肾血管平滑肌脂肪瘤治疗的新观点

New viewpoint on the treatment of renal angiomyolipoma

目的 探讨肾血管平滑肌脂肪瘤治疗的最佳方案。方法 42例患者按肿瘤直径分为 3组 :G1组(≤ 4cm) 17例 ,G2组 ( >4～≤ 8cm) 18例 ,G3组 ( >8cm) 7例 ;对肿瘤的大小、症状与治疗方案选择之间的关系进行分析。结果 G1组中 76.5 % ( 13 /17例 )的患者无任何症状 ,其中 2例行肿瘤剜除术 ,其余患者定期随访。G2组中 5 5 .6% ( 10 /18例 )的患者伴有临床症状 ,10例行肿瘤剜除术 ,4例行肾极切除术 ,1例选择性动脉栓塞后择期行肾极切除术。G3组中 85 .7% ( 6/7例 )有临床症状 ,其中 2例行肿瘤剜除术 ,3例行肾极切除术 ,2例行肾切除术。本组共有 3 6例患者得到随访 (随访率为 86% ) ,平均随访时间为 48个月 ,随访结果显示患者的患肾功能正常 ,肿瘤无复发。结论 肿瘤直径≤ 4cm的肾血管平滑肌脂肪瘤患者多无临床表现 ,临床处理以观察为主 ;肿瘤直径为 >4～≤ 8cm者可依其临床症状及瘤体大小考虑相应的治疗 ;>8cm者多有临床表现且有瘤体破裂继发出血可能 ,应积极行手术治疗 。

Objective To introduce an optimal treatment of renal angiomyolipoma (RAML). Methods We performed a study of 42 cases (45 kidneys) with RAML. The lesions were divided in 3 groups based on the size of single largest tumor: Group 1(≤4 cm), Group 2 (>4～≤8 cm), Group 3 (>8 cm). The relationship among the size, symptoms and treatment was analyzed. Results In Group 1, 76.5%(13/17) were asymtomatic, 2 patients had undergone enucleation of the lesion, the others were followed up without suigrcal intervention. In group 2,55.6% (10/18) had clinical complaints.Of the 16 cases, tumor enucleation was done in 10, partial nephrectomy in 4, selective emergency arterial embolization followed by partial nephrectomy in 1. In Group 3, 85.7%(6/7) of the patients were symptomatic, all patients acquired surgical operation including tumor enucleation in 2, partial nephrectomy in 3, and nephrectomy in 2. Thirty six patients had been followed up for 15 to 135 months(mean 48 months). No recurrence occurred, and the renal functions were preserved successfully. Conclusion The patients with RAML≤4 cm are likely to be asymptomic and should be observed, with RAML ≥8.0 cm, surgery is necessary. The treatment of tumors between 4 and 8 cm depends on the size and associated symptoms. Nephron sparing surgery(NSS) is considered as optimum choice