肝细胞腺瘤47例的诊断与外科治疗

目的 总结肝细胞腺瘤(hepatocellular adenoma,HCA)的诊断与外科治疗经验.方法 回顾性分析1989-2009年收治的47例HCA患者的临床资料.结果 本组47例肝细胞腺瘤均为单发病变,术前确诊7例(14.9％),误诊为其他性质的肝占位病变40例(85.1％),最后诊断经术中快速冰冻病理切片或术后病理证实,术前误诊率高达85.1％,其中误诊肝癌11例,肝血管瘤10例,局灶性结节增生14例,肝占位性质待查5例.术前经B超、CT、MRI、DSA等影像检查,只能提示肝占位病变,最后确诊仍需手术探查和病理检查.本组47例HCA均无明确诱因,均采取手术治疗,分别行局部切除、肝段、肝叶或半肝切除术.为预防复发或恶变,切缘距瘤体边缘1.0cm以上.本组术后随访45例,随访率达95.7％,随访6年患者均存活,未见肿瘤复发.结论 HCA临床少见,术前误诊率高,手术切除是HCA惟一有效的治疗方法,预后良好.

Diagnosis and surgical treatment of hepatocellular adenoma

Objective To summarize our experience on the diagnosis and surgical treatment of hepatocellular adenoma (HCA).Methods Clinical data of 47 HCA cases managed from 1989 to 2009 were analyzed retrospectively. Results All were single lesions.Preoperative correct diagnosis was established in only 7 cases ( 14.9％ ).Tentative malignant space-occupying lesions was diagnosed in other 40 cases (85.1％),including hepatocellular carcinoma in 11 cases,liver hemangioma in 10 cases,liver focal nodular hyperplasia in 14 cases and miscellaneous in the remaining 5 cases.Local resection,segmental hepatectomy,hepatic lobectomy and hemiheptectomy were performed according to the size and location of the lesions.To prevent recurrence or malignant transformation,not less than 1.0 cm safe margin was allowed in all cases.Final diagnosis was made by fast frozen pathology or postoperative pathology.Postoperatively 45 cases were followed up to 6 years without recurrence.Conclusions Preoperative misdiagnosis of HCA is common.Surgical resection is the only effective treatment,and the prognosis of HCA is favorable.