肝脏罕少见实性占位病变的诊断和治疗(附38例病例报告).docVIP

肝脏罕少见实性占位病变的诊断和治疗(附38例病例报告) 　　作者：秦颖,倪勇,王成友,王成林　　作者单位：吴阶平医学基金会临床科研资助项目(编号 2005-86-F) 518035 深圳市第二人民医院肝胆外科(秦颖、倪勇、王成友); 518036 北京大学深圳医院影像中心(王成林) 　　【摘要】 目的 探讨肝脏罕少见实性占位病变的诊断和治疗经验。 方法 回顾性分析38例经手术病理确诊的肝脏罕少见实性占位病变病例资料。 结果 38例患者中有肝局灶结节性增生(FNH)18例，肝原发性肉瘤8例，肝炎性假瘤(IPL)5例，肝结核瘤2例，肝上皮样血管平滑肌脂肪瘤(EAML)1例，肝细胞腺瘤(HA)3例，肝淋巴管瘤1例。38例患者均获手术探查并随诊。有2例肝肉瘤未能手术切除， 36例行手术切除，术后恢复良好，其中30例肝脏良性占位随诊无复发。 结论 肝脏罕少见实性占位术前容易误诊。结合临床及各种影像学检查资料可提高肝脏罕少见实性占位的诊断率。超声造影和细针穿刺细胞学检查在肝脏罕少见实性占位的诊断中有重要意义。大多数肝脏罕少见实性占位应积极手术治疗。 　　【关键词】 肝占位;诊断;治疗;影像学;穿刺活检 　　Diagnosis and treatment of the rare tumor-like lesions of liver　　Qin Ying, Ni Yong, Wang Chengyou, et al　　Depatrment of Hepatobiliary Surgery,Shenzhen Second Peoples Hospital,Guangdong 518035,China.　　[Abstract] Objective To explore the diagnosis and treatment of the rare tumor-like lesions of liver. Methods The clinical data of 38 patients with the rare tumor-like lesions of liver proved by the pathology were analyzed retrospectively. Results 18 of 38 cases were focal nodular hyperplasia(FNH),8 were primary hepatosarcoma,5 were inflammatory pseudotumor of the liver(IPL),2 were liver tuberculoma,1 was epithelioid angiomyolipoma(EAML)，3 were hepatocellular adenoma(HA) and 1 was lymphangioma of liver. All of 38 patients were treated with surgical operation and followed up.2 hepatosarcoma cases did not recieve complete resection.36 cases underwent operation with an uneventful recovery.30 cases of benign liver space occupying lesions did not recur at follow-up. Conclusion Rare hepatic lesions are easily misdiagnosed . We could improve the correct diagnosis rate by comprehensively analyzing the clinical and imaging materials. Contrast enhanced ultrasonography and US-guided aspiration biopsy are very useful for the diagnose of rare tumor-like lesions of liver.Surgical resection is the rational choice to most rare tumor-like lesions of liver. 　　[Key words] Liver lesions; Diagnosis; Treatment;Images;aspiration biopsy 　　影像学技术的发展提高了肝脏罕少见实性占位病变的发现率，但也暴露了临床上对其定性和鉴