[1]徐剑.改善肝FNH临床诊断和治疗 ——附病理确诊74例临床资料分层分析[J].徐州医科大学学报,2019,39(08):585-589.
 Improve Clinical Diagnosis and Management of Hepatic FNH —Analyzing 74 cases confirmed by pathology with clinical data stratification[J].Journal of Xuzhou Medical University,2019,39(08):585-589.
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改善肝FNH临床诊断和治疗 ——附病理确诊74例临床资料分层分析()
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《徐州医科大学学报》[ISSN:2096-3882/CN:32-1875/R]

卷:
39
期数:
2019年08期
页码:
585-589
栏目:
出版日期:
2019-08-25

文章信息/Info

Title:
Improve Clinical Diagnosis and Management of Hepatic FNH —Analyzing 74 cases confirmed by pathology with clinical data stratification
作者:
徐剑
文献标志码:
A
摘要:
摘 要 【目的】 探讨肝局灶性结节性增生 (FNH)诊治临床面临的困惑,提出改善临床诊治现状的方法。【方法】 以符合1.病理确诊;2.临床病史、肝功能(ALT、AST、TB和DB)、肝炎(乙肝、丙肝)指标、肿瘤标志物(AFP、CA199、CEA和PSA)齐全;3.具备肝脏CT、MRI平扫增强或超声造影三项之一或以上的临床资料为入选条件,收集2012年5月至2018年12月期间,符合以上入选条件的病例资料,进行分层分析,并归纳总结其临床诊疗的特点和改善措施。【结果】共筛选出74例,其中,49例(66.22%)为男性,仅1例女性有服用避孕药史;16-35岁病人占68.92%(51例),最小16岁,最大77岁;74例全部实施B超检查,68例(91.89%)无症状,为B超体检时发现。实施CT平扫增强51例(68.92%),MRI平扫增强41例,超声造影26例。同个病人同时实施两项或三项影像较少。各组(除MRI组或CT与MRI联合组外)与CT组比较实施例数有统计学差异(P<0.05)。以影像诊断报告提示或首先怀疑肝FNH来设定影像诊断阳性率,则B超诊断阳性率36.49%,MRI平扫增强55.81%,CT平扫增强57.47%,超声造影80.77%,联合影像诊断阳性率除MRI联合CT平扫增强为61.90%外,其他联合诊断阳性率达80%以上,据此,临床共51例(68.92%)可以确立肝FNH诊断。以CT和MRI平扫增强中肝FNH特征性表现进行回顾性分析,获得校正影像诊断阳性率,则CT和MRI平扫增强的校正诊断阳性率较前有显著性统计学差异(P<0.05),分别为80.85%和88.37%。校正后临床诊断阳性率则达到87.84%(65例)。以1.影像学富动脉血供表现;2.肿瘤标志物和肝功能正常;3.结合病人年轻(<35岁),无肝炎、无肝硬化等与血管瘤、肝癌等作鉴别诊断,临床高度提示肝FNH病例总数达69例(93.24%)。治疗上,49例开腹切除,有8例合并胆囊切除(胆囊结石仅1例),其术后27例(55.10%)并发胸水、肺不张;15例行腹腔镜切除,3例合并胆囊切除(1例胆囊结石),其术后6例(40.00%)并发胸水、肺不张;3例TAE(经肝动脉超选择血管栓塞)治疗,1例(33.33%)术后胸腹水、发热,肝酶升高;5例RFA(射频消融)无明显并发症;2例活检确诊FNH采取随访观察3年,未见明显变化。【结论】提高临床和影像医生对肝FNH的综合认识,以影像学特征表现为主线,综合肿瘤标志物和肝功能正常,结合病人年轻无症状,无肝炎、无肝硬化表现为线索,尽可能获得肝FNH临床诊断,尽量选择随访观察;对极少数与肿瘤难以临床鉴别,才考虑包括活检在内的外科操作。
Abstract:
Improve Clinical Diagnosis and Management of Hepatic FNH —Analyzing 74 cases confirmed by pathology with clinical data stratification Abstract Abstract Objective To explore the clinical confusion of the diagnosis and treatment of hepatic focal nodular hyperplasia (FNH), and to propose the measures to improve clinical diagnosis and treatment. Methods To meet 1. established pathological diagnosis; 2. complete items of clinical history, liver function (ALT, AST, TB and DB), hepatitis (hepatitis B, hepatitis C) indicators, tumor markers (AFP, CA199, CEA and PSA) , and 3. clinical data with one or more of liver CT, MRI plain and enhancement scan or contrast-enhanced ultrasound were selected as the enrollment conditions. Case data meeting the above enrollment conditions from May 2012 to December 2018 were collected for stratified analysis. And summarize their characteristics and improvement measures of its clinical diagnosis and treatment. Results A total of 74 cases were screened out, of which 49 cases (66.22%) were male. Only 1 woman had a history of taking birth control pills; 16-35 years old patients accounted for 68.92% (51 cases), the youngest was 16 years old, and the oldest was 77.The diagnostic accuracy of the imaging diagnosis report or suspected liver FNH to determine the positive rate of imaging diagnosis, the B-ultrasound diagnosis rate was 36.49%, the CT scan was 57.47%, the MRI was 55.81%, and the contrast-enhanced ultrasound was 80.77%. The MRI combined with CT scan was enhanced to 61.90%, and the other combined diagnosis positive rate was over 80%. A total of 51 cases (68.92%) could establish the clinical diagnosis of liver FNH. The CT and MRI have the characteristic features of FNH in the liver for retrospective analysis to obtain the positive rate of clinically corrected imaging diagnosis. The corrected positive rate of CT and MRI plain and enhancement was significantly improved, which was 80.85% and 88.37%, respectively. There was a significant statistical difference (P < 0.05). The adjusted clinical diagnosis rate reached 87.84% (65 cases). Clinically, the number of cases of liver FNH was 69 (93.24%). 49 cases underwent open resection, 8 cases with cholecystectomy (only 1 case of gallstones), 27 cases (55.10%) with pleural effusion and atelectasis after operation; 15 cases underwent laparoscopic resection, 3 cases with gallbladder excision (1 case of gallstones); 6 cases (40.00%) with pleural effusion and atelectasis after operation; 3 cases of TAE (transcatheter hepatic artery superselective vascular embolization), 1 case (33.33%) of postoperative thoracic and ascites, and liver enzymes were elevated; 5 cases of RFA (radiofrequency ablation) had no complications; 2 cases of biopsy confirmed FNH were followed up for 3 years, no significant changes were observed. Conclusion Improve the comprehensive understanding of hepatic FNH by clinical and imaging doctors, with the characteristic features of imaging as the main line, comprehensive tumor markers and normal liver function, combined with young and asymptomatic patients, without hepatitis and cirrhosis as a clue. The clinical diagnosis of liver FNH was obtained, and follow-up observation was selected as far as possible. It is hardly necessary to consider surgical operations including biopsy except that hepatic FNHs are difficult to be clinically identified. [Keywords] Hepatic focal nodular hyperplasia(FNH); Liver neoplasms; Hepatic hemangioma; Differential diagnosis
更新日期/Last Update: 2019-09-18