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肝血管平滑肌脂肪瘤的診斷與治療

目的報告8例肝血管平滑肌脂肪瘤的影像學特征及病理學特點，探討其診斷與治療方法。方法對8例經手術及病理證實的肝血管平滑肌脂肪瘤的術前影像學表現（B超、CT、MRI、99mTcPMT）、手術情況及病理特點進行分析。結果B超： 腫瘤呈強回聲光團6例，低回聲光團2例； 邊界清楚7例，血供豐富、內部回聲不均勻4例，其中1例內部呈分隔網狀結構。彩色Doppler超聲示腫瘤血供豐富，均測及動脈頻譜，阻力指數為0.4～0.5。靜脈造影示腫瘤內血流信號明顯增加。CT： 平掃示腫瘤呈低密度影7例，不均勻5例，邊界清楚7例，腫瘤內見軟組織影2例，脂肪成分2例。增強掃描示動脈期明顯強化，門脈期及延遲期逐漸呈低密度。MRI: 腫瘤呈短T1、長T2信號，增強后強化明顯，脂肪抑制后短T1變成長T1。99mTcPMT示腫瘤呈放射性增強，5 min相腫塊區呈放射性缺損，2 h、5 h延遲相腫塊區未見放射性填充，肝血池相腫塊呈放射性填充。病理及免疫組化： 腫瘤由成熟的脂肪、血管及平滑肌組成，HMB45陽性。術前確診3例。結論B超示強回聲光團，CT呈低密度影中出現軟組織影、脂肪成分，增強明顯，MRI出現脂肪信號，脂肪抑制后短T1變成長T1，增強明顯。99mTcPMT示腫瘤呈放射性增強，5 min相呈放射性缺損，延遲相未見放射性填充，肝血池相呈放射性填充。這些是肝血管平滑肌脂肪瘤的影像學特點，結合病史可作出診斷。此病應盡早手術治療，行肝部分切除術。最后確診依靠病理檢查及免疫組化分析。

乏脂肪腎血管平滑肌脂肪瘤與腎細胞癌鑒別診斷中主要CT征象價值的系統評價

目的?應用Meta分析方法對乏脂肪腎血管平滑肌脂肪瘤（renal angiomyolipoma，RAML）與腎細胞癌（renal cell carcinoma，RCC）鑒別診斷中主要CT征象的價值進行評價。方法?電子檢索Cochrane圖書館、PubMed、MEDLINE（OVID）、EMbase數據庫以及中國期刊網（CNKI、CBM、VIP）的英文及中文文獻，檢索時間為2001年1月～2008年11月。按照Cochrane協作網推薦的診斷試驗的納入標準篩選文獻，進行文獻質量評價和提取資料。采用RevMan 5、Meta-disc 1.4軟件檢驗異質性、進行Meta分析及繪制SROC曲線。結果?共納入7篇文獻，包括482例患者和513個病灶。Meta分析結果顯示，平掃密度、病灶突出、病灶單發或多發、病灶內有無鈣化、各征象對RAML和RCC的鑒別診斷均具有一定的價值，其中皮質掀起征最高，均勻強化及延遲強化其次。結論?本系統評價結果顯示，除瘤內測得脂肪成分外，尚有上述8種CT征象在鑒別RAML和RCC方面具有臨床應用價值。

