肾血管平滑肌脂肪瘤自发破裂出血的急诊处理(附24例报告)

目的 探讨肾血管平滑肌脂肪瘤自发破裂出血的急诊处理.方法 对24例肾血管平滑肌脂肪瘤自发破裂出血患者的临床资料及随访结果进行回顾性分析.术前均行B超和CT检查,22例诊断为肾血管平滑肌脂肪瘤自发破裂出血,2例未能排除肾癌出血.3例保守治疗,4例行选择性肾动脉栓塞术,17例急诊手术.结果 3例保守治疗患者中1例病情稳定,2例改行手术治疗.4例行肾动脉栓塞术患者栓塞成功,出血停止.4例行肾切除术,13例行保留肾单位手术,其中5例行后腹腔镜手术.术后病理诊断为肾血管平滑肌脂肪瘤并出血.随访3个月～6年,肿瘤无复发或转移.结论 B超和CT是诊断肾血管平滑肌脂肪瘤出血的重要手段.治疗可以选择保守治疗、肾动脉栓塞或者急诊手术.     

肾血管平滑肌脂肪瘤的诊断与治疗(附15例报告)

目的探讨肾血管平滑肌脂肪瘤的诊断与治疗方法。方法总结分析15例肾血管平滑肌脂肪瘤的临床资料。结果诊断符合率B超为66.7%,CT为86.7%。诊断为肾血管平滑肌脂肪瘤14例,误诊为肾细胞癌1例。行肿瘤剜除肾部分切除8例,肾切除4例,根治性肾切除1例。结论B超和CT是诊断肾血管平滑肌脂肪瘤的重要手段,脂肪含量少,瘤体出血是影像学不典型导致误诊的原因,术中快速冰冻切片可避免误诊。手术治疗应尽量采用保留肾脏手术。     

肾血管平滑肌脂肪瘤18例报告

目的 探讨肾血管平滑肌脂肪瘤的诊断及治疗。方法 回顾性分析近10年来收治的肾血管平滑肌脂肪瘤18例的临床资料。结果 18例术前行B超检查．16例行CT检查。手术治疗16例．其中行肾切除术2例．肿瘤剜除术14例，术后均病理检查证实；定期随访2例．随访2～5年，无肿瘤恶变及复发。结论 对肾血管平滑肌脂肪瘤直径大于4cm．可手术治疗；对肿瘤直径小于4cm，可观察。     

肾血管平滑肌脂肪瘤21例诊治分析

目的 提高肾血管平滑肌脂肪瘤的诊断与治疗水平。方法 回顾性分析21例肾血管平滑肌脂肪瘤患的临床资料并结合献讨论其诊断和治疗。结果 18例行手术治疗，术后病理证实为肾血管平滑肌脂肪瘤，定期观察3例，随访1～2年无复发、恶变。结论 B超、CT是诊断本病的主要检查方法，手术治疗的原则是尽可能的保留正常肾脏组织。     

肾血管平滑肌脂肪瘤的诊治(附19例报道)

本文报道19例肾血管平滑肌脂肪瘤,13例有腰痛,2例有肉眼血尿症状,4例体检发现。19例均行B超检查,16例行CT检查。15例行手术治疗,其中13例行肾脏切除术,2例行肾部分切除手术;4例随访观察。认为B超、肾动脉造影、CT是肾血管平滑肌脂肪瘤的主要诊断方法,14例术前明确诊断。根据病人的全身情况、临床症状及肿瘤的大小、部位,决定手术方式及处理,多数采用肾切除术,少数采用肾部分切除术及随访观察治疗。     

肾血管平滑肌脂肪瘤的诊断与治疗（附32例报告）

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、肾部分切除及紧切除术。结果：B超诊断准确率为78．1％（25／32）,CT诊断准确率为87．1％（28／32）。对病变小、无症状者（5／32）采用定期观察,中等大小者（24／32）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－50、CD63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。     

24例肾血管平滑肌脂肪瘤诊治分析

目的提高肾血管平滑肌脂肪瘤的诊治效果.方法回顾性总结分析24例肾血管平滑肌脂肪瘤患者的临床资料.结果3例(12.5%)术前误诊.诊断正确率B超为52.6%(10/19),CT为75%(9/12),MRI为80%(12/15),B超联合CT为90%(9/10).治疗以保留肾单位的肿瘤局部剜除术为主.结论应提高对肾血管平滑肌脂肪瘤的术前诊断水平,治疗中尽量保留肾单位.     

