目的:探讨CTA和MRI在四肢骨骼肌肌内血管瘤的诊断和治疗中的价值,以及手术治疗的疗效.方法:2003年4月至2011年2月,采用手术切除或密集环形缝扎方法治疗18例四肢骨骼肌内血管瘸患者.其中男8例,女10例；年龄5～28岁,平均12.5岁；病程1～5年.主要症状为易变性肿物和疼痛,部分有多次破渍出血史.18例行MRI检查,11例同时行CTA检查,证实为骨骼肌内血管瘤.据肿块变化、疼痛、复发3方面情况评价手术效果.结果:18例分布情况:上肢6例,下肢12例.病理分型均为血管畸形,其中毛细血管型畸形13例,静脉型畸形4例,动静脉瘘型畸形1例.18例随访时间为6个月～2年,平均8.8个月.术后显效15例,有效2例,不满意1例.结论:CTA和MRI对四肢骨骼肌内血管瘤诊断符合率高,CTA三维立体解剖成像,对确定最佳的手术入路、保护重要血管以及处理瘤体供应血管有重要的价值.在肌肉侵犯的术前判断及手术方式决策上,MRI较CTA更有价值.%Objective:To study on CTA and MRI in the diagnosis and treatment of hemangioma in the limb skeletal muscles, and to explore therapeutic effects of surgical treatment. Methods: From April 2003 to February 2011,18 patients with intramuscular hemangioma in extremities were treated with surgical excision or dense circle suture method. Among the patients, 8 patients were male and 10 patients were female,ranging in age from 5 to 28 years,with an average of 12.5 years. The course of disease ranged from 1 to 5 years. The main symptoms included variable mass and pain,partly with repeated burst bleeding. Eighteen patients underwent MRI examination and 11 patients underwent CTA examination. The operative effects were evaluated by the mass changes,pain and recurrence. Results:There are 6 cases of upper limbs and 12 cases of lower limbs. All pathologic types of all patients with were vascular malformation,in which 13 with blood capillary malformation,4 with vein malformation,and 1 with arteriovenous fistula malformation. All the patients were followed up,and the duration ranged from 6 months to 2 years,with a mean of 8.8 months. Fifteen patients got an excellent result,2 good and 1 poor. Conclusion:The accordance rate of CTA and MRI in the diagnose of intramuscular hemangioma in skeletal muscle are high. CTA 30 stereo-anatomy imaging has a considerable value in choosing the optimal operative methods,protecting important blood vessel and disposing provision blood vessel. As to the preoperative determination of muscle invasive and the decision of operative method, MRI is more valuable than CTA.
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