小肠血管瘤和血管畸形的临床病理分析

目的 探讨小肠血管瘤和血管畸形的临床病理特征和病理诊断。方法对51例十二指肠、空肠及回肠的血管瘤和血管畸形进行回顾性研究。结果过去30年中诊断的51例小肠血管瘤和血管畸形中,患者年龄1．4～75．0岁,平均年龄与中位年龄均为40岁;男女性别比无差异;病变部位主要为回肠(18例)和空肠(16例),共占66．7％;主要临床症状是下消化道出血及肠梗阻;大体类型有息肉型、浅溃疡型、血管曲张型、包块型、弥漫浸润型及隐匿型,多为单发;组织学表现以动一静脉血管瘤,又称动一静脉畸形居多,占86．3％(44／51例),其他类型还有海绵状血管瘤、毛细血管瘤、遗传性出血性毛细血管扩张症及Dieulafoy病等。结论小肠血管瘤和血管畸形的组织学诊断困难,必须结合临床及动脉造影结果。

Hemangioma and vascular malformation of small intestine: a clinicopathologic analysis of fifty-one cases

OBJECTIVE: To investigate the clinicopathologic features of small intestinal hemangioma and vascular malformation. METHODS: A retrospective analysis was performed on 51 cases of hemangioma and vascular malformation involving the duodenum, jejunum and ileum in the past 30 years. RESULTS: The patient's age ranged from 1.4 to 75.0 years, with an average/median age of 40 years for the 51 cases. The ratio of male and female was almost equal. In most cases, the lesions were located in the ileum (18 cases) and jejunum (16 cases) accounting for 66.7%. The predominant symptoms and signs were either intestinal hemorrhage or obstruction. Grossly, the lesions appeared as polyp-like, ulcerative, varices, solitary mass, diffuse infiltration or in an occult status. Histologically, arteriovenous hemangioma also called arteriovenous malformation was more common seen accounting for 86.3%. Other less common vascular lesions included cavernous hemangioma, capillary hemangioma, Rendu-Osler-Weber syndrome and Dieulafoy disease. CONCLUSIONS: Histologic classification and denomination for hemangioma and vascular malformation of small intestine are still controversial. It is very important to correlate clinical manifestations with arteriography findings in histologic diagnosis of hemanigoma and vascular malformation of the small intestine.