巨大肝脏局灶性结节增生的手术切除

目的 探讨巨大肝脏局灶性结节增生(FNH)手术切除的可行性和安全性.方法 分析1996-2007年第二军医大学东方肝胆外科医院收治的巨大FNH29例,病变平均直径12.5 cm(10～26 cm),向肝外突出者26例,压迫肝外器官者10例,紧靠或压迫第一、第二、第三肝门者19例.结果 所有病例均手术切除,无手术病死,术中平均出血量747 ml(100～4000 ml),27例施行第一肝门阻断,平均阻断时间26 min(13～78 min).19例累及肝门者.术中平均出血量1011 ml,平均肝门阻断时间30 min,7例肝创面未对拢缝合;发生术中大出血(出血量>1000 ml)7例,术后肝创面胆瘘1例.随访27例,平均时间46个月(4～132个月),未发现病变复发.存活时间最长1例已达11年.结论 肝切除是治疗巨大FNH安全、可行的方法.对于累及肝门者,只要辨清病变与肝内管道的关系、紧贴病变进行切除,并注意肝创面处理,可以减少手术并发症的发生.

Hepatectomy for huge focal nodular hyperplasia of the liver

Objective To evaluate the safety and feasibility of hepatectomy for huge focal nodu-lar hyperplasia of the liver. Methods The clinical data of 29 cases of huge FNH of the liver with an average diameter of 12.5 cm (10-26 cm) who were admitted to our hospital from 1996 to 2007 were retrospectively analyzed. Lesions protruded from the liver in 26 cases, compressed extrahepatic organs in 10 and adjoined or compressed hepatic hila in 19. Results All the lesions were successfully resected without operative death. The mean intraopreative blood loss was 747 ml (100-4000 ml). The first he-patic portal blocking was performed in 27 cases and the mean blocking time was 26 min (13-78 min).Among 19 cases of huge FNH involving hepatic hila, the mean intraopreative blood loss was 1011 ml,the mean blocking time 30 min and the liver cross-section was not completely sutured in 7 of these ca-ses. The intraoperative hemorrhea occurred in 7 and postoperative biliary fistula in 1. Twenty-seven cases were followed up for a median of 46 months (4-132 months) with no recurrence and the longest survival time had reached to 11 years. Conclusion Hepatectomy is a safe and feasible means for huge focal nodular hyperplasia of the liver. For those involving hepatic hila, distinguishing between the le-sion and intrahepatic vessels, performing resection closely around the lesion and dealing with the liver cross-section properly may be helpful to reduce the surgical complications.