巨大肾血管平滑肌脂肪瘤的保留肾单位手术治疗

目的：探讨提高手术治疗巨大肾血管平滑肌脂肪瘤效果的措施。方法：对13例巨大肾血管平滑肌脂肪瘤的患者，采用控制肾蒂血管和后控制肾蒂血管、术中出血回收回输技术、创面修复及生物蛋白胶粘合，切除巨大肿瘤，保留肾脏。肾盂破损的予以修复，同时置入双J管。结果：13例均成功地切除肿瘤组织，保留肾组织。肾盂修复置入双J管，术后无继发性出血和尿瘘发生。术后3个月复查，2例静脉肾盂造影肾脏显影良好，8例术后分别行B超和CT检查，提示肿瘤切除术后改变，血供无异常，血清肌酐、尿素氮正常。结论：综合应用创面修复技巧、血液回收回输技术及生物蛋白胶，可以有效地增加保留肾脏的机率。

Nephron-sparing surgery for huge renal angiomyolipoma

Objective:To improve the level of surgical management for huge renal angiomyolipoma. We evaluated the surgical management of the huge angiomyolipoma, with special attention to the feasibility of nephron-sparing surgery.Methods:Nephron-sparing surgery was performed in 13 patients with huge renal angiomyolipoma. The average tumor size was 18 cm (range 10-29 cm). The huge tumor mass was remove and suture the incised renal parenchyma and urinary collecting system were sutured. We used the methods clamping hilar vascular or without clamping hilar vascular, and intraoperative autologous blood transfusion and technique of management tumor bed and fibrin glue adhesive material.Results:13 cases of huge renal tumor were removed, with nephron-spare and without postoperative bleeding and urinary fistula. Follow-up after operation 3 months, Two cases received intravenous pyelography, Eight cases were scanned by ultrasounds or computed tomography no patient had local recurrence, all patients renal function was preserved.Conclusions:We consider that tumorremoval is an effective therapy in patients with a very large tumor. Using intraoperative autologous blood transfusion and technique of management tumor bed with fibrin glue adhesive material can increase successful opportunity of nephron-sparing surgery for huge renal angiomyolipoma.