What Is Adenoma Surgery?

Hepatic adenoma, also called hepatocellular adenoma (HCA), is a rare benign tumor of the liver. Reports of hepatic adenomas have gradually increased since the 1960s and may be related to the increased use of contraceptives. It has been reported that the incidence of the disease among people taking long-term contraceptives is (3 ~ 4) / 10000, while the incidence of the disease is only 1/1000000 in women who have not taken contraceptives and who have taken contraceptives for less than 2 years. Among benign liver tumors, the incidence of hepatic adenoma is second only to hepatic hemangioma.

Basic Information

English name

adenoma of liver

Visiting department

Hepatobiliary surgery

Multiple groups

Young women

Common causes

Closely related to oral contraceptives

Common symptoms

Asymptomatic or dull right upper quadrant, with nausea, anorexia, etc.

Causes of liver adenoma

The true cause of this disease is unknown, and it is believed that its occurrence is closely related to oral contraceptives: more than 90% of patients with hepatic adenomas occur in young women, and at least 75% of patients have a history of taking contraceptives, and are over 30 years old Women who take contraceptives have an increased risk of disease; the incidence of hepatic adenomas is directly related to the time and dose of contraceptives taken; postmenopausal women rarely have hepatic adenomas, and hepatic adenomas that occur in men may be related to Diabetes, glycogen storage disease and the use of androgens.

Clinical manifestations of hepatic adenoma

Clinical manifestations vary with tumor size, location, and the presence or absence of complications. 5% to 10% are asymptomatic and found by accident during physical examination or surgery. Approximately one-third of patients with hepatic adenomas have abdominal masses and recent right upper quadrant pain may be dull, with discomfort such as nausea and anorexia; but when the tumor ruptures and bleeds, the patient may experience sudden right upper quadrant drama Pain, physical examination can be found abdominal muscle tension, local tenderness, rebound pain, severe cases may have the performance of hemorrhagic shock; jaundice and fever occasionally, should be noted by clinicians that HCA not only has a tendency to rupture and bleeding, but also There is also the potential for malignant transformation into hepatocellular carcinoma.

Abdominal mass

This type is more common. Except for the upper abdominal mass, patients often have no symptoms. The tumor can be affected during physical examination. The surface is smooth, hard, and there is no tenderness. The mass moves up and down with breathing. If it is a cystadenoma, there may be a cystic sensation at palpation. When the mass gradually increases and compresses the adjacent organs, symptoms such as abdominal fullness, discomfort, nausea, and epigastric pain may occur.

2. Acute abdomen type

Adenomas are supplied by separate arteries. The arteries are generally not supported by connective tissue. Intratumoral bleeding often occurs, sometimes leading to rupture of the capsule. Patients with intratumoral bleeding may have sudden right upper quadrant pain, accompanied by nausea, vomiting, fever, etc. At the time of physical examination, there may be tension and tenderness in the right upper quadrant muscle and rebound pain. Often they are misdiagnosed as acute cholecystitis and undergo surgery. The liver glands are only found during the operation. Tumor, intratumoral bleeding caused by tumor rupture, patients may have severe right upper quadrant pain, abdominal tenderness and rebound peritoneal irritation symptoms, severe cases can cause shock due to excessive bleeding.

Liver adenoma diagnosis

For the mass of the right upper abdomen that slowly increases, usually without symptoms, or only slight dull pain, epigastric pain, nausea, etc., nodules of varying size are found during physical examination, and the surface is smooth and hard, without tenderness. Up and down activities should consider the possibility of this disease. For patients with long-term masses in the right upper abdomen, when sudden severe pain in the right upper abdomen or signs of intra-abdominal bleeding occur, the possibility of adenoma rupture should be considered. If the above manifestation is a married female patient and has a long history of oral contraceptives, it is of reference value for the diagnosis of this disease.

Liver adenoma treatment

Anyone who has been diagnosed as having a hepatic adenoma through examination of a space-occupying lesion in the liver should strive for surgical treatment as soon as possible, whether or not it is symptomatic. Because of oral contraceptives, the possibility of malignant changes in hepatocellular adenoma cannot be ruled out. The diagnosis should be surgically resected, and those who cannot be surgically avoided pregnancy. Urgent surgery is required when the tumor is ruptured. The hepatic artery can be clamped to stop bleeding. If the tumor cannot be removed because it is located in the hilar or adjacent large vessels and bile ducts, the hepatic artery or one hepatic artery should be ligated or embolized. There are several methods of surgery:

Tumor resection

When the tumor invades part of the liver, wedge resection can be performed together with part of the liver tissue. When the tumor is near the first and second hepatic hilum and cannot be completely resected, intravesical ablation is feasible, but it is easy to relapse after surgery. It is not possible to exclude malignant patients and try not to use this surgery.

Lobectomy

When the tumor invades a lobe or hepatic liver, hepatic lobe or hepatectomy is feasible, but the general condition is not good. Patients with liver cirrhosis should be cautious when performing hepatic lobe or hepatectomy.

3. Hepatic artery ligation

The tumor is located deep in the first and second hepatic hilums. When the adjacent large blood vessels and bile ducts or the tumor is tightly adhered to adjacent organs and cannot be easily separated to remove the tumor, the natural hepatic artery or one hepatic artery can be ligated to reduce the Blood supply and prevent rupture bleeding.