肝血管平滑肌脂肪瘤16例治疗体会

Clinical analysis of hepatic angiomyolipoma(report of 16 cases)

目的探讨肝血管平滑肌脂肪瘤(HAML)的临床特点、诊断、治疗和预后。方法回顾性分析16例(男6例,女10例)经病理确诊的HAML患者的临床资料。结果无临床症状患者12例。B超检查15例,显示肿块内回声不均匀。强回声8例,中等回声2例,低回声团块5例。CT平扫13例,为低密度到中等密度病灶,4例测得CT负值[(-35.5～-99)HU],除1例增强扫描强化不明显外,其余动脉期明显强化。MRI检查7例,T1WI上肿瘤为低信号,T2WI上为相对高信号。3例肝动脉造影显示:肿瘤血管丰富,实质期肿瘤染色明显。14例行免疫组织化学染色,肿瘤平滑肌样细胞表达HMB-45均为阳性。16例均手术完整切除。除1例死于术后心功能衰竭,其余15例随访未见肿瘤复发。结论综合各项影像学检查有助于该肿瘤特征的显示和术前正确诊断。肿瘤平滑肌样细胞表达HMB-45阳性,是诊断HAML的可靠依据。手术治疗是惟一的有效方法。

Objective To study the clinical feature, diagnosis, treatment and prognosis of hepatic angiomyolipoma （HAML）. Methods The clinical materials of 16 surgically treated patients with HAML were retrospectively analyzed （10 females and 6 males）, Results Among these 16 patients, 12 cases were discovered to have no clinical symptom. Ultrasonography showed inhomogeneous echo in all 15 cases. With unenhanced CT, 13 cases showed low to moderate density shadows, and the distinct enhancement in 12 tumors was noted with enhanced CT scan. 7 cases undergoing MRI all showed low signal in T1WI and inhomogeneous high signals in T2WI. The myoid cells in all tumors showed over-expression of HMB-45. One patient died of postoperative heart failure, 15 patients were followed up for 3 months to 18 years without tumor recurrence. Conclusions The combination of imaging data is helpful in the diagnosis of HAML. The Expressions of HMB-45 Can be used to confirm the diagnosis. The key to cure is complete surgical excision.