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目的:探讨肾血管平滑肌脂肪瘤(RAML)的诊断和治疗方法。方法:回顾性分析102例肾血管平滑肌脂肪瘤患者的临床资料,按肿瘤直径分为3组:A组21例(<4cm),B组(≥4～≤8cm)63例,C组(>8cm)18例。结果:A组中17例(81%)患者无任何症状,其中3例行肿瘤剜除术,其余患者定期随访。B组中50例(79%)患者有临床症状,44例行肿瘤剜除术,8例行肾部分切除术,4例行肾切除术,2例行肾癌根治切除术,5例患者定期随访。C组中16例(88%)患者有临床症状,所有病例都进行了手术治疗,其中4例行肿瘤剜除术,6例行肾部分切除术,2例行肾癌根治切除术,1例行选择性肾动脉栓塞术后择期行肾切除术,在6例行肾切除术的患者中,有一例因伴发下腔静脉瘤栓而同时行了下腔静脉瘤栓取出术。所有病例术后病理检查均证实为肾血管平滑肌脂肪瘤。结论:肿瘤直径<4cm的患者多无临床症状,可临床随访;肿瘤直径≥4cm的患者应积极行手术治疗,以保留肾单位的手术为首选。
Objective: To investigate the diagnosis and treatment of renal angiomyolipoma (RAML). Methods: The clinical data of 102 patients with renal angiomyolipoma were retrospectively analyzed. Tumor diameter was divided into 3 groups: group A (n = 21), group B (n = 4 to ≤ 8 cm), group C (n = 8cm) in 18 cases. Results: Seventeen patients (81%) in group A had no symptoms. Three patients underwent tumor resection and the remaining patients were followed up regularly. Fifty patients (79%) in group B had clinical symptoms, 44 were treated with tumor excision, 8 were treated with partial nephrectomy, 4 were treated with nephrectomy, 2 were treated with radical nephrectomy, and 5 were regularly treated Follow-up. Sixteen patients (88%) in group C had clinical symptoms. All the cases were treated surgically. Among them, 4 patients underwent tumor resection, 6 underwent partial nephrectomy, 2 underwent radical nephrectomy, and 1 Elective nephrotic embolization after elective nephrectomy in 6 cases of patients undergoing nephrectomy, one case of inferior vena cava thrombus with concurrent suppository of inferior vena cava tumor thrombectomy. Postoperative pathology in all cases confirmed renal angiomyolipoma. Conclusion: There are no clinical symptoms in patients with tumor diameter <4cm, and they can be followed up clinically. Surgical treatment should be actively performed in patients with tumor diameter ≥ 4cm, and the surgery of retaining nephron should be the first choice.