肝细胞腺瘤外科治疗临床分析

目的 分析肝细胞腺瘤(hepatocellular adenoma,HCA)的诊断与外科治疗方法。方法 回顾性分析2008年11月至2020年8月7例HCA患者的临床资料。结果 7例均为体检发现,男4例,女3例;年龄27~59岁。3例患者体质量指数(BMI)>24 kg/m2,4例在正常范围。7例均为单发病变,术前准确诊断HCA2例(28.6%)。所有患者均行手术治疗,其中6例行腹腔镜下肝切除术,1例行剖腹肝切除术,术后病理检查证实为HCA。结论 HCA术前诊断困难,多无明显临床表现,大多为体检时发现,对于包膜完整、单一病灶、无肝硬化及肿瘤消耗表现,且AFP正常,CT动脉期均为明显强化;门静脉期持续强化或MRI早期不均匀强化的患者应高度怀疑HCA可能。HCA手术治疗安全有效,术后应重视定期随访与复查。

Objective To summarize the experience in the diagnosis and surgical treatment of hepatocellular adenoma(HCA).Methods A retrospective analysis was conducted on the clinical data of 7 patients with HCA who underwent surgical treatment at the Hepatobiliary Pancreatic Surgery Department of Zhejiang Provincial People's Hospital and the Tongde Hospital of Zhejiang Province from November 2008 to August 2020.Results all 7 patients were found by physical examination,with 4 males and 3 females.Age ranged from 27 to 59 years.Three patients had a body mass index(BMI)greater than 24,and 4 patients were within the normal range.All 7 cases were single lesions,and 2 cases of HCA were correctly diagnosed before surgery,accounting for only 28.6%.All patients underwent surgical treatment,with 6 undergoing laparoscopic hepatectomy and 1 undergoing open hepatectomy.Postoperative pathology confirmed HCA.Conclusion The preoperative diagnosis of HCA is difficult,and there are often no obvious clinical manifestations.Most of the time,physical examinations have found that for a single lesion with intact capsule,there are no signs of cirrhosis or tumor depletion,and AFP is normal.CT arterial phase shows significant enhancement.Patients with continuous enhancement in the portal vein phase or uneven enhancement in early MRI should be highly suspicious.Surgical treatment is safe and effective,Regular follow-up and re examination should be emphasized after surgery.