肾血管平滑肌脂肪瘤的诊断与治疗(附19例报告)

目的:提高肾血管平滑肌指肪瘤的诊断与治疗水平。方法:总结19例肾血管平滑肌脂肪瘤患者的临床资料。结果:通过IVP、B超、CT获得诊断,确诊13例,误诊6例。肾切除术者6例,肿瘤剜除及肾部分切除术者7例,等待观察者6例。结论:应提高肾血管平滑肌脂肪瘤的术前诊断水平,采以各种措施保留肾单位。     

双侧肾血管平滑肌脂肪瘤的诊断和治疗

目的：探讨双侧肾血管平滑肌脂肪瘤的诊治方法。方法：回顾性分析13例经手术治疗的双侧肾血管平滑肌脂肪瘤患者的诊治资料。男2例，女11例；平均年龄42岁。术前均经B超和CT检查，11例诊断肾血管平滑肌脂肪瘤，2例不排除有癌性结节。行单侧保肾手术5例，一期双侧保肾手术8例。结果：13例术中快速冰冻和术后病理检查结果均为肾血管平滑肌脂肪瘤。术后1例血肌酐短暂升高(350μmol／L)，2周后降至正常；12例肾功能未受影响。13例随访1～4年，肾功能正常，肿瘤无复发。结论：B超和CT是诊断双侧肾血管平滑肌脂肪瘤的重要手段，具有独特的影像学特点；术中快速冰冻切片检查有助于正确诊断和手术方法的选择；手术时应注意保留正常肾组织，保护肾功能。     

小肾癌25例的诊治体会

目的 探讨直径小于4cm的小肾癌的诊治效果。方法 对25例直径小于4cm的小肾癌的诊治进行回顾性总结。结果 25例均行B超、CT检查，B超明确诊断16例，准确率64％(16／25)；CT明确22例，准确率88％(22／25)。16例行根治性肾切除术，9例行保留肾单位手术。随访10-102个月，平均56．6个月。9例行保留肾单位手术中，发生术后出血1例，局部复发1例。结论 小肾癌的诊断主要依据B超、CT等影像学检查综合分析作出，其中CT是最有价值的检查万法。根治性肾切除术治疗小肾癌疗效可靠、安全，仍是首选手术方式。     

自发性肾包膜下血肿的影像特征与治疗方法选择

目的：探讨自发性肾包膜下血肿的诊治方法。方法：对20例自发性肾包膜下血肿临床资料进行回顾性分析。结果：20例中,行肾切除术6例、根治性肾切除2例、保留肾脏手术1例,血肿穿刺引流6例,肾动脉栓塞术1例,保守治疗4例。痊愈13例,未见血肿复发;死亡4例;失访3例。结论：自发性肾包膜下血肿多见于肾肿瘤,治疗取决于出血的严重程度和原发病。     

A case report of spontaneous rupture of renal cell carcinoma difficult to be distinguished from angiomyolipoma

A 56-year-old woman was admitted with right flank pain as the chief complaint without any trauma. Abdominal and chest computed tomography (CT scan) demonstrated with low-density area in a retroperitoneal hematoma suspected of spontaneous rupture of angiomyolipoma and hematothorax. Superselective transarterial embolization and drainage of the thoracic cavity were performed. Three months later a right renal tumor in perirenal hematoma was revealed by abdominal CT scan and suspected renal cell carcinoma. Right nephrectomy was performed. Histopathology revealed renal cell carcinoma. Including this case, 31 cases of spontaneous rupture of renal cell carcinoma have been reported in the Japanese literature.     

