肾肿瘤白发性破裂16例诊治分析

目的探讨以自发破裂出血为主要临床表现的肾脏肿瘤的诊治。方法回顾性分析16例肾肿瘤自发性破裂患者的临床资料。所有患者均行B超和CT检查，3例行MRI检查以鉴别肾细胞癌与错构瘤，术前确诊12例。9例急诊行患肾切除术，5例行保留肾单位手术（nephronsparing surgery，NSS），2例行选择性肾动脉栓塞术（transcatheter arterial embolization，TAE）。结果14例手术患者术后病理诊断。肾恶性肿瘤7例，错构瘤7例。16例均获随访，随访时间6～46个月，定期复查B超或CT，所有患者未见肿瘤复发，其中行TAE的2例患者，肿瘤明显缩小。结论自发破裂出血为主要临床表现的肾脏肿瘤中恶性肿瘤比例较高，螺旋CT是鉴别良恶性的主要方法。治疗以肾切除手术为主，良性肿瘤可考虑行NSS或TAE。

Diagnosis and management of spontaneous rupture of renal tumours（report of 16 cases）

Objective To investigate the diagnosis and management of spontaneous rupture of renal tumour. Methods The clinical data of 16 cases with spontaneous rupture of renal tumours were reviewed. All the 16 cases were diagnosed by ultrasonography and spiral CT, and 3 cases were diagnosed by MRI. 11 cases were diagnosed exactly before operation. 9 cases underwent nephrecto- my,and 5 cases received nephron-sparing surgery（NSS）, and 2 cases received selected transcatheter arterial embolization. Results 7 of those 14 patients who underwent sugery were confirmed as ma- lignant tumours,and others were renal angiomyolipoma, so malignant tumor were more common. Patients cases were followed up from 6 months to 46 months. All of them had no evidence of recur- rence. Conclusions Ultrasonography and spiral CT are usually sufficient for differentiating renal cell carcinoma from hamartoma, malignant tumour hold a high percent. Nephrectomy is often applied. And only when the turnout is benign,NSS or selective arterial embolization can be performed.