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目的探讨肝脏局灶性结节性增生的诊治经验。方法回顾性分析31例FNH患者的临床表现、影像学检查、诊断及治疗方法等临床资料。结果全组31例中25例(80.6%)为40岁以下青壮年,23例(74.2%,23/31)无明显症状,HbsAg阳性1例,肝功能,AFP,CA19-9等肿瘤标记物均在正常范围内。单发肿瘤27例,4例为2个病灶。病灶多位于Ⅳ,Ⅴ,Ⅷ肝段。病灶大小0.5～15.0 cm。FNH术前诊断符合率分别为:彩超3.2%(1//31),CT 32.1%(9/28),MRI 20.0%(2/10),肝动脉造影0(0/3)。术前诊断正确3例(9.7%),误诊为肝癌13例(41.9%),肝腺瘤4例(12.9%),肝血管瘤2例(6.5%),诊断不明9例(29.0%)。手术切除29例,2例经皮穿刺活检及影像学检查等确诊后予保守治疗。随访时间8个月至6.5年,29例术后均无复发。未手术2例,随访时间18～53个月,均健在,肿块大小无明显变化。结论 FNH患者往往无临床症状,对影像学检查结果进行综合分析,是提高FNH正确诊断率的有效方法。怀疑FNH者,可经皮穿刺活检协助诊断,对于诊断明确、无症状的FNH,可定期观察,无需治疗。[中国普通外科杂志,2011,20(1):71-74]
Objective To investigate the diagnosis and treatment of focal nodular hyperplasia in liver. Methods A retrospective analysis of 31 cases of FNH patients with clinical manifestations, imaging studies, diagnosis and treatment of clinical data. Results Twenty-five of the 31 patients (80.6%) were young adults under 40 years of age. Twenty-three patients (74.2%, 23/31) had no obvious symptoms, one was HbsAg positive, one was liver function, AFP, CA19-9 and other tumor markers All within the normal range. 27 cases of single tumor, 4 cases of 2 lesions. More lesions in Ⅳ, Ⅴ, Ⅷ liver segment. Lesion size 0.5 ~ 15.0 cm. The coincidence rates of preoperative diagnosis of FNH were 3.2% (1 // 31), CT 32.1% (9/28), 20.0% (2/10) of MRI and 0 (0/3) of hepatic arteriography respectively. 13 cases (41.9%) were misdiagnosed as liver cancer, 4 cases (12.9%) had hepatic adenoma, 2 cases (6.5%) had hepatic hemangioma, and 9 cases (29.0%) had unidentified diagnosis. Surgical resection in 29 cases, 2 cases of percutaneous biopsy and imaging studies confirmed the conservative treatment. Follow-up time of 8 months to 6.5 years, 29 patients had no recurrence. No surgery in 2 cases, followed up for 18 to 53 months, are healthy, no significant change in the size of the tumor. Conclusion FNH patients often have no clinical symptoms, and the comprehensive analysis of imaging findings is an effective way to improve the correct diagnosis of FNH. Suspected FNH who can be assisted by biopsy biopsy diagnosis, diagnosis of clear, asymptomatic FNH can be observed regularly, without treatment. [Chinese Journal of General Surgery, 2011,20 (1): 71-74]