泌尿系统吻合性血管瘤临床特点及诊治分析

Clinical characteristics of urological anastomosing hemangioma

目的探讨泌尿系统吻合性血管瘤(AH)的临床特点及诊治经验。方法回顾性分析2015年6月至2021年11月南京医科大学第一附属医院收治的泌尿系统AH患者的一般情况、影像学检查、治疗经过、病理及随访结果等临床资料。结果共收集10例AH患者临床资料。6例为体检发现,3例因腰痛、1例因肉眼血尿就诊;输尿管AH患者有2年前行输尿管镜碎石手术史;术前CT检查见肿瘤位于左侧5例,右侧5例(左肾上腺区2例,右肾上腺区2例,左肾门旁1例,左肾盂内1例,右肾下极2例,左腹膜后1例,右输尿管1例);肿瘤直径1.0~4.3 cm;肿瘤呈类圆形6例,形态不规则4例;CT平扫呈低密度6例,混杂密度4例;所有患者顺利完成手术治疗,开放手术1例,腹腔镜手术9例,其中机器人辅助手术3例;术后病理证实为肾脏AH4例,肾上腺AH4例,输尿管AH1例,腹膜后AH1例;术后病理与影像诊断一致率50%(5/10),为肾肿瘤2例,肾上腺肿瘤2例,腹膜后肿瘤1例;随访11~79个月,未见肿瘤转移及复发。结论泌尿系AH是一种罕见的良性血管瘤,术前确诊困难,腹腔镜及机器人辅助腹腔镜手术切除泌尿系统AH安全有效。AH患者应予个体化诊治,注意避免过度治疗。

Objective To summarize the clinical characteristics and treatment of patients with urological anastomosing hemangioma(AH).Methods The clinical data of patients with urological AH in the First Affiliated Hospital of Nanjing Medical University from Jun.2015 to Nov.2021 were analyzed retrospectively,including baseline data,imageological examination,treatment outcomes,pathological results and follow-up data.Results Ten cases of urological AH were included.Six patients were diagnosed by routine checkup,3 patients presented with flank pain and one case with gross hematuria.The ureteral AH patient experienced trans-urethral ureteroscopic lithotripsy 2 years ago.Preoperative CT scan revealed 5 cases of left side tumor,5 cases of right side(2 cases in left adrenal zone,2 cases in right adrenal zone,one case in left renal hilum,one case in left renal pelvis,2 cases in lower pole of right kidney,one case in left retroperitoneum and one case in right ureter).The tumor diameters of this group of patients ranged from 1.0 to 4.3 cm.CT scan revealed 6 patients with tumor of circular-like shape,4 of irregular shape.Low density tumor was found in 6 patients.And 4 cases of heterogeneous density were found by CT scan.All patients received surgery successfully.One of them received open surgery and 9 cases received laparoscopic surgery,including 3 patients with robot-assisted surgery.Four case of renal AHs,4 cases of adrenal AHs,one case ureteral AH and one case of retroperitoneal AH were confirmed by postoperative pathological examination.Consistency rate of preoperative imaging diagnosis and postoperative pathological examination was 50%(5/10,2 renal tumors,2 adrenal tumors and 1 retroperitoneal tumor).Neither metastasis nor recurrence was found during 11-79 months of follow-up.Conclusions Urological AH is a rare benign hemangioma with difficulty in preoperative differential diagnosis.Tumor resection by laparoscopic or robot-assisted surgery is safe and effective.However,individualized management of AH patient is necessary to avoid overtreatment.