肝囊性占位性病变的诊断与治疗
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摘要
肝囊性病变分为寄生性和非寄生性。寄生性病变主要指肝囊性包虫病,非寄生性病变可再分为良性、交界性和恶性病变。目前对肝囊性占位性病变的规范治疗尚不健全,查阅了国内外相关文献资料,结合文献对肝囊性相关疾病的病因、临床表现、诊断及治疗相关问题进行综述,以提高对本病的认识。
Cystic lesions of the liver are classified into parasitic and non-parasitic lesions. Parasitic lesions mainly refer to hepatic cystic echinococcosis,and non-parasitic lesions can be further classified into benign,borderline,and malignant lesions. At present,there are still no comprehensive standard treatment of cystic space-occupying lesions in the liver. With reference to related literature in China and foreign countries,this article reviews the etiology,clinical manifestations,and diagnosis and treatment of hepatic cystic diseases,so as to improve the understanding of this disease.
Cystic lesions of the liver are classified into parasitic and non-parasitic lesions. Parasitic lesions mainly refer to hepatic cystic echinococcosis,and non-parasitic lesions can be further classified into benign,borderline,and malignant lesions. At present,there are still no comprehensive standard treatment of cystic space-occupying lesions in the liver. With reference to related literature in China and foreign countries,this article reviews the etiology,clinical manifestations,and diagnosis and treatment of hepatic cystic diseases,so as to improve the understanding of this disease.
引文
[1] Chinese College of Surgeons(CCS)Chinese Committe. Expert consensus on the diagnosis and treatment of hepatic cystic and alveolar echinococcosis(2015 edition)[J]. Chin J Dig Surg,2015,14(4):253-264.(in Chinese)中国医师协会外科医师分会包虫病外科专业委员会.肝两型包虫病诊断与治疗专家共识(2015版)[J].中华消化外科杂志,2015,14(4):253-264.
[2] XIE TH,LYU HL,ZHAO YY,et al. Correlation between CT findings and clinical pathological changes of hepatic hydatid cyst[J]. J Pract Med,2013,29(13):2107-2110.(in Chinese)谢天皓,吕海龙,赵阳阳,等.肝囊性包虫病的CT表现与临床病理改变的相关性研究[J].实用医学杂志,2013,29(13):2107-2110.
[3] SEO JK,KIM SH,LEE SH,et al. Appropriate diagnosis of biliary cystic tumors:Comparison with atypical hepatic simple cysts[J]. Eur J Gastroenterol Hepatol,2010,22(8):989-996.
[4] CHEN JD,XIONG YQ,DONG K,et al. Comparative study of absolute alcohol and lauromacrogol injection in treating pure hepatic cysts[J]. J Clin Ultrasound in Med,2015,17(9):610-613.(in Chinese)陈吉东,熊晏群,董科,等.无水乙醇与聚桂醇注射液治疗单纯性肝囊肿的对比研究[J].临床超声医学杂志,2015,17(9):610-613.
[5] MARRERO JA,AHN J,RAJENDER REDDY K,et al. ACG clinical guideline:The diagnosis and management of focal liver lesions[J]. Am J Gastroenterol,2014,109(9):1328-1347.
[6] ARDITO F,BIANCO G,VELLONE M,et al. Long-term outcome after laparoscopic fenestration of simple liver cysts[J].Surg Endosc,2013,27(12):4670-4674.
[7] WAANDERS E,VENSELAAR H,TE MORSCHE RHM,et al. Secondary and tertiary structure modeling reveals effects of novel mutations in polycystic liver disease genes PRKCSH and SEC63[J].Clin Genet,2010,78(1):47-56.
[8] MASYUK TV,MASYUK AI,LARUSSO NF. Therapeutic targets in polycystic liver disease[J]. Curr Drug Targets,2017,18(8):950-957.
[9] GEVERS TJ,INTHOUT J,CAROLI A,et al. Young women with polycystic liver disease respond best to somatostatin analogues:A pooled analysis of individual patient data[J]. Gastroenterology,2013,145(2):357-365.
