肝脏局灶性结节性增生的诊断与治疗

Diagnosis and treatment of hepatic focal nodular hyperplasia

目的：探讨肝脏局灶性结节性增生（FNH）的诊断及治疗方法。方法：对1999-01-2015-09病理学确诊的24例FNH的临床资料进行回顾性分析。结果：24例FNH均经腹部超声、CT或MRI影像学检查,无肝炎病史,血清AFP、CEA等肿瘤学指标阴性。单发病灶23例,2个病灶1例。男2例,女22例。平均年龄（35.3±5.7）岁。平均病灶直径（4.1±0.9）cm。术前肝活检病理学确诊10例。肝部分切除术10例;肝左外叶切除术2例;腹腔镜肝切除术2例;经皮射频消融（RFA）治疗6例;腹腔镜RFA治疗3例。1例随访观察13个月,病灶无明显变化;2例肝切除术后并发胸腔积液,术后随访1-54个月,病灶无复发。结论：本组FNH多见于育龄妇女,大部分FNH病灶具有特征性的CT及MRI表现,肝活检病理学检查是FNH最可靠的诊断手段。病理确诊的患者可随访观察,但外科切除仍然是FNH最可靠的治疗方法,腹腔镜手术、射频消融（RFA）治疗具有微创、术后恢复快、并发症少等优点。

Objective：To investigate the diagnostic and therapeutic methods of hepatic focal nodular hyperplasia（FNH）.Methods：The clinical data of 24 FNH patients diagnosed by pathology from January1999 to September 2015 were retrospectively analyzed.Results：Twenty-four FNH patients underwent abdominal ultrasound,CT or MRI examinations,without virus hepatitis,and the serum oncologic markers such as AFP and CEA were negative.The single lesion was found in 23 patients,and two lesions in one patient.The mean age was（35.3±5.7）years,and the mean lesion diameter was（4.1±0.9）cm.The FNH was verified in 10 patients by preoperative liver biopsy.The open partial hepatectomy was performed in 10 patients,open left external lobectomy of liver in 2,laparoscopic hepatectomy in 2,percutaneous radiofrequency ablation（RFA）therapy in 6,and laparoscopic RFA in 3.The lesion had no obvious change in one patient after follow-up of 13 months.The pleural effusion was found in 2patients after open hepatectomy.There was no recurrence in 23 patients during postoperative follow-up period（1to 54months）.Conclusion：The FNH may be found mainly in women of reproductive age,and the most FNH lesions are distinctive in CT and MRI.The pathology diagnosis for liver biopsy is the golden standard.The follow-up is feasible for FNH patients demonstrated by pathology,but the surgical resection is still the most effective treatment method for FNH lesions.The laparoscopic surgery and RFA therapy have the advantages of minimal invasion,fast postoperative recovery and fewer complications.