肾肿瘤自发性破裂出血的临床诊治分析

The diagnosis and treatment of spontaneous rupture of renal tumors

目的:探讨以自发破裂出血为主要临床表现的肾脏肿瘤的诊治。方法:回顾性分析21例肾肿瘤自发性破裂患者的临床资料。其中17例患者行超声检查,21例行CT检查,9例行MRI检查。术前18例诊断为肾血管平滑肌脂肪瘤,3例诊断为肾癌。所有病例均行手术治疗,11例行保留肾单位手术,7例行肾切除,3例行根治行肾切除。结果:术后病理证实19例为肾血管平滑肌脂肪瘤,2例为肾癌。其中18例获得随访3个月-5年,肾血管平滑肌脂肪瘤病例中保肾手术者未观察到同侧复发,2例患者术后1-4年因对侧发现肾血管平滑肌脂肪瘤直径>4cm采取肿瘤剜除术。结论:自发破裂出血为主要临床表现的肾脏肿瘤以肾血管平滑肌脂肪瘤为主,CT是首选检查。治疗以手术为主,良性肿瘤可考虑行保留肾单位手术,恶性肿瘤则以肾切除手术为主。

Objective：To investigate the clinical manifestations,diagnosis and treatment of spontaneous rupture of renal tumors. Methods： To retrospectively analyze the clinical data of 21 cases of spontaneous rupture of renal tumors,17 patients were examined by ultrasonography,21 patients by CT,9 patients by MRI,18 patients were diagnosed as renal angiomyolipoma and 3 patients as renal cell carcinoma. All patients underwent surgical treatment,11 patients underwent nephron sparing surgery,7 patients routine nephrectomy and 3 patients radical nephrectomy. Results： Pathological results confirmed 19 cases of renal angiomyolipoma,and 2 cases of renal cell carcinoma. 18 cases were followed up for 3 months -5 years. Among the cases of renal angiomyolipoma,ipsilateral recurrence were not observed,2 patients underwent tumor enucleation. because of the contralateral renal angiomyolipoma after 1-4 years. Conclusion： Renal angiomyolipoma is the most common one in renal tumors with spontaneous rupture. CT is the preferred examination. Nephron sparing surgery is considered for benign tumor,and nephrectomy for malignant tumor.