肝血管平滑肌脂肪瘤81例诊治分析

摘要

目的 总结肝血管平滑肌脂肪瘤的临床表现、影像学特征及病理学特点,探讨其诊断与治疗方法.方法 回顾性分析2000年5月至2017年6月成都市第二人民医院和四川大学华西医院81例肝血管平滑肌脂肪瘤的临床表现、影像学特征、病理形态及免疫组化特点.结果 81例患者中,20例有临床症状,术前影像学诊断出20例.行根治性肝切除61例,单纯肝活检2例,肝活检后行射频消融治疗18例.肿瘤细胞表达相应黑色素瘤细胞标记物(HMB 45、Mart-1)和平滑肌细胞标记物.1例患者术后肿瘤复发(1.2％,1/81),无死亡病例.结论 肝血管平滑肌脂肪瘤的影像学表现多样,诊断主要依靠于病理表现和免疫组化.治疗策略应根据肿瘤大小、部位及临床症状选择.由于肝血管平滑肌脂肪瘤有恶性潜能,手术后应密切随访.%Objective To study the clinical manifestations,imaging and pathological features of,and to analyse our experience in diagnosing and treatment of,hepatic angiomyolipoma.Methods The clinical manifestations,imaging features,pathological morphology and immunohistochemical characteristics of hepatic angiomyolipoma from 81 patients were analyzed retrospectively.Results Twenty patients had clinical symptoms.A preoperative imaging diagnosis was made in 20 patients.Radical liver resection was performed in 61 patients,liver biopsy in 2 patients,and radiofrequency ablation after liver biopsy in 18 patients.All tumor cells expressed the markers of melanoma cells (HMB 45,mart-1) and smooth muscle cells.Recurrence of tumor was found in one patient after operation (1.2％,1/81).No patients died on follow-up.Conclusions The imaging manifestations of hepatic angiomyolipoma were varied,and the diagnosis depended on pathological findings and immunohistochemistry staining.The treatment strategy should be selected according to tumor size,location and clinical symptoms.Patients should be followed-up closely after surgery because of the malignant potential of hepatic angiomyolipoma.