肾部分切除术治疗中老年人肾血管平滑肌脂肪瘤临床疗效分析

Nephron-sparing surgery for renal angiomyolipoma in middle aged and elderly patients

目的探讨应用保留肾单位的肾部分切除术（NSS）治疗中老年人单发的肾血管平滑肌脂肪瘤（AML）的临床效果和安全性。方法回顾分析北京大学人民医院泌尿科自2002年9月至2011年9月行NSS治疗的12例肾单发的肾AML病例，观察术前术后肾功能、肿瘤大小、病理结果、手术并发症及预后，总结其临床特点。结果12例患者平均年龄60．2岁（45～65岁），男性2例，女性10例；其中1例为孤立。肾。2例患者行开放的肾NSS；10例行腹腔镜NSS。肿瘤最大径3．5～12．0cm，平均（6．8±3．3）cm，术中发现AML在。肾脏基底的直径都较小，类似蘑菇形状，而且肿瘤侵犯肾实质深度均表浅。术后病理结果显示经典型AML9例，上皮样型2例，平滑肌瘤型1例。12例术中失血量100～750ml，平均250ml，患者均无输血。术后1例发生腹膜后血肿。术前、术后10d血肌酐水平分别为（87±34）mmol／L与（92±37）mmol／L，差异无统计学意义（t=2．073，P=0．733）。随访12～48个月，平均26．5个月，无肾功能不全。结论对于中老年人单发肾脏AML行NSS治疗可保留患肾功能，手术安全有效。

Objective To evaluate the effcacy and safety of nephron-sparing surgery（NSS） in the treatment of renal angiomyolipoma（AML） in middle-aged and elderly patients. Methods From September 2002 to September 2011, NSS was performed in 12 cases with renal AML in our hospital. Renal function was observed before and after surgery. Tumor size, pathological findings, surgical complications and prognosis were retrospectively analyzed. Clinical features were summarized. Results The age of patients ranged from 45 to 65 years（median 60.2 years）. There were 2 males and 10 females in this study, including 1 cases with solitary kidney. Open NSS were performed in 2 cases and laparoscopic surgery in 10 cases. Tumor diameter was（6.8±3.3） cm on average, ranged from 3.5 cm to 12.0 cm. Intraoperative findings showed that diameters of AML in the basal kidney were small, similar to the ＂ mushroom＂ in shape, and the depth of tumor invasion into the renal parenchyma was superficial. Pathologic results showed that pathologically classic AML was found in 9 cases, epithelial-like type in 2 cases, leiomyoma type in 1 case. Mean intraoperative blood loss was 250 m1（100 750 ml）. Postoperative retroperitoneal hematoma occurred in 1 case. Serum creatinine level showed no statistically significant difference between pre surgery and 10 days after surgery （（87 ±34） mmol/L vs. （92±37） mmol/L,t=2.073,P〉0.051. During mean follow-up of 26.5 months （12-48 months）, no renal insufficiency was found. Conclusions NSS is an effective and safe treatment for renal AML in middle-aged and elderly patients.