Department of Surgery, Jefferson Medical College, Thomas Jefferson University, 1100 Walnut Street, 5th Floor, Philadelphia, PA 19107, USA.
J Gastrointest Surg. 2012 Sep;16(9):1782-9. doi: 10.1007/s11605-012-1922-6. Epub 2012 Jun 12.
Hemorrhage within a hepatic cyst (hemorrhagic hepatic cyst, HHC) is a complication of liver cysts that is difficult to differentiate from other neoplastic entities on imaging. Even when accurately diagnosed, there has been a lack of consensus on the optimal treatment strategy. After presenting our experience with a patient treated via laparoscopy, we aimed to conduct a review of the literature on HHCs.
A computerized search in Medline, PubMed, Google Scholar, and The Cochrane Collaboration was carried out for journal articles or abstracts published from 1950 to 2011.
A total of 24 patients with HHCs were identified from 1983 to 2011. The cohort had an even gender distribution with a mean age of 62.7 years. Most patients presented with abdominal pain (80 %), while three (14 %) patients were asymptomatic at the time of presentation. CT imaging and ultrasound were unable to accurately diagnose HHC, whereas hyperintensity on MRI was a reliable diagnostic tool. Three (13 %) patients were managed conservatively with observation. Seven (30 %) patients had percutaneous transhepatic drainage. Among these, two patients experienced recurrence that required repeat treatment. Two (9 %) patients underwent open unroofing of their HHC and one (4 %) laparoscopically, without recurrences. Seven (30 %) patients underwent hepatic resection, whereas six (26 %) patients had a cyst enucleation for their HHCs. All patients had uneventful recoveries, with a mean follow-up of 25 months.
MRI is a reliable diagnostic tool in the setting of an HHC. Laparoscopic unroofing of HHCs may represent a less morbid and safe treatment modality with low recurrence rates. Given the low level of clinical evidence available so far, these results should be interpreted with caution.
肝囊肿内出血（出血性肝囊肿，HHC）是肝囊肿的一种并发症，在影像学上难以与其他肿瘤实体相区别。即使准确诊断，对于最佳治疗策略也缺乏共识。在介绍我们通过腹腔镜治疗的患者的经验后，我们旨在对 HHC 文献进行综述。
在 Medline、PubMed、Google Scholar 和 The Cochrane Collaboration 中进行计算机检索，以获取 1950 年至 2011 年发表的期刊文章或摘要。
从 1983 年至 2011 年，共从文献中确定了 24 例 HHC 患者。该队列的性别分布均匀，平均年龄为 62.7 岁。大多数患者有腹痛（80%），而在就诊时无症状的有 3 例（14%）。CT 成像和超声无法准确诊断 HHC，而 MRI 上的高信号是可靠的诊断工具。3 例（13%）患者接受保守治疗，观察。7 例（30%）患者经皮经肝穿刺引流。其中 2 例复发，需要重复治疗。2 例（9%）患者接受开放肝囊肿开窗术，1 例（4%）患者接受腹腔镜手术，均无复发。7 例（30%）患者接受肝切除术，6 例（26%）患者接受肝囊肿切除术。所有患者均顺利康复，平均随访 25 个月。
MRI 是 HHC 诊断的可靠工具。腹腔镜肝囊肿开窗术可能是一种较少侵袭性和安全性更高的治疗方法，复发率低。鉴于目前临床证据水平较低，应谨慎解释这些结果。
