis (1 case). Primary indications for OLT were recurrent cholangitis and/or decreased quality of life (11 cases), complications of portal hypertension (6 cases), portal hypertension plus cholangitis/decreased quality of life (5 cases), and malignancy (4 cases). Of the 11 patients with portal hypertension as a major indication for transplant, 2 had undergone transjugular intrahepatic portal-systemic shunting and 3 others had portal vein thrombi. Histopathologically, NRH was prominent in 8 of these 11 patients (73%) and obliterative portal venopathy in 6 (55%). NRH was also present in 4 of the 15 (27%) patients who were transplanted for other indications. These results indicate that precirrhotic portal hypertension is a predominant or major contributing factor to OLT in a significant minority (11 of 306, 3.3%) of patients with chronic biliary tract disease. The occurrence of NRH in some patients transplanted for other indications suggests it is a histologic pattern that can precede the development of clinically significant portal hypertension.     

Laparoscopic resection of focal nodular hyperplasia

Focal nodular hyperplasia (FNH) is a benign liver lesion incidentally discovered with increasing frequency because of the proliferation of imaging studies. Radiographic characterization can diagnose this pathologic lesion and nonoperative therapy is the standard of care. However, if radiographic studies and fine needle biopsy are inconclusive, operative intervention may be required. Depending on the anatomic location of the lesion, biopsy and/or resection can be performed laparoscopically. A patient with biliary dyskinesia and focal nodular hyperplasia is presented. She underwent laparoscopic cholecystectomy with excision of the FNH. This paper reviews the case as well as the diagnosis and treatment of FNH.     

肝脏局灶性结节性增生的诊断与治疗

目的探讨肝局灶性结节性增生(focalnodularhyperplasia,FNH)的临床诊断与治疗。方法总结分析病理证实的42例FNH的临床病理、影像学、实验室检查及随访资料。结果42例病理确诊的FNH手术前检查包括AFP、肝功能等实验室检查。术前影像学的诊断准确性较低,对病灶的性质不能肯定的占50%以上。手术疗效确切,术后随访1年以上1例复发。结论肝脏局灶性结节性增生的诊断,依赖于临床与实验室和影像学检查,对诊断不明或不能排除肝癌者应手术治疗。     

肝脏局灶性结节性增生12例的诊断与治疗

目的 探讨肝脏局灶性结节性增生(focal nodular hyperplasia,FNH)的诊断与治疗.方法 回顾性分析我院2003年1月至2006年12月收治的12例肝脏局灶性结节性增生的临床资料.结果 3例患者有上腹不适症状(25%),ALT升高5例(41.67%),AST升高3例(25%),AFP升高2例(16.67%),1例患者HBsAg为阳性(8.33%).B超、CT和MRI对该病的确诊率分别为0、20%和25%,经统计学分析,CT和MRI对FNH的确诊率无显著性差异.11例经手术切除获得诊断,1例经肝穿刺活检证实为FNT.12例均康复出院并获随访,平均随访时间为28个月,无1例复发.结论 FNH的术前诊断率低,确诊主要依赖于术前或术中病理学检查.FNH大多预后良好,但对于术前诊断不明,特别是合并有肝炎或肝硬化病史的患者仍应手术治疗.