[10] WIJNANDS TF,RONOT M,GEVERS TJ,et al. Predictors of treatment response following aspiration sclerotherapy of hepatic cysts:An international pooled analysis of individual patient data[J]. Eur Radiol,2017,27(2):741-748.
[11] YANG J,RYU H,HAN M,et al. Comparison of volume-reductive therapies for massive polycystic liver disease in autosomal dominant polycystic kidney disease[J]. Hepatol Res,2016,46(2):183-191.
[12] BAKOYIANNIS A,DELIS S,TRIANTOPOULOU C,et al. Rare cystic liver lesions:A diagnostic and managing challenge[J].World J Gastroenterol,2013,19(43):7603-7619.
[13] CAROLI A,ANTIGA L,CAFARO M,et al. Reducing polycystic liver volume in ADPKD:Effects of somatostatin analogue octreotide[J]. Clin J Am Soc Nephrol,2010,5(5):783-789.
[14] CHRISPIJN M,GEVERS TJ,HOL JC,et al. Everolimus does not further reduce polycystic liver volume when added to long acting octreotide:Results from a randomized controlled trial[J]. J Hepatol,2013,59(1):153-159.
[15] NG TS,ROCHEFORT H,CZAPLICKI C,et al. Massive pancreatic pseudocyst with portal vein fistula:Case report and proposed treatment algorithm[J]. Pancreatology,2015,15(1):88-93.
[16] BHASIN DK,RANA SS,NANDA M,et al. Endoscopic management of pancreatic pseudocysts at atypical locations[J].Surg Endosc,2010,24(5):1085-1091.
[17] KIM HJ,KIM CY,HUR YH,et al. Peribiliary cysts developed in normal underlying liver:Report of a case[J]. Korean J Hepatobiliary Pancreat Surg,2013,17(3):131-134.
[18] TU J,JIA Z,YING X,et al. The incidence and outcome of major complication following conventional TAE/TACE for hepatocellular carcinoma[J]. Medicine,2016,95(49):e5606.
[19] VALERO V,AMINI N,SPOLVERATO G,et al. Sarcopenia adversely impacts postoperative complications following resection or transplantation in patients with primary liver tumors[J].J Gastrointest Surg,2015,19(2):272-281.
[20] KIM HY,KWON SH,OH JH,et al. Percutaneous transhepatic embolization of a bronchobiliary fistula developing secondary to a biloma after conventional transarterial chemoembolization in a patient with hepatocellular carcinoma[J]. Cardiovasc Intervent Radiol,2016,39(4):628-631.
[21] DHAMIJA E,PAUL SB,GAMANAGATTI SR,et al. Biliary complications of arterial chemoembolization of hepatocellular carcinoma.[J]. Diagn Interv Imaging,2015,96(11):1169-1175.
[22] de JONG EA,MOELKER A,LEERTOUWER T,et al. Percutaneous transhepatic biliary drainage in patients with postsurgical bile leakage and nondilated lntrahepatic bile ducts[J]. Dig Surg,2013,30(4-6):444-450.
[23] ISMAIL H,DEMBOWSKA-BAGINSKA B,BRONISZCZAK DA,et al. Treatment of undifferentiated embryonal sarcoma of the liver in children-single center experience[J]. J Pediatr Surg,2013,48(11):2202-2206.
[24] LIU L,CHEN W,LU X,et al. Pyogenic liver abscess:A retrospective study of 105 cases in an emergency department from East China[J]. J Emerg Med,2017,52(4):409-416.
[25] JOEL JM,JEYASINGH SD,KALYANARAMAN S. Biliary cystadenoma:A case report[J]. J Clin Diagn Res,2016,10(2):19-20.
[26] LIANG X,ZHENG JH,GAO JQ. Advances in diagnosis and treatment of intrahepatic biliary Cystadenoma[J]. Chin J Dig Surg,2018,17(12):1176-1180.(in Chinese)梁霄,郑俊浩,高佳琦.肝内胆管囊腺瘤的诊断与治疗进展[J].中华消化外科杂志,2018,17(12):1176-1180.
