肾血管平滑肌脂肪瘤的外科手术时机及方式

Surgical occasion and manner for renal angiomyolipoma

目的探讨不同直径肾血管平滑肌脂肪瘤(RAML)的手术时机及治疗方式的选择。方法对76例行手术治疗的RAML患者的临床资料进行回顾性分析。结果11例行肾切除术,25例行肾部分切除术,40例行肿瘤剜除术(开放手术34例,经后腹腔镜行肿瘤剜除术6例)。本组病例术后病理诊断均为RAML。平均随访52个月,仅1例肿瘤局部复发。无继发性出血。结论根据肿瘤直径大小、部位及有无症状综合考虑,确定手术时机;保留肾单位手术是治疗RAML安全有效的治疗方法,后腹腔镜下对直径较小的RAML行单纯剜除术创伤小、恢复快。

Objective To study the occasion and manner of surgical intervention for renal angiomyolipoma（RAML） with different diameters. Methods The data of 76 patients with RAML underwent surgery were analyzed retrospectively. Results Seventy six patients with RAML underwent surgery,of whom renal resection was performed in 11 cases, partial resection in 25 cases, and simple tumor enucleation in 40 cases （34 cases under open surgery and 6 cases under retroperitoneal laparoscopy）. All cases were confirmed to be RAML by pathology. No secondery bleeding occurred. The patients were followed up for average 52 months. Only one patient had local recurrence. Conclusion Selection of surgical manner should be on the base of considerating diameter and position of the tumor. Nephron sparing surgery is an effective and safe method in RAML patients. Simple tumor enucleation under retroperitoneal laparoscopy is suitable for some cases with less trauma and quicker recovery when the tumor is smaller in diameter.