肾血管平滑肌脂肪瘤的诊断与治疗(附32例报告)

Diagnosis and treatment of renal angiomyolipoma (Report of 32 cases)

目的 :提高肾血管平滑肌脂肪瘤的诊断与治疗水平。方法 :总结肾血管平滑肌脂肪瘤 32例的诊断及治疗经验 ,根据肿瘤直径分为 :小 (<4cm)、中 (4～ 8cm)、大 (>8cm)三类 ,同时根据病变大小及症状分别采取观察、栓塞、肿瘤切除、肾部分切除及肾切除术。结果 :B超诊断准确率为 78.1% (2 5 /32 ) ,CT诊断准确率为 87.1%(2 8/32 )。对病变小、无症状者 (5 /32 )采用定期观察 ,中等大小者 (2 4/32 )采用肿瘤切除 (13/32 )、肾部分切除 (9/32 )和肾切除 (2 /32 ) ;病变大者 (3/32 )则采用肾切除术。 32例患者全部获随访 ,均生存。结论 :结合 B超、CT以及HMB- 45、HMB- 5 0、CD6 3和细针穿刺细胞学检查明确诊断 ,根据病变大小和症状分别选择观察、栓塞、肿瘤切除、肾部分切除及肾切除术 ,治疗肾血管平滑肌脂肪瘤效果良好。

Purpose:To study the diagnosis and treatment of renal angiomyolipoma.Methods:We performed a retrospective study of 32 cases with renal angiomyolipoma from 1990 to 1998. Their lesions were classified as small (<4 cm), medium (4～8 cm) or large (>8 cm) based on the size of the lesion in each kidney. Our management options included observation, embolization and partial or total nephrectomy.These treatment are usually based on the symptoms or the size of the lesion.Results:B Mode ultrasound was performed in 32 patients with a diagnostic accuracy of 78.1 % (25/32), and CT was 87.1 % (28/32). Small asymptomatic lesions (5/32 pationts) tend to remain stable but should be periodically evaluated. Medium (24/32 patients) and large sized lesions (3/32 patients) required intervention, including enucleation (13/32 patients) and partial (9/32 patients) or total nephrectomy (5/32 patient).Conclusions:The diagnosis was established by ultrasound, CT scan, HMB 45, HMB 50, CD63 and fine needle aspiration cytology. Current management options include observation, embolization, enucleation and partial or total nephrectomy. Recommendations for treatment are usually based on the patient symptoms or the size of the lesion.