71例肝脏局灶结节性增生患者诊治分析

目的探讨肝脏局灶结节性增生(FNH)的临床特点、影像学表现及治疗策略。方法回顾性分析中国医学科学院肿瘤医院1997年至2012年病理诊断为肝脏局灶结节性增生的71例患者的诊断、治疗及预后等临床资料,结合文献复习讨论其临床特点和治疗策略。结果 71例患者中,男性43例,女性28例,年龄(13～53)岁,平均年龄37.0岁。71例患者中的33例(46.5%)有临床症状,主要表现为上腹不适、腹部肿物及乏力;40例(56.3%)患者病灶位于肝左叶,27例(38.0%)患者位于肝右叶,4例(5.7%)患者病灶累及肝左右叶;6例(8.5%)患者为多发病灶,病灶直径0.8～14.0cm,中位直径4.0cm。另外,71例患者中行术前超声检查61例,增强螺旋CT检查42例,MRI检查22例;术前超声诊断准确率仅为19.7%(12/61),增强螺旋CT诊断准确率61.9%(26/42),MRI诊断准确率77.3%(17/22)。71例患者均行手术治疗且无明显术后并发症。结论联合多种影像学检查有助于提高肝脏局灶结节性增生的诊断率,对于有临床症状、不排除恶性或病灶在短期内增大的患者应行手术治疗,包括腔镜下肝切除在内的外科治疗对于治疗FNH安全有效。

Retrospective analysis on diagnosis and treatment of 71 patients with focal nodular hyperplasia

Objective To analyze the clinicopathologic characteristics, imaging features and treatment strategies of patients with focal nodular hyperplasia of liver （FNH）.Methods The clinicopathologic characteristics, diagnosis, therapy and prognosis of 71 patients with FNH were retrospectively analyzed and the related literatures were reviewed. Results Among the 71 patients, 43 were male and 28 were female, with the average age of 37 years old （13-53 years old）. There were 33 cases had clinical manifestations including abdominal discomfort, abdominal mass and fatigue. The lesions of 40 patients lied in the left lobe of liver, 27 in right lobe and 4 in both. There were 6 cases with multiple foci. The median tumor diameter was 4.0 cm （0.8-14.0 cm）. The diagnostic accuracies of ultrasound, enhanced CT scan and enhanced MR scan were 19.7%, 61.9% and 77.3%, respectively. All the 71 patients underwent surgical operation and no obvious postoperative complications were observed. Conclusions Combination of various imaging methods is beneficial to the improvement of diagnosis of FNH. Sugical management should be offered to patients with clinical manifestations, ambiguous diagnosis or tumor growth. Surgical resections including laparoscopic liver resection are safe and effective for FNH patients.