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    改善肝局灶性结节性增生临床诊断和治疗——附病理确诊74例临床资料分层分析

    Improvement of clinical diagnosis and management of hepatic FNH——an analysis of 74 cases

    • 摘要: 目的 探讨肝局灶性结节性增生(focal nodular hyperplasia,FNH)临床面临的诊治困惑和改善措施。方法 收集2012年5月—2018年12月,经病理确诊,临床资料齐全,肝CT、MRI平扫增强或超声造影(以下称CT、MRI、造影)三项之一或以上检查符合的肝FNH病例,分析总结其诊疗临床特点和改善措施。结果 筛选出74例,男性占66.22%(49例),仅1例女性有服避孕药史。15~35岁占68.92%(51例),91.89%(68例)无症状。按照影像提示或首先怀疑肝FNH来界定B超、CT、MRI和造影阳性诊断率,则分别为36.49%、57.47%、55.81%和80.77%,MRI联合CT为61.90%,其他联合达80%以上;其临床阳性诊断率为68.92%(51例)。回顾分析肝FNH特征性表现,获CT和MRI校正阳性诊断率分别为80.85%(χ2=6.034,P<0.05)和88.37%(χ2=11.328,P<0.01),临床校正阳性诊断率则达到87.84%(65例)(χ2=7.815,P<0.01),较校正前差异有统计学意义。结合患者年轻(<35岁),无肝炎、无肝硬化,肿瘤标志物和肝功能正常等与血管瘤、肝癌等鉴别,高度提示肝FNH的临床诊断率达93.24%(69例)。结论 提高临床和影像医生对肝FNH的综合认识,以影像特征表现为主线,结合患者年轻,无症状,无肝炎、无肝硬化,肿瘤标志物和肝功能正常,必要时联合影像检查,可最大限度获得临床诊断,从而大大改善肝FNH的诊疗。

       

      Abstract: Objective To explore the current problem in diagnosis of hepatic focal nodular hyperplasia(FNH) and possible improvement strategies.Methods Clinical data were collected from FNH patients from May 2012 to December2018,where the patients were pathologically diagnosed,with one or more liver CT and MRI plain and enhancement scanning or contrast-enhanced ultrasound that were consistent with hepatic FH1.Their clinical diagnostic features and treatment strategies were summarized.Results A total of 74 cases were screened out,including 66.22%(49 cases) were men and only 1 woman with a history of taking birth control pills.There were 68.92% patients(51 cases) within a range of 16-35 years,and 91.89%(68 patients)presented no symptoms.The positive diagnosis rate of FNH was 36.49%for B-ultrasound,57.47% for CT,55.81% for MRI,80.77% for combined use of MRI and CT,and above 80% for other combined uses.The clinical diagnosis rate was 68.92%(51 cases).In light of retrospective analysis of FNH characteristics,the CT and MRI corrected positive rates were 80.85%(χ2=6.034,P<0.05) and 88.37%(χ2=11.328,P<0.01),respectively;and the positive rate of corrected clinical diagnosis reached 87.84%(65 cases)(χ2=7.815,P<0.01),which were statistically significant compared with those before correction.With respect to patient age(<35 years old),without hepatitis,cirrhosis and normal tumor markers and liver function,the diagnosis rate of hepatic FNH was 93.24%(69 cases).Conclusions Good clinical diagnosis of hepatic FNH can be achieved through enhancing the comprehensive understanding of clinicians towards hepatic FNH,basically considering image characteristics in addition to patient age,normal tumor markers and liver function,without hepatitis and cirrhosis,and combined imaging examinations when necessary,so as to greatly improve hepatic FNH diagnosis and treatment.

       

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