Tratamiento quirúrgico de las lesiones focales de hígado
Surgical treatment of focal liver lesions
Palabras clave:
hígado, lesión focal, tumores hepáticos, resección hepática, tumores benignos, tumores malignos, focal lesion, liver tumors, liver resection, benign tumors, malignant tumors
Resumen
La lesión focal hepática se define como una formación de contenido sólido o líquido que no forma parte de la anatomía normal del hígado. Es de naturaleza muy variada y comprende desde lesiones benignas de curso indolente hasta tumores malignos de naturaleza agresiva. El uso de pruebas de imágenes es fundamental para estas lesiones, lo que genera que sean diagnosticadas de manera incidental mucho más frecuentemente. Entre los tumores benignos se destacan el adenoma hepatocelular, el hemangioma hepático, la hiperplasia nodular focal; y entre los tumores malignos el hepatocarcinoma y el colangiocarcinoma. Es difícil generalizar e incluir un manejo para todos los tumores benignos, excluyendo a los adenomas hepáticos, que casi siempre tienen indicación quirúrgica. La ventaja de realizar cirugía en estos tumores es que al no tener que dejar márgenes oncológicos es menos el tejido sano resecado, con menos riesgo de insuficiencia hepática y complicaciones en general, además que los tiempos de isquemia son menores. En cuanto a los tumores malignos, la cirugía es el pilar del tratamiento, generalmente requiriendo cirugías hepáticas mayores, y los tumores se pueden resecar sólo si se puede preservar suficiente parénquima hepático con un flujo de entrada y salida vascular ybiliar adecuado; para los colangiocarcinomas la resección hepática logrando márgenes negativos es potencialmente curativa. La cirugía laparoscópica para resecciones hepáticas menores muestra claros beneficios perioperatorios sobre la cirugía abierta de hígado con un nivel de evidencia moderada a alta.
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Ros PR, Mortele KJ. Hepatic imaging. An overview. Clin Liver Dis 2002; 6: 1 – 16.
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Bioulac-Sage P, Taouji S, Possenti L et al. Hepatocellular adenoma subtypes: the impact of overweight and obesity. Liver Int 2012; 32: 1217 – 21.
Farges O, Ferreira N, Dokmak S et al. Changing trends in malignant transformation of hepatocellular adenoma. Gut 2011; 60: 85 – 9.
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Shaked O, Siegelman ES, Olthoff K e t al. Biologic and clinical features of benign solid and cystic lesions of the liver. Clin Gastroenterol Hepatol 2011; 9: 547 – 62 e1-4.
Laumonier H, Bioulac-Sage P, Laurent C e t al. Hepatocellular adenomas: magnetic resonance imaging features as a function of molecular pathological classification. Hepatology 2008; 48:808 – 18.
Cho SW, Marsh JW, Steel J et al. Surgical management of hepatocellular adenoma: take it or leave it? Ann Surg Oncol 2008; 15: 2795 – 803.
Ribeiro Junior MA, Chaib E, Saad WA et al. Surgical management of spontaneous ruptured hepatocellular adenoma. Clinics (Sao Paulo) 2009; 64: 775 – 9.
Maoz D, Sharon E, Chen Y et al. Spontaneous hepatic rupture: 13-year experience of a single center. Eur J Gastroenterol Hepatol 2010; 22: 997 – 1000.
Papanikolaou V, Giakoustidis D, Patsiaura K et al. Management of a giant ruptured hepatocellular adenoma. Report of a case. Hippokratia 2007; 11: 86 – 8.
Bioulac-Sage P, Laumonier H, Couchy G e t al. Hepatocellular adenoma management and phenotypic classification: the Bordeaux experience. Hepatology 2009; 50 : 481 – 9.
Foster JH, Berman MM. The malignant transformation of liver cell adenomas. Arch Surg 1994; 129: 712 – 7.
Leese T, Farges O, Bismuth H. Liver cell adenomas. A 12-year surgical experience from a specialist hepato-biliary unit. Ann Surg 1988; 208: 558 – 64.
Gandolfi L, Leo P, Solmi L, Vitelli E, Verros G, Colecchia A. Natural history of hepatic haemangiomas: clinical and ultrasound study. Gut 1991;32: 677–680.
Bahirwani R, Reddy KR. Review article: the evaluation of solitary liver masses. Aliment Pharmacol Ther 2008;28:953–965.
Glinkova V, Shevah O, Boaz M, Levine A, Shirin H. Hepatic haemangiomas: possible association with female sex hormones. Gut 2004;53:1352–1355.
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Publicado
2021-07-22
Cómo citar
Al Awad Jibara, A., Ramirez, A. J., & Valera García, V. G. (2021). Tratamiento quirúrgico de las lesiones focales de hígado: Surgical treatment of focal liver lesions. Revista Profesional HígadoSano, (21), 46-63. https://doi.org/10.5281/zenodo.5120870
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