肝脏血管平滑肌脂肪瘤的诊断与治疗  

The diagnosis and treatment of hepatic aniomyolipoma

作　　者：胡雷[1] 尉公田[1] 孙延富[1] 张友磊[1] 王义[1] 

机构地区：[1]第二军医大学附属东方肝胆外科医院肝外二科,上海200438

出　　处：《肝胆胰外科杂志》2010年第4期279-283,共5页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的总结肝脏血管平滑肌脂肪瘤(HAML)的临床、影像学和病理学特点以及治疗方法。方法对1999年12月至2007年12月间我院治疗的110例HAML患者的临床资料进行回顾性分析。所有患者均行B超检查,多数患者同时行CT或MRI检查。所有患者均行肝切除术,经病理及免疫组化明确诊断并随访至今。结果 110例患者中女80例,男30例,年龄25～68岁,多数(86/110)无明显临床症状。肿瘤长径平均5.9 cm。B超多表现为不均质高回声光团;部分患者CT、MRI见动脉期病灶明显强化,门脉期仍有不同程度强化。病理学检查证实肿瘤由脂肪组织、厚壁血管及平滑肌细胞以不同比例构成。免疫组化结果HMB45(107/110)、SMA(109/110)、CD117(43/60)、CD34(40/60)表达阳性。所有病例随访无复发。结论由于HAML影像学表现多样,术前往往不易明确诊断,大部分患者通过术后病理及免疫组化明确诊断,HMB-45和SMA阳性是HAML的病理学特征。治疗上目前仍以手术切除肿瘤为首选,疗效满意。Objective To study the clinical,imaging and pathological features and the treatment of hepatic aniomyolipoma（HAML）.Methods Data of 110 HAML cases treated at our hospital from December 1999 to December 2007 were retrospectively analyzed.All cases received liver resection after the imaging examinations（all underwent type-B ultrasonography,and most underwent CT/MRI）,proved by pathology and immunohistochemistry,and were followed up till now.Results There was marked female predominance（80）,age 25~68,and most of the patients（86/110） had no symptoms.Average tumor diameter was 5.9 cm.Most cases showed heterogeneous high echo in type-B ultrasonography.Some cases showed the tumors as markedly enhanced on arterial phase,moderately and slightly enhanced on portal venous and（or） delayed phase.Pathological1y,all tumors were composed of adipose tissue,blood vessel cells and smooth muscle cells in different proportions.Immunohistochemistry showed that most cases were positive for HMB45（107/110）,SMA（109/110）,CD117（43/ 60） and CD34（40/60） expression.Follow up study showed a benign course and no signs of recurrence.Conclusion HAML usually shows various patterns in imaging studies,and preoperative radiological diagnosis is difficult.Definitive diagnosis of HAML depends on the pathohistological findings,HMB-45 and SMA positive staining of myoid cells has been used as a pathologic characteristic of HAML.Surgical resection is effective for HAML treatment.

关 键 词：肝肿瘤 血管平滑肌脂肪瘤 诊断 治疗 肝切除术 

分 类 号：R735.7[医药卫生—肿瘤]