Department of Surgery, Amsterdam, The Netherlands.
Br J Surg. 2014 Jun;101(7):847-55. doi: 10.1002/bjs.9493. Epub 2014 Apr 24.
Hepatocellular adenoma (HCA) is a benign hepatic lesion that may be complicated by bleeding, although the risk of bleeding is ill-defined. The aim of this study was to assess risk factors for bleeding in patients diagnosed with HCA.
Patients with HCA were included prospectively from January 2008 to July 2012. Patient characteristics were noted. Patients underwent dynamic magnetic resonance imaging (MRI) and/or computed tomography (CT) at presentation and during follow-up. Lesion characteristics on (follow-up) imaging were noted, and bleeding was graded as intratumoral (grade I), intrahepatic (grade II) or extrahepatic (grade III). The standard of reference for diagnosis was histopathology, or dynamic MRI and/or CT findings. Possible risk factors were included if mentioned in literature (lesion size, body mass index), or based on clinical experience (lesion location, visible vessels on imaging).
A total of 45 patients (median age 39 (range 22-60) years; 44 women) with 195 lesions (median size 24 (10-250) mm) were evaluated. Bleeding occurred in 29 patients (64 per cent) and in 42 lesions (21.5 per cent) with a median size of 62 (10-160) mm. Size was a risk factor for bleeding (P < 0.001), with an increased number of bleeding events in lesions of 35 mm or more. Exophytic lesions (protruding from liver) had more bleeding (16 of 24, 67 per cent) than intrahepatic (9 of 82, 11 per cent) or subcapsular (17 of 89, 19 per cent) lesions (P < 0.001). Lesions in segments II and III had more bleeds than those in the right liver (11 of 32 versus 31 of 163; P = 0.049), as did lesions in which peripheral or central arteries were visualized on imaging (10 of 13 versus 32 of 182 lesions with no visible vascularization; P < 0.001).
Risk factors for bleeding of HCA include diameter of 35 mm or more, visualization of lesional arteries, location in the left lateral liver, and exophytic growth.
肝细胞腺瘤（HCA）是一种良性肝病变，尽管其出血风险尚未明确，但可能会并发出血。本研究旨在评估诊断为 HCA 的患者出血的危险因素。
本前瞻性研究纳入了 2008 年 1 月至 2012 年 7 月期间的 HCA 患者。记录患者特征。所有患者在就诊时和随访期间均接受了动态磁共振成像（MRI）和/或计算机断层扫描（CT）检查。记录病变特征，并根据影像学表现将出血分级为肿瘤内（I 级）、肝内（II 级）或肝外（III 级）。诊断标准为组织病理学，或动态 MRI 和/或 CT 发现。如果文献中提到（病变大小、体重指数）或基于临床经验（病变位置、影像学上可见血管），则将可能的危险因素纳入其中。
共评估了 45 例（中位年龄 39 岁[范围 22-60 岁]；44 例女性）患者的 195 个病灶（中位大小 24 毫米[10-250 毫米]）。29 例患者（64%）和 42 个病灶（21.5%）发生出血，中位病灶大小为 62 毫米[10-160 毫米]。病灶大小是出血的危险因素（P < 0.001），35 毫米或以上的病灶出血事件增加。外生性病变（突出于肝脏）比肝内（82 个中的 9 个，11%）或包膜下（89 个中的 17 个，19%）病变出血更多（24 个中的 16 个，67%）（P < 0.001）。II 段和 III 段的病灶比右肝的病灶出血更多（32 个中的 11 个与 163 个中的 31 个；P = 0.049），在影像学上显示病灶周围或中央动脉的病灶比无血管化的病灶出血更多（13 个中的 10 个与 182 个中的 32 个；P < 0.001）。
HCA 出血的危险因素包括直径 35 毫米或以上、病灶动脉显影、病变位于左外侧肝脏、外生性生长。
