肝脏炎性假瘤的病因与诊治(附9例报告)

The Cause, Diagnosis and Treatment of Hepatic Inflammatory Pseudotumor (A Report of 9 Cases)

目的:提高对肝脏炎性假瘤的认识和诊断水平。方法:报告9例肝脏炎性假瘤的诊治情况,结合文献就其病因及诊治问题进行探讨。结果:本病术前诊断困难,易与原发性肝癌相混淆。本组误诊8例,只1例经肝穿确诊;手术治疗8例,行左外叶切除2例,右肝第V段切除1例,局部切除5例;保守治疗1例,均治愈,随访1~10年,无复发。结论:本病少见,病因尚不清楚,可能与细菌感染、免疫反应及真菌感染有关。BUS及CT检查是发现肝脏肿块的重要手段,但诊断需要依靠肝穿活检或术中及术后病理检查;治疗应以手术治疗为主,如已经病理确诊,可行保守治疗。

Objective: To improve the understanding and the diagnostic level of Inflammatory pseudotumor (IPL). Method: The clinical data of 9 cases IPL were retrospectively analyzed, the diagnosis and the treatment were discussed. Results: Only 1 patient was correctly diagnosed by liver biopsy as HIP and cured by non-operative management, while 8 were misdiagnosed, 2 cases were underwent lateral lobectomy;1 case was underwent right posterior lobectomy;5 cases were underwent partial hepatectomy respectively. All patients were cured without recurrence on following-up 1 - 10 years. Conclusion: Hepatic inflammatory pseudotumor is an uncommon disease, and its cause is still unclear. It may be associated with bacterial infection, immunoreaction, mycetic infection, etc. Although B-mode ultrasongraphy and CT are of great value in finding liver masses, the percutaneous liver biopsy or the pathological examination is always needed to confirm diagnosis and avoid unnecessary peration. Resection is the preferential treatment, except that those patients confirmed by pathology may be treated conservatively.