肝脏少见良性占位性病变诊疗分析  

Diagnosis and treatment of rare benign lesions in the liver

作　　者：杨育新[1] 谢楠[2] 许彦丽 袁富贵 Yang Yuxin;Xie Nan;Xu Yanli;Yuan Fugui(Department of General Surgery,Shizong County People's Hospital,Qujing,Yunnan 655000,China;Department of Hepatobiliary and Pancreatic Surgery,Second Affiliated Hospital of Kunming Medical University Kun ming,Yunnan 650101,China)

机构地区：[1]师宗县人民医院普外科,云南曲靖655000 [2]昆明医科大学第二附属医院肝胆胰外科,云南昆明650101

出　　处：《医药前沿》2020年第36期32-34,共3页Journal of Frontiers of Medicine

摘　　要：目的:分析不同影像学方法对肝脏少见良性占位性病变的诊断准确率及影像诊疗特点,以期提高对肝脏少见良性占位性病变的诊疗认识及不同影像诊断方法的适宜选择。方法:分析我院所收治2008年1月—2019年1月确诊的27例肝脏少见良性占位性病变患者,结合患者的影像学诊疗资料对比分析不同影像学诊疗经验及影像方法选择。结果:所有患者均行B超检查,其中行腹部CT检查者20例(包括平扫加增强两部分),核磁共振成像MRI检查者18例(平扫加增强两部分)。结合患者最终病理确诊情况,B超诊断准确率为37.0%,CT和MRI诊断准确率明显高于B超,分别为62.9%、70.3%,余下患者均以肝脏占位性质待查而行手术切除以明确病因,部分患者诊断考虑肝癌可能。由于部分患者有乙肝表面抗原阳性因素和(或)丙型肝炎,均考虑肝癌诊断,结合患者术后或活体组织病理诊断结果,患者存在一定程度误诊及诊断困难。本次的27例病患中,2例行上述影像诊断难以确诊,均行肝脏穿刺活体取材病理确诊为肝细胞局灶性结节性增生而定期随访,余下25例患者均行手术切除并行病理诊断,所有患者诊断明确,术后恢复良好。结论:肝脏少见良性占位性病变临床诊疗存在诊断难点,尤其病变不典型者。结合多种影像学诊疗方法可明显增加本病临床诊断准确率,但依然存在误诊可能,因此最终确诊依靠于病理诊断,对于影像学诊断困难者或高度考虑为恶性疾病患者而言,手术是必要的,但应充分评估,特别是提高该病肝脏活体穿刺确诊比率。Objective To explore the diagnostic accuracy and imaging diagnosis and treatment characteristics of different imaging methods for rare benign liver lesions,in order to improve the diagnosis and treatment of rare benign liver lesions and the appropriate choice of different imaging diagnosis methods.Methods To analyze 27 patients with rare benign space-occupying liver lesions diagnosed in our hospital from January 2008 to January 2019,and compare and analyze different imaging diagnosis and treatment experience and imaging method selection based on the imaging diagnosis and treatment data of the patients.Results All patients underwent B-ultrasound examination,of which 20 cases underwent abdominal CT examination(including plain scan and enhanced two parts),and 18 cases underwent MRI examination(plain scan and enhanced two parts).Combined with the patient's final pathological diagnosis,the diagnostic accuracy of B-ultrasound was 37.0%,and the diagnostic accuracy of CT and MRI was significantly higher than that of B-ultrasound,62.9%and 70.3%,respectively.The remaining patients are of liver-occupying nature to be investigated Surgical resection is performed to determine the cause,and some patients consider the possibility of liver cancer.Because some patients have Hepatitis B surface antigen positive factors and/or hepatitis C,the diagnosis of liver cancer is considered.Combined with the results of postoperative or biopsy pathological diagnosis of the patient,the patient has a certain degree of misdiagnosis and difficulty in diagnosis.Of the 27 patients this time,2 cases were difficult to be diagnosed by the above-mentioned imaging diagnosis.All were diagnosed as focal nodular hyperplasia of hepatocytes by liver biopsy and pathology.The remaining 25 cases were all underwent surgical resection and pathology.Diagnosis,all patients had a clear diagnosis and recovered well after surgery.Conclusion The clinical diagnosis and treatment of rare benign spaceoccupying lesions of the liver is difficult to diagnose,especially thos

关 键 词：肝脏 少见良性占位病变 影像学 诊断和治疗 

分 类 号：R575[医药卫生—消化系统]