Belghiti J, Pateron D, Panis Y, Vilgrain V, Fléjou J F, Benhamou J P, Fékété F
Digestive Surgery Unit, Hôpital Beaujon, Clichy-Paris, France.
Br J Surg. 1993 Mar;80(3):380-3. doi: 10.1002/bjs.1800800340.
The surgical treatment of benign liver tumours (focal nodular hyperplasia (FNH) and hepatic adenoma) remains controversial. From 1984 to 1990, all 51 women aged below 50 years who presented with presumed benign liver tumours and without chronic liver disease underwent tumour resection. Preoperative assessment included liver tests, ultrasonography and dynamic computed tomography in all patients, plus angiography (n = 20), magnetic resonance imaging (n = 22) and technetium-sulphur colloid liver scintigraphy (n = 19). The aims of this study were to compare preoperative and final pathological diagnosis and determine whether surgical treatment was justified. Preoperative assessment suggested FNH in 18 patients and hepatic adenoma in 11. In 22 patients, the distinction between FNH and adenoma could not be determined before operation. Operative procedures included resection of one segment or less in 22 patients, two segments in 14 and three or more segments in 15. There was no postoperative death and no serious complication. The final diagnosis after pathological examination of resected specimens was FNH in 36 patients (71 per cent), including the 18 presumed before operation to have FNH, hepatic adenoma in 12 (24 per cent) and malignant lesions in three (6 per cent): hepatocellular carcinoma (HCC) arising in normal liver, fibrolamellar carcinoma, and adenoma containing areas of HCC in one patient each.
(1) precise preoperative diagnosis of benign liver tumours remains difficult despite new imaging methods; (2) malignant liver tumours can go unrecognized; and (3) resection of all these lesions can be carried out safely. Resection of presumed benign liver tumours should be performed in young women when a preoperative diagnosis of FNH is not firmly established.
良性肝肿瘤（局灶性结节性增生（FNH）和肝腺瘤）的外科治疗仍存在争议。1984年至1990年，所有51例年龄在50岁以下、表现为疑似良性肝肿瘤且无慢性肝病的女性均接受了肿瘤切除术。所有患者的术前评估包括肝功能检查、超声检查和动态计算机断层扫描，另外20例行血管造影，22例行磁共振成像，19例行锝-硫胶体肝闪烁显像。本研究的目的是比较术前和最终病理诊断，并确定手术治疗是否合理。术前评估提示18例为FNH，11例为肝腺瘤。22例患者术前无法确定FNH和腺瘤的区别。手术方式包括22例患者切除一个或更少肝段，14例切除两个肝段，15例切除三个或更多肝段。无术后死亡病例，也无严重并发症。切除标本病理检查后的最终诊断为FNH 36例（71%），包括术前诊断为FNH的18例；肝腺瘤12例（24%）；恶性病变3例（6%）：正常肝脏发生的肝细胞癌（HCC）、纤维板层癌以及1例分别含有HCC区域的腺瘤。
（1）尽管有新的成像方法，良性肝肿瘤的术前精确诊断仍然困难；（2）恶性肝肿瘤可能未被识别；（3）所有这些病变的切除均可安全进行。当术前未明确诊断为FNH时，年轻女性应切除疑似良性肝肿瘤。