胸腔鏡手術治療胸膜脂肪瘤一例

頸部對稱性脂肪瘤的診治

【摘要】　目的　探討頸部對稱性脂肪瘤的診斷和治療。　方法　對2004年3月-2010年10月收治的5例頸項部脂肪瘤患者，其臨床癥狀、體征、術前術后處理及結果等臨床資料進行回顧。　結果　5例均為男性，以頸、項部大量皮下脂肪堆積為主要臨床表現，其中1例伴有胸部上分皮下脂肪堆積，呈對稱性隆起。3例患者伴阻塞性睡眠呼吸暫停低通氣綜合征，2例患者有睡眠打鼾但無明顯呼吸暫停。4例患者有脂肪肝和長期酗酒史，但肝功能無異常改變，其中1例（1/4）有多次乙醇中毒史。1例患者無酗酒史，但訴經常作頸部刮痧治療。5例均行外科手術切除，術中見腫瘤為白色無包膜脂肪組織。術后隨訪3個月~2年，1例術后1年復發，未行再次治療，其余未見明顯復發。　結論　頸部對稱性脂肪瘤是脂肪組織彌漫性、對稱性沉積于頸胸部皮下淺筋膜間隙和（或）深筋膜間隙的良性疾病。患者以中年男性居多，長期的酗酒史及典型的臨床表現對于該病的診斷有一定幫助，但酗酒可能并非唯一病因。對于影響美觀及功能的患者，其手術療效較理想。【Abstract】　Objective　To explore the diagnosis and treatment of symmetric lipomatosis in the neck.　Methods　We retrospectively analyzed the clinical manifestations, signs, preoperative and postoperative management, and the treatment outcome of five patients with symmetric lipomatosis hospitalized in the Department of Otolaryngology-Head and Neck Surgery of West China Hospital between March 2004 and October 2010.　Results　All the five patients are male with a large quantity of subcutaneous fat deposit in and around the neck. Among them, one patient demonstrated extending upper thorax mass in the form of symmetrical apophysis; three experienced obstructive sleep apnea hypoventilation syndrome, and two had the symptom of snoring without apnea. Four patients had a long history of alcohol abuse with fatty liver, but had no liver dysfunction. In these four patients, one had alcoholism for many times. One out of the five patients had no history of alcohol abuse, but said to have been treated by a traditional Chinese medical technique GUASHA. All the patients underwent resection surgery, during which a large amount of noncapsulated white adipose tissue was confronted. The duration of follow-up lasted from three months to two years. There was one case of recurrence one year after the surgery and the patient refused re-operation. No obvious recurrence was found in the rest of the group.　Conclusions　Symmetric lipomatosis is a benign lesion characterized by diffused and symmetric accumulation of adipose tissue in the superficial or deep fascia space in the cervico-thoracic region. It mainly takes place in the middle-aged people. Long history of alcohol abuse and typical clinical manifestations can help to reach the diagnosis, but alcoholism may not be the only cause in etiology. Surgery may be the feasible therapeutic modality up to now.

肝臟血管平滑肌脂肪瘤的多層螺旋CT表現特征及其病理學基礎

【摘要】　目的　探討肝臟血管平滑肌脂肪瘤（hepatic angiomyolipoma，HAML）的多層螺旋CT影像學表現特征及其與病理學基礎的相關性，以進一步提高CT診斷的準確性。　方法　收集2008年11月-2010年12月經手術病理證實的16例HAML患者。所有患者均行螺旋CT平掃及動脈期、門脈期增強檢查，重點觀察HAML的分型及其相應CT表現及影像-病理的相關性。　結果　16例患者共20個病灶，19個為稍低密度病灶，其中11個病灶內可見明顯的脂肪密度影；1個為稍高密度病灶。動脈期所有病灶均有不同程度的強化表現，15個病灶內可見到較明顯條狀及扭曲的血管影。門脈期15個病灶有持續強化。　結論　多層螺旋CT能準確反映HAML的分型及其病理特征，對臨床表現不典型患者的診斷和鑒別診斷有較大診斷價值。【Abstract】　Objective　To discuss the correlation between the features of multislice spiral CT results for hepatic angiomyolipoma (HAML) and their pathological basis, and to further improve the diagnostic accuracy through CT examination.　Methods　Sixteen HAML patients diagnosed pathologically between November 2008 and December 2010 in our hospital were enrolled in our study. All patients underwent multi-slice spiral CT scanning of pre-and post-contrast arterial phase, and portal venous phase. Focus was put on observation of HAML types and their corresponding manifestations, and the correlation between CT imaging and the pathologic basis.　Results　There were 20 lesions in the 16 patients. Among the 19 hypodense lesions, 11 were clearly seen with fat density shadow. One out of the 20 lesions showed as slightly hyperdense. On the arterial phase scanning, all lesions showed enhancement, and obvious vascular shadow could be seen in15 lesions. On the portal venous phase, 15 lesions continued to strengthen.　Conclusions　Multi-slice spiral CT can accurately reflect the classification of HAML and its pathological features. It has a great value in the diagnosis and differential diagnosis of patients without typical clinical manifestations.