Renal angiomyolipoma: report of 2 cases of tuberous sclerosis in female siblings

Two cases of renal angiomyolipomas in female siblings associated with tuberous sclerosis were reported. The first case was a 47-year-old housewife who visited the hospital because of severe right flank pain. Bilateral renal angiomyolipomas and hemorrhage in the right angiomyolipoma were recognized by computerized tomography, ultrasonography and renal angiography. After 2 months she had another episode of left flank pain and was diagnosed to have hemorrhage in the left renal tumor. The pain remissed by conservative treatment. Bilateral nephrectomy and hemodialysis would be necessary if she were to have a third attack. The second case was her 36-year-old sister with the chief complaint of left flank pain and genital bleeding. CT and renal angiography suggested a large angiomyolipoma in her left kidney and a small one in her right kidney. Left nephrectomy, right partial nephrectomy and hysterectomy were performed to prevent intratumoral hemorrhage. The histopathological diagnosis was angiomyolipoma of kidneys, uterus and lymphnodes of right renal hilus. Although pre-operative differentiation of angiomyolipoma from renal cell carcinoma has been difficult, recently diagnosis has become possible by CT, ultra-sonography and angiography.     

肾错构瘤破裂出血的诊断及外科治疗(附9例报告)

目的提高肾错构瘤破裂出血的诊断和治疗水平。方法回顾性分析9例肾错构瘤破裂出血的诊治过程。结果9例患者均行外科手术治疗,其中3例行患肾切除术,2例行肾部分切除术,4例行肿瘤切除术。术后病理诊断均为肾错构瘤,无恶变。9例患者均恢复顺利,5例患者获随访,时间2个月~14年,平均91.6个月,无肿瘤复发。结论肾错构瘤破裂出血在临床上无典型临床表现,B超和CT检查为术前确诊主要依据,尽早手术探查是首选治疗手段,术中尽可能选择保肾手术。     

Spontaneous perirenal hemorrhage: a 10-year experience at our institution

OBJECTIVE: To report our experience in patients with spontaneous perirenal hemorrhage (SPH) seen at our institution over a 10-year period. MATERIAL AND PATIENTS: Over the years from 1992 to 2002, 13 patients with SPH without a history of trauma, were treated at our hospital. There were 5 male and 8 female patients with a mean age of 55.7 years (range 36-79 years). The patients' records were reviewed retrospectively with respect to etiology, clinical presentation, radiologic findings and therapeutic management of SPH. RESULTS: All patients were presented with flank or abdominal pain. Radiological evaluation included ultrasonography (U/S) in 7 cases and computed tomography (CT) in 13 cases. An underlying renal mass was indentified employing U/S in 2 cases and using CT in 10 cases respectively. The etiology of SPH was determined in 12 cases. The most common causes were angiomyolipoma (5 patients) and renal cell carcinoma (4 patients). Out of the remaining 4 cases with SPH, one was associated with anticoagulant therapy; polyarteritis nodosa and Wegener angeitis were the underlying diseases in 2 cases respectively; finally, the etiology could not be determined in 1 case. All but two patients were managed surgically. Complete nephrectomy was performed in 6 cases, partial nephrectomy in 4 and simple evacuation of the haematoma was performed in 1 case. CONCLUSIONS: SPH presence should arouse suspicions concerning its etiology, since the most common cause is a renal tumor and approximately 50% of such tumors are malignant. CT scanning is a useful imaging modality for the initial evaluation of SPH, permitting identification of the underlying cause in most instances.     

不典型肾错构瘤的诊断与治疗（附18例报告）

目的：探讨不典型肾错构瘤的误诊原因,提高其诊治水平。方法：回顾性分析18例不典型肾错构瘤的临床资料。18例均行B超检查,15例行CT扫描,8例行MRI扫描,6例行IVU检查。3例接受保守治疗;15例接受手术治疗,其中3例行肿瘤剜除术,5例行肾部分切除术,7例行肾癌根治术。结果：B超诊断肾错构瘤10例（10／18）,CT诊断肾错构瘤7例（7／15）。3例保守治疗者获得随访,肿瘤大小无明显变化,无转移。15例手术治疗者术后病理检查均为肾错构瘤,随访未见肿瘤转移或复发。结论：大部分肾错构瘤可通过B超、CT等影像学检查明确诊断;对于不典型肾错构瘤,术前应仔细分析影像学检查,结合病史尽量明确诊断,减少不必要的肾切除。     

