肾血管平滑肌脂肪瘤的临床研究

Clinical investigation of renal angiomyolipoma

目的 探讨肾血管平滑肌脂肪瘤 (RAML)诊治方法及肿瘤自发性破裂的危险因素。方法 回顾性分析 6 8例RAML患者资料 ,根据肿瘤大小分为A组 (≤ 4cm ,35例 )和B组 (>4cm ,33例 )。结果 7例肾穿刺活检确诊 ,无穿刺并发症。 6 8例中 2 8例 (41 2 % )有症状 ,其中A组 4例(11 4 % ) ,B组 2 4例 (72 7% ) (P <0 0 1)。 9例自发性破裂者肿瘤大小 (11 6cm± 5 1cm)与 5 9例未破裂者 (5 3cm± 2 9cm)比较差异有显著意义 (P <0 0 1)。 9例自发性破裂者动脉瘤大小 (13 6mm± 5 8mm)与 7例未破裂者 (2 6mm± 3 0mm)比较 ,P <0 0 1。治疗包括保守观察 10例 (随访 2～ 7年 ,肿瘤无明显变化及其它并发症发生 ) ,肿瘤剜除术 30例 ,肾部分切除 14例 ,肾切除术 11例 ,后腹腔镜肾切除术 3例 (随访 2个月～ 12年 ,未见肿瘤复发及手术相关并发症 )。结论 B超 /CT介导下肾穿刺活检对于诊断不明者具有重要作用 ;肿瘤自发性破裂与肿瘤和动脉瘤大小有关 ;保留肾单位手术在RAML治疗中具有重要地位。

Objective To study the diagnosis and management of renal angiomyolipoma(RAML),and to identify risk factors affecting spontaneous angiomyolipoma rupture. Methods The data of 68 patients with RAML from 1989 to 2002 were retrospectively reviewed. These patients were divided in two groups on the basis of tumor size,35 patients in group A(≤4 cm) and 33 patients in group B(>4 cm). Results Seven patients were identified by image-guided percutaneous biopsy,and no major complications was noted.Sixteen patients with RAML were examined with angiography and 9 of 16 patients had got spontaneous rupture.41.2 % of patients were symptomatic,4 cases (11.4%)in group A and 24 (72.7%)cases in group B( P <0.01).There were significant differences in mean tumor size (11.6 cm± 5.1 cm vs 5.3 cm±2.9 cm, P <0.01) and mean aneurysm size (13.6 mm±5.8 mm vs 2.6 mm±3.0 mm, P <0.01) between 9 cases of the ruptured tumor and 59 cases of unruptured tumor,9 cases of the ruptured and 7 cases of unruptured tumor with angiography,respectively.Treatment consisted of conservative observation in 10 patients(no radiographic changes during the follow-up of 2～7 years); partial nephrectomy in 14 patients,tumor enucleation in 30 patients,total nephrectomy in 14 and posterior laparoscopic nephrectomy in 3(no recurrence and complication correlation to operation during the follow-up of 2～144 months). Conclusions It is an important role that percutaneous biopsy guided by ultrasonography or computerized tomography performs in managing suspicious and/or indeterminate RAML.A higher probability of rupture is related to tumor and/or aneurysms size.Nephon-sparing surgery is the first choice for surgical treatment of RAML.