腎上腺髓脂肪瘤的彩色多普勒超聲診斷

【摘要】　目的　探討腎上腺髓樣脂肪瘤的彩色多普勒超聲表現和超聲診斷價值。　方法　回顧性分析2005年3月-2010年9月58例61個經手術及病理證實的腎上腺髓脂肪瘤病灶的彩色多普勒超聲表現，對病變的大小、內部回聲特點及血流特點進行分析。　結果　在2005年3月-2007年12月的28個病灶超聲診斷出腎上腺病變23個，正確率82.1%；診斷為髓脂肪瘤2個，正確率7.1%；漏診1個，誤診4個。2008年1月-2010年9月，33個病灶超聲診斷出腎上腺病變30個，正確率90.9%；診斷為髓脂肪瘤19個，正確率57.6%；無漏診，誤診3個。52個病灶超聲表現為邊界清晰，形態基本規則，內部呈均勻中等強回聲（與腎集合系統回聲相當），內部未測及血流信號， 另8個病灶表現為中等強回聲與低回聲相間。　結論　腎上腺髓樣脂肪瘤具有特征性的彩色多普勒超聲聲像圖表現， 可用于發現病變并對多數腎上腺髓樣脂肪瘤做出定性診斷。【Abstract】　Objective　To evaluate the value of sonographic diagnosis of adrenal myelolipoma.　Methods　Sonographic findings from 58 patients with pathologically proved adrenal myelolipoma from March 2005 to September 2010 were retrospectively analyzed. The size of the lesion, internal echo features, and characteristics of blood flow were observed and analyzed.　Results　In 28 patients with pathologically proved adrenal myelolipoma from March 2005 to December 2007, adrenal lesions was diagnosed in 23 with an accurate rate of 82.1%; adrenal myelolipoma was diagnosed in two with an accurate rate of 7.1%; missed diagnosed in one; misdiagnosed was in four. In 33 patients with pathologically proved adrenal myelolipoma from January 2008 to September 2010, adrenal lesions was diagnosed in 30 with an accurate rate of 90.9%; adrenal myelolipoma was diagnosed in 19 with an accurate rate of 57.6%; no missed diagnosed occurred; misdiagnosed was in three. The sonographic features in 52 lesions were smooth borders and homogeneous hyperechoic; no color Doppler flow signal inside was detected.　Conclusion　Adrenal myelolipoma has special sonographic features. Ultrasonography is a reliable imaging method for the diagnosis of adrenal myelolipoma.

腎上腺髓樣脂肪瘤(附28例報告)

:目的:探討腎上腺髓樣脂肪瘤的臨床、影像學及病理特點。方法:回顧性分析28例腎上腺髓樣脂肪瘤患者的臨床資料,結合文獻分析其特點。結果:28例患者腫瘤均經手術切除,并經病理檢查證實為腎上腺髓樣脂肪瘤,隨訪至今未見復發。結論:腎上腺髓樣脂肪瘤的診斷主要依靠B超、CT和MRI,術前診斷困難,確診需經病理學檢查,手術切除是有效的治療方法。

肝血管平滑肌脂肪瘤的影像學表現及其診斷（附3例報道）

目的 探討肝血管平滑肌脂肪瘤（HAML）的CT表現及相關臨床特點。方法 回顧性分析3例經手術病理確診的HAML患者的臨床、CT及病理資料，分析其影像學表現及特點。結果 3例患者均為女性，其中2例有腹痛表現，1例無任何癥狀。2例實驗室檢查均正常，1例除乙肝標志物（+）外，其余正常。CT表現: 腫瘤位于肝右葉前上段1例，右葉后下段1例，左內葉1例; 腫塊內可見脂肪成分及軟組織成分，其中脂肪成分CT值為-80～-20 HU（平均-50 HU）; 增強后均有不同程度強化，可見強化血管影。術中見均為外生性包塊。免疫組化染色HMB45（+）、αSMA（+）、S100（+），符合血管平滑肌脂肪瘤的診斷。結論 HAML是一種少見的良性腫瘤，其影像學表現有一定特征性，確診有賴于免疫組化檢測HMB-45。

肝血管平滑肌脂肪瘤的臨床病理分析

【摘要】目的探討肝血管平滑肌脂肪瘤的臨床病理特點、診斷及鑒別診斷。 方法對3例肝血管平滑肌脂肪瘤患者有關病理檢查結果進行回顧性分析。 結果腫瘤位于肝右葉2例，肝左葉1例。腫瘤直徑為2～10　cm，平均6.2　cm。3例腫瘤內均見平滑肌、脂肪、畸形厚壁血管，但未見髓外造血灶。對黑色素瘤（HMB45）、結合蛋白（desmin)及肌動蛋白（actin)檢查均呈陽性反應。術后隨訪6～36個月，未見腫瘤復發。結論肝血管平滑肌脂肪瘤由3種成分組成，病理形態變化多樣，必須與多種肝腫瘤相鑒別。平滑肌細胞HMB45表達呈強陽性反應是診斷肝血管平滑肌脂肪瘤較可靠的依據。

縱隔巨大脂肪瘤切除一例