肾错构瘤117例的诊断与治疗

目的探讨肾错构瘤（RAML）准确的诊断方法及选择最佳治疗方法。方法回顾性分析手术治疗RAML患者117例,其中男性24例（24/117,20.51%）,女性93例（93/117,79.49%）,术前应用彩超、CT、IVU或CTU、MRI等检查明确诊断,根据病情采用保留肾单位肾肿瘤剜除术（NSS）或肾切除术,术后定期随访,复查彩超、CT、IVU。结果术前确诊为RAML的病例64例（64/117,54.7%）,术前误诊为肾癌患者21例（21/117,17.94%）。根据病情98例（98/117,83.76%）采用NSS,19例（19/117,16.24%）行肾切除术。手术时间（92.5±3.1）min（40～180min）,NSS肾蒂阻断时间（15.5±0.7）min（3～35min）,失血量（129±4.2）mL（40～800mL）,肿瘤直径（4.8±0.9）cm（0.7～25cm）。117例病例中肿瘤直径≥4cm的64例,其中行NSS手术的45例,手术时间（99.4±2.8）min（65～180min）,出血（142.3±4.7）mL（50～800mL）,肾蒂阻断时间（17.4±1.2）min（9～35min）。肿瘤直径〈4cm的53例,均行NSS治疗,手术时间（86.8±2.8）min（40～150min）,出血（117.7±3.9）mL（40～300mL）,肾蒂阻断时间（13.9±1.4）min（3～20min）。肿瘤直径〈4cm的较肿瘤直径≥4cm的患者手术时间短,肾蒂阻断时间短,出血量少,患者术后恢复快,最大限度保留了肾脏的功能。无死亡病例,NSS术后1例（1/117,1.27%）漏尿并继发感染,二次手术行肾切除,另1例随访8年后复发,二次行NSS治疗。所有患者均术后3～6个月复诊,行CT及IVU检查,肾脏排泄功能基本正常。结论彩超、CT在RAML诊断及鉴别诊断、术后随访中起到了重要的作用,NSS是治疗RAML安全而有效的方法,对于肿瘤直径〉2cm的RAML我们建议积极行手术治疗。

Diagnosis and therapeutic experience of 117 cases with renal angiomyolipoma

Objective To explore the diagnosis and optimal approach of treatment for renal angiomyolipoma(RAML).Methods Data of 117 patients with RAML,including 24 male(20.51%) and 93 female(79.49%),were retrospectively analyzed.Before operation,patients received color Doppler ultrasound examination,CT,IVU,CTU or MRI,and then underwent nephron-sparing surgery(NSS) or nephrectomy.During the follow-up,patients were reexamined with color Doppler ultrasound,CT,and IVU.Results Of all patients,64(54.7%) were correctly diagnosed as RAML before operation,and 21(17.94%) were misdiagnosed as renal cell carcinoma.98(83.76%) patients underwent NSS and 19(16.24%) nephrectomy.The operation time was(92.5±3.1)min(40~180 min),renal blood supply occlusion time was(15.5±0.7)min(3-35 min),the intraoperative blood loss was(129±4.2) mL(40~800 mL).The tumor diameter of RAML was(4.8±0.9) cm(0.7~25 cm).64 patients whose tumor diameter was greater than 4.0 cm underwent NSS.For these patients,the operation time was(99.4±2.8)min(65~180 min),renal blood supply occlusion time was(17.4±1.2)min(9~35 min),and intraoperative blood loss was(142.3±4.7)mL(50~800 mL).53 patients whose tumor diameter was less than 4 cm underwent NSS.For them,the operation time was(86.8±2.8)min(40~150 min),the renal blood supply occlusion time was(13.9±1.4)min(3~20 min),and intraoperative blood loss was(117.7±3.9)mL(40~300 mL).The operation time,renal blood supply occlusion time,and recovery time were significantly shorter for patients whose tumor diameter was less than 4 cm,and the renal function was better preserved.Conclusions The color Doppler ultrasound and CT play important role in the diagnosis,differential diagnosis and follow-up of RAML.NSS is safe and effective for the treatment of RAML.For RAML with diameter greater than 2 cm,surgical treatment is recommended.