不同直径肾错构瘤的手术方法选择

Choose of sugical intervention for renal leiomyolipomas with different diameter

目的:探讨肾错构瘤(RAML)的诊断和治疗方法。方法:对102例RAML患者按肿瘤直径分为3组:A组(<4cm)21例,B组(4～≤8cm)63例,C组(>8cm)18例;A组中17例(81%)患者无任何症状,治疗以定期随访为主。B组中50例(79%)患者有临床症状,52例行保留肾单位手术,4例行肾切除术,2例行肾癌根治切除术,5例患者定期随访。C组中16例(88%)患者有临床症状,所有病例都进行了手术治疗,10例行保留肾单位手术,6例行肾切除术,其中2例行肾癌根治切除术,1例行选择性肾动脉栓塞术,后择期行肾切除术,1例因伴发下腔静脉瘤栓而同时行了下腔静脉瘤栓取出术。结果:所有病例术后病理检查均证实为RAML。结论:肿瘤直径<4cm的患者多无临床症状,可临床随访;肿瘤直径≥4cm的患者应积极行手术治疗,以保留肾单位的手术为首选。

Objective：To discuss the diagnosis and treatment of renal leiomyolipoma. Methods：Clinical data of 102 cases of renal leiomyolipoma were reviewed retrospectively. The cases were divided in 3 groups based on the size of single largest tumor： Group A（〈4 cm）, Groups B（4～≤8 cm）, Groups C（〉8 cm）. In Group A, 81%（17/21） of the patients were asymtomatic, regular followed up was primary. In Groups 13, 79 % （50/63） had clinical complaints. Of the 63 cases, Nephron-sparing surgery was done in 52, nephrectomy in 4, radical nephrectomy in 2, regular follow-up in 5. In Group C, 88% （16/18） of the patients were symptomatic, all patients acquired surgical operation including Nephron-sparing surgery was done in 10, radical nephrectomy in 2, selective emergency arterial embolization followed by nephrectomy in 1, nephrectomy in 6 of which dislodged tumor embolus from postcava in 1. Results：All cases were confirmed renal leiomyolipomas by pathology after operation. Conclusions：The patients with RAML〈4 cm are likely to be asymtomatic and should be observed, With RAML≥4 cm, surgery is ecessary. Nephron-sparing surgery（NSS） is optimum choice.