van Gulik T M
Academisch Medisch Centrum/Universiteit van Amsterdam, afd. Heelkunde, Postbus 22.660, 1100 DD Amsterdam.
Ned Tijdschr Geneeskd. 2007 Jun 16;151(24):1325-6.
The recommendation of Van der Windt et al. in this issue that the diagnosis 'hepatocellular adenoma' can be made only on the basis of imaging studies should be applied with caution. Tissue diagnosis remains the gold standard. Although the real risk of malignant degeneration of hepatocellular adenoma remains unknown, there is agreement that preventive excision is indicated when the size is > 5 cm. In case of bleeding from a hepatocellular adenoma, selective embolisation of the proper hepatic artery is effective. Secondary resection of the adenoma following bleeding is not always necessary. The withdrawal of oral contraceptives is the first recommendation after a diagnosis of hepatocellular adenoma is made, which is often followed by regression of the tumour. The elective embolisation of a hepatocellular adenoma via the hepatic artery is a new, promising form of treatment that can lead to regression. The recommendations made in the article constitute a good point of departure for a national discussion.
范德温特等人在本期中的建议,即仅基于影像学研究才能做出“肝细胞腺瘤”的诊断,应谨慎应用。组织诊断仍然是金标准。尽管肝细胞腺瘤恶变的真正风险尚不清楚,但人们一致认为,当肿瘤大小>5 cm时,应进行预防性切除。对于肝细胞腺瘤出血,选择性肝固有动脉栓塞有效。出血后不一定需要二次切除腺瘤。诊断为肝细胞腺瘤后,首先建议停用口服避孕药,之后肿瘤往往会消退。通过肝动脉对肝细胞腺瘤进行选择性栓塞是一种新的、有前景的治疗方式,可导致肿瘤消退。文章中的建议是全国性讨论的良好出发点。