目的報(bào)告8例肝血管平滑肌脂肪瘤的影像學(xué)特征及病理學(xué)特點(diǎn)，探討其診斷與治療方法。方法對(duì)8例經(jīng)手術(shù)及病理證實(shí)的肝血管平滑肌脂肪瘤的術(shù)前影像學(xué)表現(xiàn)（B超、CT、MRI、99mTcPMT）、手術(shù)情況及病理特點(diǎn)進(jìn)行分析。結(jié)果B超： 腫瘤呈強(qiáng)回聲光團(tuán)6例，低回聲光團(tuán)2例； 邊界清楚7例，血供豐富、內(nèi)部回聲不均勻4例，其中1例內(nèi)部呈分隔網(wǎng)狀結(jié)構(gòu)。彩色Doppler超聲示腫瘤血供豐富，均測(cè)及動(dòng)脈頻譜，阻力指數(shù)為0.4～0.5。靜脈造影示腫瘤內(nèi)血流信號(hào)明顯增加。CT： 平掃示腫瘤呈低密度影7例，不均勻5例，邊界清楚7例，腫瘤內(nèi)見(jiàn)軟組織影2例，脂肪成分2例。增強(qiáng)掃描示動(dòng)脈期明顯強(qiáng)化，門脈期及延遲期逐漸呈低密度。MRI: 腫瘤呈短T1、長(zhǎng)T2信號(hào)，增強(qiáng)后強(qiáng)化明顯，脂肪抑制后短T1變成長(zhǎng)T1。99mTcPMT示腫瘤呈放射性增強(qiáng)，5 min相腫塊區(qū)呈放射性缺損，2 h、5 h延遲相腫塊區(qū)未見(jiàn)放射性填充，肝血池相腫塊呈放射性填充。病理及免疫組化： 腫瘤由成熟的脂肪、血管及平滑肌組成，HMB45陽(yáng)性。術(shù)前確診3例。結(jié)論B超示強(qiáng)回聲光團(tuán)，CT呈低密度影中出現(xiàn)軟組織影、脂肪成分，增強(qiáng)明顯，MRI出現(xiàn)脂肪信號(hào)，脂肪抑制后短T1變成長(zhǎng)T1，增強(qiáng)明顯。99mTcPMT示腫瘤呈放射性增強(qiáng)，5 min相呈放射性缺損，延遲相未見(jiàn)放射性填充，肝血池相呈放射性填充。這些是肝血管平滑肌脂肪瘤的影像學(xué)特點(diǎn)，結(jié)合病史可作出診斷。此病應(yīng)盡早手術(shù)治療，行肝部分切除術(shù)。最后確診依靠病理檢查及免疫組化分析。
引用本文： 黃剛,馬曾辰,欽倫秀,孫惠川,湯釗猷,張連海,張建平. 肝血管平滑肌脂肪瘤的診斷與治療. 中國(guó)普外基礎(chǔ)與臨床雜志, 2002, 9(6): 439-440. doi: 復(fù)制
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- 2. Ahmadi T, Itai Y, Takahashi M, et al. Angiomyolipoma of the liver: significance of CT and MR dynamic study [J]. Abdom Imaging,1998; 23(5)∶520.
- 3. Tsui WM, Colombari R, Portmann BC, et al. Hepatic angiomyolipoma: a clinicopathologic study of 30 cases and delineation of unusual morphologic variants [J]. Am J Surg Pathol， 1999; 23(1)∶34.
- 4. 蔡中瓊，黃剛. 多發(fā)性子宮肌瘤合并肝血管平滑肌脂肪瘤1例 [J]. 國(guó)際中華臨床醫(yī)學(xué)雜志，2001; 2（2～3）∶147.
- 5. Nonomura A, Minato H, Kurumaya H. Angiomyolipoma predominantly composed of smooth muscle cells:problems in histological diagnosis [J]. Histopathology， 1998; 33(1)∶20.
- 6. Nonomura A, Mizukami Y, Takayanagi N, et al. Immunohistochemical study of hepatic angiomyolipoma [J]. Pathol Int，1996; 46(1)∶24.
- 7. Messiaen T, Lefebvre C, Van Beers B, et al. Hepatic angiomyo(myelo)lipoma: difficulties in radiological diagnosis and interest of fine needle aspiration biopsy [J]. Liver，1996; 16(5)∶338.
- 8. Yeh HC,Klion FM.Angiomyolipoma: ultrasonographic signs of lipomatous Hepatic tumor [J].J Ultrasound Med，1996; 15(4)∶337.
- 9. Murakami T, Nakamura H, Hori S, et al. Angimyolipoma of the liver. Ultrasound, CT, MRI imaging and angiography [J]. Acta Radiol，1993; 34(4)∶392.
- 10. Ukai K, Fuji A, Nishiwaki J, et al. Giant hepatic angiomyolipoma associated with disseminated intra vascular coagulation [J]. Intern Med，1997; 36(3)∶186.