肝脏良性实质性占位病变的鉴别诊断及外科治疗

目的：提高肝脏良性实质性占位病变的鉴别诊断水平，减少因误诊导致的不必要手术及不当的手术方式。方法：回顾性分析本中心1984年5月-2000年2月间收治的36例，经手术及术后病理证实的肝脏良性实质占位病变患者的诊断过程及外科治疗方式。结果：炎性假瘤23例，局灶性脂肪变性4例，脂肪瘤、局灶性结节性增生各3例，结核球2例，错构瘤1例。瘤变直径0.9-20.0cm,平均3.9cm。36例患者除病变外肝脏均无硬 变表现，AFP均为阴性，2例HBV标记物阳性。患者均接受病变切除术，4例炎性假瘤患者因误诊为肝癌在病变切除术后安置皮下植入式注药装置。29例患者获得随访0.84-14.3年（平均5.9年），2例死于心肺疾患，1例错构瘤患儿术后1年死于肿瘤复发，26例患者无占位性病变复发。结论：AFP、HBV阴性、无肝硬变是肝脏良性实质占位病变与肝癌鉴别的重要依据，手术切除治疗肝脏良性实质占位病变有优良疗效。

DIFFERENTIAL DIAGNOSIS AND SURGICAL MANAGEMENT OF BENIGN SPACE-OCCUPYING LESIONS OF LIVER

Objective To improve the preoperative differentiation between benign and malignant hepatic disorders and lessen operative intervention because of a misdiagnosis.Methods A retrospective analysis was performed for the diagnosis and operative intervention for 36 cases with benign space occupying lesions of liver from May 1984 to Feb.2000 in our surgical center. Results There were 23 cases with inflammatory pseudotumor,4 focal fatty degeneration,3 focal nodular hyperplasia,3 lipoma,2 tuberculoma and 1 harmatoma.The diameter of the lesions ranged from 0.9 cm to 20.0 cm with an average of 3.9 cm.No liver cirrhosis occurred and serum AFP was negative in the 36 cases,while HBV marker was positive in 2 patients.We performed lesion resection for all the patients,but four patients with inflammatory pseudotumor underwent implantation of subcutaneous implantable drug delivery system because of a diagnosis of hepatocyte carcinoma.29 patients were followed up for 0.8 14.3 years(mean 5.9 yrs).Three patients died of cardiopulmonary diseases and recurrence of harmatoma respectively.26 patients survived without hepatic lesions recurrence.Conclusion The negativity of serum AFP and HBV marker and no liver cirrhosis is the characteristics of patients with benign space occupying lesions of liver to differentiate from hepatic malignancy.Focal lesion resectional therapy has good effects on patients with benign space occupying lesions of liver.