肝十二指肠韧带原发肿块诊治分析(附16例报道)

Diagnosis and Treatment on Primary Mass of The Hepatoduodenal Ligament:Report of 16 Cases

目的探讨肝十二指肠韧带(hepatoduodenal ligament,HDL)原发肿块的临床特点及其诊治方法。方法回顾性分析四川大学华西医院2004年9月至2013年5月期间收治的诊断为肝十二指肠韧带原发肿块的16例连续病例的临床资料。结果 HDL原发肿块的症状与血液检查结果均缺乏特异性。16例中14例进行了腹部超声检测,15例进行了腹部增强CT扫描,其中分别有3例(21.4%)和5例(33.3%)明确了肿块的位置及良恶性;联合超声和增强CT检查后,12例患者中有6例(50.0%)明确了肿块的位置及良恶性;再联合增强MRI检查后,10例(62.5%)明确了肿块的位置及良恶性。所有患者均进行了腹腔探查与肿块活检,其中11例(68.8%)行HDL肿块切除术,2例(12.5%)行单纯HDL肿块活检辅以胆道T管引流术;1例(6.2%)行HDL脓肿引流术,2例(12.5%)行单纯冰冻活检。患者均好转出院。结论 HDL原发肿块诊断困难,多种影像学检查的联合应用可提高无创诊断的准确性,手术及其他积极治疗能对其提供良好的预后。

Objective To investigate the clinical characteristics of primary mass of the hepatoduodenal ligament（HDL） and present some thoughts in the diagnosis and treatment of this disease. Methods Sixteen consecutive patients diagnosed as having a primary mass of the HDL in the West China Hospital of Sichuan University from September 2004 to May 2013 were retrospectively investigated. Results The symptoms and blood testing both lacked specificity. In this group， fourteen patients were examined by ultrasound and fifteen by contrast-enhanced computed tomography， with 3/14 （21.43%） and 5/15 （33.33%） respectively defining the location of the lesions and characteristic of benign/malignant. When combining the ultrasound and contrast-enhanced computed tomography， six of twelve （50.00%） defined the location and characteristic of benign/malignant. When combined with contrast-enhanced magnetic resonance， ten of sixteen （62.5%） defined the location and characteristic of benign/malignant. All cases underwent abdominal exploration， 11 cases（68.8%） were porformed mass resected， 2 cases （12.5%） were porformed the simple HDL mass biopsy combined with biliary drainage with T tube， 1 case （6.2%） was porformed drainage for abscess of HDL， and 2 cases （12.5%） were porformed simple frozen biopsy. All cases recovered and discharged. Conclusions The diagnosis of a primary mass of the HDL is difficult. The united usage of multiple imageological examinations can increase the accuracy rate of the noninvasive preoperative diagnosis. Surgery and other active treatment can produce good prognosis.