肝脏局灶结节性增生的诊断与外科治疗

Diagnosis and surgical treatment of hepatic focal nodular hyperplasia： a report of 63 cases

目的总结肝脏局灶结节性增生的诊断和外科治疗经验。方法回顾性分析63例经手术病理证实的肝脏局灶性结节患者临床资料。结果本病多见于中青年，31～50岁者50例（79．4％），男女之比2．94：1。本病起病隐匿，56例（89％）无明显临床症状，HBsAg阳性者3例（4．8％）。肝功能正常者58例（92．1％），5例（7．9％）总胆红素及rGT轻度升高，但AFP、CEA、CAl9-9均为阴性。肝脏局灶性结节的病灶多为单发（95．2％），肿瘤直径平均为4．5cm。病灶位于左肝叶25例、中肝叶6例、右肝叶29例、尾状叶3例。彩色超声检查：2例（3．2％）病灶中央有粗大的血管通过，血流丰富，高流速，低阻力。61例行CT动态扫描（96．8％），增强后早期均匀明显强化，其中6例出现中央星状瘢痕。59例行MRI检查（93．7％），早期明显增强、均匀，5例出现中央星状瘢痕T2WT高信号。本组63例患者均行手术治疗，其中局部切除34例；肝段或肝叶切除术16例；半肝切除术13例。本组无手术死亡，患者无严重并发症。结论FNH是一种肝脏良性病变，术前误诊率高达25．4％；提高对FNH的认识水平，结合临床及各种影像检查的资料，可明显提高诊断率。

Objective To summarize the diagnosis and surgical treatment of hepatic focal nodular hyperplasia （FNH）. Methods The clinical data of 63 patients with FNH proved by pathology were analyzed retrospectively. Results The disease mainly affected young to middle aged, 50 cases （79. 4% ） were of 31 - 50 years old. Male and female ratio was 2.94 ： 1. Fifty-six patients （89%） were asymptomatic, 3 cases were HBsAg positive （4.8%）. Liver function was basically normal （92. 1% ）, 5 cases （7.9%） were with elevated level of total bilirubin and rGT. AFP, CEA and CA19-9 was all negative. FNH occured as a single node in 95.2% cases, ranging from 1.5 cm to 17 cm in diameter （ average 4.5 cm）. Of these patients, 25 lesions were present in the left lobe, 29 in the right lobe, 6 in the mid lobe, and 3 in the caudate lobe. A big central artery was found in 2 cases （3.2%） as found by color Doppler ultrasound. CT scan showed transient immediate enhancement in 96. 8% （61/63） of patients, with central scar in 6 cases. MRI demonstrated early vigorous enhancement in 93.7% （59/63） of patients, with central scar in 5 cases. All patients underwent surgical resection： including local resection in 34 cases; segmentectomy or hepatectomy in 13 cases; hemihepatectomy in 15 cases. There was no postoperative mortality and major complications. Conclusions FNH is a kind of hepatic benign disease and characteristic of high preoperative misdiagnosis rate （25.4%）.