Shimada M, Takenaka K, Gion T, Fujiwara Y, Taguchi K, Kajiyama K, Shirabe K, Sugimachi K
Department of Surgery II, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Arch Surg. 1998 Jun;133(6):643-6. doi: 10.1001/archsurg.133.6.643.
To clarify some of the difficulties in determining the appropriate surgical indications for cystic lesions mimicking a neoplasm in the liver.
A retrospective review of hepatic resections for cystic lesions mimicking a neoplasm in the liver between August 1, 1986, and July 31, 1996.
A university hospital with a long history of hepatic resection for cystic lesions mimicking a neoplasm in the liver.
Ten patients with such cystic lesions in the liver, who underwent a hepatectomy during a recent 10-year period, were included in this study.
Detailed clinicopathologic data were analyzed, and comparisons were made between the preoperative and postoperative diagnoses.
The postoperative diagnoses consisted of cysts, including cysts complicated by an infection or hemorrhage in 7 patients, localized cystic dilation of the bile duct due to hepatolithiasis in 1, cystadenoma in 1, and mucin-producing cholangiocarcinoma in 1. In only one case was postoperative diagnosis identical to the preoperative diagnosis. In one case, an intraoperative pathological examination showed the tumor to be a mucin-producing cholangiocarcinoma instead of a cystadenocarcinoma. A tumor-marker analysis of the fluid in the cystic lesions also did not contribute to a definite diagnosis. Furthermore, cytological examination of the fluid could not completely exclude malignancy. Neither mortality nor morbidity occurred in any of the patients, and their mean length of hospitalization after hepatectomy was only 13.7 days.
The accurate diagnosis of cystic lesions mimicking a tumor remains problematic; however, the results of hepatectomy for such cases are normally satisfactory. Such cystic lesions of the liver should be indicated for hepatectomy whenever the possibility of a cancerous neoplasm cannot be completely ruled out.
阐明在确定肝脏中类似肿瘤的囊性病变的合适手术指征方面存在的一些困难。
对1986年8月1日至1996年7月31日期间因肝脏中类似肿瘤的囊性病变而进行肝切除术的病例进行回顾性研究。
一家在肝脏中类似肿瘤的囊性病变肝切除术方面有着悠久历史的大学医院。
本研究纳入了10例在最近10年期间接受肝切除术的肝脏此类囊性病变患者。
分析详细的临床病理数据，并对术前和术后诊断进行比较。
术后诊断包括囊肿，其中7例为伴有感染或出血的囊肿，1例为肝内胆管结石导致的局限性胆管囊性扩张，1例为囊腺瘤，1例为黏液性胆管癌。仅1例术后诊断与术前诊断相同。1例术中病理检查显示肿瘤为黏液性胆管癌而非囊腺癌。对囊性病变内液体进行肿瘤标志物分析也无助于明确诊断。此外，对液体进行细胞学检查也不能完全排除恶性肿瘤。所有患者均未发生死亡或并发症，肝切除术后平均住院时间仅为13.7天。
准确诊断类似肿瘤的囊性病变仍然存在问题；然而，此类病例的肝切除结果通常令人满意。只要不能完全排除癌性肿瘤的可能性，肝脏的此类囊性病变就应考虑行肝切除术。
