肝脏增生性瘤样病变72例临床分析

Surgical management of nodular hyperplasia tumor-like hepatic lesions： a study of 72 cases

目的 探讨肝脏增生性瘤样病变的诊断与治疗,提高对肝脏良性占位的诊断和治疗水平.方法 回顾性分析1987年1月至2010年12月收治的72例肝切除术后病理证实为增生性瘤样病变患者的临床资料.其中男性46例,女性26例,年龄15～72岁,中位年龄49岁.34例患者术前有上腹不适、乏力、发热等症状.本组72例患者均接受手术切除,共切除78个病灶.13例行肝叶切除术,19例行肝段切除术,1例行左半肝切除术,39例行肝不规则切除术.结果 72例患者中,术后病理为肝局灶性结节性增生47例,肝腺瘤样增生3例,肝不典型增生结节3例,肝炎性假瘤3例,肝肉芽肿4例,肝硬化结节3例,肝炎结节6例,肝再生结节1例,肝淋巴组织增生2例.术后随访6～96个月,无一例死于原发病,1例3年后复发,未予特殊处理.结论 对于合并症状、不能完全排除恶性或有恶变倾向的病变,如肝腺瘤样增生、不典型增生结节、肝硬化再生结节等应积极行手术治疗,其他良性病变如明确诊断可考虑保守治疗.

Objective To explore and improve the diagnosis and treatment of benign hyperplasia tumor-like hepatic lesion.Methods The clinical data of 72 patients who had undergone hepatic resection for benign non-cystic hepatic lesions between January 1987 and December 2010 were analyzed retrospectively.There were 46 male and 26 female patients.The median age was 49 years（ranging 15 to 72 years）,and diagnosis were confirmed by postoperative pathological examination.Thirty-four cases had symptoms,such as abdominal discomfort in right upper quadrant,fever,fatigue.All the cases had undergone hepatic resection; totally 78 lesions were removed.The surgical procedure including hepatic lobectomy for 13 cases,hepatic segmentectomy for 19 cases and non-anatomy resection for 39 cases.Results The finally diagnosis included focal nodular hyperplasia in 47 cases,adenomatous hyperplasia in 3 cases,hepatic dysplastic nodule in 3 cases,inflammatory pseudotumor in 3 cases,hepatic granuloma in 4 cases,nodular cirrhosis in 3 cases,hepatitis nodule in 6 cases,nodular regenerative hyperplasia in 1 case,lymphoid hyperplasia in 1 case.The postoperative complication rate was low（19.4%,14/72）.The followup period was 6 to 96 months.There was no mortality caused by lesion.One patient developed recurrence after 3 years.Conclusions It is suggested that symptomatic lesions,lesions when malignancy cannot be excluded,and lesions which have canceration tendency,just like adenomatous hyperplasia,dysplastic nodule,and nodular cirrhosis regenerative hyperplasia need surgical resection.Operation is not necessary for other nodular hyperplasia lesions if the diagnoses are identified.