[27] CHENG PR,SU Y. A case of intrahepatic biliary cysta-denoma[J]. J Clin Hepatol,2018,34(6):1292-1293.(in Chinnese)程鹏瑞,苏洋.肝内胆管囊腺瘤1例报告[J].临床肝胆病杂志,2018,34(6):1292-1293.
[28] CHEN YW,LI CH,LIU Z,et al. Surgical management of biliary cystadenoma and cystadenocarcinoma of the liver[J].Genet Mol Res,2014,13(3):6383-6390.
[29] NAKANUMA Y,ZEN Y,HARADA K,et al. Tumorigenesis and phenotypic characteristics of mucin-producing bile duct tumors:An immunohistochemical approach[J]. J Hepatobiliary Pancreat Sci,2010,17(3):211-222.
[30] WANG MQ,DUAN F,LIU FY,et al. Treatment of symptomatic polycystic liver disease:Transcatheter super-selective hepatic arterial embolization using a mixture of NBCA and iodized oil[J]. Abdom Imaging,2013,38(3):465-473.
[31] DEMEUSY A,HOSSEINI M,SILL AM,et al. Intrahepatic pancreatic pseudocyst:A review of the world literature[J]. World J Hepatol,2016,8(35):1576-1583.
[32] WANG ZX,LI YG,WANG RL,et al. Clinical classification of Caroli's disease:An analysis of 30 patients[J]. HPB(Oxford),2015,17(3):278-283.
[33] CAO D,XIN JJ,CHEN YP. An asymptomatic case of Caroli disease[J]. J Clin Hepatol,2018,34(6):1296-1297.(in Chinese)曹丹,辛杰晶,陈延平.无症状Caroli病1例报告[J].临床肝胆病杂志,2018,34(6):1296-1297.
[34] CHEN CB,HU WD,ZHAO WW,et al. Laparoscopic hepatectomy for the treatment of Caroli’s disease:A case report[J].Ann Surg Treat Res,2018,94(3):162-165.
[35] SONG JS,LEE YJ,KIM KW,et al. Cholangiocarcinoma arising in von Meyenburg complexes:Report of four cases[J].Pathol Int,2008,58(8):503-512.
[36] SONG SF,SUN XD,LUO FX,et al. Progress in diagnosis and treatment of intrahepatic cholangiocystadenocarcinoma[J/CD]. Chin J Hepatic Surg:Electronic Edition,2018,7(1):8-11.(in Chinese)宋世飞,孙晓东,骆飞翔,等.肝内胆管囊腺癌的诊治进展[J/CD].中华肝脏外科手术学电子杂志,2018,7(1):8-11.
[37] XU MY,SHI XJ,WAN T,et al. Clinicopathological characteristics and prognostic factors of intrahepatic biliary cystadenocarcinoma[J]. Chin Med J,2015,128(9):1177-1183.
[38] HEYWOOD G,van BUREN SF,SMYRK T,et al. Multilocular cystic hepatocellular carcinoma(CHCC)mimicking mucinous cystadenocarcinoma[J]. Hepatogastroenterology,2003,50(50):368-370.
[39] ZHENG BO,ZHU YJ,WANG HY,et al. Gender disparity in hepatocellular carcinoma(HCC):Multiple underlying mechanisms[J]. Sci China Life Sci,2017,60(6):575-584.
[40] DONG JH,AN WM,MA W,et al. Primary hepatic malignant fibrous histiocytoma mimicking hepatocellular carcinoma:A report of two cases[J]. Oncol Lett,2014,8(5):2150-2154.
[41] HE B,XU KY,HUANG KT,et al. Undifferentiated embryonal liver sarcoma in childhood:A case report[J]. Oncol Lett,2014,8(3):1127-1132.
