Erdogan Deha, Busch Olivier R C, van Delden Otto M, Ten Kate Fiebo J W, Gouma Dirk J, van Gulik Thomas M
Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Liver Int. 2006 May;26(4):433-8. doi: 10.1111/j.1478-3231.2006.01244.x.
Hepatocellular adenomas (HCA) may present with spontaneous haemorrhage and rupture. The aim of this study was to assess management in 22 patients treated for haemorrhage and/or rupture of HCA.
Between May 1990 and July 2005, 22 female patients were diagnosed with acute haemorrhage and/or rupture of lesions highly suspicious of HCA. Preoperative imaging diagnostics and pathologic specimens were reviewed.
Twelve haemodynamically stable and four unstable patients could be treated conservatively. One patient underwent acute partial liver resection, whereas four patients underwent laparotomy with initial packing of the liver. In one patient, selective embolisation of the left hepatic artery was performed. Fifteen patients eventually underwent resection after a mean time of 8 months after initial treatment. Six patients did not undergo resection and showed no complications or rebleeding after a mean follow-up of 24.6 months. Only in seven patients, histopathological examination showed HCA, and in one patient, HCA with focal nodular hyperplasia.
HCA with haemorrhage and/or rupture does not necessarily require immediate liver resection. Conservative treatment is justified in stable patients. In case of an instable patient with or without hemoperitoneum, laparotomy with packing or selective embolisation can stop the bleeding.
肝细胞腺瘤（HCA）可能会出现自发性出血和破裂。本研究的目的是评估22例因HCA出血和/或破裂而接受治疗的患者的治疗情况。
1990年5月至2005年7月期间，22例女性患者被诊断为高度怀疑HCA的病变急性出血和/或破裂。回顾术前影像诊断和病理标本。
12例血流动力学稳定和4例不稳定的患者可采用保守治疗。1例患者接受了急性部分肝切除术，4例患者接受了剖腹手术并对肝脏进行了初步填塞。1例患者进行了左肝动脉选择性栓塞。15例患者在初始治疗后平均8个月最终接受了切除术。6例患者未接受切除术，平均随访24.6个月后未出现并发症或再出血。只有7例患者的组织病理学检查显示为HCA，1例患者为伴有局灶性结节性增生的HCA。
伴有出血和/或破裂的HCA不一定需要立即进行肝切除术。稳定患者采用保守治疗是合理的。对于有或无腹腔积血的不稳定患者，剖腹手术填塞或选择性栓塞可止血。
