肝脏血管平滑肌脂肪瘤169例临床分析  

Clinical study of 169 patients with hepatic angiomyolipoma

作　　者：余锋 王葵[1] 闫振林[1] 张小峰[1] 李俊[1] 董辉[3] 丛文铭 施乐华[1] 沈锋[1] 吴孟超[1] 

机构地区：[1]第二军医大学东方肝胆外科医院综合治疗一科,上海200438 [2]解放军第一0一中心医院肝胆外科 [3]第二军医大学东方肝胆外科医院病理科,上海200438

出　　处：《中华外科杂志》2010年第21期1621-1624,共4页Chinese Journal of Surgery

摘　　要：目的 总结和探讨肝脏血管平滑肌脂肪瘤的诊断方法和治疗原则.方法 对1992年1月至2010年5月收治的169例肝脏血管平滑肌脂肪瘤患者的临床表现、诊断方法、治疗方法和随访资料进行回顾性分析.其中男性46例,女性123例,男女比例1∶2.7 年龄17～73岁,中位年龄45岁 病史2 d～16年,平均0.54年.结果 本组169例患者中,96例（56.8%）肿瘤见于肝右叶,149例（88.2%）呈单发.术前确诊率为13.6%,119例（70.4%）术前误诊为原发性肝癌或肝海绵状血管瘤.MRI鉴别肿瘤良恶性的准确率高于CT（x2=5.508,P=0.019）.168例患者行手术切除,1例行经皮肝穿刺微波热凝术.1例术后肝创面出血,3例术后胸腔内大量积液,无围手术期死亡发生.所有患者术后病理学诊断均证实为肝脏血管平滑肌脂肪瘤.全组随访未见复发和转移.结论 MRI是诊断肝脏血管平滑肌脂肪病瘤的主要方法.治疗主要取决于肿瘤的大小、部位和生长速度等,肿瘤最大径＞5 cm、有临床症状、肝肿瘤位于肝中叶或尾状叶及生长速度较快者,均应手术切除.Objective To review and investigate the optimal preoperative diagnostic means and treatment principles of hepatic angiomyolipoma （HAML）. Methods The clinical features, treatment,prognostic and follow-up data of 169 HAML patients treated between January 1992 and May 2010 were retrospectively analyzed. The median age of the patients,including 46 male and 123 female （male/female, 1/2. 7）,was 45 years （range, 17-73 years）. The mean case history was 0. 54 year with a range of 2 d to 16 years. Results Among the 169 patients, 149 patients （ 88.2% ） had a solitary tumor and 96 patients （56. 8% ） were detected in the right lobe. The overall preoperative diagnostic rate was 13.6% and 119 patients （70. 4% ） were misdiagnosed as hepatocellular carcinoma or hepatic cavernous hemangioma. The diagnostic accuracy of MRI is higher than CT in distinguishing the nature of the tumor （x2 = 5. 508,P = 0. 019 ）. One hundred and sixty-eight patients received surgical resection and one received percutaneous microwave coagulation therapy. One patient occurred postoperative hemorrhage and 3 patients developed hydrothorax. The postoperative mortality and recurrence for all the patients were 0. Postoperative pathology confirmed the diagnosis of hepatic angiomyolipoma. Follow-up study showed a benign course and no signs of recurrence. Conclusions MRI is the main diagnostic means of HAML. Treatment strategies of HAML depends largely on tumor size,location and growth rate. Surgical management is suggested to patients with the following criteria： （ 1 ） tumor size greater than 5 cm （2） with clinical symptoms （3） faster tumor growth （4）the tumor located at 1,4,5,8 segments of liver.

关 键 词：肝肿瘤 脂肪瘤 肌 平滑 血管 诊断 

分 类 号：R686[医药卫生—骨科学]