肝细胞腺瘤9例诊疗分析  

Diagnosis and Treatment Analysis of 9 Cases of Hepatocellular Adenoma

作　　者：张齐[1] 杨野[1] ZHANG Qi;YANG Ye(Department of Elderly Surgery,The First Hospital,China Medical University,Shenyang 110001,China)

机构地区：[1]中国医科大学附属第一医院老年外科,沈阳110001

出　　处：《中国医科大学学报》2018年第8期730-734,共5页Journal of China Medical University

摘　　要：目的探讨肝细胞腺瘤(HCA)的临床表现、治疗方法和预后。方法回顾性分析中国医科大学附属第一医院自2010年12月至2015年5月间经肝部分切除手术治疗的9例HCA患者的临床资料。结果 9例HCA患者中,女性居多(6/9,66.7%),其中1例女性HCA患者有口服避孕药史(其他服药史不详)。全组患者中位发病年龄33岁(25~52)岁。多数(8/9,88.9%)无临床症状。肿瘤标记物糖类抗原19-9和甲胎蛋白均正常。超声、CT及磁共振增强扫描多提示病灶动脉期强化,门脉期、延迟期去强化。组织病理检查结果提示诊断HCA,6例(66.7%)为单发病灶,3例(33.3%)为多发病灶。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,3例存在异型。9例HCA均经手术切除,随访16~60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的病因,口服避孕药物可能诱发HCA。动态影像学检查有助于诊断,因HCA有病灶破裂出血及癌变的风险,首选手术治疗,预后良好。Objective To review the clinical features,therapeutic approach,and prognosis of hepatocellular adenoma（HCA）. Methods Clinical data of 9 patients with HCA visiting the First Hospital of China Medical University from December 2010 to May 2015 were analyzed retrospectively. Results Patients diagnosed with HCA included 6 females（66.7%） and 3 males（33.3%）. One female patient had a history of oral contraceptive use. The median age at presentation was 33 years（range 25-52 years）. Most patients（n = 8,88.9%） had no remarkable symptoms. Tumor markers,including CAl9-9 and AFP,were normal. On dynamic ultrasonography,computed tomography,and magnetic resonance imaging,most lesions showed contrast enhancement in the arterial phase and washout in the portal venous and delayed phases. For all patients,HCA was solitary,and on histopathology evaluation,atypia and dysplasia were observed in 6 patients,dysplasia in 3 patients,active tumor cell growth in 1 patient,and atypia in 3 patients. All patients underwent liver resection. No recurrence presented during the 16-60 months of follow-up. Conclusion Most patients with HCA have no clinical symptoms. Hepatic steatosis may be a potential cause of HCA,and oral contraceptives play an important role in HCA pathogenesis. Dynamic imaging examinations are helpful for diagnosis. In view of the associated risks of hemorrhage and malignant transformation,surgical resection is the optimal treatment. The prognosis of HCA is favorable.

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]