[42] LI PK,GENG XP,LIU FB,et al. Two cases of undifferentiated embryonal sarcoma of the liver were reported and reviewed[J]. J Hepatobiliary Surg,2010,18(5):399-400.(in Chinese)李培坤,耿小平,刘付宝,等.肝脏未分化胚胎性肉瘤2例报道并文献复习[J].肝胆外科杂志,2010,18(5):399-400.
[43] QIU LL,YU RS,CHEN Y,et al. Sarcomas of abdominal organs:Computed tomography and magnetic resonance imaging findings[J]. Semin Ultrasound CT MR,2011,32(5):405-421.
[44] SHATTAF A,JAMIL A,KHANANI MF,et al. Undifferentiated sarcoma of the liver:A rare pediatric tumor[J]. Ann Saudi Med,2012,32(32):203-205.
[45] MORI A,FUKASE K,MASUDA K,et al. A case of adult undifferentiated embryonal sarcoma of the liver successfully treated with right trisectionectomy:A case report[J]. Surg Case Rep,2017,3(1):19-25.
[2] XIE TH,LYU HL,ZHAO YY,et al. Correlation between CT findings and clinical pathological changes of hepatic hydatid cyst[J]. J Pract Med,2013,29(13):2107-2110.(in Chinese)谢天皓,吕海龙,赵阳阳,等.肝囊性包虫病的CT表现与临床病理改变的相关性研究[J].实用医学杂志,2013,29(13):2107-2110.
[3] SEO JK,KIM SH,LEE SH,et al. Appropriate diagnosis of biliary cystic tumors:Comparison with atypical hepatic simple cysts[J]. Eur J Gastroenterol Hepatol,2010,22(8):989-996.
[4] CHEN JD,XIONG YQ,DONG K,et al. Comparative study of absolute alcohol and lauromacrogol injection in treating pure hepatic cysts[J]. J Clin Ultrasound in Med,2015,17(9):610-613.(in Chinese)陈吉东,熊晏群,董科,等.无水乙醇与聚桂醇注射液治疗单纯性肝囊肿的对比研究[J].临床超声医学杂志,2015,17(9):610-613.
[5] MARRERO JA,AHN J,RAJENDER REDDY K,et al. ACG clinical guideline:The diagnosis and management of focal liver lesions[J]. Am J Gastroenterol,2014,109(9):1328-1347.
[6] ARDITO F,BIANCO G,VELLONE M,et al. Long-term outcome after laparoscopic fenestration of simple liver cysts[J].Surg Endosc,2013,27(12):4670-4674.
[7] WAANDERS E,VENSELAAR H,TE MORSCHE RHM,et al. Secondary and tertiary structure modeling reveals effects of novel mutations in polycystic liver disease genes PRKCSH and SEC63[J].Clin Genet,2010,78(1):47-56.
[8] MASYUK TV,MASYUK AI,LARUSSO NF. Therapeutic targets in polycystic liver disease[J]. Curr Drug Targets,2017,18(8):950-957.
[9] GEVERS TJ,INTHOUT J,CAROLI A,et al. Young women with polycystic liver disease respond best to somatostatin analogues:A pooled analysis of individual patient data[J]. Gastroenterology,2013,145(2):357-365.
[10] WIJNANDS TF,RONOT M,GEVERS TJ,et al. Predictors of treatment response following aspiration sclerotherapy of hepatic cysts:An international pooled analysis of individual patient data[J]. Eur Radiol,2017,27(2):741-748.
[11] YANG J,RYU H,HAN M,et al. Comparison of volume-reductive therapies for massive polycystic liver disease in autosomal dominant polycystic kidney disease[J]. Hepatol Res,2016,46(2):183-191.
[12] BAKOYIANNIS A,DELIS S,TRIANTOPOULOU C,et al. Rare cystic liver lesions:A diagnostic and managing challenge[J].World J Gastroenterol,2013,19(43):7603-7619.
[13] CAROLI A,ANTIGA L,CAFARO M,et al. Reducing polycystic liver volume in ADPKD:Effects of somatostatin analogue octreotide[J]. Clin J Am Soc Nephrol,2010,5(5):783-789.
