肝细胞腺瘤的临床诊治

目的 探讨肝细胞腺瘤的临床诊断和治疗.方法 回顾性分析30例经外科诊断、处理的肝细胞腺瘤病人的临床资料.结果 本组术前诊断与术后病理诊断相符合率为76.7%(23/30例).本组28例行手术切除,2例行射频消融治疗.无术后复发或恶变病例报告.结论 术前CT或MRI能明确大部分肝细胞腺瘤诊断,手术切除是有效、实用的治疗方...     

肝细胞腺瘤10例诊治分析

目的 探讨肝细胞腺瘤(HCA)的准确诊断及合理治疗方法.方法 对10例HCA病人进行回顾性分析并做文献综述.结果 多数HCA病人无明显症状,血清学检查正常.病理显示11个病灶中有2个存在局部恶变,3个存在不典型增生.多数病灶影像检查有特征性表现.手术切除疗效确切.结论 HCA无特异性的临床表现,影像检查对HCA有较高的诊断价值;怀疑HCA者不建议穿刺活检,积极的手术切除是较好选择.     

肝细胞腺瘤的诊治

目的 探讨肝细胞腺瘤(hepatocellular adenoma,HCA)的诊断和治疗经验.方法 回顾性分析我院1990年1月至2007年4月收治的18例HCA患者的临床、病理和影像学资料.结果 男女比例为11:7,1例女性患者有口服避孕药史.33%(6/18)的患者表现为右上腹不适或右上腹痛.CT和MRI增强扫描显示不规则出血或脂肪变性,多数病灶动脉期均匀强化,门脉期及延迟期造影剂退出.全部患者均经手术完整切除肿瘤.10例病灶内有出血表现,2例病理检查发现癌前病变.术后随访至2007年12月均存活无复发.结论 国内HCA多为自发性,且与口服避孕药无关,增强扫描有一定特异表现.手术完整切除肿瘤是首选的治疗方法,且预后良好.     

肝细胞腺瘤47例的诊断与外科治疗

目的 总结肝细胞腺瘤(hepatocellular adenoma,HCA)的诊断与外科治疗经验.方法 回顾性分析1989-2009年收治的47例HCA患者的临床资料.结果 本组47例肝细胞腺瘤均为单发病变,术前确诊7例(14.9％),误诊为其他性质的肝占位病变40例(85.1％),最后诊断经术中快速冰冻病理切片或术后病理证实,术前误诊率高达85.1％,其中误诊肝癌11例,肝血管瘤10例,局灶性结节增生14例,肝占位性质待查5例.术前经B超、CT、MRI、DSA等影像检查,只能提示肝占位病变,最后确诊仍需手术探查和病理检查.本组47例HCA均无明确诱因,均采取手术治疗,分别行局部切除、肝段、肝叶或半肝切除术.为预防复发或恶变,切缘距瘤体边缘1.0cm以上.本组术后随访45例,随访率达95.7％,随访6年患者均存活,未见肿瘤复发.结论 HCA临床少见,术前误诊率高,手术切除是HCA惟一有效的治疗方法,预后良好.     

肝细胞腺瘤11例

肝细胞腺瘤(hepatocellular adenoma,HCA)发病原因不十分清楚,尽管已有HCA发生恶变的报道[1],但HCA是否为肝细胞瘤(HCC)的癌前病变仍有不同看法.HCA发生机制不明,一般认为与长期口服避孕药、激素或类固醇药物以有与糖原贮积病、酪氨酸血症等疾病有关[2～4],国外已有HCA存在基因变异的研究报道[5,6].     

肝细胞腺瘤的诊治体会（附3例报告）

肝细胞腺瘤的诊治体会（附３例报告）浙江省湖州市第二人民医院外科（３１３０００）颜艾，张国雷，平金良肝细胞腺瘤（ＬＣＡ）罕见，发生率较低（１）。本院自１９９０年至１９９５年，手术切除并经病理证实的肝细胞腺瘤共３例，现报告如下：临床资料例１女性，２９岁。...     