A case of spontaneous rupture of renal cell carcinoma

A case of spontaneous rupture of renal cell carcinoma is reported. A 53-year old man was admitted with the chief complaint of sudden gross hematuria and right flank pain on December 28, 1979. On the following day, the clinical impression was right ruptured kidney, and therefore right nephrectomy was done. Pathological diagnosis was renal cell carcinoma. He received the post-operative irradiation of a total of 5,000 rads. He was seen five years later, at which time there was no evidence of local recurrence or distant metastasis of cancer. Thirty three cases of spontaneous rupture of renal cell carcinoma were collected from Japanese and English literature. Most common chief complaint is abdominal or flank pain. Excretory urography, ultrasonography, CT scan and angiography are useful, but it is difficult to diagnose preoperatively when the tumor is small. Therefore, it is important to suspect occult cancer when a reasonable cause of rupture is undetermined. In these indeterminate cases primary nephrectomy should be considered strongly.     

Angiomyolipoma: a case report and a statistical study of 147 cases in Japanese literature

A 32-year-old housewife with gross hematuria and right flank pain had excretory urography and angiography performed. A large right renal mass with neovascularity was demonstrated. Computerized tomography also revealed a large well-demarcated renal mass with low value of HU. Right nephrectomy was done and histopathological diagnosis was angiomyolipoma weighing 1100 g. A statistical study was made on 147 cases of renal angiomyolipoma in the Japanese literature including this case. The male to female ratio was 1 to 2.9, and the average age of male and female patients was 37.8 and 39.0 years, respectively. Thirty-eight per cent of the cases were associated with tuberous sclerosis. The main clinical signs were flank pain, flank mass and hematuria. In 80% of the cases, nephrectomy was done because of the difficulty of preoperative differential diagnosis from renal cell carcinoma. Recently, CT and sonography have become a great help in diagnosing angiomyolipoma, because they can demonstrate the fat in the renal mass. Conservative or surgical treatment to save the kidney can be used more often when it becomes possible to make a clear differential diagnosis between angiomyolipoma and other malignant diseases.     

Spontaneous perirenal hemorrhage: A 10-year experience at our institution

Objective: To report our experience in patients with spontaneous perirenal hemorrhage (SPH) seen at our institution over a 10-year period. Material and patients: Over the years from 1992 to 2002, 13 patients with SPH without a history of trauma, were treated at our hospital. There were 5 male and 8 female patients with a mean age of 55.7 years (range 36–79 years). The patients' records were reviewed retrospectively with respect to etiology, clinical presentation, radiologic findings and therapeutic management of SPH. Results: All patients were presented with flank or abdominal pain. Radiological evaluation included ultrasonography (U/S) in 7 cases and computed tomography (CT) in 13 cases. An underlying renal mass was indentified employing U/S in 2 cases and using CT in 10 cases respectively. The etiology of SPH was determined in 12 cases. The most common causes were angiomyolipoma (5 patients) and renal cell carcinoma (4 patients). Out of the remaining 4 cases with SPH, one was associated with anticoagulant therapy; polyarteritis nodosa and Wegener angeitis were the underlying diseases in 2 cases respectively; finally, the etiology could not be determined in 1 case. All but two patients were managed surgically. Complete nephrectomy was performed in 6 cases, partial nephrectomy in 4 and simple evacuation of the haematoma was performed in 1 case. Conclusions: SPH presence should arouse suspicions concerning its etiology, since the most common cause is a renal tumor and approximately 50% of such tumors are malignant. CT scanning is a useful imaging modality for the initial evaluation of SPH, permitting identification of the underlying cause in most instances. This revised version was published online in August 2006 with corrections to the Cover Date.     

肾错构瘤破裂出血的急诊处理

目的：探讨肾错构瘤(RAML)破裂出血的诊治方法。方法：回顾性分析11例RAML破裂出血的急诊处理过程。结果：11例患者均经病理明确诊断，4例行患肾切除术，2例行肾部分切除术，5例行肿瘤切除术。11例患者均恢复良好。结论：B超和CT检查为术前确诊主要依据；对RAML破裂出血应采取积极的治疗态度；手术治疗仍为主要治疗方法。