骨骼肌肌肉内血管瘤

Intramuscular hemangioma of skeletal muscle

目的探讨肌肉内血管瘤(intramuscularhemangioma,IMH)的诊断、治疗与误诊的原因。方法收集自1962年10月～1998年12月术后经病理证实、110例资料完整的IMH病例,分析发病年龄、性别、分类、临床症状与体征,以及X线片、CT、SPECT、MRI与超声检查的临床价值,描述其手术方法、病理学分类、手术效果与复发原因,提出鉴别诊断、并发症及复发的预防措施。结果解剖分布:颈部占11.82%,躯干占10.91%,上肢占16.36%,下肢占60.91%。以局限性疼痛、深压痛,运动或劳累后肿块增大、疼痛加重为主要症状与体征;可分为毛细血管、海绵状、混合型三类,混合型IMH常存在静脉型、上皮样型与肉芽肿型等血管瘤的组织学表现。毛细血管型IMH42例(38.18%),海绵状IMH37例(33.64%),混合型IMH31例(28.18%)。随访49例,占44.55%,术后疗效优24例(48.98%),良11例(22.45%),不满意10例(20.41%),差4例(8.16%)。结论体积小而深同时合并纤维、脂肪、瘢痕增生的混合型IMH易误诊。行MR检查能够确诊,核素显像有参考价值。IMH增大可压迫神经引发疼痛,一般不侵犯神经组织,手术治疗最为理想,主张将IMH相关血管结扎,手术不彻底易引起复发,难以切除的残余肿瘤可以行血管硬化剂等方法治疗;IMH易感染但不会产生恶变,反应区相关血管的结扎对预防肿瘤复发、减少?

Objective Hemangioma had been recognized as one of the most common tumors; however, intramauscular hemangioma (IMH) was a kind of uncommon benign tumor in skeletal muscle. A large number of orthopaedic surgeons knew little about it's specific clinic features. This paper was to report the diagnosis and therapy of 110 IMH cases, and to review tbe causes for misdiagnosis as well. Methods From oct. 1962 to Dec. 1998, 110 patients underwent surgical therapy with the definitive histological diagnosis; the clinical feature, gender, age, value of X-ray imaging, computed tomography(CT), single photon emission computed tomography (SPECT)?magnetic resonance imaging (MRI) and ultrasonography of IMH were analysed. Surgical technique, pathological classification, postoperation effects, prognosis and recurrence reason were discussed. Measures for cmplication and recurrence prevention, differential diagnosis were put forward. Results Anatomical distribution was 11.82% in the neck, 10.91% in the trunk, 16.36% in the upper limb and 60.91% in the lower limb. The disease was characterized by localized pain within soft tissue, local mass, deep tenderness, muscular soreness and mass expansion after exercise. According to Allen's classification, three types were defined: 1) capillary type; 2) cavernous type; 3) mixed type, combination of both, which included miscellaneous types of deep soft tissue(venous,arteriovenous,epithelioid and granulation tissue type). There were capillary type (38.18%), cavernous (33.64%) and mixed type(28.18%). Forty-nine of 110 cases were followed up for an average of six years and two months, the result of 48.98% patients was excellent, 22.45% was good, and 20.41% was unsatisfactory. Only four of 49 cases had local recurrence which was susceptible to infection. Conclusion Intra muscular hemangioma is easy to be mis or under diagnosed, especialy when it is deep or small localized, and it can rarely be diagnosed radiologically unless calcified phlebolithes occurs. Usually, peripheral nerve is not invaded, but could be compressed by the tumor. MRI is most helpful to define the diagnosis, and SPECT can also provide helpful diagnostic information. Although it can be treated by various methods, surgical excision provides the best result. Recurrence can always attribute to incomplete excision. Wide excision of the lesion is the treatment of choice. Preoperative embolization of IMH can reduce intraoperative blood shedding. Embolization combined with surgery forms a new modern approach to treat IMH.