Gugenheim J, Mazza D, Baldini E, Evangelista A, Iovine L, Mouiel J
Servizio di Chirurgia Digestiva e Trapianto Epatico, Università di Nizza, Sophia Antipolis, Ospedale "Saint Roch", Nice, France.
Minerva Chir. 1995 Mar;50(3):161-5.
Benign liver tumors often require surgical treatment because of the diagnostic difficulties of their nature and because of annoying symptoms. With the aim of assessing if surgery is a safe therapeutic option we reviewed the data concerning 36 consecutive patients who underwent hepatic resection during the period January 1988-January 1993 at our Institution for 42 presumed benign liver tumors. Patients had a preoperative assessment consisting of biochemical tests, abdominal echography and contrast-enhanced scan in all cases, magnetic resonance imaging in 6 cases, celiacmesenteric angiography in 14 cases and percutaneous liver biopsy in 5 cases. We realised 5 major hepatectomies and 31 minor resections. There was no perioperative mortality. The postoperative complication rate was 5.5%. Mean hospital stay was 15.1 days (range 5-35 days). On follow-up, ranging from 4 to 60 months (mean 24 months), all patients are alive, without recurrence and free of symptoms. Histologic examination of specimens showed cavernous hemangioma in 20 cases, focal nodular hyperplasia in 19 cases and hepatic adenoma in 3 cases. Histologic findings were in accord with preoperative diagnosis in 57.9% of cases of cavernous hemangioma, in 42.8% of cases of focal nodular hyperplasia and in no case of hepatic adenoma. Our experience confirms that accurate preoperative diagnosis of presumed benign liver tumors is difficult in spite of complete radiologic investigations and liver biopsy. For this reason and for the risk of dangerous complications, such as malignant transformation and intraperitoneal hemorrhage, we believe that surgery is the treatment of choice in the majority of cases. This attitude, when realised in a center with experience in hepato-biliary surgery and using modern technical features is safe and efficient.
由于良性肝肿瘤的性质诊断困难以及存在令人不适的症状，通常需要进行手术治疗。为了评估手术是否是一种安全的治疗选择，我们回顾了1988年1月至1993年1月期间在我们机构连续接受肝切除手术的36例患者的数据，这些患者共患有42个疑似良性肝肿瘤。所有患者术前均进行了生化检查、腹部超声检查和增强扫描，6例进行了磁共振成像检查，14例进行了腹腔肠系膜血管造影检查，5例进行了经皮肝穿刺活检。我们实施了5例大肝切除术和31例小切除术。无围手术期死亡病例。术后并发症发生率为5.5%。平均住院时间为15.1天（范围5 - 35天）。在4至60个月（平均24个月）的随访中，所有患者均存活，无复发且无症状。标本的组织学检查显示，20例为海绵状血管瘤，19例为局灶性结节性增生，3例为肝腺瘤。在海绵状血管瘤病例中，57.9%的组织学结果与术前诊断一致；在局灶性结节性增生病例中，42.8%一致；在肝腺瘤病例中，无一例与术前诊断一致。我们的经验证实，尽管进行了全面的影像学检查和肝活检，但对疑似良性肝肿瘤进行准确的术前诊断仍很困难。出于这个原因以及存在恶性转化和腹腔内出血等危险并发症的风险，我们认为在大多数情况下手术是首选的治疗方法。在一个具有肝胆外科经验并采用现代技术特点的中心实施这种治疗方法是安全有效的。
