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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 To investigate the diagnosis, treatment and misdiagnosis of intramuscular hemangioma (IMH). Methods Totally 110 patients with IMH confirmed pathologically after operation from October 1962 to December 1998 were enrolled in this study. The age, sex, classification, clinical symptoms and signs of the patients were analyzed. The clinical value of ultrasonography was described. The surgical methods, pathological classification, surgical effect and the causes of recurrence were described. The differential diagnosis, complications and recurrence prevention measures were proposed. Results Anatomical distribution: neck accounted for 11.82%, trunk accounted for 10.91%, upper limb accounted for 16.36%, lower limb accounted for 60.91%. The limitations of pain, deep tenderness, exercise or fatigue after the tumor increases, the pain as the main symptoms and signs; can be divided into capillaries, sponge-like, mixed type three types of mixed IMH often exist vein type, epithelial type and Hemangiomas of granuloma type and other histological manifestations. Capillary IMH42 cases (38.18%), spongiform IMH37 cases (33.64%), mixed IMH31 cases (28.18%). There were 49 cases (44.55%) followed up, 24 cases (48.98%) were excellent, 11 cases (22.45%) were good, 10 cases (20.41%) were unsatisfactory and 4 cases (8.16%) were poor. Conclusions Small and deep misdiagnosis of mixed IMH combined with fibrous, fat and scar hyperplasia may be misdiagnosed. Line MR examination can be diagnosed, nuclide imaging has reference value. Increased IMH can cause painful compression of the nerve, the general does not infringe on nerve tissue, the ideal surgical treatment, advocate the IMH related blood vessels ligation, surgery is not completely easy to cause recurrence, difficult to remove the residual tumor can be treated with vascular sclerosis agent; IMH Infection but does not produce malignant transformation, the reaction zone related vascular ligation to prevent tumor recurrence, reduce?