肾血管平滑肌脂肪瘤治疗方式的选择及疗效(附94例报告)

The management selection and clinical outcomes in renal angiomyolipoma(report of 94 cases)

目的探讨肾血管平滑肌脂肪瘤(renal angiomyolipoma,RAML)干预治疗方式的选择及其疗效。方法回顾性分析近5年收治的94例RAML患者的临床资料,其中男25例,女69例,平均年龄42岁,肿瘤平均直径为6.6cm。单发RAML73例,多发RAML21例。结果 RAML破裂出血并行急诊手术4例,其中2例行患肾全切术,2例行选择性动脉栓塞术控制出血后择期行保留肾单位手术(nephron-sparing surgery,NSS);择期手术90例,其中NSS71例,患肾全切术13例,选择性动脉栓塞术2例,射频消融术4例。开放及后腹腔镜下NSS对于直径在7cm以下的RAML在手术时间、出血量及并发症发生率方面差异无统计学意义(P>0.05),而术后住院天数两者的差异有统计学意义(P<0.05)。随访3～48个月,未见肿瘤复发或转移。结论 NSS是RAML的治疗首选,其中腹腔镜NSS对于体积较小的肿瘤具有创伤小、术后恢复快等优势。选择性动脉栓塞对于控制RAML急性破裂出血有独特优势,也用于多发肿瘤及RAML复发等情况。射频消融对于直径较小的RAML微创而有效。

Objective To discuss the management of renal angiomyolipoma（RAML） and compare the clinical outcomes. Methods The data of 94 patients with RAML in recent 5 years was retrospectively reviewed,25 cases were male and 69 cases were female.The average age was 42 years old, and the average diameter was 6.6 cm. 73 cases were single RAML,21 cases were multiple tumors. Results 4 patients underwent emergent surgery due to bleeding from tumor rupture, 2 cases of nephrectomy, and 2 patients underwent selective arterial embolism（SAE） before nephron-sparing surgery（NSS）.The other 90 patients had several different interventions, 71 for NSS, 13 for nephrectomy, 2 for SAE, and 4 for radiofrequency ablation（RFA）. The operative and laparoscopic NSS have no significant difference in operation time, estimated blood loss and complication rates（P〈0.05） for the patients with tumor diameter≤7 cm. However, the statistical difference was found in hospital days after surgery（P〈0.05）. Follow-up period was 3-48 monthes and no tumor metastasized or occurred again. Conclusions NSS, especially laparoscopic, is the first choice for surgical management of RAML, which shows the advantage of decurtation of hospital days. SAE is effective in controlling hemorrhage for RAML in the acute setting and also for the multiple or recurrence tumors.RFA is a new and effective nephron-sparing technology with the advantage of minimal invasion.