[14] CHRISPIJN M,GEVERS TJ,HOL JC,et al. Everolimus does not further reduce polycystic liver volume when added to long acting octreotide:Results from a randomized controlled trial[J]. J Hepatol,2013,59(1):153-159.
[15] NG TS,ROCHEFORT H,CZAPLICKI C,et al. Massive pancreatic pseudocyst with portal vein fistula:Case report and proposed treatment algorithm[J]. Pancreatology,2015,15(1):88-93.
[16] BHASIN DK,RANA SS,NANDA M,et al. Endoscopic management of pancreatic pseudocysts at atypical locations[J].Surg Endosc,2010,24(5):1085-1091.
[17] KIM HJ,KIM CY,HUR YH,et al. Peribiliary cysts developed in normal underlying liver:Report of a case[J]. Korean J Hepatobiliary Pancreat Surg,2013,17(3):131-134.
[18] TU J,JIA Z,YING X,et al. The incidence and outcome of major complication following conventional TAE/TACE for hepatocellular carcinoma[J]. Medicine,2016,95(49):e5606.
[19] VALERO V,AMINI N,SPOLVERATO G,et al. Sarcopenia adversely impacts postoperative complications following resection or transplantation in patients with primary liver tumors[J].J Gastrointest Surg,2015,19(2):272-281.
[20] KIM HY,KWON SH,OH JH,et al. Percutaneous transhepatic embolization of a bronchobiliary fistula developing secondary to a biloma after conventional transarterial chemoembolization in a patient with hepatocellular carcinoma[J]. Cardiovasc Intervent Radiol,2016,39(4):628-631.
[21] DHAMIJA E,PAUL SB,GAMANAGATTI SR,et al. Biliary complications of arterial chemoembolization of hepatocellular carcinoma.[J]. Diagn Interv Imaging,2015,96(11):1169-1175.
[22] de JONG EA,MOELKER A,LEERTOUWER T,et al. Percutaneous transhepatic biliary drainage in patients with postsurgical bile leakage and nondilated lntrahepatic bile ducts[J]. Dig Surg,2013,30(4-6):444-450.
[23] ISMAIL H,DEMBOWSKA-BAGINSKA B,BRONISZCZAK DA,et al. Treatment of undifferentiated embryonal sarcoma of the liver in children-single center experience[J]. J Pediatr Surg,2013,48(11):2202-2206.
[24] LIU L,CHEN W,LU X,et al. Pyogenic liver abscess:A retrospective study of 105 cases in an emergency department from East China[J]. J Emerg Med,2017,52(4):409-416.
[25] JOEL JM,JEYASINGH SD,KALYANARAMAN S. Biliary cystadenoma:A case report[J]. J Clin Diagn Res,2016,10(2):19-20.
[26] LIANG X,ZHENG JH,GAO JQ. Advances in diagnosis and treatment of intrahepatic biliary Cystadenoma[J]. Chin J Dig Surg,2018,17(12):1176-1180.(in Chinese)梁霄,郑俊浩,高佳琦.肝内胆管囊腺瘤的诊断与治疗进展[J].中华消化外科杂志,2018,17(12):1176-1180.
[27] CHENG PR,SU Y. A case of intrahepatic biliary cysta-denoma[J]. J Clin Hepatol,2018,34(6):1292-1293.(in Chinnese)程鹏瑞,苏洋.肝内胆管囊腺瘤1例报告[J].临床肝胆病杂志,2018,34(6):1292-1293.
[28] CHEN YW,LI CH,LIU Z,et al. Surgical management of biliary cystadenoma and cystadenocarcinoma of the liver[J].Genet Mol Res,2014,13(3):6383-6390.
[29] NAKANUMA Y,ZEN Y,HARADA K,et al. Tumorigenesis and phenotypic characteristics of mucin-producing bile duct tumors:An immunohistochemical approach[J]. J Hepatobiliary Pancreat Sci,2010,17(3):211-222.
