小儿肝脏巨大良性肿瘤及肿瘤样病变  

HEPATIC BENIGN TUMOR AND TUMOR-LIKE LESIONS IN THE CHILDREN

作　　者：李白莉[1] 孙晓毅[1] 余东海[1] 陈孝平[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院外科,武汉430030

出　　处：《肝胆外科杂志》2009年第3期175-179,共5页Journal of Hepatobiliary Surgery

摘　　要：目的小儿肝脏良性肿瘤及肿瘤样病变的诊断、鉴别诊断和治疗具有较多困难。本文总结小儿肝脏良性肿瘤的临床特点和手术治疗经验。方法五年间手术切除12例肝脏良性肿瘤和瘤样病变,其中男性6例,女性6例,平均年龄6.4岁,肿瘤类型:婴儿性血管内皮瘤3例;肝结节性增生、肝囊肿和肝错构瘤各2例;炎性假瘤、炎性肌纤维母细胞瘤和淋巴管瘤各1例。术前均行各项常规检验以及B超、CT和/或MRI影像学检查。结果所有病例术前HBsAg为阴性,3例AFP轻度增高(<200ng/L),血红蛋白和白蛋白化验值显著高于同期的恶性肿瘤组(123.82±12.4对102±16.74和39.36±9.68对32.63±4.84,P<0.05)。术前影像学检查中10例肝良性肿瘤(83%)未能明确肿块性质,6例(50%)初步诊断为肝母细胞瘤或肝细胞癌等。本组肿瘤平均直径11.09±2.98cm(8～16cm),全部12例用肝肿瘤切除术治疗,其中左叶切除1例、左外叶切除3例、右叶或右叶肝段5例,瘤体切除术3例,无并发症和手术死亡。随访6个月～7年,全部健康存活,无复发。结论肝脏良性肿瘤和瘤样病变具有病理分类繁多、每种病变在临床上少见和罕见的特点;常以肝占位变出现,但缺乏特征性症状和体征,影像学资料非常难与恶性肿瘤相鉴别,即使肿瘤巨大,全身一般情况也良好。在充分的术前准备和良好的手术技巧的条件下,小儿肝脏良性肿瘤手术切除成功率非常高,预后良好。Objective To summarize the experience in diagnosis and treatment of hepatic benign tumor and tumor-like lesions in the children. Methods Twelve patients with benign hepatic tumor ortumor-like lesions underwent hepatectomy from January 2002 to June 2007. Of these cases, male 6, female 6, with an average age of 6.4 years. The cases of each pathologic tapes were ： infantile hemangioendothelioma （IHE） 3, mesenchymal hamartoma （MHL） 2, hepatic cyst（HC） 2, inflammatory pseudotumor（ IPT）2, focal nodular hyperplasia（FNH） 2, inflammatory myofibroblastic tumor（IMT） 1, and Lymphangioma （LL）1. All examinations of laboratory and image, including B-ultrasonic,CT and MRI, were done. Results HbsAg was negative in all patients, AFP enhanced lightly but less then 200ng/L in 3 petients, the values of hemoglobin and albumin of blood in BHT group were significantly more then that in malignent hepatic tumor group（ n = 19） of the same term, （ 123.82± 12. 4 vs 102 ± 16. 74 and 39. 36 ±9.68 vs 32. 63±4. 84,P 〈0. 05） ; In imagine examinations, the being quality of tumors could not be confirmed in 10 （83%） and tumors were diagnosed as hepatoblastoma or hepatic cellular carcinoma in 6 （50%）. The average diamester of tumers is 11.09 ±2. 98 cm（8 - 17 cm）. The hepatectomy were performed for all patients. Occluding of selective or total blood flow were applied in all patients before hepatectomy. Operative procedures included 9 hepatic segmentectomies or hepatic lobectomies and 3 local resections of the lesion. No operative mortality and no serious morbidity were happened. All patients survived heathly and no re- currenced during follow-up period from 6 moths to 7 years. Conclusion Hepatic benign tumor and tumor-like lesions in the children have various pathological types, but lack specific symptoms and signs and hard to distinguish them from hepatic malignant tumor in imaging studies; Even with a grant tumor, patient had usually a good condition. Under the condition of enough preoperation

关 键 词：肝脏 良性肿瘤 瘤样病变肝切除术 

分 类 号：R735.7[医药卫生—肿瘤]