45例肾血管肌脂瘤的治疗

TREATMENT OF RENAL ANGIOMYOLIPOMA IN 45 PATIENTS

目的 :探讨肾血管肌脂瘤的治疗方法。方法 :45例患者中 2 3例未作特殊治疗 ;6例超选择性动脉栓塞治疗、 7例行肿瘤剜除术或肾部分切除术、 9例行全肾切除术。结果 :随访 2 1例 ,平均随访时间 3 6a。未作特殊治疗的病例中未发生肿瘤破裂出血 ,2例肿瘤体积增大但仍无症状 ;超选择性动脉栓塞病例无症状复发、无破裂出血、肾功能稳定。手术患者均保持肾功能稳定 ,无肿瘤复发。结论 :对本病应采取保守性治疗原则。超选择性肾动脉栓塞是简单、有效的治疗方法 ,适用于各种体积的有症状肾血管肌脂瘤 ,是优先选择方案。对诊断不明确的不典型肾血管肌脂瘤 ,开放手术既能达到治疗目的又可提供组织学诊断。

Objective:To describe our experience in treatment of angiomyolipoma(AML).Methods:Observation in 23 patients,selective arterial embolization in six patients and partial or total nephrectomy in 16 patients were performed.Results:We followed up 21 patients with mean of 3 6 years.No observation patient had subsequent renal hemorrhage and two patients had radiographic progression but asymptomatic.Selective arterial embolization resulted in preservation of renal function without symptomatic recurrence or hemorrhage at a mean of 4 5 years.All patients surgically treated had stable renal function without recurrence.Conclusion:We support a conservative treatment scheme for renal AML.Selective embolization is a simple,effective treatment and may be the preferred therapy for symptomatic AML.Partial or total nephrectomy may be reserved for the patients with atypical AML of uncertain diagnosis.