肝脏局灶性结节性增生38例临床分析并文献复习

Clinical Analysis of 38 Cases of Hepatic Focal Nodular Hyperplasia and Literature Review

背景与目的:肝脏局灶性结节性增生(focalnodularhyperplasia,FNH)临床上较少见,其诊断标准和治疗方法争论较大。本研究拟探讨FNH的诊断原则和治疗方法。方法:回顾分析中山大学肿瘤防治中心1997年7月～2004年7月收治的38例FNH患者的临床资料并复习文献,对该病的发病特点、临床表现、诊断及治疗方法进行总结。所有患者随访至2004年7月。结果:38例FNH患者中,30例(78.9%)为40岁以下青壮年;26例(68.4%)无临床症状;32例(84.2%)肝功能正常,所有患者AFP均为阴性。B型超声诊断正确率5.3%(2/38),彩色超声诊断正确率45.5%(5/11),超声造影诊断正确率100%(2/2),螺旋CT增强双期扫描诊断正确率36.8%(14/38)。34例(89.5%)行手术切除病灶,1例行穿刺活检加经皮肝动脉栓塞术(transcatheterarterialembolisation,TAE),2例行穿刺活检加瘤内无水酒精注射术(percutaneousethanolinjection,PEI),1例仅行穿刺活检术。患者行切除术后均恢复良好,且无并发症。有2例FNH患者分别于切除术后69个月和32个月复查发现切除处新生病灶,经再次手术切除后病理证实为肝细胞癌。患者行TAE及PEI术后病灶均无明显改变。随访37例患者均生存,另1例患者行PEI术后1年因其他疾病死亡。结论:FNH患者发病隐匿,无明显临床症状,多种影像学联合检查对FNH的诊断及鉴别诊断具有较大价值。明确诊断的无症状FNH患者可密切随访暂不手术。未能确诊、有症状、病灶增大明显或伴有肝炎肝硬化者应考虑手术切除。FNH患者预后较好。

BACKGROUND ＆ OBJECTIVE： Focal nodular hyperplasia （FNH） is a rare benign hepatic tumor, and its diagnosis and treatment remain controversial. This study was to summarize the clinical features of FNH, and explore its diagnosis and treatment principles. METHODS： Clinical data of 38 FNH patients, treated in our hospital from Jul. 1997 to Jul. 2004, were studied retrospectively with literature review to summarize the clinical feature, diagnosis, and treatment of FNH. All the patients were followed up till Jul. 2004. RESULTS： Among the 38 patients, 30 （78.9%） were under 40 years old, 26 （68.4%） were asymptomatic, 32 （84.2%） had normal liver function, and alpha fetoprotein （AFP） was negative in all the patients. Correct diagnosis rates were 5.3% （2/38） for B ultrasonography, 45.5% （5/11 ） for color Doppler ultrasound, 100% （2/2） for contrast-enhanced ultrasound, and 36.8% （14/34） for double-phase helical CT scan. Of the 38 patients, 34 （89.5%） underwent hepatic resection without any complication, 1 underwent biopsy and transcatheter arterial embolization （TAE）, 2 underwent biopsy and percutaneous ethanol injection （PEI）, 1 only underwent biopsy. The size of lesions didn＇t change after TAE or PEI. HCC appeared in 2 patients with hepatitis 69 and 32 months after the resection of FNH lesions. At the end of follow-up, 37 patients were survival, and the other one died of other disease 1 year after PEI. CONCLUSIONS： The patients with FNH usually have no clinical symptoms with good prognosis. The combination of multiple imaging measures is of help to the diagnosis of FNH. We recommend close observation for patients with confirmed diagnosis of FNH and without clinical symptoms, and recommend surgical resection for those with equivocal diagnosis, symptoms, lesion enlargement, or accompanied with hepatitis or cirrhosis.