肝脏孤立性坏死结节的诊断与治疗：附76例报告

Diagnosis and treatment of solitary necrotic nodule of liver： a report of 76 cases

目的探讨肝脏孤立性坏死结节（SNN）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76例SNN病人的临床、病理、影像学资料及治疗效果。结果大多数SNN病人无明显症状，血清学检查正常。病理显示病灶内部为凝固性坏死，周边纤维组织包绕，并可见炎细胞浸润。大多数病灶超声为内部欠均匀的低回声结节，CT平扫为低密度，T1W、T2W为等或低信号，CT、MRI增强扫描后病灶无强化，少数病灶可见轻度延迟强化的包膜。手术切除疗效确切，术后随访无复发。结论肝脏孤立性坏死结节无特异性临床表现，CT、MRI增强扫描对SNN有较高的诊断价值；手术切除是SNN首选的治疗方法，但对诊断明确而瘤体较小者，可密切随访及定期观察。

Objective To study the diagnosis and proper treatment of solitary necrotic nodule （SNN） of the liver. Methods The clinical and pathological data, preoperative imaging findings and treatment outcome of 76 patients with liver SNN treated in our hospital in recent 3 years were retrospectively analyzed. Results Most of the patients were asymptomatic and the serum test was normal. Histopathologically, the liver SNN presented as coagulative necrotic nodules enveloped by fibrous capsule infiltrated with various inflammatory cells. Most of the lesions were inhomogeneous hypoechoic on US, low-density on CT and hypointense or isointense signal on both T1- and T2- weighted images related to parenchyma of the liver. On dynamic CT or MRI, most of the nodules demonstrated no enhancement after contrast injection. Thin delayed enhanced capsule could be seen in a few of lesions. The outcome was satisfactory with surgical resection. No recurrence was observed after the postoperative follow-up of 40 months. Conclusion The liver SNN has no specific clinical manifestations. Dynamic CT and MRI images are of great value in its diagnosis. Surgical resection is the optimal treatment for SNN. For proved SNN and that with a diameter less than 3 cm, close periodic follow-up can be done.