• 1.武警廣東總醫(yī)院肝膽外科（廣州510507）;;
  • 2.上海醫(yī)科大學中山醫(yī)院（上海200032）;

目的報告8例肝血管平滑肌脂肪瘤的影像學特征及病理學特點，探討其診斷與治療方法。方法對8例經手術及病理證實的肝血管平滑肌脂肪瘤的術前影像學表現(xiàn)（B超、CT、MRI、99mTcPMT）、手術情況及病理特點進行分析。結果B超： 腫瘤呈強回聲光團6例，低回聲光團2例； 邊界清楚7例，血供豐富、內部回聲不均勻4例，其中1例內部呈分隔網狀結構。彩色Doppler超聲示腫瘤血供豐富，均測及動脈頻譜，阻力指數(shù)為0.4～0.5。靜脈造影示腫瘤內血流信號明顯增加。CT： 平掃示腫瘤呈低密度影7例，不均勻5例，邊界清楚7例，腫瘤內見軟組織影2例，脂肪成分2例。增強掃描示動脈期明顯強化，門脈期及延遲期逐漸呈低密度。MRI: 腫瘤呈短T1、長T2信號，增強后強化明顯，脂肪抑制后短T1變成長T1。99mTcPMT示腫瘤呈放射性增強，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，HMB45陽性。術前確診3例。結論B超示強回聲光團，CT呈低密度影中出現(xiàn)軟組織影、脂肪成分，增強明顯，MRI出現(xiàn)脂肪信號，脂肪抑制后短T1變成長T1，增強明顯。99mTcPMT示腫瘤呈放射性增強，5 min相呈放射性缺損，延遲相未見放射性填充，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特點，結合病史可作出診斷。此病應盡早手術治療，行肝部分切除術。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. 中國普外基礎與臨床雜志, 2002, 9(6): 439-440. doi: 復制

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  1. 1. Chang JC, Lee YW, Kim HJ. Preoperative diagnosis of angiomyolipoma of the liver [J]. Abdom Imaging, 1994; 19(6)∶546.
  2. 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. 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. 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]. 國際中華臨床醫(yī)學雜志，2001; 2（2～3）∶147.
  5. 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. 6. Nonomura A, Mizukami Y, Takayanagi N, et al. Immunohistochemical study of hepatic angiomyolipoma [J]. Pathol Int，1996; 46(1)∶24.
  7. 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. 8. Yeh HC,Klion FM.Angiomyolipoma: ultrasonographic signs of lipomatous Hepatic tumor [J].J Ultrasound Med，1996; 15(4)∶337.
  9. 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. 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.