少见类型肝脏良性占位性病变的诊断及治疗

Diagnosis and treatment of rare types of hepatic benign space occupying lesions

目的总结少见类型肝脏良性占位性病变的诊治经验。方法回顾分析2009年1月至2018年12月经手术治疗及病理证实的113例原发于肝脏的少见类型良性占位性病变患者的临床资料。结果113例患者中男51例,女62例。年龄12~83岁,平均44.3岁。91.2%为单发病灶,8.8%为多发病灶。手术方法包括肝脏部分切除98例,肝脏消融12例,肝脏部分切除联合消融3例。术后病理共21种类型,占比最大的5种类型为局灶性结节性增生30例、肝细胞腺瘤16例、异型增生结节14例、血管周上皮样细胞肿瘤12例、黏液性囊性肿瘤11例,共占据了73.5%。术后随访6~120月均健在。结论少见类型肝脏良性占位性病变术前不易确诊。术前磁共振检查有一定帮助。对于未有恶变报道的类型,可以考虑保守治疗或随访观察,交界性或难以明确诊断者应积极手术切除。

Objective To summarize the experience of diagnosis and treatment of rare type of hepatic benign space occupying lesions.Methods The clinical data of 113 patients with rare type of hepatic benign space occupying lesions confirmed by surgery and pathology from Jan 2009 to Dec 2018 were retrospectively analyzed.Results There were 51 males and 62 females,age ranging from 12 to 83 years,with an average of 44.3 years.91.2%of the 113 cases were single lesions and 8.8%were multiple lesions.Surgical methods included hepatectomy in 98 cases,ablation therapy in 12 cases and hepatectomy combined with ablation in 3 cases.There were 21 types of pathology in 113 patients.The top five types were focal nodular hyperplasia(30 cases),hepatocellular adenoma(16 cases),dysplasia nodules(14 cases),perivascular epithelioid cell tumors(12 cases),and mucinous cystic neoplasms(11 cases),accounting for 73.5%cases.All the patients were alive in the follow-up period ranging from 6 to 120 months.Conclusion Preoperative diagnosis of rare benign space-occupying lesions of the liver is very difficult.Preoperative MRI is helpful for diagnosis.Conservative treatment or follow-up observation can be considered for the type malignancy have never been reported.For the borderline types or those with difficulty in definite diagnosis,surgical removal is recommended.