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目的总结肝脏局灶性结节性增生(focal nodular hyperplasia,FNH)的临床、病理表现及诊治方法,旨在提高诊治水平。方法回顾分析2005年6月-2011年6月,山西医科大学第三附属医院普外科经病理证实为FNH共27例的临床表现、辅助检查及诊治方法。结果共27例FNH患者,均为单发;男性17例,女性10例,平均年龄41.1岁;所有女性患者均无长期口服避孕药史。大多数FNH患者无明显症状,肝功能正常,所有患者AFP、CA19-9等肿瘤标志物在正常范围内。病灶直径2.2-11cm,其中20例病灶小于或等于5.0cm,术前确诊率为77.8%(21/27),3例经肝脏穿刺活检病理诊断为FNH;其中彩超63.0%(17/27),CT80%(16/20),MRI81.8%(9/11),CT与MRI联用4例。术前误诊为原发性肝细胞癌(hepatocellular carcinoma,HCC)4例(14.8%),误诊为肝细胞腺瘤(hepatocelllular adenoma,HCA)2例(7.4%)。开腹手术切除22例,腹腔镜下手术切除2例,3例经穿刺活检及影响学检查等确认后予以保守治疗。结论 FNH患者往往无临床症状,多数不需要手术治疗,但由于与HCC(hepatocellular carcinoma,HCC)、HCA等疾病难以鉴别,故合理检查提高疾病诊断率可减少过度治疗。
Objective To summarize the clinical and pathological features of focal nodular hyperplasia (FNH) in the liver and its diagnosis and treatment methods. Methods Retrospective analysis from June 2005 to June 2011, the Third Affiliated Hospital of Shanxi Medical University, Department of Surgery confirmed by FNH pathology of a total of 27 cases of clinical manifestations, laboratory examinations and diagnosis and treatment methods. Results A total of 27 cases of FNH patients were single; 17 males and 10 females, mean age 41.1 years; all women had no history of oral contraceptives. Most patients with FNH showed no obvious symptoms and had normal liver function. All the tumor markers such as AFP and CA19-9 were within the normal range. The diameter of the lesion was 2.2-11cm, of which 20 lesions were less than or equal to 5.0cm, the preoperative diagnosis rate was 77.8% (21/27), and 3 cases were diagnosed as FNH by liver biopsy. Among them, 63.0% (17/27) CT80% (16/20), MRI81.8% (9/11), CT and MRI combined 4 cases. Four cases (14.8%) of primary hepatocellular carcinoma (HCC) were misdiagnosed before operation, and 2 cases (7.4%) were misdiagnosed as hepatocellularlular adenoma (HCA). Open surgery in 22 cases, laparoscopic resection in 2 cases, 3 cases by puncture biopsy and impact study confirmed after conservative treatment. Conclusions Patients with FNH usually have no clinical symptoms. Most of them do not need surgery. However, due to the difficulty in differentiating patients with hepatocellular carcinoma (HCC) and HCA, reasonable examination to improve the diagnosis rate can reduce over-treatment.