154例肾血管平滑肌脂肪瘤诊治原则的探讨

Diagnosis and Treatment of Renal Angiomyolipoma:Report of 154 Cases

目的探讨肾血管平滑肌脂肪瘤的诊疗方法及治疗时机。方法收集并分析中国医科大学附属一、二院自1992-2007年治疗的154例肾血管平滑肌脂肪瘤患者的临床资料。其中148例均行B超检查,134例行CT检查,60例行MIR检查。行以上影像学检查,确诊率可达95%以上。126例行手术治疗,其中肾切除49例,肿瘤剜除62例,肾脏部分切除术15例,手术治疗者均经病理证实。临床观察28例。结果观察者中肿瘤均有不同程度的增长。在最初的37例观察者中,有9例行手术治疗。观察者多数为肿瘤较小者(直径<4 cm)。33例肾破裂出血者,有32例肿瘤直径>4 cm,另一例<4 cm,位于肾一极轮廓之外。结论B超、CT、MRI是诊断肾血管平滑肌脂肪瘤的很好手段,三者结合使确诊率明显提高。对于瘤体>4 cm、生长较快或位于肾脏表面向外生长及乏脂的肾血管平滑肌脂肪瘤因破裂出血风险明显增加,应积极手术干预治疗。手术治疗应尽量多的保留肾单位。

Objective To investigate the diagnostic methods and operation timing of renal angiomyolipoma(AML).Methods Medical records of 154 AML patients from china medical university from 1992 to 2007 were collected and analyzed.148 patients underwent B-ultrasound,134 patients computerized tomography(CT),and 60 patients magnetic resonance imaging(MRI).Under these imaging examination,the final diagnosis rate can achieve 95%.In 126 patients with operation,49 patients underwent the nephrectomy and 62 patients the resection of AML.Pathologic diagnosis to tissue speciments from 126 patients with operation was AML.28 patients without operation underwent clinical observation.Results Variant tumor growth was observed in the patients undergoing clinical observation.In first 37 patients undergoing clinical observation,9 patients had to undergo operation,while most of the AML without operation was less than 4 cm in diameter.32 out of 33 patients with tumor breach and bleeding were greater than 4 cm in diameter and with nephrectomy,another one with breaching and bleeding was smaller than 4 cm in diameter but erupted the renal face.Conclusion B-ultrasound,CT and MRI all contribute to the diagnosis of AMI.Combination of the three methods can increase the accuracy of diagnosis.Operation is necessary to AML greater than 4 cm in diameter and the AMLs who grow faster and grow towards the surface of the renal.Nephron should be saved in operation as far as possible.