45例肝脏少见良性实性占位性病变的临床诊治分析

Analyzing diagnosis and treatment of 45 cases with rare benign hepatic tumor

目的探讨肝少见肝脏良性占位病变的临床特点,提高对肝脏少见良性占位性病变的认识及临床确诊率。方法回顾性分析45例肝脏少见良性占位性病变,结合患者的临床资料分析肝少见良性占位性病变治疗经验。结果 B超检查45例,腹部CT检查38例,MRI检查35例,其中B超检出率为42.2%,CT和MR检出率高于B超,分别为60.5%和65.7%,未能检出者均误诊为肝癌或仅诊断肝脏占位性质待定。伴随HBV、HCV及肝硬化17例均被误诊为原发性肝癌或占位性质待查,未检出率100%。45例患者中,3例经肝穿病检证实为局灶性结节增生行定期随访;其余42例均行手术治疗,术后经病理病检确诊,术后康复出院率100%。结论多种影像学检查可提高肝脏少见良性占位检出率,但确诊有赖于病理检查。并非少见良性占位性病变均需手术切除,但因确诊困难,如何避免不必要的手术是目前临床所面临的难题。

Analyzing diagnosis and treatment of rare benign hepatic tumor to enhance the final diagnosis. Methods Retro- spective analyzing the diagnosis and treatment of 45 cases with rare benign hepatic tumor in order to learn from the experience. Results The findings demonstrated that 45 cases were examined with abdominal B-Ultrasound and the accuracy rate of diagnosis was 42. 2% , 38 cases and 35 cases were examined with CT and MRI, and the accuracy rate of diagnosis were 60. 5% and 65.7% % respectively. The erroneous diagnosis cases were mistaken as primary carcinoma of the liver（PCL） or liver space-occupying lesions, while 17 cases with HBV ,HCV or liver cirrhosis were mistaken all as PCL, the mistaken rate was 100%. Among in 45 patients, 42 were accepted surgery therapy, and 3 patients with confirmed diagnosed of focal nodular hyperplasia with needle biopsy. 100% of patients treated with surgery therapy were recovered successfully in hospital. Conclusion Examination with B-Ultrasound, CT and MRI can enhance the finding diagnosis of rare benign hepatic tumor, but the confirmed diagnosis is depended on needle biopsy. Not all kind of benign tumors are needed surgery operation, while it is very difficult how to avoid unnecessary surgery therapy.