肝脏局灶性结节增生的诊断和治疗

Diagnosis and treatment for focal nodular hyperplasia of the liver

目的 探讨肝脏局灶性结节增生（focal nodular hyperplasis,FNH）的临床诊断和治疗方法.方法 回顾性分析36例FNH患者的临床资料.所有患者均行血清学和影像学检查.对于诊断不明确、有明显临床症状者以及虽明确诊断FNH但病灶进行性增大者行相应的手术治疗.确诊为FNH无明显临床症状者随诊观察.结果 36例患者中男22例,女14例.29例患者无明显临床症状.33例患者肝功能正常,HBsAg阳性1例.所有患者肿瘤标志物均正常.术前B超检查均未明确诊断.术前CT检查10例,诊断FNH 4例.术前MRI检查12例,诊断FNH 7例.CT联合MRI检查14例,诊断FNH 10例.手术切除30例,B超引导下经皮射频消融治疗2例,术后随访14 ～ 72个月无复发.4例患者保守治疗,定期影像学观察,随访3 ～ 22个月,病灶无明显增大. 结论 FNH临床表现无特异性.联合CT和MRI检查有助于明确诊断.对于诊断不明确、有明显临床症状者需手术治疗,射频消融是一种疗效肯定的微创治疗方法.FNH预后良好.

Objective To investigate the diagnosis and management of focal nodular hyperplasis （FNH）.Methods Clinical data of 36 FNH patients who were admitted to the Peking University People＇s Hospital from February 2009 to August 2015 were retrospectively analyzed.All the patients received serological and imaging examinations.Appropriate surgical treatment was done on symptomatic patients and those in which diagnosis was established but lesions progressly enlarged.Conservative treatment was done on FNH confirmed patients without symptoms.Results Of the 36 patients,22 were male and 14 were female.29 patients had no obvious clinical symptoms.The liver function was normal in 33 patients,HBsAg positive in 1 case.Serum tumor markers were normal in all patients.B ultrasound made no identification of FNH in all patients.CT was done in 10 cases,and FNH was suggested in 4 cases.MRI done on 12 cases and the diagnosis of FNH was made in 7 cases.Combination CT and MRI performed in 14 cases made definite FNH diagnosis in 10 cases.Surgical resection was performed in 30 cases,and 2 cases were treated with percutaneous radiofrequency ablation.No recurrence was found during a follow up of 14-72 months.4patients treated conservatively were imaging followed-up for 3-22 months without tumor development.Conclusion The clinical manifestations of FNH are atypical and unobvious.Combined CT and MRI examinations can help establish the diagnosis of FNH.Resection or ablation was suggested on patients in which malignancy can not be excluded.