肾血管平滑肌脂肪瘤82例的诊断与治疗

Diagnosis and treatmen of renal angiomyolipoma (report of 82 cases)

目的 提高肾血管平滑肌脂肪瘤的诊疗水平。方法 对 82例肾血管平滑肌脂肪瘤进行了回顾性分析。结果 B超诊断准确率 76 .8% (6 3/ 82 ) ,CT诊断准确率 86 .7% (39/ 4 5 ) ,MRI诊断准确率 84 .2 % (16 / 19)。根据肿瘤大小及症状分别采用观察与手术 ,对肿瘤直径 <4cm ,诊断明确且无症状 5 9例定期观察。手术 2 3例中行肿瘤剜除术 18例 ,肾部分切除 2例 ,肾切除 2例 ,根治性肾切除 1例。病理检查 2 2例良性肾血管平滑肌脂肪瘤 ,1例恶变。全部术后患者随访 ,肿瘤无复发。结论 B超、CT、MRI是诊断肾血管平滑肌脂肪瘤的重要检查方法 ,相互结合能提高术前的诊断准确率。术中应常规作冰冻切片 ,有助于确诊、手术方式的选择和排除恶变 ,为避免误诊对瘤体多部位取材也极为重要。

Objective To improve the diagnosis and treatment of renal angiomyolipoma (RAML). Methods A retrospective review of 82 cases with RAML was conducted. Results The correct diagnosis rate was 76.8%(63/82)by B-ultrasound, 86.7%(39/45)by CT and 84.2%(16/19)by MRI. According to the size of the neoplasm or symptoms of each patient, observation and surgical intervention were used respectively. Fifty-nine cases who had no symptoms but had neoplasm less than 4 cm in diameter underwent observation or operation. Among 23 cases who were operated on 18 had been treated with enuoleation, 2 with partial nephrectomy, 2 with nephrectomy and 1 with radical nephrectomy. Pathological diagnosis had been performed in all the cases, in which 22 were found with benign tumor and 1 was found suffering malignant change. All the cases that had been operated on had been followed up. No recurrence of tumor was found. Conclusion B-ultrasound, CT and MRI are important methods to diagnose RAML, and a combination with B-ultrasound, CT and MRI can raise the rate of correct diagnosis. A routine intraoperative frozen slice sample analysis should be helpful to diagnose, to choose the correct surgical method and to except malignant change. To avoid misdiagnosis, it is important to sample more frozen slices of the neoplasm during operation.