肝脏局灶性结节增生的诊断和治疗(附21例报告)

目的：探讨肝脏局灶性结节增生(focal nodular hyperplasia，FNH)的诊断和治疗经验。方法：回顾性分析两所医院1996年4月至2001年4月5年间收治并经病理证实的21例FNH的临床、影像学和病理学资料。结果：FNH术前正确诊断率较低(19．0％)，该病多见于中、青年(50岁以下占81．O％)，多无症状(57．1％)，多无乙型肝炎病毒感染(95．2％)，肝功能和AFP检查均正常(100％)；彩色多普勒检查发现80．0％(12／15)的病灶有血管通过，66．7％(10／15)的病灶血流丰富；CT动态扫描增强后60．0％(9／15)早期显著强化，60．0％(9／15)强化均匀；MRI检查强化后64．3％(9／14)早期明显强化，57．1％(8／14)信号均匀，35．7％(5／14)的病灶出现中央疤痕。本组行手术切除20例，1例未经任何治疗。结论：FNH在临床和影像学上均有一定特征，综合分析临床与多种影像学资料可提高正确诊断率。诊断FNH明确者不需外科治疗。

Diagnosis and Treatment of Hepatic Focal Nodular Hyperplasia (Report of 21 Cases)

Objective To explore the clinical features and sum up the laws of the hepatic focal nodular hyperplasia (FNH) in its diagnosis and treatment. Methods FNH was an uncommon benign hepatic tumor that often posed diagnostic dilemmas. We analyzed retrospectively the clinical, imaging of ultrasound, imaging of computed tomography (CT) and magnetic resonance images (MRI), and pathological materials of 21 patients with FNH proven by the pathological diagnosis during 5 years from April 1996 through April 2001 in two hospitals. Results The diagnosis of FNH remained a challenge for clinicians and surgeons. Rate of correct diagnosis of FNH was low preoperatively (19.0%). The lesions of FNH were seen in males and females (m/f: 14/7). Only three female patients (3/7) had the history of taking oral contraceptive. Patients with FNH were largely young and middle age persons (81.0% under 50 years), discovered by accident (57.1%), without infection of the hepatitis B virus (95.2%) and with normal liver functions (100%) and serum AFP levels (100%). Color Doppler ultrasound showed blood vessels passing through the lesion (80.0%) and there was abundant in blood (66.7%). CT scan showed that the lesion had transient immediate enhancement in 60.0% of patients and had homogeneous signal in 60.0% after bolus injection. MR imaging demonstrated early vigorous enhancement (64.3%), homogenous signal (57.1%) and having central scar (35.7%) in the lesion. The demonstration of a central scar in the lesion was very helpful for the diagnosis of FNH. MRI was more helpful for the diagnosis of FNH using liver specific contrast agents: superparamagnetic iron oxide(SPIO). All patients underwent focus resection (18 cases) or segmentectomy (2 cases), except one having no treatment. Conclusion FNH shows some typical clinical and imaging features. We could increase the rate of correct diagnosis by comprehensively analyzing the clinical and imaging materials. It is very important and necessary to determine a definite diagnosis of FNH, hepatic adenoma (HA) and primary liver cancer (PLC) preoperatively, because the HA and PLC must be surgically resected, FNH can only be followed up.