本文收集３例经手术病理证实的原发性肝脏平滑肌肉瘤。重点讨论了病理、ＣＴ表现及其鉴别诊断。作者认为：当ＣＴ扫描时肝脏出现巨大混合性占位病灶，且以囊性成份为主时，应考虑肝脏平滑肌肉瘤的可能，但进一步确诊须依靠病理，甚至是电镜和免疫组织化学技术。当肝脏平滑肌肉瘤病灶相对小，无囊性成份出现时，不易与肝细胞癌进行鉴别。 This article collected three cases of primary liver leiomyosarcoma confirmed by pathology. Focuses on pathology, CT findings, and differential diagnosis. The authors believe that when CT scans show a large mixed-occupying lesion in the liver and cystic components predominate, the possibility of liver leiomyosarcoma should be considered, but further diagnosis depends on pathology, even electron microscopy and immunohistochemistry. When liver leiomyosarcoma lesions are relatively small and no cystic components are present, it is not easy to differentiate with hepatocellular carcinoma.