肝脏局灶性结节性增生的临床诊疗分析

Retrospective analysis on diagnosis and treatment of patients with focal nodular hyperplasia

目的:探讨肝脏局灶性结节性增生(focal nodular hyperplasia,FNH)患者的临床特点、影像和病理学特征及临床诊治。方法:回顾性分析复旦大学附属中山医院2006年6月至2014年7月期间进行手术切除252例FNH患者临床资料,并选取典型病例,从影像学、病理学等方面与其他肝脏良、恶性肿瘤进行对比和分析。结果:252例患者中,172例患者经彩超检查,拟诊断为FNH者111例,诊断符合率为64.53%;98例患者行超声造影检查,明确诊断为FNH者82例,诊断符合率为83.67%;45例患者行CT平扫加增强检查,明确诊断为FNH者31例,诊断符合率为68.9%;142例患者行MRI检查,明确诊断为FNH者110例,诊断符合率为77.5%。免疫组化标志物检查显示,CK7、CK19、CD34、GS在252例患者中阳性率分别为78.97%、71.03%、80.95%、38.89%,并呈特征性表达。结论:FNH在影像学上表现出特征性的中央瘢痕改变,可以结合患者的临床表现及病理表型,提高与其他肝脏肿瘤鉴别的准确性。在FNH的诊治过程中,增强MRI结合超声造影可以提高FNH的诊断准确率。对于临床症状明显、短期内病灶显著增大或出现病灶内出血、与肝腺瘤及肝细胞癌鉴别困难者,则需考虑手术切除。

Objective：To study the clinical features,imaging and pathological characteristics,as well as the clinical diagnosis and treatment of patients with hepatic focal nodular hyperplasia（FNH）.Methods：Retrospective analysis was used in observing the clinical data of the 252 cases of FNH patients experiencing the surgical removal in Zhongshan hospital affiliated to Fudan University during June 2006 to July 2006,among which the typical cases were selected for the comparison of imaging and pathologic features with benign and malignant tumor.Results：252cases of FNH patients were recruited,150 cases of male and 102 cases of female,the sex ratio of 1.47∶1,age from 15 to 71years old,average age 33.3±9.1.42 patients in this group manifested clinical symptoms,accounted for 16.7%,among them 28cases（11.1%）of patients with abdominal discomfort and 9cases（3.57%）patients with abdominal neoplasm.80 patients manifested abnormal liver function,mainly showing moderately elevated ALT and AST;99.2% of patients was classified as Child-Pugh A.The rate of 252 FNH patients showing AFP,HBsAg positive combined with hepatic cirrhosis were 0.40%,3.17%,and 1.59%,respectively.Among the252 patients,172cases had ultrasound diagnostic report showing a total of 111 patients diagnosed with FNH（coincidence rate：64.53%）;98cases had ultrasound contrast showing 82 patients with a clear diagnosis of FNH（coincidence rate：83.67%）;45cases had routine and enhancement CT showing 31 patients with a clear diagnosis of FNH（coincidence rate：68.9%）;142cases had MRI showing 110 patients with a clear diagnosis of FNH（coincidence rate：77.5%）.The positive rate of immunohistochemical markers CK7,CK19,CD34 and GS in 252 patients were 78.97%,71.03%,80.95%,38.89%,respectively,all manifesting characteristic expression.Conclusions：Combined with its clinical manifestation and pathological phenotypes,the characteristic of central scar changes of the FNH patients in imaging can improve the accuracy of differential rate with other hepatic tumor.In the process of diagnosis and treatment of FNH,enhanced MRI combining with contrastenhanced ultrasound can improve the diagnostic accuracy of FNH.For those with significant clinical symptoms,rapid progression in lesions,focal hemorrhage or difficulties to identified with hepatic adenoma and hepatocellular carcinoma（HCC）,surgical resection should be considered.