肝脏血管平滑肌脂肪瘤的诊断与治疗  

Diagnosis and treatment of hepatic angiomyolipoma

作　　者：胡伟杲[1] 傅思源[1] 李爱军[1] 潘泽亚[1] 周伟平[1] 黄罡[1] 杨远[1] 吴孟超[1] 

机构地区：[1]第二军医大学东方肝胆外科医院肝外三科,上海200438

出　　处：《中华消化外科杂志》2010年第2期127-129,共3页Chinese Journal of Digestive Surgery

基　　金：上海市杨浦区卫生局基金资助课题

摘　　要：目的总结肝脏血管平滑肌脂肪瘤的临床、影像及病理特征，探讨提高术前确诊率的途径。方法回顾性分析2000年至2007年第二军医大学东方肝胆外科医院收治并经病理检查证实的73例肝脏血管平滑肌脂肪瘤患者的影像学特点及诊治经验。根据影像学特点对患者进行分型并进行相应治疗。结果术前确诊7例。B超检查诊断率为0，CT检查诊断率为13％（7／56），MRI检查诊断率为6％（2／33）。根据影像学检查结果分型：血管瘤型6例，脂肪瘤型17例，平滑肌瘤型4例，混合型46例。手术切除72例，RFA治疗1例。24例患者出现肺部感染、胸腔和腹腔积液、轻度肝功能损害。术后免疫组织化学检测阳性率依次为：HMB45〉平滑肌肌动蛋白〉波形蛋白〉增殖细胞核抗原〉CD34〉癌胚抗原蛋白〉CD18〉CD19〉p53。1例术后因复发死亡。结论肝脏血管平滑肌脂肪瘤易误诊，影像学分型有助于术前正确诊断，治疗上应积极手术切除。Objective To study the clinical, imaging and pathological features of hepatic angiomyolipoma, and to investigate methods in improving the preoperative diagnosis rate. Methods The imaging features and treatment experience of 73 patients with hepatic angiomyolipoma who had been admitted to the Eastern Hepatobiliary Surgery Hospital from 2000 to 2007 were retrospectively analyzed. All patients were classified according to the imaging features and corresponding treatments were applied. Results Of all patients, 7 were diagnosed preoperatively. The diagnostic rate of B ultrasound, computed tomography and magnetic resonance imaging were 0, 13% （7/56） and 6% （2/33）, respectively. According to the results of imaging examination, 6 patients were with the type of hemangioma, 17 with the type of lipoma, 4 with the type of leiomyoma and 46 with mixed type. One patient was treated by radiofrequency ablation and 72 by surgical resection. Twenty-four patients were presented with pulmonary infection, pleural effusion, ascites or slight hepatic dysfunction. Postoperative immunohistochemical assay demonstrated that HMB45 had the highest positive expression rate, then followed by smooth muscle actin, vimentin, proliferating cell nuclear antigen, CD34, polyclonal carcinoembryonic antigen, CDI8, CD19 and p53. One patient died of postoperative tumor recurrence. Conclusions Hepatic angiomyolipoma is easy to be misdiagnosed, while imaging classification is helpful in the diagnosis. Surgical resection is beneficial to patients with hepatic angiomyolipoma.

关 键 词：肝肿瘤 血管平滑肌脂肪瘤 肝切除术 影像学 诊断 

分 类 号：R735.7[医药卫生—肿瘤]