Surgical management of hepatocellular adenoma: Take it or leave it?
Surgical management of hepatocellular adenoma: Take it or leave it?
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DOI：
10.1245/s10434-008-0090-0
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发表时间：
2008-10-01
影响因子：
3.7
通讯作者：
Gamblin, T. Clark
中科院分区：
文献类型：
--
作者：
Cho, Sung W.;Marsh, J. Wallis;Gamblin, T. Clark
背景：肝细胞腺瘤（HA）是一种罕见的肝脏良性肿瘤。手术切除通常是为了减少出血和恶性转化的风险。我们试图评估我院HA患者的临床表现、手术治疗和预后。方法：我们对1988年至2007年间接受HA手术切除的41例患者进行了回顾性分析。结果：38例患者为女性，就诊时的中位年龄为36岁（范围19-65岁）。最常见的临床表现是腹痛（70%），其次是偶然的影像学发现（17%）。22例患者有口服避孕药的使用史。HA中位数为1（范围1-3）。开腹手术32例（三节切除术3例，半肝切除术15例，节段切除术7例，节段切除术4例，楔形切除术3例），腹腔镜手术9例（半肝切除术1例，节段切除术5例，楔形切除术2例）。估计失血量中位数为225毫升（范围0-3400毫升）。中位住院时间为6天（范围1-15天）。手术并发症包括需要经皮引流的胸腔积液（n = 2）、肺炎（n = 1）和伤口感染（n = 1）。无围手术期死亡。12例HA出血。2例HA患者发生肝细胞癌。中位随访时间为23个月（范围1-194个月），所有患者均存活。结论：鉴于出血发生率为29%，恶性并发症发生率为5%，如果患者合并症和HA的解剖位置有利，我们建议手术切除而不是观察。腹腔镜方法可以安全地用于选定的病例。
Background: Hepatocellular adenoma (HA) is a rare benign tumor of the liver. Surgical resection is generally indicated to reduce risks of hemorrhage and malignant transformation. We sought to evaluate clinical presentation, surgical management, and outcomes of patients with HA at our institution.Methods: We performed a retrospective review of 41 patients who underwent surgical resection for HA between 1988 and 2007.Results: Thirty-eight patients were women, and the median age at presentation was 36 years (range, 19-65 years). The most common clinical presentation was abdominal pain (70%) followed by incidental radiological finding (17%). Twenty-two patients had a history of oral contraceptive use. Median number of HA was one (range, 1-3). There were 32 open cases (3 trisectionectomy, 15 hemihepatectomy, 7 sectionectomy, 4 segmentectomy, and 3 wedge resection), and 9 laparoscopic cases (1 hemihepatectomy, 5 sectionectomy, 1 segmentectomy, and 2 wedge resection). The median estimated blood loss was 225 mL (range, 0-3400 mL). The median length of stay was 6 days (range, 1-15 days). Surgical morbidities included pleural effusion requiring percutaneous drainage (n = 2), pneumonia (n = 1), and wound infection (n = 1). There was no perioperative mortality. Twelve patients had hemorrhage from HA. Hepatocellular carcinoma was observed in two patients with HA. Median follow-up was 23 months (range, 1-194 months), at which time all patients were alive.Conclusion: In view of 29% hemorrhagic and 5% malignant complication rates, we recommend surgical resection over observation if patient comorbidities and anatomic location of HA are favorable. A laparoscopic approach can be safely used in selected cases.