探讨肝脂肪瘤临床诊治特点及预后。

回顾性分析2023年11月昆明医科大学第二附属医院就诊的1例肝脂肪瘤患者临床资料。患者男，32岁，体检发现肝脏占位入院。查体：腹部正常。血常规、血液生化、凝血功能、AFP正常，CA50升高。腹部超声示肝肾间隙高回声区；超声造影示病灶早期呈不均匀稍低增强，晚期呈低增强。腹部增强CT示肝右后叶包膜下脂肪密度影。MRI示肝右后叶肝包膜下类圆形长T1、长T2信号影，无强化；脾脏明显增大，实质信号未见异常，无强化。MRCP示肝内外胆管无扩张。复习肝脂肪瘤相关文献并总结诊治经验。

术前诊断为肝包膜下脂肪瘤。患者不明原因脾大，地中海贫血基因检测报告示654位点突变的β-地中海贫血，叶酸降低（2.69 ng/ml）。术前血液科协助诊治，考虑β-地中海贫血，无须脾脏切除。于2023年11月30日行开腹肝右后叶切除，肝右后叶7 cm×3 cm×2 cm肿物，质地稍硬，脂肪瘤样改变。术后病理学诊断为肝脂肪瘤。术后血红蛋白进行性降低，排除手术后继发性出血可能，考虑β-地中海贫血所致，输注悬浮红细胞纠正贫血。患者恢复良好，无胆漏、腹腔感染、肝衰竭和切口感染等相关并发症发生。

肝脂肪瘤是来源于间叶组织的少见良性肿瘤，恶变发生率低。对于肝脂肪瘤的诊断与鉴别，应结合患者的临床表现、影像学检查和组织病理学特征进行综合考虑，积极手术切除仍然是最佳的治疗方案，预后良好。

To investigate the clinical diagnosis and treatment characteristics and prognosis of hepatic lipoma.

Clinical data of a 32-year-old male patient with hepatic lipoma admitted to Department of Hepatobiliary and Pancreatic Surgery of the Second Affiliated Hospital of Kunming Medical University in November 2023 were retrospectively analyzed. He was hospitalized due to a liver-occupying mass during physical examination. Physical examination revealed nontender abdomen. Complete blood count, blood biochemistry, coagulation function and AFP level was detected normal, while CA50 level was increased. Abdominal ultrasound showed hyperechoic area in the space between liver and kidney. Contrast-enhanced ultrasound revealed that the lesions showed uneven and slight hypoenhancement in the early stage and hypoenhancement in the late stage. Abdominal contrast-enhanced CT showed subcapsular fat density shadow in the right posterior lobe of liver. MRI showed round-like long T1 and long T2 signal shadows in the subcapsular area of the right posterior lobe, without enhancement. Spleen was significantly enlarged. No abnormality was found in parenchymal signals, and no enhancement was observed. MRCP showed no dilatation was seen in the intra-and extra-hepatic bile ducts. Literature review about liver lipoma was conducted and the experience of diagnosis and treatments was summarized.

Preoperatively, the patient was diagnosed with subcapsular lipoma. He showed unexplained splenomegaly. Genetic test revealed β-thalassemia with 654 site mutation, and the folic acid level was decreased (2.69 ng/ml). Preoperatively, Department of Hematology assisted the diagnosis and treatment. The possibility of β-thalassemia was considered. No splenectomy was required. On November 30, 2023, a 7 cm×3 cm×2 cm mass with slightly hard texture and lipomatous changes of the right posterior lobe was resected. Postoperative pathological examination confirmed the diagnosis of hepatic lipoma. Postoperatively, hemoglobin level was progressively decreased. The possibility of postoperative secondary bleeding was excluded, which was considered to be induced by β-thalassemia. Transfusion of suspended red blood cells was given to treat anemia. The patient was recovered well without bile leakage, abdominal infection, liver failure or incision infection.

Hepatic lipoma is a rare benign tumor derived from mesenchymal tissues, and the incidence of malignancy is low. The diagnosis and differential diagnosis of hepatic lipoma should be made by comprehensively considering clinical manifestations, imaging examination and histopathological characteristics of patients. Active surgical resection remains the optimal treatment with favorable prognosis.