肾错构瘤的诊治及预后分析

Diagnosis,treatment and prognosis of renal hamartoma

目的探讨提高肾错构瘤(renal hamartoma,RH)诊治水平的方法。方法回顾分析106例RH的诊治资料。全部患者均经B超和CT检查,92例诊断为RH;14例经B超检查诊断为占位性病变,性质待定,其中5例CT诊断为RH,另9例CT诊断肾癌不排除者再行MRI检查后7例诊断为RH。结果105例术中及术后病理诊断为RH,B超诊断符合率85.8%(91/106),CT诊断符合率90.6%(96/106),MRI诊断符合率77.8%(7/9),1例术前B超和CT检查诊断为RH,病程10年,肿瘤未见明显增大,但术中肉眼和术后病理诊断为肾透明细胞癌。106例中除6例因肿瘤巨大肾实质较少、出血较多或术中病检发现为恶性变而行肾切除和2例行选择性肾动脉栓塞术外,其余均行保留肾单位手术(nephron-sparing surgery,NSS)。11例术中阻断肾蒂患者,术后肾功能无明显异常。所有患者术后B超复查无肿瘤复发和转移。结论B超和CT是诊断RH的重要检查方法,相互结合能提高术前的诊断准确率,必要时可辅以MRI检查。除极少病例需要行肾切除术外,RH患者应尽量行NSS。

Objective To approach and improve the diagnosis and treatment of renal hamartoma（RH）. Methods The literature and data of 106 patients of RH were reviewed. Preoperative ultrasonography and CT scanning was undertaken in all cases. RH was diagnosed in 92 and cancer could not be ruled out in the other 14. Results 105 cases were diagnosed as RH at operation and after operation. 1 case who was diagnosed as RH with Ultrasonography and CT before operation was found to be renal cell carcinoma. All cases except for 7 cases were performed nephron-sparing surgery. No local tumor recurrence has been noted. Conclusions Ultrasonography and CT are very im- portant to diagnosis of RH and combinatiom of both can improve the accuracy of diagnosis. Although some cases of hamartoma may require complete nephrectomy, most can be managed by conservative nephron-sparing approaches.