肝腺瘤和肝腺瘤病的诊断与治疗

肝腺瘤和肝腺瘤病临床上并不多见，后者尤为罕见，诊治较复杂。肝腺瘤的年发病率为3／100万，年发病率在长期口服避孕药物的人群中比较高，约3-4／10万。[第一段]     

肝细胞腺瘤46例临床分析

肝细胞腺瘤是一种较罕见的肝脏良性肿瘤，正常人群发病率约为1／100万～4／10万。至1979年国外仅报道200余例。作者收集国内近30年来文献报道共46例。现综合报道如下。     

肝细胞腺瘤36例临床分析

目的 探讨肝细胞腺瘤(HCA)的准确诊断及合理治疗方法.方法 回顾性分析近3年来收治的36例HCA患者的临床、病理、影像学资料及治疗效果.结果 大多数HCA患者无明显症状,血清学检查正常.病理显示局部癌变1例,瘤内出血坏死19例,其中1例肿瘤破裂出血至腹腔.大多数病灶CT、MRI增强扫描后动脉期病灶均匀强化,门静脉、延迟期造影剂退出.手术切除疗效确切.结论 HCA无特异性临床表现,CT、MRI增强扫描对HCA有较高的诊断价值;因其可发生破裂出血及癌变,故对怀疑HCA者手术切除是首选的治疗方法.     

肝细胞腺瘤的临床诊治及文献复习

目的分析肝细胞腺瘤的临床特点及诊治经验。方法回顾性分析我院2000年1月至2012年12月外科切除并经病理诊断为肝细胞腺瘤的16例患者临床资料。结果肝细胞腺瘤一般无明显症状,邵分表现为右上腹隐痛不适等非特异性症状。1例合并乙肝,l例合并乙肝及丙肝,所有患者AFP均为阴性。术前诊断符合率为43．75％（7／16）。均接受手术治疗,随访10～160个月,l例术后130个月复发,再次手术后健康存活,其余患者均健康生存。结论肝细胞腺瘤好发于年轻女性,超重可能与发病有关,其临床表现多不典型,常规影像学方法确诊率较低,CT、MRI增强扫描有一定诊断价值。手术切除是肝细胞腺瘤主要的治疗方法。治疗后可复发,需定期复查。     

逆行肝脏部分切除术

目的为常规方法切除困难的肝脏肿瘤寻找一种新的切除径路。方法手术程序与常规肝切除术相反,即首先离断肝脏,然后分离肿瘤与膈肌间的粘连或切除受累膈肌,切断相应韧带,去除肿瘤。如周围脏器被肿瘤侵犯或有紧密粘连难以分离,则将受累部分器官连同肿瘤一起切除。结果１９９４年６月至１９９６年１月已用该法切除肝脏恶性肿瘤１１例,平均手术时间为１９２ｍｉｎ（１５０～２５０ｍｉｎ）,术中平均失血量１４６０ｍｌ（８００～４２００ｍｌ）,全组无手术死亡,术后均顺利恢复。结论逆行肝脏部分切除术是常规法切除困难肝脏肿瘤的一种良好切除径路     

肝脏孤立性坏死结节十例

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.     

肝细胞腺瘤的诊断和治疗

目的 探讨肝细胞腺瘤的诊断及治疗。方法 对4例肝细胞腺瘤病例进行回顾性分析并作文献综述。结果 我院1996-2001年共治4例经病理证实的肝细胞腺瘤病人，发病率占同期肝切除病人的0.13%，男：女为3：1，平均年龄为50岁，全部经手术治疗，术前确诊率为75%。结论 肝细胞腺瘤术前应联合行影像学检查以确诊，应首选手术治疗。     

Glycogenosis storage type I diseases and evolutive adenomatosis: an indication for liver transplantation

We report on two cases of type I glycogen storage disease (GSD) complicated by malignant tumors. A 23-year-old man had GSD Ia with adenomatosis. He underwent transplantation for rapidly growing and radiologically changing adenomata. At histological examination, one adenoma had become a hepatocellular carcinoma. A 22-year-old, HBV-infected woman had GSD type Ib with adenomatosis. At follow-up, several tumors showed changing morphological characteristics. Pre-transplant laparotomy confirmed the presence of a metastatic cholangiocarcinoma. Liver transplantation should be considered in GSD type I patients with adenomatosis, especially when tumor characteristics change. Regular detailed Doppler ultrasound and magnetic nuclear resonance screening during childhood and adolescence are, therefore, mandatory in order for the timing of transplantation to be optimized.     

