Boozari B, Kubicka S
Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover.
Internist (Berl). 2010 Jan;51(1):53-62. doi: 10.1007/s00108-009-2526-4.
Focal nodular hyperplasia is a polyclonal hyperplasia of liver cells as a result of locally enhanced blood flow because of vessel malformations. Only symptomatic FNH is an indication for resection or enucleation. In contrast to FNH growth of adenoma is dependent on sexual hormones. Solitary HNFalpha-inactivated and inflammatory adenomas larger than 5 cm should be removed because of risk of tumor rupture or bleeding, while beta-catenin mutated adenomas should be surgically removed at any stage because of risk of malignant transformation. The prognosis of patients with HCC is dependent on the tumor stage, but also on the liver function. Resection is the treatment of choice for HCC in patients without liver cirrhosis. Patients with liver cirrhosis and early HCC without extrahepatic metastasis can be successfully treated by liver transplantation. If transplantation is not possible these tumors should be removed by local percutaneous ablation. Transarterial chemoembolization is an effective treatment for more advanced HCC in patients with good liver function. Studies showed that the multikinase inhibitor sorafenib significantly improves survival of patients with advanced or metastatic HCC in child A cirrhosis. The only curative option for patients with intrahepatic cholangiocarcinomas is surgical resection. Patients with unresectable cholangiocarcinomas should be treated with a chemotherapy consisting of Gemcitabine-Cisplatin-combination.
局灶性结节性增生是由于血管畸形导致局部血流增加而引起的肝细胞多克隆增生。只有有症状的局灶性结节性增生才是切除或剜除术的指征。与局灶性结节性增生不同，腺瘤的生长依赖于性激素。大于5cm的孤立性肝细胞核因子α失活型和炎症性腺瘤，因有肿瘤破裂或出血风险应予以切除，而β-连环蛋白突变型腺瘤因有恶变风险在任何阶段均应手术切除。肝细胞癌患者的预后取决于肿瘤分期，也取决于肝功能。对于无肝硬化的肝细胞癌患者，手术切除是首选治疗方法。对于有肝硬化且无肝外转移的早期肝细胞癌患者，肝移植可成功治疗。如果无法进行移植，这些肿瘤应通过局部经皮消融切除。经动脉化疗栓塞是肝功能良好的晚期肝细胞癌患者的有效治疗方法。研究表明，多激酶抑制剂索拉非尼可显著提高Child A级肝硬化的晚期或转移性肝细胞癌患者的生存率。肝内胆管癌患者唯一的治愈选择是手术切除。无法切除的胆管癌患者应采用吉西他滨-顺铂联合化疗。