[30] WANG MQ,DUAN F,LIU FY,et al. Treatment of symptomatic polycystic liver disease:Transcatheter super-selective hepatic arterial embolization using a mixture of NBCA and iodized oil[J]. Abdom Imaging,2013,38(3):465-473.
[31] DEMEUSY A,HOSSEINI M,SILL AM,et al. Intrahepatic pancreatic pseudocyst:A review of the world literature[J]. World J Hepatol,2016,8(35):1576-1583.
[32] WANG ZX,LI YG,WANG RL,et al. Clinical classification of Caroli's disease:An analysis of 30 patients[J]. HPB(Oxford),2015,17(3):278-283.
[33] CAO D,XIN JJ,CHEN YP. An asymptomatic case of Caroli disease[J]. J Clin Hepatol,2018,34(6):1296-1297.(in Chinese)曹丹,辛杰晶,陈延平.无症状Caroli病1例报告[J].临床肝胆病杂志,2018,34(6):1296-1297.
[34] CHEN CB,HU WD,ZHAO WW,et al. Laparoscopic hepatectomy for the treatment of Caroli’s disease:A case report[J].Ann Surg Treat Res,2018,94(3):162-165.
[35] SONG JS,LEE YJ,KIM KW,et al. Cholangiocarcinoma arising in von Meyenburg complexes:Report of four cases[J].Pathol Int,2008,58(8):503-512.
[36] SONG SF,SUN XD,LUO FX,et al. Progress in diagnosis and treatment of intrahepatic cholangiocystadenocarcinoma[J/CD]. Chin J Hepatic Surg:Electronic Edition,2018,7(1):8-11.(in Chinese)宋世飞,孙晓东,骆飞翔,等.肝内胆管囊腺癌的诊治进展[J/CD].中华肝脏外科手术学电子杂志,2018,7(1):8-11.
[37] XU MY,SHI XJ,WAN T,et al. Clinicopathological characteristics and prognostic factors of intrahepatic biliary cystadenocarcinoma[J]. Chin Med J,2015,128(9):1177-1183.
[38] HEYWOOD G,van BUREN SF,SMYRK T,et al. Multilocular cystic hepatocellular carcinoma(CHCC)mimicking mucinous cystadenocarcinoma[J]. Hepatogastroenterology,2003,50(50):368-370.
[39] ZHENG BO,ZHU YJ,WANG HY,et al. Gender disparity in hepatocellular carcinoma(HCC):Multiple underlying mechanisms[J]. Sci China Life Sci,2017,60(6):575-584.
[40] DONG JH,AN WM,MA W,et al. Primary hepatic malignant fibrous histiocytoma mimicking hepatocellular carcinoma:A report of two cases[J]. Oncol Lett,2014,8(5):2150-2154.
[41] HE B,XU KY,HUANG KT,et al. Undifferentiated embryonal liver sarcoma in childhood:A case report[J]. Oncol Lett,2014,8(3):1127-1132.
[42] LI PK,GENG XP,LIU FB,et al. Two cases of undifferentiated embryonal sarcoma of the liver were reported and reviewed[J]. J Hepatobiliary Surg,2010,18(5):399-400.(in Chinese)李培坤,耿小平,刘付宝,等.肝脏未分化胚胎性肉瘤2例报道并文献复习[J].肝胆外科杂志,2010,18(5):399-400.
[43] QIU LL,YU RS,CHEN Y,et al. Sarcomas of abdominal organs:Computed tomography and magnetic resonance imaging findings[J]. Semin Ultrasound CT MR,2011,32(5):405-421.
[44] SHATTAF A,JAMIL A,KHANANI MF,et al. Undifferentiated sarcoma of the liver:A rare pediatric tumor[J]. Ann Saudi Med,2012,32(32):203-205.
[45] MORI A,FUKASE K,MASUDA K,et al. A case of adult undifferentiated embryonal sarcoma of the liver successfully treated with right trisectionectomy:A case report[J]. Surg Case Rep,2017,3(1):19-25.