Ehrl Denis, Rothaug Katharina, Herzog Peter, Hofer Bernhard, Rau Horst-Günter
Department of Visceral, Thoracic und Vascular Surgery, Clinic of Dachau, 85221 Dachau, Germany.
HPB Surg. 2012;2012:891787. doi: 10.1155/2012/891787. Epub 2012 Aug 8.
The continuous development of highly sensitive clinical imaging increased the detection of focal lesions of the liver. These accidentally detected liver tumors without liver-specific symptoms such as cholestasis have been named "incidentalomas." Diagnostic tools such as sonography, computed tomography, or magnetic resonance imaging are used increasingly in asymptomatic individuals without defined suspected diagnoses in the setting of general prevention or followup after a history of malignancy. But despite continuous improvement of diagnostics, some doubt regarding the benign or malign behavior of a tumor remains. In case an asymptomatic hemangioma or FNH can be preoperatively detected with certainty, the indication for surgery must be very strict. In case of symptomatic liver lesions surgical resection should only be indicated with tumor-specific symptoms. In the remaining cases of benign lesions of the liver, a "watch and wait" strategy is recommended. In case of uncertain diagnosis, especially in patients with positive history of a malignant tumor or the suspected diagnosis of hepatocellular adenoma, surgical resection is indicated. Due to the continuous improvement of surgical techniques, liver resection should be done in the laparoscopic technique. Laparoscopic surgery has lower morbidity and shorter hospitalization than open technique.
高灵敏度临床成像技术的不断发展提高了肝脏局灶性病变的检出率。这些在无胆汁淤积等肝脏特异性症状情况下偶然发现的肝脏肿瘤被称为“偶发瘤”。超声、计算机断层扫描或磁共振成像等诊断工具越来越多地用于无症状个体，这些个体在一般预防或恶性肿瘤病史后的随访中没有明确的疑似诊断。但尽管诊断技术不断改进，对于肿瘤的良性或恶性行为仍存在一些疑问。如果术前能确定检测到无症状的血管瘤或局灶性结节性增生，手术指征必须非常严格。对于有症状的肝脏病变，只有在出现肿瘤特异性症状时才应考虑手术切除。对于其余肝脏良性病变的情况，建议采取“观察等待”策略。在诊断不确定的情况下，特别是有恶性肿瘤病史阳性或疑似肝细胞腺瘤诊断的患者，应进行手术切除。由于手术技术的不断改进，肝脏切除术应采用腹腔镜技术进行。与开放手术相比，腹腔镜手术的发病率更低，住院时间更短。
