家庭醫業 流行病學 臨床症狀 蘇子華 葉慶輝 家庭醫學與基層醫療第二十四卷第九期. 1 國軍左營總醫院家庭醫學科住院醫師 2 國軍左營總醫院家庭醫學科主任關鍵詞 :liver hemangioma, hepatic cavernous hemangioma,

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1 蘇子華 1 葉慶輝 2 前言 流行病學 1.5~2 0.4% 7.3% 1 國軍左營總醫院家庭醫學科住院醫師 2 國軍左營總醫院家庭醫學科主任關鍵詞 :liver hemangioma, hepatic cavernous hemangioma, focal liver lesion, ultrasound () : 1 臨床症狀 331

2 1. A - V shunt hemobilia 鑑別診斷 (focal nodular hyperplasia) 相關檢查 (fibrinolysis) fibrinogen 4. ESR CEA AFP CA-199 影像學診斷超音波 6 (heterogenous) 6 (homogenous) 電腦斷層 332

3 ( d y n a m i c contrast-enhanced) (tri-phase arterial, portal venous, delayed phase) (arterial phase) (portal venous phase) (delayed phase) 核磁共振 T 1 T2 (gadolinium) ( n e p h r o g e n i c s y s t e m i c f i b r o s i s, nephrogenic fibrosing dermopathy, NSF/ NFD) 2 (fluid level) 鎝 - 紅血球造影 (Tc99m-RBC scan) 2 82%100%2 (pedunculated giant liver hemangima) 血管攝影 肝切片 (AFP) 治療

4 圖一 圖二 圖一 : 未打顯影劑前, 在右葉上一低密度影像即為肝血管瘤圖二 : 注射顯影劑後, 肝血管瘤中心仍為一低密度影像, 即 central thrombosis 來源 : 參考資料 1 表一各項檢查敏感度及特異性 檢查方式 超音波 超音波加彩色都卜勒 注射顯影劑電腦斷層 核磁共振 T2 影像 注射顯影劑電腦斷層併注射顯影劑核磁共振 敏感度 *1 46% 69% 66% 96% 100% 特異性 57% * 2 86%*3 100%*4 92%*5 98.9%*6 資料來源 : *1. 參考資料 2 *2:Quaia E, Stacul F, Gaiani S et al: Comparison of diagnostic performance of unenhanced vs SonoVue - enhanced ultrasonography in focal liver lesions characterization. The experience of three Italian centers. Radiol Med ;108: *3:Kudo M, Tochio H, Zhou P: Differentiation of hepatic tumors by color Doppler imaging: role of the maximum velocity and the pulsatility index of the intratumoral blood flow signal. Intervirology. 2004; 47: *4:Leslie DF, Johnson CD, Johnson CM, Ilstrup DM, Harmsen WS: Distinction between cavernous hemangiomas of the liver and hepatic metastases on CT: value of contrast enhancement patterns. AJR Am J Roentgenol. 1995;164: *5:McFarland EG, Mayo-Smith WW, Saini S, et al: Hepatic hemangiomas and malignant tumors: improved differentiation with heavily T2-weighted conventional spin-echo MR imaging. Radiology. 1994;193:43-7. *6:Hori M, Murakami T, Kim T et al: Hemodynamic characterization of focal hepatic lesions: role of ferucarbotranenhanced dynamic MR imaging using T2-weighted multishot spin-echo echo-planar sequence. J Magn Reson Imaging. 2006; 23: 外科治療 ( f o r m a l segmental resection or enucleation of the hemangioma) 334

5 (hepatic lobectomy) 動脈栓塞 (polyvinyl alcohol) 2 (surgical ligation of feeding vessels) (radiofrequency ablation) (hepatic irradiation)(orthotopic liver transplantation) 討論 參考資料 1. Lee CW, Chung YH, Lee GC, Kim JY, Lee JS.: A case of giant hemangioma of the liver presenting with fever of unknown origin. J Korean Med Sci. 1994;9: D e F r a n c o A, M o n t e f o r t e M G, M a r e s c a G.: Integrated diagnosis of liver angioma: comparison of Doppler color ultrasonography, computerized tomography, and magnetic resonance. Radiol Med (Torino). 1997;93: Glinkova V, Shevah O, Boaz M, Levine A, Shirin H: Hepatic haemangiomas: possible association with female sex hormones. Gut. 2004;53: Brannigan M, Burns PN, Wilson SR.: Blood flow patterns in focal liver lesions at microbubbleenhanced US. Radiographics. 2004;24: Chai FL, He GX.: Laparoscopic radiofrequency ablation of hepatic cavernous hemangioma. A preliminary experience with 27 patients. Surg Endosc. 2006;20: