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