Intrahepatic rupture of a caudate lobe adenoma in liver adenomatosis

Hepatic adenomatosis is a rare benign disease that is more common in young and middle-aged women who are non-steroid dependent; it is usually symptomatic, progressive, and susceptible to hemorrhagic complications. Malignant transformation within adenomas is rare. The management of hepatic adenomatosis remains difficult due to the absence of predictive signs of complications, other than the size of the adenomas. Resective surgery is usually indicated, but liver transplantation could be an indication in highly symptomatic or progressive forms of the disease and represents the treatment of choice in cases of malignant transformation. We report a case of intrahepatic rupture of a caudate lobe adenoma which occurred in an adolescent with hepatic adenomatosis; we also present a brief review of the literature.     

Glycogenosis storage type I diseases and evolutive adenomatosis: an indication for liver transplantation

We report on two cases of type I glycogen storage disease (GSD) complicated by malignant tumors. A 23-year-old man had GSD Ia with adenomatosis. He underwent transplantation for rapidly growing and radiologically changing adenomata. At histological examination, one adenoma had become a hepatocellular carcinoma. A 22-year-old, HBV-infected woman had GSD type Ib with adenomatosis. At follow-up, several tumors showed changing morphological characteristics. Pre-transplant laparotomy confirmed the presence of a metastatic cholangiocarcinoma. Liver transplantation should be considered in GSD type I patients with adenomatosis, especially when tumor characteristics change. Regular detailed Doppler ultrasound and magnetic nuclear resonance screening during childhood and adolescence are, therefore, mandatory in order for the timing of transplantation to be optimized.     

原发性肝癌的外科治疗5524例报告

目的探讨原发性肝癌的外科治疗效果。 方法1960年1月～1998年12月共施行原发性肝癌肝切除术5?524例。比较1960年～1977年(181例)、1978年～1989年(921例)、1990年～1998年(4?422例)3个阶段肝癌治疗的效果。结果3个阶段术后1个月内住院病死率分别为8.48%、0.43%和0.31%,而5年生存率分别为16.0%、30.6%和48.6%。结果表明,以常温下间歇肝门阻断,指捏加钳夹法切肝,大血管损伤的妥善处理和局部根治性肝切除为标志的肝脏外科技术,在肝癌外科技术中具有普遍的实用价值。结论早期肿瘤切除、部分具有适应证患者的术前肝动脉插管化疗栓塞、术中无瘤技术、术后综合治疗、以及肿瘤复发再切除可显著延长患者无瘤生存期,降低肝癌复发的危害性。二期切除可使中晚期肝癌患者重获手术切除机会,但并非适用于所有大肝癌,对肝癌的可切除性要有一个准确的判断。     

Hepatocellular adenoma in a male with familial adenomatous polyposis coli

Hepatocellular adenoma (HA) is a benign liver tumor most frequently occurring in young women using oral contraceptives. We report a rare case of HA in a 27-year-old male patient with familial adenomatous polyposis (FAP). The patient underwent a total colectomy and ileo-rectal anastomosis for FAP in 2003. A preoperative computed tomography scan of the abdomen disclosed a tumor in the left-lobe of the liver, 5.8 cm in diameter. Pathologic examination of a needle biopsy disclosed HA, but he had never used anabolic steroids or other known inducers of HA. The size of the liver mass gradually increased to 8.5 cm during a follow-up period of 38 months, and a left hepatectomy was performed in 2006. Pathology of the resected specimen confirmed the diagnosis of HA. Although FAP is known to be complicated with neoplasia in various extracolonic organs, only five reported cases of HA have developed in patients with FAP, including this case. This is the first report of HA to develop in a male FAP patient.