Mangiante G, Nicoli N, Marchiori L, Procacci C, Colombari R, Aurola P P, Serio G
Istituto di Patologia Chirurgica, Università di Verona.
Chir Ital. 1994;46(1):50-60.
Therapeutic choices for benign liver tumours have changed over the last 20 years. From 1975 to December 1993, we observed 145 hemangiomas (HMG) (57.2% females-mean age 47.3 years, 42.8% males-mean age 50.4 years): we resected 42 symptomatic hemangiomas: mortality rate was 2.3%. 93 HMG without symptoms were only followed-up: 5 of these increased in size and were resected. 27 symptomatic cases over 50 focal nodular hyperplasia (FNH) were resected, 7 cases were resected and 3 biopsied during laparotomy performed for other pathology. Postoperative mortality was nil. 13 cases were only followed-up after diagnosis by imaging techniques and fine needle biopsy: over a mean period of 23 months. No variations have been recorded. Increases in GGT and ALP were present respectively in 34% and 22% of FNH-cases. Scintigraphic techniques were the most diagnostically accurate (96.2%). All 16 hepatocellular adenomas (HCA) were removed (11 females, 5 males), postoperative mortality was nil: oestrogen administration was present in 36.4% of female cases, histological diagnosis v/s well differentiated hepatocellular carcinoma was difficult in 2 cases, whilst 3 cases had spontaneous rupture. We resected also 8 cases of biliary adenomas in order to determine a precise diagnosis v/s liver metastases, and 4 biliary cystadenomas for their malignant potential. Asymptomatic HMG and FNH for their low tendency to increase, can be only observed, whilst HCA must be fully resected for risk of bleeding and misdiagnosis v/s well differentiated hepatocellular carcinoma.
在过去20年中，良性肝肿瘤的治疗选择发生了变化。从1975年到1993年12月，我们观察了145例肝血管瘤（HMG）（女性占57.2%，平均年龄47.3岁；男性占42.8%，平均年龄50.4岁）：我们切除了42例有症状的肝血管瘤，死亡率为2.3%。93例无症状的肝血管瘤仅进行随访：其中5例瘤体增大后被切除。27例有症状的局灶性结节性增生（FNH）病例被切除，7例在因其他病理情况进行剖腹手术时被切除，3例进行了活检。术后死亡率为零。13例经影像学技术和细针活检确诊后仅进行随访，平均随访期为23个月，未记录到变化。FNH病例中分别有34%和22%出现谷氨酰转肽酶（GGT）和碱性磷酸酶（ALP）升高。闪烁扫描技术诊断准确性最高（96.2%）。所有16例肝细胞腺瘤（HCA）均被切除（女性11例，男性5例），术后死亡率为零：36.4%的女性病例曾使用雌激素，2例难以进行组织学诊断以鉴别高分化肝细胞癌，3例发生自发性破裂。我们还切除了8例胆管腺瘤以明确诊断与肝转移的区别，以及4例胆管囊腺瘤以评估其恶变潜能。无症状的肝血管瘤和FNH因其增大倾向低，可仅进行观察，而HCA因有出血风险和误诊为高分化肝细胞癌的风险，必须完整切除。
