肝血管平滑肌脂肪瘤的诊断和治疗  

DIAGNOSIS AND TREATMENT OF LIVER ANGIOMYOLIPOMA

作　　者：崔健[1] 周信达[1] 钦伦秀[1] 樊嘉[1] 吴志全[1] 马曾辰[1] 汤钊猷[1] 

机构地区：[1]上海医科大学中山医院肝癌研究所,上海200032

出　　处：《肝胆外科杂志》1999年第6期415-417,共3页Journal of Hepatobiliary Surgery

摘　　要：目的　研究肝血管平滑肌脂肪瘤 ( angiomyolipoma,AML)临床、影像学、病理学特点 ,探讨如何降低本病误诊和漏诊率及提高外科疗效。方法　经病理证实的 AML9例。所有病人术前均接受 CT及 B超检查 ,部分病人还行彩色多普勒、MRI及血管造影。术前 3例临床诊断为原发性肝癌 ,1例为肝脂肪肉瘤 ,2例为 AML,3例为血管瘤。所有病人均行肝切除并随访至今。结果　剖腹探查发现肿瘤大多 ( 6/ 9)位于右肝 ,界限清晰 ,部分肿瘤有包膜。组织学检查显示肿瘤由脂肪细胞、梭形平滑肌样细胞及管壁异常增厚的小血管构成。9例中 2例病理曾诊断为原发性肝癌 ,1例诊断为肝腺瘤。HMB- 4 5单克隆抗体免疫组化检测发现全部肿瘤平滑肌样细胞均呈阳性反应。结论　肝 AML可能比以往认为的常见 ,易误诊。HMB- 4 5作为特异性免疫组化标记物对诊断有一定价值。对肝Objective To study the clinical,imaging and pathological features of liver angiomyolipoma(AML),decrease the possibility of misdiagnosis and discuss the outcome of surgical treatment for patients liver AML with.Methods Nine cases with liver angiomyolipoma which diagnosis was idenfified by pathology were collected for the study.B-ultrasongraphy and dynamic CT examination were carried out for all the patients.MRI,color doppler-sonography (CD-SO) and angiography were also done for some patints.for these patients,the diagnosis of hepatocellular carcinoma was considered in three cases,liposarcoma for one,angiomyolipoma for two,and haemangioma for three,prospectively.Surgical exploration and hepatic resection were performed for all the patients who have been followed up till now. Results Most tumors(6/9)were located in right lobe.All the tumors were well-circumscribed with or without capsulate.Histological observations showed that the tumor was composeal of myoid cells,adipose cells and abnormal thick-walled vessels.Erroneous pathological diagnosis was cocurred in three patients (two was hepatocellular carcinoma and one was hepatocellular adenoma).In all cases,immunohistochemical results showed that the myoid cells were positive for HMB-45. Conclusions Liver angiomyolipoma may be more common than what we have thought before.Many cases would have been misdiagnosed as other liver diseases.Immunohistochemical marker HMB-45 was great value for the diagnosis.For AML patients,surgical resection could get good results.

关 键 词：平滑肌脂肪瘤 诊断 肝肿瘤 AML 外科手术 

分 类 号：R735.7[医药卫生—肿瘤]