Hoekstra Lisette T, Bieze Matthanja, Erdogan Deha, Roelofs Joris J T H, Beuers Ulrich H W, van Gulik Thomas M
Academisch Medisch Centrum, Afd. Chirurgie, Amsterdam, the Netherlands.
Ned Tijdschr Geneeskd. 2012;156(31):A3820.
A liver haemangioma is a benign, usually small tumour comprised of blood vessels, which is often discovered coincidentally; giant haemangiomas are defined as haemangiomas larger than 5 cm. The differential diagnosis includes other hypervascular tumours, such as hepatocellular adenoma, hepatocellular carcinoma, metastasis of a neuro-endocrine tumour or renal cell carcinoma.- The diagnosis is based on abdominal ultrasonography and can be confirmed by a CT or MR scan. A wait-and-see approach is justified in patients without symptoms or with minimal symptoms, even in the presence of a giant haemangioma. Surgical resection of a giant haemangioma is only necessary when the preoperative diagnosis is inconclusive, or when the haemangioma leads to mechanical symptoms or complications. Extirpation is the only effective form of treatment of the giant haemangioma; enucleation is preferred over partial liver resection. A known complication of a giant haemangioma is the occurrence of disseminated intravascular coagulation, the Kasabach-Merritt syndrome; intervention is then demanded.
肝血管瘤是一种良性肿瘤，通常较小，由血管组成，常为偶然发现；巨大血管瘤定义为直径大于5 cm的血管瘤。鉴别诊断包括其他高血运肿瘤，如肝细胞腺瘤、肝细胞癌、神经内分泌肿瘤转移或肾细胞癌转移。诊断基于腹部超声检查，可通过CT或磁共振成像扫描确诊。对于无症状或症状轻微的患者，即使存在巨大血管瘤，采取观察等待的方法也是合理的。只有在术前诊断不明确，或血管瘤导致机械性症状或并发症时，才需要对巨大血管瘤进行手术切除。摘除术是治疗巨大血管瘤的唯一有效方法；与肝部分切除术相比，更倾向于采用剜除术。巨大血管瘤的一个已知并发症是发生弥散性血管内凝血，即卡萨巴赫-梅里特综合征；此时需要进行干预。
