肝细胞腺瘤和肝腺瘤病11例诊治分析  

Hepatoceilular adenoma and liver adenomatosis., a report of 11 patients

作　　者：刘立国[1] 吴凡[1] 吴健雄[1] 王黎明[1] 荣维淇[1] 钟宇新[1] 徐泉[1] 王一澎[1] 苗成利[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院肿瘤研究所腹部外科,100021

出　　处：《中华肝胆外科杂志》2012年第3期166-168,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨肝细胞腺瘤（hepatocellularadenoma，HCA）及肝腺瘤病（1iveradenomato—sis，LA）的临床表现、治疗方法和预后。方法回顾性分析经手术治疗的10例HCA及1例I．A患者的临床资料。结果本组女性发病居多，共7例、（63．6％），1例女性肝腺瘤病患者有口服避孕药病史。全组中位发病年龄33（范围25～70）岁。多数无临床症状（72．7％）。肿瘤标记物CAl9—9和甲胎蛋白（AFP）正常。超声造影、CT及磁共振（MRI）增强扫描多提示病灶动脉期强化，门脉期、延迟期去强化。组织病理提示10例为单发病灶，诊断FICA，其中1例肿瘤细胞轻度异型及不典型增生，1例存在细胞不典型增生，1例细胞生长活跃；另外1例为多发病灶，细胞存在异型，诊断肝腺瘤病。11例患者均经手术切除，经随访21～125个月，无复发。结论HCA患者多无明显临床表现，肝脂肪变性可能为HCA和LA的共同病因，口服避孕药物可能为LA的病因。动态影像学检查有助于诊断，HCA有病灶破裂出血及癌变危险，首选手术治疗，预后良好。Objective To review the clinical features, therapeutic approach and prognosis of hepatocellular adenoma （HCA） and liver adenomatosis （LA）. Methods The clinical data from pa- tients with histopathological diagnosis confirmed on operative specimens were analyzed retrospectively. Results There were 10 patients with HCA and 1 with LA. The disease was found mainly in females （n=7, 63.6%）, and only one female patient with LA had a history of use of oral contraceptive. The median age at presentation was 33 years （range, 25--70 years）. Most patients （n=8, 72.7%） had no significant symptom. Tumor markers including CA19-9 and alpha-fetoprotein （AFP） were normal. On dynamic uhrasonography, CT and MRI, most lesions showed contrast enhancement in the arterial phase and washout in the portal venous phase and delayed phase. For the 10 patients with HCA, the lesion was solitary. On histopathology, atypia and dysplasia were present in 1 patient, dysplasia in 1 patient, and active tumor cell growth in 1 patient. The patients with liver adenomatosis had multiple lesions and atypia. All patients underwent liver resection. There was no recurrence on follow-up which ranged from 21 to 125 months. Conclusions Most patients had no clinical symptoms. Hepatic steatosis may be a potential cause for HCA and LA. Oral contraceptive plays an important role in the patho- genesis of LA. Dynamic imaging examinations were helpful for diagnosis. In view of the associated risks of hemorrhage and malignant transformation, surgical resection is the optimal treatment. The prognosis is good.

关 键 词：肝脏 肝细胞腺瘤 肝切除术 诊断 

分 类 号：R735.7[医药卫生—肿瘤]