A Single-Center Surgical Experience of 122 Patients With Single and Multiple Hepatocellular Adenomas
A Single-Center Surgical Experience of 122 Patients With Single and Multiple Hepatocellular Adenomas
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DOI：
10.1053/j.gastro.2009.07.061
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发表时间：
2009-11-01
期刊：
影响因子：
29.4
通讯作者：
Belghiti, Jacques
中科院分区：
文献类型：
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作者：
Dokmak, Safi;Paradis, Valerie;Belghiti, Jacques
背景与目的：肝细胞腺瘤(Ha)具有出血和恶变的危险，需要手术切除。患有多种形式的HA的患者很难管理。我们评价了122例单发和多发HAS患者术后的特点和转归。方法：1990-2004年间，122例(男性14例)患者接受手术切除。并发症(出血和恶性)根据大小、数量和组织学亚型(脂肪变性、毛细血管扩张和未分类)进行评估，平均随访期为70个月。结果：出血性HA占21%，恶性HA占8%。并发症的风险与HAS的数目无关，但与大小(>；5 cm)有关，尤其是毛细血管扩张型和未分类的亚型。脂肪变性HA患者发生并发症的风险较低。恶性HA在男性中更常见(43%)；所有接受部分切除治疗的患者在平均78个月的随访期后存活，没有复发恶性肿瘤。109例良性HA术后复发或进展率为8%，消退率为9%。在随访期内怀孕的11名妇女中没有观察到并发症。结论：大于5 cm、毛细血管扩张型或未分类亚型的患者，男性合并疾病的风险增加；切除应仅限于这些患者。并发症的风险与HAS的数目无关，因此多发性HAS患者不需要肝移植。
BACKGROUND & AIMS: Hepatocellular adenoma (HA) is associated with risk of bleeding and malignancy, justifying resection. Patients with multiple forms of HA are difficult to manage. We evaluated the characteristics and outcome of 122 patients with single and multiple HAs after surgery. METHODS: From 1990 to 2004, 122 patients (14 male) underwent surgical resection. Complications (hemorrhage and malignancy) were assessed according to size, number, and histologic subtype (steatotic, telangiectatic, and unclassified), with a mean follow-up period of 70 months. RESULTS: Hemorrhagic HA occurred in 21% of cases and malignant HA occurred in 8%. Risk of complications was not related to the number of HAs but was associated with size (>5 cm), especially of telangiectatic and unclassified subtypes. Patients with steatotic HA had a low risk of complications. Malignant HA was more Frequent in men (43%); all patients treated by partial resection survived, without recurrent malignancy, after a mean follow-up period of 78 months. After 109 patients with benign HA revealed recurrence or progression of HA in 8% and regression in 9% of cases. No complications were observed in 11 women who became pregnant during the follow-up period. CONCLUSIONS: Patients with HAs greater than 5 cm, telangiectatic or unclassified subtypes, and men have an increased risk of complicated disease; resection should be restricted to these patients. The risk of complications was not related to the number of HAs, so patients with multiple HAs do not need liver transplantation.