肝细胞腺瘤的诊断与外科治疗经验

目的总结17例肝细胞腺瘤的诊断及外科治疗经验。方法采用回顾性分析的方法,对1990年1月-2010年12月收治的17例肝细胞腺瘤的临床特点、诊断与误诊情况、外科治疗及随诊情况进行分析总结。结果 17例肝细胞腺瘤仅占同期收治的1679例肝脏肿瘤的1.01%,术前误诊率100%,17例中5例(29.41%)合并肿瘤内出血,6例(35.29%)恶变。14例手术者全部获成功切除,手术成功率100%;另外3例选择肝穿刺活检者,确诊后放弃治疗并失访。14例手术切除者全部获得随访,其中8例良性病变者,仅1例术后3月因上消化道大出血及肝功能衰竭死亡,其余均未见复发;6例恶变患者,术后2年生存率100%,其远期效果还在观察随访中。结论肝细胞腺瘤极为少见,临床特征不明显,术前极易误诊,容易并发出血及恶变,建议手术切除。

Objective To summarize our experience on the diagnosis and surgical treatment of hepatocellular adenoma （HCA）. Methods 17 cases of HCA diagnosed from January 1990 to December 2010 were analyzed retrospectively, including clinical characteristic, diagnosis, surgery and follow-up. Results The percentage of patients with HCA was only 1.01% in patients diagnosed with hepatocellular tumor at the same time （17 in 1679）. Incorrect diagnosis before initiating operation was 100%. Internal haemorrhage appeared in 29.41% cases （5 in 17） and malignant transformation occurred in 35.29% cases （6 in 17）. 14 cases of HCA acquired complete resection, with the successful surgery rate about 100%. The other 3 cases chose to receive needle biopsy of liver. After diagnosis, these patients had no treatment and lost contact. All 14 cases were followed up. Only one case with benign tumor died 3 months later as a result of gastrointestinal haemorrhage and liver failure, the other 7 benign cases never recurred. The 2-year survival rate was 100% among 6 malignant transformed cases. Long-term effect of surgery to such patients still needs observation. Conclusion HCA is very rare. Preoperative misdiagnosis is common since clinical characteristic of HCA is not evident enough. Surgical resection is recommended to avoid haemorrhage and malignant transformation.