5例肝血管平滑肌脂肪瘤的诊断与治疗分析

doi:10.3969/j.issn.1009-976X.2022.01.009

摘要/Abstract

摘要： 目的探讨肝血管平滑肌脂肪瘤（HAML）的临床、影像学、病理学特点及治疗方法。方法回顾性分析我院2016年1月至2020年10月间收治的5例肝血管平滑肌脂肪瘤病例,并结合相关文献对本病进行探讨。结果 5例肝血管平滑肌脂肪瘤病人均经外科手术治疗,预后良好,所有病人术后随访期间,未见肿瘤复发及转移,无死亡病例。结论肝血管平滑肌脂肪瘤临床罕见,常缺乏特征性临床表现,早期诊断困难。明确诊断有赖于术后病理及免疫组化结果。治疗方案首选手术治疗,其疗效确切,预后良好。

关键词: 肝血管平滑肌脂肪瘤, 肝切除, HMB45

Abstract: Objective To analyze the clinical, imaging, pathological features and treatment of hepatic angiomyolipoma （HAML）. Methods Five cases of hepatic angiomyolipoma admitted to our hospital from January 2016 to October 2020 were retrospectively analyzed, and the disease was discussed in combination with relevant literature. Results All the 5 patients with hepatic angiomyolipoma received surgical treatment with good prognosis. During the postoperative follow-up, no tumor recurrence or metastasis was observed in all the patients, and no cases died. Conclusion Hepatic angiomyolipoma is rare in clinical practice, often lack of characteristic clinical manifestations, and early diagnosis is difficult.The diagnosis depends on postoperative pathological and immunohistochemical results. Surgical treatment is the first choice of treatment, which has definite curative effect and good prognosis.

Key words: hepatic angiomyolipoma, liver resection, HMB45

中图分类号:

R657.3

李硕, 林杰, 王卫东. 5例肝血管平滑肌脂肪瘤的诊断与治疗分析[J]. 岭南现代临床外科, 2022, 22(01): 56-60.

LI Shuo, LIN Jie, WANG Wei-dong. Diagnosis and treatment of five cases of hepatic angiomyolipoma[J]. Lingnan Modern Clinics In Surgery, 2022, 22(01): 56-60.

参考文献

[1] Tsui WM, Colombari R, Portmann BC, et al.Hepatic angiomyolipoma: aclinicopathologic study of 30 cases and delineation of unusual morphologic variants[J]. Am J Surg Pathol, 1999, 23(1): 34-48.
[2] Ishak KG.Mesenchymal tumors of the liver[M]//OkudaK, Peters RL, eds. Hepatocellular Carcinoma. New York: John Wiley and Sons, 1976: 247-304.
[3] 丛文铭, 吴孟超, 陈汉, 等.肝血管平滑肌脂肪瘤一例[J].中华外科杂志, 1992, 30(10): 618.
[4] Camanni M, Bonino L, Delpiano EM, et al.Hysteroscopic management of large symptomatic submucous uterine myomas[J]. J Minim Invasive Gynecol, 2010, 17(1): 59-65.
[5] 刘毅强, 孙宇, 李忠武, 等.穿刺活检在诊断肝血管平滑肌脂肪瘤中的价值[J].诊断病理学杂志, 2011, 18(1): 52-55.
[6] Chang Z, Zhang JM, Ying JQ, et al.Characteristics and treatment strategy of hepatic angiomyolipoma: a series of 94 patients collected from four institutions[J]. J Gastrointestin Liver Dis, 2011, 20(1): 65-69.
[7] Cai PQ, Wu YP, Xie CM, et al.Hepatic angiomyolipoma: CT and MR imaging findings with clinic-pathologic comparison[J]. Abdom Imaging, 2013, 38(3): 482-489.
[8] 徐少真, 潘江峰.肝血管平滑肌脂肪瘤的MRI与CT影像表现[J].医学影像学杂志, 2016, 26(4): 658-661.
[9] 王珏儒, 邱法波, 李振凯, 等.中国肝血管平滑肌脂肪瘤近23年的流行病学特征及诊治经验[J]. 肝胆胰外科杂志, 2012, 24(3): 183-191.
[10] Yang X, Li A, Wu M.Hepatic angiomyolipoma: clinical, imaging and pathological features in 178 cases[J]. Med Oncol, 2013, 30(1): 416-421.
[11] Jimbo N, Nishigami T, Noguchi M, et al.Hepatic angiomyolipomasmay overexpress TFE3, but have no relevant genetic alterations[J]. Hum Pathol, 2017, 61: 41-48.
[12] Makhlouf HR, Remotti HE, Ishak KG.Expression of KIT (CD117) in angiomyolipoma[J]. Am J Surg Pathol, 2002, 26(4): 493-497.
[13] Klompenhouwer AJ, Verver D, Janki S, et al.Management of hepatic angiomyolipoma: A systematic review[J]. Liver Int, 2017, 37(9): 1272-1280.
[14] Ding GH, Liu Y, Wu MC, et al.Diagnosis and treatment of hepatic angiomyolipoma[J]. J Surg Oncol, 2011,103(8): 807-812.
[15] 施保柱, 杨明华, 高福洋, 等.肝血管平滑肌脂肪瘤77例诊治分析[J]. 肝胆胰外科杂志, 2015, 27(1): 42-43.
[16] 李超, 梁磊, 王明达, 等.肝血管平滑肌脂肪瘤的诊断及治疗选择(附130例回顾性分析)[J]. 腹部外科, 2019, 32(6): 404-407.
[17] 王锦, 王立明.手术切除治疗肝血管平滑肌脂肪瘤2例报告[J]. 临床肝胆病杂志, 2016, 32(1): 157-158.
[18] 洪海杰, 陈燕凌, 蔡欣然.腹腔镜肝切除术在肝血管平滑肌脂肪瘤中的应用[J]. 中国微创外科杂志, 2019, 19(3): 267-269.